Forensic Pathology

This is the place where death rejoices

to teach those who live.
 Introduction
A death that is unexpected or is thought to have
been caused by injury or trauma is always
investigated.
Coroner

Medical Examiner
 Coroner vs. Medical Examiner
Coroner a public official, appointed or elected,
who makes inquires into deaths and completes
death certificates.
Determines cause/manner of death
Decides if foul play

May or may not have medical training

 Coroner vs. Medical Examiner
Medical Examiner a physician, evaluates
medical history and physical exam of deceased
to determine cause and manner of death.
Must receive special training to become a forensic
pathologist
Forensic Pathology unnatural or suspicious disease
or injury
In most large US cities, the medical examiner is
required to be a forensic pathologist.
 Forensic Pathologist
Education and Training
Medical school 4 years
Post medical training
3 to 5 year residency in general pathology
Additional year of training
In medical examiners office (forensic pathology)
American Board of Pathology Exam
Training / Knowledge in other areas of Forensics
 In US 500 Forensic Pathologists

About 25 of the 500 also have LAW DEGREES

 Deaths Investigated
Two Main Categories
1. Persons who die suddenly when in apparent good
health, those who are unexpected to die, or those
who are without medical treatment for fatal
diseases.
Public Health Threat (bacterial meningitus)
Death in public places (electrocution in public place)

Maternal Death

Death outside of medical facility

 Deaths Investigated
2. Deaths caused by unnatural causes
Examples:
Acts of violence
Drug related

Trauma / Asphyxiation

Weather

Vehicular accident
 Deaths Investigated
Special Categories:
Under 18
Death of an individual under legally dependent care.

Death in correctional facility

On aircraft or ship

MURDERS ARE THE SMALLEST

NUMBER OF DEATHS
INVESTIGATED!
 Three facets of guilt:
Motive
Means
Opportunity
 Medical Examiners Duties:

Review eyewitness statements

Examine crime scene
Autopsy
Photography
Report
Testimony
 Duties and Responsibilities
Establish the cause of death
Establish the time of death
Infer the type of weapon used
Determine the manner of death
Identify the deceased
Determine the effects of trauma or pre-existing
conditions.
 Postmortem Lividity
(Livor Mortis)
The Settling of blood that causes the skin to
change color
 30 Minutes:
Changes in skin color first appear
on fair-skinned persons
 4 to 8 hours:
The blood in capillaries settles
PERMANENTLY
 Between 1 and 8 hours:
(1) Blanching Light-colored marks
made by finger pressure
 (2)
Where a trained investigator will begin..
Why livor mortis is important
Has the body been
moved?
 Rigor Mortis
The period of time that a body goes through a
state of Rigidity
Caused by lactic acid build-up in the body.
 Rigor Mortis Progression
Shorter muscles face, fingers, toes
 Neck
 Then moves down and out the long muscles of the
legs and forearms
 Legs stiffen last
 Rigor MortisTime-line
1-4 hours: Jaw and neck rigid, rest of body limp
Up to 8 hours: everything down to the legs is
rigid
For 12 hours: everything remains rigid
24 hours: Jaw is limp, everything else is rigid
30-32 hours: everything but the legs are limp
36 hours: entire body is limp (no rigidity)
decomposition has begun
 Circumstances affecting
Rigor Mortis
Starvation
 Extreme temperatures
 Physical exertion
 Effects of fire
 or water (in the case of drowning)
 Decomposition
Bacteria: Co2 is produced, abdominal swelling
 Blood vessels:
discoloration of skin in upper abdomen
marbling effect

Red darker red purple green

 Putracine foul- smelling, nauseating odors
 Algor Mortis
Either Liver temperature (LT)
or Rectal Temperature (RT)
Drop of about

2 degrees
per hour
 Factors affecting temperature loss:
Size (mass) of body
Body Temperature at death
Temperature of crime scene
 The Autopsy Examination
You've got to be the type of person who can emotionally
disconnect [from] it. I mean, if you went into a case looking at it
as, 'Geez, this is somebody's little girl or somebody's little boy,'
you'd never be able to do the case. You can't personalize it in any
way... When you walk in, you never forget that this is
somebody's loved one. You never forget that, but when you walk
in to do the job, you kinda put that information aside. You look
at them more as a puzzle, and your job is to sort out this puzzle.
I've got to find out what happened. Who, what, why, when,
where. I mean, that's what my job is, to sort out and get those
answers. And, do it in a respectful way.
A lot of people can't do this type of job. A lot of people
don't want to do this type of job. There are a lot of jobs I
wouldn't want to do either.
Eric Kiesel
Atlanta's Fulton County Deputy Chief Medical Examiner
 HISTORY OF AUTOPSY
EGYPTIONS
1600 BCE

HIPPOCRATES
5TH + 4TH CENTURY BCE
AUTOPSIES TO DETERMINE THE CAUSE OF
DEATH:
 The Autopsy Examination
Legality
Permission required family can request an autopsy
be performed (usually free)
Next of kin must sign autopsy permit.

Religious considerations

Mandatory when death is suspicious of foul play or

if public health concern (in most states)
 The Autopsy Examination
Attending Personnel
Diener autopsy assistant
Prosector - pathologist

Pathologist Assistant

Precautions protective

clothing
 The Autopsy Examination
The External Exam = done first when body is
examined.
Looking for:
Wounds

Contusions (Bruises)

Unusual marks on the body

Overall impression of the body

 Forensic Autopsy
An intensive search for information
To locate PHYSICAL EVIDENCE to determine the cause of death
 The Autopsy Examination
At this point, a general description of the body is made.
All identifying features are noted including:
Race
Sex
Hair color and length
Eye color
Approximate age
Any identifying features (scars,tattoos, etc.)
 The Autopsy Examination
Opening the Body
Y-incision: incision made from left and right
shoulders to mid-chest and straight down to pubic
region.
 No bleeding (usually) because there is no blood
pressure.
If head is to be opened, an incision is made across
the head from one ear to the other.

-----------------------------------------
 The Autopsy Examination
Rib cage is cut at the cartilage that joins the ribs
to the breastbone with a scalpel, saw or knife to
enter the chest cavity. Soft tissue peeled back to
look for abnormalities.
 Chest plate (ribs and breastbone) are removed
and examined. Often fractured during CPR.
Skull is cut in front and back for
removal.
 The Autopsy Examination
Removing and Examination of the Organs
Each organ is removed, photographed and weighed.
Organs are usually dissected and slides prepared to look
for disease or irregularities.
 THE HEART

Checked for TRAUMA

Pulmonary artery
 The pulmonary arteries carry blood from the
heart to the lungs.

They are the only arteries (other than umbilical arteries in the
fetus) that carry deoxygenated blood.
Looking for a blood clot that has dislodged from a
vein traveling through the heart

To the pulmonary artery: SUDDEN DEATH

Blood samples are taken from the
AORTA

Blood-typing and Blood/Alcohol test

 Larynx and Trachea

Food lodged in trachea

Checked for food bolus (choking)

Lungs
Drowning
 Diatoms

lungs

stomach

Blood stream

Bone marrow
 Heroin Use

Carbonate crystals

Used to mix heroin

Will be found in the lungs

 Death in fires

If alive
During
Fire there
Will be
soot and ash
in the Trachea
Bronchi
And
Lungs
 If CO2 levels in blood are greater than
2%

The victim was alive at the onset of the fire

 Samples taken

CO2 and other

gases in lungs

Microscopic slides
Liver
 Liver
A healthy liver:

Soft, pliable, vulnerable to blunt-force trauma

 Cirrhotic Liver

Caused by hepatitus, malnutrition, drug & alcohol use

Jaundiced Liver
Kidneys filter blood
 The Kidney Punch

A World Boxing Association foul

 Drug use
Drug addicts who have a cirrhotic liver
cannot metabolize proteins

Toxins pass out of the liver and

Damage kidneys
 Diseased Kidneys

Jaundiced kidneys
Polycystic liver
 Stomach
Important in drug-overdose cases

Helps establish activities prior to death

 POISONS

CYANIDE
-red color of organs
-almond-like odor
(only 50% of pop can detect the odor)
-KCN used for executions
 Estimated time of death

If TIME OF MEAL and MENU are known

Intestines

Location of food can help

determine time of death
 Pair swallows 850 g cocaine..
Katriya Connor, 23, a chef from Waterloo in Liverpool,
became violently ill on a flight from Cancun in Mexico
to Birmingham on February 6, after scores of packets
of cocaine that she had swallowed burst in her stomach.
She died within hours on an airport runway in the
Azores, where the flight had been diverted, while
paramedics desperately tried to save her life. A 21-year-
old man, apparently travelling with Ms Connor, also fell
into a coma on the flight and remains seriously ill on
the island.
(from The Guardian)
 Stomach of drug mule

Drug packets in rectum area

Bladder

URINE SAMPLE
Reproductive Organs

Inspected for
pregnancy

(Teenage suicide)
The Brain
Removal of Brain
A blood clot caused by a blow to the head
can be fatal
Formaldehyde fixes the brain for better dissection
 Autopsy
Conclusion
 Samples are obtained of bodily fluids and sent to
toxicology for examination.
Blood
Urine

Bile
 Manner and Cause of Death
Mechanism biochemical or physiological
abnormality produced by the cause of death
that is incompatible with life.
Manner of Death homicide, suicide, natural
causes, accidental or undetermined.
Cause disease or injury that initiated the
lethal chain of events that lead to death
 Manner of Death

homicide
Suicide

accidental trauma occurring from acts

NO REASONABLE person
would have felt have a high probability
of injury or death
natural cause
undetermined
Determination of Cause of Death
One can die of a massive hemorrhage (the
mechanism of death) due to a gunshot wound
through the head (the cause of death) as a result
of being shot (homicide), shooting yourself
(suicide), dropping the gun and it discharging
(accidental), or not being able to tell how it
occurred (undetermined). All of which are
manners of death.
 Causes of Death
Brain Damage:
Subdural hematoma
Brain Damage:
Subarachnoid
hematoma
 Brain Damage:
Intracerebral hematoma:
Suffocation
Positional Asphyxiation
Positional Asphyxiation
SADS
Choking
 Drowning
Vomitos amigos: Drug/alcohol
Intoxication
 Neck Injuries
Strangulation
accidental
suicide

homicide
 Petechial hemorrhage
Ruptures in the tiny capillaries
Hyoid Bone
 Hanging

Nature of rope and knots

 Suicide by hanging

Male suicide Female suicide

 Jugular vein
On average, blood accounts for 8% of total body weight
5 to 6 liters of blood for males
4 to 5 liters of blood for females
A 40 percent blood loss results in death.
The loss of 1.5 L can
cause incapacitation.

Jugular vein
 Stab Wounds:
Sharp Force Trauma

Type of knife used (width, length, single or

double-edged)

Stabbing wounds

Slicing wounds
 Blunt Force Trauma
Caused by being struck by a flat surface
Gunshot Wounds
International Gun Statistics
Classification of Traumatic Death
Four Categories:
Thermal
Chemical

Electrical

Mechanical

Asphyxiation interference of oxygen to brain

Can be caused by all mechanisms
 Mechanical Trauma
Blunt or Sharp
Penetrating or Non-penetrating
Mechanical Trauma occurs when the applied
physical force exceeds tensile strength of the
tissue, causing lacerations (blunt force) or
incised wounds (sharp)
 Mechanical Trauma
Sharp Force Trauma
Most common cause of death = exsanguination
Major arteries or the heart are damaged
Blunt Force Trauma
Cause contusions or lacerations
Most common cause of death = significant damage
to brain or internal bleeding
 Mechanical Trauma
Firearm Injury
Contact wound blackening of skin around wound
(gas burns skin), small in size
Distant wound circular skin defect and rim of
abraded skin around the edges
Exit wound is larger and more irregular than entry
wound.
 Chemical Trauma
Death that results from drugs or poisons
Alcohol = most common drug that causes death
Rarely kills directly, but contributes to about 50% of
traumatic deaths.
Other chemicals:
Drugs
Carbon Monoxide

Cyanide / Arsenic (poisons)

 Thermal Trauma
Exposure to excessive heat or cold
Hypothermia excessive cold
Hyperthermia excessive heat

Causes death via a breakdown in the normal

mechanisms that maintain body temperature.
Thermal Burns death usually occurs as a result
of complications (shock; mechanism = multiple
organ failure)
Cause of death in fires inhalation of CO, not
burns
 Electrical Trauma
Passage of electricity through a person
Low Voltage heart experiences ventricular
fibrillation (quivering of the heart; beats faster than
the body can handle)
High Voltage forces heart into tetany, a
contraction that is broken when the circuit is broken.
Heart generally starts again with a normal rhythm
Loss of limbs or electrical burns are possible within
seconds of shock.