**2.1 Identification**

The first step to any examination is to determine the identity of the individual. This can be carried out by law enforcement (who are usually the first responders to the death scene), or by the presiding Coroner or Medical Examiner. Thus, by the time the body arrives in the morgue, the identity has been determined.

Establishment of identity can occur through various methods. The degree of certainty is best classified as definitive, presumptive, or speculative. Definitive

identification is legally sufficient, and it is based on the objective comparison of antemortem and postmortem information. This includes visual recognition (most widely used method of identification), fingerprints, dental record comparison, radiographs/unique anthropomorphic features and/or surgical devices (somewhere serial numbers can be obtained), and deoxyribonucleic acid (DNA) analysis. Presumptive identification is when positive identification has more likely than not been established. This includes recognition of clothing, unique tattoos, scars, birthmarks, or items at scene such as various papers, medication bottles, or identification bearing the decedent's name. Speculative identification is an initial guess, which carries the lowest degree of certainty. In many instances, not one but many methods based on the circumstances surrounding the death, investigation of the scene, and examination of the body are used to accumulate sufficient evidence that points to the decedent's identity [6]. Various special techniques such as artist's sketches and reconstruction methods (forensic sculptors, computer programs) can also be employed in selected circumstances [7, 8].

#### **2.2 External examination**

External examination begins by obtaining measurements of height and weight without clothing, and any other features that may help with documentation (such as arm span, foot length, center of gravity from umbilicus to heel, etc.). Medical interventions should be documented, such as endotracheal tubes, intravascular catheters, penetrating tubes or wires. The descriptions should preferentially involve assessments of proper positioning of interventions through markings that are visible externally, as well as externally visible injuries associated with the interventions.

The overall appearance and assessment of nutritional status are also documented. Postmortem changes are assessed, which include the degree of rigor mortis, the distribution of livor mortis, and any other postmortem changes that may be present (decompositional changes of various degrees).

The rest of the external examination can be carried out in various orders depending on personal practice, but a logical way would be to start from the top of the head. The quality and distribution of hair over the head are recorded, together with observations of the scalp including skin conditions and/or injuries. The facial features are then documented, including descriptions of the eyes, ears, nose, mouth, and palpation of the bones of the face to identify any fractures underneath. Description of the eyes should include the color of the irides, and examination of the sclera and palpebral conjunctivae for any discoloration (e.g., scleral jaundice) and/or petechial hemorrhages. Evaluation of pupillary sizes after death is not indicative of their ante-mortem appearance due to early changes after death [9].

Examination of the neck should include documentation of any abnormal markings and injuries that may suggest self-harm and/or criminal actions. If injuries are suspected, a layered neck dissection procedure should be performed in a bloodless field (see Section 4 below).

Examination of the extremities aims to look for any deformities that may suggest acute or previous injuries, and scars or markings that may add to the social history (such as scars on the wrist in cases of self-harm, or track marks in cases of intravenous drug use). In certain criminal investigations, fingernails can be clipped and submitted for further testing that may link the victim to the assailant.

Examination of the torso follows, with documentation of overall size and shape that may suggest underlying diseases (such as a barrel chest in chronic obstructive

pulmonary disease) and/or injuries (such as a flail chest in multiple rib fractures). Examination of the torso also includes the back, which is ideally performed with the body positioned prone on the table. Again, documentation of any abnormalities that may suggest disease or injuries is done, and the anus is also examined for any abnormalities.

The body is then positioned supine, lying on a block between the shoulder blades, and the internal examination can begin.

### **2.3 Internal examination**

There are several ways of incising into the skin to expose the underlying structures. The most commonly employed skin incisions include the Y-shaped incision, the modified Y-shaped incision, and the I-shaped incision. The Y-shaped incision goes from the tips of the shoulder on each side obliquely down, joining at the middle of the chest, roughly between the nipples, and the incision is then continued down vertically along the midline of the front of the body, stopping at the pubis. The modified Y-shaped incision is when the top most incisions start from behind each ear down the sides of the neck toward the middle of the chest. The I-shaped incision is a single straight vertical incision that goes from the top of the neck down the midline of the front of the body to the pubis [10, 11].

The skin is then peeled back from the underlying bones, by cutting roughly parallel to the skin surface along the subcutaneous layer of soft tissues. The chest plate is removed by first separating the sternoclavicular joints, and cutting the ribs near the anterior costochondral junctions, preferably cutting through the cartilaginous parts so that the cut edges are relatively dull to reduce risk of injury during subsequent evisceration.

There are several techniques for evisceration (the removal of organs from body cavities) [12, 13]. The technique of Virchow employs removal of body organs one after another. This technique is good for demonstrating pathology in individual organs, but the relationships between various organs may be hard to interpret. The technique of Letulle or the en masse technique is when the cervical, thoracic, abdominal, and pelvic organs are removed as one mass, and then subsequently dissected into organ blocks. This technique is good for preserving vascular supply and relationships between organs. However, the organ mass is sometimes awkward to handle, and an assistant may be required to help with handling. The technique of Ghon or the en bloc technique is where the cervical and thoracic organs, the abdominal organs, and the urogenital system are removed as separate organ blocks. This is a mixture of the Virchow and en masse techniques, allowing the preservation of anatomical relationship sufficiently while enabling one person to execute without an assistant. Finally, the technique of Rokitansky consists of in-situ dissection combined with en bloc removal.

The organs are then examined individually, and any diseases and/or injuries are documented. During examination, sections of organs may be submitted for subsequent microscopic examination (see Section 5.1 below).
