Methyl Alcohol

Poisoning caused by methyl alcohol is relatively uncommon. Methanol is oxidized by the liver to formaldehyde, which in turn is oxidized to formic acid. Formic acid is six times more toxic than methanol. Symptoms of acute methanol poisoning are weakness, nausea, vomiting, headache, epigastric pain, dyspnea, and cyanosis. Inebriation is not a prominent symptom. The symptoms may occur within half an hour after ingestion or may not appear for 24 h. If a fatal amount of methyl alcohol has been...

Vitreous

Next to blood, the most important tissue for toxicological purposes is vitreous. In some ways, vitreous has an advantage over blood in that, caused by its acellular nature and relative isolation, it is less susceptible to biochemical changes and contamination. Because of this, valid electrolyte studies can be done on the vitreous that cannot be performed on blood. In the case of certain drugs, such as alcohol, vitreous can provide a picture of the blood concentration 1-2 h prior to death....

Methamphetamine and Amphetamine

Methamphetamine is a potent CNS stimulant that is readily produced illicitly.14,18 In the brain, it acts by both increasing release of dopamine and blocking its re-absorption, causing hyperstimulation of receptor neurons. Methamphetamine is also a cardiovascular stimulant. It blocks re-uptake of norepinephrine and causes an increase in catecholamine release. The euphoric effect is similar to cocaine but may last as long as ten times that of cocaine. Methamphetamine is metabolized to...

Blunt Force Injuries of the Abdominal Viscera

Abdomen Complete 76700

The abdominal organs are vulnerable to a variety of injuries from blunt trauma because the lax and compressible abdominal walls, composed of skin, fascia, and muscle, readily transmit the force applied to the abdominal viscera. If the victim anticipates the blow and tightens the abdominal muscles, this will disperse the force of impact and thereby reduce the probability of internal injuries. Thus, the boxer who has conditioned his abdominal muscles and is prepared to receive such blows will...

Digoxin Succinylcholine and Insulin

Before ending this section, three more drugs should be mentioned digoxin, succinylcholine, and insulin. Two of the three are medications and one is a muscle relaxant. In the older forensic literature, these were three drugs that could be used to commit murder, with a fair certainty that they could not be detected. This is no longer the case. Digoxin is a cardiac glycoside used in the treatment of congestive heart failure and other cardiac disorders. It is the most common form of digitalis...

Cardiomyopathy

The cardiomyopathies constitute a diverse group of diseases of both known and unknown etiology characterized by myocardial dysfunction, that is, diseases that are not the result of arteriosclerotic, hypertensive, congenital, or valvular disease.28 Cardiomyopathies can be grouped into three general categories dilated or congestive, hypertrophic, and restrictive-obliterative. The last category is usually rarely encountered by the forensic pathologist, since it deals with entities such as...

The Living Rape Victim

Vagina Rape Victim

Rape presents a unique problem to physician clinicians in that they often inherit the burden of not only treatment, but proper collection of evidence. For the correct handling of rape cases, both medically and legally, there must be coordination between the physicians examining the victims and the police agency with jurisdiction. It is preferable that victims of rape be examined at one central hospital by experienced physicians trained in the handling and treatment of such patients and in the...

Subdural Hematomas

The subdural hematoma is the most common lethal injury associated with head trauma Figure 6.12 . The high mortality associated with subdural hematomas is due in part to associated brain damage.14 Since a large number of subdural hematomas are caused by falls, it is not uncommon to find contrecoup contusions in association with subdural hematomas. Unlike epidural hematomas, subdural hematomas are often not associated with a fracture of the skull and can occur in the absence of cerebral...

Autopsy Findings

Autopsy findings in CO deaths are fairly characteristic. In Caucasians, the first impression one gets on viewing the body is that the person looks very healthy. The pink complexion is caused by coloration of the tissue by car-boxyhemoglobin, which has a characteristic cherry-red or bright-pink appearance that can be seen in the tissue. Cherry-red livor mortis suggests the diagnosis even before autopsying the individual. It must be realized, however, that this color can be simulated by prolonged...

Hypertensive Cardiovascular Disease

Sudden death in individuals with hypertension is usually associated with, and probably in most instances due to, accompanying coronary atherosclerosis. The atherosclerosis present can be either the usual form, with eccentric plaque-like deposits of atheromatous material, or a concentric form with uniform thickening of the coronary arteries. In the latter case, while the lumen may be technically patent, the severe concentric narrowing of the vessels accomplishes the same hemodynamic effect as...

Cause Manner and Mechanism of Death

Two of the most important functions of the medical examiner's or coroner's office are the determination of the cause and manner of death. Clinicians, lawyers, and the lay public often have difficulty understanding the difference between cause of death, mechanism of death, and manner of death. Simply put, the cause of death is any injury or disease that produces a physiological derangement in the body that results in the death of the individual. Thus, although differing widely, the following are...

Neonaticide

This can be defined as the deliberate killing of a child within 24 h of its birth. The perpetrator is usually the mother. She delivers the child and kills it. Occasionally, she is assisted by a relative or a friend, but usually neonaticide is an act committed by a single individual with no witnesses. Most of the perpetrators are young and unmarried. Some claim not to have realized they were pregnant until they went into labor. Their goal is either to conceal the fact that they gave birth to a...

Etiology of SIDS

The etiology of SIDS is presumably multifocal and includes not only natural causes, but accidents and, rarely, homicides. New theories as to etiology seem to arise every few years, then disappear only to be resurrected in future years. Theories have included prolonged QT interval immunopathogenesis unstable homeostatic control, etc. Two hypotheses should be mentioned, however. First is that SIDS deaths can be produced by DPT diphtheria-pertussis-tetanus inoculations. A study by the National...

Stab Wounds by Anatomical Location

Lethal Knife Wounds

Most fatal stab wounds are located in the left chest region. Among a number of explanations is that most people are right handed and, when facing a victim, will tend to stab the left chest. In addition, if the intention is to kill someone, one would stab in the left chest where the heart is thought to be. Most fatal stab wounds of the chest involve injury to the heart or aorta. Deaths due solely to a stab wound of the lung are less common. Fatal stab wounds of the right chest usually involve...

Battered Baby Syndrome

Battered Baby Syndrome

The battered baby syndrome refers to a condition characterized by repeated intentional acts of trauma to a young child inflicted at the slightest or most trivial provocation. Deprivation of food and water is a variant of this trauma. Classically, the child presents to a physician or an emergency room with an acute injury accompanied by evidence of both old and recent bruises, fractures, and other injuries. There might be skull or extremity fractures, ruptured viscera, subdural hematomas, or...

The Burned Body

Burnt Body Pugilistic

On gross examination, it is usually impossible to distinguish acute antemor-tem from postmortem burns. Microscopic examination of the burns is not helpful unless the victim has survived long enough to develop an inflammatory response. Lack of such a response, however, does not necessarily indicate that the burn was postmortem. One of the authors VJMD had occasion to examine microscopic slides of third-degree burns incurred in Vietnam, with the patients subsequently evacuated to Japan where they...

Adult Pedestrians

Pedestrian Scuff Marks The Road

If an adult is struck by a truck with a high front, the situation is the same as with a child. With non-braking or late-braking, the impact to the adult is above the center of gravity and the individual is slammed down and run over. If the truck is braking hard prior to impact, the individual is thrown forward. If adults are struck by an automobile or light truck, rather than a truck with a high front, a different pattern of injuries occurs because victims are impacted below the center of...

SIDS and the Munchausen Syndrome by Proxy

Over the years, a number of causes have been proposed for SIDS. One suggestion was that the episodes of prolonged apnea seen in premature infants are a form frustre of SIDS. This concept was proposed by Steinschneider in an article in Pediatrics in 1972.18 He studied five infants, three of whom were referred to him at about 1 month of age because of cyanotic episodes of undetermined etiology. Two subsequently died of what was called the sudden infant death syndrome three survived. One of the...

Traumatic Brain Swelling and Edema

Transtentorial Herniation

Following significant head injury, whether clinically mild or severe, swelling of the brain can occur. Brain swelling may be focal, adjacent to an area of brain injury or diffuse, involving one or both cerebral hemispheres. Brain swelling is due to an increase in intravascular cerebral blood volume secondary to vasodilatation congestive brain swelling , or an absolute increase in the water content of the brain tissue, or a combination of the two. An increase in tissue water content, or cerebral...

Chemical Asphyxiants

In chemical asphyxia, inhalation of a gaseous compound prevents utilization of oxygen at the cellular level. The most common chemical asphyxiant encountered by a medical examiner is carbon monoxide. Carbon monoxide poisoning is discussed in Chapter 14. Hydrogen cyanide and its salts, potassium and sodium cyanide, are potent, rapidly acting poisons. Cyanide produces cellular hypoxia by combining with the ferric iron atom of intracellular cytochrome oxidase. There is no cumulative effect from...

Gentle Homicides and the Lethal Variant of Munchausens Syndrome by Proxy

Sids Death

Probably the most commonly missed method of homicide in infants and young children is smothering. Based on the authors' experiences, smothering is, after impulse homicides, the second most common type of homicide in infants. In infants, smothering is very easily accomplished. One closes off the child's nose with two fingers, at the same time pushing up on the lower jaw with the palm to occlude the airway. Other methods have involved placing a pillow or towel over the child's face and pressing...

Severity of Burn Injuries

Skin Slippage

The severity of thermal injury in an individual depends on Figure 13.2 A and B Radiant heat burns with erythema, blistering of skin and skin slippage continued . Figure 13.2 A and B Radiant heat burns with erythema, blistering of skin and skin slippage continued . Figure 13.2 continued C Cooked skin caused by prolonged exposure to low heat. Figure 13.2 continued C Cooked skin caused by prolonged exposure to low heat. The extent of the burned area The presence of inhalation injuries In living...

Stab Wounds from Weapons Other than Knives

Stab Wound

When an individual is stabbed with an implement other than a knife, the stab wound may have a characteristic appearance because of the unusual nature of the weapon. Because ice picks are no longer common household objects, ice pick wounds are rarely seen nowadays. Ice picks produce small, round, or slit-like wounds that can be easily missed or confused with wounds caused by .22-caliber bullets or shotgun pellets Figure 7.8 . A single ice pick wound might be missed on a cursory examination of a...

Ligature Strangulation

Ligature Marks Strangulation

In ligature strangulation, the pressure on the neck is applied by a constricting band that is tightened by a force other than the body weight. Virtually all cases of ligature strangulation are homicides. In the authors' experience, ligature strangulation is the most common method of homicidal asphyxia, though the incidence of manual strangulation follows fairly closely. In a study of 133 homicides caused by asphyxia, ligature strangulation accounted for 48 of the deaths manual strangulation for...

Chop Wounds

Intoxicated Carbon Monoxide

Chop wounds are produced by heavy instruments with a cutting edge, e.g., axes, machetes, and meat cleavers. The presence of an incised wound of the skin, with an underlying comminuted fracture or deep groove in the bone, indicates that one is dealing with a chopping weapon Figure 7.31 . When the perpetrator pulls out a weapon that has embedded itself in the bone, he might give it a sharp twist, fracturing or breaking off the adjacent bone. In tangential wounds of the skull, chopping instruments...

Smothering

Hand Over Mouth And Nose Smother

Asphyxia by smothering is caused by the mechanical obstruction or occlusion of the external airways, i.e., the nose and mouth. Deaths such as these are usually either homicide or suicide, very rarely accident Figure 8.1 . The most common form of suicidal smothering is the placing of a plastic bag over an individual's head Figure 8.1 A . If it is heavy plastic, it may be secured at the neck. More commonly, suicides employ the thin, filmy plastic bag used by dry cleaners. Here, there is often no...

Fractures of the Skull

Hinge Skull Fracture

The second type of injury that can be incurred is to the skull. In general, whenever a head is either struck with or strikes an object having a broad flat surface area, the skull at the point of impact flattens out to conform to the shape of the surface against which it impacts. As the skull is flattened and bent inward, adjacent, but more distant areas, are bent outward by a wave of deformation consisting of the central area of inbending and the peripheral outbending Figure 6.1 2,3 This...

Incised Wounds of the Neck

Incised Wounds Suicide Victim

Incised wounds of the neck can be accidental, homicidal, or suicidal. Accidental wounds are extremely rare, usually seen only when an individual goes through a sheet of glass or is struck in the neck by a flying fragment of glass or some other sharp-edged projectile. Thus, in one case, a 13-year-old male was struck by flying glass when a bottle containing dry ice exploded. The fragment of glass severed his left jugular vein, causing exsanguination. Homicidal incised wounds of the neck present...

Appearance of Stab Wounds in Skin

Knife Stab Wounds

The size and shape of a stab wound in the skin depends on the nature of the blade and knife, the direction of the thrust, the movement of the blade in the wound, the movement of the individual stabbed, and the state of relaxation or tension of the skin. The sharpness of a weapon will determine the appearance of the margins of the wound sharp and regular abraded and bruised, or jagged and contused. With a blunt cutting edge, the edges of the wound may be abraded. If an individual is stabbed such...

Incised Wounds

Incised Wound Back Forearm Pictures

Incised wounds or cuts are produced by sharp-edged weapons or instruments. A knife is the classical example of a weapon used to inflict an incised wound, though, in fact, any instrument with a sharp edge can do so e.g., a piece of glass, metal, or paper. The sharp edge of the instrument is pressed into and drawn along the surface of the skin, producing a wound whose length is greater than its depth. In incised wounds, the length and depth of the wound will not provide information as to the...

Reyes Syndrome

Reye Syndrome Rash

Reyes syndrome is an entity of unknown etiology affecting children, in which an upper respiratory tract infection, chicken pox, and, rarely, gastroenteritis are followed by vomiting, convulsion, coma, hypoglycemia, elevated blood ammonia, and abnormal serum transaminase values. Individuals dying of the entity show fatty metamorphosis of the liver, with multiple small fatty cyto-plasmic vesicles in the hepatocytes, myocardial fibers, and tubular cells of the kidneys. These are extremely fine...

Contusions

Eyelid Contusion

A contusion or bruise is an area of hemorrhage into soft tissue due to rupture of blood vessels caused by blunt trauma Figure 4.5 . Contusions may be present not only in skin, but also in internal organs, such as the lung, heart, brain, and muscle. A large focal collection of blood in an area of contusion is referred to as a hematoma. A contusion can be differentiated from an area of livor mortis in that, in a contusion, blood has escaped into soft tissue and cannot be wiped or squeezed out, as...

Decomposition

Marbling Putrefaction

Decomposition involves two processes autolysis and putrefaction. Autolysis is the breakdown of cells and organs through an aseptic chemical process caused by intracellular enzymes. Since it is a chemical process, it is accelerated by heat, slowed by cold, and stopped by freezing or the inactivation of enzymes by heat. Organs rich in enzymes will undergo autolysis faster than organs with lesser amounts of enzyme. Thus, the pancreas autolyzes before the heart. The second form of decomposition,...

Time of Death

Tardieu Spots Hanging

Determination of the time of death is important in both criminal and civil cases. In criminal cases, it can set the time of the murder, eliminate or suggest suspects, confirm or disprove an alibi. In civil cases, the time of death might determine who inherits property or whether an insurance policy was in force. Unfortunately, all methods now in use to determine the time of death are to a degree unreliable and inaccurate. They usually give vague or dubious answers. The longer the postmortem...