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(BQ) Ebook Knight forensic pathology includes The forensic autopsy, The pathophysiology of death, The establishment of identity of human remains, The pathology of wounds, Head and spinal injuries, Chest and abdominal injuries, Self-inflicted injury and somethings esle.
KNIGHT’S Forensic Pathology Those who have dissected or inspected many bodies have at least learned to doubt, while those who are ignorant of anatomy and not take the trouble to attend to it, are in no doubt at all Giovanni Morgagni 1682–1771 The Father of Morbid Anatomy Taceant colloquia Effugiat risus Hic locus est ubi mors gaudet succurrere vitae (Let conversation cease Let laughter flee This is the place where death delights to help the living.) Latin proverb Seldom say never – seldom say always! Forensic proverb Third Edition KNIGHT’S Forensic Pathology Pekka Saukko Dr.med.univ (Vienna), Dr.Med.Sci., Specialist in Forensic Medicine, Dr.h.c Professor and Head, Department of Forensic Medicine, University of Turku, Finland Bernard Knight CBE, MD, DM (Hon), BCh, MRCP, FRCPath, FHKCPath, DSc (Hon), LLD (Hon), PhD (Hon), DMJ (Path), Barrister of Gray’s Inn Emeritus Professor of Forensic Pathology, University of Wales College of Medicine, UK Formerly Consultant Forensic Pathologist to the Home Office, UK PART OF HACHETTE LIVRE UK First published in Great Britain in 2004 by Hodder Arnold, part of Hachette Livre UK 338 Euston Road, London NW1 3BH http://www.hoddereducation.com © 2004 Edward Arnold (Publishers) Ltd All rights reserved No part of this publication may be reproduced or transmitted in any form or by any means, electronically or mechanically, including photocopying, recording or any information storage or retrieval system, without either prior permission in writing from the publisher or a licence permitting restricted copying In the United Kingdom such licences are issued by the Copyright Licensing Agency: Saffron House, 6–10 Kirby Street London EC1N & 8TS Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made In particular (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however it is still possible that errors have been missed Furthermore, dosage schedules are constantly being revised and new side-effects recognized For these reasons the reader is strongly urged to consult the drug companies’ printed instructions before administering any of the drugs recommended in this book British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN: 978 340 76044 10 Commissioning Editor: Serena Bureau Development Editor: Layla Vandenbergh Project Editor: Anke Ueberberg Production Controller: Deborah Smith Cover Design: Stewart Larking Typeset in 10/12.5 AGaramond by Charon Tec Ltd., A Macmillan Company Printed and bound in India What you think about this book? 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Please send your comments to feedback.arnold@hodder.co.uk Contents 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 Preface to the third edition Preface to the second edition Preface to the first edition vi vii viii The forensic autopsy The pathophysiology of death The establishment of identity of human remains The pathology of wounds Head and spinal injuries Chest and abdominal injuries Self-inflicted injury Gunshot and explosion deaths Transportation injuries Abuse of human rights: deaths in custody Burns and scalds Electrical fatalities Complications of injury Suffocation and ‘asphyxia’ Fatal pressure on the neck Immersion deaths Neglect, starvation and hypothermia Deaths associated with sexual offences Deaths associated with pregnancy Infanticide and stillbirth Sudden death in infancy Fatal child abuse Deaths associated with surgical procedures Dysbarism and barotrauma The pathology of sudden death Forensic dentistry for the pathologist Poisoning and the pathologist Forensic aspects of alcohol Carbon monoxide poisoning Agrochemical poisoning Poisoning by medicines Death from narcotic and hallucinogenic drugs Corrosive and metallic poisoning Deaths from organic solvents 52 98 136 174 222 235 245 281 301 312 326 339 352 368 395 412 421 431 439 451 461 480 488 492 527 541 552 560 566 570 577 585 595 Appendix Technical methods Appendix Council of Europe Committee of Ministers Recommendation No R (99) 600 610 Index 618 •v• Preface to the third edition It is pleasant to record that the second edition of Forensic Pathology consolidated the international reputation of the original book as one of the foremost manuals of forensic pathology in the English language This new third edition generally follows the same successful pattern, but there are some significant differences The editorship is being transferred to Professor Pekka Saukko and this volume is the product of the collaboration with the original author As with previous editions, the text has undergone a complete revision to update where necessary and add new material where relevant A major change is the extensive use of colour to replace original monochrome illustrations and in numerous new illustrations, including micrographs More than 300 colour illustrations have been added, of which 175 are completely new from the archives of both the Cardiff and Finnish institutes, and others Another major improvement has been in the reference material where both corrections and numerous additions have been made ‘Further reading’ is intended for those readers who not have access to electronic libraries and to offer an overview of the literature on a particular topic The new edition maintains the philosophy of evidencebased forensic pathology with emphasis on the avoidance of over-interpretation, which regrettably still leads to instances of miscarriage of justice It is hoped that the new edition of this well-established textbook, with its emphasis on practical procedures and common-sense evaluation of autopsy findings, will continue to be of assistance to forensic pathologists all over the world • vi • Pekka Saukko Bernard Knight Preface to the second edition The most gratifying reception accorded in many parts of the world to the first edition of this book has led to the need for an updated version less than five years later No radical changes have been made in the format, but like an airliner during its periodic major service, every part has been scrutinised and replaced where it has become outdated or defective In addition, new material has been added where appropriate Forensic pathology, unlike its sister discipline forensic science, does not change quickly or have dramatic developments such as the current DNA revolution Indeed, because its base is the interpetation of autopsy findings, forensic pathology still rests largely on the principles of morbid anatomy founded in the nineteenth century and earlier However, this is not to say that it remains fossilised in the era of Virchow – new findings and techniques appear constantly, albeit at a measured pace compared with other disciplines The most useful of these advances have been incorporated into this new edition In particular, the sections on child abuse, head injuries and traumatic subarachnoid haemorrhage have been amended or supplemented Sixty new illustrations have been incorporated, and another area of attention has been the references and recommended reading, as there were some textual citations not listed in the first edition – and very many more have been added However, the literature is now so vast, both in forensic journals and scattered profusely throughout other specialist publications, that it is futile to try to capture all of even the most seminal papers, which now need computerised and other modern library techniques for their retrieval One of the many reviewers of the previous edition complained that many of the references were old, but I make no apology for this The value of a publication is in its content, not in its date, as Harvey’s De Motu Cordis and Morgagni’s De Sedibus clearly demonstrate! Some of the most valuable papers in forensic pathology were written decades or even a century ago; the critical writings of Moritz, Shapiro, Adelson, Helpern, Gonzales, Polson – right back to Taylor and Tardieu in the nineteenth century – are examples of careful observation and logical thinking which some modern pathologists, given to overinterpretation, would benefit from studying The critical attitude to every autopsy finding has been maintained in this new edition A number of recent criminal trials and Appeals have emphasised the vital need for expert medical witnesses to be totally objective in their interpretation of physical findings To quote from the new (1996) Practice Guidelines of the Policy Advisory Board in Forensic Pathology of the British Home Office: ‘The evidence should be objective: speculation should be avoided Unwarranted conclusions can never be defended The role of the expert witness is not to provide the evidence which supports the case for the Crown nor for the defence, unless that opinion is objectively reached and has scientific validity.’ Perhaps, in the interests of justice, an additional new forensic aphorism should be on the frontispiece: ‘If you can’t prove it, don’t claim it!’ • vii • Bernard Knight 1996 Preface to the first edition This is a textbook of forensic pathology, not forensic medicine Though there is a considerable overlap, forensic medicine includes medical jurisprudence, the legal aspects of medical practice and many ethical matters, none of which are found – nor are intended to be found – in these pages Such topics have marked geographical limitations, as a result of legal, ethnic, cultural, and even religious variations from place to place Even within the British Isles it is almost impossible to write a single book on medical jurisprudence that can equal justice to the different legal systems of England and Wales, Scotland and Ireland The subject matter of this volume has no such geographical constraints, as it is solely concerned with the examination of the dead body for medicolegal purposes Even in this limited sphere, police procedures and the habits of pathologists will vary considerably with country and with resources, but it is hoped that the routines, techniques and philosophy offered in this book will offer a guide to good practice that can then be modified according to local circumstances The contents are intended to lead the pathologist – and in some countries, the non-pathologist – through the procedures that are needed in the examination of a body found under obscure, suspicious, or frankly criminal circumstances In developed countries with sophisticated medicolegal systems, such autopsies will be performed only by forensic pathologists or by histopathologists with considerable experience, but in many areas of the world – especially the developing countries – lack of manpower and resources as well as considerations of distance and facilities mean that almost any doctor may be called upon to perform medicolegal examinations For both of these classes of medical men and women this book aims to act as a guide and a source of reference The subject matter follows a fairly conventional pattern, but the treatment of each topic is designed to offer practical advice linked with a philosophical approach that leads the doctor to analyse and question the interpretations drawn from physical findings All too often, dogmatic opinions are derived from an unsound factual base, learned from lectures or textbooks that repeat previous dogma with little sense of critical evaluation In some parts of the world forensic pathology is learned by rote from teachers who studied it themselves in the same fashion, and who have little or no practical experience in the hard schools of mortuary or witness-box I hope that this book will at least stimulate trainee forensic pathologists to think twice, question and disagree – not least about some of the material in the following pages Some conventions have been discarded in the format of this book The author feels that it is disruptive for ease of reading to have every line clogged with references to other authors, except where essential to the topic under discussion Thus most references have been consolidated into groups, placed at the end of the appropriate sections in each chapter In addition to actual references, there are many suggestions for further reading on the same topic It is quite impossible to be comprehensive in offering relevant titles, as the amount published on forensic matters is now overwhelming, several hundred new titles appearing each month A representative selection is offered, much of it quite recent – these papers themselves will then offer a relevant bibliography, so that the topic can be followed in almost geometric progression There is no discussion of forensic serology, as this is now a discipline of its own Similarly, the toxicology is confined to a detailed consideration of the pathologist’s role in obtaining samples and interpreting the results from the analytical laboratory Though the most common poisons are discussed, this is purely from the autopsy aspect Like serology, toxicology is now a vast subject that stands independently and it seems futile merely to scratch the surface in a text devoted to forensic morbid anatomy Another departure from the conventional text is that concise reminders of the forensic anatomy of important regions are given, adjacent to the topic under discussion Many pathologists learned their anatomy a long time ago and it can be useful before an autopsy, or writing the report, or appearing in court, to have a quick refresher about the relations of the aortic arch to the second rib or the exact structure of the laryngeal cartilages Illustrations in forensic textbooks are traditionally profuse and often spectacular The only justification for a photograph is that it instructs, however, rather • viii • Preface to the first edition than entertains or shocks This book uses photographs only where a relevant point is displayed, with a full caption that stands alone without having to refer to the text Many line drawings are used, as the author feels that they often get the message across better than a photograph, which of necessity contains irrelevant and perhaps distracting features Similarly, many books are replete with anecdotal cases; these can be valuable, but often are more intriguing than useful The space devoted to these can usually be put to better use and they are employed sparingly in this text Where the pronoun ‘he’ is used throughout this book, it is intended that the word ‘she’ is equally applicable, unless obviously inappropriate from the context Finally, an Appendix is offered with basic reference material on weights, sizes, temperatures, conversion tables and other useful facts Histological and histochemical techniques relevant to forensic needs are given in detail • ix • Bernard Knight 1990 Index petechial haemorrhage (contd.) fatal pressure on neck 371 fat embolism 344 in hanging 388 head injuries 14 love bites 528, 530 lungs, examination 24 post-mortem artefacts 36 posture affecting 355 scleral/eye 354 significance 355–6 strangulation 354, 382–3 subpleural 355, 403 sudden infant death syndrome 454, 456–7 traumatic ‘asphyxia’ 364 pethidine, blood/tissue levels 580 petrol 560 pets, post-mortem damage 76 Pfitner’s table, bodily dimensions 108 pharynx, thermal damage 320 phencyclidine 580 phenols 588 deaths from 587–8 phenothiazines, poisoning 573 phloxine–tartrazine stain 602 phosgene, in fumes from fires 322 phosphotungstic acid-haematoxylin stain (PTAH) 342, 499 photography at autopsy 13, 15, 32–3 bite marks 528, 530–1, 532 cameras 32–3 child abuse 476 exhumation 37 film type 32 identification by dentition 537 illumination 32, 530–1 scene of death composition 33 photosuperimposition techniques 128 physical abuse in custody see custody, deaths in fatal, evidence 301–5 see also child abuse physical activity cadaveric spasm and 63 sudden death and 519 timing of rigor mortis 60–1 physique, hypothermia relationship 415 pial veins 347 pia mater 189 piercing, infanticide 444 pigmentation, mottled, in heat injury 303, 304 pistols, injuries 271–2 placenta, examination in infanticide 443 plastic bag sexual asphyxia 390, 391, 596 suffocation 359–60, 596 plastic bullets 274 plastic containers, for samples 545 plastic polymers, fumes from fires 322 platelets 342, 346 platysma muscle, bruising 373 pleural adhesions 21, 225, 226 pneumoconiosis, formalin inflation of lungs 24–5 pneumonia, paraquat poisoning vs 567 pneumothorax 223, 225–6 autopsy 18, 31 barotrauma/dysbarism 489, 490 causes 225 natural/unexpected deaths 226 resuscitation artefacts 41 ‘sucking wound’ 225 tension 225 types 225 poisoning 541–51 agrochemicals 566–9 antimony 591 arsenic see arsenical poisoning autopsy 543 corrosive acids/alkalis and phenols 587–8 cyanide 585–7 detection of poison/chemical 543 drugs of dependence 577 ethylene glycol 589 exhumation 38–9 fatal concentrations, variations 542–3 fatal dose concept 541–2 hallucinogenic drugs 577–84 hospital deaths 543 medicines 8, 543, 570–6 autopsy appearances 570–1 autopsy difficulties 570–1 laboratory test results 571 mode of death 571 see also specific drugs/medicines metals 589–92 narcotic drugs 577–84 organophosphorus pesticides 567–8 oxalic acid and oxalate salts 588–9 paraquat 566–7 ricin injection 550 sample collection see sample collection samples, ‘exhibit labels’/‘exhibits officer’ 544 subendocardial haemorrhage in 348 thallium 591–2 polaroid cameras, use at autopsy 32 police autopsy request bite marks on 528 police cells, suicide in 308 police surgeons 421 politics, human rights abuse and 301 polyarteritis nodosa 511 polymerase chain reaction (PCR) 428 • 648 • Index polymorphonuclear leucocytes, infiltration 168, 170 polyps, sudden death from 516 pontine haemorrhage 517 post-concussion state 209 post-mortem artefacts 36 abrasions 139, 143, 149–50 aortic tears 285 bleeding behind larynx 59, 150, 375 blisters/bloating/discoloration 36 blood from mouth/nostrils 12, 15, 36 bruises/bruising 13, 36, 149–50 burns 331–2 defibrillators 12, 36, 41 epidural haemorrhage vs 192 gastromalacia 36 haemorrhage 57, 59, 150, 375 haemorrhage patches 36 myocardium discoloration 36 neck, haemorrhage 59, 150, 375, 377 pancreas 36 petechiae 36 petechial haemorrhage 36 putrefied corpse 36, 65 resuscitation see resuscitation artefacts post-mortem bleeding 225, 233, 340 post-mortem blood clots 341 post-mortem changes 56–63 burns 317 hypostasis 56–60 immersion deaths 67–8, 396–7, 398–9 surgery/anaesthesia-related deaths 480 toxicological 545–6, 547 see also decomposition; hypostasis, post-mortem; rigor mortis post-mortem cooling see cooling, post-mortem post-mortem dependent oedema 56 post-mortem examination see autopsy post-mortem hypostasis see hypostasis, post-mortem post-mortem interval cerebral hypoxia diagnosis 213 entomology and 76 see also entomology estimation 78–90 body cooling/temperature 7, 79–83 gastric emptying 83, 85, 87–8 multiple site temperatures 83 post-mortem chemistry 89–90 rectal temperature 81–2 retinal changes 54 at scene of death 6–7 ‘temperature ratio’ concept 83 thermometry 82–4, 83 vitreous humour chemistry 88–9, 89–90 see also cooling, post-mortem; rectal temperature hypostasis relationship 57 rigor mortis and 60, 61 ‘spot-check’ for 61 post-mortem overspill 363 postural asphyxia 355, 365 posture drunken prisoners 307 effect on cooling curve 80–1 petechial haemorrhages and 355 sudden infant death syndrome 453 potassium 88, 89 release in drowning 401 potassium cyanide 585, 586 potassium fluoride 545, 546 potassium permanganate 434 pre-auricular sulcus 111 precipitation (jumping from height) 240 predators, post-mortem damage see animal predation; insects pregnancy 65 deaths associated 431–8, 517 see also abortion ectopic 436 evidence from skeleton 114 legal termination 431, 432 seatbelt problems 289 premedication, excessive 484 pressure, adverse effects 488–91 pressure marks 359, 360 pressure sores 414 Prinsloo and Gordon artefact 59, 150, 375 procurator fiscal propane 561, 595 propeller-induced injuries 399 property, personal mass disasters 43–4 see also clothing propylene 589 prostaglandins, illegal abortions 434 protein ante-mortem vs post-mortem burns 317 dating of bones 127 identification of bone fragments 108 pubic bone, sex differentiation 111 pubic hair 104 examination in sexual offences 423 ‘pubic scars’ 114 pubic symphysis, age estimation 118–20 ‘Pugilistic’ attitude 63, 316, 321 pulmonary artery, injuries 228–9 pulmonary barotrauma 489 pulmonary damage, explosions 275 pulmonary embolism 24, 340–3, 513, 520 after legal termination of pregnancy 432 after surgery 483, 520 appearances 341–2 dating 342–3, 520 medico-legal aspects 340, 341–2, 520 post-mortem blood clot vs 341 predisposing factors 341, 520 • 649 • Index pulmonary embolism (contd.) rare causes 513 sources of embolus 341, 520 sudden death, deep vein thrombosis 513–14, 520 trauma/disease interaction 340–1, 341, 520 pulmonary fat embolism 343 pulmonary granuloma 577 pulmonary haemorrhage 275, 286 drowning 403 vehicular accidents 286 pulmonary inflammation 455 pulmonary ligament 226 pulmonary oedema 343, 356, 455 carbon monoxide poisoning 562 deaths from corrosives 587 drowning 402–3 hypertensive heart disease 505 hypothermia 418 morphine addicts 578–9 pulmonary thromboembolism 513–14, 520 pulmonary tuberculosis, sudden death 516 pulsation, absence 352 ‘punch-drunk’ syndrome 204 punching, in child abuse 472 puncture marks, autopsy resuscitation artefacts 40–1 puncture wounds 153 pupils ‘cadaveric position’ 54 morphine administration effect 579 sign of death 54 Puppe’s rule 266 purging of body fluids 36, 65 Purkinje cells, sudden death in epilepsy 514–15 putrefaction 64–9 bacteria 64–5, 68 blisters 64, 65 definition 64 facial bloating 65 fingernail 65 gas formation 64, 65, 435 inhibition by adipocere formation 71 internal organs 66–7 purging due to 36, 65 sequence of changes 64–7 timing 64, 67, 69 temperature effect 64, 67, 68 see also decomposition putrefied corpse bruising, glycophorin A detection 40 external/internal examination 39–40 fingerprints 39, 102 identification 39, 101, 102 insect infestation 39 post-mortem artefacts 36, 65 sex determination 104 pyloric spasm 553 pyogenic infections, in cocaine addicts 582 quinine, illegal abortions 434 quinsy 515 race 11 determination dentistry, forensic 105, 533–4 from skeletal remains 122–3 identity establishment 105 sex determination 108, 110 skull features 110, 122, 123 subdural haemorrhage in child abuse 470–1 see also ethnic characteristics radiation, burns 314–15 radiocarbon test 127–8 radiography/radiology age estimation in skeletal remains 117, 121 air gun injuries 272 ante-mortem, identity establishment 125 in barotrauma 31 bullet wounds 266 child abuse 32, 476 gunshot/explosion deaths 31, 276 identification by dentition 537 identification in explosion deaths 276–7 mass disasters 44 medico-legal autopsy 32 mutilated remains 31 neck, in manual strangulation 373–4 pneumothorax 31 vertebral artery trauma 203 radiostrontium 128 radius, in stature estimation 117 railway injuries 297–8 Rambo knife 143, 155 rape anal 427, 428, 429 children 425–6, 427, 429 crime scene deaths associated 421 evidence 425–6 genital injuries 424 see also sexual offences, deaths associated rats, post-mortem damage 75 razors, stab/incised wounds 163 rectal temperature cooling curve 79–80 in hypothermia 416 measurement methods and controversy on 81–2 post-mortem interval estimation 81–2 Henssge’s nomogram 83, 84–5, 86 at scene of death 7, 81–2 ‘temperature ratio’ concept 83, 87 rectum foreign bodies 426 rupture 231 ‘red flare’ 317 • 650 • Index reflex cardiac arrest see cardiac arrest, reflex refrigeration, infectivity effect 11 ‘refrigerator effect’ 596 relatives attendance at autopsy information on autopsy renal failure, after trauma 345 report, autopsy see autopsy, medico-legal, report respiration cessation as sign of death 55 changes in lung in infants 446–7 chest wall injuries and 223 evidence in newborn 445–8 obstruction, foreign bodies 515 ‘respirator lung’ 345 respiratory arrest, in electrical fatalities 328 respiratory infections 454, 456 respiratory insufficiency, in fat embolism 343 respiratory paralysis, in electrocution 327 resuscitation artefacts 36, 40–1, 224, 353 -adrenergic catecholamines 41, 353 airway damage 41 bruising chest/heart/face 40 categories of damage 40–1 defibrillators 12, 36, 41 gastric contents 41 haemorrhages 40, 41 Heimlich manoeuvre 41 pneumothorax 41 puncture marks 40–1 see also cardiopulmonary resuscitation (CPR) rete pegs 168 retina child abuse 472–3 sign of death 54 retinal haemorrhages 41, 472–3 retinal vessels, ‘trucking’ 54–5 retraction balls/globes 210 retrograde amnesia 209–10 retropharyngeal abscess, rupture 515 revolvers 247, 248 see also rifled weapons, wounds rheumatic valve disease 506, 507 ‘Rhyl mummy’ 72 rib fractures 223–4 callus formation 467, 468 child abuse 224, 467–8 pneumothorax 223 respiration affected 223 ‘string of beads’ 467 vehicular accidents 285, 290 ricin 550 rifled weapons 248 ammunition 248 barrel length 263 muzzle velocity 268 test firing 263, 270 rifled weapons, wounds 258–67 abrasion collar 263–4, 268–9 blowback into barrel (‘back spatter’) 261 in bone 266, 267, 270 burning/blackening 259, 262 close-range 261–2 contact 258–60 direction of discharge 265–6, 268 entrance wounds 262, 264, 265, 266, 267 exit wounds 260, 262, 263, 268–9 extreme trajectory 265 fouling 263 gas rebound 263 grease ring (‘ring of dirt’) 264–5 hyperaemia around 260, 262 mechanics 245–6 medium-distance 263 muzzle gases 259 muzzle imprint 260 posture affecting 266 powder tattooing 262–3 range of discharge estimation 263, 270–1 rust stains 260, 261 shelving/undercutting 265 soot/smoke soiling 262–3 stellate 268 suicidal 259, 261 tangential/glancing 269 ‘through-and-through’ 268 unburnt explosive/filler on skin 263 rifles 247, 248 right coronary artery 495 right ventricle hypertrophy 25 stab wounds 226 rigidity, cadaveric see rigor mortis rigor mortis 60–3 biochemistry 61–2 ‘breaking’ 62 charting teeth and 536 duration 60 electrical fatalities 61 external examination 13 false, heat and cold stiffening 63 fingerprint taking 101 goose-flesh in 61, 395 gross effects 62 height of body 103–4 instant/cadaveric spasm 63 movement of body after 62 non-skeletal muscle/tissues 60, 61 removal of clothes testing 60, 61 timing/sequence 60, 61 factors affecting 60–1 ‘ring fracture’ 181, 185, 214, 283, 290 road traffic accidents see vehicular accidents; vehicular injuries • 651 • Index Royal College of Pathologists 30, 44 rubber bullets 274 ‘Rule of Nines’ 13, 313 sacrum, sex characteristics 112 salicylate poisoning 571–2 saliva, samples 422, 528 sample collection in abortion deaths 436 at autopsy 19–21, 547–50 bile 548 bites/bite marks 528, 531 blood 19–20, 547–8 containers 545 for cultures 29 for DNA testing 106, 604 road traffic deaths 296 sites not suitable 19–20, 547 sites/procedures 19–20 body fluids 19–21, 549 cerebrospinal fluid 21, 548 in child abuse 476 containers for 30, 545 in cyanide poisoning 586–7 in drug overdoses 543–4 entomological 78 exhumation 37 intestinal contents 549 microbiological 20, 29, 45–6 microbiological contamination 29 obscure autopsy 45–6 in poisoning deaths 38–9, 543–4 retention, legal issues saliva 422, 528 scene of death semen 106, 423, 424 in sexual offences 106, 423, 424 in solvent/volatile substance abuse 549–50, 597–8 stomach contents 27, 545, 549 in sudden infant death syndrome 456 in surgical/anaesthetic-related deaths 486 tissues 550 toxicological 29–30, 46, 486, 543–4 avoiding operator contamination 545 containers 30, 545 information for laboratory 544 mass disasters 44 post-mortem changes 545–6, 547 preservation 544, 545–6 request form 30 sampling site 546–7 timing 544 toxicology kit 20 urine 20, 548 vitreous humour 20–1, 88, 548–9 vomit 549 samples ancillary investigations 29 DNA profiling 106 histology 30, 46, 486 labelling and continuity of evidence 544 microbiological culture 20 post-mortem changes 545–6, 547 tape sand, in body, in immersion deaths 396, 404 Saphir’s myocarditis 508 sarcoidosis, cardiac 509 saw, internal examination of thorax 18 scalds 312–14 child abuse 474 scalp bleeding 176 after death 176 bleeding below 175 in child abuse 463 forensic anatomy 174–5 injuries 174–8 abrasions 175 bruising 175–6, 463 from falls 177–8 ‘flaying’ 176 lacerations 151, 152, 175, 176–7 petechiae 354 scalping injuries 152, 176 scanning electron microscopy 332–3 scapula fractures 468 sexing from 113 scars age of 102–3 appearance/coloration 102, 103 ethnic differences 102 histology 103 human rights abuse 102, 303, 304 identity establishment 102–3 knife and bullet wounds 102 surgical 102 traumatic 102 scene of death 4–7 attendance by pathologist body blood splashes 5–6 clothing/property position removal equipment/thermometers 4–5 examination 4–7 personnel at photographs 6, 33 protection samples solvent abuse 597 • 652 • Index sudden infant death syndrome 453 time since death estimation 6–7 see also post-mortem interval, estimation sciatic notch, greater 111 scissors, injuries from 164–5, 166 scleral haemorrhage, in child abuse 472 scratches 137, 141 see also abrasions; fingernail, abrasions screwdriver wounds 153 scrotum injuries 233 putrefaction 64, 65 rigor mortis 61 SCUBA diving 488, 489, 561 season, putrefaction timing 64, 67 seasonal incidence, sudden infant death syndrome 453 seatbelts 287–9 cervical spine damage despite 284 children/small persons 289 criticisms 288 injuries due to 288–9 injury reduction 287–8, 288 kinetic energy transfer reduced 137 lap-strap type 287, 288 legislation 287 mechanism of action 287 pregnancy 289 types 287, 288 self-biting, in children 474 self-inflicted injuries 235–44 non-suicidal 235, 240–3 characteristics 242 features assisting recognition 241 for gain 241 wound position and clothing self-martyrdom 240 semen collection/sampling 106, 423, 424 post-mortem ejaculation 12–13, 61, 391 testing 106, 424, 426–8 ‘spot’ test 428 seminal fluid, DNA profiling sample 604 seminal stains 427–8 senile myocardium 509 septicaemia, in illegal abortion 433–4 septum, ruptured 502 serological tests, bones/bone fragments 108, 127–8 serotonin, in dating wounds 169 sex determination 11 bodily dimensions 108 cytological examination 104 dentistry, forensic 533 DNA analysis 104, 533 fluorescence 104 identification from teeth 533 non-skeletalized bodies 104 skeletal remains 108–14 accuracy 108 bone length 112, 113 long bones 112–13 other bones 113–14 pelvis characteristics 111–12 pregnancy evidence 114 sacrum characteristics 112 skull 108–11 teeth 109 sex differences infant, sudden infant death syndrome and 452 stature estimation 114 sexual asphyxia 389–92, 596 features 389–91 mechanism 389 medico-legal aspects 391–2 plastic bag 390, 391, 596 suicide vs 390 sexual intercourse, evidence 425–6 sexual offences, deaths associated 421–30 bites/bite marks 421–2, 528, 529, 530 bruising 421, 422, 427 children 106 see also child abuse, sexual decapitation 423 DNA profiling 106, 424, 428 external examination/findings 421–4 fingernail examination 423 homicide 421, 423, 424 homosexual 427, 428–9 human rights abuse 305 internal examination 424–5 interpretation of minimal findings 425–6 rectal temperature cautions 82 sample collection 106, 423, 424 semen testing 106, 424, 426–8 shaken-baby syndrome 193, 469–70, 471 shaking, subdural haemorrhage after 193, 469–70, 471 shark attacks 76 shaving, head 14 shear stress 193, 206, 209 Sheehan’s haemorrhage 348 ships, suffocation in tanks 358 shock 170 shock waves, explosions/missiles 246, 275 shooting, human rights abuse 305 shotguns 246–8 ammunition 246, 247–8 cylinder and choke barrels 246 test firing 253 twelve-bore 247 shotgun wounds 249–58 appearance 249, 251–3, 255–8 burns 250, 251, 252 carbon monoxide levels 250, 252, 267 • 653 • Index shotgun wounds (contd.) cartridge constituents contributing 249 close discharge 251–3 contact wounds 249–51 entrance vs exit wound 267 muzzle impression 250, 251 over bone 250–1 direction of discharge/injury 254–5 exit wounds 255, 259, 267 features 251–3, 255–8 foreign body embolism 345 hair singeing 251, 253 internal tract 255–6 mid-to-distant range 253–4 radiography 257, 258 range of discharge estimation 249, 271 ‘rat-hole’ appearance 249, 253 secondary damage 256 shape 249–50, 254 shelving/undercutting 254–5, 256 short-to-mid-range discharge 253 skull 266, 267 soiling/burning 249–50, 251, 252 suicidal 253, 254, 255 tangential 256, 257–8 tattooing in 252 ‘through-and-through’ 267 track 255 twelve-bore shotguns 251, 252, 253, 254, 255, 256, 258 hunting accident 259 wad wounds 254, 256–7 siderophage 577 SIDS see sudden infant death syndrome (SIDS) sixpenny bruises 148, 463 skeletalization 67 skeletal remains 106–8 age determination from see age estimation are the remains bones? 107 dating see under dating evidence of pregnancy from 114 extrajudicial execution 305 facial appearance reconstruction 128–9 fatal abuse 302 general categorization 107 human origin, determination 107–8 identification 99, 106–8, 537 personal identity 123–5 see also under dentistry, forensic photosuperimposition techniques 128 race determination 122–3 sex determination see sex determination stature estimation see under stature skeleton, reassembly and layout 108 skin in age determination 11, 104 blisters see blisters burning see burns colour 12 abortion deaths 346 barotrauma 489 burnt bodies 99 carbon monoxide poisoning 57, 562 cyanide poisoning 586 ethnic characteristics 99 hypostasis effect 99 hypothermia 416, 417 putrefaction 64, 65 crepitance 489 destruction, second degree burns 313 forensic anatomy 137–8, 174 haemorrhages, in hypostasis 57, 58 heated, splits in 316, 318 infections, in neglect/starvation 414 maceration see maceration in mummification 72 in neglect/starvation 413–14 pigmentation, in identity establishment 99, 105 ‘rain-drop’ punctate pigmentation 590 resistance to electrical current 328 stab wounds 162–3 structure 138 temperature 79, 82 thickness, stab wounds 162 ‘skin popping’ 578 skin-slippage 64, 65, 99 skull bullet/shotgun wounds 266, 267 children 464–5, 466 examination at autopsy 22 facial appearance reconstruction 128–9 flexibility, in infants 183 forensic anatomy 108, 181–2 identification from age estimation 120–2 personal identity 124–5 race determination 110, 122, 123 sex determination 108–11 muscle ridges 109 removal at autopsy 19 stress lines 183 suture lines 120–2, 181 diastasis (springing) 185, 187, 188 tensile strength 186–7 thickness 181–2 skull fractures 181–9 ante-mortem vs post-mortem 182 anterior fossae, black eyes 179, 180 axes/cutting weapons 186 basal linear 184–5 base of skull 185 blood below pericranium 175 blunt injuries 177, 183 child abuse 185, 464–6 children 180, 185, 466 • 654 • Index comminuted, bullet wounds 266, 267 comminuted depressed 183, 186 dangers 188–9 depressed 177, 184, 186, 187, 188 traumatic epilepsy after 188–9 extradural haemorrhage associated 190–2 falls 184, 187 force required for 186–7 frontal bone 466 ‘growing’ 466 ‘hinge’ 183–4, 188, 290 horizontal cracks 466 infections 189 linear 183, 184–5 mechanics 182–4 ‘struck hoop’ analogy 182, 183, 206 meningeal haemorrhage after 188 motorcyclists 185, 188, 290–1 occipital 184, 466 occipitoparietal 464 pond fracture 185–6, 186 Puppe’s Rule 184 ‘ring fracture’ 181, 185, 214, 283, 290 shotgun wounds 258 significance 182, 204 sites 183–4 ‘spider’s web’ (mosaic) 184, 186 ‘staggered’ 466 stepped 185 types 184–6 vehicular accidents 188–9, 284, 287 slashes 154–5, 155 slippery elm 433 smoke autopsy appearance of burns 315–16 inhalation 317, 322 soiling 252 see also fume inhalation smothering 358–61 accidental 360 definition 353 infants 358, 359, 444, 456–7 cot deaths vs 456–7 sodium 89 release in drowning 401 sodium fluoride 545, 546 sodium hydroxide, burns 588 sodium hydroxide test, carbon monoxide poisoning 562 soft tissue injuries, pedestrians 294 soil, decomposition of buried bodies 69 solvent abuse 595–9 asphyxia 596 autopsy 597–8 chemical effects 596 dangers 595–6 effects 595 facial examination 598 medico-legal aspects 596 methods of abuse 595 physical danger 596 reflex cardiac arrest 595–6 substances used 589, 596–7 sudden death 595–6 somatic death 52, 53 Sommer’s movements 62 soot inhalation 322–3 staining, of skin 252, 262–3 space-occupying lesions, intracranial 193 ‘Spanish windlass’ 240, 379, 380, 381 spark burns/lesions 329, 330, 331 spasm, cadaveric 61, 62–3 Spaulding’s sign 443 specimen collection see sample collection spermatozoa, retrieval 428 spiked instruments, stab wounds 156 spinal anaesthesia, deaths related 485 spinal column, stature estimation 116 spinal cord haemorrhage 216 hyperflexion/hyperextension injuries 216 infarction 216 injuries 216 removal/examination at autopsy 23, 24 spinal injuries 214–16 compression damage 181, 214 deceleration 214, 215 examination at autopsy 23 fractures in falls 181, 214 hyperflexion/hyperextension 214–15 splanchnic shunt 397 spleen cyanide poisoning 587 damage, in chronic alcoholism 558 examination at autopsy 27 haemorrhage 231, 233 injuries 231, 286 rupture 231 vehicular accidents and 286 weight, in drowning 406 spontaneous combustion 323–4 stab wounds 153, 155–66 amount of force used 161–3 characteristics 156–64 chest 160, 162, 222–3, 225, 226–7, 229 haemothorax and 224–5, 225 heart 223, 226–7, 229, 238 lung injuries 226 suicidal 238 depth 159 direction 158–9, 159–61 homicide 155, 160, 161, 163 human rights abuse 303–4 infanticide 444 • 655 • Index stab wounds (contd.) kinetic energy transfer 136 kitchen utensils 164 knife dimensions and blade type 156, 157–8 length 157 movement of knife within (‘rocking’) 156, 158–9, 161 multiple 157, 158, 160 nature of weapons 155–6 non-suicidal self-inflicted 241 pneumothorax 225 razors/glass 163–4 sexual offences 423 ‘shelving’ (undercut) 159, 160 skin 162–3 skin thickness 162 suicidal 238 see also suicidal injuries, knife wounds survival period after 170 ‘through-and-through’ 226, 227 track 160 unilateral ‘fish-tail’ split 158 ‘V-shaped’ 160 ‘stagnant anoxia’ 352 ‘staining’ see hypostasis, post-mortem staining techniques 600–2 stamping injuries 147, 149, 153 flail chest 224 great vessels 228–9 head 179 heart 227 starvation 412 ‘dry’/‘wet’ types 413 general features 412–14 infanticide 445 medico-legal problems 414 stature estimation from skeletal remains 114–16 calculation systems 115–16, 117 dried bones 114 fragmentary bones 116 length of long bones 114, 115, 116 spinal column 116 intact body, identity establishment 103–4 tables, female/male 115, 116 ‘Stavanger definition,’ sudden infant death syndrome (SIDS) 451 steel workers, identity establishment 103 steel works, carbon monoxide poisoning 561 steering wheel injuries 223, 229, 283, 287 abdominal 229 sternal rib methods, age estimation 120 sternum autopsy in air embolism 347 fractures 224, 468 sexing from 113 stillbirth 439–40 decomposition of fetus 64 definition 439 determination 440–1 legal criteria 440–1 proof of separate existence and 445, 446 stomach in aspirin poisoning 572 in barbiturate poisoning 574 carcinoma 516 contents see gastric contents in cyanide poisoning 586 deaths from corrosives 588 in drowning 404 emptying see gastric emptying examination at autopsy 27 injuries 229–30 in paraquat poisoning 566, 567 ‘red velvet’ in arsenical poisoning 590 rupture 230, 231, 472 strangulation 369 abrasion marks 141, 148, 372–3 cricoid cartilage 376, 378, 382 deaths in custody 308 definition 353 features 370 hypostatic artefacts of oesophagus vs 59, 373 infanticide 443–4 ligature 353, 379–83 accidental 383 asphyxia 382 embedded 380–1 facial appearance 380 hanging mark vs 381–2, 386 homicide 379 infanticide 443–4 knots 382 laryngeal horn fracture 378, 782 ligature mark 141, 308, 379, 380–2 mode of death 381, 382–3 nature of ligature 379–80, 381 position of mark 381–2 signs of local injury 382 suicidal 240, 380 manual 371–9 autopsy appearances 371–3 bruising on neck 371–2, 373, 374 cardiac arrest 374, 378–9 carotid artery damage 378–9 fingernail abrasions/marks 141, 372–3, 373 internal appearance 373–4 laryngeal fractures 377 laryngeal fracture significance 377 laryngeal injuries 376–7, 378 spurious bleeding behind larynx 375 vagal inhibition 371, 378 • 656 • Index petechial haemorrhage 354, 382–3 scleral haemorrhage in 354 stress coronary atherosclerosis and trauma 518 effect on digestion 88 ruptured berry aneurysm and 199, 512 stroke, cerebral haemorrhage and 207 strontium 405 struck-hoop’ action 206 ‘stud-guns’ 273–4 subarachnoid haemorrhage 196–8 alcohol and 199 appearances/mechanism 196–8 bleeding sources 197, 512 blood volume 199 bruise below ear 148 in child abuse 470–1 haemolysis 197 investigation methods 203 mechanism and relevance 198 medico-legal implications 198–9, 519–20 rapidity of death 198, 199, 511 resuscitation artefacts 41 rotational trauma to head/neck 200, 202 ruptured berry aneurysm 198–9, 511, 519–20 sudden death due to 196, 198, 511–12, 519–20 trauma and 196–7, 198, 519 trauma/disease interaction 519–20 vertebral artery injury 200, 202, 203 subarachnoid space 189 subclavian veins, blood samples 20, 548 subcutaneous fat, in burns 315 subcutaneous tissue bruising 144–5 sample collection 550 subdural haemorrhage 192–6 acute 193–4 blood volume 193 in boxers 204 child abuse 192, 193, 469, 470, 471 chronic 194–5 enlargement mechanism 195 closed head injuries 193 colour changes 194, 196 dating 195–6, 197 elderly 192–3 forensic implications 195, 198 formation 193, 195 latent interval and coma 194, 197–8 ‘neomembrane’ formation 195 racial aspects 470–1 shaking causing 193, 469–70, 471 ‘spontaneous’ 192 subdural space 189 subendocardial haemorrhage 286, 348–9, 590 ‘submarining’ 289, 304 subpleural petechial haemorrhage 355 succinate dehydrogenase 498, 501 succinylcholine 550 sucking wounds, chest 225 suction lesions, bites in sexual offences 421–2 suction petechiae 530 love bites 148, 421–2, 474, 528, 530 sudden death 492–526 abdominal catastrophes 516–17 abortion 517 aneurysm rupture 509–13, 519–20 aspirin poisoning 571, 572 bronchial asthma 515 cardiac disease 493–511 aortic valve disease 506–7 cardiomyopathies 507–9 coronary insufficiency 503–5 exertion relationship 519 hypertensive 505–6 myocarditis 508–9 senile myocardium 509 trauma relationship 518–19 see also coronary atherosclerosis; myocardial infarction definition 492–3 electrical fatalities 329 in epilepsy 514–15 gastrointestinal haemorrhage 516 genitourinary system 517 haemoptysis 516 in morphine addicts 578 in old age (senile myocardium) 509 pathologists 492 pneumothorax causing 226 pulmonary thromboembolism 513–14, 520 respiratory obstruction 515 solvent abuse 595–6 subarachnoid haemorrhage 196, 198, 511–12, 519–20 suprarenal haemorrhage 349, 510 trauma/disease relationship 517–20 tuberculosis 516 vagal cardiac arrest 370 women of child-bearing age 511 sudden infant death syndrome (SIDS) 451–60 autopsy failure 45, 456–7 procedure 456 autopsy findings 359, 360, 454–5 external 453 histological 455, 456 body secretions 453 case history 10, 453 causation theories 455–6 congenital disorders and 455 counselling 456, 457 organizations 457 definition 451 • 657 • Index sudden infant death syndrome (SIDS) (contd.) factors influencing risk 452–3 gastric contents in air passages 363 histology 455, 456 incidence 451–2 medico-legal problems 456–7 multiple 457 negative autopsy 45, 456 petechiae 354 petechial haemorrhage 454, 456–7 posture at death 453 publicity campaigns and 452, 455 scene of death 453 seasonal variation 453 smothering of infants and 359 ‘Stavanger definition’ 451 suffocation vs 456–7 symptoms 453 sudden unexpected death (SUD) see sudden infant death syndrome (SIDS) suffocation 352–67 autopsy signs 360 carbon monoxide, poisoning 357–8 children 358 cot deaths vs 456–7 definition 353, 357 human rights abuse 304 plastic bag 359–60, 596 suicidal gestures 235 suicidal injuries 235–40 fire-arm wounds 239 automatic pistol 273 rifled weapons 259, 261 shotguns 239, 252, 253, 254, 255 humane veterinary killer 273 jumping from heights 240 knife wounds 236–9 abdominal 238 chest 238 clothing 8, 239 cut throats 236–7, 237 neck 238 wrist 237–8 multiple methods 237, 239 sites 236 stab wounds 238 ‘tentative incisions’ 236, 238 suicide agrochemical poisoning 566 ‘asphyxia’ 240 in bathroom 400, 401, 405 burning 239–40 carbon monoxide poisoning 560 choking due to foreign bodies 361 corrosive poisons 587, 588 in custody 308 cyanide poisoning 585 electrical fatalities 239, 326, 334 falls from height 240 hanging 240, 385, 388 homicide vs 235, 236, 238, 239 injuries before immersion in water 398 by insulin 575 ligature strangulation 240, 380 medicine overdose methods 235 by motor vehicle 297 multiple methods 297 notes 239, 391 plastic bag suffocation 359, 360 railway 297–8 sexual asphyxia vs 390, 392 submersion 239 sulphuric acid 588 supraorbital ridges, in sex determination 109 suprapubic angle 111 suprarenal artery, damage 232 suprarenal haemorrhage 232, 295, 349, 510 suprarenal vessels, damage 232 surgical procedures, deaths associated 480–7 autopsy 480–2, 486 bronchial obstruction 481 classification system 482 disease process causing 482–3 histology 483, 485, 486 medico-legal aspects 482, 483 mode/causes of death 482–4 pulmonary embolism 483, 520 sudden death in gastrointestinal haemorrhage 516 technique/equipment failure 483–4 see also anaesthetic-related deaths suspension, in torture 305 sutural diastasis 466 suxamethonium 486 syphilis 469, 511 ‘tache noire’ 54 talc, granuloma 577 tape, samples Tardieu’s spots 354, 355, 364, 454 tartar emetic 591 tattooing, in gunshot wounds 252, 262–3 tattoos decomposition 101 ethnic characteristics 100, 105 identity establishment 100–1 initials 100 morphine addiction 579 pigments 100, 101 removal 101 significance 100 taurodontism 534 • 658 • Index teeth absence 535 age determination 104–5, 534–5 avulsion/breakage, in child abuse 473 bite marks 530, 531–2 bull-tooth (taurodontism) 534 Carabelli’s cusp 534 choking due to 361 eruption times 533, 534 fillings 535, 537, 538 impressions 531, 532 loosened/broken 178 milk 534 occlusal attrition 534, 535 pink 530, 538 racemization of amino acids 105, 535 racial differences 105, 533–4 sex determination 109 see also dentistry, forensic ‘telefono’ 304 Telkkä’s table, stature calculation 116 temperature heat injury 312 putrefaction 64, 67, 68 scalds severity 314 skin 79, 82 tissue, electrical fatalities 330 water, immersion deaths 369, 396, 400 temperature, ambient decomposition of buried bodies 68 decomposition of immersed bodies 67 effect on cooling curve 81 low cerebral function recovery after immersion 369 deaths from exposure 419 hypothermia 415 immersion deaths 396, 697, 698 post-mortem interval estimation putrefaction 68 rigor mortis timing 60 succession of insects on corpses 76 temperature, body adipocere formation 70 auditory meatus ‘core’ 79, 416 defects 312 diurnal variations 80 gradient for cooling 79 initial, effect on cooling curve 80 malignant hyperthermia 485 measurement methods 81–2 post-mortem interval estimation 7, 79–83 see also cooling, post-mortem raised, sudden infant death syndrome 453 rectal see rectal temperature skin 79, 82 taking at scene of death ‘temperature ratio’ concept 83, 87 vitreous humour chemistry 88 temporal bone, petrous, haemorrhage 405 temporal bruise 176 tendon tags 126 tension pneumothorax 225 terrorist explosions 274–5, 277 terrorist weapons 248 testes fetal maturity estimation 448 stimulation and sudden cardiac death 370 thallium poisoning 591–2 theophylline 515 thermal burns see burns thermocouples 81, 82 thermometers 4, 81, 82 thermometry, post-mortem interval 82–4, 83 thighs, bruising, in sexual offences 422 thorax autopsy in air embolism 347, 436 barotrauma 489 contents, removal at autopsy 21 internal examination at autopsy 18 see also chest throat blows to 371 cut 236–7, 238 air embolism in 346 thromboembolism, pulmonary 513–14 thrombosis coronary artery see coronary artery mesenteric 516 mural 495, 502–3 see also deep vein thrombosis; venous thrombosis throttling, definition 353 ‘through-and-through’ wounds 226, 227, 267, 268 thymic haemorrhage 454 thymus, petechial haemorrhages in 354 thyroid cartilage 376 injuries, in manual strangulation 378 thyroid horn fractures 382, 388 see also larynx, fractures injuries, in manual strangulation 377 tibia fractures 293 stature estimation 117 tissue, sample collection 550 toluene abuse 596–7 tongue examination 23 haemorrhages 378 tonsillar herniation 212 torture 301 beatings 302–3 • 659 • Index torture (contd.) electrical 304 inversion in and postural asphyxia 365 patterned electric marks 332 scars 102, 303 see also custody, deaths in toxicology 541 analyses 542–3 laboratory, information for 544 laboratory records 542 mass disasters 44 poisoning/drug abuse amphetamine 581 antidepressants 573 arsenic 590–1 barbiturates 573–4 cyanide 586–7 ethylene glycol 589 medicines 571, 572 methadone 580 narcotics 579–80 organophosphorus pesticides 568 paracetamol 572–3 paraquat 567 sample collection see sample collection solvent abuse 596–7 surgical/anaesthetic-related deaths 481, 486 toluene abuse 596 see also poisoning trachea compression 368 soot inhalation 322–3 tracheobronchial tree, barium in 363 traffic accidents see transportation injuries; vehicular injuries tranquilizer drugs, poisoning 573 transfusion accidents 482 transplant surgery 53 transport, body 7, 38 transportation injuries 281–300 cause of death 295–7 motorcyclists 290–1 myocardial infarction in 496, 498 pedal cyclists 291 pedestrians see pedestrians railway 297–8 suicide/homicide by 297 vehicular see vehicular injuries transsexualism 104 transvestism 391 tranylcypromine 573 trauma in acute alcoholism 557 berry aneurysm rupture, and 198–9 complications after see complications of injuries disease relationship 198–9, 517–20 see also coronary atherosclerosis pulmonary embolism after 341, 520 pulmonary fat embolism after 343 subarachnoid haemorrhage and 196–7, 198, 519–20 suprarenal haemorrhage after 349 traumatic asphyxia see under ‘asphyxia’ trichloroethylene 486, 597 trichloromethane 597 tricyclic antidepressants, poisoning 573 Trotter and Gleser system 115 tuberculosis, sudden death 516 twinning, sudden infant death syndrome and 452–3 tyres, bruises/abrasions from 142, 143, 144 UK, sudden infant death syndrome in 452 ultraviolet light dating bones 127 myocardial infarction 500 semen testing 427–8 umbilical cord examination in infanticide 443 post-partum changes 443, 445 unconsciousness 53 ‘undertaker’s height’ 11, 21, 103 unexpected death see sudden death United States, sudden infant death syndrome in 452 urea 89 urethra, injuries 233 urine alcohol levels 555 purging, in putrefaction 65 sample collection methods 20, 548 sample preservation 546 toxicological analysis 543, 544 ‘Utus paste’ 434 vagal inhibition 363, 370–1, 378, 399–400 see also cardiac arrest, reflex vagal reflex see cardiac arrest, reflex vagina in abortion deaths 346, 432 examination at autopsy 16 in fatal sexual offences 426, 427 foreign bodies 426 perforation, in illegal abortion 432 tearing/injuries 426, 427 vaginal discharge 12 vaginal fluid, DNA profiling sample 604 Valsalva experiments 371 vasectomy 428 vasovagal cardiac arrest see cardiac arrest, reflex vasovagal reflex/shock see cardiac arrest, reflex vegetative state 52–3 vehicles airbags 289 exhaust fumes 560–1 fragments, hit-and-run accidents 294, 296 • 660 • Index modern design/safety features 283, 286, 287–8, 289 reversing warnings 293 see also seatbelts rear-seat restraints 287 seatbelts see seatbelts windscreen glass 282, 284 vehicular accidents in acute alcoholism 557 concertinaing 281 deceleration and G forces in 281 delayed bleeding 340 drivers 283–4 ‘faking’ 297 fires in 288, 297 a frame 283 frontal 281, 283 ‘hit-and-run’ 294, 296 intrusion of structures 283 pedestrians in see pedestrians rear impact 281, 283, 284 roll-overs 281, 283, 286, 287 side-impacts 283 suicide 297 ‘tail-gating’ 290–1 types 281 unrestrained 282 vehicular injuries 281–91 aorta ruptured 285 autopsy 296–7 brush abrasions 139, 290, 294 cervical spine hyperflexion 215, 284 clothing examination in 8, 296 delayed death 295 disease, natural 295–6 dynamics 281–2 see also deceleration injuries ejection 286, 287 seatbelt effect 287 facial 282, 284 flail chest 223, 294 ‘flaying’ 294 head see under head injuries hyperflexion/hyperextension injuries 214, 215 liver injuries 231, 232, 286, 287 lung 285–6 multiple 295 natural deaths and 295–6, 296 pattern abrasions from tyres 142, 143, 294, 296 pattern of injuries 282–7 driver 282–6 front-seat passenger 287 rear-seat occupants 287 to pedestrians see pedestrians pulmonary haemorrhage 286 radiator injuries 143 ruptured aorta 228, 229, 285 seatbelt effects see seatbelts steering wheel see steering wheel injuries suicidal and homicidal 297 vulnerability of children 289–90 see also deceleration injuries; other specific injuries venereal disease 424, 426 venous congestion, in traumatic ‘asphyxia’ 364 venous obstruction, congestion in asphyxia 356 venous thrombosis 340–1, 341–2 dating 342–3 see also deep vein thrombosis ventilation inadequate, carbon monoxide poisoning 561 mechanical, adult respiratory distress syndrome 345 ventricular fibrillation drowning 401 electrical fatalities 328, 329, 333 vernix caseosa 443 vertebral artery forensic anatomy 201 occlusion 369 trauma 200–4 autopsy appearances 201–2 autopsy demonstration 202–4 investigations 203 mechanism 202 spinal blocks 203 vulnerable points 202 vertebral bodies, compression fractures 214, 215 vertebro-occipital block 203 vessel fragility, bruising and 145 veterinary pistols 273 vials, sample collection 549 video cameras 128 Virchow’s triad 348–9, 520 virus infections, myocarditis 509 virus infections, in sudden infant death syndrome 456 viscera, examination at autopsy 21, 23 ‘vital reaction’ 169, 171, 317, 332, 363 vitreous humour chemistry, post-mortem interval estimation 89–90 glucose levels 90, 575 post-mortem interval estimation 88–9 potassium levels 88, 89 sample collection 20–1, 88, 548–9 sample preservation 546 volatile substances sample collection 549–50, 597–8 see also solvent abuse voltage 328 voluntary organizations 412, 457 vomit aspiration 361–2, 557 external examination at autopsy 12 sample collection method 549 vomiting, in solvent abuse 596 • 661 • Index vulva examination at autopsy 16 injuries 233 in sexual offences 423, 424 Wales, dating skeletal remains in 126 walkers, deaths from exposure and 419 ‘washer-woman’s skin’ 395, 396 wasting conditions 414 water adipocere formation 70 carbon monoxide poisoning 561 deprivation 412 explosions in 275 immersion deaths and see immersion deaths in plastic bags 360 Waterhouse–Friederichsen syndrome 349 Webley veterinary pistol 273 Weedol 566 weight body 603 external examination 12 brain, at autopsy 29 heart see heart, weight wetcutting, brain, at autopsy 27 whip, multi-thonged 303 whiplash injury 215, 283, 284 whipping, torture and human rights abuse 303 WHO method, staining 602 Widmark equation/factor 556 Wilson’s classification of burns 312–13, 313 World Health Organization (WHO) cardiomyopathies classification 508 cardiomyopathies definition 507 death certificates 55 staining method 602 sudden death definition 492–3 ‘undetermined death’ 10 wound classification 137 wounding, survival period after 169–71 wounds ‘ante-mortem’ vs ‘post-mortem’ 167–9, 170–1 chronological histological changes 167–8 classification and types 137 dating 166–9, 170, 171 defence 165–6, 167, 168 definition 136 gunshot/firearm see rifled weapons, wounds; shotgun wounds healing 103, 167–8 histochemical changes 168–9 mechanism 136–7 negative/positive vital reactions 169 pathology 136–73 razors/glass and china 163–4 scissor 164–5, 166 wrists slashing, scars in identification 102 suicidal cutting 237–8 XTC (Ecstasy) 581 xylene abuse 597 Zahn, lines of 503, 510 zonal lesions 499 zygomatic process, sex determination 109 • 662 • ... always! Forensic proverb Third Edition KNIGHT S Forensic Pathology Pekka Saukko Dr.med.univ (Vienna), Dr.Med.Sci., Specialist in Forensic Medicine, Dr.h.c Professor and Head, Department of Forensic. .. record that the second edition of Forensic Pathology consolidated the international reputation of the original book as one of the foremost manuals of forensic pathology in the English language... additional new forensic aphorism should be on the frontispiece: ‘If you can’t prove it, don’t claim it!’ • vii • Bernard Knight 1996 Preface to the first edition This is a textbook of forensic pathology,