FORENSIC
OR LEGAL MEDICINE : that branch of medicine dealing with
the application of medical knowledge (both somatic and psychic human biology)
to the purposes of law (de rebus medicis sub specie iuris). This
term and medical jurisprudence (the application of the principles
of law as they relate to the practice of medicine, to the obligations of
the practitioner to his patient, and to the relations of physicians to
each other and to society in general) are sometimes used as synonyms, but
some authorities consider the first as a branch of medicine and the second
as a branch of law.
jurisprudence : the scientific study or application of the principles
of law and justice.
dental jurisprudence : the application of the principles of law
and justice as they relate to the practice of dentistry, to the obligations
of the practitioner to his patient, and to the relations of dentists to
each other and to society in general. This term and forensic dentistry
are sometimes used as synonyms, but some authorities consider the first
a branch of law and the second a branch of dentistry
The first structured analysis of legal medicine was written down by Paolo
Zacchia (Quaestiones medico-legales) : a lesion leads to
a disease, which may result in restitutio ad integrum
or into a lessening
doctrinal or legal medicine
forensic or applied medicine
Hippocrates'
Oath : "I swear by Apollo the physician, and Aesculapius,
and Health, and All-heal, and all the gods and goddesses, that, according
to my ability and judgment, I will keep this Oath and this stipulation-
to reckon him who taught me this Art equally dear to me as my parents,
to share my substance with him, and relieve his necessities if required;
to look upon his offspring in the same footing as my own brothers, and
to teach them this art, if they shall wish to learn it, without fee or
stipulation; and that by precept, lecture, and every other mode of instruction,
I will impart a knowledge of the Art to my own sons, and those of my teachers,
and to disciples bound by a stipulation and oath according to the law of
medicine, but to none others. I will follow that system of regimen which,
according to my ability and judgment, I consider for the benefit of my
patients, and abstain from whatever is deleterious and mischievous. I will
give no deadly medicine to any one if asked, nor suggest any such counsel;
and in like manner I will not give to a woman a pessary to produce abortion.
With purity and with holiness I will pass my life and practice my Art.
I will not cut persons laboring under the stone, but will leave this to
be done by men who are practitioners of this work. Into whatever houses
I enter, I will go into them for the benefit of the sick, and will abstain
from every voluntary act of mischief and corruption; and, further from
the seduction of females or males, of freemen and slaves. Whatever, in
connection with my professional practice or not, in connection with it,
I see or hear, in the life of men, which ought not to be spoken of abroad,
I will not divulge, as reckoning that all such should be kept secret. While
I continue to keep this Oath unviolated, may it be granted to me to enjoy
life and the practice of the art, respected by all men, in all times! But
should I trespass and violate this Oath, may the reverse be my lot!"
It deals with :
diet at advantage of
suicide
abortion
castity
holiness
lack of competition with surgeons
professional secret
Aim differs from clinical medicine as objective precision is required
for probative value and to guarantee the possibility of a second opinion.
E.g. for determination of ethanolemia,
the enzymatic method is an evidence : it is an easy-to-use, rapid,
sensitive, quantitative method but has false positives and negatives and
is not specific for ethanol
gas-chromatography (GC) is a proof : not easy to use, not easily
automatizable, but high sensitivity and specificity, allows contemporanous
dosing of all volatile substances
Modus operandi :
verification
evaluation
Medicolegal activities :
report (e.g. technical report for public prosecutor, office technical advice)
institutional checks
private activities (privates, insurances)
Activities for the living patient :
evaluation of personal damage
:
penal law (personal injuries)
very mild injuries
mild injuries
severe injuries (e.g. loss of a testis)
very severe injuries
civil law (compensation for biological damage, i.e. health and properties)
thanatology : the medicolegal study of
death
and conditions affecting dead bodies. After the observation period an antiputrefactive
treatment is practiced (expecially in the hot months between April and
September by injecting 500 mL of formalin into body cavities)
cadaver : a dead body; generally applied to a human body preserved
for
anatomical study
Karnia-Kernicki device (exhibited at Turin Expo in 1898) introduced
air into the coffin when a minimal movement was detected
corpse : a dead body; used to refer specifically to a human body
in the early period after death
decedent : a person who has recently died
coroner : an officer who holds inquests in regard to violent, sudden,
or unexplained deaths.
morgue : a place where dead bodies may be temporarily kept, for
identification or until claimed for burial.
death cronology / thanatocronology
: estimation of post-mortem interval (PMI)
postmortal digestion
postmortal bear growth (0.5 mm per day) when the time of the last shaving
is known
physical-chemical properties of blood, CSF, and ocular humors
cadaveric or postmortal phenomena
: accurate measure for the first 2-3 days after death
abiotic phenomena (negative signs)
immediate phenomena
loss of consciousness
loss of sensitivity
loss of motility
loss of muscle tonee
loss of circulation (arrest of heatbeat and lack of pulse)
loss of breathing (lack of chest expansion)
consecutive phenomena
cadaver cooling / algor mortis (more
properly termed equilibration with environmental temperature) : due to
loss of thermogenesis. It doesn't follows Newton's law (i.e. is not directly
proportional to the difference of temperature between the body and the
foreign environment); diagramatic representation of some variables in body
coooling curves (sigmoid). 3 phases are distinguished according to the
"infinite cylinder" theory :
first 3-4 hours : no decrease in first 45'; "initial temperature plateau"
(-0.5 °C/hr) is found on average in 22% of all cooling curves with
the plateau incidence being significantly highest in the rectal curves
(27% of rectal curves compared with 7% of brain and liver curves, P<0.1%)ref
: cell processes continue
following 6-8 hours : fast (-1 °C/hr)
following > 12 hours : slow (-0.75 => -0.5 => -0.25°C/hr) => environmental
temperature within 18-24 hours (from a minimum of 11 to a maximum of 30
hours)
- 0.5°C due to cutaneous evaporation
Body cooling below 22-24°C is a certain sign of death
A more accurate description of the curve is given by
cause of death (poisons, infectious diseases, ...)
conductivity and temperature of the surface(s) where they body was placed
(air, water, fields, ...)
Distrectual thermographies require measurements of :
environmental temperature
rectal temperature (hepatic and brain (e.g. hypothalamic (Thy))
temperatures measured by multiple-probe microwave thermography system are
under study but not legal in many countries)
thanatometer : a L-shaped thermometer used to prove the occurrence
of death by registering the reduction of the bodily temperature
=> Hennage nomogram : +/- 3 hours with IC = 95%)
dehydration of cadaver due to continuous evaporation (expecially
if thin skin (e.g. in babies or after contusions) and high environmental
temperature, low environmetal humidity) and stopped intake of water =>
pergamenaceous and brown-yellowish skin (beginning from scrotum, nasal
alae, lips), borders and fundus of external wounds (excorition, abrasion,
sulcus from hanging or strangling, thanato-ophthalmology after 12-24
hours : corneal opacification with defoliation of epithelium (Winslow's
tela), eyeball collapse (Louis' sign) due to intraocular hypotension
(12 mmHg after 10'; 10 mmHg after 20'; 7 mmHg after 30'; 3-4 mmHg after
2-3 hrs), black spots at corners of eyes due to transparence of choroid
black pigments for disseccation of sclera when eyelids remain opened (Sommer's
sclerotical spot : absent in drawned cadavers). Irregular pupul borders,
post-mortal anisochoria, mydriasis and miosis (appearing between 5 and
7 hours and 15 and 18 hours after death) may be due to causes other dehydration,
e.g. agony, relaxation or rigor of iris sphincter muscle
loss of neuromuscular excitability after stimulation with galvanic
or faradic current, relfex hammer, thermal or pharmacological tests : after
4-8 hours in skeletal muscles and 2-3 days in smooth muscles => anserine
skin in drowned or low-temperature cadavers is due to thermal excitation
of erecetor pili muscles whose status is then fixed by rigor mortis. Scrotum
wrinkling, nipple erection and deferens contraction are due to the same
cause
cadaveric or postmortem rigidity / rigor
mortis : the stiffening of a dead body, accompanying the depletion
of ATP in the muscle fibers. It appears after 2-3 hours (onset stage),
beginning in the muscles of mastication (the cadaver can't open the mouth)
=> face (including mydriasis) and neck => upper trunk and arms => lower
limbs (Nysten's law). Craniocaudal progression depends only on the
ability to detect the phenomenon first at those locations where the muscular
structures that lock joints are small. It extends to whole body within
12-24 hrs and remains the same in intensity in the first 36-48 hours (stable
stage : expecially if the cadaver is muscular), then relaxation occurs
(including miosis) in the reverse order of onset between 72-84 hours (resolution
stage). Within 9 hours rigidity reforms once superated, then not. Low
temperature delays onset and spreading and increase intensity and duration;
high temperatures anticipate onset and reduce duration. Intensity depends
on degree of muscular development : weaker and shorter in newborns, earlier
onset with lower intensity and shorter duration in cachexia or bleeding
deaths; delayed onset with stronger and longer duration in violent and
sudden deaths (in which residual vital phenomena are more accentuated);
weaker and shorter in degenerative muscular hypotrophies; earlier onset
with stronger and shorter duration if physical exercise was practiced just
before death of high body (seizures, tetanus, epilepsy, eclampsia, acute
asphyxia, strychnine poisoning) or environmental temperature occurs
cataleptic or statuary rigidity : the body is instantaneously fixed
in the position it had at the moment of death (seen in soliders on battlefield
and animals killed during run or flight)
muscular rigidity due to drawning, carbonization or hypothermia simulates
behaviours other than istantaneous ones
heart rigor mortis (occurring 2-3 hours after death) may simulate systolic
arrest
smooth muscle rigor mortis is seen as cutaneous orripilation, scrotum wrinkling,
sperm ejaculation due to contraction of seminal vesicles and vasa deferentes
stomach rigidity lifts mucosal areas
small bowel develops annular strictures leading to a rosary shape
cadaveric ecchymoses
: stains seen on the more dependent portions of the body (skin and viscera)
after cessation of circulation, giving the appearance of bruises (localization
is difficult in dark-skinned races and in deaths due to massive hemorrhages,
while they are easy to see in deaths due to asphyxia). They require differential
diagnosis with noncadaveric ecchymosesand
are due to gravitary hemometakinesis (communicating vessels law)
in passively dilating vessels, causing spots located according to position
of the cadaver (hypostasis : poor or stagnant circulation in a dependent
part of the body or organ, as in venous insufficiency; livor mortis
/ postmortem lividity : discoloration appearing on dependent parts
of the body after death, as a result of cessation of circulation, stagnation
of blood, and settling of the blood by gravity)
supine cadaver : posterior (neck, ears, back, posterior face of limbs;
when abundant, even lateral), except areas ischemized by pressure over
supporting surfaces (scapulae, calves (sockets), buttocks, ...)
prone cadaver : ventral
lateral decubitus cadaver : in dependent half-body
hanged cadavers : glove- and socket-shaped (unless tight sockets ischemize
calves and feet)
in drowned cadavers : face, shoulders and anterior chest
paradoxical hypostases in epistatic areas (e.g. jugular and supraclavicular
pits, sternal region, groin) due to residual contraction of arterioles
Kinds :
repletion hypostasis (stage I) : just hemometakinesis up to 8-10 hours,
for differential diagnosis with ecchymoses
diffusion hypostasis (stage II) : filtration of hemoglobin from
hemolysis into plasma and tissues after 15 hours
Chronology :
phase I : onset after 30'-1 hour, evident after 4-6 hours. In the first
6-8 hours they can migrate completely after change of position
phase II : relative or partial migration (8-12 hours); maximal intensity
between 12th and 18th hour after death
phase II : absolute immobility (> 15 hours, but no so absolute).
They can be ischemized with digital pressure in the first 48 hours, then
not due to peripheral hemoconcentration and hemolysis => dyschromias
Early and intense in blood hypoviscosity (acute asphyxia, sudden death,
anticoagulant poisoning); late and poor in rapid blood coagulation (burns),
dehydration (cholera, profuse diarrhea) and bleeding death
When blood mass remains fluid and pushes over capillaries and venules,
blood filtrates and hypostatic petechiae form, as in lower limbs of hanged
persons.
When appearing on discordant surfaces they mark cadaver displacement
in the first 16 hours.
Color :
normally wine red-bluish
cyanosis in asphyxia
cherry red in carbon
monoxide poisoning
(when HbCO > 60%) or in cadavers preserved in cold environments (slowing
down hemoglobin reduction)
bright red in cyanhydric acid and cyanide poisoning
slate blue in potassium chlorate, permanganate, aniline, nitrites, and
nitrobenzoles poisoning due to methemoglobinemia
green in H2S poisoning
and after putrefaction (brown after transformation of methemoglobin into
hematin)
pink in cadavers preserved in water (where oxygen may diffuse in superficial
dermal capillaries), fetuses and newborns (thin skin allows oxygen diffusion)
or at low temperature (which delays hemoglobin reduction)
Ecchymoses should not be confused with vital congestive of inflammatory
phenomena of various organs (expecially lungs)
acidification (all body fluids and tissues
other than gastric juice, urine and sweat are usually alkaline) due to
arrest of organic oxidation and accumulation of catabolytes into tissues
(expecially lactic acid due to postmortal glycolysis, which causes a fall
to glycemia in he first 12 hours, eventually followed by hyperglycemia;
normoazotemia within 48 hours, followed by hyperazotemia), begins earlier
if environmental temperature is high and completes after 4-7 hours,
stopped by onset of putrefaction (degradation
of polymers into alkaline monomers) => autolysis
transformating or positive phenomena : onset depends on environmental
conditions, e.g. season (1 day in summer corresponds to about 1 week in
winter) or room (cold cellars vs. warm attics)
destructive transformating phenomena
autolysis : rupture of lysosomal membranes
due to progressive acidification (faster onset at 37°C and if agony
occurred; delayed by cold). It occurs at different times in different organs,
mainly mediated by gastric and pancreatic hydrolases, leading to bacterial
overgrowth. Onset is as follows : gastric mucosa, pancreas, adrenal medulla
=> liver, spleen, kidney, muscles and nervous tissues => connective tissues;
RBCs within 24-72 hours; WBCs within 10-90 hours; lymphocytes within 48
hours; hypoalbuminemia and hyper-b-globulinemia.
autodigestion : due to gastric and pancreatic juices affecting stomach
(acidic gastromalacia) and pancreas (wax drop lysis in peripancreatic
and omental fatty tissue) and then surrounding organs (esophagus, spleen
and lungs (acidic pneumomalacia))
putrefaction : decomposition especially
of proteins catalysed by bacterial enzymes (expecially Clostridium
perfringens)
from anaerobic (obliged and facultative) first and aerobic bacteria of
the bowel flora then. From bowels they migrate into blood and lymph vessels
reaching all tissues. Decomposition of organic substances leads to formation
of alkaloids, inert and toxic substances :
ptomaine : any of several toxic bases formed
by decarboxylation of an amino acid, often by bacterial action, such as
...
cadaverine : a foul-smelling nitrogenous base, pentamethylenediamine,
produced by decarboxylation of lysine. It is produced in decaying protein
material by the action of bacteria, particularly species of Vibrio.
putrescine / tetra-methylene-diamine : a polyamine first found in
decaying animal tissues but now known to occur in almost all tissues and
in cultures of certain bacteria. It is formed by decarboxylation of ornithine
and is itself a precursor of spermidine
neurine : a poisonous ptomaine with a fishy odor, formed by dehydration
of choline during putrefaction and found in decaying fish, fungi, and also
in the brain and in many other normal tissues; used in biochemical research
ptomatropine [ptomaine + atropine]
: a poison from putrid sausages and the viscera of corpses of those dead
from typhoid fever; it has effects somewhat like those of atropine.
Putrefaction is
delayed in fetuses, died newborns, and live newborns who haven't breathed
or haven't been lactated yet (sterility of gastrointestinal tract), acute
anemia folowing traumas (bleeding reduces germ development), antiseptical
or antibacterials (therapy or poisons : sublimate, phenol, cyanides, arsenic)
faster if T = 25-35°C, wounds (external contamination), babies (due
to higher suurface/volume ratio and juicer tissues), lymphatic and pletoric
patients and cadavers just removed from water (due to higher water content),
patients affected by chronic disease or sepsis, agony or prolonged resuscitation
manuevers, asphyxia, insulation, folgoration, heat stroke (blood hypoviscosity
allows multiplication and spreading of germs)
Casper's law : putrefaction time in air is 2-fold shorter than in
water and 4-fold shorter than below field (accelerated in humid, germ-rich
fields, delayed in dry fields; longer in metallic boxes as metals have
antimicrobial properties).
fermentation : the anaerobic enzymatic conversion of organic compounds,
especially carbohydrates, to simpler compounds, especially to ethyl alcohol,
resulting in energy in the form of adenosine triphosphate (ATP); the process
is used in the production of alcohol, bread, vinegar, and other food or
industrial products. It differs from respiration in that organic substances
rather than molecular oxygen are used as electron acceptors. Fermentation
occurs widely in bacteria and yeasts, the process usually being identified
by the product formed; e.g., acetic, alcoholic, butyric, and lactic fermentation
are those that result in the formation of acetic acid, alcohol, butyric
acid, and lactic acid, respectively.
heterolactic fermentation : one that produces lactic acid and one
or more additional products, such as ethanol, acetic acid, and carbon dioxide
homolactic fermentation : one that produces only lactic acid as
a product
mixed acid fermentation : a type carried out by most Enterobacteriaceae,
in which acetic, lactic, succinic, and formic acids are formed in proportions
varying by species and growth conditions
stormy fermentation : the rapid fermentation of milk produced by
Clostridium
perfringens, marked by rupture of the clotted milk by the pressure
of the gas which develops.
chromatic or color phase (18-36 hours)
due to water-soluble pigments (sulfomethemoglobin,
choleglobin, sulfohemoglobin, pseudohemoglobin and cruoralbin, ...; differential
diagnosis with H2S
poisoning)
: green to brown spots beginning in right iliac fold (where the abdominal
wall lies just over appendix and intestinum caecum, the most contaminated
body area; left iliac fold in cadavers with situs viscerum inversum; natural
orifices of fetuses and newborns whose intestinal content is still sterile;
first appearing elsewhere if subcutaneous hematoma(s), fistulas, ulcers,
septic hot-spots, trasudates or anomalous hypostases occurred) => abdminal
wall => trunk => head and limbs along superficial veins (putrefactive
venous network at the root of upper and/or lower limbs)
emphysema (3-6 days in summer, weeks in
winter) : gases (N2, NH3, CH4, H2,
H2S, CO2, ), diffuse from bowels (where they may
cause fecal loss, rectal and vaginal prolaxuses and fetal expulsion) to
bloodsteam (leading to postmortal blood circulation and bleeding)
and then to tissues. First evident in loose fatty tissue, appears as crepitation
at palpation => putrefactive epidermolysis. Also green-brownish
patches and facies nigroides (swollen face, eyelids, and lips, protrused
eyeballs and tongue), sunken neck, expanded chest, protrused breast, divaricated
and semiflexed limbs, tumefaction of scrotum and erection of penis. Enormous
volume (gigantesque look) and can float on water. Lungs collpase because
of intraabdominal hypertension, pushing foam into airways. Fat is liquified
by putrefaction and simulates vital fatty embolisms.
colliquation / liquefaction (2-3 weeks
in summer and months in winter) : the conversion of a material into a liquid
form (cadaveric malacia); dermal-epidermal bullae => epidermolysis;
occurring first in gastrointestinal mucosa, pancreas, spleen, adrenals
(2-3 years), then in gastrointestinal submucosa, encephalon, liver, kidneys,
spinal cord, lungs, myocardium, skeletal muscles, pregnant uterus (hypervascularization
and softening due to pregnancy), and finally in nonpregnant uterus, prostate,
heart, tendons, aponeuroses, large arteries and ligaments (3-5 years);
skin color changes from greennto brown-black because of transformation
of heme into hematin. Tyrosine, cholesterol, hematoidin and phosphate crystals
due to fat and protein digestion; sclerotic nodules and corneal tissues
survives.
skeletization : the removal of the soft
parts from the skeleton (3-5 years after death), followed by the removal
of the organic bone component => decalcification => polverization. Fossilization
in particular conditions. Long bones resist better.
other forms of cadaver destructions :
fauna (insect larvae, insect, fish, crustaceans, birds, rodents and carnivora
may attack the soft tissues)
flora (fungi - aspergilli, penicilli, oospores, kenomycetes, trichoderma
- may destroy the epidermis) in cadavers left to open spaces or poorly
immersed in water or land
Sometimes abdominal hypertension and relaxation of uterine channel may
cause expulsion of fetus by a dead pregnant, simulating delivery by a living
pregnant. Putrefaction depends on :
intrinsic factors
age
constitution : faster in bodies containing many fluids (including drawned
cadavers placed out of water)
kind of death (greater in asphyxia, agony, ... smaller in hemorrhages and
anemia)
extrinsic factors :
temperature (greater at intermediate temperatures, ideal for growth of
mesophilic bacteria)
humidity
clothes
special transformating phenomena
maceration : the softening of a body by
soaking (common in cadavers immersed in water for weeks (skin folding begins
after 4-5 days and detachment after 7-15 days; hair detachment simulating
baldness; soaking facilitates putrefaction). In obstetrics, the degenerative
changes with discoloration and softening of tissues, and eventual disintegration,
of a fetus retained in the uterus (a sterile and hence nonputrefactive
environment) after its death (bleeding fetus => lithopedion)
mummification (from 2 months to 1 year,
maintained for centuries) : conversion into a state resembling that of
a mummy, such as occurs in dry gangrene, or the shriveling and drying up
of a dead fetus in oligohydramnios
(papiraceous fetus), due to dehydration in hot and dry (ventilated)
environments, eventually aided by hydrovorous molds, expecially in thin,
cachectic cadavers died from profuse hemorrhages or dehydration, and leaved
in upright position (so that fluids migrate downwards). Dehydration prevents
bacterial growth and putrefaction. Skin rehydration
may reveal fingerprints.
saponification : the act or process
of converting subcutaneous (1-6 weeks) (and sometimes muscular (2-3 months)
and visceral (4-5 months)) triglycerids and mineral salts into partly free
saturated fatty acids (oleic, palmitic, stearic) and other oleic compounds
(oxyacids, hydroxyacids, ...) and partly whitish, oily soaps (adipowax;
fusible at 50-70°C, alcohol-soluble) and glycerol by bacterial enzymes
(lecithinase). It involves mainly skin but also the viscera. After
months it solidifies. In chemistry, the term now denotes hydrolysis of
an ester by an alkali, resulting in the production of a free alcohol and
an alkali salt of the ester acid. Completed within 6-12 months : with time
adipowax dries and becomes friable.
corification (1-2 years) : transformation
in leather of cadavers closed in cases ermetically sealed with zinc or
lead (metallic antimicrobials), which allows drying but prevents essication
and putrefaction, giving skin elastricity and
a yellowish color, lining muscles and joints. A brown fluid residuated
on the field of the case. Arsenic and lead from seals may fix into cadaver's
hair.
forensic entomology : from the first
day to several weeks can be accurately estimated
death mask : a plaster cast of the face of a dead person
cremation : the burning or incineration
of dead bodies in an establishement (crematorium)
embalming : the treatment of the dead body
with antiseptics and preservatives, to prevent putrefaction
exhumation : disinterment; removal of the dead body from the earth
after burial
infanticide : left to nature, a baby delivered
before pregnancy month 6 would die anyway. Medicolegal questions :
datation :
size
length (from talus to head apex when lower limbs are extended)
lunar months method
in the first 5 months of fetal life length (cm) = (number of months)2
after the first 5 months of fetal life, length (cm) = (number of months)
x 5
nine-month fetus = 48-52 cm
umbilical cord length = 50 cm
placental weigth = 600 g
transverse body diameter = 33-38 cm
hair length 2-3 cm
no lanugo
navel half way between xyphoid and pubis
nails at the end of fingertips
reactive inflammation of the implantation basis of the umbilical cord (aseptic
vascular necrosis)
testes are palpable within scrotum
labia majora cover labia minora
examination of the free end of the umbilical cord after immersion in water
: cut or laceration marking lack of care
vernix caseosa in the armpits marking lack of care (no wash)
talcus marking care
X-rays looking for ossification nuclei
Beclard's nucleus appears in the second half of the ninth month (once detected
by serial sectioning)
astragalus nucleus appears at fetal month VII
calcaneal nucleus appears at fetal month V (its lack suggests the fetus
would have not survived anyway after delivery)
demonstration of autonomous life : breathing :
chest X-rays
necropsy : atelectasis (lungs have consistence and color like spleen and
liver, and are placed in the corner between ribs and vertebral column).
Gold standard is macroscopic examination confirmed by microscopic examination,
eventually galenic hydrostatic or pulmonary docimasia : immersion
of the cardiotracheopulmonary block (closed at the free end) into water
at 37°C. The heart should be kept afloat by the inflated lungs. When
heart is afloat alone putrefactive heart emphysema should be suspected.
Pulmonary segments can be used to detect regional inflation
Raygat's hydrostatic test : floating of the lungs of a dead infant
when placed in water indicates that the child was born alive
duration of life :
in the hypothesis of cephalic presentation (the only one which allows autonomous
delivery), pressure gradient creates delivery hematoma or tumour in a quadrant
of the skull vault, which is reabsorbed in a few time
meconium into bowels : expulsion of meconium into amniotic fluid suggests
fetal hypoxia causing contractions
umbilical cord desiccation marks the time lapsed since delivery, not since
death
foreign body inflammatory reaction => granulation tissue and erythem appearing
at least 24 hours since delivery (look for granulocytic infiltrates at
microscopy)
cause of death (effective mortality of maternal acts) :
causes leaving no probes :
confination asphyxia (e.g. bags, hand overe mouth and nose)
abandonement in cold environment
natural causes
criminal medicine
military legal medicine
forensic sexuology
sexual violence :
defloration (the rupturing of the hymen in sexual intercourse, in vaginal
examination, or by manipulation) : analysis of hymen after inflation of
small balloon introduced in vagina
vaginal swab looking for semen (compare DNA)
ecchymoses
ballistics : the scientific study of the motion of projectiles in
flight.
wound ballistics : the scientific study of the speed and direction
of missiles (bullets and other projectiles) in relation to the injuries
they produce
fibers, paints, glasses
synchrotrons : a powerful X-ray beam that can
reveal the chemical makeup of tiny samples, e.g. metal traces found on
suspect's clothing (firearms, heavy metals, glass left behind at a hit-and-run
accident, source of confiscated marijuana). Synchrotron radiation leaves
the sample intact, so that the experiment can be repeated many times
dactyloscopy : examination of fingerprints
for purposes of identification
fingerprint : an impression of the cutaneous ridges of the fleshy
distal portion of a finger, made by applying ink and pressing the finger
on paper; such records (as well as prints of hand or foot) are used as
means of establishing identification
sprays may soon enable forensics to lift fingerprints from surfaces as
rough as rock. Mists of iodine benzoflavone or ruthenium tetroxide can
reveal prints on uneven and porous surfaces, heard a conference last week
in Sydney. Conventional aluminium or titanium dioxide powders work well
only on smooth materials such as glass or metal
researches on paternity : around one in 25 dads could unknowingly be raising
another man’s child : the implications are huge because of the growing
reliance of judicial and health systems on DNA profiling and genetic testing,
such as organ donation and criminal identification. More frequent testing
means more parents are likely to learn about their children’s true status,
with devastating consequences for some families. More instances of the
phenomenon, which scientists politely term “paternal discrepancy,” may
come to light through the ever-more common paternity tests being conducted
in Western countries, the researchers said. In the USA, rates of such tests
more than doubled to 310,490 between 1991 and 2001. In the UK, around a
third of pregnancies are unplanned, around 1 in 5 women in long term relationships
has had an affair. Other developed countries have reported similar figures.
There are few support services to help those affected and there is little
guidance on what roles healthcare or criminal justice system workers should
play in disclosing paternal discrepancy. In a society where services and
life decisions are increasingly influenced by genetics, our approach to
paternal discrepancy cannot be simply to ignore this difficult issueref.
DNA
polymorphisms : A bitter dispute has erupted between Japan and North
Korea over DNA tests used to establish whether cremated remains belong
to a Japanese citizen abducted in 1977. The argument is the latest twist
in an episode that has soured relations between the two countries for years.
During the 1970s and 1980s, North Korea was believed to have abducted at
least 13, and perhaps as many as 100, Japanese citizens to work in its
espionage programme. Now the 2 nations are falling out over the feasibility
of correctly identifying DNA from the ashes of one of those abducted. In
the autumn of 2002, North Korea ended years of denials and admitted that
members of its armed forces abducted 13 Japanese citizens from Japan and
Europe. The North Korean leader, Kim Jong-il, claimed that the abductions
were carried out by the military without government permission. Japan says
it has evidence of two more abductees, and believes that there were in
fact many more. Pressure on North Korea to release survivors has since
seen five abductees return to Japan accompanied by their families. Information
on eight others, which North Korea says are dead, has been slow to arrive,
leading to speculation that some of them are still alive. On 15 November
2004, Japanese officials returned from talks in Pyongyang carrying what
North Korea claimed to be the cremated remains of Megumi Yokota, who was
abducted in 1977 at the age of 13. According to North Korean reports, Yokota
married a North Korean, but later killed herself after entering a mental
hospital. At Teikyo University in Tokyo, tests on 5 samples of the ashes
found DNA from 2 sources — but neither of them matched DNA from Yokota's
umbilical cord, which had been kept by her parents, as is common in Japan.
In December, these results were passed to North Korea, but on 26 January
the Korean government issued a statement that branded them a "fabrication".
According to Hatsuhisa Takashima, a spokesman for Japan's foreign ministry,
North Korea called into question the methods used in the tests and claimed
that the remains, which had been heated to 1,200 °C, could not contain
any surviving DNA. The North Korean statement also asked why researchers
at Teikyo University were able to extract DNA when the National Research
Institute of Police Science in Tokyo, which also had 5 samples to work
with, had been unable to do so. Teikyo University's Tomio Yoshii, one of
Japan's leading forensics experts, says there are several reasons why he
managed to extract DNA from all 5 of his samples. These include the fact
that he used nested PCR, which amplifies DNA twice instead of once as in
conventional PCR, and the possibility that his original samples were of
better quality than those at the other lab. Little forensic work has been
done on cremated specimens in Japan, and most experts, including Yoshii,
thought it unlikely that DNA would have survived cremation at 1,200 °C,
but DNA could survive if exposed to such heat for only a short time. The
bones are like stiff sponges that can absorb anything. If sweat or oils
of someone that was handling them soaked in, it would be impossible to
get them out no matter how well they were prepared. Takashima says that
North Korea has sent remains that it said belonged to an abductee in the
past, only to admit later that they were from another source. The Japanese
government responded to the current incident on 26 January by calling North
Korea's handling of the situation "deplorable". It threatened "stringent
actions" that, according to Takashima, may include the cancellation of
125,000 tonnes of food aid and other trade sanctions. Japanese officials
also say that they want to retest the DNA in question. But Yoshii says
his 5 samples — the largest of which weighed only 1.5 grams — were used
up in his tests. And that, observers say, leaves little prospect of the
disagreement being resolvedref.
forensic anthropology
: use of bone remnants for identification
pattern of muscles beneath the skin of the face that shape smiles
could lead to better face recognition systems. A software analyses how
the skin around the subject's mouth moves between 2 images by tracking
changes in the position of tiny wrinkles in the skin, each just a fraction
of a millimetre wide. The data is used to produce an image of the face
overlaid with tiny arrows that indicate how different areas of skin move
during a smile. This movement is is not affected by the presence of make-up
or the size of the subject's smile. The system is sensitive enough to produce
such a map from muscle twitches even when people are trying to keep their
expression unchanged. Each person's map may be unique. Further this software
might enable doctors to make an early diagnosis of nerve disorders causing
distinctive asymmetries in the movement of facial muscle by studying facial
maps
governments are racing to get the biometric passports systems up and running
before October 2005, a deadline imposed by the US Congress. In 2002, Congress
stated that if countries wished to stay in the US visa waiver scheme they
would have to start issuing biometric passports. Countries planning to
adopt the new security systems, based on various combinations of face,
iris and fingerprint recognition, include the United States, Britain, Germany
and Australia. But experts speaking at the Institution of Electrical Engineers
in London on 14 Dec 2004 warned that the technology is not ready for use
so soon. Use of the technology is being driven too fast by politics. Without
the visa waiver scheme, which allows people to visit the United States
for up to 90 days without a visa, all travellers will have to be fingerprinted,
interviewed, and have their details checked against FBI files after a visit
to their local US embassy. The process is costly and can take weeks to
complete. From October 2005, the United States wants all new passports
to be fitted with a chip that stores a digital image of the passport holder's
face. This allows you to pass through border control simply by having your
documents read, and your face scanned, by a machine that can match the
2. Most European Union countries are aiming for this method as it should
be relatively simple to implement. But Britain is also trying to construct
a national database of all these records, which can be cross-checked for
additional security. This may be used in a national identity-card scheme,
which could run from 2008. To test the biometric system, the UK Passport
Service has been running a trial of the technology since 26 April 2004,
and has already scanned the faces, irises and fingerprints of about 10,000
people. The trial has highlighted many problems. For example, users found
it difficult to focus on the iris camera, and relatively tall or short
people had problems positioning themselves in front of the unit correctly.
Wearing glasses or contact lenses seems to confuse the system, and scanners
cannot pick up details of people with faint fingerprints, such as some
Asian women. The scans are also quite time consuming. The manufacturers
of these systems are doing the whole field a disservice by underestimating
the time it takes to use the machine. Although the biometric system may
eventually bring more security, it will probably mean longer processing
times at airports. And if people's first experience of biometrics is negative,
they may become prejudiced against the technology, making it even less
effective.
on April 23, 2004 US airport security screeners refused to let Athena LaPera,
35 (whose husband works for Frontier Airlines), board a flight home to
Denver returning home from vacationing in St. Augustine because they said
she no longer resembled her identification photos. She has lost weight
and hair because of chemotherapy treatments since the photos were taken
for her US passport and Colorado driver's licence. She finally flew out
of Orlando International Airport on a Frontier Airlines flight 2 days after
she was turned away by security screeners.
forensic entomology
: collection, rearing and preservation of the hematophagous (blood
feeding) and necrophagous (carrion feeding) insect fauna (entomofauna)
feeding and breeding on the corpse when the groups of species of arthropods
(waves of succession) characteristic for stages of decomposition
of the corpse and the developmental rate at a temperature similar to the
death scene are known. The aim is to...
identify a missing body (especially on badly decomposed corpses
or skeletonized human remains) from content of the digestive tract of necrophagous
larvae that fed on decomposed bodies (both human mtDNA and STRs are
successfully amplified from maggots stored in ethanol or without any preservation
fluid. Formalin-containing preservation solutions reduces the recovery
of DNA. The best results are observed from maggots stored without any preservation
fluid at -70°Cref)
interpret evidence used for PMI estimations, or more appropriately
a "time since colonization". A record of the length of the largest larvae
collected from a corpse can be used to estimate the age of the oldest larvae
present and, therefore, give an estimate of minimum time since death. Consequently,
factors that affect post-mortem larval length will impact on any estimate
of PMI based on it. Methods used to kill and preserve larvae are known
to affect post-mortem lengthref.
In the warm season there are many insect species, which enable us to estimate
the time of death, but in the cold season there are less species. Some
seasonally active carrion invertebrates leave remnants of their presence
that remain long after the completion of flesh decay. Remnants may include
fly puparia (pupal cases) or insect exoskeletal elements
(remains of necrophagous insects, particularly puparial cases, are often
preserved for a long time, and consequently can serve as late alternative
specimens for toxicological analysis when suitable tissues are not available).
The presence of these remnants among old, decomposed remains can therefore
indicate possible months in which death occurredref.
toxicological examination of necrophagous larvae (entomotoxicology)
from a corpse to identify and estimate drugs and toxicants ingested by
the person when alive and the proof of possible postmortem manipulations
(e.g. morphine for determining ante-mortem opiate intoxicationref).
Entomotoxicology also investigates the effects caused by drugs and toxins
on arthropod development in order to assist the forensic postmortem interval
estimates. However, several remarks on the limitations of entomotoxicology
have been highlighted recentlyref
place of the investigated death
investigations dealing with people who are alive but in need of care, by
revealing information about cases of neglect (e.g. child neglect,
...)
It may be important to prove the presumed association of fly larvae to
a corpse, especially if it is in doubt whether all maggots used for entomological
expertise developed and fed on it. The present study demonstrates for the
first time the possibility of analyzing human microsatellite DNA present
in the digestive tract of necrophagous larvae that fed on decomposed bodies
with a postmortem interval up to four months. Identification of the host
species (e.g., animal source like pig) can be achieved by analysis of the
cytochrome b generef Sometimes the only entomological evidence is in the form of photographs
(see forensic photography) and close
up photographs taken by police at the crime scene showed the first egg
eclosionref.
The species identification of fly eggs is particularly important :
morphological features
scanning electron microscope has been used for this purpose
light microscopy : a 1% potassium permanganate solution to stain egg surfaces
for 1 min, followed by dehydration in 15, 70, and 95%, absolute alcohol
(each solution for 1 min) and the eggs are permanently mounted. The characteristics
are based on the width of plastron, morphology of plastron area surrounding
the micropyle and chorionic sculpturing, with the length of egg being used
as supplemental feature.
PCR : large sub-unit (lsu, 28S) ribosomal RNA (rRNA) gene, mitochondrial
DNA cytochrome oxidase I (COI) and II (COII) gene
Calliphoridae
(blow flies) are probably most important, not only because they occur in
abundant numbers but also because they are one of the earliest groups to
find corpses.
Sarcophagidae
(flesh flies) : up to now no suitable key for the identification of the
immature stages exists : sequence data of selected regions of the CO I
and ND 5 genes of the most important European flesh fly taxa associated
with cadavers can act as reference standards for species determinationref.
weather station data are used by forensic entomologists to estimate ambient
temperatures at body discovery sites. Correlation data from sites may also
be collected to correct for site and station differences but caution is
required if weather patterns during correlation differ greatly from those
while the body was in situref
keeping larvae of Protophormia
terraenovae (Robineau-Desvoidy) at 4°C does not just simply
lead to a cessation of metabolism but disturbs the regular development.
10 days of cooling induced an error in estimating post-mortem interval
(PMI) of more than 6h. The effect of low temperature on the developmental
time between the return to 24°C to adult emergence depended on the
larval stage that was refrigerated. When first instar larvae and prepupae
were refrigerated, the time to emergence at 24°C decreased with an
increase of duration of the refrigeration period. Time to emergence increased
under the same conditions when second instar larvae and pupae were refrigeratedref.
A project led by Zoe Adams, a forensic entomologist at the Natural History
Museum in London is placing dead piglets drawn from the many ones on farms
who are accidentally killed when their mothers roll over on top of them
in and around London - in woodlands, open pastures, inside deserted offices
and on rooftops - for PMI estimation.
Web resources : Maggots:
More than meets the eye
gender verification
in competitive sports : the possibility that men might masquerade as
women and be unfair competitors in women's sports is accepted as outrageous
by athletes and the public alike. Since the 1930s, media reports have fuelled
claims that individuals who once competed as female athletes subsequently
appeared to be men. In most of these cases there was probably ambiguity
of the external genitalia, possibly as a result of male pseudohermaphroditism.
Nonetheless, beginning at the Rome Olympic Games in 1960, the International
Amateur Athletics Federation (IAAF) began establishing rules of eligibility
for women athletes :
initially, physical examination was used as a method for gender
verification, but this plan was widely resented
chromatin test (for determination of genetic sex) : examination
of somatic cells (buccal smear) for presence of the sex chromatin situated
at the periphery of the nucleus in normal females but not in normal males;
an index of the presence of XX chromosomal constitution. It was introduced
at the Mexico City Olympic Games in 1968. The principle was that genetic
females (46,XX) show a single X-chromatic mass, whereas males (46,XY) do
not. Unfortunately, sex chromatin analysis fell out of common diagnostic
use by geneticists shortly after the International Olympic Committee (IOC)
began its implementation for gender verification. The lack of laboratories
routinely performing the test aggravated the problem of errors in interpretation
by inexperienced workers, yielding false-positive and false-negative results.
However, an even greater problem is that there exist phenotypic females
with male sex chromatin patterns (e.g. androgen insensitivity, XY gonadal
dysgenesis). These individuals have no athletic advantage as a result of
their congenital abnormality and reasonably should not be excluded from
competition. That is, only the chromosomal (genetic) sex is analysed by
sex chromatin testing, not the anatomical or psychosocial status. For all
the above reasons sex chromatin testing unfairly excludes many athletes.
Although the IOC offered follow-up physical examinations that could have
restored eligibility for those 'failing' sex chromatin tests, most affected
athletes seemed to prefer to 'retire'
all these problems remain with the current laboratory based gender verification
test, polymerase chain reaction based testing of the SRY gene, the
main candidate for male sex determination. Thus, this 'advance' in fact
still fails to address the fundamental inequities of laboratory based gender
verification tests
the IAAF considered the issue in 1991 and 1992, and concluded that gender
verification testing was not needed. This was thought to be especially
true because of the current use of urine testing to exclude doping: voiding
is observed by an official in order to verify that a sample from a
given athlete has actually come from his or her urethra. That males could
masquerade as females in these circumstances seems extraordinarily unlikely.
Screening for gender is no longer undertaken at IAAF competitionsref.
circumstantial examination : place, position, clothes, loss of fluids,
findings of drugs, boxes, containers, syringes around the cadaver
clinical examination (past and current therapies, case-history and interview
with relatives, friends, and health-care workers if admitted to hospital
or emergence departments, or general practictioner if found at home)
sampling from living patients
peripheral venous blood
emissed urine
urine adulteration markers :
temperature = 32-38°C within 4 minutes
pH = 4.2-7.5 (some adulterers add hypochlorite to impair immunochemistry)
creatinine < 40 mg/dL (some adulterers drink many water to dilute analytes)
specific gravity : 1.007-1.035 kg/L (some adulterers drink many water to
dilute analytes)
flavors (alcohol; almond from cyanides; rotten eggs for sulfides; garlic
from phosphonates and arsenicals)
necrosis of oral cavity after ingestion of caustics
autopsy / necropsy : the postmortem examination
of a body, including the internal organs and structures after dissection,
so as to determine the cause of death or the nature of pathological changes.
inspection of gastrointestinal walls (gastric hemorrhages from arsenicals)
ampling
fluids
blood (collected with a needle-less syringe because of partial clotting)
postmortem clot : a blood clot formed
in the heart or in a large blood vessel after death.
heart clot : postmortem coagulation within
the heart.
heart blood : 20 mL
femoral vein blood is preferred for determination of alcoholemia : 5 mL
(2.5 mL preserved with NaF)
bladder urine : 20 mL
bile
gastric content may contain remnants of foods or gastroresistant pills
and suggest the duration of postmortal digestion for estimation
of PMI
organs
liver : 100 g
encephalon : 200 g
pseudoheterotopia : displacement of gray or white matter of the
brain or cord, produced by unskillful manipulation during autopsy.
vitreous humor
1 kidney
hair (for toxicological history of the subject (including arsenic poisoning)
rather than acute aetiology)
lung : 100 g from apex (only when gas inhalation is suspected)
fatty tissue (only when poisoning by highly lipophilic chemicals is suspected)
muscles (if cadaver is putrefacted)
Factors affecting samples :
fresh corpse
metabolic biodegradation
post-mortem redistribution (e.g. from blood into gastric content)
putrefacted :
grade of putrefaction
loss of hydrosoluble compounds => decreased analyte concentrations, so
that therapeutic use or abuse can no longer be distinguished
comparative criterion can no longer be used (in vitro putrefaction
can no longer simulate natural putrefaction)
Samples should be immediately analysed or preserved at -20°C without
preservatives (only NaF for femural vein blood if alcoholemia will be measured
: NaF inhibits glycolytic usage of ethanol and prevent post-mortem increase
in alcoholemia). Adequate preservation is essential to achieve an eventual
second opinion.
both qualitative (identification of active ingredient) and quantitative
(compatibility with symptoms & signs) assays should be performed
poison : any chemically defined substance (not living organism,
but including products of living organisms, i.e. toxins) that, when relatively
small amounts are ingested, inhaled, or absorbed, or applied to, injected
into, or developed within the body (excluded are objects thrown over, e.g.
projectiles and caustics, as they can be at least theoretically seen and
avoided), has chemical action that causes damage to structure or disturbance
of function, producing symptoms, illness, or death. Even allergens
are legally considered as poisons if the hypersensitivity of the intoxicated
was known by the poisoner or probable
irritant or acrid poison : one that produces irritation or inflammation,
such as the mineral acids, oxalic acid, the caustic alkalis, antimony,
arsenic, the salts of copper, some of the compounds of lead, silver nitrate,
and the salts of zinc, iodine, cantharides, or phosphorus
acronarcotic or acrosedative poison : a poison that may produce
either irritation, narcotism (or sedation), or both together; most common
ones are from plant sources. Stramonium and belladonna are examples of
acronarcotics and aconite is an acrosedative.
arrow poison : a preparation of plant alkaloids used on arrows in
certain primitive societies
catalyst poison : a substance firmly bound to the active areas on
the surface of a catalyst, which prevents the adsorption of the reactants
for the desired chemical reaction
corrosive poison : any poison which acts by directly destroying
tissue
hemotropic poison : a poison which has a special affinity for erythrocytes
mitotic poison : a toxic principle that interferes with cell division.
muscle poison : one that interferes with normal action or functioning
of muscle.
fatigue poison / kenotoxin : a hypothetical toxin supposedly produced
in muscle by muscular contractions, causing fatigue
narcotic poisons : poisons causing stupor or delirium, such as opium
and hyoscyamus.
sedative poisons : those which directly depress the vital centers,
as hydrocyanic acid, potassium cyanide, hydrogen sulfide, and other of
the poisonous gases.
vascular poison : a poison which acts by affecting the blood vessels
venom : a poison, especially one secreted by an animal such as a
snake or arthropod, including the concept of effective dose causing disease
venenation / poisoning : a condition of being poisoned, which requires
entry of the venom within the body, while throwing caustics over skin is
not an envenomation
biochemical mechanisms are studied by toxicokinetics and toxicodynamics
(lethal synthesis)
chemical mechanisms is more direct (e.g ingestion of caustics :
strong acids cause coagulative necrosis, while stong alkali cause membrane
saponification and colliquative necrosis; eventually aspiration pneumonia)
Toxicological analyses :
classical approach : to test every toxic is unpracticeable
probabilistic approach
screening techniques : immunoassays
(10% false positives due to cross-reactions : they shouldn't have medicolegal
value but often influence the ideas of the court)
confirmation techniques : gas
chromatography (GC)
extracts analytes with volatile solvents removing contaminants + mass
spectrometry (MS)
(electron beams fragment the analytes in peculiar ways producing a mass
spectrum which can be compared with databases containing mass spectra from
up to 117,000 different chemicals). A drawback is the likelihood to ignore
poorly represented chemicals.
Anomalous situations :
venom without venenation : a toxic is found in concentrations above DL50
due to development of tolerance after chronic administration
venenation without venom : no toxic is found despite venenation is strongly
suspected
Factors affecting data interpretation :
preanalytical
analytical
pharmacodynamic
pharmacokinetic : e.g. opiate catabolites may come from both drugs of abuse
(e.g. heroin) and medicinal drugs (e.g. codeine)