In a homicide or suspicious death, the external examination will usually take considerably more time than the internal examination. The process of describing, measuring, recording and photographing the injuries and other features on the body is very time-consuming.
Photography
Photography is particularly valuable in enabling another pathologist at a later stage to be put in the best possible position to come to his or her own conclusions.
As a general rule, at the autopsy in a homicide or suspicious death, photographs should be taken of:
• the face;
• the clothed body (back and front);
• the unclothed body (back and front);
• regional photographs, demonstrating injuries or other points of importance;
• close-up views of individual identifying marks or physical characteristics;
• close-up views of individual injuries of importance; and
• internal findings of significance.
Where relevant, a measuring scale and the case number should be included in photographs of injuries. It should be borne in mind that complications can arise when trying to assess the size of an injury in a photograph by reference to the tape measure in it. This is because many body surfaces are not flat and thus they defeat the two-dimensional capacities of routine photography. A variety of techniques can be used to overcome this limitation. The use of circular discs on the skin adjacent to the injury can help to determine whether the photograph has been taken perpendicular to the relevant skin surface.
Trace evidence
Depending on the circumstances, the collection of trace evidence may be of importance. The first stage of the physical examination of a body involves removal of clothing, jewellery and any other wrappings from the body, followed by inspection of the external surface of each region of the body. In doing this, great care must be taken not to lose any trace evidence that may be trapped in hair, or adhering to the surface of the skin. The clothed and unclothed body and injuries should be inspected for foreign material which may have been left by an assailant or weapon. Samples for gunshot residues should be taken before commencement of the autopsy. There are very good reasons for doing this as early as possible, preferably at the scene, to avoid the artefacts and contamination associated with numerous people having access to the body and its subsequent removal and transport to a mortuary.
For evidential purposes, all items removed from the body must be documented, including being described and photographed before being collected in a controlled, safe and secure manner for later possible forensic examination. Among other procedures, this involves labelling and logging of specimens in such a way that a continuous chain of custody of the item is maintained from the time of its collection until its appearance in court as an exhibit.
[33.710]
One of the fundamental differences between the forensic and the hospital autopsy is the time spent on the external examination. In the forensic autopsy, this time will frequently be considerably more than that spent on the internal examination as it often will provide answers to critical questions about the circumstances surrounding the death. The internal examination must never commence until a full external examination of a deceased body has been made. It must include both the anterior and posterior aspects of the body and the various body orifices. The following should be noted and recorded where relevant:• the age, sex and race of the deceased;
• lividity and its distribution, post-mortem rigidity, decomposition;
• the height, weight, general development and nutrition;
• pigmentation of skin and whether it is general (eg, jaundice or “bronzing”) or local (as in significant naevi, petechiae and tattoos);
• signs of resuscitation, medical or surgical intervention;
• signs of trauma, whether old or recent, including the presence of scars, abrasions, wounds, injection sites, lacerations, fractures and bruises;
• signs of chronic intravenous drug abuse;
• the presence on the body surfaces of abnormal masses of tissue, malformations, deformities or other abnormalities;
• eye colour, as well as the state of the conjunctivae and the presence of petechiae, haemorrhages, jaundice or congestion; and
• evidence of trauma, bruising or other abnormality revealed by examination of all orifices and of the perineum. Such orifices include the external ears, the nasal passages, the mouth, the vagina and the anus. A very detailed examination of the genitalia and anus is required where sexual activities are suspected.
In forensic pathology practice it is often convenient to separate the processes of external examination of the body into the examination of the head and neck from the examinations of the trunk and limbs. In deaths involving physical assault, the head is very often the focus of the attack and consequently may receive a very large number of applications of force. Detailed assessment of head and neck injuries is critical in forensic pathology practice and the basis of this examination is covered below.
Cranio-facial region
The biggest impediment to the satisfactory examination of the head is the presence of the head hair. In order to examine the scalp, it is often necessary to completely shave the head. If this is not done the pathologist may miss external evidence of head trauma. Because of the presence of bone immediately beneath the skin over the head, the scalp can take on the impression of the surface of the object that struck it. Such patterned abrasions, if correctly recorded by means of photographs and charts, can be useful in identifying the object that inflicted the injuries.
Much of the external examination of the head is very similar to the general external medical examination performed on the living. Indeed, similar medical and dental equipment can be used. For example, auroscopes may be of use in examining the nose and the mouth as well as the ears. The ordinary characteristics of faces with which we are all familiar should be noted.
These include features such as eye and hair colour, skin pigmentation, facial hair, shape of ears, nose and lips. In addition, the appearance of hair style and the distribution and type of cosmetics on the face should be described. Evidence of previous medical treatment and injuries including scars as well as marks such as tattoos must also be noted as these can assist with confirming identification as well as corroborating other information from medical records or witness statements. In the case of a forensic autopsy, detailed injury descriptions are crucial if the pathologist is to assist with reconstructing the circumstances surrounding the infliction of head injuries and effectively present such evidence in court. In this regard the use of charts, diagrams and photographs to record the observations and findings is essential.
Great care must be taken not to lose trace evidence that may be present in the external ears, the nose or within the mouth. Such material may be foreign to the body or comprise body tissues
such as fragments of bone or teeth. Where the body is grossly decomposed, there is a risk that easily detached structures may be lost from the body during handling and transportation. Teeth are a good example of such vulnerable structures and every care must be taken to ensure that they are not lost during body recovery. In the case of badly burnt remains, the skeletal tissues themselves may become carbonised. In this state the bony and dental hard tissue remains may be extremely friable and brittle; as a result they may need to be stabilised with resins, glues and/or waxes before the body remains are handled.
Post-cranial region
The external examination of a body in a forensic autopsy concentrates as much on the extraneous material as it does on human tissues. Such an examination therefore includes not only the surface of the body, but also all of the clothing, jewellery and other foreign material that may be present. The identification of paint flakes, soil, grime and vegetable matter on the surface of the body may be of considerable importance in an investigation, and collection of that material for further forensic examination may be required. Similarly, the nature of jewellery, its type and position on the body, can be significant. In some cases, the presence of jewellery may contribute to particular injury patterns; in other cases, it may be a unique personal item that can help to confirm the identity of an individual.
A record of the basic morphometric features of the body is an essential element to all autopsies. In routine cases this may simply take the form of measurements of height and weight. However, in the case of some autopsies, additional measurements will need to be made. In the case of skeletal remains, morphometric assessment of key portions of the skeleton are relevant for anthropological assessment of race, sex, height and age.
While measurements of a body are difficult to obtain with a high degree of precision, it is important to at least record the weight and size of the body. Height, or crown heel length, is only one of a variety of morphometric values that can be determined from a body. The use of multiple measurements as a technique for the identification of an individual is only of historical importance today but isolated measurements can still be of value in distinguishing between a small number of different individuals. For example, shoe and hat size may be a good discriminator between some individuals.
[33.740]
The process of external examination at autopsy involves the largest organ of the body, namely the skin. The presence of old and recent injuries to the body surface is of particular interest to the forensic pathologist but the recording of patterns of pigmentation, tattoos, hair distribution and the presence of dermatological diseases can be of considerable importance in determining the identity of an individual. The hands and feet may show anatomical features acquired as a result of particular occupations and the loss of digits is a useful identifying characteristic. Documentation of rigor mortis (the stiffening of muscles after death) and livor mortis (the discolouration of the skin caused by the settling of the blood in dependent blood vessels after death) are also important but in bodies showing advanced decomposition these features are often obscured.The description of wounds is critical to any forensic medical examination, whether the subject is deceased or living. Descriptions of all injuries should be recorded in detail in the autopsy notes, using terms that are objective rather than subjective. For example, an injury might be objectively described as “a red zone of skin measuring 5 cm in diameter with areas of brown and yellow discolouration within it and having an indistinct border”. A subjective description of this same wound might be “a 5 cm bruise showing signs of ageing”. The advantage of an objective description of a wound is that it does not presuppose the cause or nature of the injury.
While cumbersome, such objective descriptions are of particular use to other medical experts who may be seeking alternative explanations for the injury.
Descriptions of identifying marks, wounds and injuries should always be given by reference to the patient in the standard anatomical position: the body standing erect and facing forwards, with the arms by the side and the palms of the hands facing the front. This standard body position provides a constant reference point for terms such as superior, inferior, anterior and posterior, and provides consistency in the description of such marks on the body.
The position of marks and wounds on the body should also be located by reference to fixed bony landmarks wherever possible. This is preferable to using soft tissue landmarks such as the umbilicus or the nipples. The position of such characteristics can be measured in relation to bony prominences such as the tibial tuberosity, the iliac crest or spinous process.
In describing a wound, the forensic medical examiner takes note of its site, its size, its shape and its surrounds. The colour, contour, course and contents of a wound should also be recorded. In addition to these general descriptive features, the forensic examiner should comment on other characteristics such as the depth of the wound and the nature of its borders.
The general principle for describing injuries in forensic autopsies is that the description in the notes made following an accurate forensic medical examination should assist in the identification of the individual and in the reconstruction of the events in which the injury occurred. As a result, it is vital that the recording of injuries and identifying features should be optimum. Charts, x-rays, photographs and videos should be used where appropriate.