FORENSIC PATHOLOGY

 
 WEEK 1
Introduction to Forensic Pathology – Principles and Overview

Learning Outcomes

CLO1: Determination of the time, cause, mechanism and manner of death.

CLO2: Basic knowledge of ballistics and gunshot wounds.
CLO3: Proficiency in the methods by which a detailed external examination of the decreased
should be carried out, to include methods of assessing the “postmortem interval”.
CLO4: Medical examination and detailed description and assessment of injuries and their
sequelae on both the living and deceased persons throughout the age spectrum, including
cases of abuse that would enable a full evaluation of such aspects of direct legal interest as
their method of infliction, possible causation, consequences and complications.
CLO5: Compilation of authoritative medico-legal reports to the relevant authorities, describing in
detail the findings and results of any examinations carried out and including a full and pertinent
commentary which provides balanced scientific opinion and conclusions.

Introduction
Forensic pathology is the subspecialty area of pathology that is specifically involved in the
investigation of sudden, unexpected, and/or violent deaths. Thus, the practice of forensic
pathology involves applying forensic scientific and pathological techniques to the investigation of
lethal episodes. In a more general sense, forensic pathology can also be considered part of the
somewhat larger discipline of forensic medicine that applies forensic sciences to medical issues.

Forensic as a specialty deals with both the legal and pathological aspects of a case. Various
designations are employed for specialists practicing forensic pathology in different parts of the
world: forensic pathologists, medico-legal consultants, autopsy surgeons, police surgeons,
medica jurists, forensic medicine experts. For this course the term forensic pathologist is used
for the experts practicing forensic pathology. 
Role of a Forensic Pathologist
Forensic pathology deals mostly with the pathology of intentional (homicidal and
suicidal) and unintentional (accidental) trauma or injury, in cases where bodily damage may be
the major finding and in deaths from natural causes in cases the cause cannot be certified by a
physician. In addition deaths from occupational exposure to hazardous materials and industrial
deaths maybe of medicolegal significance.
 The primary role of the forensic pathologist is to determine the cause of death base on a
detailed. And complete autopsy and to confirm if the cause of death is in accordance with the
manner of death as proposed by the investigating agencies enquiring into sudden, suspicious,
and unnatural deaths. In cases involving mechanical trauma/injuries, the forensic pathologist
deal mostly with the examination of the deceased or injured person to determine the nature and
cause of the injuries or death. 
The role of the forensic pathologist is vital in cases of alleged  medical negligence,
sexual assault, domestic violence, and torture. The forensic pathologist may also be involved in
criminal investigation in the examination of the accused/suspect, the scene of the crime/death,
and the collection of evidentiary material. Plays a key role in criminal cases as well as civil
cases involving. Insurance and other claims and attends to courts of law as an expert witness
providing valuable opinion on cases thus help in administration of justice. 
Medico-legal Systems and Investigation of Deaths
In most European and Asian countries the forensic medical expert examinations are conducted
based on the decision of the investigating and interrogating agencies, the court or the
prosecutor.  In the United States the Medical Examiner and Coroner system exist for
medicolegal investigation of sudden, suspicious, and non-natural death. The authority to
investigate death in Australia and England lies with a coroner.
Aims of Medicolegal Autopsy
Autopsy involves the standardized dissection of a dead body primarily to determine the cause
and manner of death.  Other aims are to estimate the tie since death, establish the identity of
the deceased, and collect essential evidences surrounding the death. The medicolegal autopsy
answers the basic questions of “why,” “how,” “when,” and “who” with regard to sudden,
suspicious, and non-natural deaths.
The cause of death is the injury of the disease that produces a physiological derangement in the
body, resulting in the death of the individual.
The cause of death is divided into primary and secondary causes of death. The primary cause
of death includes the immediate and antecedent causes responsible for the fatal outcome, while
the secondary cause of death includes the conditions that are not related to the primary cause
of death but contribute substantially to the death of an individual.

Manner of Death
 The manner of death explains the circumstances associated with the death and the way
in which the cause of death came about. Broadly classified as natural and nonnatural.
Nonnatural deaths are further classified as homicidal, suicidal or accidental depending on the
intent of the act leading to the death of an individual.
Medicolegal Autopsy
The autopsy is a standardized procedure that comprises of a detailed external and
internal examination and collection of evidentiary material. The identity of the deceased must be
confirmed first before starting the autopsy.
The identity of the deceased is usually established by the relatives of the deceased and
the investigating officers.
Identification marks are noted on the body. Examination of any congenital or acquired
abnormality may help in establishing the identity  of the deceased.
In cases where the visual identification is difficult as in cases of dismembered, mutilated,
and charred remains, dental examination and DNA profiling are often used to confirm the
identity of the unknown person.
External Examination
 The external examination of a body besides a detailed examination of the entire body
also includes a description of the clothing of the deceased ad photographs of the body. Any
trauma observed in the body is noted in detail with measurements and the same is correlated
with the damage to the clothing. Clothing is removed from the deceased with utmost care, trace
evidence on the clothing or the body is preserved for further analysis at the forensic science
laboratory.
After removal of clothes, the age, sex, general physique (height and weight), and the
state of nutrition  are noted. Examination of the eyeballs, external body orifices is essential.
Postmortem changes in the body are appreciated as they primarily give insight into the time
since death. Postmortem changes frequently observed on external examination that help in
estimating the time of death includes algor mortis, livor mortis, rigor mortis, degree of
decomposition, and insect activity. In cases of mechanical violent and traumatic deaths, a
detailed description of the external injuries is vital, must be photographed and described in detail
with regard to their size and location in the body.
Internal Examination
The internal examination follows a detailed examination. It starts with the dissection of the dead
body and the naked eye inspection of underlying tissues and organs. The prime object of the
internal examination is to examine the contents of the head, neck, thorax, and abdomen for
injuries/pathology.
The forensic pathologist examines the thoracoabdominal cavity usually following one of the
following techniques: 
1.  Virchow method: In the Virchow method, each organ is removed one by one and
examined in detail
2. Rokitansky method: In the Rokitansky method , in situ dissection and removal of organs
are carried out
3.  Ghon method: The Ghon method is characterized by an en bloc removal of organs.
4.  Letulle method: The Letulle method is characterized by an en masse removal of
cervical, thoracic, abdominal, and pelvic organs and their subsequent dissection into
organ blocks. 
The internal examination is followed by microscopic, biochemical, immunologic, and
toxicological investigations whenever required.
Histology, postmortem biochemistry, and evaluation of postmortem parameters of metabolic
dysfunctions, immunohistochemistry, postmortem toxicology, X-rays, and modern methods of
imaging such as computed tomography (CT), postmortem CT angiography, and magnetic
resonance imaging (MRI) are important additional investigations frequently used in modern
autopsy work.
Evidentiary Materials Collected at Autopsy
Blood samples are usually collected for chemical, toxicologic, and serologic investigations,
Blood is preferably taken from the peripheral veins from the groin or the neck.
In cases of suspected poisoning the stomach and and its contents, a piece of the liver with the
gall bladder, and both kidneys are subjected to chemical and toxicologic analysis. 
Specific viscera and body fluids should be preserved depending  on the nature of poison
allegedly consumed.
In cases of alleged sexual assaults, swabs are collected from  genitalia for examination of body
fluids along with pubic hair combings to identify foreign materials.
In cases of gunshot wounds, the clothing and the recovered bullets are preserved and sent for
forensic analysis.
In cases of unidentified bodies, fingerprints are taken and matched with reference databases.
 In decomposed, mutilated, and dismembered remains, the teeth are subjected to a forensic
dental examination and DNA analysis.
Exhumation
It is the act of removing a corpse from a place of burial also known as disinterment. In forensic
pathology it is the act of lawfully bringing out  a buried dead human body for medicolegal
purposes (Williams and Davidson 2014)
Exhumation performed for autopsy reason is exhumation autopsy. Exhumation autopsy is an
extremely rare event since the cause and manner of death is nearly always certified prior to
burial. Certification typically occurs via the decedent’s physician, by a physician present near
the time of death, or by a medical examiner who performed a postmortem investigation. 
In civil litigation, situations may arise where the cause or manner of death is in dispute as in a
medical negligence claim, an exhumation autopsy may provide a materially relevant answer.