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 Examiner’s 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

2

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.