Forensic Pathology for Police, Death Investigators,
Attorneys, and Forensic Scientists

Joseph Prahlow
Forensic Pathology
for Police, Death
Investigators, Attorneys,
and Forensic Scientists
Joseph Prahlow
Indiana University School of
Medicine – South Bend and the South
Bend Medical Foundation, Inc.
530 North Lafayette Blvd.
South Bend, IN 46601
USA
jprahlow@sbmfl.org
ISBN 978-1-58829-975-8 e-ISBN 978-1-59745-404-9
DOI 10.1007/978-1-59745-404-9
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2009937148
© Springer Science+Business Media, LLC 2010
All rights reserved. This work may not be translated or copied in whole or in part without the written
permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York,
NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in
connection with any form of information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed is forbidden.
The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are
not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject
to proprietary rights.
While the advice and information in this book are believed to be true and accurate at the date of going

to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any
errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect
to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
Dedication
This textbook was written to the glory of God and is dedicated to my Lord and
Savior, Jesus Christ. I believe that it is appropriate to briefly share with the reader
why such a dedication is in order, and how my life’s work has helped me to come to
a better understanding of things eternal. My job has helped to confirm for me three
specific insights into life and death.
First, by having the unique privilege of being able to actually see inside the physi-
cal body of someone, and to then view their tissues under a microscope, I have come
to the conclusion that the human body is an absolute marvel. From its anatomic
structures visible to the naked eye, all the way down to its smallest molecules, as
well as its complex physiology, the human body is nothing other than spectacular.
To suggest that such a marvelous entity, along with all of the other incredible bio-
logical forms within our world, somehow randomly came into existence does not
make sense to me. The incredible complexity of nature is proof to me that there is a
higher power, a power able to create such complexity, a power who I know as God.
I consider life on earth as a gift from this higher power. As a Christian, I believe that
God’s original intent was for us to live in harmony with Him and each other.
Second, as a forensic pathologist, I am confronted on an almost daily basis with
the fact that physical death represents an unavoidable part of the entire process of life
on earth. We cannot escape death. As a Christian, I believe that the human condition
of unavoidable physical death results from the fact that we are sinful beings. I see all
too frequently within my work the fact that human beings have a sinful free will. I
believe that our sin separates us from God and His original intent to live in harmony
with us.
The third insight that my job has provided for me involves the recognition of a

spiritual component of life. Throughout the history of the world, many humans have
been aware of and concerned about their mortality. Is there a “soul,” a “spirit,” or
a “life-force?” If so, does it die along with the physical body? If not, what happens
to it? Through my work as a forensic pathologist, I have come to understand and
believe that, without a doubt, there is a soul (spirit, life-force). Dead bodies simply
represent “empty shells.” When I work on dead bodies, the true “person” is no
longer present. As a Christian, I believe that the human spirit lives on beyond the
death of the physical body. I also believe that what happens to the spirit depends
on one thing. That one thing is whether or not, during life on earth, a person has
v
vi Dedication
accepted the free gift of Jesus Christ as their Lord and Savior. If you believe that
Jesus Christ suffered and died, taking your sin on Himself, and then rose from the
grave, defeating sin, then you will live with God for eternity after your physical
death on earth. This is my belief and faith as a Christian, and it is my prayer for
everyone reading this.
Foreword
Forensic pathology is a unique profession. As a forensic pathologist, I am privileged
to see, on an almost daily basis, the wonders of the human body and the value of
life. At the same time, my job affords me the opportunity to see the fragility of life,
the ravages of disease, and the unimaginable horrors that are perpetrated on some
people by their fellow human beings.
In recent times, forensic pathology has become very popular within the pub-
lic and various media outlets. To an extent, this popularity has been beneficial to
my profession, in that more of society has a basic understanding of what we do.
However, many misperceptions and myths persist. Occasionally, as a result of such
misperceptions, forensic pathologists are faced with the task of educating the public
(such as jurors), as well as other professionals, regarding the fallacies of such myths.
My hope is that this textbook will help to correct these misperceptions. At the same
time, it is my hope that this text will help to educate its readers about a truly unique

profession.
There are several outstanding, up-to-date forensic pathology textbooks in exis-
tence today. For the most part, these texts are written for a specific audience, namely
pathologists, or more specifically forensic pathologists. Although such texts may
be suitable for many of the professionals with whom forensic pathologists inter-
act, none of these fine textbooks has been written specifically for the non-forensic
pathologist. When I was asked to write this text, it was for the purpose of writing
specifically for the non-forensic pathologist professionals who frequently or occa-
sionally interact with forensic pathologists. As such, the reader will note that several
of the early chapters in the book address issues that are not ordinarily covered in
the typical forensic pathology textbook, such as general overviews of medicine and
pathology, as well as anatomy and physiology.
The overall goal of this textbook is to provide police officers, death investiga-
tors, attorneys, and other forensic scientists with a working knowledge of forensic
pathology, in order to better enable these individuals to interact with forensic pathol-
ogists during their daily duties. Because forensic pathology is an incredibly visual
discipline, it is necessary to include numerous photographs in this text. I am a firm
believer that providing more photographs is better than providing fewer photographs
and color photos are better than black and white. As such, this entire book-
writing endeavor has created somewhat of a challenge: how can we provide enough
vii
viii Foreword
quality photographs in a format that is affordable to the intended audience? My
hope is that we have succeeded in this endeavor. We have attempted to include
within the textbook itself the minimum number of black and white photographs
necessary to provide a basic understanding of the concepts presented, but we have
also included a computer disc containing color versions of each textbook image.
In addition, the computer disc contains numerous extra color images of additional
topics/issues, with references to these extra images within the textbook itself.
The photos in this text are largely taken from autopsy cases that I performed;

however, there are numerous photos from cases performed by my colleagues in
Indiana, North Carolina and Texas. In most of these instances, I actually saw the
cases with my own eyes, as others performed the autopsies. Occasional images are
from cases that were performed by fellow forensic pathologists, but were not per-
sonally witnessed by me. I have attempted to identify these latter cases throughout
the text by giving appropriate recognition to the pathologist or office from which
the photographs originated. Every attempt has been made to protect the identity of
the individuals shown in the photographs, while attempting to illustrate a particular
point of forensic interest.
An attempt has been made to provide as much information as possible within this
book, recognizing that the text is meant to be an overview of forensic pathology,
and not an all-encompassing review of each topic. Each chapter provides numerous
references for additional reading, and an appendix at the end of the book provides
a listing of additional resources. My hope is that this text fills a need for a forensic
pathology text specifically geared toward those professionals who work alongside
or interact with forensic pathologists.
Acknowledgements
I am indebted to many individuals and institutions for enabling me to produce this
book. I extend my gratitude to my editor, Harvey Kane, and my publisher, Springer,
for their patience, encouragement, and professionalism during the entire process.
Very importantly, I acknowledge and respectfully express my heartfelt thanks to
my patients, for without them I would not be able to perform my job. Death is often a
very tragic event, but I believe that it is possible to learn something from every death.
To my patients, I offer my heartfelt thanks, and I offer my sincere condolences to
the families and loved ones of those for whom I am privileged to work.
I am also indebted to the various institutions with which I have been associated
throughout my education and professional career, including the following, which
were each an important part of my formal education: Valparaiso University, Indiana
University School of Medicine, including Indiana University School of Medicine –
Northwest, the Department of Pathology of Wake Forest University School of

Medicine, North Carolina Baptist Hospital, the Dallas County Medical Examiners
Office, the Southwestern Institute of Forensic Sciences, and the University of
Texas – Southwestern Medical Center. I am grateful to my current employer, asso-
ciations, and affiliations, each of which have been supportive of me in my work: the
South Bend Medical Foundation, Indiana University School of Medicine – South
Bend at the University of Notre Dame, Elkhart General Hospital, Memorial Hospital
of South Bend, and St. Joseph Regional Medical Center.
I would like to extend a special “thanks” to the administrative support I have
had over the years, including Genoal, Melinda, Connie, Judy, Liz, Stacey, Diane,
Melissa, Ann, Jim, Bob, Ann, Diane, Annette, Heather, Peggy, Sandi, and Diane
and her crew. I also say “thanks” to my current partners at the South Bend Medical
Foundation: Nicole, Fred, Al, Blair, Frank, Jim, Amobi, Derrick, Luis, Nita, Rick,
Kristen, Dave, Bill, Kurtis, John, Odeta, Joyce, Bobbie, and Bob, as well as my
colleagues at the medical school, including Rudy, Jack, Suzie, Carl, Ed, Ken, Molly,
Rob, Tracy, Mike, Gary, David, George, Faye, Diane, and Mark.
I am privileged to have had the opportunity to work with and learn from many
outstanding police officers, death investigators and coroners, attorneys, and foren-
sic scientists over the years. In particular, I would like to thank those with whom I
continue to work, including toxicologist Prentiss Jones, the coroners and deputy
coroners of St. Joseph, Elkhart, Fulton, Pulaski, LaPorte, Marshall, and Porter
ix
x Acknowledgements
Counties, as well as police officers from South Bend, Mishawaka, Elkhart, Goshen,
LaPorte, Michigan City, Valparaiso, Portage, St. Joseph County, Elkhart County,
LaPorte County, Marshall County, Porter County, the Indiana State Police, and the
Metro-Homicide Unit of South Bend/St. Joseph County. I would like to specifically
thank the autopsy assistants with whom I have worked over the years. They perform
incredible work for very little pay and very little thanks. I especially would like
to thank Eddie, John, and Jim from North Carolina, Hamo, Andrew, Joe, Darren,
and Sid from Texas, and Wayne, Andre, Chip, Sherri, Suzie, Jared, and Whitney in

Indiana.
Throughout my career, I have been incredibly blessed by knowing, working with,
and learning from many outstanding forensic pathologists. I am indebted to each
of them, especially John Pless, Pat Lantz, Gregory J. Davis, Don Jason, Jeffrey
Barnard, and Rick Hoover. I am also indebted to the following professional orga-
nizations: the American Academy of Forensic Sciences (AAFS), the American
Society for Clinical Pathology (ASCP), the College of American Pathologists
(CAP), and the National Association of Medical Examiners (NAME). By partic-
ipating in various educational programs, committees, and organizational forums
supported by these organizations, I have had the great fortune of meeting and
working with some of the best people in medicine, forensic sciences, and forensic
pathology. The following is just a sampling of the colleagues with whom I have had
the good fortune of working in one capacity or another. Most are forensic patholo-
gists. Sadly, some are no longer with us. Some I know well; others not so well. Some
I see often. Others I see very rarely. Some are well-known within the forensic pathol-
ogy community. Some may be considered “giants” in the field. Others are relatively
unknown outside of their particular office. Each is an outstanding professional.
Each is considered a friend. I apologize if I have overlooked anyone. T Andrew, M
Anzalone, J Arden, A Baker, E Balraj, J Barnard, N Batalis, M Bell, L Biedrzycki,
C Boden, J Carter, M Case, J Cavanaugh, S Cina, M Clark, S Clark, J Clouse, S
Cohle, K Collins, S Colvin, S Comfort, S Conradi, T Corey, G Dale, J Davis, GJ
Davis, GG Davis, J deJong, JS Denton, V DiMaio, G Di Vella, J Dix, M Doberson, D
Dolinak, E Donoghue, J Downs, L Dragovic, MF Ernst, M Fierro, L Finelli, S Fiore,
C Fligner, M Flomenbaum, D Fowler, R Froede, J Frost, J Gerns, M Gonsoulin,
J Goodin, M Graham, M Greenwald, A Gruszecki, J Guileyardo, K Gunson, W
Gunther, K Haden-Pinneri, R Hanzlick, A Hart, C Harvey, D Hawley, J Howard, J
Hunsaker, D Jason, J Jentzen, P Jones, F Jordan, M Kalelkar, W Kemp, R Kohr, P
Lantz, W Lavezzi, B Levy, D Little, J Luke, C Mallak, J McClain, P McFeeley,
D McNally, F Miller, C Milroy, M Nashelsky, T Noguchi, K Nolte, J Oeberst,
W Oliver, G Peterson, J Pless, JK Pinckard, R Prichard, R Quinton, B Randall,

D Reay, R Reichard, K Ross, L Salzberger, L Sathyavagiswaran, G Schmunk,
D Schultz, MA Sens, C Siebert, G Simmons, S Spotswood, C Stern, D Stewart,
M Super, E Todd, J Townsend-Parchman, S Turner, J Urban, S Wagner, M Ward,
V Weedn, C Wetli, D Wolf, R Zumwalt.
Besides being blessed by my teachers and colleagues, I have been blessed by
and have learned a great deal from my students throughout my career. They help to
Acknowledgements xi
keep me humble. I have a great deal of respect for them, and I enjoy being able to
participate in their education.
I would also like to thank my family. Starting with my childhood family, I would
like to thank my parents, August and Lois, and my siblings for their love and support
throughout my lifetime. Moving on to my own family, I would like to express my
love and thanks to my children, Jacob, Samuel, Noah, Joseph, and Mary Anna. I
would like to proclaim my most sincere appreciation and deep love for my wife,
Tamara. Thanks for your love and support! Finally, I would like to publicly express
my thanks for my Lord and Savior, Jesus Christ, for His saving grace, and His loving
example of how to live my life.

Contents
Part I Introductory Topics
1 Introduction to Pathology 3
Disc Image Legends . . . 15
Selected References . . . 15
2 Introduction to Forensic Sciences 17
Overview 17
ChainofCustody 18
Admissibility of Tests, Evidence and Testimony . . 18
Expert Witness 18
Forensic Science Disciplines 19
ForensicPathology 19

Forensic Anthropology 19
Forensic Odontology . . 19
ForensicEntomology 20
ForensicToxicology 22
Forensic Psychiatry . . 22
Trace Evidence 22
FirearmsandToolmarksExaminers 24
Document Examination 25
Fingerprint Evidence . . 26
Serology/DNA 27
OtherDisciplines 29
Disc Image Legends . . . 32
Selected References . . . 32
3 Introduction to Forensic Pathology 35
Overview 35
DutiesoftheForensicPathologist 36
Investigation 37
Autopsy 37
Verification of Identity . 40
Documentation of Findings . . . 40
xiii
xiv Contents
DeathCertification 41
Testifying 41
Consultation 42
TrainingandQualificationsofForensicPathologists 43
Disc Image Legends . . . 46
Selected References . . . 47
4 Death Investigation 49
Introduction . . . 49

DeathInvestigationSystemsWithintheUnitedStates 50
Overview 50
Jurisdictional Issues . . 51
Coroner Systems 51
MedicalExaminerSystems 52
MixedSystems 53
DutiesofDeathInvestigators 53
Overview 53
Initial Investigation . . 54
Scene Investigation . . 55
Follow-upInvestigation 60
Grief Counseling 61
Disc Image Legends . . . 61
Selected References . . . 62
5 Death Certification 63
Introduction . . . 63
Death Pronouncement . . 66
CauseofDeath 68
Manner of Death 71
Disc Image Legends . . . 79
Selected References . . . 79
6 Overview of Anatomy and Physiology 81
Introduction . . . 81
Overview 81
GrossAnatomy 82
Histology 90
Physiology 91
BodyRegionsandCompartments 92
Specific Organ Systems . 92
IntegumentarySystem(Skin) 92

MusculoskeletalSystem 94
NervousSystem 97
CardiovascularSystem 104
RespiratorySystem 106
GastrointestinalSystem 108
Contents xv
Hepatobiliary System . 111
Reticuloendothelial System (Including the Immune System) 113
Endocrine System . . . 116
GenitourinarySystem 120
Special Sensory Structures 122
Disc Image Legends . . . 124
Selected References . . . 126
Part II General Topics in Forensic Pathology
7 The Postmortem Forensic Examination/Autopsy 129
Introduction . . . 129
ForensicVersusHospitalAutopsies 130
Investigation 133
ExternalExamination 134
InternalExamination 137
Ancillary Procedures . . . 153
Autopsy Report . 154
External Examination Only (Without Autopsy) 156
After-the-FactandIn-AbsentiaCases 157
AutopsyAssistants 158
Office Accreditation and Forensic Autopsy Standards . 159
Disc Image Legends . . . 159
Selected References . . . 161
8 Postmortem Changes and Time of Death 163
Introduction . . . 163

Early Postmortem Changes 163
LivorMortis 163
RigorMortis 166
AlgorMortis 168
Other Early Postmortem Changes 168
Decomposition . 169
PostmortemInjuries 177
TimeofDeathEstimation 179
Disc Image Legends . . . 182
Selected References . . . 184
9 Identification of Human Remains 185
Introduction . . . 185
PoliciesforIdentificationofBodies 188
Common, Non-scientific Methods of Identification . . 188
HospitalIdentification 188
VisualIdentification 188
Scientific Methods of Identification 190
Fingerprint Identification 190
xvi Contents
DentalIdentification 191
RadiologicIdentification 192
DNAIdentification 194
Identification Based on Other Unique Features 195
CircumstantialIdentification 198
UnidentifiedRemains 198
Disc Image Legends . . . 200
Selected References . . . 201
Part III Major Causes/Mechanisms of Death
10 Natural Deaths 205
Introduction . . . 205

InfectiousDisease 207
CardiovascularSystem 208
Congenital Heart Disease 209
Congestive Heart Failure (Heart Failure) . 210
Coronary Artery Atherosclerosis 211
Coronary Artery Dissection . . . 214
Other Coronary Artery Disorders 214
Aortic Aneurysms (Abdominal and Thoracic) . . . 215
CerebrovascularDisease 216
Vasculitis . . . 217
FibromuscularDysplasia 217
Myocarditis . 217
Hypertensive Cardiovascular Disease . . . 218
ValveDisorders 219
Hypertrophic Cardiomyopathy . 220
Dilated Cardiomyopathy 220
Restrictive Cardiomyopathy . . . 222
Deep Venous Thrombosis 222
Conduction System Abnormalities 222
Neoplastic Heart Disease 223
CentralNervousSystem 223
Congenital Anomalies . 223
CerebralPalsy 223
Infection 224
SeizureDisorders 225
Dementia 226
CerebrovascularDisease 226
Hypertensive Disease . 226
Spontaneous Intraparenchymal Hemorrhage 227
Ruptured Berry Aneurysm 227

Ruptured Arteriovenous Malformation (AVM) . . . 227
DuralSinusThrombosis 228
Neoplasia . . . 229
Contents xvii
RespiratorySystem 229
Congenital Anomalies . 229
Neonatal Conditions . . 230
Upper Airway Conditions 230
Pulmonary Thromboembolism . 231
Bacterial Pneumonia . . 231
Aspiration Pneumonia . 232
Viral Pneumonia 232
Other Infections (Tuberculosis, Fungi, Parasites) . . 232
Asthma 233
Chronic Obstructive Pulmonary Disease (COPD) . . 234
ChronicLungDisease 235
Pulmonary Hypertension 235
Neoplasia . . . 235
Sarcoidosis 235
Gastrointestinal and Hepatobiliary System . . 236
Congenital Anomalies . 236
Gastritis . . . 236
PepticUlcerDisease(PUD) 236
Cirrhosis/Esophageal Varices . . 237
Mallory–WeissTears 238
Other GI Abnormalities 238
Hemochromatosis . . . 239
Pancreatitis . . 240
Reticuloendothelial and Immune Systems . . 240
AutoimmuneDisorders 241

Leukemia/Lymphoma . 241
Immunodeficiency . . . 242
Endocrine System 243
GenitourinarySystem 244
Bones, Joints, and Soft Tissues . . . 245
Multisystem and Other Disorders . 245
Amyloidosis 246
Chronic Alcoholism . . 246
Diabetes Mellitus . . . 247
SickleCellDisease 248
Inborn Errors of Metabolism . . 249
OtherGeneticDisorders 250
Sarcoidosis 251
Psychiatric Disease . . 251
Disc Image Legends . . . 252
Selected References . . . 254
11 Drug-Related and Toxin-Related Deaths 257
Introduction . . . 257
InvestigationofDrug-RelatedDeaths 258
xviii Contents
AutopsyFindingsinDrug-RelatedDeaths 261
ToxicologyIssues 263
DeathCertification 267
Specific Drugs and Toxins 269
Ethanol and Related Substances . . 269
Ethanol 269
Ethylene Glycol 272
Methanol . . . 272
Isopropanol . 273
Amphetamines and Similar Substances . . . 273

OtherStimulants 274
Barbiturates 275
Cocaine 275
Opiates and Related Substances . . 277
Morphine 279
Heroin 279
Methadone . . 280
Fentanyl . . . 281
OtherOpiates 281
Psychoactive Drugs of Abuse (Hallucinogens) 282
Marijuana . . 282
LysergicAcidDiethylamide(LSD) 282
Phencyclidine (PCP) . . 283
Mescaline(Peyote) 283
Mushrooms(Psilocybin) 283
Other Hallucinogens . . 284
Over-the-Counter (OTC) Drugs . . 284
Acetaminophen 285
Aspirin(Salicylate) 285
Ephedrine/Herbal Ecstasy 286
OtherPrescriptionDrugs 286
Antidepressants 286
Nonbarbiturate Sedative Hypnotic Drugs . 286
Antipsychotic Drugs . . 287
Anabolic Steroids . . . 288
Insulin 288
Volatiles and Inhalants . . 289
NitrousOxide 291
Hydrocarbons 291
HeliumandOtherSimpleAsphyxiants 293

HeavyMetals 294
Arsenic 294
Cadmium 295
Iron 295
Lead 295
Contents xix
Mercury 295
OtherPoisons 296
Organophosphates . . . 296
Strychnine . . 296
Naturally-OccurringToxins 296
Disc Image Legends . . . 297
Selected References . . . 299
12 Blunt Force Injury Deaths 301
Introduction . . . 301
ClassificationofBluntForceInjuries 302
Abrasions 302
Contusions 304
Lacerations . . 305
Fractures 308
Avulsions 310
BluntForceHeadandNeckTrauma 311
Skin and Mucosal Injuries 312
Subcutaneous Injuries . 312
Skull and Facial Bone Injuries . . 313
Epidural, Subdural, and Subarachnoid Hemorrhage . 315
GrossBrainInjuries 317
Microscopic Brain Injuries . . . 320
Neck, Spinal Cord, and Vertebral Artery Injuries . . 321
Special Topics Related to Blunt Force Injuries 322

Mechanisms of Death in Blunt Force Trauma 322
Delayed Deaths Related to Blunt Force Injury . . . 324
PatternedInjuries 325
ClothingExamination 327
Specific Subtypes of Blunt Force Injury . . 327
Disc Image Legends . . . 332
Selected References . . . 334
13 Gunshot Wound Deaths 337
Introduction . . . 337
Types of Weapons and Ammunition 337
Gunshot Wounds 343
Entrance Wounds . . . 344
Range of Fire . 346
Exit Wounds . 351
Graze Wounds 351
Caliber 352
Miscellaneous Features of Handgun Wounds 354
Characteristics of High-Velocity Wounds . 354
Shotgun Wounds 356
Miscellaneous Issues . . . 362
xx Contents
InternalExamination 362
Mechanism of Injury . . 366
Documentation 367
X-Rays 368
ClothingExamination 368
GunshotResidue 368
Manner of Death Issues 369
Special Weapons, Ammunition, and Circumstances 370
Disc Image Legends . . . 373

Selected References . . . 376
14 Sharp Force Injury Deaths 379
Introduction . . . 379
Stab Wounds . . 381
Incised Wounds . 385
Chop Wounds . . 388
Special Issues . . 388
InternalExamination 388
Mechanism of Injury . . 390
Trace Evidence 390
ClothingExamination 390
Defensive Wounds . . . 391
HesitationMarks 391
Self-Inflicted Wounds/Suicide . . 392
“Self-Injurious Behavior” (“Cutting”) . . . 392
Accidental Sharp Force Injuries . 393
Direction of Incised Wound . . . 393
Handedness of Attacker 393
X-Rays 394
Decomposition 395
Postmortem/Perimortem Wounds 395
Artifacts 397
Disc Image Legends . . . 398
Selected References . . . 399
15 Asphyxial Deaths 401
Introduction . . . 401
Suffocation 403
SimpleAsphyxia(EnvironmentalAsphyxia) 403
Smothering(ExternalAirwayObstruction) 405
Choking (Internal Airway Obstruction) . . 406

Mechanical Asphyxia (Traumatic Asphyxia) 408
Positional Asphyxia . . 410
CombinationFormsofSuffocation 410
Neck Compression (Strangulation) . 411
Hanging . . . 412
Contents xxi
Strangulation . 415
Ligature Strangulation . 416
Manual Strangulation . 417
Non-ligature, Non-manual Neck Compression . . . 418
ChemicalAsphyxia 419
Carbon Monoxide . . . 419
Cyanide . . . 422
Hydrogen Sulfide . . . 423
OtherIssues 423
AutoeroticAsphyxia 423
Choking Game 424
RestraintAsphyxia 425
CombinationAsphyxialDeaths 427
Drowning 428
Disc Image Legends . . . 428
Selected References . . . 430
16 Drowning 433
Introduction . . . 433
Physiology and Mechanism of Death in Drowning . . 434
Scene Investigation 435
AutopsyFindings 437
CausesofDeathOtherThanDrowning 444
SCUBADeaths 445
Manner of Death 446

Disc Image Legends . . . 447
Selected References . . . 447
17 Electrical Deaths 449
Introduction . . . 449
Electrocution 451
Mechanism of Death in Electrocutions 453
Scene Investigation 453
AutopsyFindings 455
LowVoltage 455
HighVoltage 457
Other Features 459
Lightning 461
Non-Lethal Electronic Shock Devices 464
Death Certification and Manner of Death . . 465
Disc Image Legends . . . 465
Selected References . . . 466
18 Temperature-Related Deaths 469
Introduction . . . 469
Hypothermia . . 470
xxii Contents
General Features 470
Scene Investigation . . 471
AutopsyFindings 471
DeathCertification 475
Hyperthermia . . 475
General Features 475
Scene Investigation . . 476
AutopsyFindings 477
DeathCertification 478
Disc Image Legends . . . 479

Selected References . . . 479
19 Burns and Fire-Related Deaths 481
Introduction . . . 481
Burn Types . . . 484
DryBurns 484
RadiantBurns 484
Scald Burns . 485
ChemicalBurns 487
Fire-RelatedBurns 488
FireDeaths 489
QuestionstoAddress 489
Autopsy 492
Mechanism of Death . . 496
DeathCertification 497
FireInvestigation 498
Cremations 498
Disc Image Legends . . . 499
Selected References . . . 500
20 Deaths in Infancy and Childhood 501
Introduction . . . 501
Discarded Fetuses/Infants and Fetal/Infant Deaths
in Unattended Births . . . 502
WhoistheMother? 503
WastheFetus/InfantViable? 503
Was the Fetus/Infant Live-Born or Stillborn? 503
WhatWastheCauseofDeath? 505
Birth-RelatedInfantDeaths 506
InfantDeaths 508
Natural Death in Childhood 513
Accidental Childhood Deaths . . . 514

Suicidal Childhood Deaths 516
Homicidal Childhood Deaths 516
Classification of Childhood Homicides . . . 526
ViolentOutburst(AngryImpulse) 527
Contents xxiii
Negligence/Neglect . . 527
Sadistic Acts of Punishment . . . 528
Munchausen’s Syndrome by Proxy 529
UnwantedChild 529
Unwanted Pregnancy (Neonaticide) 529
Spouse Revenge 530
PostpartumMentalDisorder 530
Acute Psychosis 530
Altruism 530
Euthanasia (True Mercy Killing) 531
Sexual Abuse . 531
ViolentOlderChild 532
Drug and Alcohol Abuse 532
SeizureDisorder 532
Innocent Bystander . . 532
Pediatric Autopsy Considerations . 533
Disc Image Legends . . . 535
Selected References . . . 537
21 Miscellaneous Topics 539
Introduction . . . 539
AircraftCrashes 540
Allergic Reactions (Anaphylaxis) . 542
Animal Attacks . 544
ArtifactsandMimics 544
Emboli 546

Pulmonary Thromboemboli . . . 547
Systemic Thromboemboli 548
BoneMarrowandFatEmboli 548
AmnioticFluidEmboli 548
Gas/AirEmboli 549
BulletandOtherForeignBodyEmboli 550
Exhumations . . 550
ExplosionsandBlastInjuries 554
High-ProfileCases 554
HomicidebyHeartAttack 555
In-CustodyDeaths 556
Mass Fatality Incidents . . 560
Multiple Causes of Death . 561
Nutrition and Hydration Disorders . 562
Obesity 563
Malnutrition and Starvation . . . 563
Vitamin Deficiencies . . 564
Anorexia 564
Bulimia 565
xxiv Contents
Dehydration 565
Overhydration 566
FoodPoisoning 566
Occupational Deaths . . . 567
Organ and Tissue Procurement Issues 568
PostmortemChemistryTests 572
PostmortemCultures 574
Pregnancy-Related Maternal Deaths 575
Product-Related Deaths . 578
Radiation 578

IonizingRadiation 578
Non-ionizingRadiation 580
Sexual Assault . 580
Terrorist Agents 581
Biologic Agents 581
Chemical Agents 582
Therapy-RelatedDeaths 583
Disc Image Legends . . . 586
Selected References . . . 588
AircraftCrashes 588
Allergic Reactions (Anaphylaxis) 588
Animal Attacks 588
Emboli 588
Exhumation . 589
ExplosionsandBlastInjuries 589
High-ProfileCases 589
HomicidebyHeartAttack 589
In-CustodyDeaths 589
Mass Fatality Incidents 589
Nutrition and Hydration Disorders 590
Occupational Deaths . . 590
Organ and Tissue Procurement Issues . . . 590
PostmortemChemistryTests 590
PostmortemCultures 590
Pregnancy-Related Maternal Deaths 590
Product-Related Deaths 591
Radiation 591
Terrorist Agents 591
Therapy-RelatedDeaths 591
Appendix: Additional Resources and Reference Books 593

Index 595