Forensic Pathology

Dr Shipman

GP serial killer (~250 victims), convicted 2000 and died 2004, prompted reform

Modern Coroners

judicial officers who investigate violent unknown deaths supported by coroner’s officers

Chief coroner

created in 2009, national leadership, current HH Judge Thomas Teague KC

Coroner stats 

453 coroners in England and Wales - 75 senior, 25 area, 353 assistants in 81 areas

Inquest

public hearing

Medical Examiners

independent doctors reviewing death certificates, safeguards and bereavement support

Forensic Pathologists

doctors trained in histopathology, Home Office registered, serve police/coroners

Pathology Delivery Board

oversees services, stakeholders include Home Office, CPS, coroner regulators

Home Office Pathology Units

maintain standards and funds training

Role of pathologists 

to find cause, mechanisms and manner of death 

Professional Standards

GMS, FSR, Royal college of pathologists

Mortuary/Records

must be HTA licensed, keep full records of test and results

Human Tissue Act 2004 

governs human tissue removal, storage and use acting as quality control

UK Pathologists

pathologists rarely come to scene unless necessary

Scene work

specimen recovery from the body, protection of trace, notes, PPE and risk assessment

Court 

pathologist will act as expert witness and give autopsy report

Death certificate

needed to register death and indicate disposal of body

medicolegal

where medical knowledge is applied within a legal context

Postmortem

occurring after death

Perimortem

occurring at the time of death

Antemortem

occurring before the time of death

Somatic Death

end of vital life functions that leads to cessation

Cellular Death

cell-tissue death no metabolic or respiration action

Brain death

irreversible brain damage unresponsive to stimuli

PMI

Post-mortem interval

PVS

Persistent vegetative state

Postmortem changes (PMC)

physico-chemical changes after death to help pathologist find TOD

PMC in eyes 

pupils become fixed and unreactive. Sclerae will go yellow to brown to black

Postmortem Hypostasis

livor mortis; purple-yellow colour of the skin due to inflation of blood

Livor Mortis

begins in first 20 mins, decolourisation around 8 hours and established around 12 hours causing red purple colour of the skin.

Rigor Mortis 

stiffening of muscles creating goose flesh appearance

Supine position

lying flat on the back, face up position for examiners

Factors affecting rigor mortis 

environmental temp, muscle activity, surface area and type of death

Average temp body conditions

warm/flaccid - <3 hours

warm/stiff - 3-8 hours

cold/stiff - 8-36 hours

cold/flaccid - >36 hours

flaccid 

muscles are relaxed without tone

cadaveric spasm

instantaneous rigor associated with violent intense deaths

Algor Mortis

cooling of the body after death

Pugilistic Attitude 

Typical PM body position

Decomposition

Putrification and mummification

Putrification

bacteria invades gut tissues with green discolouration around organ areas

Mummification 

dehydration of the tissue

Adipocere

grave wax that accumulates on body parts with fat due to chemical reaction

Skeletonization

soil can preserve skeleton

Body farms

remains voluntarily given for research, atmospheric pressure affects decomposition

Entomology

blowfly arrive to body quite quickly

Stages of Decay

Fresh, Bloated, Decay, Post-Decay, Dry

Fresh stages

blowflies and flesh flies colonise corpse, eggs laid in warm areas

Bloated stage

corpse begins to swell, maggots and rove beetles feed

Decay stage

large masses of maggots still feed, beetles attracted to corpse

Post-Decay stage

corpse is drying, more flies less beetles

Dry stage

skin and bone left, insect digest keratin

Factors affected Algor Mortis 

initial body temp , size, posture, clothing and bleeding

Nomogram method

used for calculating algor mortis using correction factors like weight and ambient temperature

Vitreous Humour

transparent mass in the eye between the lens and retina; used to estimate TOD by measuring potassium levels.

VM Postmortem equation

PMI = 7.14 * [K+] - 39.1

Stomach contents

TOD can identified based on what meal was eaten (light- 2hrs, heavy- 4/6 hrs)

MCCD

Medical Certificate of Cause of Death

Autopsy

investigative dissection to do a complete evaluation

COD

cause of death

Coronial inquest

public judicial inquiry into how a person died

Consented autopsy

relatives and clinical team with unanswered question can have a consented autopsy

NOK

Next of kin

Types of autopsy 

Clinical (Academic) and Forensic (medicolegal)

Clinical Autopsy

external examination of body comparing to clinical work with permission of NOK

Forensic Autopsy

legal authority for unnatural or criminal deaths with registered pathologist

Pathology Delivery Board 

oversees provision of forensic pathology services in England & Wales

Objective of forensic autopsy 

Positive ID, COD/TOD, abnormalities, samples, organs/tissues

Audio reports

can be used as evidence alongside autopsy report

External examinations

inspecting physical outer layers (purging, rule of nine and body diagrams)

Internal examinations

Incisions

Incisions

standards midline, Y-shape, T-shape

Standard midline

most common incisions

Y-shape incision 

a better cosmetic position used in strangulation and hanging

T-shape incisions

subclavicular inspection of body cavity

Letulle method

removes organs backwards

Ancillary investigation

secondary investigations where samples are taken after initial exam (microbiology, toxicology, histology)

Virtopsy

virtual autopsy which help visual everything court (MRIs and 3D processing)

Virtospy pros and cons

reproducible and non-invasive, high costs and time

Asphyxia

interference with oxygenation

Anoxia

complete lack of oxygen

Hypoxia

partial lack of oxygen

Types of anoxia

anemic, stagnant, histotoxic

Anemic anoxia

carbon monoxide doesn’t allow oxygen to bind to haemoglobin

Stagnant anoxia

loss of blood leads to lack of haemoglobin

Histotoxic anoxia

cyanide functions at cellular level

Neck Anatomy

Vascular structures, nervous structures, airway structures

Vascular structures

carotid artery and jugular vein

Carotid Artery

takes blood to the vein

Juglar vein

carry deoxygenated blood from brain and tissues to the heart

Nervous structures

vagus nerve and phernic nerve

Vagus nerve

affects heart and respiration; parasympathetic processes

Phrenic nerve

controls diagraphm 

Airway structures

nose and mouth (external) , trachea and pharynx (internal)

Lung disease

disease of the lung reduces gas exchange (cystic fibrosis)

Tissue in asphyxia

inability of tissues to utilise oxygen

Mechanical asphyxia

asphyxia in a forensic context

Normal O₂ levels in Young/Middle-Aged

90-100mmHg

Normal O₂ levels in over 60

60-85mmHg

Petechial Haemorrhages (PH)

small pin-sized collections of blood caused by rupture of blood vessels

Thoracic serious membrane   

PH also found in pluera and pericardium