CARNEGIE CAREER COLLEGE Main Campus Location: 1292 East Waterloo Road, Mogadore, Ohio 44260 (330) 628-1532 UNDERSTANDING THE FORENSIC AUTOPSY by Dr. Richard Ceroni, PhD, MA, M.ED, LICDC Reprinted with permission, 2006 Medical Aspects of Forensic Crime Scene Investigation INTRODUCTION Imagine being buried alive. Prior to the 19th century, the determination of death was highly elusive and speculative. Medical personnel did not have the advantage of stethoscopes and other medical equipment to determine if a person was truly deceased. It is believed that many were buried alive. To correct this problem, waiting mortuaries were developed and people close to death were placed on cot and watched until the body began to decay and this indicated death. The stethoscope, electrocardiogram (EKG) measuring electrical activity of the heart, electroencephalogram (EEG) measuring brain waves, and loss of blood flow as measured by nuclear scanning instruments all contributed to a more qualified assessment of death. The field examiner and coroner’s staff attempt to determine the cause of death, with the coroner’s office making the final decision. CAUSES AND MECHANISMS OF DEATH The cause of death is in essence the reason why a person died and the mechanism of death is the actual physiological change that caused death. The mechanism of death may come from several different causes. Field examiners ask several questions; 1. How and why did these events occur? 2. Who or what caused these events and why? 3. Was the death caused by the victim (suicide), another person (accidental or with purpose), an accident, or from normal causes (disease). There are five accepted manners of death; 1. Death by natural causes: Heat attack, pneumonia, stroke, and so on. 2. Accidental death: Unplanned or unforeseen events fall into this category. 3. Suicide death: The individual initiated the death, such as by gunshot, drug overdoses, hangings, and so on. 4. Homicide death: Death that occurs by the hand of another (planned or unintentional). 5. Undetermined death: Cause not determined. THE FORENSIC AUTOPSY Autopsies are performed by pathologists (physician who specializes in the field of pathology, or disease and injury. Forensic pathologists perform medico-legal autopsies, but hospital pathologists may be designated into this role in some jurisdictions. An autopsy is required in any death where the following occurs; 1. Traumatic death: Death which is accidental, homicidal, or self-induced. 2. Unusual death: Death by unnatural or suspicious causes. 3. Sudden death: Death that occur within a few hours of the onset of symptoms. 4. Unexpected death: Death that occurs in someone not expected to die. In most deaths, a physician simply issues a death certificate, but many types of death must be reported, including; violent death, deaths that occur in the workplace, deaths that are suspicious, sudden or unexpected deaths that occur during incarceration or while in police custody, deaths that are unattended by a physician, that occur within 24 hours of admission to a hospital, from medical or surgical procedures, during an abortion (performed medically, self-induced, or illegally), upon discovery of a known or unidentified body which is unexpected, prior to disposal of a body by means of cremation or burial at sea, and upon a request from a court system. ASPECTS OF AN AUTOPSY 1. Identification of the body: Most identifications of a deceased body are routine with family members or friends making an identification. Unfortunately, on occasion identification requires special assessment. The deceased body must be carefully handled by all involved and not moved until the proper field evaluations are completed so that crime scene evidence is not lost. The body should not be moved any more than necessary during the examination at the crime scene. In traumatic death, the victim’s hands must be properly covered with paper bags to protect any trace evidence, and the body must be carefully wrapped in clean sheets or placed into a clean body bag. In this way, trace evidence is not cross-contaminated. At the morgue, crime lab technicians will carefully transport the sheets or body bag to the crime lab to preserve trace evidence such as fibers, hair, dirt, paint chips, glass, or other materials. 2. Measuring and weighing the body: The body must be measured and weighed as a first step in the autopsy. 3. Photographing the body: The body must be photographed, clothed and unclothed first, and at various aspects of the autopsy. Every scar, birthmark, tattoo, or unusual physical feature is photographed and documented. Every injury is photographed and recorded. 4. Checking the victim’s clothing: The clothing must be properly observed and checked for trace evidence. Damaged clothing may correspond to specific body injuries. 5. Establishing time of death: The medical examiner attempts to use the state of rigor mortis (stiffening of muscles) and blood lividity (settling of blood) as part of the effort to determine the time of death. 6. X-rays: X-rays are not used as part of every autopsy, but may reveal broken off remains in the body (e.g. knife tip). Bullets tend to deform and break up inside the body, leaving behind chips and fragments. 7. Trace evidence: Trace evidence is vital to every case, including clipping and scraping the fingernails of the victim, combing the victim’s pubic hair in sexual assault cases, checking for semen and other body fluids, and the taking of hair samples from the victim’s head, eyebrows, eyelashes, and pubic area for comparisons with any foreign hair found on or around the crime scene. After trace evidence is retrieved, fingerprints are taken (if possible). 8. Examining injuries: Injuries, new and old are photographed and marked on a diagram. The exact location of a wound may explain whether an assailant is right or left handed. Types of injuries include; lacerations (cuts or slices), and these are measured in terms of location and depth. Bruises or contusions are evaluated and both measured and photographed. If the wounds are spread over the arms, legs, and torso of the victim, a struggle is suggested. Arm and hand wounds suggest defensive wounds. Contusions around the throat suggest strangulation by ligature or manual methods. Stab wounds are counted and width, depth and thickness of each is evaluated and recorded. The wound that lead to the killing thrust is determined. Hesitation wounds often accompany suicide attempts (small nicks and cuts), before the final fatal wound. Gunshot wounds are evaluated in terms of entry and exit points, and the possible gun distance upon firing.    DISSECTING THE HUMAN BODY 1. Making the incision: The medical examiner makes a Y-shaped incision to the front of the body. The incision has three arms, two extending from each shoulder down to the lower end of the sternum, and the third continuing down the midline of the abdomen and pubis. The ribs and clavicle are cut away with a saw or shears and the breastplate is removed, exposing the heart, lungs, and chest blood vessels. 2. Removing the heart and lungs: These vital organs are removed en bloc (as one unit), and exposed to blood typing, DNA analysis, and toxicological testing (aorta, heart, and peripheral vein). 3. Abdomen examination: Tissue samples are taken from the abdomen for microscopic examination. 4. Sample collection: The contents of the stomach are examined and samples are taken for toxicological examination. Stomach contents can determine the time of death if the content and timing of the victim’s last meal can be determined. In addition to stomach contents, ocular fluid from the eyes, bile from the gall bladder, and liver samples can give clues to chemicals in body. 5. Brain and head examination: The medical examiner looks for trauma to the skull. An incision is made behind the ear and over the top of the head to the other ear, so the scalp can be peeled forward to expose the skull. The brain is first examined in- situ (in place) and removes it for a complete inspection and to obtain tissue samples. 6. Organs returned to body: The organs are returned to the body and the body is re-sutured, and released for funeral services. TOXICOLOGICAL ANALYSIS 1. Stomach contents and ocular fluid may reveal any drugs the victim ingested before death. 2. Urine and bile may reveal the drugs that the victim used during the past several days. 3. Hair can reveal signs of chronic heavy metal (arsenic, mercury, and lead) ingestion. 4. Blood is helpful to determine the levels of alcohol and other drugs ingested. THE AUTOSPY REPORT The medical examiner’s final report consists of the details uncovered during the autopsy and lists a series of conclusions. In some cases, the medical examiner must sometimes wait for lab results before issuing a final report. Toxicological reports can take several days or weeks. IDENTIFICATION OF THE DECEASED BODY BY CRIME SCENE INVESTIGATORS by Dr. Richard Ceroni, PhD, MA, M.ED Reprinted with permission, 2006 Medical Aspects of Forensic Crime Scene Investigation IDENTIFICATION OF THE BODY The condition of the body when found depends on how long ago the death occurred and whether it was exposed to the elements or buried in some manner. As a general rule, one week in the open is equal to two weeks in the water, or eight weeks in the ground. If the body is intact, the size, sex, race, scars, tattoos, dental records, fingerprints, DNA, clothing, and so on can aid in identification. But when the body is a skeleton, the identification is more difficult and requires dental record matches, forensic artist sketches and other methods. ARTIFCATS AT THE CRIME SCENE Artifacts include rings and jewelry (can have names, initials, or dates inscribed inside), clothing (may identify manufacturer), and the coffin or a blanket used to bury the body (usually done to hide the body and to stop animals and scavengers from exposing the body parts). A makeshift wooden coffin may provide information on the construction materials used, blankets or sheets (may have manufacturer information), and plastic bags may contain fingerprints of both the victim and suspect. DISTINCTIVE BODY MARKINGS Distinguishing marks such as scars, tattoos, and birthmarks can aid in body identification. Birthmarks are irregular and can be distinctive in identification. Tattoos can often a match up to people who were arrested before (photographed at booking for previous crimes) and are easily identified by family and friends. Gangs have certain types of tattoos. WOUNDS OR IMPLANTED MEDICAL EQUIPMENT Scars from prior injuries and surgeries may be beneficial in body identification. Surgical appliances can provide identification when x-rayed or during the autopsy. Good examples are an artificial hip, pacemaker, implantable defibrillator, heart valves, and other appliances can have traceable serial numbers. FINGERPRINTS If the corpse is not significantly deteriorated, fingerprints can be obtained and matched against known missing persons. By injecting saline into the tips of the fingers (causing the pads to swell), epidermal ridges (fingerprints) can be revealed. The skin over the pads of the fingertips can be sliced away and viewed with a microscope. Even mummified bodies with leathery skin can be checked for fingerprints by soaking them in water or glycerin which causes them to swell rendering a possible fingerprint. DENTAL FEATURES People have variations in their teeth when compared to others. Teeth differ in terms of length, width, and shapes, as well as missing teeth, misaligned teeth, specific fillings, bridges, implants, chips, furrows, and so on. HUMAN BONES If the skeleton is intact, determination of sex and race can be made almost 100 percent of the time, determination of age can be made within 5 to 10 years, and determination of height within 1 ½ inches. Determination of whether the bones are human is not an easy task. The front paws of a bear resemble the human hand, turtle shells can appear to be a human skull, and the ribs of sheep and deer are similar to human ribs. Bones of an infant are difficult to determine from small animals. Teeth of infants are difficult to differentiate from small animals. The infant skull is not totally fused and can be in two parts, thus resembling animal parts. 1. Teeth: The development of teeth begins before birth and progresses, baby teeth are lost (20), replaced with 32 permanent teeth. Permanent teeth are apparent at about age 12, with the last teeth being the wisdom teeth appearing at age 18. This general timeline helps to determine the age of people 18 years or younger at death. 2. Skull: The skull of an infant is usually in several pieces, and later the parts fuse into one separated by sutures (jagged lines). 3. Long bones: The long bones change with aging, and the growth plate fuses when the long bones stop growing and this helps to determine if a body is younger than 25 years (when growth officially stops). 4. Pelvis: The pubic symphysis (thin band of cartilage that attaches the pelvis to the spinal column) has a zig-zag shape in the early years, and as age progresses it straightens, and stop growing at age 50. 5. Ribs: In young people, the area where the ribs attach to the sternum are rounded and smooth in appearance, but with aging become pitted and sharp. Examination of the rib-sternal junctions can determine age with 1 1/2 years up to age 30, and within 4-5 years up to age 70. 6. Bone density: Bones lose calcium with aging and subsequent density and this assists with age determination. DETERMINING HEIGHT AND STATURE Unfortunately, an intact skeleton is not always the case, and the remains are usually only a partial skeleton, and this makes height determination difficult. The long bones of the body provide an estimate of height of the victim (usually equal to five times the length of the upper arm bone (humerus). The thicker bones indicate thicker muscles. If a person is right handed, the right side forearm and arm bones tend to be larger, and vice-versa. DETERMINING SEXUAL GENDER Determining the sex of infants and children from bones is more difficult than adults, because gender-specific changes do not occur until puberty. In adults, the identification of sexual gender is much easier. The most reliable bones for determining sex are the pelvic bones. The male pelvis is designed only for support and movement, but the female pelvis is adapted for childbirth. The female pelvis is therefore wider and has a deeper pelvic outlet. The male skull tends to have more distinct ridges and is larger and thicker. The mandible (jaw bone) of the male is slightly curved, and the female mandible tends to be straight. DETERMINING RACE Determining race from skeletal remains is very difficult, because no single skeletal trait is racially distinct. Caucasians tend to have high, rounded or square skulls, straight faces, narrow protruding noses, and triangular eye sockets. Negroid skeletal remains tend to have lower and narrower skulls, wider and flatter noses, with prominent protruding teeth. Mongoloid skeletal remains have broad, round skulls with an arched profile, and round wide facial dimensions. A mixture of racial features makes identification of race almost impossible. ESTIMATING TIME SINCE DEATH 1. Examining artifacts from the burial site: Clothing, jewelry, casket materials, and other items may determine the period of burial. 2. Chemical analysis: Measurements of the nitrogen levels in bones, which decreases as they deteriorate is useful. Temperature and moisture affect the rate of deterioration. Amino acids also disappear from bones at different rates. 3. Ultraviolet light can be used to determine rate of deterioration. Fresh bones fluoresce (glow) a pale blue color under UV light, and with time fluorescence diminishes.