Today, the class was able to meet a real, live coroner, and learn all about decomposition, cause and manner of death, and cool cases interspersed with photos of Gothic cathedrals in France.
Monday, 30, August, 2010
Friday, 27, August, 2010
- Date and Time of Death
- Why this is important
- Postmortem “clocks”
II. Death is a medical diagnosis
- Pronounced time
- Pronounced vs. Actual
- Prolonged down time
- “Not dead until they’re warm and dead”
- Advanced decomposition
- Obvious fragmentation of the body
- Pedestrian vs. Train accidents
- The time of death is sometime between the time the person was last seen and the time that he was found. .
- This is the most accurate way of determining the time of an unwitnessed death
- Witnessed deaths are a whole lot easier.
IV. Postmortem clocks
- Rigor mortis
- Livor mortis
- Algor mortis
- Insect activity
- Gastric contents
V. Rigor mortis
- Skeletal muscle
- fibers actin and myosin
- cross linking and shortening
- Release is an active process requiring ATP
- Chemical process—faster with heat, retarded by cold
2. systemic process
- Occurs all over
- First noticeable in the jaw
- Peaks at 12-24 hours
- Wears off in 48-72 hours
3. “Breaking” rigor
- Not breaking the joint
- Moving against resistance, will break protein cross-links
- Does not recur, but process might have been incomplete
VI Algor mortis
A. Cooling of the body
B. Depends on many factors
- Body habitus
- Ambient temperature
- Environmental factors (sun, wind)
- 2-3 hour plateau
- Drops approximately 1.5°/hour (1-3°)
- Reaches temperature of environment
- If environment is hot, the body will be hot as well.
VII. Livor mortis
- Post-mortem pooling of blood
- Lack of circulation, blood under influence of gravity goes to dependent parts
- Heart patients may begin during life.
- Blanching vs. fixed
- Finger pressure will move corpuscles
- Fixed around 12 hours
- Putrefaction vs. Autolysis
- Putrefaction breakdown by bacteria
- Does not occur in sterile environments
2. Autolysis breakdown by body’s own enzymes
- Most noticeable in RLQ approximately 24-48 hours
- Cecum closest to surface
- Spread of gut bacteria
- Postmortem cultures bloody worthless unless PMI <12 hours
C. Marbling of skin
- Bacteria traveling through vascular tree
- Oxidizing hemoglobin
D. Putrefactive gas formation
- Bacteria make methane, etc.
- 1:2:8 Air, Water, Land
- Dry areas promote mummification
- Wet areas promote adipocere “grave wax”
- a. Mutter Museum
- b. Dead man’s hand
- c. Stinks to high heaven
- A. Maggots, flies, beetles
- B. Maggots
1. Fly larvae
- C. Flies
- D. Beetles
- Dermestid beetles
- Carpet beetles
- E. Wasps
1. Yellowjackets, etc.
X. Gastric contents. Imperfect clock
1. Very dependent on emotional state.
- Rough guide
- 1. Small meal 1-2 hours
- 2. Regular meal 3-4 hours
- 3. Thanksgiving 6-8 hours
XI. Body Disposal Methods
1. Forbidden by Orthodox Jews, Muslims, Catholics
2. Samuel–Saul and the Witch of Endor
3. Burial of body parts–resurrection
- Sky Burial
Thursday, 26, August, 2010
I just recently got confirmation that I had paid off a load of student debt. There is quite a feeling of relief. I’m not totally out of the woods yet, but I’m very, very glad–it was certainly a worthwhile investment, but it took YEARS–and professional school may take years more–but it was worth it.
I do find it amusing, that my school, whom I work for, hits me up for
- alumni contributions,
- my student loans, AND
- An employee’s contribution to the annual fund.
- United Way
- A day of Service to the community
Yeah. I keep thinking we should work out some sort of barter system here, but it never transpires. I don’t mind paying the loans–that was part of the deal after all. The other funds, I give to my undergraduate alma mater, and pay for scholarships, so some other poor schlub can go to college. For the rest, I think keeping my work life and home life separate is a very good idea.
Wednesday, 25, August, 2010
Cause, Manner and Mechanism of Death
1. Cause—That injury or illness that was incompatible with life
2. Mechanism—How the cause was incompatible with life.
3. Manner—How the cause came about
4. What, How, and Why
B. Why is this important?
1. Double indemnity
2. Insurance policies
3. Criminal penalties
II. Cause of Death
A. That injury or illness that was incompatible with life
1. Gunshot wound of head
2. Hypertensive and atherosclerotic cardiovascular disease
3. Group A β-hemolytic Streptococcus sepsis
4. Blunt impacts to head with skull and brain injuries.
III. Mechanism of Death
IV. Manner of Death
A. How the cause came about
B. Five manners of death
C. Violent vs. Natural
1. Violence trumps the natural
D. Accident, Suicide, Homicide
F. No value judgment
G. No Dumbicide, unfortunately, we could use this one.
V. Causation and temporal delay
A. Proximate cause
B. “But-for” causation
C. Time delay
Monday, 23, August, 2010
For the past eight years or so, I’ve been teaching forensic pathology. This year, again, I’m going to live blog my class. I’ve had problems in the past with people getting so focused on the powerpoints that they aren’t paying attention to the lecture. Some folks, in fact, don’t bother to buy the book and just skate on the lectures. Thankfully, I have a teacher’s support group who said “Why are you doing this, you’re nuts?!
I got annoyed at handing out handouts–and this got to be expensive and an annoyance. So, I’m going to post the lecture handouts here, in outline form. It is a trivial search–we’ll see if they can find them. This year I’m also going to have to pull questions from the book and only the book. This should be helpful in determining sheep from goats.
B. Why I do this
C. What you should know
II. Class expectations
B. Two examinations
C. Stress applications
III. Outside Experiences
B. Crime lab
C. Shooting range
1. Four Rules
a. Rule 1 All guns are always loaded
b. Rule 2. Never let your muzzle cover anything you aren’t willing to destroy.
c. Rule 3. Keep your finger off the trigger until your sights are on the target.
d. Rule 4. Be sure of your target and what is beyond it.
D. Professional behavior
3. Don’t take anything
4. Don’t talk about it
A. Show up on time
B. Behaviour critically important
C. Be polite
B. Ancient China
1. Provision for medical examiners
2. Blood and the sickle
3. Could not force an autopsy
C. Justinian code
1. Provision for expert testimony
D. Richard Coeur de Leon
1. Trouble on Crusades
a. Pissing contest with Leopold of Austria
b. Thrown into prison
c. “King’s Ransom” beggared the country
2. New office, Keeper of the King’s Pleas
b. Made sure that the king got what he was owed
c. Property of suicides were forfeit to the crown
3. Check on the power of the Shire Reeve
a. Knightly rank
b. Powers of arrest
E. British Colonies
1. Common law
2. William Penn
F. Present day
1. Medical Examiners
Running the tutoring program, it is very distressing to get a request for help two days before the exam (or worse, at 1800 of Friday for an exam on Monday.
It is also worrisome when a student comes and asks for help with anatomy, and you ask if they need help with Gross anatomy, histology, embryology, or neuroanatomy (which are the four subdisciplines that comprise anatomy) and the say “What are those?”
Saturday, 21, August, 2010
Cleveland is a great city. I love the lake, the Library, the West Side Market, there’s a lot of good stuff in Cleveland. But the city itself, has problems. The city services are so bad they have to have a law to force city workers to live within the city limits. There exists a squad of rat-you-out policemen, who go around and check, so the city and sue and/or fire the people who wish to live outside the city.
Despite this, the city is hemorrhaging residents. There are two obvious reasons for this;
1. The city services are terrible
2. The city schools are worse than terrible.
It seems the only thing the city of Cleveland is good or efficient at is parking enforcement. Or, now, going through your garbage. Passing on the work of sorting and making money for the city to its citizens. And that is why, friends, I live in the suburbs.
Friday, 20, August, 2010
Thursday, 19, August, 2010
An audit disclosed 230 cases processed by the North Carolina State Bureau of Investigation were marred by failings, including withholding of evidence to the defense. Three people have been executed in that state, those cases were not audited, for the people are dead.
The North Carolina justice system shook Wednesday as an audit commissioned by Attorney General Roy Cooper revealed that the State Bureau of Investigation withheld or distorted evidence in more than 200 cases at the expense of potentially innocent men and women.
The full impact of the disclosure will reverberate for years to come as prosecutors and defense attorneys re-examine cases as much as two decades old to figure out whether these errors robbed defendants of justice. Some of the injustices can be addressed as attorneys bring old cases back to court. For others, it’s too late: Three of the defendants in botched cases have been executed.
This is something that always haunts me, and leads to my profound ambivalence about the death penalty. The state needs to get it right. The forensic people are not advocates for one side or another, but for the truth. Anything else is a show trial and an injustice.