Keywords

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

The removal of a body from a grave (exhumation) requires legal authority, often in the form of a court order. Next of kin may also have a prior right to be heard. Exhumation may be deemed necessary either in cases where a court order was not issued in a timely fashion around the time of death or if new evidence justifying exhumation has since come to light. Since it is often the case that particular questions require clarification, it is important to establish in advance whether exhumation is an appropriate approach to answering these questions.

The utility of exhumation varies greatly depending on the period of time a body has spent in an inground grave (burial time). It may be possible to detect poisoning many years after burial—depending on the preservability of the poison—particularly in the case of heavy metals. Hair analysis also offers the possibility of confirming regular use of medications such as ß-blockers.

Many relevant factors are unknown prior to exhumation, and in most cases, it is impossible to safely determine them retroactively. Exhumations are typically performed to clarify cause of death and determine identity in cases of intoxication, suspected homicide, medical malpractice, or accidents, including traffic accidents. The authorities concerned are often interested in those findings which can be reasonably expected from exhumation, depending on both the nature of the diagnostic question being asked and the specific length of time since burial.

5.1 Macroscopic Findings on Exhumation

The conditions prevailing in an earthen grave can differ significantly and may vary to a considerable degree according to the climate zone and time of year. Although groundwater level is avoided when the depth of a grave is determined, water may nevertheless accumulate in the case of prolonged rainfall, with the result that a body may need to be recovered from a water-filled casket (Fig. 5.1).

Fig. 5.1
figure 00051

Exhumation from a water-filled casket following prolonged rainfall

Full size image

It is often possible to make numerous findings after exhumation despite factors such as autolysis, putrefaction, possible animal predation, fungal colonization (Fig. 5.2), mummification, adipocere, and artifacts (e.g., caused during body recovery). There is no linear correlation between postmortem interval and the detectability of findings, which depends far more on ambient conditions and the diagnostic question being posed. A body may have undergone decomposition to an extent that it is no longer possible to make a targeted assessment.

Fig. 5.2
figure 00052

Extensive whitish-gray fungal colonization following a burial time of 7 months

Full size image

In the case of a naturally mummified body, putrefaction, autolysis, as well as possible animal predation and mummification processes take place simultaneously. When this is the case, mummification, that is to say, the drying out of tissue, inhibits other decomposition processes. Brain tissue often takes on a pulp-like consistency within days or weeks, making a differentiated assessment impossible (Fig. 5.3).

Fig. 5.3
figure 00053

Brain tissue that has undergone pulp-like transformation (burial time, 7 weeks)

Full size image

However, important findings such as extensive intracranial or intracerebral hemorrhage may be detectable for longer periods of time. Lack of water tends to slow down autolysis and putrefaction; this can mean that the internal organs of a body may undergo complete decomposition, while the outer layer, in particular the skin, remains preserved by the mummification process, especially in cool, dry ambient conditions. The surface of the body is dry and rigid and has a light brown-ocher color (Fig. 5.4).

Fig. 5.4
figure 00054

Burial time, 6 years. (a) Mummification in dry, cool ambient conditions with brown-ocher-colored drying and stiffening of the body surface. (b) Partial involvement of the extremities, including hands and fingers, in the mummification process

Full size image

In the case of mummification, skin injuries such as incision and stab wounds as well as gunshot wounds can still be detected after long burial times. Even larger wounds and hemorrhage are identifiable in mummified bodies if subcutaneous soft tissue can be well visualized (Fig. 5.5). Dental findings, including evidence of dental treatment, can be made after significantly longer burial times (Fig. 5.6).

Fig. 5.5
figure 00055

Soft tissue dissection of the back in a partially mummified body (burial time, 1.5 years); anatomical structures can be well visualized

Full size image
Fig. 5.6
figure 00056

Dental status on exhumation following a burial time of 1.5 years

Full size image

Adipocere. This refers to the transformation of body fats into adipocere. Fatty tissue either undergoes an oily transformation or becomes a greasy waxlike mass that eventually dries out and hardens with time to the consistency of chalk, particularly under dry-air conditions. Once adipocere has formed, it may be difficult, if not impossible, to detect findings in internal organs; injuries, on the other hand, can remain well identifiable. Table 5.1 lists a selection of macroscopic findings that can still be made even after prolonged postmortem intervals.

Table 5.1 A selection of pathomorphological findings correlated with burial times
Full size table

Even after exhumation, it is possible to differentiate between ante- and postmortem injury and changes to a body. Postmortem artifacts include injuries caused by a primary event (e.g., fire-related artifacts such as heat fractures), postmortem transport, as well as the breaking open of a casket lid and other changes related to the recovery of a body from a grave. Depending on the deceased’s prior history, injury may have been caused by previous attempts at resuscitation, e.g., serial rib fractures. Other types of postmortem damage develop according to the postmortem interval, such as autolysis of the pancreas, gastric wall rupture and escape of gastric contents, rectal prolapse due to gas buildup in the abdomen, and hypostatic accumulation of blood. Internal organs gradually lose their color to become dirty reddish brown, e.g., the vascular intima throughout the body. Depending on the position of the body, lesions such as extensive petechiae or ecchymoses may be seen, particularly in the head, neck, and shoulder region in the case of a head-down position.

5.2 Histological Findings on Exhumation

Histological and histopathological findings following prolonged postmortem intervals have been the subject of several investigations in the past (Table 5.2). The detection of usable microscopic findings depending on the postmortem interval, especially in the context of exhumation, is by nature temporary and reliant on many factors. Thus, methods of forensic–histological diagnosis are limited in the presence of autolysis and putrefaction, being only of modest use, for example, in autopsies on bodies taken from mass graves. In the case of mummification, on the other hand, tissue and organoid structures, as well as potential pathological findings, can be seen microscopically for a significantly longer period of time as compared with in the presence of autolytic and putrefactive processes. However, microscopically, numerous problems of differentiation are encountered, for example, when distinguishing tubular necrosis in the kidney from purely autolytic changes. Detecting acute myocardial infarction can also be challenging and is only possible for a limited period of time. Finally, structures are prone to various autolytic processes in the postmortem period. Leukocytes and nuclei of granulocytes are seen as exceedingly resistant to autolysis and putrefaction. Evidence of bronchopneumonia could be shown following exhumation even after 392 days. Others have diagnosed confluent bronchopneumonia after a postmortem interval of 95 days. However, there is no specific sequence or timeline for changes to internal tissues and organs resulting from autolysis and putrefaction, nor can a fixed time or period of time be determined for single organs. In general, the uterus is considered to be an organ relatively resistant to putrefaction.

Table 5.2 Detectability of selected histological findings subject to postmortem periods according to data in the literature
Full size table

5.3 Chemical–Toxicological Analysis Following Exhumation

Experience with a number of poisons or types of intoxication has been gained in terms of potential toxin detection following prolonged burial times (Table 5.3). This process involves taking very particular specimens, such as the bottom boards of a casket, casket fittings, and soil samples from above, below, beside, and at some distance from the casket. For autopsy purposes, samples of the following, where available, should be taken for chemical–toxicological analysis:

Table 5.3 Toxin detection following exhumation
Full size table

  • Blood (cardiac blood, femoral vein blood)

  • Liver sections

  • Kidney sections

  • Lung sections

  • Brain sections

  • Bile fluid

  • Gastric contents

  • Intestinal contents, subdivided into small and large intestine contents

  • Muscular system

  • Fatty tissue (particularly in the case of volatile gases such as anesthetics)

  • Hair

  • Finger- and toenails

  • Vitreous fluid

  • Synovial fluid (knee joint)

  • Cerebrospinal fluid

Gaining information on poison concentrations from chemical–toxicological analysis following exhumation is problematic, since although it is still possible to identify a poison as such, the postmortem metabolization of toxic substances needs to be taken into account. Thus, drawing conclusions about fatal intoxication should be done so with caution and only when all other facts have been taken into consideration.

5.4 Exhumation of Mass Graves

A distinction is made between mass graves intended as a final place of burial and those intended as a temporary measure. Mass graves are usually created when there are large numbers of deceased, and these numbers, combined with external circumstances or time considerations, prohibit normal burial.

Most notably in postwar periods (including civil war), and especially in the case of possible war crimes, there is a desire to remove the deceased expediently. Typically, bodies are randomly placed in large pits and possibly also strewn with quicklime to accelerate the process of decomposition. Mass graves of this kind are usually opened and mass exhumations undertaken as part of criminal proceedings at the International Criminal Court in the Netherlands. In addition to identifying victims, it is also important to establish the cause of death in each individual case. As the time interval between death and exhumation increases, it becomes ever more challenging to assign individual body parts or bones to the relevant individuals.

It is not uncommon in the case of terrorist attacks, serious accidents such as air crashes and ferry disasters, as well as natural disasters like earthquakes, floods, and tsunamis for the sheer number of bodies to vastly exceed normal cooling and storage capacities. In such cases, creating temporary mass graves may be the only option available. However, this type of mass grave is created in a well-ordered manner to facilitate, as far as possible, the later exhumation and examination of the deceased.