Death

Definition
• According to Black’s Law-
“Cessation of life or ceasing to exit”

• Medicolegal Definition-
Death is permanent and irreversible cessation of functions of the three
interlinked vital system of the body namely, the Nervous, Circulatory and
Respiratory system.
 Types of
Death

• Somatic Death
• Molecular/Cellular Death
 Somatic Death

• Deaths commonly referred to with the cessation of the

functions of nervous, circulatory and respiratory system
are also known as somatic death/ clinical death
 Cellular/ Molecular
Death
• Due to lack of oxygen supply individual cells of different tissue or organ die.

This death of the individual cells is known as

cellular/Molecular Death
 Mode of
Death
• The process of death may be initiated by failure of any of the 3 vital system of
the body

 Coma- Failure of the nervous system

 Syncope- Failure of the Circulatory system

 Asphyxia- Failure of the respiratory system

 Com
a
• In coma there is loss of consciousness which may be partial or complete
• Types-

 Deep Coma- When there is full unconsciousness giving no response to any

sort of stimulus, it is called as Deep Coma

 Partial Coma- When the patient is partially conscious and responds to deep
painful stimuli, it is called as Partial Coma
 Reason of
Coma
1. Cerebral compression- Due to head injury
2. Infective status like- Encephalitis, Meningitis, Abscess
3. Compression caused by a new growth
4. Metabolic Disorder – like Diabetes, uremia
5. lack of circulation in brain- due to embolism or occlusion of carotid/
vertebral arteries.
6. Effect of certain drugs like opium, barbiturate, alcohol, CO, CO2 etc.
 Syncope

• In syncope there is failure of function of the heart and

the circulatory system
 Causes of
Syncope
1. Pathology of Heart – this may be in the myocardium, pericardium,
the heart valves, the conduction system of the heart and the heart
circulation
2. Vegal Inhibition of the heart- vagus is a mixed nerve which has
motor supply to part of the palate, larynx, pharynx and sensory
supply to pharynx, oesophagus and rest of the respiratory tract.
Among the organ it supplies are heart, lungs and stomach.
Stimulation of vagus causes inhibition of the heart.
3. Anaemia- particularly sudden loss of excessive amount of blood
due to injury or some disease- then chance of death is very high
4. Anoxia- in severe hypoxia, the otherwise healthy heart may fail to
function normally

5. Cardiac poison- they may cause heart failure

6. Over-exercise/ exhaustion may cause Syncope

 Asphyxia

• In Asphyxia there is prevention of exchange of air between the atmosphere

and the lungs alveoli and there is lack of oxygen supply to the tissue
 Cause of Asphyxia

• Mechanical
• Toxic
• Traumatic
• Pathological cause
 Mechanical
Constriction around the neck
Closure of the external respiratory orifices
Occlusion of the respiratory passage from inside
Toxic
 Poisons which depress the respiratory center like – opium, barbiturates, CO2 etc.
 lack of oxygen in the inhaled air
 Poison which causes paralysis of the respiratory muscle like- Cobra
Snake poison
Traumatic
Injury in both lungs
Pulmonary embolism
Pathological causes
 Infective condition and new growth of the lungs or in the respiratory gland
Changes after Death/Post
mortem Changes
• Immediate changes
• Early changes
• Late changes
 Immediate Changes

• Stoppage of function of Nervous System

• Stoppage of Respiration
• Stoppage of Circulation
Stoppage of function of Nervous System

The Subject has no sense

Loss of both sensory and motor function
Loss of all reflexes
No tonicity of muscle
pupil are widely dilated
 Stoppage of Respiration
• With Somatic death, There is total stoppage of respiration.
Which Can be established by the following.
 No respiratory movement will be visible
 No breathing sounds Can be heard by auscultation
 Feather Test / cotton Test →
A feather or a few cotton fiber are held in front of nose, then if respiration is
continuing, it will rhythmically move with the inspiration and expiration
 Mirror Test→
A Mirror is held in front of the nose and mouth of the person if respiration is
continuing, then the shining surface of the mirror will partly become hazy due
to condensation of the moisture in the air ,on the cold shining surface of the
mirror
 Stoppage of Circulation
• The following test may be performed to know, if the circulation has ceased or in
continuing -
• Radial, brachial, femoral and Carotid pulsation will be absent.
• Auscultation of heart- Absence of The heart beat
• ECG- in case of cessation of circulation the ECG curve in absent,
• Diaphanous Test/ Transillumination Test →
if, in a dark room the outstretched hand is held against some light-Rays, then in
Presence of circulation the hand will appear Pinkish and translucent
If The Circulation ceases, then The hand will appear yellowish and opaque.
• Magnus test
fingers fail to show bluish discoloration and edema to a ligature applied at the base
• I card Test- Fluorescein dye on being injected at a given site in a dead Body fail to
produce yellow-green discoloration as seen in a Living person
 Early Changes
• Facial Pallor
• Loss of elasticity of skin
• Primary relaxation of the muscle
• Changes in the eye
• Cooling of the dead body/ Algor Mortis
• Post-mortem staining/ Livor Mortis
• Rigor mortis
 Facial Pallor/Pallor
Mortis
• After death, due to stoppage of circulation, blood drains from the capillaries
and small vessels to big ones. Generally, the face appears pale and bloodless.

But in case of strangulation the face is congested and cyanotic due to

obstruction of venous returns
 Loss of Elasticity
of Skin

• This occurs due to loss of tonicity of the skin muscles

 Primary relaxation of the
muscle
• After death muscles loss their tonicity and becomes flaccid, joints are
loose and chest will become flattened.

• During this stage of primary relaxation muscular tissue are still alive
and they will still response to electrical stimuli.
 Changes in the
Eye
• With death eyelids usually closed due to loss of tone of muscle of the eyelid.
• Haziness of the Cornea - Cornea will became hazy due to drying and
desiccation and deposition of dust over the Corne. But This haziness will pass
of if water is poured over cornea.
The Cornea will become permanently hazy due to decomposition after
(10-12) hr. after death.
• Pupils- The pupils are dilated after death. because of the relaxation of muscle
of the iris.
Later They are constricted with the onset of rigor mortis.
• Tache noire→ If the eyelids
remain open for (3-4) hr after
death, there is formation of
two yellow, triangle on the
Sclera at each side of the iris.
which become brown and then
Black.
• Loss of intraocular tension-
Intraocular tension falls rapidly
after death. The eye balls look
Sunken in the orbit.
 Algor Mortis/ Cooling of
•
Dead
Definition
Body
"Algor' Means – Coolness
Mortis means- Death
Falling down of Body Temperature after death, where the body temperature
equilibrates with its environmental temperature
• Mechanism
The fall of Temperature of The Cadaver occurs due to the facts that, after death
There is no heat Generation due to loss of all physical, chemical and metabolic
functions of the Body, There is constant loss of the body heat until it Comes to the
level of the environmental temperature,
Loss of the Body heat occurs by way of conduction, Convection and Radiation.
When the Body is in the atmospheric environment the body loose temperature
by way of conduction, and convection when the Body is in the water medium.
• Process
After death the surface (outer cove) temperature falls rather rapidly for
some time but during this period. The loss of heat from depth (inner core) of the
body is rather negligible. This is due to the thickness of the Skin and the
subcutaneous tissue

After some hours there has been reasonable fall of the surface temperature
start heat loss from inside the body

Then fall of temperature at the inner core of the body achieves a regular and
constant pattern.
 Factor which influence the Algor
Mortis
1) Atmospheric Temperature
more difference between the Temperature of the dead body and the
atmospheric temperature, the more is the rate of fall of the body
temperature

2) Body Buit- A thinly built dead body loss heat rapidly

3) Sex- female bodies retain Body heat for longer period because of
their subcutaneous fatty tissue
4) Age
Rate of loss of heat in more in children and elderly, Compared to adults,
because the Surface area of the body is more.

5) Clothing or covering of the body

A body well covered with cloth retains the heat for a longer period

6) Air Movement
More air movement more loss of a heat

7) Media of Disposal - Cooling in earliest in water and late in buried bodies.

 Post Mortem Caloricity

Post mortem Caloricity is a phenomenon where the body temperature

remain high instead of Cooling and this is due to

1. Cause of death- in death occurring due to infectious diseases - heat is

produced by the action of the infective organisms

2. If death in preceded by a severe convulsion - it causes an increase in the

body temp..(e.g. in strychnine poisoning or tetanus disease)

3. In case of death due to heat or Sun stroke, there is hyperpyrexia at the time
of death.
 Medico-Legal
Importance
• It is a sigh of death
• It helps in the estimation of the time of death
• Rapid Cooling - Delay The process of Riger mortis and decomposition
 Post-Mortem
Lividity/Livor Mortis
• Definition –
It is the gravitational settling of the blood in the dependent parts of The
body, which is no longer being pumped through the Body after death, causing
Bluish-Purple or reddish-Purple discoloration.
• Mechanism-
When the body is left undisturbed, the staining starts appearing
in small patches at the dependent parts of the body- by the end of the
1st hour after death
In Supine lying body, the stained Patches first appear over the
back of the shoulders and Posterior aspect of the abdomen.
Gradually the small patches increase in size and coalesce with
each other to form uniformly stained large areas on the back of the
trunk. and also on the back of the limbs
For completion of the spreading of The Post-mortem staining, it
takes about
(5-6) hours
 After formation, The Staining gets fixed over the areas.

Bluish discoloration of the affected area is not due to Asphyxia. The reason
behind Such coloration of the affected area is that, in dead bodies oxygen,
dissociation Continue and there may be reflux of deoxygenated venous blood into
the capillaries.

So, blood in capillaries, including that which has settled on depended part
is reddish Purple in fair complexioned persons which appears somewhat more
bluish in dark complexioned subject.
 Contact Pallor
The areas of the dependent parts which remain in direct contact with the
ground or the bed, do not show any Staining and appear rather pale than what
these appears were during life. This phenomenon is known as Contact Pallor
Factors influencing the
formation of the post-mortem
Staining
• Fixed, undisturbed Poisoning of the dead body for some hours after
death
• Due to excessive loss of blood during or before death or in severely
anemic subject Post mortem staining may not be appreciable
• Post-mortem staining is more prominent in fair-complexioned
• Post mortem staining is well formed in case of death due to Asphyxia.
If the body has been suspended vertically as in hanging, Postmortem
staining will be most marked in the leg, external genitalia, Lower parts
of forearms.
 Medico-legal
importance
• It is sign of Death
• The Time since death can be roughly estimated
• It indicate The Posture of The body at the time of death
• Cause of death may be judge from The distribution and color of PM staining
• From form The Color of The Livor mortis
1) In death due to HCN- Cherry Red/Pinkish
2) In Cyanide salt poisoning - bright violet
3) In CO Poisoning-Pinkish
4) In Phosphorus, pot. Chlorate, nitrate - chocolate brown.
5) In case of H2S- Greenish blue
6) In the early phases of its formation, it may be confused with bruise,
 Rigor Mortis/Cadaveric
Rigidity
• Definition
Rigor Mortis is that state of the Rigor muscles of a dead body when they
become Stiff or rigid with some degree of shortening.
The phase of Primary relaxation of the muscles Continues for about an
hour which is followed by stiffening rigidity. It indicates molecular death of the
concerned muscles.
 Mechanism
[Link] Depletion:
When a person dies, oxygen supply is cut off, and the body's cells stop producing
ATP through aerobic respiration.

[Link]'s Role:
Calcium ions, which are normally stored within a cell's sarcoplasmic reticulum,
flood into the muscle cells.

[Link]-Myosin Binding:
Calcium ions trigger the interaction between actin and myosin filaments, forming
cross-bridges and causing the muscle to contract

4.. No ATP for Relaxation:

With ATP depleted, the myosin heads cannot detach from the actin filaments, and
the muscles remain in a contracted state.

[Link]:
Rigor mortis typically starts in smaller muscles like those in the face and jaw, then
progresses to the limbs, becoming complete in all muscles after about 12 hours.
[Link]:
After about 24 hours, the muscle proteins begin to break down
due to autolysis (self-digestion), causing the muscles to relax
and the body to become flaccid again
• Onset
It Commences after about 3 to 4 hours. reaches maximum stiffness
after 12 hours. and gradually dissipates from approx. 24 hours after death

• Muscle Involved-
Rigor mortis occurs both in the voluntary and involuntary muscle
It occurs earlier in the involuntary or smooth muscles than in the
voluntary muscle

• Started From-
Eyelid
 Factor which influence the formation of Rigor
Mortis
1. Age- Riger Mortis does not develop in a fetus of less than 7 months intra-
Uterine age

2. It occurs early in children

3. Body Built- Rigor Mortis comes early and Passes off early in thinly built
subject. In well-Built subjects with strong muscle, it comes late and stays longer.

4. Atmospheric temperature-
At high atmospheric temperature rigor mortis Comes early and Passes off
early.
5. In Exhaustive diseases/convulsion- precedes death rigor mortis appears
and passes of early.

6. In deaths due to wasting diseases, rigor mortis Comes early and passes off
early.

7. In septicemia death - also it occur early.

8. In death due to Strychnine and HCN-Rigor morties comes early and goes
late.

9. In death due to asphyxia, hanging, CO Poisoning death R. Mortis Comes

late.
 Medico legal
importance
• It is sign of death
• During the early phase after death rigor mortis gives good idea about time of
death.
• Rigor mortis indicates molecular death of the muscle
• The position in which the dead body was lying for some hours after death can
be known.
• Some conditions occurring in dead bodies may be confused with Rigor mortis.
These are-
1. Cadaveric spasm
2. Cold stiffening
3. Gas stiffening
4. Heat stiffening
 Cadaveric
spasm
• It is a condition in a dead body in
which the muscles of the body which
were in a state of Strong Contraction
immediately before death, Continues
to be so contracted at the moments
of death and after death without
passing through the stage of Primary
relaxation.

It is rarely found Condition,

formed at the moment of death and
persists till rigor mortis start.
 Late
Change
• Putrefaction
• Adipocere
• Mummification
 Putrefaction/Decomposition
• Definition-
Decomposition can be defined as process by
which the complex organic body tissue break down
to simple inorganic compound, due to the action of
ferments produced by The Saprophytic
microorganisms or due to autolysis.
This Process leads to discoloration of dead
body, evolution of foul-smelling gas, swelling of the
dead Body with gradual and total destruction of the
different body parts.
 Factors which influence The Process of
Putrefaction
 External factor
1. Atmospheric temperature -High atmospheric temperature Promotes early
decomposition.

2. Moisture-Presence of Moisture Promotes decomposition by Promoting the

growth of the organism.

3. Air- Air movement retards The Process of decomposition

4. Clothing - a) In summer, clothing may slightly reduce The rate of
decomposition by preventing invasion of the body by air born organism.

b) In winter, if the body in covered with Clothing, Then that will help the
process of decomposition by retaining body heat.

5. Invasion of the body by animals and insects-

a) In water, fish and other aquatic animals like Crabs, tortoise may injure the
dead body helping invasion of the body by bacteria which enhance
decomposition

b) on land, dogs and Jackals may partly destroy the dead body and that causes
early decomposition.
 Internal factor
1. Age- In case of intra-uterine death, decomposition is aseptic and is
only by way of Autolysis, hence the rate of decomposition is slow.
2. Sex- Sex does not have much to influence. the process of
decomposition. further the female body retains body heat for a
longer period which may enhance the process of decomposition a
little
3. Condition of the body -A thin body decomposes Late in comparison
to a fat body due to lees fluid content
4. Cause of death - When cause of death is Septicemia, decomposition
is rapid
5. Surface injury - Dead body having external injury will decompose
fast
 Medico-legal importance

1. Decomposition is the surest sign of death.

2. Advance decomposition obliterates the identity of the deceased.

3. Advance decomposition also obliterates the cause of death of the deceased.

4. From the stage of decomposition time passed after death can be assessed.
 Mummification
• Definition – In mummification, there is rapid
drying of the dead body due to environmental
factors. When the Soft tissue become dark, hard
and Stay preserved. The dry, hard skin gets
almost adhered to with The Underlying bone

• Time required for Mummification charge to

occur-3 weeks to 3 month roughly.
 Factor affecting mummification Change

1. Hot Atmosphere -as in the deserts of the tropics

2. Dry atmosphere-Mummification can not occur in high humid condition.

3. Free Air Movement - helps rapid evaporation of the body fluid.

4. Contact of the body with absorbing media- Dead body lying on the sand,
infant body covered with a dry absorbing towel, dries up early for rapid
absorption of body fluid
 Medico-legal
importance
1. It is one of the Surest sign of death

2. It also give rough idea about the time passed after death

3. Identification of the dead body –

Once mummification has occurred in a dead body, its identification is
possible because the body is not grossly destroyed and many identification
features likes old scars deformities, tatoo marks may be detected.

4. Cause of death- As the body is not grossly destroyed, injuries can be

detected
 Adepocer
 Definition e
It is in the formation of soft, whitish,
Crumbly, waxy and greasy material occurring in
fatty or fat containing tissue of dead body.

 Time required for Adepocere formation-

In hot and moist environment, it is seen to
occur by the end of the first week
In cold environment takes 3 weeks to
occur
Completion of the process may take 3
monthn
Factor which influences Adepocere
formation
1. Atmospheric or environmental temperature –
Heat favors and Cold retard the process of Adepocere changes

2. Moisture- Water is essential for The chemical reaction to occur. Intrinsic

fluid is used to initial phase but to completion of the Process Presence of
moisture in the air is necessary.

3. Air Movement- Air movement retards the Process of Adepocere.

4. Running water- In case of a Submerged body, running water retards the

process of Adepocere formation.
 Medico-legal
Aspect
1. It is Surest sign of death
2. It also give Some rough idea about the time passed after death
3. Identification of the subject is possible
4. Injury over the body remains intact.
Autopsy
• Definition→ Autopsy is defined as the dissection of dead body for different
purposes of ascertaining Cause of Suspicious or Unnatural death.

• Type-
1. Purely Academic
2. Pathological or clinical Autopsies
3. Medico legal Autopsies
Academic Autopsy- Dead bodies are dissected by the students of Anatomy
for academic Purposes.
Object- to know details about the different external and internal organs and
structure of The human body.
Pathological/ Clinical Autopsy -It is performed by The pathologists or
clinicians to diagnose the cause of death, where The diagnosis could not be
reached during treatment
Object- to find out the cause of death
helps the pathologists to know the Pathology of organ due to some diseases
Medicolegal Autopsy- in unnatural and Suspicious Circumstances of death,
dissection of the dead body and their examination is compulsory by Law.
 Object
1. To Know The exact cause of death.
2. To find out the time passed after death.
3. To establish identity.
4. To Know The nature of death
5. To Know The types of weapon or Poison used.
6. whether one or more than one person was/were involved, in case of homicide
7. whether any other offence was related with Death
8. To know whether more than one method more than 1 weapon were used.
9. whether the dead body or its position was disturbed sometimes after death
 Rules of Autopsy
1. It can be conducted only strength of on the s a requisition received from an authorized
person
2. PM examination can be performed only in an authorized centre
3. all registered medical practitioners in Govt. service can conduct the examination
4. A Police officer or any other authorized person should identify the dead body
5. Conduction of Medico-legal PM examination does not require any consent from the
relatives or friends of dead body.
6. The dead body should preferably be dissected with the help of natural sunlight, but
under urgency it may be carried on at night with the help of artificial light.
7. when a dead body reaches the mortuary the date and hour of its arrival and the date
and hour of conduction of PM examination Should be recorded.
8. It is recommended that, the autopsy Surgeon Should himself dissect the dead body with
The help of an assistant
9. Before starting The PM examination, the doctor should go Through the Inquest report
and the requisition.
 Procedure
A) External Examination
B) Internal Examination
External Examination
1. Body Weight, length
2. body build, complexion
3. scalp hair- length, color, dust etc.
4. Beards and Moustaches description
5. Any Marks, stains, tear, cuts, deformities, tattoo marks etc.
6. Eye Condition- Changes in Cornea, Closed or opened, discharge etc.
7. Any discharge from mouth/nostril
8. Congestion, Cyanosis, Pallor, petechial hemorrhage, post-mortem staining, Contact Pallor Should be noticed.
9. Blood, mud or other stain on The body.
10. State of rigor mortis, Cadaveric spasm, state of decomposition, maggots.
11. Female breasts- teeth bite mark, nail Scratches any other marks
12. Discharge per vagina, any other finding
13. Any ante-mortem injury, anywhere
14. Any Ligature material in present then it should be taken out and then Note down the Ligature Mark
 15. External injury-
All the external wounds should be recorded with all their details, on the
following heading
a) Types of injury
b) Size
c) Shape
d) Site
e) Presence of defense cuts
f) injection marks
 Internal Examination
A. Abdominal cavity opening
B. Chest Cavity opening
C. Neck
D. Cranial cavity
E. Spinal cord
A single incision is given for opening both the thoracic and abdominal cavities. To
open the cranial cavity one more incision is needed. To expose the structures of the neck,
three different types of incisions are recommended.

A. Abdominal cavity opening

To Open the chest and abdominal cavities, one single incision, starting from the
sternal notch above to the symphysis pubis below.
Abdominal cavity open first
After incision skin is flapped out, muscles are dissected and then abdominal organs
1. Stomach- stomach is taken out by placing two ligature at cardiac end and
two ligatures below pylorus end of stomach.
Examination points-
 wall of stomach
 any stain, congestion, ulceration or perforation
Content of stomach-quantity, color, smell etc.
After examination, stomach is stitched up
2. Liver
Examination points-
 an injury or pathology
Weight
Macroscopic examination- multiple incision given
Gall bladder is dissected – any pathology or Any stone is noted
• 3. Kidney-Removed along with adrenal glands
Examination points-
 the surface of the kidneys along with the covering capsules should be examined
for congestion, haemorrhage, and injury
 kidneys are bisected transversely along with longitudinal axes- noted any
congestion, haemorrage, and injury
4. Urinary Bladder- Urine should be removed first to avoid all chance of
contamination with blood and other material
Examination points-
 The bladder should be examined for any pathology, haemorrage, congestion
or injury
5. Pancreas – the pancreas and the adrenal glands are to be examined. If
necessary tissue from these gland are to be preserved for histopathological
examination
6. Intestine – dissected in entire length
Examination points-
 Injury
 Poison reaction
 Ulcerative colitis
 Perforation
7. Uterus – first examined in situ and then removed.
Examination points-
 Dimensions, weight, gravid, parous
 any pathology

8. Spleen – taken out , any pathology or injury noted
9. Abdomen – In penetrating wound of the abdomen, the intra-abdominal vessels may be injured and there may be
excessive intraabdominal haemorrage.
Excessive intra-abdominal haemorrage also occurs due to gross injury to abdominal organs like liver, kidney etc.

B. Chest Cavity opening

To open the chest cavity, after retraction of the skin sidewise, the cartilaginous parts of the ribs are
cut on both sides and the manubrium is separated from the clavicles at the sternoclavicular joints
Chest cavity is examined for haemorrage, injury of ribs
1. Heart-Separated after applying double ligature at base of heart and then dissected.
Examination Points-
 Valves condition
 Ischemic lesions
 InfarctionHemorrhagic spot
 Clots, Liquid blood, froth or air bubbles
 Injury

2. Pericardium
Examination Points-
Pathology or Injury
Pericardial Effusion
Pericardial Hemorrhage
Pericarditis
3. Pleura
Examination Points-
Pleuritis
Pleural Adhesion
Petechial Haemorrhage
Injury, Haemothorax, Pneumothorax
4. Lungs
Examination Points-
Injury, Disease
Asphyxial Death-Congestion in lungs
Drowning Death- Oedematous, Emphysema
Blunt force injury-Lung Wound
C. Examination of Neck
"V” shaped incision is given, the apex being at the Sternal notch, with the
two wings extending upwards and Laterally up to the mastoid Process of both
side.
The skin is flapped upto the margin of The mandible
Examination point
Hyoid bone fracture
Thyroid cartilage fracture
Neck Compression
Injury to Carotid arteries.
 D. Examination of cranial Cavity
A Circular incision around the head at the level 1" above the eyebrow,
extending sidewise up to the occipital lobe
Examination Point
Fracture of skull bone
Dura or extradural Haemorrhage
Subdural, subarachnoid haemorrhage
Congestion
Gunshot injury.
E. Examination of spinal cord
A midline incision is given on the back along the entire length of neck and
trunk
it is exposed only when it is necessary
• 3. Kidney-Removed along with adrenal glands
Examination points-
 the surface of the kidneys along with the covering capsules should be examined
for congestion, haemorrhage, and injury
 kidneys are bisected transversely along with longitudinal axes- noted any
congestion, haemorrage, and injury
4. Urinary Bladder- Urine should be removed first to avoid all chance of
contamination with blood and other material
Examination points-
 The bladder should be examined for any pathology, haemorrage, congestion
or injury
5. Pancreas – the pancreas and the adrenal glands are to be examined. If
necessary tissue from these gland are to be preserved for histopathological
examination
6. Intestine – dissected in entire length
Examination points-
 Injury
 Poison reaction
 Ulcerative colitis
 Perforation
7. Uterus – first examined in situ and then removed.
Examination points-
 Dimensions, weight, gravid, parous
 any pathology

8. Spleen – taken out , any pathology or injury noted
9. Abdomen – In penetrating wound of the abdomen, the intra-abdominal vessels may be injured and there may be
excessive intraabdominal haemorrage.
Excessive intra-abdominal haemorrage also occurs due to gross injury to abdominal organs like liver, kidney etc.

B. Chest Cavity opening

To open the chest cavity, after retraction of the skin sidewise, the cartilaginous parts of the ribs are
cut on both sides and the manubrium is separated from the clavicles at the sternoclavicular joints
Chest cavity is examined for haemorrage, injury of ribs
1. Heart-Separated after applying double ligature at base of heart and then dissected.
Examination Points-
 Valves condition
 Ischemic lesions
 InfarctionHemorrhagic spot
 Clots, Liquid blood, froth or air bubbles
 Injury

2. Pericardium
Examination Points-
Pathology or Injury
Pericardial Effusion
Pericardial Hemorrhage
Pericarditis
3. Pleura
Examination Points-
Pleuritis
Pleural Adhesion
Petechial Haemorrhage
Injury, Haemothorax, Pneumothorax
4. Lungs
Examination Points-
Injury, Disease
Asphyxial Death-Congestion in lungs
Drowning Death- Oedematous, Emphysema
Blunt force injury-Lung Wound
C. Examination of Neck
"V” shaped incision is given, the apex being at the Sternal notch, with the
two wings extending upwards and Laterally up to the mastoid Process of both
side.
The skin is flapped upto the margin of The mandible
Examination point
Hyoid bone fracture
Thyroid cartilage fracture
Neck Compression
Injury to Carotid arteries.
 D. Examination of cranial Cavity
A Circular incision around the head at the level 1" above the eyebrow,
extending sidewise up to the occipital lobe
Examination Point
Fracture of skull bone
Dura or extradural Haemorrhage
Subdural, subarachnoid haemorrhage
Congestion
Gunshot injury.
E. Examination of spinal cord
A midline incision is given on the back along the entire length of neck and
trunk
it is exposed only when it is necessary
 Exhumation
Definition- Lawful digging out of an already buried body from The for grave to
PM Examination
Procedure-
• Done under first class judicial or executive magistrate
• It should be dove under day light
• The magistrate and a doctor should be Present during the process
• Soil from above, below and two sides of the body or the coffin should
be Preserved in clean Containers.
• Before the body is lifted out, The medical officer should examine the
body inside The grave.
• Before removal from the grave the body Should be Photographed.
• After all These are done, The body is sent for Post-mortem Examination

Medico-legal importance
 Criminal Case
To Know the cause and manner of death in Suspected homicide taken as Suicide.
Death due to Criminal abortion and criminal negligence
Retrieving l Some vital object like bullets

 Civil Case
Identification in done for accidental death claim, insurance, Compensation claim
etc.
 The Transplantation

of

Human Organs and Tissue

Act (THOTA)-1994
 Introducti
•
on
This Act was enacted to provide for the regulation of removal, storage and
transplantation of human organ or tissue for therapeutic purposes.
• “Human organ”- means any part of a human body consisting of a structured
arrangement of tissues which, if wholly removed, cannot be replicated by
the body.
• "Transplantation" means the grafting of any human organ from any living
person or deceased person to some other living person for therapeutic
purposes.
• This act has total 7 Chapters
• 1ST Chapter- deal about ‘PRELIMINARY’
• 2nd Chapter- deal with ‘AUTHORITY FOR THE REMOVAL OF HUMAN ORGANS
OR TISSUES OR BOTH’
• 3rd Chapter- deal with ‘REGULATION OF HOSPITALS’
• 4th Chapter- deal with ‘APPROPRIATE AUTHORITY’
• 5th Chapter- deal with ‘REGISTRATION OF HOSPITALS’
• 6th Chapter- deal with ‘OFFENCES AND PENALTIES’
• 7th Chapter- deal with ‘MISCELLANEOUS’
 Authority for the removal of human organs

• For therapeutic purposes, any donor can be prescribed, authorized to remove

any human organ of his body before death.
• If any donor had, in writing and in the presence of two or more witnesses (at
least one of whom is a near relative of such person), authorized the removal
of any human organ of his body, after his death, for therapeutic purposes, the
person lawfully grant to a registered medical practitioner all reasonable
facilities for the removal of that human organ from the donor's dead body.
• Where any human organ is to be removed from the body of a deceased
person, the registered medical practitioner shall satisfy himself, before such
removal, by a personal examination, that life is extinct in such body or, where
it appears to be a case of brain-stem death.
• Where any human organ is to be removed from the body of a person in the
event of his brain-stem death, no such removal shall be undertaken unless such
death is certified namely-
(a) The registered medical practitioner in charge of the hospital in which
brain-stem death has occurred.
(b) An independent registered medical practitioner, being a specialist, to be
nominated by the registered medical practitioner, from the panel of names
approved by the appropriate authority.
(c) A neurologist or a neurosurgeon to be nominated by the registered
medical practitioner from the panel of names approved by the appropriate
Authority.
(d) The registered medical practitioner treating the person whose brain-
stem death has occurred.
 Removal of human organs not to be authorized in
certain cases

1. No authority shall be given if the person believes that an inquest

may be required to be held in relation to such body.
2. A person whom such body has been hand over solely for the
purpose of interment, cremation or other disposal.
 Authority for removal of human organs in
case of unclaimed bodies in hospital or prison

1. In the case of a dead body lying in a hospital or prison and not claimed by any
of the near relatives within 48 hours from the time of the death, the authority
may be given of the management or control of the hospital or prison.

2. No authority shall be given if the person has reason to believe that any near
relative of the deceased person is likely to claim the dead body even through
such
 Authority for removal of human organs from
bodies sent for postmortem examination for
medico-legal or pathological purposes
• The person competent under this Act to give authority for the removal of any
human organ from such dead body may, if he has reason to believe that such
human organ will not be required for the purpose for which such body has
been sent for post-mortem examination.
 Restrictions on removal and transplantation of human
organs
• No human organ removed from the body of a donor before his death shall be
transplanted into a recipient unless the donor is a near relative of the recipient.
• Where any donor authorizes the removal of any of his human organs after his
death may be transplanted into the body of any recipient who may be in need
of such human organ.
• If any donor authorizes the removal of any of his human organs before his death
for transplantation into the body of such recipient, not being a near relative, as
is specified by the donor by reason of affection or attachment towards the
recipient, such human organ shall not be removed and transplanted without the
prior approval of the Authorization Committee.
 Registration of hospitals engaged in removal,
storage or transplantation of human organs
• No hospital shall commence any activity relating to the removal, storage or
transplantation of any human organ for therapeutic purposes if not registered
under this Act.

Preservation of human organs

After the removal of any human organ from the body of any person, the
registered medical practitioner shall take such steps for the preservation of the
human organ so removed as may be prescribed.
 Punishment for removal of human organ without authority

• Any person, who renders his services at any hospital for purposes of
transplantation, helps in any manner in, the removal of any human organ
without authority, shall be punishable with imprisonment for a term which
may extend to 5 years and with fine which may extend to 10,000 rupees.
• Any registered medical practitioner shall be reported by the Appropriate
Authority for taking necessary action including the removal of his name from
the register of the Council for a period of 2 years for the first offence and
permanently for the subsequent offence.