Suicidal hanging within an automobile.

Accidental asphyxia related to cars has been described in different reports, but suicidal hanging in an automobile is very unusual. Two cases of suicidal hanging inside an automobile are described, illustrating an unusual form of hanging. In one case, the deceased used his belt as a ligature, and the point of attachment was the window of the car. The second victim used the safety belt of the passenger seat. In both cases, the automobile engine was turned off, all the windows were closed, and the door locks were blocked. The medicolegal cause of hanging was based on the scene of the investigation, police and witness reports, social history, autopsy findings, and toxicologic examinations.     

The forensic pathologist and the determination of driver versus passenger in motor vehicle collisions. The need to examine injury mechanisms, occupant kinematics, vehicle dynamics, and trace evidence

Five cases of vehicular homicide are presented in which the determination of an occupant's role in a motor vehicle collision was an important medicolegal question. The identification of the occupant's role in a motor vehicle collision can be determined by the forensic pathologist. The investigation that coordinates an examination of injury mechanisms, occupant kinematics, vehicle dynamics, and trace evidence will facilitate such a determination. This determination protects the innocent passenger, when faced with criminal or civil charges, from being falsely prosecuted as the driver. The examination of the above-mentioned components in a multi-occupant collision takes on particular forensic importance when a surviving driver claims to be a passenger: the victim rather than the assailant.     

Technical and interpretive pitfalls of postmortem CT: Five examples of errors revealed by autopsy

Image acquisition of dead bodies, particularly using postmortem computed tomography (PMCT), has become common in forensic investigations worldwide. Meanwhile, in countries such as Japan which have an extremely low rate of autopsy, PMCT is being increasingly used in the clinical field to certify the cause of death (COD) without performing an autopsy or toxicological tests, even in cases of unnatural death. Additionally, these PMCT images are predominantly interpreted by clinical personnel such as emergency physicians or clinicians who are not trained in PMCT interpretation and who work for the police, that is, the so-called police doctors. Many potential pitfalls associated with the use of PMCT have been previously described in textbooks and published papers, including the pitfalls of not performing a complete forensic pathology investigation, and the use of physicians without appropriate PMCT training to interpret PMCT and direct death investigation and certification. We describe five examples in which apparent misdiagnosis of COD based on PMCT misinterpretation was revealed by autopsy. Here are the five examples of errors: (1) Postmortem changes were misinterpreted as COD, (2) resuscitation effects were misinterpreted as COD, (3) COD was determined after an incomplete examination, (4) fatal findings caused by external origin were wrongly interpreted as ‘of internal origin’ based on PMCT, and (5) non-fatal findings on PMCT were wrongly interpreted as fatal. Interpretation of PMCT by appropriately trained physicians and an accompanying complete forensic investigation, including autopsy when indicated, is necessary to prevent significant errors in COD determination and related potential adverse medicolegal consequences.     

PSYCHIATRISTS IN BLUE: POLICE APPREHENSION OF MENTAL DISORDER AND DANGEROUSNESS*

This article examines the discretionary judgments and reporting practices of police officers, in their apprehension of 528 defendants subsequently remanded for psychiatric assessment in a forensic unit located in Toronto, Canada. Analysis of arrest documents indicated that police routinely invoked labels of mental illness and dangerousness, and that they recommended psychiatric assessment in over a third of cases that eventuated in clinical remands. A significant relationship was yielded between police judgments and clinical assessments concerning the dangerousness of defendants. The police reports of forensic patients demonstrated the tendency of arresting officers to recommend psychiatric assessment as a vehicle for ensuring the dual application of judicial and therapeutic interventions. These police records were replete with moral assessments about mentally disordered defendants and with a number of strategies designed to influence the subsequent decisions of other legal and psychiatric authorities. In this study the police functioned as forensic gatekeepers, alerting clinicians and other officials to signs of mental disorder and criminality and to appropriate courses of action. At the initial point of arrest, the police assisted in laying the groundwork for the subsequent institutional careers of medicolegal subjects.     

Social Media and Medicolegal Death Investigation: Logged in…To the Morgue

Social media (SM) represent a global consumer phenomenon with an exponential rise in usage within the last few years. The various applications and websites are relatively easy and fast to access, and the number of users increases continuously. SM are an incredible source of freely available, public information about their users. The purpose of this study is to provide information about the usefulness of SM in forensic practice. The electronic database of the Cook County of Medical Examiner's Office (“CCMEO”) in Illinois was searched for investigative narratives that included specific SM keywords, in the period from August 2014 to January 2018. A total of 48 cases met the study's criteria. Among these, “Facebook” has been found to be the most helpful SM for medicolegal investigation purposes. Information obtained by SM can play an important role in forensic practice since it can be used to clarify certain aspects of the medicolegal death investigation, with particular regard to time and manner of death.     

An unusual death by transcranial stab wound: homicide or suicide?

Penetrating stab wounds of the brain are uncommonly seen in modern times and occur almost exclusively in homicides. We report an unusual death by self-stabbing. A 24-year-old man was found dead at home, the handle of a kitchen knife protruding from his forehead. Data such as the psychiatric history of the victim, the multiplicity and site of wounds, the implement used, the presence of hesitation, and defense wounds were studied to elucidate the manner of death, and the suicidal nature of the event was established after police investigation. Atypical injuries require a careful forensic investigation, and medico-legal aspects of the differentiation between homicide and suicide are discussed in this particular case. A review of the literature revealed few cases of suicidal transcranial stab wounds.     

Pathologic features of suicidal deaths caused by explosives

Suicidal explosions that lack a terrorist background are only rarely encountered in the field of forensic pathology. The investigation of explosion-related fatalities can be a substantial challenge in medicolegal casework. Determining whether the manner of death is suicide, homicide, or accident in such cases can present an especially difficult task to the forensic pathologist. This study considers the pathologic features of suicidal deaths caused by explosives without a terrorist background. The modus operandi of the decedents reflected familiarity and proficiency, or at least a degree of specialized knowledge, with the construction and use of explosive devices. All explosions were set off in confined spaces. The injury patterns consisted of a combination of primary blast injuries (e.g. decapitation, traumatic amputation of limbs, gross lacerations of the body surface, blast injuries of gas-containing and hollow organs), secondary blast injuries (e.g. splinter-induced penetrating trauma), tertiary blast injuries (e.g. abrasions and contusions), and burn injuries (mostly of the flash type). The previously described symmetric distribution pattern of injuries in suicidal explosions was apparent only to a certain degree in the present series. Our observation of superficially sharp-edged wound margins with bridging in the depths of the lesion in blast-induced lacerations of the skin should deserve further attention in forthcoming cases of explosion-related fatalities because this finding is a diagnostic possibility that may support the theory of an explosion-related fatality under special circumstances, e.g. when the body has been dumped away from the place of death. Because a terrorist attack may be initially suspected in each case of suicide involving explosives, the importance of a joint inquiry based on expertise from police investigators, bomb experts, and forensic pathologists is evident.     

Investigation of cremations and severely burned bodies

Among the most difficult cases for law enforcement and medicolegal investigators to investigate are those in which victims have been deliberately burned to cover up a crime, or those in which cremation has resulted from an accident or suicide. This difficulty arises from the fact that the bodies may be destroyed or fragmented. The major objective in these investigations are twofold: The first task is to identify the body using every means available, including the aid of such experts as forensic pathologists, forensic anthropologists, dentists, toxicologists, and serologists as well as fire investigators, who can contribute to the investigation by providing information about the course of the fire.     

Forensic issues in cases of Diogenes syndrome

Diogenes syndrome is a syndrome described in the clinical literature in elderly individuals characterized by social isolation and extreme squalor. A number of typical features are found in the forensic evaluation of these deaths as the cases usually initiate medicolegal investigations due to the circumstances and the lack of recorded medical histories. Examinations of the death scenes are often difficult as victim's houses are in a state of disrepair, with filth and clutter, and pet dogs may resent the intrusion of strangers. Bodies are often filthy, with parasitic infestations, and are often putrefied due to the social isolation of the deceased and the delay in the finding of the corpse. Bodies may be traumatized from postmortem animal depredation by rodents or pets (eg, cats, dogs), and injuries such as bruises and lacerations may be present from falls associated with terminal illnesses or alcoholism. Blood or putrefactive fluids may be spread throughout the house by pets. Treatable medical conditions are often present in advanced stages, and features of hypothermia may be found. Attending police may suspect robbery due to disarray of the house and homicide due to apparent "bleeding" around the body from purging of putrefactive fluids, injuries from falls, or postmortem animal activity and "blood stains" throughout the house from antemortem injuries and/or fluid spread by animals. Finally, the identification of the deceased may be compromised by decay and/or postmortem animal activity. Thus, in addition to having typical clinical manifestations, such individuals appear to form a distinct subset of forensic cases having characteristic death scene and autopsy features and presenting particular difficulties in postmortem evaluations.     

A suicide decision as a motive for murder--an airplane as the murder weapon

It is supposed that some fatal aviation accidents of "cause unknown" especially of light and private airplanes are possibly intended by a suicidal act. However it is difficult to prove this suggestion. A case of a light aircraft accident is reported in which the medicolegal autopsy and the police investigation revealed, unexpected, a simultaneous homicide and suicide caused by a stabbing attack on the pilot. This paper stresses the importance of autopsies of the victims in aircraft accident investigation and discuss the medicolegal and psychopathological aspects of the case.     

Importance and Approach to Manner of Death Opinions in Opioid-Related Deaths

The majority of opioid-related deaths are accidental. However, the number of opioid-related suicidal deaths is likely under recognized. Presented here is a case of suicide by heroin overdose. The manner of death would have likely been deemed accidental if not for critical information shared by the decedent’s family during follow-up telephone interviews between the forensic pathologist and the decedent’s family, which included text messages that were sent by the decedent just before his death that were not known at the time of the initial medicolegal death scene investigation. This case highlights that when a forensic pathologist establishes an engaged relationship with the decedent’s family, the information elucidated can prove to be invaluable in reaching an informed opinion about the manner of death. For overdose cases, identifying an accurate manner of death allows the design of public health efforts that adequately address the health risks in the community. For aid in the determination of the manner of death for overdose cases, we propose a five-step checklist that may assist forensic pathologists and medicolegal death investigators when approaching similar cases.     

Forensic medicine and medicolegal investigation in Sri Lanka

In a small country such as Sri Lanka, very interesting applications of forensic medicine and medicolegal investigation exist. We present information that provides an important addition to the knowledge of medicolegal investigators all over the world.     

Medical problems and criteria regarding the use of tear gas by police

Litigation against police agencies for the use and misuse of control agents and procedures has become an important issue for the forensic medical specialist and expert witness. As police technology improves, it becomes apparent that more information for forensic experts will be required in this area. One such area of concern is the use of tear gas by police. This paper addresses the basic types of gas in terms of their chemistry, uses, and medical side effects and complications. Two types of gases--namely, chloroacetophenone (CN) and orthochlorobenzylidenemalontrile (CS)--are discussed in terms of basic properties, unique advantages, and possible harm to the body. CN and CS are relatively safe agents that can be used to control the behavior of a dangerous person. Clinical examples of their use and misuse by police are also reported. Specific guidelines are offered to help ensure a proper assessment of the dangerous person and to protect the health and lives of police personnel, perpetrators, and others exposed to the tear gas. Forensic experts called to testify about the behavior of the disturbed person or to assess the appropriateness of action taken to subdue that person must become more aware of the technology employed by police agencies to accomplish this particular job of protecting public safety.     

家庭暴力受虐妇女法医学鉴定69例分析

家庭暴力虐待妇女的法医学鉴定近年来在临床检案中较常见，但国内法医文献报道甚少。家庭暴力不仅严重损害了妇女的身体，而且给其心理、精神上造成创伤，这已引起社会的普遍关注。从法医学角度看，加强对受虐妇女的检验、调查、取证工作与研究具有重大意义。本文收集１９９３年１月至１９９５年１２月的６９件案例进行分析，并对有关问题进行初步探讨。     

侦查机关内设鉴定机构的负面影响与消解

侦查活动的特殊性使其染指于司法鉴定,侦查机关基于侦查工作之必要内设鉴定机构。侦查机关内设的鉴定机构又因侦查的追诉性质在鉴定活动中难以保持中立性,致使侦查机关的鉴定机构的性质与法律的中立性要求出现一些紧张关系,在诉讼中造成了一些负面影响。司法鉴定制度的改革旨在借助司法行政部门对司法鉴定的统一管理来催生侦查机关的鉴定机构和侦查活动相分离,从而保持侦查机关的鉴定机构具有相对的独立性,并通过制度调整后的外在监督力量与程序的制约机制来缓解这一紧张关系,以促进侦查机关的鉴定机构在诉讼中真正发挥发现事实真相的作用。     

Forensic neuropsychology: a selective introduction

During the last decade, neuropsychology has emerged as one of the fastest growing disciplines within clinical psychology. One of the most important roles for neuropsychologists is their contribution to the forensic sciences. The present paper reviews how lawyers may best utilize the services of clinical neuropsychologists. Suggestions are also offered to neuropsychologists on how better to meet the needs of lawyers. The following forensic science issues are discussed: the legal framework in which neuropsychologists function; contributions psychologists may make towards answering basic medicolegal questions such as the elucidation of the nature, extent, and duration of head injury sequelae; criteria for acceptable neuropsychological reports; medicolegal aspects of severe head injury, minor head injury (posttraumatic syndrome), and pseudo-head injury (malingering). There are many causes of damage to the nervous system (for example, industrial toxins and medical malpractice) that are eligible for compensation. Examples will be confined to head injury since the basic forensic science principles remain the same, whatever the etiology of such brain damage.     

Medicolegal aspects of witnessed suicide due to gunshot to the head. II. Legal medicine aspects and examination of the firing hand

The second part of the paper on suicides by gunshots to the head in the presence of witnesses focuses on relevant morphological autopsy findings such as entrance site, signs of close range or contact shots, bullet path etc. and also discusses selected aspects of ascertaining gunshot residues. For the identification of the shooter an integral medicolegal assessment of all the facts including the investigation results and the autopsy findings is essential. However, the morphological findings alone do not allow safe diagnosis, as for example in a homicide the temporal region, which was affected in all our cases, may have been deliberately chosen by the perpetrator as a localization typical of suicide. Thus methods to ascertain gunshot residues on the firing hand (by means of adhesive films and the polyvinyl-alcohol collection method--PVAL) are of great practical importance. In seven cases adhesive films and/or the polyvinyl-alcohol collection method were used. In one case the gunshot residues (GSR) were analysed by means of tape lifts and subsequent scanning electron microscopy (SEM). It was found that especially the combined application of topographical (adhesive tape/PVAL) and cumulative (SEM) methods allowed for the doubtless identification of the shooter, thus usually confirming the suicide. By the example of one case it is demonstrated that without the immediate collection of evidence at the scene objective reconstruction of the event becomes impossible. On the basis of the reported cases recommendations are finally given for a differentiated approach in the medicolegal evaluation of alleged witnessed suicide by gunshot (to the head).     

Medicolegal system in Greece. A combination of clinical and forensic pathology

At the Annual Meeting of the National Association of Medical Examiners in Chicago, Illinois, in November 1981, Dr. W. Sturner, Chief Medical Examiner of the State of Rhode Island, gave his perspectives as far as clinical forensic medicine and pathology are concerned. This topic, therefore, brought to mind the idea of writing an analysis of the medicolegal system in Greece. This article attempts to show the advantages, problems, and the perspectives of an old-style medicolegal investigation system, existing in Greece since 1910. The clinical aspects of forensic medicine and pathology is exemplified by the presentation of the preliminary results of the study of injuries in traffic accident victims, 1,600 cases examined by the author with the support of other colleagues in Athens, Greece.     

Modification of hematoma findings in the breast region

Subcutaneous bruises caused by blunt injury are common findings in medicolegal case work. If the hematoma involves the anterior thoracic wall, bruises are mostly absent in the region of the nipples and the surrounding areola. A similar phenomenon has already been described for hypostatic skin hemorrhages. A possible explanation for both phenomena is the special tissue texture in the nipple–areola complex. Based on four cases from the forensic autopsy material and two cases from clinical forensic examinations, the macromorphological findings and the histological correlates are presented.     

Radiocarbon dating as tool to assist in triaging cases of unidentified human remains in Victoria,Australia: A case series

In cases where human remains are unidentified because there is no initial identification hypothesis, limited contextual information, and/or poor preservation, radiocarbon (¹⁴C) dating may be a useful tool to further assist with identification. Through measuring the amount of ¹⁴C remaining in organic material, such as bone, teeth, nail, or hair, radiocarbon dating may provide an estimated year of birth and year of death for a deceased person. This information, may assist in, establishing whether a case of unidentified human remains (UHR) is actually of medicolegal significance and therefore, requires forensic investigation and identification. This case series highlights the application of ¹⁴C dating to seven of the 132 UHR cases in Victoria, Australia. Cortical bone was sampled from each case and the level of ¹⁴C was measured to provide an estimated year of death. Four of the seven cases analyzed contained the levels of ¹⁴C consistent with an archeological timeframe, one contained a level of ¹⁴C consistent with a modern (i.e., of medicolegal significance) timeframe, and the results for the remaining two samples were inconclusive. Applying this technique not only reduced the number of UHR cases in Victoria but also has investigative, cultural, and practical implications for medicolegal casework in general.