External examination of the dead body is extremely important as most evidences related to death are present above the surface. Proper and meticulous external examination can provide the investigator with important information which when corroborated with other details, can give bigger picture regarding the scenario of death.
Without impatience, a doctor must spend a significant amount of time for careful examination of the body surface.
A Procedural baseline, which can be adjusted depending on types of case, is given below:
- Following confirmation of identity, clothes are examined first. Any stains, contents, tears or cuts must be noted. In case of unidentified bodies, labels and size of the clothes must be documented to assist with identification. Apparent age of the individual should be recorded to be compared with legal documents. Changes in skin elasticity, discoloring of hair, senile hyperkeratosis, tooth loss, arthritic changes and arcus senilis are some factors that help in estimating the age group of an individual.
- Build of the patient is assessed by measuring length of the body. The length should be measured in centimeters or inches, from top of the head to heel. Body weight is measured in kilograms and should never be estimated to assess his/ her nutritional status, leanness, dehydration, edema, emaciation or obesity.
- State of cleanliness like personal hygiene is assessed by examining hair and beard length, state of nails and presence of fecal or urinary soiling. Parasitic infestations, if any, should be noted. Any dried stains must be examined and recorded mentioning the location. Skin color should be noted and must not be confused with color change due to hypostasis, congestion or generalized contusions. Any physical deformities of the deceased must be noted as well.
- For identification, marks of identification like moles, birthmarks, etc. should be documented. Acquired marks like tattoos, scars, fracture resulting in deformity, circumcision, scars of hesitation – parallel cuts over forearms, amputation etc. must be recorded. Any artefacts created on the body due to therapeutic endeavors must be differentiated and all other signs of treatment must be clarified through documentation.
- Vomitus, froth or blood if present at nose, ears or mouth, must be recorded and assessed after cleaning, to find the source. Purging of fluid must be recorded after distinguishing it from bleeding. Vaginal discharge, presence of sanitary pads and tampons must be noted in case of females. Ejaculation of semen after death is a common postmortem phenomenon and should not be related to sexual activity before death.
- Degree of rigor mortis developed over the body must be accessed by flexing all major joints of hands and legs. Livor mortis is assessed over depended parts of the body, and the site, color and fixity documented.
- Hands should be carefully examined to document injuries like defense wounds or marks of electrocution. Suicide notes held tightly in hands may have gone unnoticed at the scene of death and may be found during autopsy. In case a fist cannot be opened, incising the flexor tendons at the wrist can help open it.
- Recording injuries is the primary element of investigation in forensic cases. The injuries must be carefully examined and recorded in convenient body diagrams. Stage of healing must also be examined and documented. The color of injury may assist in estimating the age of injury as well as the stage of healing.
- The wound must be identified and further differentiated into abrasions, contusions, lacerations, incised wounds, stab wounds, burns etc. The shape and size of the injury must be noted. Condition of margins, borders, and base should be examined and documented where necessary. The location of the injury, orientation to axis of the body, and position should be documented in reference to surface anatomical landmarks. In case of burn injuries, which are widespread, ‘Rule of Nine’ should be applied.
- Injuries over the head are crucial part of external examination. Due to cushioning effect of scalp hair, especially in females, injuries like contusions usually tend to be hidden. It is important to shave the hair before examining the scalp for injury. This will provide a clear picture of the wound, along with margins and depth. Any artefacts created during shaving must be documented and differentiated from ante-mortem injury.
- Careful examination of eyes to look for petechial hemorrhages, condition of conjunctivae and sclera is a must. Petechiae should also be sought behind the ears and in the skin of the face, especially around the mouth, chin and forehead. Size of pupil may be useful in cases related to poisoning. Any defects like cataract, vitreous hemorrhage etc. should be noted.
- Examination of oral cavity may reveal false teeth, foreign bodies, remnants of ingested drugs, bitten tongue etc. In child abuse cases, injuries to frenulum of lips and gums are a common findings and should be explored. Erosion or corrosion of mucous membrane of oral cavity may be suggestive of recent ingestion of irritants or poisons.
- Bleeding may be seen from nose, mouth and ears in head injuries. Frothy blood tinged fluid is seen in deaths due to drowning and in pulmonary edema. Leakage of CSF should be accessed in case injury is located in deeper parts of ears and nose.
- Examination of male genitalia explores any disease condition or injuries whereas examination of female genitalia is of a greater forensic value.
- Routine examination of the male genitals includes general inspection of the penis, glans and scrotum, with palpation of the testes. Circumcision should be noted. Examination of anus can reveal injuries in case of sodomized victim. Flaccidity of anal sphincter after death should not be used to indicate sexual activity. Sexual abuse should not be opined without the presence of fresh mucosal tears (rule out severe constipation) or presence of semen.
- Examination of the vulva and vagina should be done regularly to exclude sexual interference or diseased condition. A detailed examination is carried out in case of death following sexual abuse.