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Postmortem Examination If you have issues viewing or accessing this file contact us at NCJRS.gov. CHAPTER 3 Postmortem Examination Thomas T. Noguchi, M.D. INTRODUCTION tions such as hepatitis and other infections due to use of contaminated needles in the Regardless of the suspected cause of death, administration of a drug. a medical examiner or coroner's postmortem 3. Death, usually violent, from situations examination should always be thorough and created by a person who, under the influence comprehensive, for deaths which come under of a high but nonlethal dose of a drug, acts in the jurisdiction of this office are often ex­ a manner incompatible with life, exposing tremely complex, dealing as they do mostly himself to life-risking situations, such as run­ with instances of sudden and unexpected de­ ning in front of a moving vehicle, jumping mise. The postmortem examination should be from a high place, or aggressively inviting vio­ approached with a certain degree of suspicion lence from others) of ot.her possible but hidden etiological fac­ tors. The true cause of death may be masked Hospital Versus Forensic Postmortt)m by the obvious findings. Examination In the simpler ca.ses, the specific cause of The primary purpose of a postmortem death may be accurately determined by any examination conducted in a hospital is to con­ competent pathologist and even by an alert firm a known or suspected diagnosis of the non pathologist physician. In more complex disease which caused the death of the patient. cases, however, those without the trained or In addition, the hospital postmortem may ingrained sense of suspicion of a forensic path­ provide knowledge concerning the tissue dam­ ologist may be misled by the apparent and age caused by the disease. Emphasis is on the. may seek no further information beyond the detailed study of specific internal organ or obvious. The average physician is often either organs involved in the disease process; only a unaware of or has a rather lax attitUde toward cursory external examination is conducted. the potential medicolegal ramifications and The forensic pathologist is not only inter­ significance of the autopsy report in coroner's ested in the direct cause of death but also in cases. As an example, a history of heart attack trying to reconstruct the circumstances and should not automatically lead to the conclu­ events which led to the death. Whatever the sion that a sudden death was due to heart immediate cause of death, he must also ascer­ disease. Drug abuse or misuse may be highly tain whether the death was an accident, a unlikely, but adverse reaction to therapeutic suicide, or a homicide. Thorough external drugs is a possibility which should not be over­ examination of the clothing worn by the looked, especially in persons under intensive deceased at the time of death and study of drug treatment of medical conditions. A nUln­ the deceased's state of mind just prior to bel' of deaths due to drugs have probably been death are as important as the examination missed because of bias induced by the medical of the internal organs. A complete and history of the deceased. thorough medical examiner/coroner's post­ Deaths involving psychoactive drugs may mortem examination must include: be divided into three categories, each of which calls for a thorough postmortem investigation: 1. Death due to the direct toxic effect of a lThese parallel the distinctions represented in drug. categories of Code 3 of the UCI form, i.e., drug in­ 2. Death as a result of secondary complica- duced and drug related (see appendix A), 15 16 NOGUCHI 1. Detailed study of the scene of death, 2. The name of the deceased noting any signs of disorder, position of the 3. The case number deceased, presence of any possible evidential 4. The date and time material, such as pills and prescription bottles 5. The name of the medical examiner in suspected drug deaths (see chapter 2, "On­ Finally, each document should be signed by sitt' Investigation "). the medical examiner. 2. Precise and detailed study of the type In addition to the written reports and and extent of any morphological damage or charts, photo-documentation is absolutely trauma, including microscopic examinations. essential. Photographs should be taken of all 3. Determination of the diref't cause of the pertinent findings, clothing, external body injury-disease, physical force, chemical surfaces, including identity photo of the de­ agents, etc. ceased's facial features as well as internal 4. Followup toxicological, biochemical, body organs. Color photographs are preferable microbiological, and other laboratory tests on to black and white. Needle marks and bruises selected tissues and body fluids as indicated in black-and-white photographs may appear as by gross findings. ambiguous dark areas on the skin which can 5. Analysis of information obtained from be misinterpreted. With color photographs family and friends pertaining to the attitudes fresh injuries can be readily distinguished from and lifestyle of the deceased. old bruises.2 The forensic pathologist has the training to Each photograph should have incorporated recognize the significance of the various infor­ within the picture the following clearly visible mation obtained, to put it together like a jig­ information: the official name of the medical saw puzzle, interpret the findings, and come examiner or coroner's office, the case number, up with a reasonable reconstruction of the the date and time, a scale (which can be a circumstances and events which led to the simple ruler) to indicate dimensions, and the death of the individual. names of the photographer and medical ex­ aminer. Chain of Evidence Finally, in approaching postmortem pro­ cedures, always keep in mind Ont, cardinal rule In the handling of any medical examiner/ of forensic postmortem examination: Do not coroner's case, the proper identification of all probe, enlarge, cut into, incise, or otherwise materials connected with each case is a MUST. distort or destroy any wound, including All articles of clothing, contents of pockets, needle pUllcture site, until it has been com­ all tissues, and other biological materials re­ pletely measured, charted, and photographed. moved for testing (e.g., blood), and all records and documents must be properly and legibly identified at the time of removal and exami­ OUTLINE OF PROCEDURE nation. Much grief and problems can be avoided when this rule is strictly adhered to 1. Review of Reports (see also chapter 2, "Onsite Investigation"). The first step in the handling of a case is Docli mentati on the complete review of all available documents Just as important as a thorough post­ pertaining to the death, including reports mortem examination is proper documentation from the police, hospital, mortuary, or coro­ of the findings. The written documentation ner's at-scene investigation. Initial and d~ e all reports read. may be in the form of "check and fill-in" sheets supplemented with short, simple nan'a­ 2. Clothing ;. tive reports and picto-charts of body sections and organs showing pertinent findings and Examine clothing for damage and unusual dimensiol)s for easy reference. Each document stains. When injury to the deceased is evident, should be identified with: 1. The official name of the medical exami­ 2Editor's note: Chapter 2 mentions the fact that ner or coroner's office not all jurisdictions accept color. ---- -- ~~-~---~----, POSTMORTEM EXMHNATION 17 pay careful attention to the relationship of fluid. Note degree of turbidity of the any damage to the clothing and the pattern of vitreous fluid. Aspirate the fluid and injury, the location of stains from blood or place in test tube for toxicological and other body fluids. Include as part of the post­ biochemical analyses. mortem protocol: The degree of turbidity of the vitreous a. Description of the clothing: type, color, fluid can be a clue to the postmortem size, manufacturer's labeJ, cleaner's interval, and in drug-induced deaths, the marks, etc. conjunctiva of the eye may show pete­ b. Description of pattern, shape, and loca­ chial hemorrhages. tion of stains, tears, bullet holes, powder d. Naso-orop!lmYllx: Examine contents of burns, knife holes, etc. nostrils and the oropharynx for the c. Description of shoes, any scuffing or possible presence of blood and foreign unusual markings. bodies. Palpate the nose for possible Preserve dirt, glass, paint, spent bullets fracture or swelling of the subcutaneous caught in clothing, or other foreign materials tissue. found on the clothing. In cocaine sniffers the nasal mucosa of Photo-document all significant findings. the septum often shows ulceration. e. Lips alld oral cavity: Closely examine 3. General External Examination the upper and lower lips (the mucosal surface as well as the external surface) Unclothe the body. Photograph the un­ for any impressions or breaks. Check the washed body. Examine the body in a system­ buccal cavity and mucosa. atic manner starting from the top of the head Drug addicts often use the buccal and going to the tip of the toes. Note the mucosa as the site of injection in an location and extent of any injuries. attempt to hide the needle marks. Also, balloons containing heroin have been 4. Detailed Examination of Skin known to be hidden in the oral cavity. In cases where problem of identifica­ Closely examine the skin surface of the tion exists, use dental charts to record entire body with a hand or head visor type condition of teeth. 6-10 x magnifying lens. Inspect the unwashed Check for presence of blood. Des­ body for staining by foreign dyes or com­ f. Ear: cribe and chart all trauma noted. monly identifiable smears such as lipsticks In drug-involved deaths, examination and lip prints.
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