Human Autopsy or necropsy means postmortem examination of a body. In every case the autopsy must be complete, all the body cavities should be opened, and every organ must be examined, because evidence contributory to the cause of death may be found in more than one organ.
Partial autopsies have no place in forensic pathologic practice. A complete autopsy is necessary to substantiate the truth of the evidence of eyewitnesses. A poor autopsy is worse than no autopsy at all, as it is more likely to lead to a miscarriage of justice.
The human autopsy should be carried out by the doctor, and not left to a mortuary attendant. The doctor should remove the organs himself. The attendant should prepare the body and help the doctor where required, such as sawing the skull cap, reconstruct the body, etc.
The approach of the forensic pathologist to the investigation of death is different from that of the hospital pathologist. The hospital pathologist has easy access to relevant information about the history, physical condition and course of the disease leading to death.
The history directs the pathologist to the appropriate ancillary investigations. His main aim is to find morphologic changes (extent of a known disease) explaining signs or symptoms of the disease and the effectiveness of treatment.
In medico-legal autopsies, often the clinical history is absent, sketchy, doubtful or misleading. In some cases, identity may not be known. He has to determine time of death and age of injuries.
If there are any inconsistencies between the apparent death scene and his actual findings of human autopsy, he has to visit scene of crime. He has to carry out careful external examination including clothing, in the determination of the pattern of injuries and their relationship to the object or weapon causing them. He has also to determine the manner and mechanism of death.
Objects of human autopsy
(1) To find out the cause of death, whether natural or unnatural. This is done by detecting, describing and recording any external or internal injuries, abnormalities and diseases.
(2) To find out how the injuries occurred.
(3) To find out the manner of death, whether accidental, suicidal or homicidal.
(4) To find out the time since death.
(5) To establish identity when not known.
(6) To collect physical evidence in order to identify the object causing death and to identify the criminal.
(7) To retain relevant organs and tissues as evidence.
(8) In newborn infants to determine the question of live birth and viability.
If autopsy is not done, the exact cause of death, the presence and extent of disease or injury, the incapacitation produced by them, and whether there was any pain or suffering becomes only speculation.
Rules for Medico-legal human autopsy
(1) The body should be labelled as soon as it arrives in the mortuary.
(2) The autopsy should be conducted in a mortuary and never in a private room. However, it may become necessary to do an autopsy at the site, when the body is in an advanced state of putrefaction, and its transportation will be difficult, and materials of evidential value may be lost in transport.
(3) It should be conducted only when there is an official order authorizing the autopsy, from the police or Magistrate.
(4) It should be performed as soon as possible after receiving requisition, without undue delay.
(5) The medical officer should first read the inquest report carefully and find out the apparent cause of death, and obtain all the available details of the case from case sheet, accident register, etc., so that attention may be directed to the significant points, while doing the postmortem examination and to carry out appropriate investigations, e.g. toxicology, microbiology, virology, radiology, etc. Lack of such information may result in loss of vital evidence.
(6) The examination in human autopsy should be conducted in daylight as far as possible, because color changes, such as jaundice, changes in bruises, changes in postmortem staining, etc. cannot be appreciated in the artificial light. If the body is received late in the evening, a preliminary examination is done to note the external appearances, the body temperature, extent of postmortem lividity and rigor mortis, etc. The actual postmortem may be conducted on the next day as early as possible.
(7) The body must be identified by the police constable who accompanies it. The names of those who identify the body must be recorded. In unidentified bodies, the marks of identification, photographs, and fingerprints should be taken.
(8) No unauthorized person should be present at the autopsy. The investigating police officer may be present.
(9) As the autopsy is conducted, details of examination should be noted verbatim by an assistant, and sketches made of all the important injuries.
(10) Nothing should be erased and all alterations should be initialled in the report.
(11) Even if the body is decomposed, autopsy should be performed as certain important lesions may still be found.
(12) Both positive and negative findings should be recorded.
(13) After completion of autopsy, the body is handed over to the police constable.
(14) P.M. report should not be issued to the party.
The human autopsy report consists of
(1) The preamble: This should mention the authority ordering the examination, time of arrival of the body at the mortuary, the date and place of examination, the name, age and sex of the deceased and the means by which the body was identified.
(2) The body of the report: This consists of a complete description of the external and internal examination of the body. It should contain a description of the nature, direction, exact situation and dimensions of the wounds. Number should be assigned to each of the wounds that are described. Diagrams are often of value. The report should include all of the positive findings and all of the relevant negative findings, because it may be taken to mean that it was not examined or specifically looked for.
(3) Conclusions of human autopsy: The conclusion as to the cause of death must be given, based on the postmortem findings. Conciseness and clear language are of high value in the expression of the opinion. The report should be detailed, comprehensive, honest, objective and scientific. This is followed by the signature and qualifications of the doctor. A properly performed autopsy furnishes objective facts which can disprove the weight and worth of misleading statements.
Human Autopsy Room Photography
Photographs are useful :
(1) to provide a visual record for the pathologist to refer to at a later time,
(2) to allow other professionals to review the pathologists findings and to formulate their own opinions,
(3) to show to the judge in trial, and
(4) for teaching purpose.
Photographs should be taken from above, and at right angles to the body to avoid perspective distortion. All objects, such as scalpels and scissors should be excluded. The case number should be placed in a corner or along one edge of the photograph.
A pointer, e.g. a narrow triangle of thin cardboard, may be used if a lesion is not readily visible. In violent deaths, front and back views of the unclean body with its clothes and also after removal of the clothes should be taken.
Then the body should be washed and in the naked body, a distant shot to indicate the location of injuries and close-up shots of major wounds to show details should be taken, keeping a scale to show the dimensions of the wound.
In an unknown body photograph of the face should be taken while doing human autopsy. Victim’s hands should be photographed to demonstrate electrical burns, defense cuts, etc. Ligatures, gags and bindings should be photographed before removal from the body.