MEDICO-LEGAL

AUTOPSY
- WHY IS IT SO IMPORTANT?

DR. ABDUL KARIM BIN HAJI TAJUDIN

PAKAR PERUNDING KANAN PATOLOGI DAN FORENSIK
KETUA JABATAN PERUBATAN FORENSIK
HOSPITAL SERDANG

FORENSIC
POSTMORTEM
SYNONYMS

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MEDICOLEGAL AUTOPSY
FORENSIC AUTOPSY
POSTMORTEM EXAMINATION

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DEFINITION
AUTOPSY which is performed on

instructions of the legal authorities

responsible for the investigation of:

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sudden
suspicious
obscure
unnatural
litigious
criminal deaths
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THE IMPORTANCE OF
AUTOPSY
ASSISTING CRIMINAL INVESTIGATION

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ASSAULT
NEGLECT
MURDER
SUICIDE
ACCIDENT

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LEGAL AUTHORITY
A CORONER
A MEDICAL EXAMINER
A PROCURATOR-FISCAL
A MAGISTRATE
A JUDGE
THE POLICE

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TYPES OF AUTOPSY
NON-CRIMINAL DEATHS

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ACCIDENTS
SUICIDES
DEATH FROM SUDDEN NATURAL
CAUSES
DEATH ASSOCIATED WITH MEDICAL
OR SURGICAL TREATMENT
INDUSTRIAL DEATHS
ETC.
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TYPES OF AUTOPSY
TRUE FORENSIC AUTOPSY
SUSPICIOUS

DEATHS
CRIMINAL DEATHS
MURDER
MANSLAUGHTER
INFANTICIDE

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FORENSIC
AUTOPSIES
PATHOLOGIST OF

DIFFERENT MODULE
NOT A FORENSIC
PATHOLOGIST
MOST OF THE TIME BY
MEDICAL OFFICERS
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CRIMINAL PROCEDURE
CODE
INQUIRIES OF DEATHS
328. Meaning of cause of death.
329. Duty of police officer to investigate
death.
330. Duty of officer to arrange for postmortem examination in certain cases.
331. Post-mortem examination of body.
332. Report of Government Medical
Officer.

HOSPITAL WITH FORENSIC

PATHOLOGIST
- Medical officer will be supervise by the Forensic
Pathologist.

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HOSPITAL WITHOUT
FORENSIC PATHOLOGIST
- Medical Officer (MO) will be supervise by
State Pathologist/ Forensic Pathologist on call.
- MO must be train or expose to the Medico
legal autopsy.
- MO in charge of the mortuary must first
undergo training for at least 2 weeks with a
Forensic Pathologist.
- Must do 20 autopsies under supervision.
cont
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HOSPITAL WITHOUT
FORENSIC PATHOLOGIST
MO must do the case with Forensic

Pathologist they refer to.

List of cases should be refer.

Where there is no cases, MO will be place in

other department.
MO have to be in the mortuary when there
are autopsy to be done.
Hospital Director must appoint MO, PPP &
PPK into manning the mortuary.
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THE OBJECTIVES OF
AUTOPSY
To make a positive identification of

the body and to assess the size,

physique and nourishment.

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CONTINUE
To determine the cause of death

1. Cause of death according section 328

CPC.
Natural
Murder
Suicide
accidental
2. Medical cause of death The disease or
injuries causing death.
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CONTINUE
To determine the mode of dying

and time of death where

necessary and possible
Natural
Murder
Suicide
accidental

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CONTINUE
To demonstrate all external and

internal abnormalities,
malformations and diseases
To detect, describe and
measure any external and
internal injuries
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CONTINUE
To obtain samples for analysis,

microbiologic and histological

examination, and any other
necessary investigations
To retain relevant organs and
tissues as evidence
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CONTINUE
To obtain photographs, and

video films for evidential and

teaching use
To produce a full written report
of the autopsy findings

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CONTINUE
To offer an expert interpretation of those

findings:
i) Able to interpret the findings of disease and
injuries.
ii) Interpret the injuries (minor, bruising,
compound fractures, etc.).
iii) Type of wounds (bruises, incisions
laceration, burns, electric marks, puncture
marks, etc.).
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CONTINUE
iv) Interpret the severity of the wounds
According to:
- the sizes
- the anatomical locations of the
wounds
- Law Section 319 & 320 Grievous
Body Hurt (GBH).

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Documenting
injuries

6 parameters must be observed

1.Type of lesion bruise,
a/w, l/w etc
2.Site area, anat. fixed
point
3.Size measure those that
can be measured,
anatomical
fixed point
4.Appearance colour,
shape, pattern
5.Orientation - axes
6.Direction of causation
varying depth, edges
configuration or skin
piling
& pain, tenderness,
stiffness &
deformities

Bruises -

Finger pad marks

Patterned bruises
spanner?
Tram track bruises- rod rigid shaped
blunt weapon

A 6-year-old
girl who
presents a few
days after
being
disciplined on
the buttocks
with a wooden
spoon by her
mother (This
pattern of
bruises is of
suspicious
shape, number,
and location.)

Blows and grip marks

Tram line bruises

Victim of domestic violence, there are multiple bruises due

to blows and grip marks on the left arm, on tram line bruises
being beaten with a stick on the left chest.

FINGER-TIP TYPE BRUISES

DISCOID

~ 1-2 CM
DIAMETER

CLUSTERED IN
CLOSE
PROXIMITY

+/- THUMB PRINT

ON OTHER SIDE
OF LIMB

Imprint bruises
A patterned
bruises on the
upper back
Alleged a male
kicked & stood
on him during
the assault.
Pattern matched
that of the
alleged
assailants
footwear
(D Wells, VIFM)

Imprint bruises

Bruises on the
abdomen
with overlying fist
Indicating spacing
between knuckles.

(D Wells, VIFM)

A 5-year-old
girl who
presented
within 24
hours of being
slapped on
the leg (These
are bruises
and not
erythema.
The linear
parallel lines
are virtually
diagnostic of
a human
handprint.)

Abrasions caused by a buckle of a bag

used in a beating

D Wells, VIFM Melbourne)

Abrasions and scratches

Multiple self inflicted

scratches

Abrasion d/t glancing kick

to the face

Laceration

Split lacerations

 Bruising &

lacerations to the
inner aspect of the
lip.
Force to the lips eg
punch
Inner lips driven
into the teeth
producing tearing
& splitting of
tissues & bruises

(D Wells, VIFM, Melbourne)

Incised wound to the wrist

Chopped wound
(a sub set of incised
wound)
Heavy sharp weapon- eg
parang
Incised wound to the hand
Defense injury

Incised Wound Defense injury, extensor, forearm, victim used her

forearm to fend herself from the assailant

Multiple stabs to the neck

Impaled knife- stab

wound

Stab wound the knife has penetrated

Deep to the hilt

Stab wound to the neck

He cough out blood &

was intubated.but
Dont forget

This patient was found to have two stab

wounds to the lower back, that easily could
have been missed given the rather dramatic
presentation of the neck injury,
Reinforcing the dictum that all trauma patients
need to be completely undressed and fully
examined

A 4-year-old
boy who was
forcibly
grabbed
about the
neck by his
father (The 2
anterior
chest bruises
are
consistent
with
thumbprints.)

Allergic skin
reaction to a
masking tape
that was
used to close
the mouth
and taped
around the
face of a
kidnapping
victim.
Penang 1992

Amorous bite injury.

Intermittent abrasions in the
erythema, and possibly skin
puncture.
Measurements must be made to
help support her case in the event
that charges are filed. To
eliminate doubt as to an
artifically-induced injury.
Pathogenicity of human oral flora,
and give antibiotics when
appropriate

Aggressive bite injury

Grievous Body Hurt (GBH)

SECTION 319 OF THE PENAL CODE

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WHOEVER CAUSING PAIN, DISEASE

OR DISABILITY TO A HUMAN BODY IS
SAID TO HAVE CAUSE HURT OR
INJURY

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CONTINUE
SECTION 320 OF THE PENAL CODE

GRIEVOUS BODILY HURT

FIRST

- IMPOTENCE
SECOND - PERMANENT LOST OF ONE OF
THE EYESIGHT
THIRD - PERMANENT LOST OF HEARING
OF ONE OF THE EAR
FOURTH - LOST OF ANY LIMB OR JOINT.
CONT
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CONTINUE

GRIEVOUS BODILY HURT

FIFTH

- DAMAGE OR PARALYSE OF LIMB OR

JOINT
SIXTH - DISFIGUREMENT OF FACE OR HEAD.
SEVENTH - FRACTURE OR DISLOCATION
BONE AND JOINT.
EIGHT - ANY INJURIES THREATENING LIFE
OR THE INJURED SUFFERED PAIN THAT
PREVENT HIM DOING NORMAL DUTIES FOR
TWENTY DAYS.
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CONTINUE
v) Legal interpretation of the wounds
- Able to interpret the type of
instruments, weapons or object causing
the wounds.
- Able to interpret whether the wound
was self inflicted, cause by others, or
defense wounds.

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CONTINUE
Type of force
Sharp weapons

Blunt weapons

Firearm

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Type of wounds

Cause of death

Incision

Murder, suicide

Stab

Murder, suicide

Slashed

Murder

Abrasion

Accident, murder, suicide

Bruising

Accident, murder

Laceration

Accident, murder

Gunshot

Murder, suicide, accident

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CONTINUE
vi) What causes the wounds
- Object hitting the body.
- Body hitting the object.
vii) Able to age the wounds

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CONTINUE
To restore the body to the best

possible condition before

release to the relatives.

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AUTOPSY
check lists
make

sure that the body has

been identified to the examiner
by the police
get more information from the
police
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AUTOPSY
checklists
prepare

checklists form
perform external examination
perform internal examination
give cause of death
make an autopsy report
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KES-KES YANG PERLU

DIRUJUK KEPADA PAKAR
PERUBATAN FORENSIK
1. Kes bunuh

Trauma tumpul (blunt force trauma) akibat pukul, tendang, pijak dan
sebagainya yang menyebabkan kecederaan parah dan fatal pada
kepala/ dada/ abdomen atau lain-lain bahagian badan.
Trauma oleh objek tajam seperti tikaman, hirisan dan cincangan.
Tembakan (gun shot) dan kesan bahan letupan (explosion death).
Mati dibakar (homicidal burns).
Smothering/ gagging.
Jerutan (strangulation) samada manual ataupun ligature.
Mati digantung (homicidal hanging).
Mati lemas yang rumit (homicidal drowning) atau jasad yang dijumpai
di dalam air yang berkemungkinan mati disebabkan trauma sebelum
dicampak ke dalam air (who may have died from injury before being
thrown into the water).
Mati akibat keracunan yang rumit (homicidal poisoning).
Samb

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KES-KES YANG PERLU

DIRUJUK KEPADA PAKAR
PERUBATAN FORENSIK

2. Kes suspicious

Di mana sejarah/ jalan cerita kematian yang diperolehi dari polis

atau waris tidak konsisten dengan kecederaan yang didapati pada
jasad si mati atau sebaliknya.

Terdapat luka-luka yang mencurigakan seperti luka tikaman, hirisan

atau tembakan pada jasad.

Jatuh dari tempat tinggi (fall from height) yang mencurigakan

seperti terdapat kesan-kesan pergelutan di tempat kejadian atau
luka hasil dari pergelutan pada jasad.

Kes bakar dalam kenderaan.

Sekiranya mendapati suspicious circumstances dan / atau

suspicious injury pada jasad yang diperiksa.

Sekiranya terdapat dakwaan (allegation) dari pihak waris atau

pihak ketiga (third party).
Samb
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3.
4.

5.
6.
7.

8.
9.

KES-KES YANG PERLU

DIRUJUK KEPADA PAKAR
PERUBATAN FORENSIK

Kematian akibat wabak seperti contoh Nipah Virus, SARS dan

selsema burung.
Warga asing (foreigners) terutamanya caucasion (Westerners/
European/ Asean Pasific) yang kebiasaannya memerlukan
pemeriksaan bedah siasat yang lengkap disertai pemeriksaan
lanjut (further investigations) dan laporan yang komprehensif.
Kematian di dalam lokap (death in custody / institution).
Kematian di pusat jagaan (nursing home) yang mencurigakan
sahaja.
Kematian semasa latihan yang melibatkan pasukan polis atau
tentera termasuk semasa Program Latihan Khidmat Negara
(PLKN).
Jasad yang digali semula (exhumation).
Kes penderaan kanak-kanak (non accidental injury in children /
child abuse / child neglect). Samb

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10.
11.
12.
13.
14.
15.

16.
17.

KES-KES YANG PERLU

DIRUJUK KEPADA PAKAR
PERUBATAN
FORENSIK
Infanticide
Kematian bersangkutan rogol / liwat / penderaan seksual (death
associated with sexual offences).
Kematian ibu mengandung yang rumit (death associated with
pregnancy).
Kematian disebabkan pembedahan / bius (death associated with
surgical procedures / surgery and anaesthesia).
Pemeriksaan bedah siasat kedua (second post mortem
examination).
Kematian di hospital / kemudahan kesihatan dengan sebab yang
tidak jelas dan bedah siasat klinikal diperlukan untuk menentukan
sebab-sebab kematian.
Kes-kes bedah siasat klinikal (clinical post mortem yang rumit dan
bermasalah).
Kes kematian ramai mangsa (mass disaster).

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