Examining Wounds During Autopsy

One of the greatest challenges of an autopsy is examining the wounds. The essence of the medical examiner’s job is to use his or her skill and experience to determine the true nature and cause of a particular wound. Depending on the type of wound or weapon used, this can get difficult. Dr. Kiesel talks about those difficulties:

” [When] they weren’t shot once, they were shot 13 times or 20 times … you’ve got to sort out paths of all these bullets. You’ve got to figure out where each bullet went. The old way of doing it was, ‘Well, he’s got 10 holes on the front, there are eight holes on the back, and there’s two bullets inside, we’re done.’ [The] legal system won’t accept that anymore”

Homicide cases have to be examined carefully and thoroughly. A part of a medical examiner’s job includes testifying in court. Medical examiners are often called upon to explain their findings on the stand. Their findings can have a large impact on the lives of all those who are part of the case.

Dr. Kiesel explains how wounds have patterns that help to determine their origins:

“Bludgeoning, where you have someone who’s been physically assaulted and beaten, you’ve got a lot of different injuries. Sometimes these injuries have patterns. Sometimes the injury patterns give you a clue as to what weapon may have been used. Sometimes there’s more than one weapon. I had a case where a person was done in by one individual, but that individual used at least four different weapons. So we had four different types of patterned injuries on that person.”

Through years of education and experience, the medical examiner learns to recognize these patterns and the types of trauma with which they are associated.

(Dr. Kiesel is the Deputy Chief Medical Examiner of Fulton County)

Examining Wounds During Autopsy

One of the greatest challenges of an autopsy is examining the wounds. The essence of the medical examiner’s job is to use his or her skill and experience to determine the true nature and cause of a particular wound. Depending on the type of wound or weapon used, this can get difficult. Dr. Kiesel talks about those difficulties:

” [When] they weren’t shot once, they were shot 13 times or 20 times … you’ve got to sort out paths of all these bullets. You’ve got to figure out where each bullet went. The old way of doing it was, ‘Well, he’s got 10 holes on the front, there are eight holes on the back, and there’s two bullets inside, we’re done.’ [The] legal system won’t accept that anymore”

Homicide cases have to be examined carefully and thoroughly. A part of a medical examiner’s job includes testifying in court. Medical examiners are often called upon to explain their findings on the stand. Their findings can have a large impact on the lives of all those who are part of the case.

Dr. Kiesel explains how wounds have patterns that help to determine their origins:

“Bludgeoning, where you have someone who’s been physically assaulted and beaten, you’ve got a lot of different injuries. Sometimes these injuries have patterns. Sometimes the injury patterns give you a clue as to what weapon may have been used. Sometimes there’s more than one weapon. I had a case where a person was done in by one individual, but that individual used at least four different weapons. So we had four different types of patterned injuries on that person.”

Through years of education and experience, the medical examiner learns to recognize these patterns and the types of trauma with which they are associated.

(Dr. Kiesel is the Deputy Chief Medical Examiner of Fulton County)

Autopsy Procedure: External Examination

• The body is received at a medical examiners office or hospital in a body bag or evidence sheet. If the autopsy is not performed immediately, the body will be refrigerated in the morgue until the examination. A brand new body bag is used for each body. This is to ensure that only evidence from that body is contained within the bag. Body bags are closed and sealed to prevent any contamination or evidence loss during transportation. Evidence sheets are an alternate way to transport the body. An evidence sheet is a sterile sheet that the body is covered in when it is moved. Just like the body bags, investigators use brand new sheets for every corpse.
• The body is moved in the bag or sheet to the examination suite. The person responsible for handling the body is often called a diener. The diener is a morgue attendant who is responsible for moving and cleaning the body and, in some cases, assisting in the autopsy. The diener will also clean the exam suite after the autopsy is over. This job may vary from facility to facility.
• When the body is received in a body bag, the seals of the bag are broken and the body is photographed inside the bag. In a forensic autopsy, it is important at this stage for the medical examiner to note the clothing of the deceased and the position of the clothing. This is because once the clothing is removed for the examination, any evidence pertaining to the position of the clothing cannot be documented.
• Evidence is collected off of the external surfaces of the body. Hair samples, fingernails, gunshot residue (if present), fibers, paint chips or any other foreign objects found on the surface of the body are collected and noted.
• If it is a homicide investigation, the hands of the deceased will be placed in bags at the scene. The medical examiner will open the bags and take residue and fingernail samples. Then the bags are removed, folded and submitted with the samples as part of the evidence.
• In some cases, a special UV radiation is used to enhance secretions on the skin or clothes. The radiation causes the secretions to fluoresce so that they may be collected for samples.
• If protocol dictates, the body will be x-rayed while still in the body bag.
• Once the evidence is all collected, the body is removed from the bag or sheet and undressed, and the wounds are examined. This is done before the body is cleaned up.
• After the body is cleaned, the body is weighed and measured before being placed on the autopsy table for reexamination. The autopsy table is typically a slanted, aluminum table with raised edges that has several faucets and drains used to wash away collecting blood during the internal investigation. The types of table used vary from facility to facility. The body is placed face up on the table, and a body block is placed under the patient’s back. A body block is a rubber or plastic “brick” that causes the corpse’s chest to protrude forward while the arms and neck fall back. This position makes the chest easier to cut open.

• At this point, a general description of the body is made. All identifying features are noted including: Race, Sex, Hair color and length, Eye color, 
  Approximate age, Any identifying features (scars, tattoos, birthmarks, etc.) 

• These features are noted on a handheld voice recorder or a standard exam form. In addition to all normal features, any external abnormalities are noted in these reports

Autopsy Procedure: Internal Examination

• The internal examination starts with a large, deep, Y-shaped incision that is made from shoulder to shoulder meeting at the breast bone and extends all the way down to the pubic bone.

• The next step is to peel back the skin, muscle and soft tissue using a scalpel. Once this is done, the chest flap is pulled up over the face, exposing the ribcage and neck muscles.

• Two cuts are made on each side of the ribcage, and then the ribcage is pulled from the skeleton after dissecting the tissue behind it with a scalpel.  During this dissection, the various organs are examined and weighed and tissue samples are taken. These samples take the form of “slices” that can be easily viewed under a microscope. Major blood vessels are also bisected and examined.

• With the organs exposed, a series of cuts are made that detach the larynx, esophagus, various arteries and ligaments. Next, the medical examiner severs the organs’ attachment to the spinal cord as well as the attachment to the bladder and rectum. Once this is done, the entire organ set can be pulled out in one piece and dissected for further investigation.

• The examiner opens the stomach and examines and weighs the contents. This can sometimes be helpful in figuring out the time of death (more on time of death later).

• The examiner will then remove the body block from the back and put it behind the neck like a pillow, raising the patient’s head so that it’s easier to remove the brain.

  The examiner makes a cut with a scalpel from behind one ear, across the forehead, to the other ear and around. The cut is divided, and the scalp is pulled away from the skull in two flaps. The front flap goes over the patients face and the rear flap over the back of the neck. The skull is cut with an electric saw to create a “cap” that can be pried off, exposing the brain. When the cap is pulled off, the dura (the soft tissue membrane that covers the brain) remains attached to the bottom of the skull cap. The brain is now exposed. The brain’s connection to the spinal cord and tentorium (a membrane that connects and covers the cerebellum and occipital lobes of the cerebrum) are severed, and the brain is easily lifted out of the skull for examination.

• Throughout this whole process, the medical examiner is looking for evidence of trauma or other indications of the cause of death. The process varies based on the nature of the case and is incredibly detailed — the forensic pathologist has to adhere to an intricate, in-depth process to ensure the proper collection and documentation of evidence.

After the examination, the body has an open and empty chest cavity with butterflied chest flaps, the top of the skull is missing, and the skull flaps are pulled over the face and neck. To prepare the body for the funeral home:

• The organs are either put back into the body or incinerated.
• The chest flaps are closed and sewn back together.
• The skull cap is put back in place and held there by closing and sewing the scalp.

Pink skin discolouration caused by monoxide poisoning. The unique skin appearance is an immediate to clue as to the cause of death.

Decomposition - is the process whereby bodily tissues are broken down into smaller molecules after death. The physical and chemical properties observed during decay are categorized into five stages: (1) fresh, (2) putrefaction, (3) black putrefaction, (4) butyric fermentation, and (5) dry decay

Time of Death

General factors used to estimate time of death are:

Body temperature, rigor mortis, postmortem lividity, appearance of the eyes, stomach contents, stage of decomposition and evidence suggesting a change in the victim’s normal routine.

Body Temperature:

• drops 2 to 3 degrees in the first hour after death; and 1 to 1.5 degrees for each subsequent hour up to 18 hours

Rigor Mortis:

• appears in the head 5 to 6 hours after death; in the upper body after about 12 hours; and in the entire body after about 18 hours.
• after about 36 hours, rigor mortis usually disappears in the same sequence that it appeared. 
• any weapon tightly clenched in the victim’s hand as a result of cadaveric spasm indicates suicide rather than murder

Postmortem Lividity:

• starts one half to 3 hours after death and is congealed in the capillaries in 4 to 5 hours
• maximum lividity occurs within 10 to 12 hours
• the location of lividity can indicate whether a body was moved after death

Eyes:

• partial constriction of the pupil occurs in about 7 hours
• in 12 hours, the cornea appears cloudy

Stomach Contents:

• the investigator should determine when and what the victim last ate - if any vomit is present, it should be preserved as evidence and submitted for examination

Water:

• a dead body usually sinks in water and remains immersed for 8 to 10 days in warm water, or 2 to 3 weeks in cold water - it them rises to the surface if not restricted
• the outer skin loosens in 5 to 6 days, and the nails separate in 2 to 3 weeks

Buried Alive

This 38-year-old male truck driver was the operator of a vehicle used to carry and haul sludge such as human waste. The loaded truck was preparing to empty at a landfill.

The landfill was a large man-made hole, measuring approximately 20 feet deep and one-half mile long. He, along with the driver of another vehicle, was dumping fecal matter in the landfill. The hatch on the rear of the dumping trailer did not open properly so he got out of his vehicle to work on it. The hatch unexpectedly opened, and the subject was buried in sludge. He was later found at the base of the hole.

Autopsy Findings

Examination of the body revealed thick, black sludge coating the entire body, including his face. Sludge was present in the nostrils and oral cavity. Sludge could be trace into the pharynx, larynx, and into the mainstem bronchi. The lungs displayed edema and congestion. Toxicology was negative for alcohol and drugs.

This case represents accidental asphyxial death caused by a combination of mechanical asphyxia and a component of upper airway occlusion.

Mechanical asphyxia occurs when pressure on the outside of the body prevents respiration. It is also reasonable to assume the nostrils and oral cavity were occluded. Therefore, asphyxia in this case is a result of chest compression combined with smothering.

Post-mortem lividity (livor mortis), or hypostasis

• the pooling of the blood dependent on the position of the body.

Lividity which does not match the position the body is found in is a good determinate of the body being moved post-mortem

Examining Wounds During Autopsy

One of the greatest challenges of an autopsy is examining the wounds. The essence of the medical examiner’s job is to use his or her skill and experience to determine the true nature and cause of a particular wound. Depending on the type of wound or weapon used, this can get difficult. Dr. Kiesel talks about those difficulties:

” [When] they weren’t shot once, they were shot 13 times or 20 times … you’ve got to sort out paths of all these bullets. You’ve got to figure out where each bullet went. The old way of doing it was, ‘Well, he’s got 10 holes on the front, there are eight holes on the back, and there’s two bullets inside, we’re done.’ [The] legal system won’t accept that anymore”

Homicide cases have to be examined carefully and thoroughly. A part of a medical examiner’s job includes testifying in court. Medical examiners are often called upon to explain their findings on the stand. Their findings can have a large impact on the lives of all those who are part of the case.

Dr. Kiesel explains how wounds have patterns that help to determine their origins:

“Bludgeoning, where you have someone who’s been physically assaulted and beaten, you’ve got a lot of different injuries. Sometimes these injuries have patterns. Sometimes the injury patterns give you a clue as to what weapon may have been used. Sometimes there’s more than one weapon. I had a case where a person was done in by one individual, but that individual used at least four different weapons. So we had four different types of patterned injuries on that person.”

Through years of education and experience, the medical examiner learns to recognize these patterns and the types of trauma with which they are associated.

(Dr. Kiesel is the Deputy Chief Medical Examiner of Fulton County)

Victim’s Body as Important Crime Scene Evidence

Corpse as a Crime Scene

When investigators scan the crime scene for evidence, their search centers around one crucial evidence to the crime – the victim’s body. Indeed, the condition of the crime victim can indicate many information that led to the victim’s death and those information are crucial during investigation. The dead victim’s body is a silent witness to the crime and qualifies as a physical evidence.

Therefore, autopsy is often conducted at criminal laboratories to determine the cause of death, the items used to kill the victim, and all other factors that contributed to the execution of the crime.

Examining Victim’s Body

Aside from the evident cause of a victim’s death, the body is sent to laboratory for further examination that could point as evidence to the crime. During the examination or analysis of a victim’s body, crime scene investigators look for common evidence that provide valid information about the crime.

Different methods and equipments are used to gather evidence that can be used to identify the cause of death to the victim. There are several resources found on the victim’s body that will help link together with the other physical evidences found by investigators at the crime scene during the initial examination. When they match those found on the victim’s body, then it will provide a valid conclusion to the investigation.

Evidences To Look For

When crime scene investigators inspect the victim’s body for possible clues to the crime, they follow a few standard protocols. There are basic criteria that investigators follow so they do not simply conduct a random search of the body but follow a methodical approach. The following are some of the criteria used when examining a victim’s corpse at the crime scene:

• How is the victim’s skin condition?
• Are there any skin marks or signs of struggle between the victim and its perpetrator?
• Was the scene where the victim laid to rest the same where she had been actually killed?
• Was the victim’s position her original position when she died or is she intentionally posed that way?
• Is the victim nude?

All these factors play a major role in providing the initial information that investigators can gather for the crime case. Plus, it will also set the stage as to what other evidences they need to look for in relation to the condition of the victim’s body upon arriving at the crime scene. Below are just some of the other type of evidences that investigators can search the victim’s body for.

Body Fluids

This type of evidence can be mechanically recovered at the crime scene upon the initial examination of investigating officers. However, it can be analyzed further at the criminal laboratories to identify what type of body fluid was found at the victim’s body. It can either be a blood stain, seminal fluids, or some other types of fluids, but they all point to what transpired during the actual crime.

Moreover, criminal investigators must also look into where specifically in the victim’s body the particular fluid was found. In some cases, the detection of seminal fluids in a victim’s body indicate that the victim was raped by the suspect before she was killed.

Latent Prints

The main goal behind a crime scene investigation is to identify the suspect involved in the crime. And all evidences gathered at the scene are intended for that same goal. Therefore, investigators use various equipments and techn

Ligature strangulation marks on a victim of the Hillside Stranglers

Vitreous humour (vitreous body)

The vitreous humour is the clear gel substance filling the space in between the lens and the retina. 

The vitreous humour (and sometimes aqueous humour, another ocular fluid) can reveal more accurate post-mortem results than blood samples because it is a more stable fluid post-mortem. An analysis of ocular fluids can be helpful in determining time of death, and can also be used to measure levels of alcohol and heroin.