Examination and Investigation After Brought Dead (BD) to Casualty

1. Immediate Classification as a Medico-Legal Case

• Accidents (traffic, machinery, falls), assault, poisoning, sexual offences, burns, comatose patients
• Sudden/unexpected deaths, suicides, homicides, infanticide
• Deaths under anesthesia or during surgery, drug mishaps, suspicious deaths
• Cases referred by police or court

The Essentials of Forensic Medicine and Toxicology, 36th ed. (2026)

2. Examination of the Body

A. Confirm Death - Signs of Death

• Pallor and loss of skin elasticity
• Eye changes:
  • Tache noire (brown/black desiccation band on exposed sclera in open eyes, within 1-4 hours)
  • Flaccidity of eyeball - intraocular tension drops to <12 g shortly after death, becomes nil at 2 hours
  • Pupils initially dilated (relaxation of iris muscles), later constricted with rigor
  • Pupils react to atropine and eserine for ~1 hour after death but not to light
  • Kevorkian sign (segmentation/trucking of retinal blood columns - visible by ophthalmoscope within minutes)
• Primary flaccidity of muscles (lasts 1-2 hours)
• Cooling of the body (algor mortis)
• Postmortem lividity (livor mortis)
• Rigor mortis (sets in 2-6 hours)

The Essentials of Forensic Medicine and Toxicology, 36th ed. (2026); Parikh's Textbook of Medical Jurisprudence

B. General External Examination

1. Identification - Note at least two individualistic identification marks (mole: color, size, shape, raised/hairy, location; scar: color, shape, margin)
2. Age, sex, build, nutritional status
3. Clothing - Note condition, stains, tears, appropriateness to season
4. Injuries - Describe systematically (type, size, shape, location, edges, color, depth). Do NOT disturb wounds if brought dead
5. Rigor mortis and lividity - Distribution and fixation help estimate time of death
6. Signs of decomposition if any
7. Any specific features suggesting cause of death - smell (alcohol, cyanide, organophosphate), color changes (cherry-red in CO poisoning), froth at mouth (drowning, organophosphate), ligature marks, track marks

Per the textbook: "If a person is brought dead to the hospital, do not examine the wounds; inform the police and do not hand over the body to the relatives." - The Essentials of Forensic Medicine and Toxicology, 36th ed.

3. Documentation

• Accident Register (AR): Record name, address, date/time of arrival, who brought the body, and general external findings. Mark all entries as MLC
• Death note: Fill the death certificate form or note on outpatient ticket without stating the cause of death
• Do NOT issue a death certificate in any of these situations:
  • Body brought dead
  • Crime already registered by police
  • Police already informed
  • Cause of death unknown
• All X-ray and lab forms must be labelled "MLC"
• Over-writing, erasures, and obliterations must be avoided; corrections should be struck through with a single line and initialed

The Essentials of Forensic Medicine and Toxicology, 36th ed. (2026)

4. Police Intimation

• Immediately inform the police having local jurisdiction - this is mandatory
• Do NOT release the body to relatives until police permission
• Autopsy is at the discretion of the police, not the doctor
• The body must be accompanied by:
  • Dead body challan (requisition from investigating officer)
  • Inquest report / Panchnama (history, circumstances, police opinion)
  • FIR copy (if available)

Parikh's Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology

5. Investigations

P.C. Dikshit Textbook of Forensic Medicine and Toxicology; The Essentials of Forensic Medicine and Toxicology, 36th ed.

6. Body Preservation and Handover

• Store the body in the mortuary under proper identification
• Do not bathe, clean, or disturb the body
• Tag the body with identification number
• Clothing and belongings are to be documented and preserved as evidence
• Release the body only on police orders, with proper documentation
• The body is sent for medico-legal autopsy (postmortem examination) to determine cause of death

Summary Flowchart

Body Brought Dead to Casualty
        |
        v
Register as MLC → Assign MLC Number
        |
        v
Confirm Death (clinical signs + ECG if needed)
        |
        v
External Examination (don't disturb wounds)
        |
        v
Documentation (Accident Register, no cause of death in certificate)
        |
        v
Inform Police Immediately
        |
        v
Investigations (toxicology, imaging as needed)
        |
        v
Preserve body, clothing, evidence
        |
        v
Do NOT issue Death Certificate / Do NOT release body
        |
        v
Await Police Instructions → Send for Medico-legal Autopsy

1. Do NOT examine wounds in detail - preserve for autopsy
2. Do NOT issue death certificate
3. Do NOT hand over body to relatives without police permission
4. ALWAYS inform the police
5. Treatment of living patients takes priority over medico-legal formalities, but for BD cases, confirm death and inform police first