110 HUMAN TISSUE AND WOUNDS AS FORENSIC INDICATORS accident involving clothing being set alight. In this scenario, the possibility that a flammable liquid may have been poured over the victim and then set alight should also be considered. Burns and scalds are a common feature of self-harm, the abuse of children and old people and deliberate torture (Greenbaum et al., 2004). Both self-harm and the abuse of others often occur over a long period of time, so there may be wounds of varying stages of healing. The distribution of the wounds will indi- cate whether the victim could have caused them him or herself. Scalds often form trickle-shaped wounds indicating the flow of the fluid and hence the ori- entation of the victim at the time, Torture with hot implements usually takes place over a restricted period and is often accompanied by physical beating. If the implement is dry, such as an iron, its shape will be reproduced in the burn, ‘The use of electric shock torture is difficult to demonstrate because, although it is extremely painful, provided that the electrodes are not applied for too long there is little associated pathology. Postmortem injuries Postmortem injuries can result from both malicious and accidental acts and if there were no witnesses to the person dying their interpretation can present dif- ficulties. For example, an elderly person suffering a fatal heart attack could col- lapse and suffer serious injuries when hitting the furniture or the floor. On discovery of the body it would be necessary to exclude the possibilities that the victim either first received a blow to the head or was thrown to the ground by an intruder and the shock had induced the heart attack. This scenario might be resolved by a combination of bloodstain pattern analysis (Chapter 2), finger- printing and wound analysis Injuries caused days or months before death are usually recognizable from signs of healing but itis difficult to generalize about postmortem injuries (Byard et al., 2002). Postmortem bruising may occur when a dead body is being recov- ered or handled in the morgue, although these bruises tend to be small. Post- mortem bruising is most likely to occur on the lower body surfaces because this is where blood pools. Decaying soft tissues are very delicate and easily damaged so it is normal to undertake a preliminary examination before the body is moved to the morgue. Clumsy handling can result in limbs becoming detached and bones broken. Vertebrates can cause extensive postmortem injuries up to and including consuming the whole corpse (Chapter 8). Invertebrates can also cause damage that may result in confusion at the time of autopsy. Feeding by der- mestid beetles and their larvae produces irregular holes and tears in mummified skin that can be mistaken for wounds caused before death. These holes tend to have jagged edges, whilst those produced by maggots tend to have smooth edges. Both histerid beetles and burying beetles (Silphidae) will cause circular-shaped holes in a body. Bite marks inflicted by the cockroach Dietyoptera blattaria haveWounos 109 blood in excess of 10 per cent. Carboxyhaemoglobin results from the inhala- tion of carbon monoxide produced by incomplete combustion of flammable materials ~ the blood and tissues appearing cherry pink intimate the presence of large amounts of carboxyhaemoglobin in the body. However, the level of car- boxyhaemoglobin needs to be confirmed by chemical analysis because low levels (less than 10 per cent saturation) might occur naturally from living near to a pollution source or from being a heavy smoker. It is also important to remem- ber that being alive is not the same as being conscious and the victim may have died before the flames reached him or her. Similarly, the absence of either of these indicators does not mean that the victim must have been already dead: a great deal depends on the individual circumstances and the amount of smoke and carbon monoxide produced. It is very difficult to distinguish between burns that were caused before, at the time of or after death. In the case of flash fires or explosions, in which death may be virtually instantaneous, there might be extensive surface burning but little evidence of soot in the lungs or carboxy- haemoglobin in the blood. A body exposed to high temperatures automatically adopts a characteristic “pugilistic posture’ in which the limbs become flexed. This occurs regardless of whether the person was alive or dead at the time of exposure. As the skin and underlying tissues dry out, they contract and splits occur that can be mistaken for wounds. The drying out of the muscles induces them to contract and because the flexor muscles are larger and more powerful than the extensor muscles they pull the body into the ‘pugilistic posture’. The bones can fracture and break and a ‘heat haematoma’ may form in the skull, leading to suspicions that the victim may have been assaulted. A haematoma is a blood clot that forms outside of a blood vessel and this is often a feature of a skull fracture or a serious blow to the head. If a body is burnt, it will inevitably destroy a great deal of forensic evidence. Consequently, it is common for a murderer to either remove the body and burn it elsewhere or burn it in sit. An examination of the scene is therefore essen- tial in determining the likelihood of a body being the victim of a suicide, a homi- cide or an accident. It is rare for persons to commit suicide by burning in the UK, although it docs happen occasionally. Usually, the victim would have covered him or herself in a flammable liquid, residues of which would be detectable, a means of setting fire to themselves would be found nearby and there would be no evidence of restraint or injuries caused before death. In the case of accidental death, there would be evidence of an innocent cause, such as a chip-pan fire or smoking in bed, and that the person had attempted to escape unless incapacitated through age, a medical condition or intoxication, This would be indicated by the position of the body ~ usually the victim attempts to reach a door or window of, if cut off, to hide in a corner or cupboard. In a homicide, the fire would be started deliberately and the victim may, if not already dead, be restrained in some way, such as being tied to a chair or con- fined to the boot of a car. The distribution of burns on the body and clothing can also provide an indication of the person’s position. For example, extensive burns to the top of the head and face would be suspicious in a reported kitchen108 HUMAN TISSUE AND WOUNDS AS FORENSIC INDICATORS swelling and this can distort the bite site. However, these problems could be at least partially overcome through the use of computer-based image capture systems that enable three-dimensional records to be made (Thali et al., 2003). Not all bites are the consequence of assault. Love bites on the neck are very common, especially among teenagers. These, and other amorous bites, are usually delivered slowly and the recipient does not draw away so aggressively. Conse- quently, there is not the evidence of dragging. However, during these bites, the skin is often sucked in and the tongue thrust forcefully against it, thereby causing the formation of tiny red spots called petechiae in the centre of the bite that result from blood leaking from damaged blood vessels. Furthermore, there may not be any evidence of tooth marks. Self-inflicted bites are commonly found on persons who become addicted to self-harm and may show similar characteristics. These bites will, however, not occur on areas of the body that are difficult to reach and there will probably be wounds of varying ages. Nevertheless, it is feasible for someone who bites himself in this way also to be attacked and bitten by someone else and wounds of varying ages are often a feature of long-standing abuse. Burns and scalds Medically, a burn is defined as a wound that results from dry heat, such as touching a hot plate, whilst a scald results from wet heat, such as exposure to steam or molten metal. However, in colloquial speech, a burn is often used to describe the wounds that result from all these situations. ‘There are several classification systems for categorizing the severity of burns, although the most commonly used is to divide them into three ‘degree cate- gories’. ‘First degree burns’ are those in which there is reddening of the skin and a fluid-filled blister may form. These superficial burns usually heal without leaving any scarring within 5-10 days. In ‘second degree burns’ the epidermis of the skin is removed down to the dermis, whereas in ‘third degree burns’ tissue lying beneath the dermis is also damaged, the underlying organs may be exposed and there may be blackening resulting from carbonization. Scalds can be cate- gorized on a similar basis although carbonization would only result from expo- sure to molten metals or similar high-temperature fluids. In terms of survival, the extent of the burns or scalds is of as much importance as their category. If over 50 per cent of the body surface is affected the chances of survival are poor, although it is difficult to generalize as there is a great deal of difference between individuals, and factors such as age, health and the speed with which medical assistance is administered all play a part in recovery. ‘The majority of people who die in house fires succumb to the inhalation of smoke and toxic fumes rather than being burnt to death. The presence of soot in the mouth and nasal passages is not a reliable indication that a person was alive at the time a fire was started because it could have entered passively. By contrast, the presence of soot in the lungs and air passages below the vocal cords is a very good indication, as is a saturation level of carboxyhaemoglobin in the