© 2001 by CRC Press LLC

Appendix

The Forensic Autopsy

The forensic autopsy differs from the hospital autopsy in its objectives andrelevance. Besides determining the cause of death, the forensic pathologistmust establish the manner of death (natural, accidental, suicidal, or homi-cidal), the identity of the deceased if unknown, and the time of death orinjury. The forensic autopsy may also involve collection of evidence from thebody, which can subsequently be used to either prove or disprove an indi-vidual’s guilt, and confirm or deny his account of how the death occurred.

Because of the possible medicolegal implications of forensic cases,not only must the aforementioned determinations be made, but the find-ings or lack of them must be documented. In many cases, the cause andmanner of death may be obvious. It is the documentation of the injuriesor lack of them, as well as the interpretation of how they occurred andthe determination or exclusion of other contributory or causative factorsthat are important.

The forensic autopsy involves not only the actual examination of thebody at the autopsy table, but the consideration of other aspects that thegeneral pathologist does not believe to be part of the autopsy—the scene,clothing and toxicology. The forensic autopsy begins at the scene. Pathologistsshould not perform a forensic autopsy unless they know the circumstancesleading up to and surrounding the death. This is a very basic principle thatis often violated. What would one think of a physician who examined apatient without asking what the patient’s symptoms or complaints were? Asin all examinations of patients, one must have a medical history. In the caseof the forensic pathologist, the “patient” is unable to render this history.Therefore, the history must be obtained by either the medical examiner orpolice investigators. This history should be known before the autopsy begins.

The scene should be documented either with diagrams or photo-graphs, preferably both. People should be interviewed and a written reportshould be given to the pathologist prior to the autopsy. It makes goodtelevision dramatics to poke and prod a body at the scene, but it does not

© 2001 by CRC Press LLC

make sense scientifically. At the scene, there is often pressure to move thebody, people milling around, inadequate lighting, no instruments, and norunning water. A body cannot be examined adequately at a scene. Whatcan be done, however, is destroy evidence or introduce fallacious evidence.Powder can be dislodged from the clothing, primer residue can be wipedaway from the hands, the body can be contaminated with the examiner’shair or with the hair of the police officer who helps turn, poke, and prodthe body, and so on.

The body should be touched and moved as little as possible at the scene.In cases of violent death, paper bags should be secured about the victim’shands so that no trace evidence will be lost. If plastic bags are used and thebody then placed in a cooler, there will be condensation of water vapor onthe hands (with possible loss of trace evidence) when it is moved back intoa warm environment. Prior to transportation, the body should be eitherwrapped in a clean white sheet or placed in a clean body bag. It should neverbe placed directly onto a cart in the back of an ambulance. Who knows whator who was lying on the cart prior to the body transport? Trace evidencefrom a prior body could be deposited on this body, or trace evidence fromthis body can be lost and subsequently transferred to another body.

At the morgue, the body should never be undressed prior to the medicalexaminer’s seeing it. This includes removing shoes and socks to place toetags. Examination of the clothing is as much a part of the autopsy as exam-ination of the wounds. The clothing must be examined for blood stains andtrace evidence as well as to see if the wounds in the body correlate with thedefects in the clothing. How does one know that the individual was not shotand then dressed?

The body should never be embalmed prior to the autopsy. Embalmingruins toxicologic analysis, changes the appearance of the wounds, and caninduce artifacts. The body should never be fingerprinted prior to examina-tion of the hands. In fingerprinting, the hands are pried open to ink thefingers. In the process, trace evidence can be lost or false evidence deposited.Tests for firearms residue can be rendered invalid by prying apart fingers andfingerprinting a body.

In all gunshot deaths and severely burnt bodies, X-rays should be taken.X-rays are especially important in gunshot wound cases in which the bulletappears to have exited. This is because the entire bullet may not have exitedbut rather only a piece of the bullet or a piece of bone. With the semijacketedammunition now in widespread use, it is common for the lead core to exitthe body and the jacket to remain. The core is of no interest ballistically. Itis the jacket that is important. The jacket might be retained beneath the skinadjacent to the exit site. It is very easy to miss the jacket material at autopsy,unless one knows, by X-ray, that it is there.

© 2001 by CRC Press LLC

The Autopsy Report

The first part of the forensic autopsy is the

External Description

.

The external description should include the age, sex, race, physique,height, weight, and nourishment of the deceased. Congenital malforma-tions, if present, should be noted. Following this, a description of theclothing should be given. This description, initially, does not need to bevery detailed. Essentially, a simple listing of the articles found or accom-panying the body should be given, for example, a short-sleeved white shirt,or a long-sleeved white shirt unbuttoned down the front, or a bloodstainedwhite T-shirt. If the case is a traumatic death with significant alterationsof the garments due to trauma, the clothing will be described in furtherdetail in another section of the autopsy.

After the description of the clothing, at least the following should bedescribed:

• Degree and distribution of rigor and livor mortis.• Hair and eye color.• The appearance of the eyes.• Any unusual appearance to the ears, nose, or face, for example, con-

genital malformations, scarring, or severe acne. (Excluded should beevidence of trauma, which will have its separate section.)

• The presence of teeth or dental plates.• The presence of vomitus in the nostrils or mouth.• Significant scars, tattoos, moles.• External evidence of disease.• Old injuries.• Evidence of recent medical and/or surgical intervention (

Note:

Youmay want to put this in a separate section entitled “Evidence of Medicaland/or Surgical Intervention”).

At this time, if fingerprints have not been taken, they should be. Inaddition, it is strongly recommended that identification photos, with thenumber of the case, be taken.

If there is injury to the body, it should now be described in the nextsection, entitled “Evidence of Injury.” All recent injuries, whether minor ormajor, external or internal, should be described in this section. There is noneed to repeat the description of these injuries in the subsequent “InternalExamination” section or to describe them in the “External Description.” Theage of the lesions should be described, if possible, at least in a general way.

There are many ways to handle the “Evidence of Injury” section. Exclud-ing gunshot and stab wounds, it is easiest to divide it into two broad areas:

© 2001 by CRC Press LLC

external evidence and internal evidence. Some examiners intermingle thesetwo. They describe the external evidence of injury to the head and then say“Subsequent autopsy reveals …” and go on to describe the internal injuriesof the head. They will then describe the external injuries of the trunk, fol-lowed by the internal injuries of the trunk.

Gunshot wounds and, to a degree, stab wounds are a different situation.In gunshot wound cases, if at all possible, each individual wound should bedescribed in its entirety before going on to a second wound. Each woundshould be located on the body (in inches or centimeters) in relation to thetop of the head or the sole of the foot and to the right or left of the midline.It should then be described (in inches or centimeters) in relation to a locallandmark, such as the nipple or the umbilicus. The features of the woundthat make it an entrance and that determine at what range the bullet wasfired should be described — for example, abrasion ring, soot, or tattooing.Pertinent negatives should be noted. Then, the course of the bullet throughthe body should be described. All organs perforated or penetrated by themissile should be noted.

It is useful to give an overall description of the missile path through thebody in relation to the planes of the body. Thus, one will say, “The bullettraveled from back to front, left to right, and sharply downward.” If the bulletexits, the exit wound should be described in relation to the entrance.

If the bullet is found, one should state where it was found, whether it isintact, deformed, or fragmented, whether it is lead or jacketed, and theapproximate caliber. A letter or number should be inscribed on the bullet,which should then be placed in an envelope with the name of the victim, thedate, case number, and location from which the bullet was recovered, theletter or number assigned it, and the name of the prosector.

If at all possible, the same general procedures should be used to describestab wounds. One should indicate, if possible, whether the weapon wassingle- or double-edged, which edge of the wound was produced by thecutting edge of the knife, the exact dimensions of the stab wound, and anestimation of the depth of the wound track. In instances where there aredozens of knife wounds, it may not be possible to handle each wound sep-arately and it might be necessary to handle them in groups.

The last part of the

“

Evidence of Injury” section should concern theclothing. The location of defects, whether they correspond to the injuries,and the presence of trace evidence, such as powder, soot, or car paint, shouldbe described.

Next is the “Internal Examination” section. Here, the major organ sys-tems as well as the organ cavities are described. The usual subdivisions ofthis section are:

© 2001 by CRC Press LLC

• Head• Body cavities• Neck• Respiratory tract• Cardiovascular system• Gastrointestinal tract• Biliary tract• Pancreas• Spleen• Adrenals• Urinary tract• Reproductive tract• Musculoskeletal system

In these sections, one would give organ weights (not necessary for adrenaland pancreas) as well as a brief description of the organs with pertinentnegatives. With the pancreas, adrenals, and spleen, if there are no positivefindings, using the term “unremarkable” as the sole description is acceptable.Do not use the term “normal” as organs are rarely normal – whatever that is.

The next section is the “Microscopic Examination.” Microscopic slidesshould be made when indicated. Samples of tissue from all major organsshould be saved, but are often not needed in forensic cases, especially intrauma cases.

Next is the “Toxicology Section” where the results of the toxicologicalanalyses are listed.

The next section is “Findings.” This, and the last section, “Opinion,”should be on a separate page. List the major findings in order of importance.It is not necessary to list every minute, often extraneous finding, as is donein some hospital autopsies. This autopsy will most likely be seen by nonphy-sicians, and having spent a half hour trying to explain acute passive conges-tion of the liver to a jury in a gunshot death, we feel the inconsequentialobservations should not be listed in “Findings.”

The last section is “Opinion.” This should briefly describe the cause ofdeath in language as simple as possible, as well as stating the manner of death.This section is intended for the public, not for physicians Thus, for example,one can say, “… died of a heart attack due to coronary atherosclerosis (‘hard-ening’ of the blood vessels that supply blood and oxygen to the heart muscle).”Or “…died of massive internal bleeding due to a gunshot wound of the aorta(the major blood vessel of the body).”

Speculation as to circumstances surrounding the death should be absentor kept to a minimum.