~FORENSIC PATHOLOGY A Handbook For Pathologists

1 If you have issues viewing or accessing this file contact us at ~FORENSIC PATHOLOGY . A Handbook For 0. Pathologists al Institute of Law Enforcement and Criminal Justice Law Enforcement Assistance Administration U. S. Department of Justice /I. O. FORENSIC PATHOLOGY . A Handbook For Pathologists Edited By NCJ~S ~. RUSSELL S. FISHER, 8E001 ~rt C H A R L E S S. PETTY, &CQUISBTIO-NS. This project w a s s u p p o r t e d by G r a n t N u m b e r NI 7 1 - 1 l S G a w a r d e d to the C o [ [ e g e of A m e r i c a n Pathologists by the National Institute of La~v E n f o r c e m e n t a n d C r i m i n a l Justice, L a w E n f o r c e m e n t Assist- a n c e A d m i n i s t r a t i o n , D e p a r t m e n t of Justice, u n d e r the Ot~ni- bus C r i m e C o n t r o [ and Safe Streets.]]]

2 Act of 1968, as a m e n d e d . Points of view or opinions stated in this d o c u m e n t are those of the contributors and do not necessarily represent the official position or po|icies of the D e p a r t m e n t of Justice. July 1977. National Institute of Law Enforcement and Criminal Justice Law Enforcement Assistance Administration U. S. Department of Justice For sale by the Superintendent of Documents, Government Printing Office Washington, 20402. Stock Number 027-000-00541-1. CONTENTS. Page Contributors .. : .. v F o r e w o r d - - R o b e r t Horn, .. ix Preface by Editors .. xi Chapter I Forensic Autopsy Procedure--Leslie I.

3 Lukash, .. 1. II Forensic Autopsy: A Procedural O u t l i n e - - F r a n k P. Cleveland, .. 7. III The Autopsy P r o t o c o l - - J o h n F. Barton, and Charles S. Petty, .. 10. IV Preservation of Medicolegal Evidence Arthur J. McBay, .. 17. V Postmortem Chemistry o f Blood, Cerebrospinal Fluid and Vitreous H u m o r - - J o h n I. Coe, .. 21. VI Time of D e a t h - - T i m e of I n j u r y - - G e o r g e S. Loquvam, .. 50. VII Postmortem Changes and Artifacts--Russell S. Fisher, .. 56. VIII Identification--Charles J/Stahl, .. 64. IX Sudden Unexpected D e a t h - - J o h n I. Coe, .. 72. X Instantaneous "Physiologic" D e a t h - - C h a r l e s S.

4 Petty, .. 77. XI Sudden Infant Death Syndrome (Crib D e a t h ) - - J e r r y T. Francisco, and Charles S. Hirsch, .. 83. XII The Battered C h i l d - - G e o r g e S. Loquvam, .. 87. XIII R a p e - - - T h e Forensic PATHOLOGY Committee, College of American Pathologists .. 92. XIV Abortion Russell S. Fisher, .. 100. XV Fire V i c t i m s - - J o h n F. Edland, .. 104. XVI Electrical Injuries and Lightning--John F. Edland, M . D .. 111. XVII Heat and C o l d - - M i c h a e l M. Baden, .. 117. XVIII The N e c k - - L e s l i e I. Lukash, and Charles S. Hirsch, .. 119. XIX Asphyxial D e a t h s - - A l l a n B. McNie.

5 123. XX D r o w n i n g - - W i l l i a m G. Eckert, and Charles S. Hirsch, .. 129. iii Page XXI Adolescent Sex Hangings--John F. Burton, .. 133. XXII " Characteristics of Wounds Produced by Handguns and R i f l e s - - - F r a n k P. Cleveland, M . D .. 136. XXIII Shotgun W o u n d s - - C h a r l e s S. H i r s c h , M . D .. 144. XXIV Cutting and Stabbing Wounds--Charles J. Stahl, M . D .. 151. XXV Blunt Trauma: General--Jerry T. Francisco, M . D .. 160. XXVI Blunt Trauma: Specific Injuries--Michael M. Baden, and Charles S. Petty, M . D .. 164. XXVII Drug Dealhs by Injection--Charles S. Hirsch, M . D .. 168. XXVIII Deaths by Inhalation or Ingestion of Drugs and Other Poisons--Allan B.

6 MeNie, M . D .. 172. XXIX Alcohol--Arthur J. M c B a y , P h . D .. 179. XXX Therapeutic M i s a d v e n t u r e - - C h a r l e s S. Petty, M . D .. 185. XXXI The Motor Vehicle Crash: Medicolegal Invesfigationm Charles S. Petty, M . D . a n d W i l l i a m G. E c k e r t , M . D .. 189. XXXII A Forensic Library for a Non-Forensic Pathologist-- Charles S. Petty, M . D .. 196. iv CONTRIBUTORS. Michael M. Baden, Deputy Chief Medical Examiner City of New York Associate Professor of Forensic Medicine New York University School of Medicine New York, New York John F. Burton, Chief Medical Examiner Oakland County Pontiac, Michigan D.

7 Frank P. Cleveland, Coroner of Hamilton County Director, Institute of Forensic Medicine, Toxicology and Criminalistics Associate Professor of Forensic PATHOLOGY University of Cincinnati College of Medicine Cincinnati, Ohio John I. Coe, Chief Medical Examiner Hennepin County 0 Professor of PATHOLOGY University of Minnesota Medical School Chief of PATHOLOGY Hennepin County General Hospital Minneapolis, Minnesota 0 William G. Eekert, Deputy Coroner Sedgwich County Adjunct Professor of Forensic Sciences Wichita State University Wichita, Kansas John F. Edland, Chief Medical Examiner Monroe County Clinical Associate Professor of PATHOLOGY University of Rochester School of Medicine and Dentistry 0 Clinical Assistant Professor of Psychiatry University of Rochester School of Medicine and Dentistry Rochester, New York V.

8 FOREWORD. This publication represents an effort on the part of the College of American Pathologists to provide the community pathologist with basic information in the performance of the medical legal autopsy. The development of the manual was made possible in part through funds provided by the National Institute of Law Enforcement and Criminal Justice of the LEAA. The major portion of the funding was used to conduct 13 seminars in Forensic PATHOLOGY attended by more than 350 community Pathologists . The authors of these chapters are all eminently qualified in the field of Forensic Medicine and the College extends to them a grateful thank you for their dedication and efforts to this project.

9 The material presented in this Handbook is not intended to serve as a substitute for existing publications, rather it is intended to serve as an additional source of information to assist the pathologist in meeting a community responsibility. The proper performance of the medical legal autopsy and the objective presentation of the findings is a public responsibility which has been accepted by many Pathologists in this country. It is the hope of the college that this publication will assist you in continuing your work in this area. Robert Horn, , President, College of American Pathologists 9. II. ix g P R E F A C E BY EDITORS.

10 Our wbrk was easy. We had a fine group of experts in the very broad field of PATHOLOGY who did the majOrity of the work in writing this manual. We have tried to preserve the flavor of each person's style of writihg. A few notes have been added to explain different points Of view, but the conterit of the chal~ters i~epres~nts the viewpoint of th~ individual authors. Our goal was easy. We Wanted tO help make available tO pathoiogists a workbook small enoUgh tO be packed in the-ba~ with the autopsy instruments; sliort enough td make it possible t6 review any given chapter prior to (or daring) an autopsy, We give it to you--the patologists.