The forensic autopsy differs from the hospital autopsy in its objectives and relevance. In addition to determining the cause of death, the forensic pathologist must establish the manner of death (natural, accidental, suicidal, homicidal or undetermined), the identity of the deceased if unknown, and the time of death or injury. The forensic autopsy may involve collection of evidence from the body, which can be used to either incriminate or exonerate an individual charged with a crime; determine that a crime had or had not been committed and provide clues towards a subject if it has.
Because of the possible medicolegal implications of forensic cases, not only do these determinations have to be made, but the findings or lack of findings must be documented. In many cases the cause and manner of death may be obvious. It is the documentation of the injuries or lack of them as well as the interpretation of how they occurred and the determination or exclusion of other contributory or causative factors that is important.
The forensic autopsy involves not only the physical examination of the body on the autopsy table, but consideration of other aspects that the general pathologist does not consider as part of the autopsy—the scene, the nature of the weapon (if any), clothing, toxicology, and the results of laboratory tests on evidence. The forensic autopsy begins at the scene. The pathologist should not perform a forensic autopsy unless they know the circumstances leading up to and surrounding the death. This is a very basic principle that is often violated. What would one think of a physician who examined a patient without asking what the patient's symptoms or complaints were? As in all examinations of patients, one must have a medical history. In the case of the forensic pathologist, the "patient" is unable to render this history. Therefore, the history must be obtained either by the medical examiner or police investigators. This history should be known prior to the autopsy.
The scene should be documented with diagrams or photographs, preferably both. Individuals should be interviewed, and a written report given to the pathologist before the autopsy. At the scene, the body should be handled as little as possible. It makes good television dramatics to poke and prod a body at the scene, but it does not make sense scientifically. At a homicide scene, there is often pressure to move the body—people are milling around, there is inadequate lighting, no instruments, and no running water. A body cannot adequately be examined under such conditions. What can be done, however, is to destroy evidence or introduce fallacious evidence. One can dislodge powder from the clothing, wipe away primer residue from the hands, contaminate the body with one's own hair or with the hair of the police officer assisting in turning, poking, and proding the body, and so forth.
In cases of violent death, paper bags should be secured about the hands prior to transport of the body so that no trace evidence will be lost. Plastic bags should not be used — with the body in a cooler, there will be condensation of water vapor on the hands (with possible loss of trace evidence) when it is moved back into a warm environment. Before transportation, the body should be wrapped in a clean, white sheet or placed in a clean body bag. A body should not be placed directly onto a cart in the back of an ambulance. Who knows what or who was lying on the cart prior to the body transport? Trace evidence from a prior body may be deposited on this body, or trace evidence from this body may be lost and subsequently transferred to another body.
At the morgue, the body should never be undressed before the medical examiner has seen it. This includes removing shoes and socks to place toe tags on the body. Rather than toe tags, the use of wrist identification bands such as those used in hospitals is recommended.
Examination of the clothing is as much a part of the autopsy as examination of the wounds. The clothing must be examined for bloodstains and trace evidence as well as to determine whether the wounds in the body correlate with the defects in the clothing. How would one know that the individual was not shot while nude or partially dressed and then dressed?
The body should never be embalmed before autopsy. Embalming ruins toxicologic analyses, changes the appearance of the wounds, and can induce artifacts. In homicides, suspicious deaths, and gun-shot related deaths, the body should never be fingerprinted prior to examination of the hands. In fingerprinting, the hands are pryed open and the fingers are inked. In the process, evidence can be lost and/or false evidence deposited. One can render tests for firearms' residue invalid in prying apart fingers and fingerprinting a body. When fingerprinting is subsequently done in homicides, it is recommended that palm prints also be taken.
In all gunshot deaths, x-rays should be taken. X-rays are especially important in cases in which the bullet appears to have exited. This is due to the fact that the bullet may not have exited but rather only a piece of the bullet or a piece of bone. With the semi-jacketed ammunition now in widespread use, it is not uncommon for the lead core to exit the body and for the jacket to remain. The core is usually of no interest forensically; it is the jacket that is important. The jacket may be retained beneath the skin adjacent to the exit site. It is very easy to miss the jacket at autopsy unless one knows that it is there by x-ray.
An identification photograph, with the case number included in the photograph, should be made after the body has been cleaned up and before the autopsy.
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