Introductory Chapter: An Overview of Post-Mortem Examination and Autopsy (original) (raw)

Death Scene Investigation from the Viewpoint of Forensic Medicine Expert

Medical expertise is crucial in death investigations. It begins with body examination and evidence collection at the scene and proceeds through history, physical examination, laboratory tests, and diagnosis – in short, the broad ingredients of a doctor’s treatment of a living patient. The key goal is to provide objective evidence of cause, timing, and manner of death for adjudication by the criminal justice system. Death investigation has been performed for centuries in all societies, although not always by medical professionals (Committee, 2003). The association of law and medicine dates back to the Egyptian culture as early as 3000 B.C. The English coroner system was mentioned in documentations around the 12th century B.C. (Spitz, 2006). Although the primary goal of a death investigation is to establish the cause and manner of death, the role of the death investigation extends much further than simply answering these two questions. A common question asked is, “Why does it matter? The person is dead.” While it is true that the dead cannot benefit, the value in death investigation is to benefit the living and future generations. In a culture that values life, explaining the death in a public forum (the meaning of “forensic”) is crucial for many reasons. And this interest goes beyond simple curiosity (Wagner, 2009). In homicide, suspected homicide, and other suspicious or obscure cases, the forensic medicine expert should visit the scene of the death before the body is removed. Local practice varies but any doctor claiming to be a forensic medicine expert should always make himself available to accompany the police to the locus of the death. This duty is often formalized and made part of a contract of service for those forensic medicine experts who are either full-time or substantially involved in assisting the police, in England and Wales, the 'Home Office Pathologists' are permanently on call for such visits and in many other jurisdictions, such as the medical examiner systems in the USA, and the European State and University Institutes of Forensic Medicine, there is usually a prearranged duty roster for attendance at scenes of death (Saukko & Knight, 2004). In many cases, the scene investigation is more important than the autopsy. A thorough and complete investigation commonly leads to the proper diagnosis of the cause and manner of death prior to an autopsy (Avis, 1993; Dix & Ernst, 1999). Why go to the scene? The purpose of having the forensic medicine expert attend the death scene is severalfold. By viewing the body in the context of its surroundings, the forensic medicine expert is better able to interpret certain findings at the autopsy such as a patterned imprint across the neck from collapsing onto an open vegetable drawer in a refrigerator. The forensic medicine expert is also able to advise the investigative agency about the nature of the death, whether to confirm a homicide by a specific means, evaluate the circumstances to be consistent with an apparent natural death, or interpret the blood loss from a deceased person as being more likely due to natural disease than to injury. This preliminary information helps the investigative agency to define its perimeter, structure its approach, organize its manpower, secure potentially important evidence, and streamline its efforts. Nonattendance at death scenes has been regarded as one of the classical mistakes in forensic pathology. Hospital pathologists performing forensic autopsies who are not trained to, or able to, attend death scenes should be provided with information on how, when, and where the body was found, by whom, and under what circumstances. In some deaths, the immediate environment does not contribute to death, such as in cases of metastatic breast carcinoma. In other cases, the environment plays a role although it does not cause the death; for example, consider a case in which a person with marked coronary atherosclerosis collapses with a dysrhythmia while shoveling snow. On the other hand, the scene description and scene photographs are critical in documenting that the physical circumstances and body posture are indicative of death due to positional asphyxia because the autopsy in these cases may yield very few findings. The most meticulous autopsy in all academia will provide only a speculative cause and manner of death in a 30-year-old man with a negative history, negative toxicology, and autopsy findings of visceral congestion. Yet at the scene, a screwdriver is next to an uncovered electrical outlet on a rain-soaked patio at the decedent's house, which is undergoing renovation. The cause and manner of death are provided by the scene (Lew & Matshes, 2005). The examination of a death scene and subsequent collection of potential evidential material requires special skill, knowledge, aptitude, and attitude. The manner in which a death scene investigation is conducted may be a critical factor in determining the success of an investigation. The thorough examination of a death scene requires a disciplined and systematic approach to recording the various observations made and collection of potential evidential material. This must be combined with the analysis of various observations and the interrelationship of potential evidentiary material (Horswell, 2005a). If resources are sufficient and the circumstances of death so dictate, it is ideal for a forensic medicine expert to perform a scene investigation. This is particularly relevant if the body remains at the scene of death, and has not been transported to the hospital during attempts at resuscitation; however, a scene investigation can be vitally important and provide valuable information even if the body has been transported to the hospital. If a body is pronounced dead at the scene (as opposed to after transport to the hospital), many death investigation systems require a scene investigation. Others have various protocols as to which case types absolutely require a scene investigation (whether or not the body is present at the scene). Case types that should always have a scene investigation include all confirmed or suspected homicides, suicides, accidents, child deaths, traffic-related deaths, in-custody deaths, and workplace-related deaths (Prahlow, 2010). Death scene investigation may include a combination of the following types of incidents and examinations: • Accidental deaths, which include a multitude of circumstances, including misadventure • Suicidal deaths, which include a multitude of circumstances • Homicidal deaths, which include a multitude of circumstances • Sudden deaths, with or without suspicious circumstances • Difficult victim identification, which includes mummification and putrefaction • Disaster victim identification dealing with multiple casualties (Horswell, 2005a) This chapter will focus on the steps of death scene investigation and some real cases will be analyzed.

Forensic and Clinical Forensic Autopsy : An Atlas and Handbook

2020

All too often, forensic pathologists perform autopsies that are limited only to the body parts that are suspect, leading to biased and inaccurate results. A correct diagnosis for cause of death can only be reached by a strict and systematic examination of the whole body. Forensic and Clinical Forensic Autopsy: An Atlas and Handbook, Second Edition provides a step-by-step, photo-assisted guide illustrating the complete autopsy, from pre-through postautopsy procedures. Chapters look at external cadaver examiner, organ removal methods, laboratory procedures including recording and imaging techniques, microscopy applications, pediatric and fetal autopsies, and checking for genetic disease and DNA diagnosis. New chapters and sections to this edition cover histology and immunohistochemistry, in addition to added coverage on forensic anthropology and molecular autopsy. From macroscopic to microscopic approaches, this volume provides detailed guidelines for performance of autopsy on every part of the human body. Using these standardized protocols and with the proper knowledge, training, and experience, pathologists-and students of pathology and forensic pathology-can rely

Clinical or postmortem? The importance of the autopsy; a retrospective study

Mædica, 2014

Medicine is continually evolving; the new technologies of diagnosis and treatment continue to improve the life expectancy and lead to new information concerning various pathologies. The autopsy is viewed more and more as an ultimate branch of medicine and used only in extreme cases or for forensic purposes. Nevertheless, many studies, including this one, prove the utility and indispensability of the autopsies, without which a complete and accurate diagnosis cannot be made. Finally, the autopsy followed by histopathological examination of the tissues remains the ultimate and most important step for the apprehension of the diseases and for further evolution of medicine. This study reveals the correspondence rate between the clinical and the postmortem diagnosis, as well as between macroscopic and histopathological diagnosis.

Research and Reports in Forensic Medical Science

Background: Autopsy is examination of a body post-mortem, with a view to determining the cause of death. Performing an autopsy has benefits for many parties: the family of the deceased, the clinician and hospital, and society at large. Materials and methods: The materials of the study were medico-legal autopsies (n=458) carried out by the Department of Forensic Medicine and Toxicology, BP Koirala Institute of Health Sciences between 15th July 2008 and 14th July 2009 (one fiscal year in Nepal). Autopsy reports were reviewed and interpreted in terms of the cause and manner of death, and demographic parameters. Results: The maximum number of reported cases was in the 21-30 years age group. The sex ratio of cases was 1.6:1 (M:F). The majority of deceased were from rural areas (60%), followed by urban areas (40%). There was no appreciable variation in the numbers of autopsies with respect to month of the year, or day of the week. Most deaths were either accidental (48.25%) or suicidal (40.83%). Homicide and natural causes accounted for 9.18% and 1.74% of deaths, respectively. Conclusion: The group most commonly affected was the young, productive age group, predominantly male. The majority of deaths were accidental or suicidal. Road traffic accident was the leading cause of accidental death. Poisoning was the leading method of suicide. Physical assault with blunt object was the most common cause of homicidal death.

A comparison of the provisional clinical diagnosis of death with autopsy findings

Romanian Journal of Legal Medicine, 2011

Autopsy rates have been in decline for the last half of the century. On the other hand, advanced technology does not seem to have reduced clinical errors. Autopsy retains a role in the evaluation of clinical practice, but its value is under consideration. The aim of the study was to determine the rates of disparity between clinical diagnosis and autopsy findings.

Medico-Legal Autopsy & Forensic Science Laboratory: Vital Tools of Criminal Justice System

Journal of Forensic Medicine, 2018

Forensic science is the application of science and technology to the detection and investigation of crime. Forensic science has shaped the world of justice, signifying the examination of crime with the help of modern and advanced technology. In this retrospective study, the viscera sent to toxicology and DNA section of FSL during autopsy at

Forensic Autopsy is reviewed from the Aspects of Ethics, Medicolegal and Humanities

Budapest International Research and Critics Institute (BIRCI-Journal): Humanities and Social Sciences

This article is motivated by the importance of learning about forensic autopsy. A forensic autopsy is carried out on the body of someone suspected of dying due to an unnatural cause such as in cases of accidents, homicides, or suicide. Forensic autopsy includes external and internal examinations relating to respect for a deceased human body. The controversy surrounding autopsy often occurs in the community. For reasons of culture, customs and religion, there is often a refusal to do autopsy. This article discusses the importance of autopsy and aspects related to ethics, humanities and medicolegal. The medicolegal police asked to do a forensic autopsy on forensic medicine experts to find the cause of death of the victim. The purpose of this article explains about the ethical, medicolegal and humanities aspects related to forensic autopsy.