Autopsy-Externaland Internalexamination
External Examination
The observation and documentation of various external characteristics of the decedent is the
essence of the external examination.
1. Clothing: They are listed and their number, labels and laundry marks, design, stains, tears, loss of
buttons, cuts, holes or blackening from firearm discharges with their dimensions should be noted.
Trace evidence like hair, fibres, paint chips, glass fragments, vegetation and insect are
collected,labeled and preserved.
Jewellery may provide evidence of identification, pockets may contain medication or drugs of
abuse and personal papers may help in identification and provide medical history.
The clothes should be removed carefully without tearing them, to avoid confusion of signs of
struggle.lfthey cannot be removed intact, they should be cut in an area away from any bullet hole
or cuts,along the seam of the garment.
After autopsy, wet clothing should be sun-dried, packed, sealed in paper bags and handed over to
the police.
2. The whole surface of the body should be carefully examined before and after washing from head
to foot,and back and front, and the details noted.
3. Body length, weight, sex, race, head hair, eyes, dentition, general state, built, development and
nourishment is noted. It should include all surgical procedures, dressings and other diagnostic and
therapeutic measures.
Following should be noted in external examination:
1. Skin: General condition (rash, petechiae, color,looseness and turgor), asymmetry of any part of
the body or muscular wasting. The presence of stains from blood, mud, vomit, feces, corrosive or
other poisons, or gunpowder is noted.
General description includes deformities, scalp hair,beard, scars, tattoo marks, moles, pupils, skin
disease,circumcision, amputations and vermilion mark.
3. Signs of disease: Edema of legs, dropsy, surgical emphysema about the chest, skin disease,
eruptions.
4. Time since death: Rectal
temperature, rigor mortis,postmortem staining, putretaction,
maggots,stomach contents, etc. are required to estimate time since death.
5. Face: Cyanosis, petechial hemorrhages, pallor,protrusion or biting of the tongue, state of
lips,gums, teeth, marks of corrosion and injuries inside the lips and cheeks.
6. Eyes: Condition of the eyelids, conjunctivae,softening of the eyeball, color of sclera, state and
color of pupils, contact lenses, petechiae, opacity of the cornea, lens and artificial eyes (which may
contribute in road traffic accidents).
7. Natural orifices, i.e. nose,
mouth, ears, urethra, vagina and anus should be observed for
anydischarges, injuries and foreign body. Leakage of blood or CSF from ears, mouth or nostrils is
noted.Samples of discharges should be taken on swabs or smears prepared on slides.
8. Neck: Bruises, fingernail abrasions, ligature marks or any other abnormalities.
9. Thorax: Symmetry, general outline, injuries.
10. Abdomen: Presence or absence of distension or retraction, striae gravidarum.
11. Back: Bedsores, spinal deformity, injuries.
12. External genitalia: General development, edema,local infection, position of testes.
13. Hands: Injuries, defense wounds, electric marks,and in clenched hands, if anything is grasped.
14. Fingernails: Presence of tissue, blood, dust or other foreign matter, may be indicative of struggle.
The final stage of external examination is the documentation of injuries, either bygrouping them
without implying an order
according to injury type and anatomical location, or by numbering them,
of infliction or ranking of severity. Each injury is characterized by its:
i. Type/nature of injury
ii. Size (length, breadth and depth)
fii. Shape
iv. Site (in relation to two external anatomical landmarks)
v. Direction of application of the force
vi. Margins, edges and base
vii. Distance of the wound from the heel
vii. Time of infliction of the injury should be studied from inflammatory and colour changes
ix. Vital reaction
x. Collect foreign materials, e.g. hair, grass, fibres, etc.
xi. If the injuries are obscured by hair, it should be shaved
wounds should not be probed until the body is opened
xii. Deep or penetrating
involved and degree should be mentioned.
I n burns, their character, position, body surface area
should be searched
Concealed punctured wounds, bruising of frenulum of lips and injection marks
for, if indicated.
be
The use of printed body sketches is very useful. The position of the injuries should
pictographically depicted on the skeleton diagrams.
is now considered as standard practice. Identifying
Photographic documentation of major injuries
with a measurement scale should be included to
markers bearing the unique autopsy number,
ensure that the photos correspond to the specific case.
utilized during external examination include
photography for the purposes of
Special procedures
trace materials,
Infrared and UV photography will enhance
identification and documentation.
tattoos, bruises and patterned injuries.
black-white photography or computer directed image enhancement can be used to
High contrast
enhance patterned injuries.
Radiological examination assists in identification, locating foreign objects such
as projectiles and
documenting old and recent bony injury
InternalExamination
It is convenient to start the examination with the cavity chiefly affected. All three major cavities of
the body, i.e.skull, thorax and abdomen should be opened and examined as a routine. The choice as
to which part of body is to be opened first-skull or the body cavities is left to the dissector.
In suspected head injury, open the skull first and then the thorax and the abdomen, but some
authors are of the view that it should be opened after blood has been drained out by opening the
heart.
In suspected asphyxial deaths due to compression of neck, open the skull and abdomen first
followed by dissection of the neck.The draining out of blood from neck vessels via the skll provides
a comparatively cleaner field for the study of neck structures.
In all other cases, the thorax and abdomen are opened first and then the skull.
SkinIncisions
Skin incisions are of three types
. -shaped incision extending from the chin straight down to the symphysis pubis and avoiding the
umbilicus (because the dense fibrous tissue is difficult to penetrate with a needle, when the body is
stitched after autopsy). Most common method followed.
i. Y-shaped incision: Straight line of Ycorresponding to the xiphisternum to pubis incision and forks
of Y runs down below the breasts and extending towards the acromion process. It is desirable in
those cases (especially females) where it is customary to keep a dressed body for viewing for
sometime after death.
if. Modified Y-shaped incision: An incision is made in midline from suprasternal notch to symphysis
pubis. The incision extends from suprasternal notch over the clavicle to its centre on both sides and
then passes upwards over the neck behind the ears. It is used when a detailed study of neck organs
is required, e.g. hanging or strangulation.
Evisceration Methods
.En masse: This method, described byLetulle,involves removing most of the internal organs in
full swoop. It is a rapid technique for removing the organs from the body although the ensuing
one
dissection is the lengthiest. It has the advantage of leaving all attachments intact.
i. Virchow's method: This method of evisceration is simply removal of individual organs one by one
with subsequent dissection of that isolated organ.It is useful in assessing individual organ
pathology,a quick and effective method, if the pathological interest is in a single organ.
ii. En bloc removal: It is a compromise between the above two methods and most widely used in
UK.Ghon developed this method, which is relatively quick, but preserves most of the important
interorgan relationships.
Rokitansky, is rarely performed which involves
iv. In situ dissection: This method developed by
dissecting the organs in situ with little actual being performed prior to dissection.lt may
evisceration
transmissible diseases. No matter which dissection
be the method of choice on patient with highly
needs to perform a dissection specific to the
technique is utilized to eviscerate, the autopsy surgeon
organ in guestion.
is cut
Hollow structures, such as blood vessels and Gl tract(esophagus, stomach and intestines)
in order to reveal the pathology present inside.
opened
loaf of bread is done.Wherever
For solid organs, many parallel cuts, in a fashion similar to slicing a
examination.
indicated, a small portion of each organ is preserved in formalin for histopathological
