Introduction to Forensic Pathology

FORENSIC PATHOLOGY OFFICER TRAINING COURSE DEPARTMENT OF HEALTH – SOUTHERN DISTRICT Introduction The purpose of the course is to teach the basics of forensic medicine to mortuary technicians with no previous knowledge of the subject. The main emphasis will be on mortuary technique, but related aspects of forensic science will be taught.The course addresses the aspects of forensic medicine that are most frequently encountered in practice, including those that may become the subject of testimony in court. THE AUTOPSY The word autopsy means, â€Å"to look at oneself†. Many other terms are used such as necropsy (to look at the dead) and postmortem (after-death). They all mean the same thing. Autopsies have been performed for a long time, and over the years the value of the autopsy has been proven.It is of use in: Assistance to family – inherited diseases, understanding the death of a loved one, peace of mind Medical Staff – hospitals and doctors can learn abou t diseases, diagnosis and also treatment Justice and Safety and Security – important information for prosecution of cases Social – insurance claims, paternity, maternity, compensation Public Health – infections such as meningitis, tuberculosis Notes: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________________________________________________________________________ Acts Regulating the Performance of Post-Mortem Examinations ACT | AIMS OF ACT | |Health Act 63 of 1977 |Postmortem in cases of contagious and infectious diseases | | |Consent of family not needed | | |Body must be exhumed if buried | | |Deals with transplantation of organs | | |Deals with removal of tissue from deceased | |Inquest Act 58 of 1959 |Procedures to be followed in unnatural deaths | | |Consent of family not needed | | |Report for inquest or criminal case | | |Removal of tissue allowed for investigation purposes | |Births and Deaths Registration Act 51 0f 1992 |Defines births and stillbirths and procedures to be followed | | |Defines conditions where a death certificate may not be issued | |Correctional Services Act 111 of 1998 |Provides for the reporting of prisoners dying of unnatural | | |causes | |Health Professions Act 56 of 1974 |Defines anaesthetic deaths | |Occupational Diseases in Mines and Works Act 78 of 1973 |Provides for patients who worked in mines – heart and lungs to | | |be sent for further testing | | |Permission from family is needed in natural deaths | | |If postmortem being done under another Act (e. g. Inquest Act), | | |then organs may be removed and sent away without consent | Notes: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________ _______________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________ Types of Autopsies The above Acts of law dictate which type of postmortem should be performed. A. The Clinical or Academic autopsy. Performed in terms of the Health Act. Usually performed by histopathologists attached to hospitals. The main indications are: a.Determining cause of death b. Providing correl ation between medical management and symptoms c. Determining the effectiveness of therapy d. Educating students and other health care workers e. Studying disease processes B. The Forensic Autopsy. Performed in terms of the Inquests Act. The objective is to apply medical knowledge to legal questions in the pursuit of justice. Usually performed by forensic pathologists or trained medical officers. a. Determination of cause of death b. Determining the time of death c. Recovering and identifying evidence d. Providing interpretation of findings e. Providing reports for law enforcement and justice Notes: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________ What is Pathology? Just as there are different types of autopsies, there are different types of pathologists. Pathology means the study of disease. Disease is defined as abnormalities in the functioning and structure of the parts of the body.Pathology can also mean the scientific study of the causes and effects of disease. Pathology may be divided into: Histopathology or Anatomical Pathology – this branch of pathology deals with autopsies and examination of changes in tissues using a microscope and other techniques. E. g. If you have a lump under your skin, the doctor can take a small piece of tissue from the lump and send it to the histopathologist who will examine it under the microscope and make a diagnosis and recommend treatment. Chemical Pathology – diseases produce changes in the fluids of the body e. g urine, blood, spinal fluid. These body fluids can be exam ined and diagnoses of disease can be made from the results. E. g.When you are sent for a blood test, the chemistry of your blood is examined by a Chemical Pathologist who may then make a diagnosis. Microbiology – The study of how bacteria and viruses cause disease by examination of body tissues and fluids and isolation of organisms. E. g. pus swabs will be sent to a microbiologist to identify the bacteria causing the disease. The microbiologist will then recommend the appropriate treatment. Forensic pathology – Forensic pathology is a branch of histopathology where a trained pathologist will examine the body and it’s tissues and offer opinions on how trauma has caused disease or disturbance in the body. Forensic pathologists have knowledge of all branches of pathology as applied to death, dying and disease. Notes: ______________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Health and Safety in the Mortuary The mortuary can be a dangerous place. Most dangerous in this environment is the individual who is ignorant of or who ignores the potential hazards at postmortem. Such people are a danger to themselves and others. A. Risks and Hazards a. Tuberculosis Caused by inhaling the agent through the air.It is rare to contract TB through the skin. With the current HIV epidemic, strains of the TB-bacterium that are very resistant to treatment are occurring. This makes contracting the disease a greater risk than before. It has been shown that corpses are more infectious than living patients. b. HIV Although there is fear of acquiring HIV through postmortems, the risk of getting HIV in this way is very low. There is currently only 1 recorded case of occupational-acquired HIV infection in a pathologist. The overall risk of getting HIV after accidental exposure by needlestick is only 0-0. 42%. Splashes of fluids into eyes/mouth carry an infection rate of 0. 04-0. 63%.Aerosol risk (breathing infected air) has not been reported. HIV can be isolated from the cranial bones, brain and spinal fluid up to 5 days after death. No HIV could be isolated from bone dust. HIV is weak once outside the body, and is easily inactivated by a solution of bleach (Jik/Domestos), formalin, alcohol, peroxide or phenol (Jeyes Fluid). c. Hepatitis B and C The way you can acquire Hepatitis B or C is similar to HIV, that is by risky sexual behaviour, intravenous drug use or through accidental occupational exposure. Hepatitis B is very infectious and staff who have not been vaccinated against Hepatitis B should not perform postmortems.Hepatitis C is less infectious, but there is no vaccination against it. The risk of transmission is 3-10%. d. Other diseases Certain viruses and bacteria can cause considerable discomfort for the autopsy technician, but are treatable. Postmortems on patients with haemorrhagic fevers are prohibited unless they are performed in specialised mortuaries. How do you reduce risk? A. Immunisation – all staff involved in autopsies or who come in contact with material from autopsies should be vaccinated against tetanus, poliomyelitis, tuberculosis and hepatitis B. B. Pre-autopsy testing – where there is reason to believe that a corpse is infected with a highly infectious organism, testing should be done before autopsy.HIV-testing in hospital autopsies is appropriate and consent is not needed. C. Clothing – the following should be worn at all times: cap, eye protection, face mask, surgical gowns and clothes, boots, apron and at least one pair of gloves. Wearing too many layers of clothes is dangerous because it makes the technician clumsy and uncomfortable. D. Reduce aerosol f ormation – care should be used when using power saws to open the skull. Intestines should only be opened under water. High pressure water hoses should not be used. Avoid splashing when handling organs. E. Equipment – equipment should be kept to a minimum and should be kept in clear view at all times. Scalpels