Death due to concussion and alcohol

We encountered 5 deaths following blunt trauma to the face and head in which the injuries were predominantly soft tissue in nature with absence of skull fractures, intracranial bleeding, or detectable injury to the brain. All individuals were intoxicated, with blood ethanol levels ranging from 0.22 to 0.33 g/dl. We feel that in these deaths, ethanol augmentation of the effects of concussive brain injury, with resultant posttraumatic apnea, was the mechanism of death.     

Investigative and autopsy findings in sport aircraft-related deaths in southwest Florida

Aircraft designated for sport or recreational use only, including ultralights, experimental aircraft and light-sport aircraft, have become increasingly popular. Because of their relative safety and the rarity of fatalities resulting from crashes of these aircraft, the forensic literature contains little information concerning the pathologic findings in such deaths. We report 9 deaths resulting from 6 sport aircraft crashes in southwest Florida, 6 pilots and 3 passengers. The vehicles involved 3 experimental aircraft, 1 ultralight and 2 "ultralight-like" aircraft. The patterns of injuries included trauma predominantly to the chest (3 cases), abdomen (1) or head (1), as well as multiple blunt force injuries involving the chest and abdomen (1) or the head and torso (3). Extremity fractures were found in only 2 cases, whereas injuries to the symphysis pubis were found in six. No "control-type" injuries were identified. These cases illustrate the varied pathologies associated with deaths due to crashes of sport aircraft and reveal the lack of uniformity associated with the investigations of such deaths.     

Deaths and COVID-19: Talk,silence and alternative realities

This article critically considers the UK Government's insidious attempts to control the narrative around COVID-19 deaths through using the interrelated strategies of “talk and ‘silence’ in order to socially construct a definitive ‘truth’” around the virus. The article traces how these strategies worked in practice and the shift which took place from numerous press briefings and Parliamentary debates to an ominous silence around the number of deaths, in particular. At the same time, as the article illustrates, the government's truth has not prevailed. Their twin strategy has been contested and resisted by grassroots organizations and radical lawyers who have demanded that Ministers should take responsibility for the tens of thousands of preventable deaths which have occurred. Rather than government talk and silence prevailing, it is the voices of the haunted relatives of the dead, demanding accountability, which are creating an alternative narrative.     

Sharp injury fatalities in New York City

We reviewed the case records of all fatalities due to sharp injuries in New York City in 1999. The epidemiological profile, circumstances, toxicology results, location, and injuries were examined. There were 120 deaths: 101 homicides, 17 suicides, and 2 accidents. The causes of death included: 112 due to stab(s) with or without incised wounds and 8 pure incised wound fatalities of which 5 were suicides. The detection of ethanol and/or illicit drugs was 61% in the homicide and 12% in the suicide groups. "Defense wounds" were reported in 49% of the homicides and "hesitation" wounds were found in 65% of the suicides. There were no self-inflicted sharp injuries of the face. Deaths due to a single stab wound occurred in 34% (34/101) of the homicides and 24% (4/17) of the suicides. Of these 38 deaths, 58% were of the anterior thorax (chest) and 71% injured the heart and/or great vessels. The remaining deaths with single stab wounds involved the femoral artery, abdominal organs, or head. There were no sharp injury suicides by Hispanics, Asians, or anyone under the age of 18 years. Over half of the suicides at home occurred in the bathroom and 78% of these occurred in the bathtub. Suicide notes were found in 24% of suicides, and an additional 24% verbally expressed a plan to commit suicide.     

Computer analysis of face and skull size by "quantitative verbal portrait" method

The aim of this study was to develop a "quantitative verbal portrait" method on the basis of universal measured signs of the face and skull. The database includes 90 cases with expert evaluation of photocompatibility with proven identity. Four groups of signs were investigated: DX and DY--the width and height between accurately fixed concrete craniometrical (facial) points and the so-called RX and RY indices--the ratio between distances within the framework of the same direction. The proposed scheme of evaluation helps compare the photograph of a live human and the skull. For evaluating the degree of identity, one should have a summary characterization of all selected signs for the skull and compare it with the sum on the photograph; sometimes it is possible to rule out the identity of the photograph and the skull by the absolute size, e.g., a very large skull cannot belong to a human with a very little face. The score for each group of signs is used for analysis of the information for detecting the similarities. Accumulation and comparative analysis of two information flows are possible: database on portraits of lost subjects and database on graphic images of the skulls of unidentified corpses.     

Occupational deaths due to penetrating chest injuries from sledgehammer fragments: two case reports and review of the literature

Occupational deaths due to projectiles from hand tools are rare. We report 2 unusual cases of individuals killed by metallic projectiles produced by the fragmentation of the head of a sledgehammer. At initial examination, these wounds appear similar to atypical gunshot or stab wounds. Proper evaluation requires radiographic examination, scene correlation, and, when possible, comparison of metallic fragments retrieved at autopsy and tools from the scene.     

Immunohistochemical quantification of pulmonary mast-cells and post-mortem blood dosages of tryptase and eosinophil cationic protein in 48 heroin-related deaths

Recent studies suggest that many fatal heroin overdoses are caused by anaphylactoid reaction. In the present study we measured tryptase and eosinophil cationic protein in post-mortem blood of 48 deaths after heroin injection. We also investigated the presence and pulmonary distribution of mast-cells using specific immunohistochemical antibody for tryptase and morphometric evaluation in those cases of heroin-related deaths. The data were compared with 44 subjects who died following head trauma and to 32 cases of fatal anaphylactic shock. In the heroin-related death cases, the measurements of serum tryptase levels and eosinophil cationic protein dosages resulted in particularly elevated concentrations compared with the trauma cases. Nevertheless, the data that our study supplies by immunohistochemical techniques indicate that when mast-cells count in the lung was determined, no definite pattern was obtained between fatal heroin overdose cases and the control groups. Furthermore, the wide range of morphine concentrations found in post-mortem blood samples suggest that the term ‘overdose’ is relative and does not sufficiently characterize death associated with heroin addiction. Our study confirms that elevated concentrations of serum tryptase are associated with many heroin-related deaths. At this moment to attribute the cause of these deaths to ‘heroin overdose’ ignores the likely causal contribution of other possible systemic reactions to the mechanism of death.     

How to Develop More Effective Policies Against Crime: Some Reflections on Drugs and Crime Research in an International Context

This paper offers some reflections on how to develop more effective policies against crime, drawing on more than 10 years of research experience on the international drug problem. The paper begins by trying to illustrate the so-called justice gap in the world, and explain why an institution such as the United Nations has a comparative advantage in closing that gap. It then details four lessons that the author has learnt from his own personal experience as head of research in the United Nations International Drug Control Programme, now called the United Nations Office on Drugs and Crime: (i) measure, count, and keep counting; (ii) publish or perish, either in inter-governmental default, or in public hysteria; (iii) limit the dangers of committing the euphemistic fallacy; and (iv) divorce research and policy, because research is policy-dependent; make research policy-relevant, and re-marry it to policy. Finally, the paper tries to show how these lessons can be applied in related areas and used as good practice in research on crime.     

Unusual facial markings and lethal mechanisms in a series of gasoline inhalation deaths

A review of deaths associated with hydrocarbon toxicity from gasoline sniffing in South Australia throughout a 10 year period from July 1987 to June 2002 revealed 4 cases. The victims were all Aboriginal people from remote inland communities. Each death had occurred while the victim was lying in bed sniffing gasoline from a can held to the face. Once unconsciousness had occurred, the mouth and nose had been pressed firmly against the can by the weight of the head. In each case, the effects of gasoline toxicity had been exacerbated by hypoxia and hypercapnia from rebreathing into the container once a tight seal had been established between the face and the can. The circular impressions left by the can edges on the faces of each of the victims provided an autopsy marker that assisted in clarifying the details of the fatal episodes. Discouraging solitary gasoline sniffing in bed may reduce the death rate in communities where this behavior is practiced.     

Trigemino‐Cardiac Reflex as Lethal Mechanism in a Suicidal Fire Death Case

In the vast majority of immediate fire deaths, the mechanism of death is inhalation of toxic gases (especially carbon monoxide), direct thermal injury, or neurogenic shock due to the redistribution of the body's blood volume produced by surface heat on the skin. We present a suicidal case that is unusual because the mechanism of immediate fire death could arguably be explained in terms of a primitive autonomic reflex/the trigemino‐cardiac reflex. Although this reflex is well known to surgeons and anesthetists, with possible lethal consequences in the course of invasive surgical procedures on the head and neck region, it is much less familiar to forensic pathologists.     

Specific Patterns of Canine Scavenging in Indoor Settings

Postmortem animal mutilations due to domestic dogs in isolated domestic deaths are taphonomic modifications regularly observed by forensic pathologists. They are rarely described in the literature; however, even though they present specific patterns. Through 41 cases, 10 at the forensic institute in Lille (France) and 31 at the New York City Office of Chief Medical Examiner (USA), plus 22 cases from the literature, specific locations and patterns of postmortem scavenging lesions are proposed. These lesions are mainly distributed in three locations: the face, especially the nose and the mouth (73.1%), the neck (43.1%), and the arm (shoulder/upper limb [29.2%], hand [26.8%]). We discuss the time span between death and scavenging, the consequences on identification, and comparison with outdoor settings. Outdoor scavenging lesions are mainly located on the trunk and limbs usually sparing the head, which strongly differs from indoor distribution and imply different animal motivations.     

Immunohistochemical quantification of pulmonary mast-cells and post-mortem blood dosages of tryptase and eosinophil cationic protein in 48 heroin-related deaths

Recent studies suggest that many fatal heroin overdoses are caused by anaphylactoid reaction. In the present study we measured tryptase and eosinophil cationic protein in post-mortem blood of 48 deaths after heroin injection. We also investigated the presence and pulmonary distribution of mast-cells using specific immunohistochemical antibody for tryptase and morphometric evaluation in those cases of heroin-related deaths. The data were compared with 44 subjects who died following head trauma and to 32 cases of fatal anaphylactic shock. In the heroin-related death cases, the measurements of serum tryptase levels and eosinophil cationic protein dosages resulted in particularly elevated concentrations compared with the trauma cases. Nevertheless, the data that our study supplies by immunohistochemical techniques indicate that when mast-cells count in the lung was determined, no definite pattern was obtained between fatal heroin overdose cases and the control groups. Furthermore, the wide range of morphine concentrations found in post-mortem blood samples suggest that the term 'overdose' is relative and does not sufficiently characterize death associated with heroin addiction. Our study confirms that elevated concentrations of serum tryptase are associated with many heroin-related deaths. At this moment to attribute the cause of these deaths to 'heroin overdose' ignores the likely causal contribution of other possible systemic reactions to the mechanism of death.     

Post-mortem cooling of the human head: an infrared thermology study

The post-mortem cooling of the human head, over the first fifteen hours after death, was measured by infrared thermology. A detailed temperature map of the head and face was obtained by the use of image processing techniques and the cooling behaviour of twelve preselected facial features was observed. The two main findings of the study were a difference in cooling pattern between the upper and the lower part of the head, and a consistency in the cooling pattern of the lower part of the head in all the cases studied. A comparison of various model fits to the raw data was undertaken and the "best" bodies, models and features were determined on a statistical basis. The formula that best fitted the raw data was a novel double application of Newton's law. The features with the least error in data fitting were the chin and zygoma; that with the most error was the mouth.     

An Unusual Case of Multiple‐Gunshot Suicide of an Alcohol‐Intoxicated Cancer Sufferer with Prolonged Physical Activity

Multishot firearm suicides are relatively rare and suggest the possibility of homicide. Physical activity following gunshots to the head, the neck, and the thorax does occur, and immediate incapacitation does not occur in every fatal gunshot wound that penetrates the head or perforates the heart. Cancer patients appear to be at increased suicide risk, but alcohol intoxication is less common in such cases. We present—to the best of our knowledge for the first time—a case of a 54‐year old, male, liver cancer sufferer, who under the influence of alcohol, discharged his revolver three times, suffered, among other wounds, a heart‐perforating wound, and died after c. 1.5 h, being able to talk until just before he died. Our case underlines the importance of keeping an open critical mind when dealing with multiple‐gunshot fatalities, especially when posttraumatic physical activity might be crucial in differentiating homicide from suicide.     

Body Height Estimation from Head and Face Dimensions: A Different Method*

Abstract: As there are cases brought for forensic examination where only the craniofacial region is available, estimation of stature from craniofacial dimensions is without doubt important in forensic cases. The study presented here attempts to estimate stature from craniofacial dimensions in the Turkish population. In the second phase of the study, the correlations between craniofacial dimensions and stature were also evaluated according to different head and face types. All measurements were taken from 286 healthy males with a mean age of 22.71 ± 4.86 years. The sample was then reclassified according to different head and face indexes. For the whole sample, correlation coefficients were low, changing only between 0.012 and 0.229. Thus, no significant increase in correlation coefficients was observed after the samples had been reevaluated according to different head and face types. As a conclusion, craniofacial dimensions are not good predictors for body height for the Turkish population.     

A review of the literature on the aging adult skull and face: Implications for forensic science research and applications

This paper is a summary of findings of adult age-related craniofacial morphological changes. Our aims are two-fold: (1) through a review of the literature we address the factors influencing craniofacial aging, and (2) the general ways in which a head and face age in adulthood. We present findings on environmental and innate influences on face aging, facial soft tissue age changes, and bony changes in the craniofacial and dentoalveolar skeleton. We then briefly address the relevance of this information to forensic science research and applications, such as the development of computer facial age-progression and face recognition technologies, and contributions to forensic sketch artistry.     

Positional Asphyxia without Active Restraint Following an Assault

Deaths due to positional asphyxia are most often accidental, associated with alcohol and/or drug intoxication. A 19‐year‐old male is reported who was assaulted and placed in a head‐down position in the back of a car were he was later found dead. Brush abrasions indicated that he had been dragged to the vehicle. The head and right shoulder were wedged into the foot well with the body uppermost. At autopsy, there was marked congestion of the face, neck, and upper chest with conjunctival ecchymoses, bruising of the face and scalp, focal subarachnoid hemorrhage, minor cerebral contusion, and diffuse cerebral swelling with early hypoxic ischemic encephalopathy (HIE). Toxicology was negative. Death was attributed to HIE resulting from the unusual positioning of the body. Cases of positional asphyxia involving others may not always include restraint, and when encountered should initiate a careful evaluation of the possible events and lethal pathophysiological processes.     

Methadone and its role in drug-related fatalities in Cologne 1989-2000

All drug-associated deaths from 1989 to 2000 were analysed at the Institute of Forensic Medicine in Cologne. Information concerning sex, gender, drug consumption, time, place and circumstances of death were analysed. A number of 605 cases were recorded; in 518 cases a toxicological analysis was possible and in 171 an autopsy was performed. When it was possible to determine the cause of death form the information available, acute drug intoxication was recorded in 65%. Heroin head the list of identified substances. Sixty-three percent of the specimens showed a combination of several substances, especially a combination of morphine, benzodiazepines, other medications and alcohol. In comparison with other studies the percentage of methadone-positive specimens is low, even though the proportion of specimens positive for methadone increased from 1989 to 2000. This analysis is discussed using background information concerning the management of substitution therapy and the available literature.     

Differentiating cause-of-death terminology for deaths coded as sudden infant death syndrome, accidental suffocation, and unknown cause: an investigation using US death certificates, 2003-2004

We compared written text on infant death certificates for deaths coded as sudden infant death syndrome (R95), unknown cause (R99), and accidental suffocation (W75). Using US mortality files supplemented with the death certifiers' written text for all infant deaths with International Classification of Diseases (ICD)-10 assigned codes R95, R99, and W75, we formed cause-of-death subcategories from common themes identified from the written text. Among all infant deaths in 2003-2004, the underlying cause of death was listed as R99 for 2128 deaths, R95 for 4408 deaths, and W75 for 931 deaths. Among the postneonatal deaths, the differences in subcategories varied between assigned ICD-10 codes: for R99-coded deaths, 45.8% were categorized as "Unknown" and 48.6% as "Pending"; for R95-coded deaths, 67.7% were categorized as "sudden infant death syndrome (SIDS)"; and for W75-coded deaths, 76.4% were categorized as "Suffocation." Examination of the written text on the death certificates demonstrates variability in the assigned ICD-10 codes which could have an important effect on the estimates of SIDS cases in the United States.