Faith,Folie à Famille,and Mummification: A Brief Review of the Literature and a Rare Case Report

Folie à deux is a rare clinical syndrome characterized by the transference of delusional ideas from one person to one or more other people in close association with the primary affected patient. Mummification indicates the preservation of the corpse of a person for a variable period of time. A brief review of the literature in this field is presented, and an exceptional case is described, characterized by the association of both these rare phenomena. The case is an example of folie à fammille which developed out of a condition of extreme religiousness and seclusion of an entire family. The shared psychosis led to the horrible death of some of the family members, while the last surviving member of the family lived for more than a year and a half with their mummified remains. The Judge commissioned a forensic psychiatry assessment to verify the survivor's ability to bear witness. The development of the psychiatric syndrome and its consequences are extensively discussed.     

A Case of Insect Colonization Before the Death

Forensic entomology is a branch of forensic science in which insects are used as evidence in legal investigations relating to humans, domestic animals and wildlife. One of the theoretical pillars on which the discipline is based concerns the fact that flies colonize a body after death. However in cases of myiasis, maggots are present before death, with consequences in the correct estimation of the minimum postmortem interval (mPMI). We report here the case of a woman, largely colonized by fly larvae, who has lain alive in her garden for four days prior to being rescued. Larvae were found on the conjunctivae, the bronchi, the rectum and vagina. The woman's death, two months later, was caused by tetanus. The consequences of myiasis on mPMI estimation are here discussed. In fact, despite she was still alive larvae, indicated and estimated age of 1.5–2.5 days, based on environmental and body temperature.     

The Biological Effects of Kambo: Is There a Relationship Between its Administration and Sudden Death?

Kambo is a substance obtained from the skin secretions of a frog, Phyllomedusa bicolor, popular in the Amazon region, which is administered via the transdermal route. We report a case of 42‐year‐old man found dead in his house. Near the corpse, a plastic box labeled as “Kambo sticks” was found. The man was a chronic consumer of Kambo and no previous pathology or genetic disease emerged in clinical history from the declaration of his general practitioner. Autopsy investigations and toxicological analysis were performed. The histopathological examination showed left ventricular hypertrophy. Toxicological screening was negative for ethanol and other drugs. Phyllocaerulein, phyllokinin, and deltorphin A were isolated from the Kambo sticks but, only deltorphin A was detected in blood sample. We describe the first forensic case of death associated with Kambo administration. We attempt to explain how its use could be related to the cause of sudden death in this case.     

Complex Suicide by Self‐stabbing and Drowning: A Case Report and a Review of Literature

Sharp force injuries and drowning are methods exceptionally combined in complex suicides. We report a challenging case of complex suicide by self‐stabbing and drowning that illustrates the difficulty in discriminating between homicide and suicide in such circumstances of death. The corpse of a young man was found submerged in a river, stabbed nine times with two wounds that had penetrated the thorax and had caused lung injuries and a hemopneumothorax. The postmortem and histological examinations were consistent with a death caused by drowning, but the manner of death still remained undetermined. Police investigation finally concluded to a suicide, although no suicide note had been left and the victim had no underlying diagnosed mental disorder. The parameters that may help distinguish suicide from homicide at the autopsy should be interpreted in light of a thorough forensic investigation to determine the exact manner of death in such a case.     

Entomological and Cardiologic Evidence of Time Since Death in Short Postmortem Intervals

Estimating the time since death of the deceased is a main goal in forensic investigations, but this can be challenging due to contradictory results derived from different investigations at the scene of death. We present a case of a 78‐year‐old woman, found dead in a small forest with broad‐leaved trees, whose husband had a history of domestic violence. Routinely performed investigations, such as postmortem rectal temperature and lividity, yielded inconsistent time since death results between only a few and longer than 20 h. This difficulty was most likely caused by high ambient temperatures of up to 38.0°C, which negatively influenced the informative value of the applied nomogram method. Additionally, performed entomological investigation of fly maggots (Lucilia illustris) recovered from the corpse and the assessment of heart pacemaker data revealed consistent and incontrovertible results. The presented case highlights the benefits of information provided by entomological investigations and data evaluation of cardiac implantable electronic devices and the combined use of the two techniques.     

The Interest of Postmortem Bacteriology in Putrefied Bodies

A 27‐year‐old man was found dead in an advanced decomposition stage at home. On external examination, his body showed petechial hemorrhages of the skin. At autopsy, petechial hemorrhages of the epicardium were found, but no sign of meningitis was detected. Toxicological investigations remained negative. Bacteriological conventional analyses showed no significant result. Neisseria meningitidis serogroup B was finally isolated on cerebrospinal fluid by a specific real‐time polymerase chain reaction. To our knowledge, there are no available data about the postmortem diagnosis of an infectious cause of death in a decomposed corpse. In such situations, the polymicrobial overgrowth usually hampers the interpretation of bacteriological conventional methods and questions their diagnostic value. Such molecular bacteriological approaches appear to constitute an important diagnostic tool for forensic scientists and should be widely processed in case of suspected infectious death or sudden death whatever the postmortem interval.     

Growth of Chrysomya megacephala (Fabricius) Maggots in a Morgue Cooler*

Abstract: In estimating the postmortem interval (PMI) using maggots obtained during autopsy, the forensic entomologist makes decisions regarding the effects of low‐temperature storage of the body on the insects. In this case report, a corpse was found in an abandoned house in the residential area of Bukit Mertajam, Penang, Malaysia. The maggots were found to be alive inside the mouth of the deceased although the corpse had been in the morgue cooler for 12 days. The maggots were reared and identified as Chrysomya megacephala (Fabricius). The emerged adult flies were kept as a stock colony, and the duration of development under the indoor fluctuating temperature regime was studied. The total duration of developmental process of this species was 9.5 ± 0.5 days, and the PMI estimated was 3.2 ± 0.6 days. This case report demonstrates the survival of Ch. megacephala maggots for 12 days and their growth inside the morgue cooler.     

Two Novel Methods for Enhancing Postmortem Fingerprint Recovery from Mummified Remains

Postmortem fingerprint collection is a routine part of many forensic death investigations. Although the production of postmortem prints is usually straight forward, several obstacles and scenarios can make the collection difficult. A common challenge occurs when finger pads are mummified. Several current techniques allow for softening and rehydration of mummified finger pads; however, despite the employment of such techniques, the production of adequate postmortem fingerprints can remain elusive. The authors present two techniques that can improve the chances of obtaining suitable fingerprints from mummified remains. The “baby powder method” involves applying a cornstarch‐based powder, such as baby powder, onto the darkened and mummified finger pads, to allow better visualization of the fingerprint detail. The “transillumination method” involves carefully dissecting away the tissues underlying the finger pad, followed by placement of a bright light source underneath the finger pad, such that the finger ridge pattern is illuminated.     

广东省室内、室外及中毒死亡案件中法医昆虫学的应用报道

基于昆虫的死亡时间推断是目前最为有效和最准确的方法,本文介绍了广东省4例应用昆虫准确判断死亡时间的案例,这些案例分别发生于3月、5月和6月,现场包括室外现场和室内现场,尸体类型包括死亡不久的尸体和高度腐败的尸体,死亡原因包括钝器窒息、锐器致死、勒颈致死及过量药物中毒致死,其中过量药物中毒致死的案例由于体内含有49倍致死剂量的氯氮平从而使昆虫的发育受到严重影响进一步使得死亡时间推断时间结果比真实时间短。     

Shells and Bones: A Forensic Medicine Study of the Association of Terrestrial Snail Allopeas micra with Buried Human Remains in Brazil

Little is known regarding the scavenger fauna associated with buried human corpses, particularly in clandestine burials. We report the presence of 20 shells of the terrestrial snail Allopeas micra, within hollow bones of human remains buried for 5 years, during the process of collecting DNA material. The fact that a large number of shells of A. micra had been found in the corpse and in the crime scene supports the assumption that there was no attempt to remove the corpse from the area where the crime occurred. Despite this, our observations cannot be used to estimate the postmortem interval because there is no precise knowledge about the development of this species. This is the first record of a terrestrial snail associated with a human corpse and its role in this forensic medicine case.     

Implant Bone Integration Importance in Forensic Identification

Odontological identification consists of the comparison of antemortem dental information regarding a missing person with postmortem data from an unidentified corpse or human remains. Usually, the comparison concerns morphologic features that the operator chooses among all the visible characteristics because of inter‐individual uniqueness; for this reason, implants can be of enormous assistance. A case concerning the recovery of a burnt oral implant, connected to a bone fragment, among 2780 charred bone fragments, suspected to have belonged to a victim of homicide, is presented to demonstrate that dental implants and their site of bone integration represent a very precious element for personal forensic identification. Because of their morphological invariability in time and because of their morphologic uniqueness, they were used as evidence to associate unidentified human charred remains to a missing person where DNA analysis failed to do so. The case illustrates the fundamental contribution, not yet described in literature, given by the clinical aspects of tooth replacement with dental implants to a forensic discipline. Clinical practitioners should therefore be aware of the great importance of their work and of dental records in a forensic identification scenario.     

Biolog-Eco法检测尸体微生物群落的代谢功能变化

目的检测死后不同时间尸体上微生物群落功能多样性的变化并评估其在死亡时间推断中的应用价值。方法采用Biolog-Eco微平板对野外实验中来自于死后0~240 h猪和人尸体的肛门拭子进行微生物群体的培养,监测其引起的光密度值变化,结合法医病理学及蝇类演替,观察自然腐败尸体微生物群落的代谢特性及其变化。结果微生物代谢功能多样性与蛆虫数量变化呈负相关关系。冷冻在0 h对每孔颜色平均变化率影响最大,48 h后基本消失,192 h后尸体微生物群落多样性相对不稳定。主成分分析将31种碳源综合为5个主成分(累积贡献率90%)。碳源tsquare分析显示,N-乙酰-D-葡萄糖氨和L-丝氨酸是推断人和猪样品PMI(0~240 h)的优势碳源。结论 Biolog-Eco法能表现死亡后0~240 h尸体上微生物群落对部分碳源利用的代谢差异,有望为死亡时间推断提供新依据。     

Implications of Genital Mutilation at Autopsy

Given the potential significance of mutilation of the external genitalia in medicolegal fatalities, a review of the literature was undertaken to identify subcategories. Such mutilations may have been sustained sometime before death, around the time of death, or after death. The most common type of ante mortem genital mutilations involves cultural practices such as male circumcision. Less common male mutilations such as subincisions are tribally based. Female genital mutilation is found particularly in African, Middle Eastern, or Asian populations. Self‐inflicted genital injuries are most common in males and may be related to attempts at suicide, or to self‐harming practices. The latter have a strong association with psychiatric illnesses. Postmortem injuries may arise from animal predation or deliberate mutilation of a corpse. The latter may be associated with ante mortem genital injuries in sadistic homicides. The range of possible causes of genital mutilations in forensic cases necessitates extremely careful evaluation.     

Insects of forensic significance in Argentina

Records from forensic expertises and trappings with beef baits conducted in Buenos Aires, Argentina (34 degrees 36'S), show that the dominating species are widespread ones (Calliphora vicina and Phaenicia sericata), with different behaviour in each large latitudinal zone. It is suggested that the range of the yearly photoperiod variation has an influence in the behaviour of the blowflies, making up for differences in the succession patterns. The Calliphorid blowflies Cochliomyia macellaria and Chysomya albiceps were found on indoors corpses; the latter also on outdoors corpses when blood was shed, and in that case as primary. Three species of beetles of the genus Dermestes, which had been associated with mummified remains, appeared 10-30 days after death. The Silphid beetle Hyponecrodes sp. cf. erythrura was found on outdoor copses in rural environments. The Nitidulid beetle Carpophilus hemipterus was found in association with the cheese skipper Piophila sp. (Diptera: Piophilidae) in medullar cavities of bones after ca. 30 days; to this association is often added the Clerid Necrobia rufipes. Lepidoptera Tineidae appear on the head of mummified indoors corpses. North of parallel 32 degrees S, the Muscid grave-fly Ophyra sp. was found breeding on a corpse outdoors in summer. A division by latitude and climate is proposed for Argentina, and an extended system is proposed for the world.     

Death Due to Coronary Artery Insufficiency Following Blunt Trauma to the Chest

There have been numerous reports of sudden cardiac death following blunt trauma to the chest, but there is lack of such references in forensic literature. It is the court of law which makes decision about trauma precipitating natural events. The forensic pathologist is scientifically trained in the medical field and would be in a better position to give clear picture about the victim's general status at the time of death, exact nature and severity of the illness he is suffering from if any. He can also assess the nature and severity of injuries sustained, and thus, his opinion as to the possible role played by the traumatic event in bringing about the death is valuable. This paper will discuss the mechanism of cardiac injury or possible cardiac injury and sudden death of an apparently healthy 36‐year‐old male following blunt chest trauma sustained during alleged assault by his neighbor.     

Virtual autopsy and forensic anthropology of a mummified fetus: a report of one case

A jar containing the mummified body of a fetus was found in a bush near a building. Full-body multislice computed tomography (MSCT) was performed prior to autopsy to study the bones and internal organs. Age was estimated by measuring femoral and tibial lengths and examining the temporal and occipital bones. The results were then compared with the autopsy and histopathological findings. MSCT was superior to autopsy for examination of the bones and internal organs. Autopsy was difficult because of the fragility of the dried corpse. MSCT determined the gestational age of the fetus and excluded skeletal abnormalities. Estimated age was similar with the two methods used. However, the major advantage of MSCT was rapid measurement of bones or anatomical regions which are difficult to examine during autopsy and which required specific preparation for further anthropological study. This case report illustrates the possibilities offered by MSCT for studying mummified bodies, even fetuses.     

Diagnosis of Hemorrhagic Stroke in an Exhumed Brain After Three Years of Burial in a Deep Grave

Abstract: We present the forensic neuropathologic analysis of an exhumed decomposed brain following long‐term interment in a 50‐year‐old white woman, who had been buried for 34 months. Next of kin authorized exhumation of the body for an autopsy to determine the cause of death. The embalmed body was anatomically intact and revealed decompositional changes with mold colonies. Internal viscera showed intact histomorphology. The brain revealed diffuse congestive swelling and extracellular edema with dissecting parenchymal hemorrhage and hematoma originating from the left putamen and thalamus and extending to the left lateral ventricle. Excitotoxic neuronal injury as well as penumbric parenchymal changes was noted. Cause of death was determined to be a hypertensive cerebral parenchymal hemorrhage. This case and our previously reported case are sentinel cases, which should encourage and guide the forensic neuropathologic work‐up and investigation of causes of death in spite of long‐term burial in deep graves.     

法医学尸体勘验过程中关键细节的应用

在法医学尸体勘验过程中,仔细分析研判尸体及现场的各个细节,确定哪些细节是关键＂依据＂,对案件的性质分析和现场重建具有举足轻重的作用。结合案例初步探讨关键细节的抓取思路和方法,以期抛砖引玉,对法医工作有所裨益。