Essential Forensic Medicine

Peter Vanezis, MB, ChB, MD, PhD, FRCPath, FRCP (Glasg.), FFLM, FCSFS, FAFMS (UK), DMJ (Path), He has been Professor of Forensic Medical Sciences and Director of the Cameron Forensic Medical Sciences at Barts and the London (Queen Mary University of London) since 2006 (now Emeritus). He was formerly Regius Professor of Forensic Medicine and Science at the University of Glasgow. He is a Fellow of The Royal College of Pathologists, Fellow of Royal College of Physicians of Glasgow, Fellow of the Faculty of Forensic and Legal Medicine and Fellow of the Chartered Society of Forensic Scientists. Peter Vanezis was awarded an OBE in June 2001, for Forensic Pathology Services in Kosovo.

• List of Contributors xixSeries Foreword xxiPreface xxiiiAcknowledgements xxv1 The Legal System, Courts, and Witnesses 1Peter Vanezis1.1 Introduction 11.2 British courts 21.3 The Supreme court of the United Kingdom 21.4 English and Welsh courts 31.5 Scottish Courts 41.6 Northern Ireland Courts 61.7 Other courts 61.8 Types of witnesses and evidence 7References 112 Investigation of the Deceased and Their Lawful Disposal 13Peter Vanezis2.1 Introduction 132.2 Certification of details of death by the Registrar of births and deaths and lawful disposal of the body 132.3 Death certificate 142.4 When may a doctor issue a death certificate? 142.5 The form of the certificate in England and Wales 142.6 Legal procedures in the coroner system 142.7 Deaths abroad 192.8 Inquests 192.9 Registration of death 212.10 Burial 212.11 Cremation 212.12 The Human Tissue Act 2004 and Human Tissue (Scotland) Act 2006 242.13 Exhumation is discussed in detail in Chapter 5 252.14 Legal procedures in death investigation: Other systems 25References 273 The Duties of a Registered Medical Practitioner and the General Medical Council 29Peter Vanezis3.1 Medical Acts 293.2 Role of the GMC 303.3 Consent 323.4 Decisions involving children and young people 333.5 Consent and capacity 343.6 Medical confidentiality 353.7 Consent for disclosure 35References 364 General Principles of Scene Examination 37Peter Vanezis4.1 Concept of the scene 374.2 Scene investigation and Locard’s principle 384.3 Scene location and associated problems 404.4 Type of incidents 464.5 The forensic pathologist and other medical personnel at the scene 47References 52Further reading 535 The Medico‐legal Autopsy 55Peter Vanezis5.1 Introduction 555.2 Historical background 555.3 Types of autopsy 575.4 Types of autopsy in the Coroner system 585.5 Autopsy procedure 605.6 Examination of the exhumed body 675.7 Safety in the mortuary and dealing with high‐risk cases 69References 70Further reading 716 Interpretation of Injuries: General Principles, Classification, and Age Estimation 73Peter Vanezis6.1 Introduction 736.2 General aspects 736.3 Timing of bruises 776.4 Colour measurement of bruising 806.5 Differentiation from artefacts and other post‐mortem appearances 826.6 Decomposition 85References 86Further reading 877 Blunt Impact Trauma 89Peter Vanezis7.1 External surface injuries 907.2 Types of incidents in which blunt impact trauma is the predominant feature 97References 1108 Sharp Force Trauma 111Peter Vanezis8.1 Introduction 1118.2 Characteristics of sharp force trauma scenes 1128.3 Incised (slash) wounds 1138.4 Stab wounds and their assessment 1168.5 Glass injuries 1248.6 Injuries from other sharp objects 127References 1279 Firearm and Explosion Injuries 129Peter Vanezis9.1 Firearm injuries 1299.2 Types of firearms 1299.3 Recoil 1309.4 Handguns 1309.5 Rifles 1319.6 Shotguns 1329.7 Wounds from firearms and other missile injuries 1349.8 Investigation of firearm injuries 1359.9 Wounds and range of discharge from rifled firearms 1379.10 Entry and exit wounds from single bullets 1419.11 Shotgun Wounds 1439.12 High‐velocity rifle wounds 1469.13 Modified projectiles 1479.14 Air‐gun injuries 1479.15 Injuries from humane veterinary killers, industrial stud guns, and blank cartridge guns 1479.16 Injuries from rubber and plastic bullets 1479.17 The effects of being shot 1479.18 Explosions 1489.19 Effects of an explosion 1489.20 Explosion injuries 1499.21 Investigating the cause of the explosion 152References 152Further reading 15310 Forensic Aspects of Asphyxia and Drowning 155Peter Vanezis10.1 Non‐mechanical asphyxia 15610.2 Mechanical asphyxias 15810.3 Types of mechanical asphyxias and related conditions 16110.4 Drowning 17410.6 Diatoms and their use in the investigation of drowning 177References 17811 Forensic Medical Aspects of Human Rights Issues 181Peter Vanezis11.1 Torture 18111.2 Development of Humanitarian Law and the Geneva Conventions 18911.3 Responses to torture and its eradication 19111.4 Physician participation in torture 19111.5 Physician participation in Capital punishment 19211.6 The investigation of mass graves/multiple deaths related to armed conflict 194References 19712 Sexual Offences 199Philip Beh12.1 Introduction 19912.2 Sexual offences 19912.3 Responding to sexual offences 20112.4 Attendance at scenes of sexual violence 20312.5 Examination for injuries in sexual assault 20412.6 Interpretation of findings 20812.7 Examination of Fatal Sexual Assault 209References 211Further reading 21113 Paediatric Forensic Medicine 213Philip Beh and Peter Vanezis13.1 Introduction 21313.2 Stillbirth/neonatal deaths 21313.3 Sudden death in infancy syndrome 21413.4 Child abuse 21613.5 Types of child abuse 21713.6 Management of child abuse 228References 23114 Sudden Natural Death 233Peter Vanezis14.1 Introduction 23314.2 Sudden/Unexpected deaths where findings at autopsy are non‐specific 23414.3 Deaths involving different body systems 23714.4 Sudden death in Schizophrenia 24014.5 Respiratory causes 24014.6 Gastrointestinal causes 242References 24315 Heat, Cold, and Electricity 245Peter Vanezis15.1 Deaths from the effects of heat 24515.2 Deaths from the effects of cold 25315.3 Deaths from electricity 25515.4 Lightning 259References 25916 Diagnosing Death and Changes after Death 261Peter Vanezis16.1 Introduction 26116.2 Is the person really dead? 26216.3 Types of death 26416.4 Diagnosis of circulatory death 26616.5 Diagnosis of brain death 26716.6 Diagnostic tests for brain stem death 26816.7 Organ donation 26816.8 Early Indications of Death 270References 28317 Identification: General Principles, including Anthropology, Fingerprints, and the Investigation of Mass Deaths 285Peter Vanezis17.1 Introduction 28517.2 Reasons for identification 28617.3 Reasons for identification in deceased individuals 28617.4 Reasons for identification in living persons 28617.5 Approach 28617.6 Biological (general) identification (what type of individual are we trying to identify?) 28717.7 Personal identification 28817.8 Victim identification and management in disasters (mass fatality incidents) 29217.9 Practical procedures for identification 29617.10 Identification of buried human remains 30517.11 The use of fingerprints in identification 305References 31018 Use of DNA in Human Identification 311Denise Syndercombe Court18.1 DNA fingerprint discovery 31118.2 Identification using DNA 31218.3 The National DNA database 31618.4 Forensic analysis 31918.5 DNA mixtures 32418.6 Lineage markers 32818.7 Mitochondrial analysis 32918.8 Kinship testing 33018.9 Missing persons investigations 33018.10 Disaster victim identification 331References 33319 Forensic Odontology and Human Identification 335Philip Marsden19.1 The human dentition 33519.2 The dental identification process 33619.3 Post‐mortem procedure 33819.4 Dental ageing 33919.5 Dental reconciliation 34019.6 Identification outcomes 34019.7 Bite Marks 341References 342Further reading 34320 Crime and Mental Health/Forensic Psychiatry 345Vivek Khosla and Orlando Trujillo‐Bueno20.1 Introduction 34520.2 Mental disorder 34620.3 Mental Disorder and Criminal Behaviour 34720.4 Organic disorders 34820.5 Substance Misuse Disorders 34920.6 Mood Disorders 34920.7 Psychotic Disorders 34920.8 Neurotic and Anxiety Disorders 35020.9 Personality Disorders 35020.10 Learning Disabilities 35120.11 Sexual Offending and Mental Disorders 35120.12 Mental Health Legislation 35220.13 Section 48: transfer of unsentenced prisoners 35320.14 Section 41: restriction order 35320.15 Section 49: restriction direction 35320.16 Specific psychiatric issues during criminal proceedings 35320.17 Serial Killers 35720.18 Clinical Forensic Psychiatry 35720.19 Secure Forensic Mental Health Services 35920.20 Conclusions and final thoughts 360References 36121 Maternal Deaths 363Mahomed Dada21.1 Introduction and definitions 36321.2 Causes of maternal deaths 36621.3 The autopsy in maternal death 36621.4 Specialised pathology in pregnancy 368References 36922 The Examination of Detainees and Death in Custody 371Peter Vanezis22.1 Defining death in custody 37122.2 Ministerial Council on Deaths in Custody 37222.3 Deaths in custody in England and Wales 37322.4 Management of detainees in police custody 37422.5 Role of the Independent Office for Police Conduct 37522.6 Deaths related to restraint 37622.7 Excited Delirium Syndrome/Acute Behavioural Disturbance 37722.8 Conflict resolution (De‐escalation) 37722.9 Methods of restraint 37822.10 Addendum 38023 Forensic Toxicology: Clinico‐pathological Aspects and Medico‐legal Issues 383Nadia Porpiglia, Chiara Laposata, and Franco Tagliaro23.1 Introduction 38323.2 Biological samples collected for toxicological analysis 38323.3 Interpretation of toxicology results 38523.4 Interactions between drugs 38723.5 Assessing the cause of death 38823.6 Alcohol 38923.7 Alcohol withdrawal syndrome 40123.8 Alcohol interaction with other drugs 402References 40224 Illicit Drug Use 405Giovanni Serpelloni and Claudia Rimondo24.1 Definitions 40524.2 Type of substances 40724.3 The legal scenario of drug use 41224.4 The drug scene today 41624.5 Consequences of drug use 420References 434Index 443