Appendix

The Forensic Autopsy

The forensic autopsy differs from the hospital autopsy in its objectives and
relevance. Besides determining the cause of death, the forensic pathologist
must establish the manner of death (natural, accidental, suicidal, or homi-
cidal), the identity of the deceased if unknown, and the time of death or
injury. The forensic autopsy may also involve collection of evidence from the
body, 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 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 are important.
The forensic autopsy involves not only the actual examination of the
body at the autopsy table, but the consideration of other aspects that the
general pathologist does not believe to be part of the autopsy—the scene,
clothing and toxicology. The forensic autopsy begins at the scene. Pathologists
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 by either the medical examiner or
police 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 report
should be given to the pathologist prior to the autopsy. It makes good
television 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 the
body, people milling around, inadequate lighting, no instruments, and no
running water. A body cannot be examined adequately at a scene. What
can be done, however, is destroy evidence or introduce fallacious evidence.
Powder can be dislodged from the clothing, primer residue can be wiped
away from the hands, the body can be contaminated with the examiner’s
hair or with the hair of the police officer who helps turn, poke, and prod
the 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’s
hands so that no trace evidence will be lost. If plastic bags are used and the
body then placed 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. Prior to transportation, the body should be either
wrapped in a clean white sheet or placed in a clean body bag. It should never
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 could be deposited on this body, or trace evidence from
this body can be lost and subsequently transferred to another body.
At the morgue, the body should never be undressed prior to the medical
examiner’s seeing it. This includes removing shoes and socks to place toe
tags. 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 and
trace evidence as well as to see if the wounds in the body correlate with the
defects in the clothing. How does one know that the individual was not shot
and then dressed?
The body should never be embalmed prior to the autopsy. Embalming
ruins toxicologic analysis, changes the appearance of the wounds, and can
induce artifacts. The body should never be fingerprinted prior to examina-
tion of the hands. In fingerprinting, the hands are pried open to ink the
fingers. In the process, trace evidence can be lost or false evidence deposited.
Tests for firearms residue can be rendered invalid by prying apart fingers and
fingerprinting 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 bullet
appears to have exited. This is because the entire bullet may not have exited
but rather only a piece of the bullet or a piece of bone. With the semijacketed
ammunition now in widespread use, it is common for the lead core to exit
the body and the jacket to remain. The core is of no interest ballistically. It
is the jacket that is important. The jacket might be retained beneath the skin
adjacent 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.

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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 the
clothing should be given. This description, initially, does not need to be
very 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 bloodstained
white T-shirt. If the case is a traumatic death with significant alterations
of the garments due to trauma, the clothing will be described in further
detail in another section of the autopsy.
After the description of the clothing, at least the following should be
described:

• 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 be
evidence 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: You
may want to put this in a separate section entitled “Evidence of Medical
and/or Surgical Intervention”).

At this time, if fingerprints have not been taken, they should be. In
addition, it is strongly recommended that identification photos, with the
number of the case, be taken.
If there is injury to the body, it should now be described in the next
section, entitled “Evidence of Injury.” All recent injuries, whether minor or
major, external or internal, should be described in this section. There is no
need to repeat the description of these injuries in the subsequent “Internal
Examination” section or to describe them in the “External Description.” The
age 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:

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external evidence and internal evidence. Some examiners intermingle these
two. They describe the external evidence of injury to the head and then say
“Subsequent autopsy reveals …” and go on to describe the internal injuries
of 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 be
described in its entirety before going on to a second wound. Each wound
should be located on the body (in inches or centimeters) in relation to the
top 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 local
landmark, such as the nipple or the umbilicus. The features of the wound
that make it an entrance and that determine at what range the bullet was
fired should be described — for example, abrasion ring, soot, or tattooing.
Pertinent negatives should be noted. Then, the course of the bullet through
the body should be described. All organs perforated or penetrated by the
missile should be noted.
It is useful to give an overall description of the missile path through the
body in relation to the planes of the body. Thus, one will say, “The bullet
traveled from back to front, left to right, and sharply downward.” If the bullet
exits, 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 is
intact, deformed, or fragmented, whether it is lead or jacketed, and the
approximate 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, the
date, case number, and location from which the bullet was recovered, the
letter or number assigned it, and the name of the prosector.
If at all possible, the same general procedures should be used to describe
stab wounds. One should indicate, if possible, whether the weapon was
single- or double-edged, which edge of the wound was produced by the
cutting edge of the knife, the exact dimensions of the stab wound, and an
estimation of the depth of the wound track. In instances where there are
dozens 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 the
clothing. The location of defects, whether they correspond to the injuries,
and the presence of trace evidence, such as powder, soot, or car paint, should
be described.
Next is the “Internal Examination” section. Here, the major organ sys-
tems as well as the organ cavities are described. The usual subdivisions of
this section are:

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 • 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 adrenal
and pancreas) as well as a brief description of the organs with pertinent
negatives. With the pancreas, adrenals, and spleen, if there are no positive
findings, 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 slides
should be made when indicated. Samples of tissue from all major organs
should be saved, but are often not needed in forensic cases, especially in
trauma cases.
Next is the “Toxicology Section” where the results of the toxicological
analyses 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 done
in 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 inconsequential
observations should not be listed in “Findings.”
The last section is “Opinion.” This should briefly describe the cause of
death 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 absent
or kept to a minimum.

© 2001 by CRC Press LLC