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FORENSIC SCIENCE PAPER NO. 14 : Forensic Medicine MODULE NO. 9 : Introduction to Forensic Pathology SUBJECT FORENSIC SCIENCE Paper No. and Title PAPER No. 14 : Forensic Medicine Module No. and Title MODULE No. 9 : Introduction to Forensic Pathology Module Tag FSC _P14_M9 FORENSIC SCIENCE PAPER NO. 14 : Forensic Medicine MODULE NO. 9 : Introduction to Forensic Pathology TABLE OF CONTENTS 1. Learning Outcomes 2. Introduction 3. Objectives of postmortem examination 4. Types of Autopsy 5. Application of digital radiological techniques in Forensic Medicine 6. Guidelines for conducting a medico - legal autopsy 7. Summary FORENSIC SCIENCE PAPER NO. 14 : Forensic Medicine MODULE NO. 9 : Introduction to Forensic Pathology 1. Learning Outcomes After studying this m odule, you shall be able to know -  W hat is Autopsy and its various types  Understand objectives of post - mortem examination  T he a pplication of digi tal radiological techniques in forensic m edicine  Guidelines for conducting a medico - legal autopsy 2 . Introduction In order to find out the exact cause of death and thereby do justice to the dead, a thorough and meticulous autopsy is essentially needed. Only a systematic step by step approach to the procedure can give a satisfactory output and helps in concluding the exact cause of death. The term autopsy has been derived from Greek word “Autopsia” which means seeing by one’s own eyes (auto and opsis). Autopsy (syn; necropsy, thanatopsy, sectio cadaveris, postmortem examination) is examination o f a person’s body after death, with a view to search primarily for the cause of death. Autopsy for the said purpose has been recorded in history and da

tes back since the period of BC. Records of Roman times narrate examination of the wounds of Julius Caes ar in 44 BC by his physician Antistius. In that context he opined that out of 23 injuries sustained over his body, only one injury over the chest was fatal. In 1302, Bartolomeo de Varigana, along with two physicians and three surgeons carried out the first medico legal autopsy. This was done by order of court of Bologna over the dead body of one Azzolino, who died under suspicious circumstances and suspected to be a case of poisoning. Some authors also mention that in 1589 it was Dr Ambroise Pare who did th e first systemic autopsy on the body of King Henry II. In India the first medico legal autopsy was done by Dr Buckley on August 1693 at Madras over a case of death due to alleged arsenic poisoning. A complete autopsy, exploring all the body cavities is ne cessary to substantiate the truth and to collect all necessary evidence s . An incomplete and poor autopsy is worse than doing no autopsy at all. The autopsy should be done entirely by the doctor and no portion of it should be left upon the mortuary attendan t. The attendant only should help the doctor in preparing the body for autopsy and other such works like sawing skull cap etc. FORENSIC SCIENCE PAPER NO. 14 : Forensic Medicine MODULE NO. 9 : Introduction to Forensic Pathology 3. Objectives of postmortem examination The objectives of a medico legal autopsy are mentioned below. 1) To find out the exact cause of death, whether natural or unnatural. This includes exact description and recording of all the evidences, injuries and whether death was due to any violence or poisoning etc. 2) To note down all the injuries, both external and internal including any p ossible malformations, deformities or disease. 3) To

find out how the injuries occurred and what is the possible weapon of offence. 4) To find out the exact manner of death, whether suicidal, accidental or homicidal. 5) To find out the time since death. 6) To find out the position of the body at the time of death, if possible. 7) In case of an unknown body, to establish the identity of the person. 8) Collection of physical evidence at wherever stage necessity arises for the sake of the case and handing over the same to the i nvestigating officer after proper sealing. 9) To retain relevant viscera and tissues whenever necessity arises and handing over the same to the investigating officer after proper sealing. 10) In postmortem examination of infants, apart from above mentioned points , it is necessary to establish the viability of the infant and if the infant was live born, then to find out the period of survival and cause of death. 4. Types of A utopsy A) Medico legal autopsy: A medico legal autopsy is conducted only on the request of a legal authority responsible for the investigation of the sudden suspicious and unnatural death. In India, such authority may represent a police officer, not below the level of sub inspector or a magistrate. In case of a medico legal autopsy, often the history is sketchy, doubtful or misleading and in some cases identity also may not be known. The consent of the next - o f - kin is not required in case of a medico legal autopsy and requisition from the legal authority is sufficient to conduct a postmortem examination. The autopsy surgeon has to determine cause of death, time since death, whether there are any apparent inconsistencies between the scene of crime and the actual findings, and if needed has t o visit the crime scene as well. He has to carry out a very meticulous external and

internal examination to conclude the cause of death and if possible to determine the manner of death and also to deduce what can be the possible weapon of offence involved in the whole fiasco. FORENSIC SCIENCE PAPER NO. 14 : Forensic Medicine MODULE NO. 9 : Introduction to Forensic Pathology B) Pathological autopsy: Clinical or pathological autopsy is done o n death due to natural causes in order to know the exact cause of death or in order to reconfirm the diagnosis made by the physician. The consent of next - of - kin is required in order to go ahead with pathological autopsy and law enforcing authority’s requisition is not needed. The hospital pathologist has access to all the relevant information regarding the patient e . g . case history, medical records etc. His main aim is to find any morphologic changes which will explain the signs and symptoms of the existing disease and the effectiveness of the treatment. This helps in determining the cause of death, extent of natural disease, co - morbidities or any previous unrecognize d disease condition. A pathological autopsy is generally research oriented. C) Psychological autopsy: Psychological autopsy is not an autopsy in a true sense. Rather it refers to the perusal of all the corroborative documents like medical history, personal history etc . relating to the victim and thorough history taking from the relative of the deceased in order to arrive to the motive of the act. D) Virtual autopsy (Virtopsy): Nowadays virtual autopsy is in phase of more popular in European countries. Forens ic Medicine and Radiology departments of The University of Bern’s Institute, has combined the various forms of latest imaginary technologies with forensic science to provide bloodless, minimum invasive method for accid

ental and homicidal deaths. E) Endosco pic autopsy: It has been suggested by some authors that, if conventional autopsy is difficult to undertake due to some unavoidable circumstances, then postmortem endoscopic examination can be performed by using trocar and telescopic device along with a vi deo camera, which is termed as endoscopic autopsy. In current Indian scenario, there are serious limitations in its practical implication though. FORENSIC SCIENCE PAPER NO. 14 : Forensic Medicine MODULE NO. 9 : Introduction to Forensic Pathology 5. Application of digital radiological techniques in Forensic Medicine a) A pplication of multi - slice C T, MRI, 3 - dimen s ional t echniques . b) Geometric presentation of body surface. c) Detection of bioch emical profile measurement by M R spectroscopy. Various post - processing techniques can provide strong forensic evidence in the court of law. MRI has a greater impact in demonstrating soft tissue injuries, organ trauma and other non - traumatic conditions. CT scan is the imaging modality of choice for both two dimensional and three dimensional documentation including postmortem diagnosis of sub - cutan eous emphysema, air embolism etc. However, the difference between the findings of ante - mortem and postmortem are not well studied. In many cultures due to religious and sentimental values autopsies are always been interrupted or strongly resisted by deceas ed’s kin. Virtopsy, if being into regular practice definitely is going to change the perspective. However, at this moment, virtopsy is not cost - effective process and also because of the fact that it is not well studied, practical application seems to be fa r - fetched idea. 6. Guidelines for conducting a medico - legal autopsy 1) Every registered

medical practitioner, working in a government setup, is legally obliged to conduct an autopsy whenever he is being served with inquest papers. He has to conduct the autopsy as early as possible and no fees should be charged for the same. 2) In India, authorization for medico legal autopsy is given by investigating police officer, not below the rank of sub inspector. However a head constable can also give authorization i n rare exceptions where no police authority at the level of sub inspectors is being posted. An executive magistrate can also give authorization for the same. Without such requisition from appropriate authority, medico legal autopsy should not be carried fo rward. Consent from the deceased’s relatives is absolutely not required for conducting medico legal autopsy. 3) The following magistrates are empowered to hold an inquest; District magistrate, sub divisional magistrate or any other Executive Magistrate speci ally empowered for this purpose by the State Government. FORENSIC SCIENCE PAPER NO. 14 : Forensic Medicine MODULE NO. 9 : Introduction to Forensic Pathology 4) Whenever a body is sent for an autopsy, it must always be accompanied by inquest report and dead body challan. A dead body challan is the formal requisition submitted to the medical officer by th e investigating police officer for performing the autopsy. 5) A dead body challan contains the name, age, sex, address, religion etc . of the deceased Also it contains information regarding time and location of the recovery of the dead body, distance from th e site to the mortuary and how the body has been transported and at what time it has been transported. It also bears name and address of the investigating police officer and relatives of the deceased. The time of receipt of the dead bod

y also has to be fil led in. 6) An inquest paper or “panchnama” are the preliminary investigation report which is submitted by the investigating police officer. An inquest report describes the available history of the case, time and place of recovery of the dead body detailing t he exact location of the dead body, the external appearance of the dead body involving his clothing, position of the body at the time of recovery, whether any injury present over the body or not, in cases of hanging description of ligature mark etc, or any such external findings present. A provisional opinion of the police officer is entered in the inquest and signatures from minimum two respectable members (panchas) of the locality are taken. 7) Ideally autopsy is performed in a well - equipped mortuary and in sufficient light equivalent to broad day light. But sometimes depending upon the circumstances, it can also be performed at the site without further delay. E. g., in cases where the body is sev erely decomposed and unable to transfer, in mass disasters, exhumation cases. A requisition from the magistrate is required in that context. 8) The hospital records and treatment records should be made available to the autopsy surgeon at the time of conducti ng postmortem examination. If the hospital records are not available, then it is the duty of the concerned IO to make them available to the concerned autopsy surgeon. Availability of such records helps the doctor to avoid future manipulations etc, especial ly in negligence cases. FORENSIC SCIENCE PAPER NO. 14 : Forensic Medicine MODULE NO. 9 : Introduction to Forensic Pathology 9) The body should be properly identified by the IO as well as relatives before beginning the autopsy. In case of unknown and unclaimed dead bodies, photogr

aphs and finger prints of the deceased are to be preserved by the police an d same to be circulated all over the media and communication services for possible chances of identification. 10) The relevant history, medical records, inquest, panchnama , everything should be scrutinized properly by the medical officer before beginning the autopsy. But communication with the relatives should be kept as minimum as possible in order to avoid possible misinterpretation of facts and biasness. 11) All the persons present during autopsy should be listed and names to be duly mentioned with signatures in the autopsy report. 12) All the injuries mentioned in the inquest paper should be re verified during the postmortem examination. Sometimes a misinterpretation may be due to the police official’s lack of knowledge regarding injury. 13) Maximum of the cases a s ingle registered medical practitioner in a government set up is sufficient to write autopsy report. In death within seven years of marriage (dowry deaths) two RMPs are required to conduct the autopsy and also sign the concerned postmortem report. In some s tates of India, even alleged murder cases or medical negligence cases, two autopsy surgeons conduct the postmortem a n d duly sign the report so as not to lead into controversy and to keep things neutral. 14) Video recording: As per recommendations of the Natio nal Human Rights Commission, in all custodial deaths, autopsy to be conducted under videography and with due requisition from magistrate, to avoid any possible controversy. 15) In India, crime scene visit is not done regularly by the autopsy surgeons. Rather scientists from Forensic science laboratory conduct the crime scene visit . But if need arises, depending on the merit of the case, examination of the crime

scene should be done by team of doctor s associated with the case concerned which is of immense help in understanding the circumstances of death as well as many related issues . FORENSIC SCIENCE PAPER NO. 14 : Forensic Medicine MODULE NO. 9 : Introduction to Forensic Pathology 16) Embalming if needed, should always be done after conclusion of the autopsy or else the embalming fluid will destroy important evidence and toxicological samples. 17) A medico legal autopsy should be complete and meticulous. An incomplete or partial autopsy is next to conducting no autopsy at all. Careful observation and useful utilization of all the acts are to be taken into consideration to reach a conclusion. 18) Ideally, the po stmortem report to be submitted within 24 hours of conducting the autopsy. 7 . Summary  The term autopsy has been derived from Greek word “Autopsia” which means seeing by one’s own eyes (auto and opsis).  A complete autopsy, exploring all the body cavities is necessary to substantiate the truth and to collect all necessary evidence.  A medico legal autopsy is conducted only on the request of a legal authority responsible for the investigation of the sudden suspicious and unnatural death.  Nowadays virtual autopsy is becoming more popular in European countries. Various post processing techniques can provide strong forensic evidence in the court of law.  In India, authorization for medico legal autopsy is given by investigating police officer , not below the rank of sub inspector.  The relevant history, medical records, inquest, panchnama everything should be scrutinized properly by the medical officer before beginning the autopsy.  Embalming if needed, should always be done after conclusion of t he autop