AUTOPSY

Autopsy

It is a comprehensive study of a dead body,

performed by a trained physician employing
recognized dissection procedure and
techniques. Tissues maybe removed for
further examination and preservation.

Autopsy vs Post-mortem Examination

Post-mortem examination- external
examination of a dead body without
incision being made. Blood and body
fluids maybe collected for examination.
Autopsy- in addition to external
examination, the body is opened and an
internal examination is conducted.

Kinds of Autopsies
Hospital or non-official autopsy
Medico-legal or official autopsy

Hospital Autopsy
Purpose:

Determine the cause of death

Provide correlation of clinical diagnosis and
clinical symptoms
Determine the effectiveness of therapy
Study the natural course of disease process
Educating students and physicians

Consent of the rightful person needed.

Medico-legal Autopsy
Purpose:

Determine the cause, mode and time of death.

Recover, identify and preserve evidentiary material.
Provide interpretation and correlation of facts and
circumstances related to death
Provide a factual, objective medical report for law
enforcement, prosecution and defense agencies
Separating death due to disease from death due to
external cause for protection of the innocent.

When shall an autopsy be performed?

Whenever required by special laws.
Upon order of a competent court, a mayor and a provincial
or city fiscal.
Upon written request of police authorities.
Whenever the Solicitor General, Provincial or City fiscal as
authorized by existing laws, shall deem it necessary to
disinter and take possession of the remains for
examination to determine the cause of death
Whenever the nearest kin shall request in writing the
authorities concerned in order to ascertain the cause of
death.

Persons authorized to conduct autopsies:

Medical health officers
Medical officers of law enforcement
agencies
Members of the medical staff of
accredited hospital

Guidelines in the performance of autopsies:

It should follow the protocols in conducting autopsies.
It must be comprehensive.
Bodies which are mutilated, decomposing or burned are
still suitable for autopsy.
Autopsies must be performed in a manner which show
respect of the dead body.
Proper identity of the deceased autopsied must be
established in non-official autopsy.
A dead body must not be embalmed before autopsy.
The body must be autopsied in the same condition when
found in the crime scene.

Stages in the conduct of Autopsy:

Preliminary examination

Examination of the surrounding

Examination of the clothing
Identity of the body

External examination

Examination of the body surfaces

Determination of the position and approximation
time of death

Internal examination

Mistakes in autopsies:
Error or omission in the collection of evidence for
identification.
Failure to take photographs, fingerprints
Error or omission in the collection of evidence required for
establishing the time of death
Failure to report rectal temperature.
Error or omission in the collection of evidence required for
other medico-legal examination.
Failure to collect nail scrapings, sample of hair,, seminal fluid
Error or omission result in the production of undesirable
artifacts or in the destruction of valid evidence.
Using hammer and chisel to open skull

Negligent autopsy:
Failure to have an adequate history or facts
and circumstances surrounding the death.
Failure to make a thorough external
examination.
Inadequate or improper internal examination.
Improper histological examination.
Lack of toxicological or other laboratory aids.
Pathologist incompetence

Jenny entered the library seeking just the right information. The problem was
a tricky one. She watch enough of those TV crime shows to know that. She
approached the young man behind the information desk. " I wonder, could
you show me where I can find information on poisons?"
"What kind of poisons?" he asked her with a nice smile. "Too many bugs on
your ros bushes?"
"Oh no, I'm a mystery writer and I want to know an untraceable poison in one
of my books to kill off a bad guy," she told him, using the line she'd rehearsed
on front of the mirror.

Even though Max had one foot in the grave and the other on the banana
peel, Jenny knew his kids would blame her for his death. Unless he died of
natural causes, they'd suspect her and demand an autopsy. After all, even
under the terms of prenuptial agreement, she d get a life estate in the house
and its content, and a pretty substantial sum of money, too. So the poison
had to be untraceable.

It seems that most poisons were traceable. But. There was one that seem to
fit the bill. She headed home after stopping at the drug store to refill Max s
medications and pick up a few things for herself.
She came home, changed into sweats, painted and reprinted her nails and
finally helped Max with his medications, as usual. She slept restlessly that
night with Max in the next room. She could hear him wheezing through the
walls. Max was old, with cardiac problems and asthma. How long could he
live anyway?
Max suffered seizure and was brought to the hospital, treated and released.
Over the next three months, Max condition deteriorated and became
weaker, more confused and suffered headaches and dizziness. During the
last visit from his kids, Max died. Jenny jumped for Joy and started packing
for her Grand Cayman vacation.
If not for the faint smell of almonds present during autopsy, the medical
examiner might never have known there was a found play. What had Jenny
used to kill Max?

CAUSES OF DEATH

Cause of Death
It is the injury, disease or the
combination of both responsible for
initiating the trend or physiologic
disturbance, brief or prolonged, which
produces the fatal termination.

Cause of Death
Immediate (primary) cause of death: it is
when trauma or diseases kill quickly that
there is no opportunity for sequelae or
complications to develop.
Proximate (secondary) cause of death:it is
when the injury or disease was survived for a
sufficiently prolonged interval which
permitted to the development of serious
sequelae which actually caused the death.

Mechanism of death
It is the physiologic derangement or
biochemical disturbance incompatible
with life which is initiated by the cause
of death. Ex: hemorrhagic shock, sepsis,
respiratory depression.
Cardio-respiratory arrest should never
stand as the cause of death.

Manner of Death
It is the explanation as to how the cause
of death came into being or how the
cause of death arose.
Natural: death is caused solely by a
disease.
Violent or unnatural death: death due to
injury of any sort.

Medico-legal Masquerade
Violent deaths maybe accompanied by
minimal or no external evidence of
injury or natural death maybe
accompanied by signs of violence.

Degree of certainty to the cause of

death:
When the structural abnormalities established beyond
doubt the identity of the cause of death.
When there is that degree of probability amounting
to almost certainty the cause of death.
When the cause of death is established primarily by
historical facts.
When neither history, laboratory and anatomic
findings is sufficient to determine the cause of death
but merely speculate as to the cause of death.
(probably)

Instantaneous physiologic death:

Sudden death within seconds or minutes after a
minor trauma or peripheral stimulation. Circulatory
failure is caused by vagocardiac stoppage of heart
and dilatation of blood vessels. (urination, kick in the
scrotum)
Death by inhibition: diagnosis by exclusion
Diseases with no pathognomic findings:

Sudden infant death syndrome

Sudden unexplained nocturnal death

For cases where there is no working diagnosis upon

death, the cause of death should be undetermined.

Medico-legal Classification:
Natural death
Violent death

Accidental death
Negligent death
Infanticidal death
Parricidal death
Murder
Homicidal death

Natural death
Affection of the CNS
Affection of the circulatory system
Affection of the respiratory system
Affection of the gastrointestinal tract
Affection of the genito-urinary tract
Affection of the glands
Sudden death in young children

If violence was applied on a dead person, the person

inflicting the physical injuries cannot be guilty of
murder, homicide or parricide.
If the violence inflicted on a person suffering from a
natural disease only accelerated the death of the
victim, the offender inflicting such violence is
responsible for the death of the victim.
If the victim died of a natural cause and the physical
injuries inflicted is independent of the cause of death,
the accused will not be responsible for the death but
merely for the physical injuries he had inflicted.

To make the offender liable for the death of

the victim, it must be proven that the death is
the natural consequence of the physical
injuries inflicted.
The physician must determine for the interest
of justice with absolute care at autopsy and
laboratory examination the real cause of
death.

Violent death
The following should be established:

The the victim at the time the physical

injuries were inflicted was in normal health.
That the death maybe expected from the
physical injuries infected.
That the death ensued within a reasonable
time.

Classification of trauma or injuries:

Physical injury
Thermal injury
Electrical injury
Atmospheric injury
Chemical injury
Radiation injury
Infection

Refusal of the victim to submit to a surgical

operation do not relieve the accused from the
natural and ordinary result of the felonious
act and does not relieve him of his criminal
liability.
The presence of infection on the wounds
inflicted if not deliberately induced by the
victim makes the offender also responsible for
it.

Death under special circumstances:

Death caused in a tumultuous array
Death or physical injuries inflicted under
exceptional circumstances.

Pathological classification of the causes

of death.
Death from syncope

Death from sudden cessation of heart action

Death from asphyxia

Death from low or absent oxygen in the blood and

tissues.

Death from coma

Death resulting from arrest in the function of the

brain.

Special Deaths
Judicial death
Euthanasia
Suicide
Death from starvation

Judicial Death
Death by
Death by
Death by
Death by
Death by
Others

electrocution
lethal injection
hanging
musketry
gas chamber

Beheading
Crucifixion
Stoning
Smothering

Euthanasia
Types of euthanasia

Active euthanasia
Active euthanasia in demand

Passive euthanasia
Orthothanasia when an incurably ill person is allowed to

die a natural death without the application of any operation

or treatment.
Dysthanasia when there is an attempt to extend the life
span of a person by the use of extraordinary treatment
without which the patient would have died earlier.

Who may perform euthanasia

The patient himself.
The physician, with or without the
knowledge and consent of the patient.
(R., v. Adams,)
Karen Quilan

Suicide:
It is an unfortunate consequence of
mental illness and social
disorganization.
Rare in children, common in adults and
elederly.
Male > female
Usually occurs at home.

Suicide
Psychological classification of suicide:

First degree deliberate, planned

Second degree impulsive, unplanned
Third degree accidental
Suicide which suggest lack of capacity for intention.
(ex. psychotics)
Self destruction due to self negligence.(reckless
driving)
Justifiable suicide (incurable diseases)

Evidences that will infer death is suicidal.

History of depression, mental disease or unresolved
personal problem.
Previous attempt of self destruction.
In committed by inflection of physical injuries, the
wounds are located in areas accessible to the hand,
vital parts of the body and usually solitary.
Others: presence of cadaveric spasm in in hand
holding the gun; bottle of poison;absence of signs of
struggle.
Presence of suicide note.
Suicide scene in a place not susceptible to public view.

Death from starvation:

Types:

Acute starvation
Chronic starvation

Causes:

Suicidal
Homicidal
Accidental

"My husband has stopped breathing." Irene said to the dispatcher of 911. The
famous politician was found faced up, his shirt partially opened and his open
jaw showing the early stages of rigor mortis.
When the medical examiner arrived at the scene,detective Wilson said, "we're
thinking this is a drug overdose, Doc. The guy was known heroine user. Even
the wife admits he liked to "chase the dragon" (inhale the vapors of heroine).
Detective Wilson continued,"We found 6 balloons of Mexican black tar heroine
in the bedside table along with the pill bottle of Xanax." Both knew Xanax
could be used to help a drug user detox after a long drug binge.
Well, let see what the body tells us,DR Lester said. He pulled on a pair of latex
gloves and as he observed, he dictated into a small digital recorder his initial
findings. "A red area over the victim's upper lip". He opened the eyelids one at
a time. "Petechial hemorrhage s in both eyes."
"What?"

DR. Lester held up his hand in the classic sign for patience and
continued his observations. "Two small, reddish brown marks on
the chest." He turned the body over. "Bruises on his back, small
scrapes on both wrists contain the distinctive markings of wrist
restraints."
"You're thinking robbery gone bad?"
DR. Lester didn't respond. His examination continued for another
half hour. When he finished, detective Wilson asked, "any
preliminary decisions on manner of death.?"
"I'll need to wait for the tox screen," he said, referring to the blood
tests that would reveal the level of drugs in the deceased's body.
Maybe accidental overdose or suicide. But I'm thinking homicide."
Why?