An external examination is similar to a (live) physical but obviously a bit more thorough. The remains are looked at from head to foot – literally! We look at the scalp through the hair, we feel the head for lumps and bumps, we check the eyes for petechia, and the mouth for trauma such as a damaged frenulum can be very telling – especially in children and infants when someone has held a hand over the child’s mouth and it struggles against the hand causing the frenulum (that little piece of skin between your front teeth and your gums) to tear. The neck is checked for enlarged glands, thyroid abnormalities, and visible contusions. The torso is checked for palpable rib fractures, lumps, extreme and unusual firmness or large amounts of free fluid. Free fluid in the abdomen can mean an internal injury with internal bleeding or it can be a sign of infection such as ascites or sepsis which can mean a liver or kidney problem or a perforated intestine. We look for signs of sexual assault as well. We look for scars – which can reveal laparoscopic surgery, bypass, hernia, cesarean sections, etc. We look at the lower legs and feet which can reveal peripheral vascular disease and diabetes. We are also looking for scars or fresh needle marks that can reveal a history of drug abuse or in an assault case the use of forced injections. We look for signs of restraint.
The external examination can tell us many things, which we then compare when we do an autopsy to see if the underlying tissues are consistent which what the external showed.