Second autopsy: The Indian scenario.

A Medico-legal autopsy is conducted to ascertain the cause of death, time of death, identification of the deceased, etc. in unnatural and/or suspicious deaths. However, the very purpose for which an autopsy is conducted may either not be served or appear to be poorly served in many a cases. In such times, another autopsy is requested and conducted on an already autopsied body commonly known as second autopsy. Rules are still unclear & varying for medico legal autopsy at different places resulting in unwarranted issues. This has resulted in a surge seen in cases of second autopsy or re-postmortem examination. With no rules governing the conduct of even a second autopsy and the sorry state of medico-legal autopsies as such in India, a lot of issues, wanted and unwanted, creep up while conduct of a second autopsy. An effort is made to draw attention towards the issues associated with the conduct of a second autopsy in India and few suggestions proposed to overcome those difficulties.

Age related changes in mechanical and thermal injuries: A post mortem study.

Dating of an injury in both living and dead is an important medico-legal issue in the field of crime investigation to fix the liability. A doctor is required to date injuries specifically and individually while preparing an injury report. In this paper we study the sequential changes in mechanical and thermal injuries and to compare the findings with available standard data. All the medico-legal deaths due to injuries, brought for post-mortem examination, over a period of four months were studied. On comparing with standard data, 71% (n=32) of the abrasions were dark red instead of bright red on first day. 92% (n=13) bruises appears bluish green instead of red colour on first day and on the 5th day, the colour appears black instead of greenish colour. In cases of incised and lacerated wound margins were difficult to separate on the 2nd day, instead of separating easily. Observations of this study did not match with the sequential colour changes mentioned in the available literature. Therefore, other parameters need to be explored for dating an injury.

A study on appraisal of effectiveness of the MCCD scheme.

Medical Certification of Cause of Death [MCCD] scheme was proposed by WHO as an imperative tool to obtain scientific and reliable information in terms of causes of mortality. It was accepted by the Government of India with suitable incorporations made in The Registration of Births and Deaths Act, 1969[1]. A cross sectional study was done with an objective to appraise the completeness and accuracy in filling up of these certificates as per the prescribed guidelines and subsequently assess the success of the MCCD training scheme. Information was collected on the various components of the cause of death certificate in all cases brought for autopsy over a period of two year and statistical analysis done. Results of the study reflected that there was a conflict of opinion and understanding as to the meaning of the terms „causes of death‟, „modes of death‟, and „manners of death‟ among the doctors. Extra effort needs to be put forth to educate and generate awareness regarding complete and accurate filling of the forms and to make them understand the very purpose of MCCD scheme, else it won’t serve the very purpose for which it was introduced. Also the lacunae in the scheme that exist need to be addressed.

Gastric contents in respiratory tract a diagnostic dilemma at autopsy.

Gastric contents in the respiratory tract are commonly found at postmortem in acute alcoholism, occasionally during a fit of epilepsy and in dead bodies that have started decomposing. Quite infrequently it may be found in fresh bodies that have undergone sudden unexpected and unattended death leading to a dilemma as to the real cause of death with dearth of any other substantial evidence. Dead body of a 36-year-old lady was brought for post-mortem examination with history of unattended and unexpected death while taking bath after her afternoon meal. On gross and histopathological examination, there was no significant finding in the cardiovascular system but respiratory tract contained gastric contents with histopathology confirming vegetable matter in the terminal bronchioles. The conflicting literature on the difference between antemortem aspiration and postmortem spill of gastric contents into the respiratory tract led to a dilemma as to the real cause of death in present case. Dilemmas of the case with difficulties in diagnosis are being presented herewith.

Partial postmortem negligence or.

Dead body of a 16-year-old female was brought for postmortem at the mortuary of New Civil Hospital, Surat from a nearby district. The body had been subjected to a medicolegal postmortem a day before at a local hospital. But the relatives suspecting foul play in the postmortem asked for a re-postmortem by Forensic Experts at New Civil Hospital. The second postmortem revealed no foul play yet raised many a questions to be answered. The details are discussed in the paper that needs sincere thought.

Fatal gastro-intestinal bleeding: A complication following spinal injury.

On 30.08.2003, a 20-year-old boy met with a vehicular accident and sustained spinal injury and left upper limb fracture. He was immediately hospitalized and seemed to recover well after treatment for a period of 15 days, when just before discharge he suddenly had hematemesis and bleeding per rectum and succumbed within another 24 hours. The case is discussed in detail.