EXHUMATIONDISINTERMENT

REPOST-MORTEM

EXHUMATION

DEFINITION Exhumation is defined as lawful

disinterment or digging out of already buried dead bodies from the grave for autopsy examination. OR

Removal of corps from grave for determination of cause of death.

OBJECTIVES1-for purposes of identification2. Second autopsy when the first report is

ambiguous.3-to determine the cause, manner of death ,

when foul play is suspected. e.g. homicide, disputed case of death or

poisoning.4-may also be required to recover some paper

or documents or other evidential material buried with dead body.

PROCEDURE

AUTHORIZATION Can be carried out only with proper

authorization.

LEGAL REQUIREMENTS The exhumation is performed under section 176

Cr.Pc and police rules 1934 section 25.36. The exhumation is performed in the early

morning in the presence of duty magistrate and police.

High court, district magistrate, district and session judges, judicial magistrate are specially empowered to order for exhumation.

TIME LIMIT FOR EXHUMATION

1. The statute law is silent about the period during which exhumation is allowed.

2. The soft tissues of dead body of an adult take about five years and of child take about ½ of this time to decompose to skeleton .

3. The bony frame does not decompose and persist for hundred of years in the grave.

Pakistan No limit.

France 10yrs

Scotland 20 yrs

Germany 30yrs

ARRANGEMENTS OF EXHUMATION

1. To make the arrangements of exhumation and postmortem in the grave yard is the duty of investigation police officer.

2. The police cordons the area and protect the grave to avoid public exposure and interference.

ARRANGEMENTS OF EXHUMATION

Team consisting of duty magistrate ,area police, and nominated medical officer reach the place of burial of deceased in early morning

Identification of grave—The magistrate ask the relatives of deceased and other persons responsible for burial to identify the grave and then orders disinterment

The grave is left open for sometimes to allow the foul gases to escape.

The body is taken out of the grave and placed at make shift autopsy table and medical officer should stand in the wind side of body to avoid inhalation of gases.

Time of start of examination noting the state of shroud as well as of body.

Precautions I. Adequate light & ventilation.

II. The workers should be in complete coverings like:

Protective masks, clothing, long shoes, goggles & gloves.

SAMPLES Sampling should be as much as possible. These are,

1. Earth sample—are collected from above , beneath , and both sides of coffin and from far areas of grave yard for control ,500 g each.

2. Hair from head and pubic area should be preserved in a dry clean glass bottle.

A search should also be made for recent or old injuries such as fractures.

3. Nails, teeth, and bones. 4. Viscerae and material from sites of viscerae like

liver, spleen , kidney, stomach, intestine. 5. A portion of burial shroud (coffin).

In case of suspected metal poisoning

such as arsenic, lead & antimony hairs, nails & long bone should be preserved.

Sample then forwarded duly labeled & sealed to forensic science laboratory.

Autopsy Artifacts

Artefact DICTIONARY MEANING: An artifact is an artificial product ,

any structure, or feature, that is not natural but has been altered by processing.

Autopsy Artefact/ Medico legal Artefact.

DEFINITION:o Any change or feature introduced

into a body after death that is likely to lead to misinterpretation of medico legally significant ante mortem findings.

Autopsy Artifacts

Two groups

1. Artifacts introduced between death and autopsy

2. Artifacts introduced during autopsy.

1. ARTIFACTS INTRODUCED BETWEEN DEATH AND

AUTOPSY These can be divided in to following

1. Agonal artifacts2. Resuscitation artifacts3. Embalming artifacts4. Intermittent and exhumation artifacts 5. Artifacts due to handling of body6. Artifacts due to rigor mortis and

postmortem staining.7. Decomposition artifacts8. Toxicological artifacts9. Miscellaneous artifacts

1. AGONAL ARTIFACTS Regurgitation and aspiration of

gastric contents, Regurgitation or aspiration of gastric

contents may occur as terminal event in the natural death or from handling of body or resuscitation.

Physician when see regurgitated material in mouth or nose may give it as a cause of death and an autopsy surgeon may fall in to the trap of misinterpreting the finding of aspirated material in air passages

2. RESUSCITATION ARTIFACTS.

The resuscitation procedure may reveal injection marks , bruises, and fractures,

1. Intra cardiac injections may be accompanied by bruising of the heart and sometimes intra pericardial hemorrhage.

2. Injection marks may be accompanied by postmortem bruise.

3. A ring like bruise on chest is sometimes seen due to application of defibrillator.

4. Ribs and even sternum are usually fractured during cardiac massage.

To avoid confusion history of resuscitative measures should be carefully noted.

Resuscitative contusion of soft tissues of neck can raise suspicion of homicidal strangulation e.g., trying to introduce tube in airway

3. EMBALMING ARTEFACTS

The embalming is done through incision at the site of approachable arteries with a trochar.

The embalmer may enlarge a homicidal stab wound to approach the artery or may introduce a trochar through gun shot wound and may change its dimension.

4. EXHUMATION ARTEFACTS In exhumed bodies, fungus growth is

common on body orifices, eyes and sites of open injuries and when the fungus is removed underlying skin presents discoloration simulating bruise.

5. ARTEFACTS DUE TO HANDLING OF BODY

Rough handling of body can result in fracture of cervical spine and absence of significant hemorrhage helps to identify the fractures on postmortem.

A post mortem bruise on region of occiput of head can result due to careless bumping of head on stature.

6. ARTIFACTS RELATED TO RIGOR/ POSTMORTEM STAINING

1. Breaking of rigor mortis during handling of body may cause a confusion of time since death.

2. Localized areas of post mortem staining may resemble a bruise.

7. DECOMPOSITION ARTEFACTS

Advanced decomposition causes swelling of lips, nose, eyelids protrusion of eyes, distension of chest, and abdomen and swelling of extremities which may lead to impression of ante mortem obesity.

Presence of bloody fluid in mouth and nose is common findings in decomposition which may lead to wrong conclusion that person died of excessive hemorrhage.

Decomposition blebs may sometimes be misinterpreted as vesication from burns.

7. DECOMPOSITION ARTEFACTS

The deep groove found around neck of decomposed body due to tight buttons of shirt may simulate ligature mark of strangulation.

The presence of gas in right side of heart due to decomposition may give false impression of air embolism.

8. MISCELLANEOUS ARTEFACTS

1. Wounds caused by animal bites may create confusion.

2. Postmortem hemorrhage Under normal circumstances blood in the body remains in fluid state for sometimes, during this time postmortem injury may open a blood vessel and lead to postmortem hemorrhage.

3. Discoloration of liver.

9. ARTEFACTS INTRODUCED DURING AUTOPSY

1. One of the most common artefact is introduction of air bubbles in to the vessels of top of brain while the dura is being pulled in sagital line.

Post mortem introduction of air in to the neck veins during reflection of skin may cause confusion because air bubbles in vessels of neck and brain are seen in death due to air embolism following attempt at criminal abortion

9. ARTEFACTS INTRODUCED DURING AUTOPSY

2. Forceful pulling of skull cap sometimes lead to fracture of skull.

3.Postmortem tears of midbrain may also be caused during removal of brain from cranium.

4.Handling of organs and incision of vessels during postmortem examination often result in extravasations of blood in cavities.

Medicolegally misinterpretation may lead to 1.Wrong cause of death 2.Wrong manner of death 3. Undue suspicion of criminal

offence

Negative Autopsy

Definition When the gross and microscopic

findings fail to reveal any apparent cause of death, along with the other laboratory examination termed as negative autopsy.

INCIDENCE: In best centers of medicolegal

examination the rate of negative autopsy ranges from 2 to 10 percent of total autopsies.

CAUSES OF NEGATIVE AUTOPSY

1. Inadequate history.2. Lack of proper external

examination.3. Inadequate/improper internal

examination.4. Insufficient histological examination 5. Inadequate pathologist`s training.

1. Inadequate history A complete history of event leading to death

should be obtained. Example; vagal inhibition, epilepsy, laryngeal

spasm, electrocution… Death due to hyper sensitivity reaction may

not present enough evidence to explain the cause of death.

In case of drowning when death is caused by laryngeal spasm no positive postmortem change is present.

2. Lack of proper external examination.

If the external examination is not made carefully the cause of death may be missed.

In death of drug addict the presence of new and old prick marks may be missed on external examination.

The death from snake bite can not be explained without proper identification of external lesion.

The death from electrocution demand a careful external examination so that the electric burns and cause of death may not be missed.

3. INADEQUATE INTERNAL EXAMINATION

Two conditions most often be missed if careful internal examination is not done, these are, 1.Air embolism 2.Pneumothorax

4. INSUFFICIENT HISTOLOGICAL EXAMINATION

If careless and insufficient histological examination is done, microscopic lesions which account for death may be missed.

5. Inadequate pathologist`s training.

The training of doctors conducting autopsy is an important factor.

Obscure Autopsy

The autopsy is termed as obscure, when there is no definite or obscure cause of death.

Causes of Obscure Autopsy

1. Concealed trauma2. Cardiac lesions3. Reflex Vagal inhibition

1.Concealed Trauma Injury to the cervical spine causing

fracture dislocation and injury to the spinal cord can cause instantaneous death with out any obvious injuries.

2. Cardiac lesions 1. In blunt force injury to heart it

may stop functioning without any visible signs.

Cardiac arrest can occur during or immediately following heavy exercises in which there is increase in heart rate and systolic pressure with progressive ischemia leading to cardiac arrest.

Cardiac arrhythmias which may be precipitated by emotional excitement can cause physiological asystole and may lead to death.

3. Reflex vagal Inhibition This can be due to pressure on neck,

blows on the larynx, chest, abdomen and genital organs.

It may occur during drowning, when the body is subjected to very cold temperature .

Any manipulation of external auditory meatus may also lead to death due to vagal inhibition.