THE KEYPIONT OF FORENSIC PATHOLOGY
TO THE INTERNATIONAL STUDENTS
Editor: Prof. LI Zhen
THE SCHOOL OF FORENSIC MEDICINE
KUNMIN MEDICAL UNIVERSITY, P R CHINA
FEBRUARY 2013
THE KEYPIONT OF FORENSIC PATHOLOGY
TO THE INTERNATIONAL STUDENTS
Chapter One – Introduction of Forensic Medicine
1 Definition of Forensic Medicine:
-An important medical subject serving for the court
-Using the principles and knowledge of basic medicine
-To solve the medical problems in the judicial procedure
-The subject of it is dead bodies, living persons, physical evidences, and document
-Must giving out a forensic report
-Usually appearing in court as a witness
2 The main branch of Forensic Medicine
Medicine::
-Forensic Pathology
-Forensic Toxicology
-Forensic Biology
-Clinical Forensic Medicine,
-Forensic Toxicological Analysis
-Forensic Anthropology
3 The forensic medicine work is to do
do::
-Case investigation
-Scene investigation
-Postmortem examination (Autopsy)
-Examination of living persons
-Examination of physical evidences
-Document examination
-Animal experiment
-Giving out a forensic report
-Appearing in court as a witness
4 The Definition of Forensic Pathology:
-An important medical subject serving for the court
-Using the principles and knowledge of pathological medicine
-To solve the medical problems in the judicial procedure
-The subject of study is dead bodies, human tissues and sometimes the relevant
document
-Must giving out a forensic pathology report
-Appearing in court as a witness on occasion
5 The main roles of Forensic Pathology:
-To determine the cause of death;
-To determine the manner of death;
-To determine the time of death;
-To identify the deceased if unknown;
-To determine the possible instrument.
6 The aims of postmortem examination:
-To provide important clues and direction for criminal or civil investigation
-To provide the expert evidence in court proceeding if a case goes to trial
7 “Washing Away the Wrongs
Wrongs””:
-Was Written by Song-Ci, a famous forensic figure, in ancient time in Chinese history
(or in Song Dynasty in China)
-A famous forensic works in ancient China
-Contains many ways and roles of examining bodies and crime scenes
-Was translated into many languages in the world
8 Song Ci:
-A famous forensic figure in ancient times in Chinese history
-Was born in 1127 and dead in 1279 (or in Song Dynasty in China)
-Wrote the book titled “Washing Away the Wrongs”
-Was translated into many languages in the world
-A great contribution to the world due to his “Washing Away the Wrongs”
9 Lin Ji:
-A very famous forensic expert in modern times in Chinese history
-Was born in 1897 and dead in 1951
-Studied in Würzburg University and Berlin University in German majored in
Forensic Medicine
-Acquire Doctoral Degree in Medicine
-Achieved a lot in forensic teaching, forensic research and forensic case work
-Trained many forensic experts distributed in many parts of China
-Established many forensic teaching departments and institutes in China
-Established the journal of Forensic Medicine Monthly
-Published many books and papers in forensic medicine
10 About the history of the School of Forensic Medicine
-Was establishes in 1983
-Began to enrolled in undergraduate students majored in Forensic Medicine in 1984
-Began to enrolled in postgraduate students majored in Forensic Medicine in 1999
-Got the “National Excellent Course of Forensic Pathology” in 2007
Chapter Two – Death
1 The classification of death:
-Violent death (suicide; homicide; accident)
-Natural death (disease)
2 The main content of death including:
-The concept of death
-The death process
-The postmortem changes
-The cause of death
-The manner of death
-The analysis of cause of death
-Estimation of postmortem interval (PMI)
3 Death can be divided into the following two stages according to if
the cells dead:
-Total death or somatic death
-Molecular death or cellular death
4 Traditional conception of death
eath::
-The complete and persistent cessation of respiration and blood circulation.
-There are two kinds of death (cardiac death and respiratory death)
5 Modern conception of death
eath::
-Brain death
6 The conception of brain death
eath::
-The complete and persistent cessation of brain function.
-No matter the respiration and the blood circulation stop or not
7 The significance of brain death
eath::
-To determine the time of stopping resuscitation
-Useful for organ transplantation
8 Death process and its meaning
meaning::
-Agonal Stage: Respiration and blood circulation exist but very weak (can be survival
after resuscitation).
-Clinical death: Respiration and blood circulation stop but the cells are alive (maybe
survival after resuscitation).
-Biological death: Respiration and blood circulation stop, and the cells are dead
(cannot
be survival after resuscitation).
9 The classification of death
eath::
Ⅰ. Violent death（Unnatural death）
-Suicidal death（suicide）
-Homicidal death（homicide）
-Accidental death（accident）
Ⅱ. Nonviolent death
-Physiological death
-Pathological death
10 The definition of apparent death
eath::
-A state of minimum of life activity.
-Respiration and blood circulation exist but very weak.
-The patient can be survival after resuscitation.
-Rescue the patients as soon as possible.
11 The most common reason of apparent death
eath::
-Alcohol poisoning, hypoxemia
-Electric trauma
-Injury
-Opium poisoning, sedative poisoning
-Uremia, diabetic coma
12 The cause of death include
includess the following:
-Underlying cause of death
-Direct cause of death
-Contributory cause of death
-Inducing factor of cause of death
-Combined cause of death
-Undetermined cause of death
13 Inducing factor of cause of death include
includess the following:
-Excitement
-Psychological trauma
-Overwork
-Smoking and drinking
-Starvation or overeating
-Sexual intercourse
-Minor trauma
-Minor illness
14 The most common dispute occasions in forensic field are:
-Disease & violent force；
-Violent force & violent force
Chapter Three – Postmortem Changes
15 Concept of the postmortem changes:
When death occurs → All factors act on the body (outside and inside
of the body) → Some changes occur (outside and inside of the body) →
Postmortem changes or postmortem phenomenon
16 Classification of the postmortem changes according to the time:
-The early postmortem changes (those appeared within 24 hours after death)
-The late postmortem changes (those appeared after 24 hours after death)
17 Classification of the postmortem changes according to if the body
is kept well:
-Destructive postmortem changes
-Preserved corpse
18 The early postmortem changes include:
-Supravital reaction
-Muscular flaccidity
-Algor mortis
-Rigor mortis
-Livor mortis
-Visceral hypostasis
-Cadaveric spasm
-Autolysis
-Local desiccation
-Postmortem turbidity of the cornea
19 The late postmortem changes include:
-Putrefaction (destructive postmortem change)
-Molded cadaver (destructive postmortem change)
-Mummification (preserved corpse)
-Adipocere (preserved corpse)
-Cadaver tanned in peat bog or“soft body”，(preserved corpse)
20 The forensic significance of postmortem changes:
-The postmortem changes should not be confused with the anti-mortem injuries and
diseases
-Performing an autopsy as soon as possible.
-To estimate some of the important factors (such as a relevant body position, the time
of
death, the cause of death, and the nature of death)
21 Definition of supravital reaction:
-One of the postmortem changes
-A reaction of soft tissues after getting an irritation
-Occurs before the stage of biological death
22 The common supravital reaction includes the following:
-Pupil contraction or dilatation
-Signs after decapitation
-Excitability of skeletal muscle
-Contraction of myocardial fibers
-Contraction of smooth muscle
-Intestine peristalsis
-Diaphoresis
-Other supravital phenomena
23 The forensic significance of supravital reaction:
-Estimate the time of death
-The stage for organ transplantation
24 The concept of muscular flaccidity:
-A complete relaxation of muscles
-The earliest sign when death occurs
-Estimate the original lying position
25 The concept of algor mortis (cooling of the body):
-Occur at the time of death
-Many factors can affect its development (such as the atmospheric temperature, the
presence or absence of clothing or covering on the body; the state of nutrition, the
causes of death)
-Estimate the time of death by recording the temperature of a body
26 The concept of livor mortis (postmortem lividity):
-After death the blood gravitates to the dependent position of the body
-The dependent capillaries become distended and make the skin a discoloration
-Normally appear as a purplish-red or purplish blue color
-Estimate the original body position by it’s position
-Estimate the cause of death by it’s color
-Must be distinguished with injury and pathological changes (such as contusion and
tissue congestion)
27 The following livor mortis indicate the different poisoning
poisoning::
-Acute carbon monoxide poisoning: cherry-red color
-Acute cyanide poisoning: bright pink color
-Potassium chloride poisoning: chocolate brown color
28 The forensic significance of livor mortis:
-One of the early signs of death
-Estimating the time since death
-The color may indicate the possible causes of death
-Suggestion of the original body position
-Must be distinguished with injury and pathological changes (such as contusion and
tissue congestion)
29 The concept of rigor mortis:
-A postmortem stiffening of the voluntary and involuntary muscles of body due to
short
of ATP
-Showing the original body posture
30 The concept of cadaveric spasm:
-Mostly involves some groups of muscles (forearms, and hands)
-Showing the body or limbs’ status before death
-Estimate the nature of death
31 The concept of autolysis:
-Destroyed structure of cells due to self-digestion by intracellular enzymes
-The pancreas and the mucous membrane of the stomach or intestine are easily be
damaged as the result of autolysis
-Performing an autopsy as soon as possible
32 The concept of local desiccation:
-The soft tissue become try and hard
-Mostly be seen at the thin area of skin, the injured skin or the mucosa
-Can be anti-mortem one or postmortem one
-Must be distinguished from a postmortem one and the anti-mortem one
-Must be distinguished with anti-mortem injury and poisoning.
33 The concept of the postmortem turbidity of the cornea
-The cornea gradually turns to white and opaque after death
-Estimate the time of death
-Must distinguish it with eyes’ disease
34 The morphological change of putrefaction includes:
-An offensive odor
-Distention of the abdomen
-Greenish discoloration of the skin
-Putrefactive networks
-Bloated cadaver
-Foaming organs (such as foaming liver, foaming brain and foaming kidney)
-Faeces be forced out of the rectum
-Stomach contents be forced through the mouth and nose
-Postmortem delivery
-The liquefaction of the tissues
-Skeletonized remains
35 The common factors influencing the rate of putrefaction:
-The atmospheric temperature
-The humidity of the atmosphere
-The medium in which the body lies
-Age, sex and the state of nutrition
-The cause of death
Chapter Four – Mechanical Injury
1 Definition of mechanical injury
injury：
Instrument + physical violence → human tissues → morphological changes &
functional changes = Mechanical injury
2 The three important factors about mechanical injury
injury：
-Mechanical forces (blunt force, sharp force, firearm force)
-Instruments (blunt force instruments, sharp force instruments, firearm instruments)
-Human tissues (skin, viscera, bones)
3 The classification of mechanical injury
injury：
A. According to the basic morphological changes of mechanical injury:
-Abrasion (scratch abrasion, brush abrasion, impact abrasion, and pressure abrasion)
-Contusion (contusion in skin, contusion in muscle, and contusion in internal organs)
-Wound (incised wound, chop wound, stab wound, and laceration)
-Fracture (linear fracture, depressed fracture, comminuted fracture, penetrated fracture)
-Rupture of viscera (visceral laceration)
-Fragmentation of the body
B. According to the instrument of mechanical injury
-Blunt instrument injury
-Sharp instrument injury
-Firearm injury
4 The forensic significance of mechanical injury
injury：
-To distinguish the postmortem & anti-mortem changes (usually by vital reactions,
such
as the bleeding, congestion, edema and inflammation)
-To estimate the instruments by the morphological changes
-To determine the nature of death by the position of the injury
-To determine the cause of death by the degree of the injury
5 The morphological changes of mechanical injury
injury：
A. Abrasion (due to blunt force)
-Scratch abrasion
-Brush abrasion
-Impact abrasion
-Pressure abrasion
B. Contusion (due to blunt force)
-Contusion in skin
-Contusion in muscle
-Contusion in internal organs
C. Wounds (due to sharp force or blunt force)
a. Wounds (due to sharp force)
-Incised wound
-Chop wound
-Stab wound
b. Wounds (due to blunt force)
-Laceration
D. Fracture
E. Rupture of viscera
F. Fragmentation of the body
6 Usually the component of a wound includes the following:
-Shape
-Length
-Width
-Depth
-Margins
-Wall
-Floor
7 A typical incised wound
-Usually spindle or oval shaped
-With a clearly cut and smooth margin
-Absent of marginal abrasion
-Depth is clearly cut, without tissue bridges
-No foreign bodies in the floor
-Without bone fracture
-Can be seen as a tentative incision
8 How to inspect a wound injury:
-To exam the wound of the shape, length, width, depth, margins, walls, and floor
-To distinguish an anti-mortem injury or a postmortem injury
-To distinguish the injury from postmortem changes and disease
-To estimate the cause of death
-To estimate the nature of death
-To estimate the possible instrument
9 The difference between an incised and a lacerated wound
Table: The difference between an incised wound and a laceration
Shape
Margin
Marginal abrasion
Depth
Floor
Bone underneath
Incised wound
Laceration
Spindle or oval shaped
Irregular shaped
Clearly cut, smooth
Irregular shaped, not smooth
Without marginal abrasion
Usually with marginal abrasion
Clearly cut, no tissue bridges
Ragged, with tissue bridges
No foreign bodies
Usually with foreign bodies
(dust, debris)
Maybe fractured
No fracture
10 The common types of fracture of the skull
-Linear fracture
-Depressed fracture
-Comminuted fracture
-Penetrated fracture
Chapter Five –Mechanical Asphyxia
1 The concept of death by mechanical asphyxia:
-The respiratory function disorder and cessation caused by some mechanical
mechanisms
-The most common mechanisms of mechanical asphyxia include the compression of
the neck, chest or abdomen, and the blocking of the airway
2 The morphological changes caused by mechanical asphyxia
include:
-Cyanosis of the skin and mucous membrane
-Petechiae haemorrhage
-Body temperature goes down slowly
-Teeth bleeding (Pink Teeth)
-Incontinence of urine and feces
-Ejaculation
-Nose running
-Salivation
-Exophthalmos
3 Asphyxia process includes
includes::
-The stage before asphyxia symptoms happen
-The stage of inspiratory dyspnea
-The stage of expiatory dyspnea
-The stage of apnea
-The stage of terminal respiration
-The stage of respiratory arrest
4 The concept of death by hanging:
-Using rope or some other things to compress his/her neck by the self-gravity and lead
to death
-The whole weight of the body is not necessary
-The shape of a ligature mark of hanging can be various according to the different
rope (soft or hard; number; the way of looping)
-The noose can be a sliding type or a fixed type
-The knot can be a slipknot or a fixed knot
-The profession and the occupational habit of a criminal suspect can be estimated by
the way of making a knot
5 The style of hanging:
-Typical hanging style (anterior constriction type)
-Untypical hanging style (lateral constriction type; posterior constriction type)
6 The local pathological changes of hanging:
-Ligature mark of hanging and the soft tissue injury on the neck
-Hyoid bone fracture
-Thyroid cartilage and tracheal cartilage fracture
- Injury of the blood vessel on the neck (carotid artery and jugular vein)
7 The types of hyoid bone fracture about hanging:
-Introversion type fracture
-Extroversion type fracture
-Traction type fracture
8 Mechanism of death by hanging:
-Airway obstruction
-Neck vascular occlusion
-Cardiac arrest by nerve reflex (carotid sinus, vagus)
-Spinal cord injury
9 Hanging ditch examination (to find out the characteristics of
hanging ditch):
-Position
-Direction
-Number
-Length
-Width
-Depth
-Color
-Foreign body (foreign matter)
-“Empty”phenomenon
10 The forensic importance of examining the body
-To distinguish the hanging with the strangulation (to estimate the manner of death)
-To distinguish the anti-mortem hanging and the postmortem hanging
11 The definition of drowning:
-Asphyxia due to aspiration of fluid into air-passages and lungs
-The whole body immersion is not necessary
-Wet drowning & dry drowning
-Drowning due to fresh water & drowning due to sea water
12 The types of drowning according to if the water is inhaled into the
lungs:
-Dry drowning (typical drowning)
-Wet drowning (untypical drowning)
13 The mechanism of death by drowning:
-Asphyxia
-Ventricular fibrillation
-Electrolyte disorder
-Reflex respiratory arrest and cardiac arrest
-Cardiac failure and respiratory failure
-Sudden death due to some diseases attack stimulated by drowning
14 Pathological changes of drowning include:
-Foam at mouth and nostrils
-Petechiae haemorrhage
-The body temperature goes done slowly
-Livor mortis shows pale pink
-Chicken skin
-Grasp a foreign matter in hand
-Washerwoman’s hand
15 Diatoms
-The micro organisms in water which can be only observed under a microscope
-Having specific morphological characteristics
-Impregnated with silica so it is not easy to damage
-Used to diagnose the drowning death by diatom test
16 Diatoms test
-To estimate the death by drowning
-Using the characteristics of silica in the shell of diatoms
-Detecting of the diatoms in internal organs can show the cause of death by drowning,
not only in lungs
-Some of the water body does not have diatoms so the result of diatom test will be
negative
17 The circumstances of drowning
-Natural disease before falling into the water
-Natural disease while already in the water
-Injuries before being thrown into the water
-Injuries while in water
-Hypothermia in the water
-Drowning
18 The manner of death by drowning:
-The manner of death duo to drowning cannot be interpreted from an autopsy alone
-The findings have to be viewed together with the circumstances
-To distinguish the death by drowning and the death before being thrown into the
water is very important and difficult
Chapter Six – Sudden Unexpected Natural Death
1 The concept of sudden unexpected natural death
-Happened suddenly and unexpectedly
-Caused by some potential natural disease
-The time span is within 24 hours from the onset of symptom to death
-The nature of death is a non-violent one
-It is easily assumed as a violent death at some occasion
2 The common inducing factors of sudden unexpected natural death:
-Excitement
-Psychological trauma
-Overwork
-Smoking and drinking
-Starvation or overeating
-Minor trauma
-Sexual intercourse
-Minor illness
3 The forensic significance of the sudden death:
-To find out the cause of death in an unclear case
-To find out the relation between the injury (asphyxia, poisoning) and the disease
-To reveal the possible criminality or to clarify some facts
-To accumulate data for medical study and statistics
4 The concept of coronary heart disease
-Also named coronary atherosclerotic heart disease
-The most common natural disease in the cardiovascular system in the world
-The typical pathological changes of it is the appearance of coronary atherosclerotic
plaque which lead to the stenosis of the coronary artery
-Cardiac infarction is usually the cause of death
-About 20% of the people who suffer from it show no symptoms in daily life
-Before giving out the cause of death the death due to violent must be excluded.
Chapter Seven – Child Abuse and Child Homicide
1 Newborn baby examination includes:
-The identification of survival ability
-The identification of survival time
-The identification of a stillbirth or a live-birth
-The identification of the cause of death
-The identification of the manner of death
2 Signs of live-birth:
-Hearing the infant’s cry
-Seeing the movement of whole body or limbs
-Seeing muscle contraction
-Shape of chest (from flat to arched shaped after breath)
-Position of the diaphragm (from 4th-5th rib to 6th-7th rib after breath)
-The change of the lungs (volume, margins, consistency, color and the expansion of
the air vesicles, the blood in the lung beds, weight)
-The Hydrostatic Test
-Histological examination shows no air goes into pulmonary alveolar
3 The common ways of maltreatment of a baby or a child include:
-Negative maltreatment (such as failure to provide proper assistance at the time of
delivery; bad nursing; malnutrition)
-Positive maltreatment (such as bit, insult or even kill the baby or the child)
4 The concept of infanticide:
-Unlawful killing or murder of a newly born infant within one year of its birth
-There is a deliberate action on the infant.
-Violent evidence can be found at postmortem examination
Chapter Eight – Medical Tangle
1 The concept of medical tangle:
-The definition of medical tangle
-The components of medical tangle
-The types of medical tangle
2 The concept of medical malpractice:
-The definition of medical malpractice
-The component of medical malpractice
3 The common types of non-iatrogenic medical tangle:
-Sudden unexpected natural death
-Inevitable complications or secondary diseases
-Rare diseases
Chapter Nine – Forensic Autopsy
1 The aims of postmortem examination:
-To provide clues and direction for criminal or civil investigation
-To provide the expert evidence in court proceeding if a case goes to trial
2 The persons involving in an autopsy
utopsy::
-Forensic experts
-Forensic technicians
-Photographers
-Recorders
-Other experts and technicians (for X-ray examination, anthropology examination,
and so forth)
3 How to perform a forensic autopsy?
-Information collection
-Preparation for autopsy
-Clothes examination
-External examination of the body
-Internal examination of the body
-Case analysis
-Giving out a forensic case report
4 The autopsy preparation includes the following:
-A bright autopsy room for postmortem examination
-The writing material for recording
-The camera for photographing
-The clothes, pants, shoes and mask or respirator for wearing
-The instruments and water for autopsy
-The containers and formalin for histological examination
-The containers for toxicological examination
-The other preparation
5 The external examination of a body includes:
-Body weight
-Body length
-Sex
-Changes for personal identification (such as tattoo)
-Medical intervention or the injury from medical treatment and resuscitation
-Post mortem phenomena
-The examination of violent death (mechanical injury, mechanical asphyxia, and
poisoning)
-The examination of nonviolent death (unexpected natural sudden death)
-The examination of other abnormal changes
-The special postmortem examination (such as an infant examination)
6 In a regular autopsy the following cavities should be opened:
-Cranial cavity
-Thoracic cavity
-Abdominal cavity
-Pelvic cavity
-Spinal cord cavity and articular cavity if needed
7 A forensic autopsy report about the body examination must
includes the followings:
A. Clothes examination
B. General condition (body weight; body length; sex)
C. External examination of the body:
-Evidence for identification (body weight; body length; sex; tattoo; scar; nutrition
status)
-Post mortem phenomena
-Evidence of medical intervention
-Evidence of mechanical injury
-Evidence of mechanical asphyxia
-Evidence of mechanical poisoning
-Evidence of natural disease
-Other abnormal changes
D. Internal examination of the body:
-Head and neck
-Cardio-vascular system
-Respiratory system
-Gastro-intestinal system
-Hepato-biliary system
-Genito-urinary system
-Haemopoietic system
-Endocrine system
E. Histological analyses
F. Toxicological analyses
G. X-Ray Examination
H. Other related laboratory examination (such as bacteria examination, fly maggot
examination)
I. The analysis of cause of death
J. The analysis of other related issues
K. The conclusion
L. The date and the signatures (at least two experts)
8 The injury from medical treatment or resuscitation includes:
-The incised wound from operation
-The injury from the tube of tracheal intubation
-The injury from catheter
-The punctures from injection
-The injury from cardiac compression
-The injury from electric defibrillation
-The rib fracture from resuscitation
-Other injury from medical treatment or resuscitation
9 The following can be the signs of personal identification
-Features
-Gender
-Body weight
-Body length
-tattoo
-Scar
-Mole or wart
-Old fracture
-Operation
-Other changes for personal identification (such as the clothes, the wearing jewelry,
and the pocket certificates)
10 The last step of the autopsy examination:
-Suture for the body
-Reshaping for the body
-Cleaning the body and wearing the body