Graduate School #4

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.

Graduate School 3#

I.          Introduction

1. Date and Time of Death
2. Why this is important
3. Postmortem “clocks”

II.         Death is a medical diagnosis

1. Pronounced time
2. Pronounced vs. Actual
3. Prolonged down time

• Hypothermia
• Electrocutions
• “Not dead until they’re warm and dead”

1. Advanced decomposition
2. Obvious fragmentation of the body

• Decapitation
• Pedestrian vs. Train accidents

III.       Algorithm

1. The time of death is sometime between the time the person was last seen and the time that he was found.            .
2. This is the most accurate way of determining the time of an unwitnessed death
3. Witnessed deaths are a whole lot easier.

IV.       Postmortem clocks

1. Rigor mortis
2. Livor mortis
3. Algor mortis
4. Decomposition
5. Insect activity
6. Gastric contents

V.        Rigor mortis

1. 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

1. Body habitus
2. Clothing
3. Ambient temperature
4. Fever
5. Environmental factors (sun, wind)

C.        Timing

1. 2-3 hour plateau
2. Drops approximately 1.5°/hour (1-3°)
3. Reaches temperature of environment
4. If environment is hot, the body will be hot as well.

VII.      Livor mortis

1. Post-mortem pooling of blood
2. Lack of circulation, blood under influence of gravity goes to dependent parts
3. Heart patients may begin during life.
4. Blanching vs. fixed
   1. Finger pressure will move corpuscles
   2. Fixed around 12 hours

VIII.     Decomposition

1. Putrefaction vs. Autolysis
   • Putrefaction breakdown by bacteria
   • Does not occur in sterile environments
     1. Maceration

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

1. Bacteria traveling through vascular tree
2. Oxidizing hemoglobin

D.        Putrefactive gas formation

1. Bacteria make methane, etc.

E.         Environment

1. 1:2:8 Air, Water, Land
2. Dry areas promote mummification
3. Wet areas promote adipocere “grave wax”

• a.         Mutter Museum
• b.         Dead man’s hand
• c.         Stinks to high heaven

XI.       Bugs

• A.        Maggots, flies, beetles
• B.         Maggots

1.         Fly larvae

2.         eggs-larvae-pupae-fly

3.         Instar

• C.        Flies

1.         Blowflies
2.         Fleshflies
3.         Bluebottles

• D.        Beetles

1. Dermestid beetles
2. 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. Burial
2. Cremation

1.         Forbidden by Orthodox Jews, Muslims, Catholics

2.         Samuel–Saul and the Witch of Endor

3.         Burial of body parts–resurrection

1. Sky Burial

Finally!

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.

Graduate School #2

Cause, Manner and Mechanism of Death

I Introduction
A. Definitions
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
B. Examples
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
E. Undetermined
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

Graduate School #1

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?!
(Thanks, Lili)

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.

Introduction
I. Me
A. History
B. Why I do this
C. What you should know

II. Class expectations
A. Professionalism
B. Two examinations
C. Stress applications

III. Outside Experiences
A. Autopsy
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
1. Dress
2. Demeanor
3. Don’t take anything
4. Don’t talk about it
5. Attendance

IV. Speakers
A. Show up on time
B. Behaviour critically important
C. Be polite

V. History
A. Julius Caesar
1. Stabbed in the rotunda
2. 23 times
3. Only one wound was fatal
4. Actual crime scene photo

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
a. “Crowner”
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
2. Coroners
3. Ohio

Knowing What You Don’t Know…

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?”

Mr Trashman, Send Me A Dream

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.

Hat tip, Breda and The League of Ordinary Gentlemen.

Sappy Cat Blogging

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.

The Ithaca Auto and Burglar

By L. Niel Smith. Produced here in it’s entirety. Read it. Found while working on a piece for next forensics camp.

The faded magazine ad haunts us across six long decades of stupidity and corruption:

“Here’s the Ithaca Auto and Burglar gun, the so-called “Sawed Off Shot Gun” which holdup men fear because its load of sixteen buckshot spread over such a wide circle that a poor gun pointer, who would miss with a revolver or pistol … is very sure to hit … handy to carry in the pocket of an auto or in a holster … Detective Harry Loose … first induced the banks in and around Chicago to use it, then its use spread to sheriffs, police departments, paymasters, watchmen, express messengers, and it’s a wonderful home protector. The U.S. Army demonstrated what American shotguns … would do during the late war. This Ithaca Auto and Burglar Gun weighs about 1 1/4 pounds, it has 20 gauge 12 1/4″ barrels, cylinder bore … Price, including excise tax, $40.55.”

The Ithaca Auto and Burglar was a veritable marvel in its time, a near-perfect blue steel and walnut “magic wand” of self-defense, against strong-arm artists and protection racketeers in the age in which it was introduced, ideal — because of its light weight, moderate caliber, limited range, and short length — for women, the elderly, and children who might require it, not only against house burglars, muggers, and the like, but against an abusive or incestuous parent.
If John Lennon had been carrying an Ithaca Auto and Burglar under his coat, the Fab Four would be selling live albums of their fifth reunion concert by now.
It is illegal — or, more accurately and revealingly, placed beyond the reach of all but an economic and political elite — and has been since 1934, because its 12 1/4″ barrels are 5 3/4″ shorter than federal law mandates, and its overall length — roughly 20″ — is shy, by about the same amount, of the minimum length specified by a statute that should never have been passed or judicially upheld in a nation with something like a Second Amendment in its Constitution.
When I was a kid, my first lesson in politics arose from the fact that my home town, Fort Collins, Colorado, was “dry” — which is to say that it was illegal to sell “adult beverages” within the city limits, and had been since Prohibition. What made it educational was that this imbecilic situation was maintained at the polls every year by a tacit coalition of self-righteously muttering church ladies like my own grandmother, and — to begin with — by bootleggers who plied their trade inside the town, and later on, by proprietors of bars and liquor stores that came to surround the “Choice City” in a tight ring.
If you understand that, you understand the politics of victim disarmament — commonly and improperly known as “gun control”. National politics of the 1930s were dominated by an unprecedented violence and corruption that sprang directly from trying to outlaw production, distribution, and consumption of ethanol. Every bit of the criminal activity — gang-wars, drive-by shootings, summary search and seizure, asset forfeiture — that we have come to associate in our times with drug prohibition arose, to begin with, in the “Roaring Twenties”.
In those days, Al Capone was the most politically powerful individual in Chicago, in the Midwest, and possibly in the United States. He purchased city councilmen, state legislators, congressmen and senators the same way that I (the daddy of an electronic-age seven-year-old) purchase AA batteries. Others of his kind did as much of the same thing as they could. I leave it to you to figure out whose interests were really being represented in Congress in 1934.
The “weapon of choice” for creatures like Al Capone was hardly the Ithaca and Auto Burglar, or even the infamous Thompson Submachinegun, it was the lives of countless revolver-carrying cannon-fodder thugs, and the influence of crooked politicians.
Who was really protected by the Ithaca and Auto Burglar and the Tommy Gun? Shopkeepers, householders, and especially truck drivers whose vehicles were often stopped and stolen (just as Florida pleasure boats are today) to serve as disposable conveyances for illicit alcohol. One store proprietor with a “sawed off” scattergun could discourage three or four goons who’d come to collect. One truck driver with a “Chicago Piano” could run off a dozen highwaymen.
As surely as the Gun Control Act of 1968 was passed to disarm the militant non-nonviolent blacks who were threatening to overturn the political apple cart …
As surely as the Brady Bill was passed because a certain variety of men — well-represented in politics — are mortally afraid to see women begin to arm themselves …
As surely as Bill Bennett and Bill Clinton’s rifle and magazine law was passed because — in this dangerous age of multiple assailants, when a single individual’s only chance against a gang is often firepower, and the ideal weapons of self-defense are semiautomatic rifles and pistols — both right wing and left wing socialists couldn’t bear the humiliation of Korean store owners successfully defending themselves against their clients during the LA riots …
The Ithaca Auto and Burglar was stamped out because it threatened gangsters and hijackers who were the real constituency of the congressmen who outlawed it.
Now Daniel Patrick Moynihan crawls dripping out of his butt of Malmsey to attack expanding handgun bullets with a proposed 10,000 percent tax, exactly as he earlier attacked small caliber cartridges. Why? Could it be because they’re effective for use by ordinary productive class people against the freelance thieves and muggers who, as a statist, Moynihan naturally identifies with?
Write Moynihan. Ask him. And while you’re at it, ask the sonofabitch why he shouldn’t spend his long-overdue retirement behind bars, for having tried to deprive every man, woman, and responsible child in this country of their unalienable individual, civil, Constitutional, and human right to obtain, own, and carry, openly or concealed, any weapon — rifle, shotgun, handgun, machinegun, anything — any time, any place, without asking anyone’s permission.
Ask him.

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