A case of fatal poisoning with the aconite plant: quantitative analysis in biological fluid.

In recent years recorded cases of plant poisoning have become rare, this may in part be due to the possibility of plant ingestion not being indicated at the beginning of an investigation. Aconitum napellus (aconite, Wolfsbane, Monkshood) is one of the most poisonous plants in the UK. It contains various potent alkaloids such as aconitine, isoaconitine, lycaconitine and napelline. Ingestion of Aconitum plant extracts can result in severe, potentially fatal toxic effects. This paper describes the analytical findings in a recent death in the UK. resulting from deliberate ingestion of Aconitum napellus extract. The concentrations of aconitine measured by HPLC-DAD in the post mortem femoral blood and urine were 10.8 micrograms/L and 264 micrograms/L, respectively. The aconitine concentration in the ante mortem urine was 334 micrograms/L and was estimated to be 6 micrograms/L in the ante mortem serum. Hence, accidental, suicidal or homicidal poisoning due to the ingestion of plant material remains a possibility and should be borne in mind when investigating sudden or unexplained death.     

Dismemberment and Mutilation: A Data-Driven Exploration of Patterns,Motives, and Styles

Classification of violent behavior, including dismemberment and mutilation, has become increasingly more significant. This study uses a data-driven classification system based upon knowledge drawn from the pertinent literature, and examination of cases of offenders who have dismembered or mutilated their victims. The latter were extracted from the Serial Killer Database, as well as media sources, and assessed for characteristics of the perpetrators and victim(s). An informational form was developed and used to establish quantitative parameters and objectively extract pertinent information that could be used for comparison and pattern analysis. Motives and styles, as well as the organized/disorganized dichotomy for murder and dismemberment/mutilation, were examined for each case. The majority of cases demonstrated defensive styles (60%), with the second most common being offensive styles (26%), which differs from previous studies that do not exclude older cases. Additionally, 68% of cases reflected organized patterns for both murder and the acts of dismemberment or mutilation. The results support a data-driven classification system that may serve as a foundational model for the investigation of specific motives of this type of deviant behavior in future research.     

From the Offences Against the Person Act 1861 to the Serious Crime Act 2015 - the development of the law relating to female genital mutilation in England and Wales

Female genital mutilation (FGM) is defined by the World Health Organization to include: ‘procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons’. It is a practice that affects many females in England and Wales and as a result, specific legislation has been introduced to tackle it. This paper explores the development of the criminal and civil law relating to FGM in England and Wales. It discusses the advantages and disadvantages of the approaches adopted and considers whether they are effective. The paper concludes that the creation of a specific criminal offence has proved to be ineffectual; that the introduction of civil FGM protection orders is a more appropriate and effective means of combatting the practice and that legal measures need to be supplemented by non-legal interventions.     

Identification of unknown human remains by comparison of antemortem and postmortem radiographs

The identification of unknown human remains by comparison of ante mortem and post mortem radiographs has found wide acceptance in recent years. This report documents two recent cases in Hong Kong in which unequivocal positive identifications were achieved by comparison of radiographs. In both cases, comparison of radiographs was the only available means of establishment of personal identity. The first case involved the identification of a very badly burned body of a 22-year-old male by the matching of the ante mortem and post mortem radiographic images of the cranial base (in particular the sella turcica), hard palate, paranasal air sinuses, mastoid air cells, the lambdoid suture, and the upper molar teeth as revealed on comparable lateral skull films. The second was the identification of a deliberately mutilated torso of a 28-year-old female by comparison of the radiographic images of the lumbar spine, pelvis, and head of the femur as revealed on plain abdominal films taken before and after death. While evidence of injury or surgery did not figure in either of the identifications, the presence of a mild scoliosis and the absence of the twelfth ribs aided identification in the latter case. Emphasis is placed in this account on the value of radiographic comparison as a means of identification because it draws upon the matching of intricate and highly individual patterns of external and internal bony anatomy that are stable over long periods of time. In cases where ante mortem radiographs and photographs are available, establishment of personal identity by comparison of radiographs is deemed preferable to identification by photographic superimposition because radiographic comparison permits the matching of a potentially larger number of unique anatomical features and is less time consuming and technically exacting.     

Medical and legal aspects of genital mutilation and circumcision part I: female genital mutilation (FGM)

Female genital mutilation (FGM) is considered to be against the law and against morality not only in Western countries, although a woman of age and able to consent may sometimes think differently. The procedure may have serious physical and emotional consequences for the girl or woman. Nevertheless there are attempts to justify the procedure with medical and hygienic pseudoarguments, ideology, freedom of religion, cultural identity and social adequacy. Outside the Western world, some people claim that religion and culture alone justify the practice. In Germany, parents can lose the right to determine the residence of their daughter, if she is faced with the risk of genital mutilation in order to prevent that the child or girl is taken to her home country. Genital mutilation as a gender-specific threat is recognized as a reason to grant asylum or prevent deportation. Proposals to make genital mutilation a separate punishable offence are presently discussed by the legislator.     

Patterns of Ecchymoses Caused by Manner of Death and Collateral Injuries Sustained in Bruising Incidents: Decedent Injuries,Profiles, Comparisons,and Clinicopathologic Significance

Abstract: We investigated how ecchymoses could be used to predict other injuries, or help establish the cause of death. Ecchymoses, fractures, lacerations, abrasions, and other data were recorded. Eleven percent of decedents had ecchymoses. Motor vehicle accident by car (MVA‐C) was the most common cause of ecchymoses and showed the most collateral injuries. Decedents of natural causes were more likely to have ecchymoses without collateral injuries. There appeared to be two groups of decedents with ecchymoses: one group is younger, comprised of victims of MVA‐C and homicides, with more injuries related to ecchymoses than others; another is an older group of victims of other accidents, natural causes, and suicide. There were no indeterminate causes of death among decedents with ecchymoses. Therefore, ecchymoses may be a surrogate marker to direct the pathologist to continue to seek a cause of death should be seen, even if the case, otherwise, appears to be indeterminate.     

Palatal rugae as an individualising marker: reliability for forensic odontology and personal identification

Personal identification is based on the comparison between ante mortem and post mortem data which can be considered unique for each individual: palatal rugae represent a useful element for such a comparison, thanks to their apparent low variability with time and unique patterns. Literature however is scarce.This pilot study aims at assessing the reliability of palatal rugae in time and at developing an identification method based on their comparison. Two casts from the upper dental arch of 39 subjects were obtained in different periods of time; at their first cast, 85.2% of patients were less than 16 years old. The second cast was performed after a period of time which varied between 4 and 65 months later than the first cast. The first cast can be taken to simulate ante mortem information, the second post mortem information. Every cast was then digitised with a scanner. In the digital images the palatal rugae were highlighted by using Adobe® Photoshop® 7.0 software; each image was coded and a comparison between “simulated” ante mortem and post mortem data was performed. In all cases ante mortem and post mortem data from the same individual were correctly matched.The study seems to indicate that this technique is highly reliable and user friendly, even on subadults, where growth processes seem not to affect the specific morphology of palatal rugae.     

Exorcising excision: medico-legal issues arising from male and female genital surgery in Australia

Genital surgery is one of the most controversial and contested practices, yet it is frequently described and referred to with little or no attention to cultural and social context. This article examines the practice, performed on both men and women, and the extent to which it clashes with issues of consent and capacity, as well as multicultural concepts of toleration for minority group practices. It then questions why female genital surgery, unlike male genital surgery, is legally prohibited in Australia. It argues that such legal gender bias stems from a liberal conception of "tolerance" and the limits of consent in Australia, placing female genital surgery in an "unacceptable" category and male genital surgery in an "acceptable" category.     

A Case of Extreme Sexual Self-Mutilation

Abstract:  We report on a case of extreme sexual self-mutilation in which the subject inflicted severe trauma to his genitalia and then falsely reported a sexual assault. The 30-year-old white male did not report the incident for 10 days and then checked into a hospital. The hospital called the Westminster Police Department after the subject reported that he was the victim of a sexual assault in our city. This case is unusual in that the subject's initial behavior and story did not indicate deception. It was not until the subject's computer was searched that investigators determined that the injuries were self-inflicted. Without this critical information the case might still remain open as a sexual assault. This case is reported to broaden our understanding of this behavior and inform investigators of the potential for this type of self-inflicted injury.     

Fatal Firearm Injuries in Tennessee: A Comparison Study of Tennessee's Two Most Populous Counties 2009–2012

Firearm injuries are a leading cause of violent death in Tennessee. This study was designed to compare the demographic and epidemiologic features of fatal firearm injuries in Shelby County and Davidson County, Tennessee between 2009 and 2012. We identified 1081 gunshot fatalities for the study period in these two counties. Shelby County had a higher overall, age‐adjusted gunshot mortality rate, a higher male age‐adjusted gunshot mortality rate, and a higher age‐adjusted gunshot homicide rate than Davidson. Age groups 25–34 years and 35–44 years had higher crude mortality rates for gunshot deaths in Shelby County than Davidson County. Both counties had higher age‐adjusted gunshot mortality rates for black males than white males, higher homicide rate for black race than white, and higher suicide rate for white race than black. Homicide was the most common manner of death, and handguns were the most common type of firearm used in both counties.     

Medical and legal aspects of genital mutilation and circumcision. Part II: Male circumcision

In the last few years, male circumcision has become the subject of controversial discussion. On the one hand, medical and hygienic arguments, ideology, freedom of religion, cultural identity and social adequacy are claimed by those supporting male circumcision. On the other hand, the justification of this practice also has to be critically scrutinized just as the question whether the parents have the right to consent to the operation. Today, opinions range from those who claim that religion and culture alone justify the practice to those who consider circumcision of minors unable to give their consent as bodily injury subject to punishment. In contrast to female genital mutilation, most positions do not postulate that circumcision violates morality. If the person concerned is able to give his consent, freedom of religion may also justify circumcision after weighing its pros and cons as well as its risks and potential side effects.     

Homicides with Mutilation of the Victim's Body

Abstract:  Information on homicide offenders guilty of mutilation is sparse. The current study estimates the rate of mutilation of the victim's body in Finnish homicides and compares sociodemographic characteristics, crime history, life course development, psychopathy, and psychopathology of these and other homicide offenders. Crime reports and forensic examination reports of all offenders subjected to forensic examination and convicted for a homicide in 1995–2004 ( n  = 676) were retrospectively analyzed for offense and offender variables and scored with the Psychopathy Check List Revised. Thirteen homicides (2.2%) involved mutilation. Educational and mental health problems in childhood, inpatient mental health contacts, self-destructiveness, and schizophrenia were significantly more frequent in offenders guilty of mutilation. Mutilation bore no significant association with psychopathy or substance abuse. The higher than usual prevalence of developmental difficulties and mental disorder of this subsample of offenders needs to be recognized.     

Animal-related fatalities--part I: characteristic autopsy findings and variable causes of death associated with blunt and sharp trauma

Animals may be responsible for an array of potentially lethal injuries. Blunt force injuries characteristically involve larger animals such as cattle or horses that may kick, crush, or trample a victim causing head and facial injuries. Farm workers in particular are at high risk of lethal injuries involving the head and torso. Significant blunt trauma may be found in vehicle occupants after collisions with large animals such as camels or moose. Rarely, zookeepers may be crushed by particularly massive animals such as elephants. Sharp force injuries usually involve carnivore bites, most often from dogs with a "hole and tear" pattern of wounding. Injuries from animals such as alligators and sharks may have a significant component of crushing. Incised wounds may result in death from exsanguination and air embolism. On occasion, blunt or sharp trauma from animal activity may be confused with postmortem damage or with inflicted injury from an assault.     

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.     

A review of blunt force injury homicides of children aged 0 to 5 years in bexar county, Texas, from 1988 to 2009

ABSTRACT: It is essential that clinical physicians, medical personnel, medical examiners, and law enforcement agencies understand the types of injuries seen and demographics of children affected by intentional blunt force as this understanding can be crucial to the death and/or criminal investigations. An understanding of the injuries can also assist in drawing conclusions regarding how those injuries could have been sustained. This study discusses the types and patterns of injuries seen in blunt force homicides in children younger than 6 years. The study found that male infants are more often intentionally injured than are female infants and that fatal head injuries most frequently occur in the first year of life, whereas most fatal thoracoabdominal injuries occur in the first 3 years of life. In children with head injuries, subdural hemorrhage was the most common finding, followed by subarachnoid hemorrhage. In 2.5% of deaths due to head injury, concurrent neck injury was seen, a percentage far lower than previous literature would suggest if shaking was the primary mechanism of injury. Twelve legal confessions were also reviewed, none of which disclosed a pure mechanism of shaking the infant.     

Pharmacogenetics in medico-legal context

Medico-legal autopsy is the primary method in determining the cause and manner of death when the death is suspected to be unnatural. In some of these autopsies, the death remains ambiguous, even after a complete autopsy including histological investigation and toxicological screenings. In cases where there are no morphological abnormalities, medico-legal genetics may offer additional means to provide knowledge of possible genetic mutations, which may have initiated the process or predisposed the individual to stress risk conditions leading to death. One class of ambiguous deaths consists of drug-related deaths where the interpretation of the toxicological results are not clear. In such situations post mortem genotyping and the analysis of metabolite rations may provide an insight to the findings. A few cases demonstrating the potential strength of pharmacogenetics in medico-legal context has been published. However, there is a paramount need for serious scientific studies before the field of post mortem pharmacogenetics can be utilized in routine medico-legal analyses casework and brought routinely into courtroom.     

All that Wheezes is not Asthma—Alternative Findings at Autopsy

Abstract: A number of questions must be asked before asthma can be accepted as a valid diagnosis: were the episodes of shortness of breath investigated? Are there changes at autopsy in keeping with asthma? Did asthma either contribute to the terminal episode, cause death, or was it coincidental? Finally, is it possible that other conditions may have accounted for the clinical manifestations? A review of files at FSSA over a 10‐year period from 1999 to 2008 identified six cases where shortness of breath and/or wheezing had been incorrectly attributed to asthma. Five were due to pulmonary thromboembolism and one to multiple injuries. In the latter case, an irreducible, left‐sided diaphragmatic hernia was present. There was no morphological evidence of asthma in any case. Autopsy examination may, therefore, be crucial in revealing other conditions that may have caused or contributed to episodic breathlessness that may have been incorrectly attributed to asthma.     

Child Abuse-Related Homicides in New Mexico: A 6-year Retrospective Review

Abstract:  We retrospectively reviewed autopsy records at a statewide medical examiner's office in order to identify and characterize deaths due to child abuse. In a 6-year period in New Mexico, the medical examiner investigated 45 deaths determined to be child abuse-related. Decedents were predominantly male (68.9%), Hispanic White (53.3%), and all were 5 years of age or younger, with a median age of 1 year. Head injuries were the most common cause of death (44.4%), followed by battered baby syndrome (15.6%). Relatives were involved as alleged perpetrators in 80% of the cases, with the father most often implicated (36.1% of cases), and 88.9% of child abuse injuries resulting in death occurred in the family's residence. Toxicology was positive in 26.7% of cases, but only two cases had substances of abuse present. Information on risk factors such as prematurity, parental age, and history of abuse was also collected.     

Sharp Force Homicide in Denmark 1992–2016

Sharp force trauma is a common homicide method. The weapon is typically a knife, which is easily accessible and does not require special skills. We have analyzed all 471 sharp force homicides in Denmark during 1992–2016 with special focus on aspects that are relevant to forensic pathologists, including the distribution of wounds and organ injuries. Most homicides were committed inside with a kitchen knife. The front left thorax was the most common area to be affected by sharp force trauma. In 18.9% of the victims, there was only one sharp injury, the majority on the thorax. The most common trajectory for stab wounds was directly posterior with no deviation to the sides or up/down followed by directly anterior. The heart (including pericardium) and lungs (including hemo- and pneumothorax) had injuries in more than 75% of the victims. 67% of victims were males. Female victims had more sharp force injuries and defense wounds than male victims. Most females were killed in domestic homicides (73.7%), most commonly in partner killings (56.4%). In contrast, many male victims were killed in a setting of nightlife/intoxication (34.0%) most by a friend/acquaintance delivering a few stab wounds. The results clearly show strong sex differences in both victims and offenders. This could be useful for shaping policies and public opinion, and as a route for understanding the developments in interpersonal violence. In the narrow setting of death investigation, our results will provide an evidence-based approach to understanding the injury patterns in sharp force homicide.     

Estimation of the post mortem period by multiple-site temperature measurements and the use of a new algorithm

The estimation of the post mortem period, in cases where death occurred under suspicious circumstances, is usually attempted using temperature measurements taken at a single body site. Early investigations of the validity of such an approach use the abdominal skin surface, the axilla and the rectum as measurement sites (B.H. Knight, Forensic Sci. Int., 36 (1987) 47-55). However, it has recently become more common to use the rectum alone, though the ear and the nasal passages have also been utilized. Whatever site is employed, the estimates are frequently found to be inaccurate. There are several fundamental reasons for these inaccuracies, the most prominent being the unknown variation in the ambient temperature between the time of death and the commencement of measurements, and the unknown body temperature at the time of death. This paper proposes a method of overcoming the above difficulties by taking a series of measurements concurrently at a number of body sites, a technique used by several previous workers (B.H. Knight, Forensic Sci. Int., 36 (1987) 47-55). Initial investigations have shown that an improved estimation of post mortem period is obtainable by the application of a suitable decision-making algorithm.