Legal Autopsy Research Articles

Profile of Autopsy Cases at District Hospital, South India in Pandemic Year 2020

Autopsy profile is one of the essential inputs for National Statistics. It gives an insight into the prevailing unnatural causes of death in the vicinity and subsequently helps stake holders take appropriate measures to prevent the same. The present study was conducted in district hospital, South India in the pandemic year, 2020. A total of 808 medico legal autopsies were conducted in Government District Hospital, Tumkur which is high in spite of pandemic and lockdown in place. Among them majority of victims were male constituting 78.85% and females attributing to 21.15% of total cases. Manner of death was analysed and accidental deaths formed the major chunk of cases comprising of 351 cases (43.44%). Suicidal deaths comprised of 35.87 % of cases and homicide deaths accounted for 3.71% of cases. Among males maximum number of cases was recorded in fourth decade with 147 cases. While in females maximum cases fell in third decade of life with 51 cases. Road traffic accident was the prime most cause of death with 241 cases comprising of 30% of total cases. Second most common cause was hanging with 137 cases comprising 17% of total cases. Surprisingly natural deaths constituted third most common cause with 125 cases comprising of 15% of the cases. Majority of cases were reported in middle age group 21-50 years which form the bread winner group. With adequate safety precautions and counselling these unnatural deaths could be prevented.

Poverty and Non-Natural Deaths among Former Mineworkers and in their Families in Transkei Region of South Africa

Background: Thousands of former mineworkers across former Transkei have already passed on, are disabled, or died due to either mining related diseases or non-natural ways of dying such as accidents, suicide, or homicide. Many ex-mineworkers have died prematurely, placing a strain on their families. This has led to dysfunctional families and has created the conditions for children from these families to commit crime. Compensation could be claimed for mining related maladies, but the non-natural deaths are unbearable for a resource-stricken family. Objective: To highlight the problem of poverty and non-natural deaths among former mineworkers, and to relate the impact on their families. Method and Material: This research, a retrospective qualitative study on former mineworkers and their children, was carried out in 2000-01 at the forensic pathology laboratory of Umtata General Hospital complex, Mthatha, Eastern Cape, South Africa. The records of interviews performed during medicolegal autopsies in 2000 and 2001were reviewed at Umtata (Mthatha) General Hospital mortuary. The interviews were routinely performed in relation to victims who were admitted at the Umtata (Mthatha) General Hospital mortuary.Results: Eighty-four family records were analysed. Of these, 21 (25%) were found to be former mineworkers and their immediate family members. There were five mineworkers and 15 children of mineworkers. Only one was the spouse of a mineworker who had died unnaturally, and one person was unaccounted for in these numbers. Three mineworkers died because of firearm injuries, one was assaulted by someone with a knobkerrie, and another one died because of alcoholic intoxication. Two of them had heavy drinking habits. Three mineworkers were unemployed. The causes of unnatural deaths were as follows: five stabbed, two from firearm injuries, one from a motor vehicle accident, one assaulted with blunt object, and three committed suicides by hanging and poisoning. Most of the victims consumed alcohol. Conclusion: A high number of former mineworkers died an unnatural death. Poverty could be an associated as an underlying cause of death.

Profile of Medico legal Autopsies Conducted at Tertiary Medico-legal Centre in Northern India

The present study is a retrospective study of medico-legal autopsies conducted in the Department of Forensic Medicine and Toxicology MMIMSR Mullana, Ambala, India, from Jan 2016 to December 2020. During this period, 793 cases of medico-legal autopsies were done in the mortuary of MMIMSR, Mullana, Ambala. The majority of victims were male 670 (84.48 %) cases and female 123 (15.52%) cases. A maximum number of post mortem done in the age group 20-40 years was 385(48.56 %) cases and minimum in age group 0-10 year were 18 (02.26%) cases. In our study, 601 (75.78%) were married, 169 (21.31%) unmarried, and unknown 23 (02.99%) cases. Hindus were 660 (83.22%), Muslim 50(06.30%), and Sikh 83 (10.48%) cases. The total number of deaths from rural areas was 406(51.20%) cases, which is slightly higher than urban area 387 (48.80%) cases. Manners of death due to natural causes were 38 (04.97%) cases and unnatural 755 (95.20%) cases. In unnatural, (accidents 551 (69.44%), Suicides 186 (23.44%) and homicides 18 (02.24%) cases). A maximum number of death due to Head injury were 235 (29.64%), shock and hemorrhage 188 (23.70%), poisoning 124 (15.64%), others-skeleton and visceral injuries 81 (10.22%), hanging 44 (05.54%), heart attack 38(04.78%), Drowning 23(02.90%), Electrocution 14 (01.76%), strangulation 13(01.64%), burns 11(1.38%), alcoholic 10(01.26%), septicemia 10(01.26%) and snake bite 2(00.26%)cases. A maximum number of deaths occurring between 0-6 hrs of injury was 395(49.82%) cases, and a minimum number of deaths in 24-48 hrs of injury was 22(02.77%) cases.

Unnatural Deaths among Autopsy Cases Brought at Tertiary Care Hospital of Western Nepal during COVID-19 Pandemic Period: A Descriptive Cross-sectional Study.

The outbreak of COVID-19 as changed patterns of mortality in different setups. The rate of suicide has increased in some countries during the pandemic while the overall death rates have decreased. The study was conducted with objective to find out the prevalence of unnatural deaths among the autopsy cases brought at tertiary care hospital during COVID-19 pandemic period. This is a descriptive cross-sectional study using the records of the medico legal autopsies conducted from 24th March 2020 to 23rd August 2020 during the COVID-19 pandemic in Pokhara Academy of Health Sciences. Ethical approval was taken from Institutional Review Committee of Pokhara Academy of Health Sciences (Reference number 28.2077/78). Whole sampling method was used. Records which were available were included in the study whereas those cases whose complete records were not available were excluded. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Out of 188 deaths studied at the autopsy during the COVID-19 pandemic period, the prevalence of unnatural deaths was 147 (78.19%) (71.04-85.33 at 95% Confidence Interval). Among these deaths, 109 (74.14%) were males and 38 (25.85%) were females. Suicide was the most common manner attributing to 78 (53.06%) of the unnatural deaths. The prevalence of suicide was more than those demonstrated by earlier observations in similar settings before the pandemic period. Suicidal deaths were more common during the COVID 19 pandemic. This is an indicator of frustration of the people and necessary steps have to be taken to decrease such deaths in similar conditions to come.

A prospective study of medicolegal autopsies to establish profile of burn deaths

Burns injuries have been a one of the major cause of concern since prehistoric time to the present era of modern medicine. Burn is considered to be the commonest cause of unnatural death in India.Burns are injuries produced by application of dry heat such as flame, radiant heat or some heated solid substance like metal or glass to the body. Dry heat, application of hot bodies, licking by flames resulting in simple burns causes local injury to the body. Moist heat leading to scalds, corrosive poisons resulting in corrosive burns. Electric spark, discharges, flashes and lightning leads to electric burns.Present study aim to know the magnitude of burn deaths in the region of southern marathwada region. Two years prospective study was conducted at Government Medical College Latur. Study of medico legal autopsies to establish the profile of burn deaths was carried out. In the present study, it is found that burns are commonly found in female (72.04%) than in females. Housewives (43.52%) were common victims followed by works (9.80%). Most of the incidences took place in morning hours (45.53%). Most common place of incidence was house (83%). Kerosene (57.63%) was the most common accelerant used to cause burn. If percentage of burn increases, the survival period decreases and vice versa. Most common alleged manner of death was accident (53, 6%).

A Study of Epidemiology of Poisoning Cases Brought For Autopsy at Tertiary Health Care Centre in South-Western Maharashtra: A Ten-Year Retrospective Study

Introduction: Present study is the study of epidemiology of poisoning cases brought for autopsy at tertiaryhealth care centre in South-Western Maharashtra by finding out the incidence, pattern, sociodemographicfactors, toxic agents, seasonal and other factors related to their deaths.Material and Methods: Present study is a retrospective cross-sectional study done in mortuary of a tertiaryhealth care centre in South-Western Maharashtra. Study included total 104 cases of death due to poisoningfrom Jan 2009 to Dec 2018 and the data collected from inquest papers, autopsy reports and regional forensicscience laboratory reports was analysed using a structured proforma in Microsoft excel sheet.Result: Out of 2570 medico legal autopsies conducted during the study period, deaths due to poisoningcomprised 104 cases i.e. an incidence of 4.05%. Maximum deaths due to poisoning are found to be due toIntentional self-poisoning (suicides) and rural areas are more affected than the urban areas. Most commonlyused toxic substance for poisoning is found to be pesticides and the maximum deaths occurred during themonsoon season. Gender-wise analysis shows that death due to poisoning is more common in males andmajority of victims irrespective of their gender were married.Conclusion: Study provides crucial information on various sociodemographic factors related to poisoningdeaths in South Western Maharashtra which is relevant in understanding the causative factors behind themortality due to poisoning and also helpful in devising preventive measure to reduce the loss of human life.

Incidental Neoplastic Tumours on Histo Pathology of Medico Legal Post Mortem Cases: A Ten Year Study

Background: Autopsy has been an important tool for detection of many rare lesions as well as studyingthe course of such lesions, highlighting the cause of death and also helps in indirect collection of data formortality and forming health policies. Aim of present study was to detect the rate and type various neoplasmswhich were either clinically undiagnosed or not the direct cause of death and their system wise analysis.Material and Methods: This is a retrospective study conducted on viscera Received between year 2011-20on 810 medico legal autopsy cases coming to Department of Pathology for histopathological examination.Result: Out of 810 cases, 09 tumours were diagnosed (1.1%). In 6 cases, it was completely incidentalfinding while in 03 cases history of malignancy was present. Tumours were mostly seen in older age group(>50 years).Conclusion: The study concludes the importance of histopathologic study in autopsies in detection ofclinically undiagnosed neoplasms and evaluating the cause of death. Thus, autopsies also indirectly aid tothe true cancer incidence statistics.

Circumstances of death and pattern of fatal railway injury

The progressive extension of railway networking and increasing number of passengers as well as goods train to meet the demands of rapid industrialization and growing urbanisation, results in an increase in the various modes of railway fatalities. To evaluate the pattern and distribution of fatal railway injuries in relation to the circumstances of death in cases of railway related deaths. The study was conducted at Forensic Medicine and Toxicology department of M.K.C.G. Medical College & Hospital, Berhampur for medico legal autopsy on selected cases of death due to alleged railway injuries, were subjected to thorough post mortem examination and the pattern of injuries noted.A total number of 1314 cases were brought for medico-legal autopsy during the study period, out of which 94 cases were selected for the present study having clear history of railway related deaths (in which either a train caused death or in which a body was found on the track) excluding all other causes of death (even the cases brought by the GRPS having natural deaths were not considered as study material). The study conducted in the department of Forensic Medicine and Toxicology revealed that the number of railway related deaths, both accidents and suicides is substantial in the locality. Amongst these, accidental railway deaths (63.83%) outnumber the other manners of death. The ante mortem nature of the railway injuries could be well established in the present case study material.

Different medico legal issues in deaths due to entrapment with animal electric traps; a study on selection of cases from the Southern Province, Sri Lanka

Introduction: Deaths due to electrocution involve both low and high voltage current and the manner of death is almost always accidental. Deliberate electrocution of wild animals by an unsafe extension of an electric line is made by drawing an electric connection from the low voltage utility bare lines. The entrapment of humans in these electric traps is observed in several geographical areas in Sri Lanka. The study intends to raise different medico legal issues pertaining to these deaths in a selected sample. Methods: A descriptive, retrospective study was carried out on 13 outdoor electrocution deaths due to contact with animal electric traps. The medico legal autopsies were carried out by the researchers and the data were collected from the autopsy and scene visit findings, police reports and the inquirers’ reports. Results: All the victims were adult males. The electric entry mark which is the hallmark of forensic diagnosis of electrocution was observed in all 13 dead bodies. It was characterised by a groove with charring at the base in 12 deaths. The macroscopic and microscopic features of electrocution were observed even in severely decomposed bodies. The cause of death was in all cases was determined as electrocution and the manner of death was determined as accidental. The trappers in 9 incidences were identified but none of them were prosecuted for breaching the laws of the Electricity Act or the Fauna and Flora Protection Ordinance of SriLanka. Conclusions: The scene visit examination was helpful to determine the manner of death and was determined as accidental which may be debatable according to the law of the country.

Demographic and autopsy characteristics of drowning deaths in a major autopsy center of Gandaki province of Nepal

Background: Autopsy examination is mandatory in all unnatural deaths as per law of Nepal and thus all deaths due to drowning are undergone medico legal autopsy. This study aims to analyze the demographic and autopsy characteristics of drowning deaths in cases brought for medico legal autopsy at a major autopsy center of Gandaki province of Nepal.
 Methods: This study was conducted based on review of database in a period of two years among 53 corpses of drowning related deaths. The demographic data and relevant information from the inquest and autopsy report of such cases were collected and presented.
 Result: The commonest age group involved in drowning deaths was <20 years, attributing to 22 (41.5%) cases, and with males (41, 77.4%) more common than females. Suicidal drowning (34, 64.2%) was the commonest manner. Maximum (19, 35.8%) deaths occurred in the rainy season and on lakes (34, 64.1%).
 Conclusion: Drowning deaths were more common among males of young age groups. Most of the drownings occurred during the rainy season, lakes were the common sites of drowning, and the commonest manner was suicidal.

An Autopsy Study of Rheumatic Heart Disease: A Prevalent Iceberg Disease

Cardiovascular diseases are a chief cause of sudden death. Rheumatic Heart Disease (RHD) exists as a hidden burden in developing countries. It occurs as a sequelae to Rheumatic Fever caused by Group A β Hemolytic Streptococcus. Despite the existence of antibiotics and prophylaxis by Penicillin it is still prevalent. A 33 year old male was found unresponsive in his house and was later declared dead. He had a history of abdominal pain for the past 6 months for which he was on medication. There was no other relevant family and past history. He had no history of alcohol intake or smoking. Complete medico legal autopsy was done and confirmed to be RHD. RHD is an “iceberg” disease which is still prevalent in developing countries. A cross reaction between foreign antigen and cardiac proteins leads to formation of autoantibodies causing autoimmune reaction. Mitral valve is commonly involved. RHD diagnosis can be established using Jones criteria during clinical examination. RHD still exists despite use of advanced antibiotics and Penicillin prophylaxis and needs to be therefore considered as a diagnosis of sudden death of young adults.

Knowledge and Attitude of Medical Students Towards Medico Legal Autopsy- A Questionnaire Based Study

Introduction: Autopsy is a research tool which has been used for centuries. Autopsy is a scientific studyof a dead body and is categorized into clinical and medico-legal autopsies. A Medicolegal autopsy or postmortem examination is a scientific examination of dead body carried out under the law of the state mainly toassist the identification and prosecution of the guilty in cases of unnatural deaths. This study is done to assessthe knowledge, Perception and Attitude of medical students towards medico legal autopsy.Materials and Methods: A questionnaire-based study was conducted among the students of Saveethamedical college, questionnaires related to autopsy were distributed and students were asked to fill them.According to the data obtained was analyzed to know the Knowledge and Attitude of Medical StudentsTowards Medico Legal AutopsyResults: Majority of the students (92.3%) thought that autopsy is necessary for all unnatural deaths. 84.6%said that inquest report, requisition letter is needed for autopsies. 80.8% knew autopsy is done to know thecause of death and reach the culprit of the crime and was a legal formality in unnatural deaths. 96.2% ofstudents have not felt performing autopsy is disrespectful to the body. 94.2% of participants had a opinionthat the autopsies they witnessed were not enough. 96.9% agreed that autopsy is necessary in medicaleducation. Almost half (49.9%) of the students felt uncomfortable while witnessing autopsy, 29.6% wereComfortable and 20.5% of students have not witnessed autopsy yet. Only 67.3% were comfortable withlive autopsies, rest 32.7% preferred virtual autopsy. 96.2% knew that preserving viscera is necessaryduring autopsy on suspected case of poisoning. Majority of students (98.1%) felt that medical studentsshould actively participate in autopsies. Most of them (98.1%) knew that both external and internalexaminations are done in autopsies and 98.5% felt that ED posting specifically for Forensic Medicine fortrauma, poisoning and other medico-legal cases is necessary during CRRI.Conclusion: Overall this study shows that students have some knowledge of autopsies but think that theautopsies that they have witnessed were not enough and encourages that medical students should witnessand actively participate in more autopsies. We also suggest to revise the Forensic Medicine curriculum byincreasing the number of teaching and practical hours thereby the students will be able to make observationsand come to conclusions in criminal matters or Medico-legal cases.

Study of the Motives of Hanging Cases Brought for Medico Legal Autopsy in a Tertiary Care Medical College Hospital of Assam

Death is inevitable for every living being however sudden demise of a human being which is unexpected dueto unnatural causes is an immense loss of valuable human resources causing irreparable loss for the familyand society at large. There are various modes of committing suicide but death by hanging is quite commonamong the masses. The present study was conducted at Tezpur Medical College & Hospital, Tezpur, Assamto find out the various motives of hanging cases in medico legal autopsies during the period 1st January 2019to 31st December 2019.

An Autopsy Study of Atherosclerotic Changes in Coronary Arteries at B.P. Koirala Institute of Health Sciences

Introduction: Atherosclerosis is a giant killer and the incidence of atherosclerosis in coronary arteries is rapidly increasing. The study was designed to assess the atherosclerotic lesions in coronary artery and to correlate the risk factors related to prevalence of atherosclerosis.
 Methods: Heart from 100 medico legal autopsy cases ranging between ages 15 to 35 years which came to BPKIHS Dharan were taken for this study and processed for coronary arteries using conventional technique. They were then studied,and grading was done based on Modified American Heart Association (AHA) classification of atherosclerosis.
 Results: Intimal thickening was noted in more than 90% in all three coronary arteries followed by intimal xanthoma whereas intermediate lesion for atherosclerosis was not found. Age, gender, smoking and alcohol in relation to atherosclerosis were found to be of no significance.
 Conclusion: The study highlights the impact of atherosclerotic lesions in the Eastern region of Nepal. Meticulous postmortem examination along with histopathological study is the best possible way to study atherosclerotic disease in humans and risk factors associated with it.

Socio-Demographic Profile of Fatal Poisoning in a Tertiary Care Teaching Hospital of Coimbatore District-A Retrospective Study

Background: Poisoning poses a major public health problem mainly in developing countries. Because ofthe rapid industrialization and advancement in agricultural sector, fatality by poisoning also increases dayby day. The aim of this study is to determine the socio-demographic profile of fatal poisoning in CoimbatoreDistrict. Methods: This retrospective study was carried out in Department of Forensic Medicine, CoimbatoreMedical College, Coimbatore, Tamil Nadu with data obtained from fatal poisoning cases brought forpostmortem examination from January 2016 to December 2016. Identification of specific poisons were donewith chemical examiner’s report. All collected data were analyzed in various possible aspects in the preparedproforma. Results: During the study period the total number of medico legal autopsies conducted were 3675out of which fatal cases due to poisoning were 600(16.33%) cases. The study showed that the incidence ofpoisoning was more common among married men ie.303 cases (50.5%) out of 600 total number of poisoncases. The incidence was more common in the age group 31 – 40 years in males (86 cases) which formed14.3 % and in females it is 21-30 years (65 cases) which formed 10.8%.When we observed the religion wisedistribution, Hindu males out numbered 369 out of 600 cases which formed 61.5%. Conclusion: Morbidityand mortality due to poisoning can be minimized by health education, early referral, establishment oftoxicological units for detection of specific poisons and appropriate guidance for proper management ofpoisoning cases at hospitals and primary health care centers.

Familicide-suicide by cut throat by a safety razor blade along withatypical hesitation wounds

A coupleand their two daughterswere found lying in a pool of blood in the bedroom by the police. A safety razor blade had been recovered at crime scenes. Cut throat injuries were present on all the persons. The husband brought dead to a hospital and later the younger daughter also succumbed to the injuries. Medico legal autopsy and investigation by the police confirmed the caseas familicide-suicide and the perpetrator was the husband.Hewas suspecting infidelity of his wife and was in depression.To the authors’ knowledge both homicide and suicide by cut throat with a safety razor blade has not been described before.Also, in this paper, we are highlighting atypical hesitation cut on the posterior neck of the perpetrator.

Loaded colon causing death: A case report

Colon can be loaded with faecal matter following acute or chronic constipation. Most of the time it can be relieved with medical or surgical interventions. Rarely does it produce complications due to perforation by impacted stool causing peritonitis and sepsis. Here we came across the case of a young female who is brought dead to casualty following vomiting and abdominal pain. The medico legal autopsy showed a hugely dilated colon loaded with faecal matter causing respiratory and cardiovascular compromise due to the pressure effect on thoracic structures. The cause for the constipation in this case was an imperforated anus at birth which was operated in childhood itself but was not cured completely. We could hardly get this kind of complication with faecal impaction from literature as there are very few reported cases.

Epidemiology and Outcome of Death Due to Burn Injuries –A Prospective Study

A burn is an injury which is caused by application of heat or chemical substances to the external or internal surfaces of the body, which causes destruction of tissues. Thermal deaths are those which result from the effects of systemic and/ or localized exposure to excessive heat and cold The present study has been carried out on 150(39 males and 111 females) cases of death due to burn, brought to the mortuary of Swaroop Rani Nehru Hospital, Moti Lal Nehru Medical College, Prayagraj for medico legal autopsy during the study period of one year extending from 01 July 2019 to 30 June 2020. Female outnumbered males i.e. 111(74.00%) females and 39(26.00%) males. Maximum number of burn deaths i.e., 56(37.33%) cases occurred in the young age group 21–30. Accidental burn injuries can be reduced by bringing about regulations to develop safer cooking appliances, promoting less inflammable fabrics to be worn at home and educating the community especially women.

An analysis of medicolegal autopsies in a tertiary care centre in West Bengal - Amorgue-based study

Medico legal autopsy is a statutory requirement in all cases of sudden, suspicious and unnatural deaths. Profiling of these autopsies helps one to understand the pattern seen among them and guide the investigating authorities and the health promotion & prevention programmes to direct their measures in this respect. The present study is a retrospective, cross-sectional, record-based study carried out in a mortuary under Dept. of Forensic Medicine & Toxicology at Purulia GMCH. Out of the total 1137 medicolegal autopsies, 225 cases were of brought-dead cases. Among the unnatural deaths, the most frequent cases were due to hanging (282 cases, 24.8%) followed by road traffic accidents (176 cases, 15.47%) and burns (99 cases, 8.7%). According to the gender, 761 cases (66.93%) were of males, 368 cases (32.36%) were females and in 8 cases (0.7%) the gender could not be ascertained (foetuses) on autopsy examination alone. Majority of the cases belonged to the age group of 21–30 years (261 cases, 22.95%) followed by 31–40 years (216 cases,18.99%) and 41–50 years (165 cases, 14.51%). Death due to road traffic injuries is a preventable occurrence and proper safety riding measures should be observed by all. Although legislation is in place for sale and purchase of poisonous substances, but still it has to be well implemented.

Effect of first sixty-eight days of lockdown due to COVID-19 on autopsy cases in atertiary care teaching hospital situated in a rural area of Himachal Pradesh

COVID-19 virus and disease were unknown before the outbreak began in Wuhan, China, and now it is a pandemic affecting many countries globally including India. On 30th of January, 2020 India reported its first case of COVID-19 in Kerala and on 24th of March 2020; the Government of India ordered a nationwide first phase of lockdown for 21 days. Our study is to compare the number and type of cases brought for medico legal autopsies in our institution during the complete lockdown period of first 68 days i.e., 25th of March to 31st of May, 2020 versus the cases brought to the same mortuary during the same period of the years 2018 and 2019. In total, 55 cases (42 were of males and 13 were of females) were brought to the mortuary in this lockdown period constituting 19% of total case of 2020 as compared to 91(21%) cases and 99 cases (21%) in the years 2019 and 2018 respectively. Present study shows drastic fall in motor vehicle accidents and shows increase in natural causes of deaths but the suicidal tendencies in the form of hanging and poisoning remained almost same as compared to previous two years and did not increase.