Postmortem artifacts - a Forensic perspective

changes introduced in dead body

1. Postmortem Artifacts by Dr m balaji singh Professor of Forensic Medicine ACS Medical College and Hospital, Chennai Courtes y : Dr Sujeet Kumar Samadder (slide share)

2. “ARTEFACT” POINTS COVERED -Definition -Classification - Description - Medico-legal Importance

3. Origin – Latin. ‘ arte’ = skill ; ‘ fact’ = something made. Artefacts - not real but something artificial. Artefact

4. definition It is a change or feature which was not (physiologically or pathologically ) present in the body before death, but caused or introduced into the body after death, leading to confusion about its nature and cause, resulting in misinterpretation of medico legally significant findings

5. Postmortem artifacts - classified according to causative agent : i . Due ­to­ postmortem ­changes ­ ii. Third ­party ­artifacts iii. Environmental ­artifacts iv. Other­ artifacts

6. Classification according time of introduction of artifact Three types 1. During resuscitative or therapeutic measures 2. Between death and autopsy. 3. During post-mortem examination

7. Due to resuscitative or therapeutic measures History Of Patient and case sheet findings are utmost importance in Forensic Medicine. - Marks of injection & defibrillator on chest - CPR – fracture of ribs & sternum - haemothorax & haemopneumothorax -Fat embolism from fractured ribs or sternum - Laceration of spleen, liver and diaphragm - Positive pressure ventilation – emphysema, sub-pleural air blebs, tension pneumothorax . Cont…

8. DEFIBRILATOR MARKS SIMULATING ANTEMORTEM ABRASION OVER CHEST

9. Doctor induced…… Endo-tracheal intubation – inexperienced hands – injury to larynx and adjacent tissue – suspicion of foul play. Carotid Angiography – neck muscle bruise – suspicion of throttling. Antemortem surgeon’s intervention on wounds may mislead autopsy findings- Kennedy phenomenon

10. Between death and autopsy Agonal artefact – ‘ agonal ’ the struggle that precedes death. a. Common agonal artefact is REGURGITATION & ASPIRATION neurogenic shock / cardiac arrest before death may prevent any significant bleeding - accidental deaths may have viscera without any pallor.

11. Aspiration – a ante mortem phenomenon

12. Embalming Artefacts: trochar insertion from neck and abdomen

13. Embalming Artefacts: Embalming : chemical treatment of dead body to protect from decay. • Trochar insertion for arterial access from • Existing wound – may change size shape direction , can create false tracks • Freshly created wound – may simulate stab or gunshot wound.-trochar insertion from neck and abdomen

14. Embalming…….. Embalming fluid pressure may extravasate blood from veins & arteries, may mistaken as bruise; Or small bruise shown as large bruise Embalming fluid interferes in toxicological analysis

15. Exhumation

16. Handling of cadaver

17. Undertaker’s fracture

18. Artefacts due to handling of cadavers From transportation Abrasion, laceration, blood spots on clothes and body, which was absent in original. From careless handling Bruise in occipital area due to head bumping on hard surface, differentiated by wiping off the bruise. Fracture ribs and vertebras. Weak, osteoporotic bones may get fractured during breaking of Rigor Mortis . Brush abrasions on back by dragging

19. Abrasion Pale yellow , no parchments Dark brown, parchment like

20. Laceration- blood clots never seen in post mortem wounds

21. Post mortem abrasion

22. clot clot

23. Artefacts due to PM changes To move the body, breaking is done, resulting in asymmetrical Rigor Mortis • May cause misinterpretation of Time Since Death. Heat/Cold stiffening may mimic Rigor Mortis.

24. PM changes- Artefacts

25. Gas stiffening may simulate Rigor Mortis with the following features one can easily differentiate it from Rigor Mortis: Putrefactive changes - inflation of tissue spaces by gases, which is not seen in heat or cold stiffening. No particular order of appearance or disappearance as in Rigor Mortis Joints are not tight, so can be moved easily. No muscle shortening as in heat stiffening. Stiffening disappears by incisions over the areas.

26. Rigor Mortis

27. Putrefaction artifacts, animal activity

28. Gas Stiffening , pealing of epidermis- putrefaction

29. Artefacts due to hypostasis • Localised hypostasis may be mistaken as bruise • Hypostasis in dependent part of – • Heart - Resemble Myocardial Infarction. • Lung - Pneumonic or broncho -pneumonic consolidation. • Intestine – suggest corrosion or strangulation. • Stomach – looks like poisoning. • Hypostasis in nails sometime confuses with cyanosis.

30. Hypostasis like bruise Contusion on the back of the body

31. Hypostasis causing colour changes • Refrigeration – pink. • Carbon Monoxide poisoning– cherry red. • Hydrogen Cyanide poisoning – bright red . • Potassium Chromate / Bichromate – chocolate brown . • Phosphorus poisoning – dark brown .

32. Marbling artifacts

33. Hypostasis of lung- looks like contusion

34. hypostasis in refrigerated body: pink color- may cause confusion with that of CO poisoning .

35. Decomposition artefacts

36. Decomposition artifacts

37. Mummification artifacts

38. Saponification artifacts , submerged body

39. Animal induced artifacts – no bleeding or clots

40. ante mortem blisters Decomposition artefacts Postmortem blebs and marbling

41. Artefacts due to post mortem corrosion Gasoline exposure to skin in accidents causes soiling After drying – looks like abrasion or thermal burn

42. Embalming – firearm injury Trochar insertion during embalming – track distortion, false track, detection of direction of fire may become difficult

43. Animal – induced Bodies found in sandy locations, will be invaded by a variety of insects such as ants and beetles. They will produce extensive superficial tissue damage which resemble abrasions . These injuries might be thought to have been produced by dragging of dead over rough ground The lack of linear patterns should be sufficient to exclude dragging injuries

44. Animal induced…… In hidden places, rats, mice , may feed on bodies . Ravenous( hungry) Animals – like fox, jackal, dogs, Buzzards ( turkey vulture), crows and birds – in open places - execute considerable damage, rendering a body almost to a skeleton in a few days, depending on the time of the year and their feeding requirements

45. Artefacts due to animals or insect bites – Rats & rodents – nibbled pale and white wounds – Dogs & jackals – deeper teeth impression like Superficial Stab Injury – Cat bite – small & rounded – by fish, crab etc- In drowned bodies – lips cheek eye lids,genitalia , fingers, toes, muscles of limbs – affected Homicidal ante mortem wounds may be altered by animal activity.

46. Ants, cockroaches bites in moist area ( eyes, lips , axila , etc), brown parchmentised area looks like ante mortem abrasion -------------------------------------------------------------- – Maggots activity – in ante mortem injuries changes stab or gun-shot wounds

47. Post mortem ant bites

48. Ant Bite marks

49. Rodent activity - Gnawing Effect

50. Animal bite resembling stab wounds

51. In drowning cases – aquatic animals body - in water – numerous invaders - cause extensive damage to the soft tissues. Crabs, shrimps and other crustaceans, some fish and sea feeding birds are the common culprits but in tropical water there are many others including turtles and sharks All possibilities - kept in mind ,close examination of the edge of the injuries may reveal characteristic teeth, beak or claw marks

52. Rodent activity

53. postmortem animal activity ( due to large lizard of Srilanka ) No blood clots

54. Animal activity on cadaver

55. Animal activity and fungus formation on cadaver

56. Postmortem vulture eating, appearing like gun shot

57. Gun shot like wound, made by maggots/ putrefaction

58. Animal bite –inner part of thigh

59. Toxicological artefacts : E rroneous results of tests due to Faulty collection technique, site, sample faulty preservation / preservative, time delay in sending and analysis of samples and viscera and Introduction of contaminants to samples . Decomposed and embalmed bodies can have ethanol & methanol respectively.

60. Artefacts due to post mortem bleeding Blood may ooze from torn or cut vessels , after death Post mortem clot is jelly like , can be wiped off easily, but ante mortem clot is firmly adherent to the tissues , cannot be wiped off easily.

61. Kennedy phenomenon and Rayalaseema phenomenon Or inserting a bullet in depths of existing antemortem stab wound over a dead body

62. Kennedy phenomenon- surgeon induced artefacts Surgical – cleaning debridement of gun-shot wounds etc, removes gun powder, and changes the all over character, as in J F Kennedy murder case

63. Artefacts induced by criminals Dismemberment of body parts, mutilation of the body, - after death. Alteration of the ante mortem injuries , to cause confusion to autopsy surgeon. Rayalasema phenomenon Bullet in stab wound

64. artifacts In burns cases

65. Heat ruptures resemble lacerations

66. Heat Stiffening

67. Heat rupture, pugilistic attitude

68. X-ray related Artefacts In a dead body- x-ray for gun-shot bullet, false missile shadow can be found due to, bullet in shirt pocket , bullet not fired, but bullet introduced between shirt folds after death etc.

69. Artefacts during Post Mortem Examination 1. Injury to visceral organs – mistaken as ante mortem injury. 2 . Fracture of skull bones , may continue with a ante mortem fracture, misinterpretation of whole fracture. 3. Hyoid and thyroid fracture during forceful extraction of neck organs. 4. oozing of blood in to the neck during autopsy- ante / post mortem ?- go with blood less neck dissection

70. Autopsy surgeon induced…. while removing the neck organs care must be exercised so as not to fracture the segments of the thyroid cartilage or the hyoid bone. In elderly /debilitated persons - unusual fragility of the bones may cause post mortem fractures - especially the ribs.

71. Medico Legal Importance of artefacts Wrong conclusion as to • Cause of death • Mode of death • Nature of death • Ante mortem or Postmortem wound Unjustified suspicion of foul play misguided direction to investigating officer miscarriage of justice

72. Take home message Interpretation of findings over dead body depends upon the ability, dedication , knowledge and wisdom of the autopsy surgeon. Artefacts may lead to IMPRISONMENT OF INNOCENT AND FREEDOM OF THE GUILTY.

73. Get freedom from confusion

74. Thanking you