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494 19 Burns and Fire-Related Deaths Fig. 19.15 The classic “pugilistic” appearance of a badly burnt body. Note that the hands have been totally consumed by thermal injury Fig. 19.16 Note that a portion of intestines is protruding from a thermally-induced defect in the abdomen Toxicology As with other deaths, toxicology tests are vitally important in fire deaths. Indeed, as detailed above, the identification of elevated and/or lethal levels of CO in postmortem blood samples allows pathologists to determine that the victim was breathing during the fire and died as a result of smoke and soot inhalation. Before sending blood samples for CO testing, it is advisable to check with the lab to be sure the samples are collected in the appropriate containers (laboratories sometimes differ in the instruments used to detect CO; different instruments may require different collection protocols). Occasionally, the blood is of insufficient quality to perform
Fire Deaths 495 a CO test or an insufficient amount of blood may be available (typically in very severely burned bodies). Collecting other tissues, such as liver, can allow CO determination via reference laboratories. Occasionally, other poisonous gases, such as cyanide, may be present in the smoke produced in fires, and specialized testing may be able to detect such poisons. Unfortunately, there is no postmortem test that allows pathologists to determine that a person died from lack of oxygen. Artifacts A variety of heat-induced artifacts may be evident in fire deaths, and these can occur whether or not death is caused by the fire. A common finding in bodies that are charred or partially charred is the presence of “skin splitting.” As the tissues become superheated after death, the skin becomes heat-fixed and shrinks to an extent, resulting in the skin splitting open to reveal the underlying subcutaneous fat (Fig. 19.17 and Disc Images 19.18 and 19.19). This fat may also burn, but not necessarily. Fig. 19.17 Fourth degree burns with extensive skin-splitting Another artifact is the presence of long bones that appear to be fractured. In reality, the bones have been partially consumed, along with the associated soft tissues. The burnt portions of bones protruding from residual charred soft tissues can occasionally be misconstrued as traumatic injuries (Disc Image 19.20). Heat-induced skull fractures are relatively common (Fig. 19.18). As a dead body becomes superheated, pressure builds within the enclosed cranial cavity. Eventually, the pressure causes skull fractures. A layer of brown, heat-fixed, sludgelike epidural blood is usually found immediately underlying and adjacent to the skull fracture sites. This skull fracture/epidural hematoma complex is considered a classic heatinduced artifact (Fig. 19.19 and Disc Image 19.21). It should be noted that subdural hemorrhage should never be considered artifactual (Fig. 19.20). Finally, it should be reiterated that, in many instances, postmortem thermal damage cannot be distinguished from true antemortem injury. As such, when thermal injury accompanies findings that confirm smoke and soot inhalation as a cause or
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Forensic Pathology for Police, Deat
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Joseph Prahlow Indiana University S
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vi Dedication accepted the free gif
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viii Foreword quality photographs i
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x Acknowledgements Counties, as wel
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Contents Part I Introductory Topics
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Contents xv Hepatobiliary System .
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Contents xvii RespiratorySystem....
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Contents xix Mercury ..............
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Contents xxi Strangulation . ......
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Contents xxiii Negligence/Neglect .
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About the Author Joseph A. Prahlow,
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Chapter 1 Introduction to Pathology
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Introduction to Pathology 5 Table 1
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Introduction to Pathology 7 Fig. 1.
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Introduction to Pathology 9 Fig. 1.
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Introduction to Pathology 11 Fig. 1
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Introduction to Pathology 13 Fig. 1
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Selected References 15 Disc Image L
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18 2 Introduction to Forensic Scien
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Chapter 3 Introduction to Forensic
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Duties of the Forensic Pathologist
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Training and Qualifications of Fore
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Training and Qualifications of Fore
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Selected References 47 Selected Ref
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50 4 Death Investigation Death Inve
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52 4 Death Investigation met in ord
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54 4 Death Investigation leading to
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56 4 Death Investigation Fig. 4.2 A
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58 4 Death Investigation Fig. 4.5 P
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60 4 Death Investigation Fig. 4.9 I
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62 4 Death Investigation apartment
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64 5 Death Certification Fig. 5.1 A
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66 5 Death Certification Fig. 5.4 A
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68 5 Death Certification latter, th
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70 5 Death Certification infrequent
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72 5 Death Certification changes in
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74 5 Death Certification suicides.
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76 5 Death Certification death is i
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78 5 Death Certification use involv
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Chapter 6 Overview of Anatomy and P
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Introduction 83 Table 6.1 (continue
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Introduction 89 Term Definition Tab
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Introduction 91 “mucous membranes
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Specific Organ Systems 93 functions
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Specific Organ Systems 95 Fig. 6.2
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Specific Organ Systems 97 Microscop
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Specific Organ Systems 107 respirat
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Specific Organ Systems 111 water co
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Specific Organ Systems 115 Platelet
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Disc Image Legends 125 Disc Image 6
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Part II General Topics in Forensic
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130 7 The Postmortem Forensic Exami
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Chapter 8 Postmortem Changes and Ti
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Early Postmortem Changes 165 Fig. 8
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Early Postmortem Changes 167 can be
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Decomposition 169 exposed to sunlig
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Decomposition 171 Fig. 8.8 As decom
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Decomposition 173 Fig. 8.12 As deco
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Decomposition 175 Fig. 8.16 If flie
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Postmortem Injuries 177 Fig. 8.20 I
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Time of Death Estimation 179 Time o
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Time of Death Estimation 181 Fig. 8
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Chapter 9 Identification of Human R
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Introduction 187 Fig. 9.2 Badly dec
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Common, Non-scientific Methods of I
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Scientific Methods of Identificatio
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Scientific Methods of Identificatio
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Identification Based on Other Uniqu
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Identification Based on Other Uniqu
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Unidentified Remains 199 Fig. 9.16
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Selected References 201 Disc Image
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Chapter 10 Natural Deaths One man d
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Infectious Disease 207 to as “hyp
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Cardiovascular System 209 refers to
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Cardiovascular System 211 related t
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Cardiovascular System 213 heart int
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Cardiovascular System 215 Aortic An
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Cardiovascular System 217 Vasculiti
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Cardiovascular System 219 Valve Dis
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Cardiovascular System 221 Fig. 10.1
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Central Nervous System 223 Neoplast
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Central Nervous System 225 Viral en
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Central Nervous System 227 Spontane
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Respiratory System 229 Fig. 10.18 T
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Respiratory System 231 Pulmonary Th
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Respiratory System 233 identificati
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Respiratory System 235 Chronic Lung
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Gastrointestinal and Hepatobiliary
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Gastrointestinal and Hepatobiliary
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Reticuloendothelial and Immune Syst
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Endocrine System 243 infection, dis
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Multisystem and Other Disorders 245
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Selected References 255 Fineschi V,
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258 11 Drug-Related and Toxin-Relat
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Chapter 12 Blunt Force Injury Death
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Classification of Blunt Force Injur
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Blunt Force Head and Neck Trauma 31
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Special Topics Related to Blunt For
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Selected References 335 Toro K, Szl
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338 13 Gunshot Wound Deaths shotgun
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340 13 Gunshot Wound Deaths Fig. 13
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346 13 Gunshot Wound Deaths targets
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348 13 Gunshot Wound Deaths (a) (b)
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350 13 Gunshot Wound Deaths Image 1
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354 13 Gunshot Wound Deaths Miscell
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362 13 Gunshot Wound Deaths may be
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368 13 Gunshot Wound Deaths X-Rays
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370 13 Gunshot Wound Deaths left-ha
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372 13 Gunshot Wound Deaths NYCLAD
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374 13 Gunshot Wound Deaths Disc Im
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376 13 Gunshot Wound Deaths Disc Im
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Chapter 14 Sharp Force Injury Death
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Stab Wounds 381 to describe the sha
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Stab Wounds 383 describing “clust
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Incised Wounds 385 Fig. 14.9 A supe
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Incised Wounds 387 Although knives
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Special Issues 389 Fig. 14.16 A sta
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Special Issues 391 Defensive Wounds
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Special Issues 393 disorders; howev
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Special Issues 395 area of “radio
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Special Issues 397 Artifacts A fina
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Selected References 399 Disc Image
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Chapter 15 Asphyxial Deaths So Juda
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Suffocation 403 Fig. 15.1 Petechiae
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Suffocation 405 Certification of th
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Suffocation 407 usual occluding sub
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Suffocation 409 being able to expan
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Neck Compression (Strangulation) 41
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Chemical Asphyxia 419 the object ha
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Chemical Asphyxia 421 Fig. 15.21 A
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Other Issues 423 to function proper
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Other Issues 425 (a) (b) Fig. 15.24
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Other Issues 427 the arms/hands bou
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Selected References 431 Prahlow JA,
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434 16 Drowning Physiology and Mech
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436 16 Drowning Fig. 16.2 Thedriver
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438 16 Drowning Fig. 16.4 “Cadave
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440 16 Drowning Finding water withi
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442 16 Drowning Fig. 16.10 Marked d
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Page 553 and 554: Classification of Childhood Homicid
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544 21 Miscellaneous Topics To summ
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546 21 Miscellaneous Topics typical
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548 21 Miscellaneous Topics quite o
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550 21 Miscellaneous Topics Fig. 21
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552 21 Miscellaneous Topics The emb
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554 21 Miscellaneous Topics various
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556 21 Miscellaneous Topics stress
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560 21 Miscellaneous Topics ampheta
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562 21 Miscellaneous Topics victim
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564 21 Miscellaneous Topics more se
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568 21 Miscellaneous Topics Organ a
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572 21 Miscellaneous Topics region
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574 21 Miscellaneous Topics Regardi
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576 21 Miscellaneous Topics and lar
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578 21 Miscellaneous Topics some wo
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580 21 Miscellaneous Topics Non-ion
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582 21 Miscellaneous Topics Yersini
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584 21 Miscellaneous Topics water (
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586 21 Miscellaneous Topics to gene
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588 21 Miscellaneous Topics Disc Im
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590 21 Miscellaneous Topics Leclair
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Appendix: Additional Resources and
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Index Note: The letters ‘f’ and
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Index 597 Arnold-Chiari malformatio
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Index 599 closed head injuries, 311
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Index 601 immediate, 68 intermediar
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Index 603 liver demonstrating cirrh
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Index 605 Death investigation syste
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Index 607 pressure related processe
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Index 609 bridging veins, 316 dura
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Index 611 brain, serially-sectioned
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Index 613 Gestational DM, 247 Gesta
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Index 615 Homicide(s), 444 by heart
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Index 617 Infant death, 501-502, 50
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Index 619 Material Safety Data Shee
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Index 621 CNS, 223-229 cerebral pal
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Index 623 Over-the-counter (OTC), 2
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Index 625 Pregnancy-related materna
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Index 627 industrial settings, 486
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Index 629 Smoke and soot inhalation
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Index 631 Thrombophlebitis, inflamm
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