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Steps of Medico-Legal Autopsy

Source: The Essentials of Forensic Medicine and Toxicology, 36th edition (2026)

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Step 1 - Preliminary / Pre-Autopsy Procedures

A. Receipt and Identification of the Body

• The body must be labelled immediately on arrival at the mortuary
• Identification is done by the accompanying police constable AND relatives of the deceased
• The names of identifying persons must be recorded
• In unidentified bodies: marks of identification, photographs, and fingerprints are taken

B. Requisition and Legal Authority

• Autopsy is conducted only after receiving a requisition from a Magistrate (or competent authority)
• The medical officer must have proper legal authority before proceeding

C. Location

• Must be performed in a mortuary - never in a private room
• Exceptions: advanced putrefaction making transport difficult, or when immediate on-site examination is essential

D. Timing

• Performed as soon as possible after receiving requisition, without undue delay
• Ideally conducted in daylight - color changes (jaundice, bruises, PM staining) cannot be appreciated in artificial light
• If body arrives late: preliminary external examination done that evening; full autopsy the next morning
• Decomposed/homicide cases should not be done at night

E. Pre-Autopsy Review

• Medical officer reads the inquest report carefully to know the apparent cause of death
• All available details obtained: case sheets, accident register, previous medical records
• This guides directed attention during the exam and selection of appropriate investigations (toxicology, microbiology, radiology, etc.)
• Review helps identify: sutured wounds, surgical incisions through injuries, therapeutic wounds (tracheostomy, chest drains), resuscitation artefacts, operative procedures

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Step 2 - External Examination

A. Clothing and Ornaments

1. List and examine every garment - type, color, consistency, size, manufacturer's label, laundry marks
2. Note tears, disarrangement of buttons/zips (indicating struggle), burn marks, bullet holes, blood or poison stains
3. Remove clothing carefully without additional tears; cut only along seams if necessary, away from bullet holes
4. Collect trace evidence (hair, fibers, glass, sand, vegetation) with forceps, seal and hand over to police
5. Wet clothing: hung to dry - do not heat-dry; do not fold while wet
6. Each article sealed in separate bags and handed over to police
7. Describe ornaments by type, design, and color

B. Nail Scrapings and Trace Evidence

• 10 separate labelled envelopes (one per finger)
• Apex of folded filter paper or cut matchstick run under nail
• Avoids contamination with deceased's own blood/epithelium

C. Body Surface Examination

• Age, sex, build, nourishment, height, weight
• Postmortem changes: lividity (site, color, fixation), rigor mortis (extent), decomposition stage
• Identifying features: complexion, hair color/length, eye color, scars, tattoos, deformities, implants
• Injuries: describe every wound - site, size, shape, margins, direction, depth, foreign material; all noted before cleaning
• Skin color changes: jaundice, pallor, cyanosis
• Natural orifices: examine mouth, nose, ears, eyes (conjunctival petechiae, corneal clarity), genitalia, anus

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Step 3 - Internal Examination

A. Standard Incision: The "Y-incision" (or "I-incision")

• A Y-shaped incision runs from both shoulders to the sternum, then straight down to the pubic symphysis (or a midline incision from chin to pubis)
• Skin and subcutaneous tissue are reflected; chest muscles stripped; sternum and costal cartilages removed with rib cutters/saw

B. Thoracic Cavity

1. Inspect before disturbing - look for blood, air (pneumothorax), fluid (hemothorax, pleural effusion)
2. Lungs: weight, color, consistency, pleural surface, cut surface; note collapse, consolidation, embolism
3. Heart: pericardium opened; note fluid/hemopericardium; heart weight; coronary arteries opened; myocardium examined (infarcts, fibrosis); valves and chambers
4. Great vessels: aorta, pulmonary vessels

C. Abdominal Cavity

1. Inspect before disturbing any organ - note blood, pus, or other fluid; measure quantity
2. Peritoneum: adhesions, congestion, inflammation, exudation
3. Note fat in mesentery and omentum
4. Observe abnormalities of organ position; old operation sites; pathological processes
5. Liver, spleen, kidneys (each measured, weighed, cut surface examined), adrenals, pancreas, stomach, bowel
6. Stomach: contents removed and preserved for chemical analysis; note smell, color, quantity, nature of contents
7. Injuries: describe course, direction, depth, structures involved; identify and label foreign objects (bullets, knife fragments)

D. Neck Dissection

1. Block (12-20 cm high) placed under shoulders to extend the neck
2. Skin incised immediately deep to platysma
3. Subcutaneous dissection up to lower jaw, laterally to clavicle
4. Sternomastoid freed from clavicular/sternal attachments and reflected bilaterally
5. Omohyoid, sternothyroid, thyrohyoid muscles exposed and reflected
6. Thyroid gland and carotid sheaths freed by blunt dissection
7. Larynx, trachea, pharynx, and oesophagus examined
8. Hyoid bone and thyroid/cricoid cartilages examined for fractures (important in strangulation)
9. Vertebral vessels and spinal cord may be examined

E. Skull and Brain

1. Scalp incision: coronal incision from ear to ear behind the vertex
2. Scalp reflected anteriorly and posteriorly
3. Skull examined for fractures before opening
4. Calvarium removed with oscillating saw or hand saw (Stryker saw preferred)
5. Dura examined - epidural/subdural hematoma noted
6. Brain removed by sectioning cranial nerves, tentorium, brainstem
7. Brain examined for: weight, lacerations, contusions (coup/contrecoup), herniation, haemorrhage (intracerebral, subarachnoid), tumors
8. Posterior fossa/cerebellum/brainstem examined
9. Spinal cord: if indicated, vertebral column opened posteriorly

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Step 4 - Organ Removal and Examination

• Virchow technique: each organ removed individually
• Rokitansky technique: organs removed en bloc
• Letulle technique: all organs removed in one mass

• Weighed and measured
• External surface examined
• Cut surface examined in systematic slices
• Sampled for histology when indicated

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Step 5 - Collection of Samples / Preservation of Viscera

• Samples sealed in airtight containers with preservatives (saturated NaCl for most; no preservative for alcohol estimation)
• Labelled with case number, date, body part, and sealed in presence of police

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Step 6 - Documentation Throughout

• Both positive AND negative findings recorded
• Verbatim dictation by assistant or voice recorder during examination
• Sketches/diagrams of injuries drawn
• Photography: mandatory for all injuries, foreign bodies, and unusual findings; include a scale
• Photographs used to correlate external and internal injuries

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Step 7 - Reconstruction of the Body

• After completion, body is reconstructed as far as possible
• Organs replaced (or retained if required as exhibits)
• Body sutured
• Body released with proper documentation

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Step 8 - Post-Autopsy Report (PM Certificate)

1. Personal data (name, age, sex of deceased; case/police reference numbers)
2. Date, time, place of autopsy
3. Identity of deceased (how established)
4. External examination findings
5. Internal examination findings (systematic, organ by organ)
6. Samples taken and preserved
7. Opinion on:
   • Cause of death (immediate, antecedent, underlying)
   • Manner of death (natural, accidental, suicidal, homicidal)
   • Time since death (postmortem interval)
   • Any other medico-legal opinion (weapon involved, injuries ante- vs postmortem, etc.)

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Summary Sequence (Mnemonic: R-E-I-S-D-R-R)

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