What is Autopsy?

What is Autopsy?

Autopsy, when broken into two different terms, Auto means Self and Opis means examination, giving to the meaning self-examination. It is defined broadly as the examination of both external and internal contents of the dead body including the histology, toxicology, and biochemistry of collected material such as viscera. Other synonyms for Autopsy are Post-mortem, Necropsy, and Thanatopsy.  Post-mortem is derived from two words; Post means after and Mortem means Death. Necropsy is derived from, Necro means Dead and Opsy means examination/ to see. Thanatopsy is derived from, Thantose means death, and Opsy means to view. Autopsy is derived originally from the Greek word “Autopsia” meaning to see oneself.

Also Read: Routes of Poison Administration

Types Of Autopsies

1.Medical or Clinical

Carried by the pathologists for the purpose of finding the cause of death, majorly when a patient dies in a hospital during course of treatment or for the confirmation of any diagnosis.

2. Anatomical/ Academic

Carried to study the human body for educational purposes. Done on the unclaimed dead bodies.

3. Medico-legal

Performed for establishing the cause and manner of death and also to know if any suspicious thing indicated; under the pursuance of law.

4. Psychological

Done in the cases of suicide to know the whereabouts of the mental status of the dead prior to the death. Generally, to know about the background, habits, mental status, relations with others.

5. Virtual

Performed without any incisions to the body, even without extracting the samples. It can be conducted with the help scanning and imaging technologies.

Reasons for conducting Autopsy

1. To find out the TSD (time since death).
2. To estimate the cause of death.
3. To estimate the manner of death.
4. To estimate the mode of death.
5. For the identification of the dead.
6. Collection of the post-mortem samples.
7. Finding the sequence in which dead had injuries, if any.
8. To know the history of diagnosis prior to the death.
9. In the case of newborns, to establish the question of the live birth, viability of the baby.

Person who Performs the Autopsy

Experts in the field of forensic medicine and forensic pathology with the necessary educational background to perform autopsies, and have gone under specialized training in the examination of the dead bodies.

Instruments in Autopsy

Major Steps in Autopsy

1. First the dead body is brought to the mortuary in a body bag, to avoid contamination and damage.
2. Then, it is kept on the Cadaver Dissection Table.
3. Complete External Examination of the dead body before cutting it open the dead body.  For example, the appearance of the skin, colour, elasticity and stain, mud or gun powder, if any.
4. Internal examination includes the incision given for cutting open the dead body.
5. Collection and preservation of viscera for further ancillary investigations like for the presence of any maggots or injury.

Also Read: Post-Mortem Interval

SIGNS OF DEATH

In determining the manner, time, cause, and mode of death; changes that occur after death, which can be-

1. Immediate changes.
2. Early changes.
3. Late changes.

Early Changes After Death

• Changes in the skin and facial pallor-

Stoppage of the circulation from the capillaries causes the skin to become pale and ash whitish. The skin loses its elasticity and the lips become brownish and hard due to drying. Wounds would not gape if done after the death.

• Primary Relaxation or Flaccidity of the muscles-

Muscles are still alive but lose their tonicity and become relaxed, their chemical reaction is alkaline and responds to electrical stimuli.

• Contact flattening and pallor-

When the areas of the body remain on the ground, blood from the vessels is pressed out, and hence, it becomes flat, even after the PM staining.

Changes in the eye-

• Loss of reflexes of corneal and pupillary.
• Pupils become dilated.
• Shape of pupils stays circular throughout life but changes after death.
• Opacity of the cornea due to drying.
• Taches Noire Schleroitiques –  when the eyes remain for 3-4 hrs. after death. Formation of yellow triangles on the sclera on the side of Iris =, which first becomes brown then, black.
• Blood flow becomes distorted in the retina.

Algor mortis-

The first sign after death means the chill of death. Change in temperature according to the surroundings. The rate of cooling is fast during the first few hours than in the coming hours.

Post-mortem Staining-

Also known as Hypostasis, livor mortis, post mortem/ cadaveric lividity, darkening of death, and flaccidity. It occurs when the circulation stops. It can be helpful in estimating the time since death. While repositioning the body, in/ from the supine position (face towards ceilings) will result in two different patterns of lividity, the primary will stay too.

Rigor mortis-

It is a Latin word meaning stiffness of death. It commences after 1-2 h of death and finishes in 12h. After death, the body uses the ATP but stops making it. Due to its deficiency of ATP, glycogen converts into the lactic acid, of which excess causes the linking of actin and myosin, resulting in the rigor mortis.

Cadaveric spasm-

Condition in which the muscles of the body were in contraction immediately before death without going through the primary relaxation.

Late Changes After Death

Putrefaction

The process by which the complex organic body tissue is broken down into simple compounds due to the saprophytic or autolysis. It occurs after rigor mortis. While in summers, it gradually occurs even before the rigor mortis could disappear. Four signs of decomposition as 4D’s-

1.1.      Discoloration- greenish discoloration in the lower abdomen.

1.2.      Distention- production of gases.

1.3.      Degradation- the integrity of the cell is lost.

1.4.      Dissolution- Liquefaction (tissues dissolve themselves).

MCQs on Putrefaction with Answers

Adipocere Formation

The word Adipocere breaks into two parts “Adipo” means fats and “cire” means wax in Latin. Fats get converted into yellowish-wax-like substances, with a rancid odour due to the hydrolysis of fats which is basically the breakdown in the presence of water. This doesn’t happen in foetuses.

• Medico-legal importance-
• Sign of death.
• TSD.
• Personal identification.
• Position of disposable body.

Mummification

It depends on the environment. It is the desiccation of the dead body from the evaporation of water, of tissues. The whole body loses weight and becomes stiff. Particularly seen in the groin, around the armpits, and neck.

EXTERNAL EXAMINATION–

Documentation is done of a number of external factors-

1. Clothing- they are listed and their numbers, including the jewellery.
2. Skin-general conditions like colour, and presence of any stains from blood, mud, or vomit.
3. General deformities- like beard, scars, tattoo marks.
4. Signs of disease-Oedema of legs, dropsy, skin disease.
5. TSD- rectal temperature, rigor and livor mortis, putrefaction.
6. Eyes- the condition of the eyelids, conjunctivae, and colour of the sclera.
7. Natural orifices-discharge from nose, mouth, ears, urethra, vagina, and anus.
8. Fingernails- the presence of blood, tissue, and dust may be indicative of struggle.

INTERNAL EXAMINATION–

Majorly, the three main cavities are cut open namely, Thorax, Skull, and Abdomen. In any suspected head injury, the skull is opened first and then the thorax and abdomen and in the case of suspected asphyxia death, open the skull and abdomen first and then followed by the neck. Majorly, the thorax and abdomen are opened first, and then the skull.

Skin Incisions (done by Stryker saw)-

1. I-shaped incision- starting from the chin straight down to the pubis symphysis while avoiding the umbilicus. This is the most commonly used method.
2. Y-shaped incision- straight Y-shaped line to xiphisternum to pubis symphysis while Y runs below the breasts towards the acromion process. It is done in the cases especially when the body is kept dressed for viewing after death.
3. Modified Y-shaped Incision- starting from the suprasternal notch to the pubis symphysis, initially from the mastoid process to the clavicle to the suprasternal notch. Generally, in the case of hanging or strangulation.

Skull and Brain-

A wooden block provides the headrest, and the incision is done from one side’s mastoid process to the other side of the mastoid process, provided that it penetrates upon Periosteum. The skull cap is then removed half of which is reflected in front and the other is reflected towards the back.

Description of an organ-

1. Size and shape- measuring tape is used.
2. Surface- any thickening, roughening, dullness or opacity is noted.
3. Consistency-the softness is judged by the finger pressure.
4. Cut surface- note colour and structural details.

Suturing of the body-

When the autopsy is done, blood is removed from the blood cavities. The dissected flaps are brought close together with thin twine and a large curved needle. The brain should be filled with cotton and then fitted in place. The scalp is then pulled over the vault and stitched back in thin twine. Then report is made.

Collection And Preservation, Packaging Of Viscera

Collection-

1. Blood- just before the autopsy, it is best to draw blood from the femoral by subclavian vein.
2. Cerebrospinal fluid- collected by the lumbar puncture in the cisterna magna by inserting a long needle.
3. Vitreous humour- A hypodermal needle with a syringe is inserted into the posterior chamber of the eye.
4. Lungs- the hilum is then divided and the lung is put into a nylon bag immediately and the bag is sealed.
5. Urine- Before dissection, urine can be collected via abdominal wall puncture.
6. Bone- 200 g is collected, convenient to cut some part of the femur.
7. Hair- about 1 g is sufficient and 10 g in case of analysis of heavy metal.
8. Maggots- maggots are preserved in case of estimating the time of death.
9. Nails- collected when removed in separate envelopes.
10. Skin- if there is a needle puncture, then that area is excised.

Preservation of Viscera

In the saturated solution of common salt.

In the cases of-

1. Poisoning.
2. Suspicion of drugs.
3. Cause of death could not be estimated in the case.
4. Burns.
5. Over decomposed.
6. Accidental deaths involving vehicles.
7. If requested by the magistrate.

In the case of suspected alkali or acid poisoning, the rectified spirit is used. It is avoided in the case of alcohol, aldehyde, and carboxylic acid. Blood is preserved in sodium or potassium Fluoride, to prevent glycolysis and growth of microorganisms.  Urine is preserved in a small amount of thymol. For bones, hairs, and nails; no preservative is used.

Packaging –

A clean, transparent sterile jar is used to preserve viscera. At least of which 1/3th part is empty. The stomach, intestines, and their contents are preserved in one bottle, spleen and kidney in another, and urine in the third one. Blood is sent in a vial. Along with the viscera box, copy of inquest papers, facts of the case, case sheet, autopsy report, and letter for the chemical examiner to examine the sample and inform the medical officer about their findings.

REFERENCES–

1. Gautam Biswas- Review of Forensic Medicine and Toxicology including Clinical and Pathological Aspects-2012- Jaypee Brothers Medical Publishers- pg. 83-135.
2. Rai bahadur Jaising P. Modi- A textbook of Medical Jurisprudence and Toxicology-24^th edition- 2011.
3. Siegel J.A. et al- Encyclopedia of Forensic sciences three volumes- 2000.

About The Author

This Article is written by Prerna. She is currently pursuing her bachelor’s in forensic science from Amity University, Noida.

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