Forensic Pathology for Police, Death Investigators, Attorneys, and Forensic Scientists (eBook)

Dedication 6
Foreword 8
Acknowledgements 10
Contents 14
About the Author 26
Part I Introductory Topics 27
1 Introduction to Pathology 28
Disc Image Legends 40
Selected References 40
2 Introduction to Forensic Sciences 41
Overview 41
Chain of Custody 42
Admissibility of Tests, Evidence and Testimony 42
Expert Witness 42
Forensic Science Disciplines 43
Forensic Pathology 43
Forensic Anthropology 43
Forensic Odontology 43
Forensic Entomology 44
Forensic Toxicology 46
Forensic Psychiatry 46
Trace Evidence 46
Firearms and Toolmarks Examiners 48
Document Examination 49
Fingerprint Evidence 50
Serology/DNA 51
Other Disciplines 53
Disc Image Legends 56
Selected References 56
3 Introduction to Forensic Pathology 58
Overview 58
Duties of the Forensic Pathologist 59
Investigation 60
Autopsy 60
Verification of Identity 63
Documentation of Findings 63
Death Certification 64
Testifying 64
Consultation 65
Training and Qualifications of Forensic Pathologists 66
Disc Image Legends 69
Selected References 70
4 Death Investigation 71
Introduction 71
Death Investigation Systems Within the United States 72
Overview 72
Jurisdictional Issues 73
Coroner Systems 73
Medical Examiner Systems 74
Mixed Systems 75
Duties of Death Investigators 75
Overview 75
Initial Investigation 76
Scene Investigation 77
Follow-up Investigation 82
Grief Counseling 83
Disc Image Legends 83
Selected References 84
5 Death Certification 85
Introduction 85
Death Pronouncement 88
Cause of Death 90
Manner of Death 93
Disc Image Legends 101
Selected References 101
6 Overview of Anatomy and Physiology 102
Introduction 102
Overview 102
Gross Anatomy 103
Histology 111
Physiology 112
Body Regions and Compartments 113
Specific Organ Systems 113
Integumentary System (Skin) 113
Musculoskeletal System 115
Nervous System 118
Cardiovascular System 125
Respiratory System 127
Gastrointestinal System 129
Hepatobiliary System 132
Reticuloendothelial System (Including the Immune System) 134
Endocrine System 137
Genitourinary System 141
Special Sensory Structures 143
Disc Image Legends 145
Selected References 147
Part II General Topics in Forensic Pathology 148
7 The Postmortem Forensic Examination/Autopsy 149
Introduction 149
Forensic Versus Hospital Autopsies 150
Investigation 153
External Examination 154
Internal Examination 157
Ancillary Procedures 173
Autopsy Report 174
External Examination Only (Without Autopsy) 176
After-the-Fact and In-Absentia Cases 177
Autopsy Assistants 178
Office Accreditation and Forensic Autopsy Standards 179
Disc Image Legends 179
Selected References 181
8 Postmortem Changes and Time of Death 182
Introduction 182
Early Postmortem Changes 182
Livor Mortis 182
Rigor Mortis 185
Algor Mortis 187
Other Early Postmortem Changes 187
Decomposition 188
Postmortem Injuries 196
Time of Death Estimation 198
Disc Image Legends 201
Selected References 203
9 Identification of Human Remains 204
Introduction 204
Policies for Identification of Bodies 207
Common, Non-scientific Methods of Identification 207
Hospital Identification 207
Visual Identification 207
Scientific Methods of Identification 209
Fingerprint Identification 209
Dental Identification 210
Radiologic Identification 211
DNA Identification 213
Identification Based on Other Unique Features 214
Circumstantial Identification 217
Unidentified Remains 217
Disc Image Legends 219
Selected References 220
Part III Major Causes/Mechanisms of Death 221
10 Natural Deaths 222
Introduction 222
Infectious Disease 224
Cardiovascular System 225
Congenital Heart Disease 226
Congestive Heart Failure (Heart Failure) 227
Coronary Artery Atherosclerosis 228
Coronary Artery Dissection 231
Other Coronary Artery Disorders 231
Aortic Aneurysms (Abdominal and Thoracic) 232
Cerebrovascular Disease 233
Vasculitis 234
Fibromuscular Dysplasia 234
Myocarditis 234
Hypertensive Cardiovascular Disease 235
Valve Disorders 236
Hypertrophic Cardiomyopathy 237
Dilated Cardiomyopathy 237
Restrictive Cardiomyopathy 239
Deep Venous Thrombosis 239
Conduction System Abnormalities 239
Neoplastic Heart Disease 240
Central Nervous System 240
Congenital Anomalies 240
Cerebral Palsy 240
Infection 241
Seizure Disorders 242
Dementia 243
Cerebrovascular Disease 243
Hypertensive Disease 243
Spontaneous Intraparenchymal Hemorrhage 244
Ruptured Berry Aneurysm 244
Ruptured Arteriovenous Malformation (AVM) 244
Dural Sinus Thrombosis 245
Neoplasia 246
Respiratory System 246
Congenital Anomalies 246
Neonatal Conditions 247
Upper Airway Conditions 247
Pulmonary Thromboembolism 248
Bacterial Pneumonia 248
Aspiration Pneumonia 249
Viral Pneumonia 249
Other Infections (Tuberculosis, Fungi, Parasites) 249
Asthma 250
Chronic Obstructive Pulmonary Disease (COPD) 251
Chronic Lung Disease 252
Pulmonary Hypertension 252
Neoplasia 252
Sarcoidosis 252
Gastrointestinal and Hepatobiliary System 253
Congenital Anomalies 253
Gastritis 253
Peptic Ulcer Disease (PUD) 253
Cirrhosis/Esophageal Varices 254
Mallory--Weiss Tears 255
Other GI Abnormalities 255
Hemochromatosis 256
Pancreatitis 257
Reticuloendothelial and Immune Systems 257
Autoimmune Disorders 258
Leukemia/Lymphoma 258
Immunodeficiency 259
Endocrine System 260
Genitourinary System 261
Bones, Joints, and Soft Tissues 262
Multisystem and Other Disorders 262
Amyloidosis 263
Chronic Alcoholism 263
Diabetes Mellitus 264
Sickle Cell Disease 265
Inborn Errors of Metabolism 266
Other Genetic Disorders 267
Sarcoidosis 268
Psychiatric Disease 268
Disc Image Legends 269
Selected References 271
11 Drug-Related and Toxin-Related Deaths 273
Introduction 273
Investigation of Drug-Related Deaths 274
Autopsy Findings in Drug-Related Deaths 277
Toxicology Issues 279
Death Certification 283
Specific Drugs and Toxins 285
Ethanol and Related Substances 285
Ethanol 285
Ethylene Glycol 288
Methanol 288
Isopropanol 289
Amphetamines and Similar Substances 289
Other Stimulants 290
Barbiturates 291
Cocaine 291
Opiates and Related Substances 293
Morphine 295
Heroin 295
Methadone 296
Fentanyl 297
Other Opiates 297
Psychoactive Drugs of Abuse (Hallucinogens) 298
Marijuana 298
Lysergic Acid Diethylamide (LSD) 298
Phencyclidine (PCP) 299
Mescaline (Peyote) 299
Mushrooms (Psilocybin) 299
Other Hallucinogens 300
Over-the-Counter (OTC) Drugs 300
Acetaminophen 301
Aspirin (Salicylate) 301
Ephedrine/Herbal Ecstasy 302
Other Prescription Drugs 302
Antidepressants 302
Nonbarbiturate Sedative Hypnotic Drugs 302
Antipsychotic Drugs 303
Anabolic Steroids 304
Insulin 304
Volatiles and Inhalants 305
Nitrous Oxide 307
Hydrocarbons 307
Helium and Other Simple Asphyxiants 309
Heavy Metals 310
Arsenic 310
Cadmium 311
Iron 311
Lead 311
Mercury 311
Other Poisons 312
Organophosphates 312
Strychnine 312
Naturally-Occurring Toxins 312
Disc Image Legends 313
Selected References 315
12 Blunt Force Injury Deaths 316
Introduction 316
Classification of Blunt Force Injuries 317
Abrasions 317
Contusions 319
Lacerations 320
Fractures 323
Avulsions 325
Blunt Force Head and Neck Trauma 326
Skin and Mucosal Injuries 327
Subcutaneous Injuries 327
Skull and Facial Bone Injuries 328
Epidural, Subdural, and Subarachnoid Hemorrhage 330
Gross Brain Injuries 332
Microscopic Brain Injuries 335
Neck, Spinal Cord, and Vertebral Artery Injuries 336
Special Topics Related to Blunt Force Injuries 337
Mechanisms of Death in Blunt Force Trauma 337
Delayed Deaths Related to Blunt Force Injury 339
Patterned Injuries 340
Clothing Examination 342
Specific Subtypes of Blunt Force Injury 342
Disc Image Legends 347
Selected References 349
13 Gunshot Wound Deaths 351
Introduction 351
Types of Weapons and Ammunition 351
Gunshot Wounds 357
Entrance Wounds 358
Range of Fire 360
Exit Wounds 365
Graze Wounds 365
Caliber 366
Miscellaneous Features of Handgun Wounds 368
Characteristics of High-Velocity Wounds 368
Shotgun Wounds 370
Miscellaneous Issues 376
Internal Examination 376
Mechanism of Injury 380
Documentation 381
X-Rays 382
Clothing Examination 382
Gunshot Residue 382
Manner of Death Issues 383
Special Weapons, Ammunition, and Circumstances 384
Disc Image Legends 387
Selected References 390
14 Sharp Force Injury Deaths 392
Introduction 392
Stab Wounds 394
Incised Wounds 398
Chop Wounds 401
Special Issues 401
Internal Examination 401
Mechanism of Injury 403
Trace Evidence 403
Clothing Examination 403
Defensive Wounds 404
Hesitation Marks 404
Self-Inflicted Wounds/Suicide 405
''Self-Injurious Behavior'' (''Cutting'') 405
Accidental Sharp Force Injuries 406
Direction of Incised Wound 406
Handedness of Attacker 406
X-Rays 407
Decomposition 408
Postmortem/Perimortem Wounds 408
Artifacts 410
Disc Image Legends 411
Selected References 412
15 Asphyxial Deaths 414
Introduction 414
Suffocation 416
Simple Asphyxia (Environmental Asphyxia) 416
Smothering (External Airway Obstruction) 418
Choking (Internal Airway Obstruction) 419
Mechanical Asphyxia (Traumatic Asphyxia) 421
Positional Asphyxia 423
Combination Forms of Suffocation 423
Neck Compression (Strangulation) 424
Hanging 425
Strangulation 428
Ligature Strangulation 429
Manual Strangulation 430
Non-ligature, Non-manual Neck Compression 431
Chemical Asphyxia 432
Carbon Monoxide 432
Cyanide 435
Hydrogen Sulfide 436
Other Issues 436
Autoerotic Asphyxia 436
Choking Game 437
Restraint Asphyxia 438
Combination Asphyxial Deaths 440
Drowning 441
Disc Image Legends 441
Selected References 443
16 Drowning 445
Introduction 445
Physiology and Mechanism of Death in Drowning 446
Scene Investigation 447
Autopsy Findings 449
Causes of Death Other Than Drowning 456
SCUBA Deaths 457
Manner of Death 458
Disc Image Legends 459
Selected References 459
17 Electrical Deaths 461
Introduction 461
Electrocution 463
Mechanism of Death in Electrocutions 465
Scene Investigation 465
Autopsy Findings 467
Low Voltage 467
High Voltage 469
Other Features 471
Lightning 473
Non-Lethal Electronic Shock Devices 476
Death Certification and Manner of Death 477
Disc Image Legends 477
Selected References 478
18 Temperature-Related Deaths 480
Introduction 480
Hypothermia 481
General Features 481
Scene Investigation 482
Autopsy Findings 482
Death Certification 486
Hyperthermia 486
General Features 486
Scene Investigation 487
Autopsy Findings 488
Death Certification 489
Disc Image Legends 490
Selected References 490
19 Burns and Fire-Related Deaths 492
Introduction 492
Burn Types 495
Dry Burns 495
Radiant Burns 495
Scald Burns 496
Chemical Burns 498
Fire-Related Burns 499
Fire Deaths 500
Questions to Address 500
Autopsy 503
External Examination 503
Internal Examination 504
Toxicology 505
Artifacts 506
Mechanism of Death 507
Death Certification 508
Fire Investigation 509
Cremations 509
Disc Image Legends 510
Selected References 511
20 Deaths in Infancy and Childhood 512
Introduction 512
Discarded Fetuses/Infants and Fetal/Infant Deaths in Unattended Births 513
Who is the Mother? 514
Was the Fetus/Infant Viable? 514
Was the Fetus/Infant Live-Born or Stillborn? 514
Stillbirths 514
Live Births 515
Intrapartum Deaths 516
What Was the Cause of Death? 516
Birth-Related Infant Deaths 517
Infant Deaths 519
Natural Death in Childhood 524
Accidental Childhood Deaths 525
Suicidal Childhood Deaths 527
Homicidal Childhood Deaths 527
Classification of Childhood Homicides 537
Violent Outburst (Angry Impulse) 538
Negligence/Neglect 538
Sadistic Acts of Punishment 539
Munchausen's Syndrome by Proxy 540
Unwanted Child 540
Unwanted Pregnancy (Neonaticide) 540
Spouse Revenge 541
Postpartum Mental Disorder 541
Acute Psychosis 541
Altruism 541
Euthanasia (True Mercy Killing) 542
Sexual Abuse 542
Violent Older Child 543
Drug and Alcohol Abuse 543
Seizure Disorder 543
Innocent Bystander 543
Pediatric Autopsy Considerations 544
Disc Image Legends 546
Selected References 548
21 Miscellaneous Topics 549
Introduction 549
Aircraft Crashes 550
Allergic Reactions (Anaphylaxis) 552
Animal Attacks 554
Artifacts and Mimics 554
Emboli 556
Pulmonary Thromboemboli 557
Systemic Thromboemboli 558
Bone Marrow and Fat Emboli 558
Amniotic Fluid Emboli 558
Gas/Air Emboli 559
Bullet and Other Foreign Body Emboli 560
Exhumations 560
Explosions and Blast Injuries 564
High-Profile Cases 564
Homicide by Heart Attack 565
In-Custody Deaths 566
Mass Fatality Incidents 570
Multiple Causes of Death 571
Nutrition and Hydration Disorders 572
Obesity 573
Malnutrition and Starvation 573
Vitamin Deficiencies 574
Anorexia 574
Bulimia 575
Dehydration 575
Overhydration 576
Food Poisoning 576
Occupational Deaths 577
Organ and Tissue Procurement Issues 578
Postmortem Chemistry Tests 582
Postmortem Cultures 584
Pregnancy-Related Maternal Deaths 584
Product-Related Deaths 588
Radiation 588
Ionizing Radiation 588
Non-ionizing Radiation 590
Sexual Assault 590
Terrorist Agents 591
Biologic Agents 591
Chemical Agents 592
Therapy-Related Deaths 593
Disc Image Legends 596
Selected References 598
Aircraft Crashes 598
Allergic Reactions (Anaphylaxis) 598
Animal Attacks 598
Emboli 598
Exhumation 599
Explosions and Blast Injuries 599
High-Profile Cases 599
Homicide by Heart Attack 599
In-Custody Deaths 599
Mass Fatality Incidents 599
Nutrition and Hydration Disorders 600
Occupational Deaths 600
Organ and Tissue Procurement Issues 600
Postmortem Chemistry Tests 600
Postmortem Cultures 600
Pregnancy-Related Maternal Deaths 600
Product-Related Deaths 601
Radiation 601
Terrorist Agents 601
Therapy-Related Deaths 601
Appendix: Additional Resources and Reference Books 602
Other Resources 603
Index 604