Coroners vs. Medical Examiners
At the view of a corpse, the law enforcement officers need to find out whether there was the fact of a violent death or not. At the same time, such signs are not always visible during the external examination. For the establishment of the violent death by the law enforcement officer performing the inspection of a dead body on the crime scene, a corpse is sent for the forensic medical examination. The task of the forensic pathology includes dealing with the questions of the medical character arising in the course of inquiry, examination and judicial proceedings. After the examination and research of the dead, the forensic pathologist defines the cause of death. Moreover, in the presence of injuries, the expert establishes their character, the mechanism of their infliction, the amount of the harm done to the human health. He/she also answers a number of specific questions raised by the law enforcement agencies.
A coroner is the official investigating the sudden death, which has happened in the unusual circumstances, and directly defining the cause of death in some countries of an Anglo-Saxon legal family. Usually, the coroners carry out the investigation when there is a suspicion of the violent acts resulting in death (as a rule, they collect the proof of murder). The coroner’s court resolves only one issue – whether the death was violent (criminal) or not. If yes, the case receives further consideration in the traditional court (Sutharshana, 2013, p. 8). Coroners and medical examiners are not synonymous concepts. The medical examiner is a doctor who has passed a special training after the graduation from the medical university. Coroners are usually elected by the community; they are chosen from the nonprofessionals.
What is the role of the forensic pathologist?
The main role of the forensic pathologist encompasses the pronouncement of death. Moreover, the expert establishes the existence of the injuries on the human body as well as defines the mechanism of the death occurrence. The forensic pathologists work on the basis of hospitals and find out the reasons of death. Their work helps the criminalists to understand the causes of human death (James, Nordby, & Bell, 2014, p. 111).
Background to Modern
The profession of the pathologist appeared in the 19th century. The first scientific principles of the morphological method that were applied in pathology were proposed by the German scientist Rudolf Virchow, who showed the cellular essence of all illnesses in practice (Sutharshana, 2013, p. 7). Eventually, it became impossible to explain the nature of the pathological processes happening in an organism with one cellular theory. There were hormonal and neurohumoral doctrines that laid the foundation of the forensic pathology as a new functional direction in medicine. At present, the forensic pathologist is the specialist possessing the theoretical and practical knowledge of the modern methods of pathophysiological diagnostics (James et al., 2014, p. 140; Sutharshana, 2013, p. 8).
Forensic Pathology – American Board of Pathology
Forensic pathology is the research of the evidence and the establishment of the objectives for the finding of truth in the criminal (civil) case. The American Board of Pathology is a member of the American Board of Medical Specialties. It includes forensic pathology and specializes in the medical examination of the causes of death (The American Board of Pathology, 2015).
Autopsy – process inframammary incision
Autopsy is the research of the corpse for the purpose of the establishment of the causes of death. According to the WHO (2012), this procedure allows inspecting the body organs and tissues with the microscopic and chemical analysis. The procedure of autopsy is similar to the surgery and is carried out by the medical personnel. The process of autopsy requires the written consent of the family of the dead (WHO, 2012).
Documentation and specimens
The documentation, including the death report and disease diagnose, is usually given to the spouse or a close relative of the dead. It contains the information about the external and internal investigations of the corpse and the cause of death. According to Sutharshana (2013), “a forensic pathologist working in this particular field will be responsible for quantitative and qualitative analysis and interpretation of patient specimens, including tissue, blood, urine, and other body fluids by laboratory means” (Sutharshana, 2013, p. 7).
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Causes and Mechanism of Death
Death is the irreversible termination of the main vital signs of the human organism, such as blood circulation, breath, the central nervous system, etc. The termination of the main functions of an organism includes the dying of the cells of a body generally owing to the termination of the access to oxygen. At the absence of respiratory movements, there is no blood ventilation, saturation by oxygen and release from the carbonic acid collected as a result of the tissues exchange (Sutharshana, 2013, p. 9). The loss of functioning of the central nervous system leads to the full disorder of the regulation and interrelation of all organism’s systems.
Manner of Death
NASH (natural, accidental, suicide, and homicide)
There are two main manners of death – natural and premature. The natural or physiological death is caused by the long consecutive fading of the vital parts of an organism. The premature (pathological) death is caused by the painful conditions of an organism as well as the failure of vital organs (a brain, heart, lungs, liver, etc.). The premature death can be sudden, as it can happen within several minutes or even seconds. The types of premature death include accidental, suicidal and homicidal (Sharma, 2011, p. 105). The determination of the method of pathological death is the competence of the law enforcement agencies, but the forensic pathologists can find out the bases for the pronouncement of the type of death at the research of the corpse, crime scene, and material evidence.
Time of Death
Rigor mortis is one of the death signs caused by the posthumous chemical processes in the muscular tissues. It is revealed in the hardening and rigidity of the muscles of a corpse’s extremities. Unlike the usual muscular contraction, here the body is not capable of completing the cycle, having broken off the interaction between the actin and myosin. The resistant muscular contracture occurs and stops only against the enzymatic decomposition of muscular tissue.
Livor mortis is the sign of the biological death. It belongs to the early putrid phenomena and is represented in the cyanotic-violet coloring of the skin. Livor mortis is caused by the passive movement of blood in vessels by gravity and its concentration in the lower parts of the body because of the termination of warm activity and the loss of tone in the vascular wall. Analyzing the behavior of livor mortis, forensic pathologists consider the cause of death, the rate of its approach (sharp or agonal), and the research technique. The medical examiners apply the standard techniques with the dosed area and the force of pressure.
The biological death is caused by the termination of the biological processes, thus leading to the gradual cooling of a corpse to 0.5-1 °C lower than the temperature of the environment. This method is widely used by the forensic pathologists, as the process of cooling is physical and almost does not depend on the body’s chemistry. It lasts for two days and allows making rather exact forecasts. This method is also simple in application (Sharma, 2011, p. 106). The results of measurements can be used in court with the obligatory presentation of the certified thermometers with the periodically renewable metrological control researches.
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Investigation of traumatic death
A mechanical trauma represents the injury of tissue, body and other anatomic formations as a result of the impact of the external mechanical force. In cases of the mechanical trauma, the injury is done by the subject who moves towards the person, while this person is either in the state of rest or movement. The mechanical trauma can also be obtained when the person moves or hits a motionless subject (for example, when falling) (Sharma, 2011, p. 106).
Sharp forces appear as a result of a blow, a sting, or by cutting with or sharp object. The trauma can be followed by the violation of the integrity of an epithelium which leads to the development of an ulcer or erosion, or the interstitial hemorrhage without the violation of the integrity of the epithelium (hematoma). There is the inflammatory reaction of the localized character with the infiltration of the actually mucous membrane around an erosion. The types of sharp mechanical traumas are diverse, starting from bruises, hypodermic hematomas, grazes, small superficial wounds, and including extensive and deep wounds, fractures of bones, separation of extremities, and the damages to internal organs.
A blunt force is one of the most widely spread types of mechanical injuries in the structure of the medical legal autopsy. There are various closed damages differing based on character, localization and volume. The crush syndrome is a peculiar consequence of the blunt trauma followed by the long crushing of the bodies with muscles (Sharma, 2011, p. 106).
Contusions represent the injuries of soft tissues without visible anatomic damages as a result of a blow or a bruise. In bruises, the integrity of blood and lymphatic vessels is broken, and there is interstitial hemorrhage. There are four degrees of contusions. The first one is light and presupposes the scratches and grazes of skin, while the last one is the most severe one and includes the full smashing of organs and bones.
Hematoma is a blood congestion in the again formed cavity at the closed mechanical injury connected with the rupture of vessels. Hematomas happen together with the bruises of the second degree, fractures of bones, ruptures of vessels, or the incomplete stoppage of bleedings in a postoperative wound. They can be arterial, venous, mixed and pulsing. There are also hypodermic, intermuscular, intra organ, and intra cranial hematomas.
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Penetrating gunshot includes any stomach, breast or head wound, having the depth of more than four cm. The penetrating gunshots can have appear as a very small hole and look harmless and safe (Sharma, 2011, p. 106). However, in the majority of cases, they result in the fatal outcome and allow the forensic pathologists to make the conclusions about the causes of human death.
The perforating gunshot is the wound having the entrance and output wounds connected by the wound channel. Such gunshots can be found in any areas of a human body and arise, as a rule, from the action of the bullet possessing much kinetic energy. The perforating gunshots are caused by the shots from firearms or explosions of shells as well as other explosives.
Contact or near-contact (stippling, powder burns) gunshot
The contact gunshot is the wound that happened a short distance from or in direct contact with a human body or clothes. The location of the gun towards the human body determines the place, speed, and force of the gunshot. The forensic pathologists can recreate the situation in which a person was murdered with the help of the study of the contact gunshot details.
Distant wounds (abraded)
The distant gunshot represents the shot that happened at a considerable distance. According to Harle (2012), “distant gunshots are such gunshots, which produce stippling at the distance. They appear as round wounds with sharp margins and an abrasion ring on the surrounding skin” (Harle, 2012).
A chemical trauma includes the damage of an organism caused by the external chemical agents. They can be various toxic substances reaching skin or organs through a gullet or airways.
Drugs and poisons
There are a lot of drugs and poisons that have the effect of chemical trauma on the human organism. They include such drug substances as Morpheus, codeine, chloroform, ethylene glycol, ethyl and methyl alcohol and barbiturates, poison like cyanide and organophosphorus compounds.
Carbon monoxide occupies the main place among the poisonous substances that change the hemoglobin level of human blood and lead to the fatal outcomes. Poisoning with carbon monoxide occurs in the aerogenic way. Getting through the lungs to the blood, carbon monoxide quickly forms the permanent connection – carboxyhemoglobin – with hemoglobin. As a result, hemoglobin loses the ability to perceive the oxygen, which leads to the oxygen starvation of tissues, brain, and subsequent death caused by the paralysis of the vital centers.
The types of poison that belong to the group of cyanides are the derivatives of hydrocyanic acid. This poison blocks the cellular enzyme – cytochrome oxidase, responsible for the digestion of oxygen by a cell. As a result, oxygen remains in blood and circulates together with hemoglobin. Therefore, during the cyanide poisoning, even the blue blood has a bright red coloring. Without the access to oxygen, the metabolic processes in the cells stop, and the organism quickly dies. The cyanide is poisonous; it can get through the skin, especially if it is damaged. The lethal dose of potassium cyanide for the person is 1.7 mg per each kilogram of weight.
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Hypothermia is the condition of an organism when body temperature decreases lower than required for the maintenance of the normal metabolism. The internal mechanisms cannot fulfill the losses of heat any more. The dots of dark brown hemorrhages on a mucous membrane of the stomach wall are the most widely spread symptoms of hypothermia.
Hyperthermia is the trauma of the tissues of a live organism arising under the influence of high temperatures and some other physical or chemical agents causing protein denaturation – acids, alkalis, or ionizing radiation. It arises when the extent of the heat absorption exceeds the extent of its dispersion. At the same time, the temperature of the tissues begins to increase up to the level where there is a cellular disintegration (44-51 °C) (Sharma, 2011, p. 106).
Electrical trauma is the damage or a burn of the tissue or a dysfunction of internal organs. It occurs when the electric current passes through a body. The electric impulse can lead to the short circuit in the electric system of an organism and, as a result, cause the the cardiac arrest, leading to death.
In the forensic pathology, there are various types of acute oxygen starvation. Asphyxia has two meanings. The first one does not presuppose a pulse, but is used to mean “asthma” and “strangulation”. Asphyxia is also a type of hypoxia combined with the increased content of the carbon dioxide in blood and tissues (Sauvageau & Boghossian, 2010, p. 1259).
Diatoms – drowning
Drowning represents the closing of the respiratory ways by liquid – water, dirt, wine or oil products, for example. It can also occur without the full immersion of a body or even a head into the liquid. Most often, drowning is an accident that happens during bathing, crashing of the vessel, casual falling in the water, etc. The forensic pathologists investigate whether drowning was the result of the murder or suicide.
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Strangulation asphyxia represents the compression of the neck with hanging or strangling. There are two principles of strangulation. The first one is the mechanism of the compression of the neck. The second one is the tool of the traumatic death (Sauvageau & Boghossian, 2010, p. 1262).
Ligature leads to the formation of the ligature mark and the general signs of fast death. The features of the ligature and the knot determine the mechanism of death. Unlike hanging, the ligature occurs at the tightening of vessels by somebody’s hand or by the means of a special mechanism.
At the strangulation by hands in gloves or through any soft subject pressed to the skin of the victim’s neck, there may not be damages, hindering the process of murder investigation. In such cases, it is possible to establish the neck strangulation fact only at the internal research of the extensive hemorrhages in muscles, fractures of a hyoid bone, cartilages of a throat and trachea.