Graduate School–Deaths in Custody

I. Situations
A. Arrest
B. Jail/Prison
C. Hospital/nursing home
D. Controversy
1. Lawsuit
2. Documentation
3. Consulting another agency
4. Keep your mouth shut
a. Forbes
b. Attica
5. Toxicology

II. Arrest
A. Occur after a violent struggle
1. After the arrest, combination of stress and drugs
2. Struggle, subdued, quiet, not breathing
3. Minor, if any injuries
4. Drugs
a. alcohol
b. P.C.P.
c. cocaine
5. Handcuff injuries

B. Mechanism
1. Catecholamine release
2. Increase heart rate, contractility, O2 demand
3. Overdrive heart, cause arrhythmia
4. After arrest
5. People complain of retribution

C. Physiologic effects
1. Cardiac arrhythmia
2. Lucky, enlarged heart
3. Really lucky, toxicology

III. Hogtie/chokehold/tazer
A. Hogtie
1. Wrists tied/cuffed to ankles
2. Rope around neck
3. Positional asphyxia
a. Ruled out

B. Chokehold
1. Bar-arm
a. Forearm to compress windpipe
b. Dangerous, not taught
c. Sudden death
2. Carotid sleeper hold
a. Moderately safer
C. Tazer
1. Shoot barbs electric charge
2. Cardiac arrythmias

IV. Police shootings
A. Tremendous controversy
B. Lawsuits

V. Jail/Prison
A. Jail vs. Prison
1. Jail, short term confinement
a. Minor offenses
b. Awaiting trial
c. Farmed out for space
d. Less professional staff
e. Lake County Cases
i. Smuggled drugs and jewelry
ii. Hanged

2. Prison long term
a. Worse folks
b. Tougher crowd
c. Interpersonal violence

B. Initial stages of confinement
1. Adjustment difficult

C. Prison violence
1. People don’t know how to behave
2. Poor impulse control

D. Disease
1. Ageing population
2. TB, Hepatitis, HIV
3. Confining authority responsible
a. Guard “slow code”

VI. Hospital/nursing home
A. Psychiatric hospitals
1. Suicide is a risk
2. Determined people can find a way
3. Choking on toilet paper

B. Dementia
1. Escape
2. Poor quality of care
C. Restraints

VII. Techniques
A. Photography
B. Incise wrists and ankles
C. Filet back
D. Analogue of child abuse

Graduate School–Rape and Sex Homicides

I. Introduction
A. Types of rape
B. Defenses to rape
C. Date rape etc.
D. Rape kit

II Types of rape
A. Rape is a crime of power and control
B. Rapists not “oversexed”
1. Many have regular partners
2. “Power rush when rapists realize they have total physical control over someone weaker; that joy at degrading and terrorizing another human being for the sexually expressed thrill of it.”—Alice Vachss
C. Types of rape
1. Power-assertive
a. 40%
b. Values
i. Machismo
ii. Aggression
iii. Traditional sex roles
iv. Cop wanna-bes
c. Random victims
d. Humiliation, trauma
e. Ejaculation on victims/urination on victims

2. Power-reassurance
a. 28% of perps
b. “Gentleman rapist”
c. Characteristics
i. of average intelligence
ii. not physically aggressive
iii. insecure about his masculinity
iv. socially-deficient
v. unable to develop relationships
d. Knows the victim
i. stalking
ii. erotomanic component
e. “Relationship
i. emulate foreplay
ii. give victim phone number
iii. set up second date
vi. fantasize about relationships

3. Anger-retalitatory
a. 28% of perps
b. Substance abuse
i. impulsive
ii. anger towards victim
iii. dumb
c. Anger related
d. spontaneous attacks to hurt
e. Leave evidence

4. Amger-excitiation
a. 5% of rapes
b. Charming, intelligent and elusive
c. Enjoys inflicting pain and humiliation
i. Anal eroticism
ii. Oral-genital contact after ano-genital contact
iii. Urinate upon victim
d. Murder for the thrill of it.

III Defenses to rape
A. Three defenses
1. It never happened
2. It was consensual
3. It wasn’t the defendant
a. “SODDI” Some Other Dude Did It

B. It never happened
1. Cast aspersions on the mental status of the victim
2. Vulnerable victims
a. Mental illness
b. Retardation
c. Incarceration
3. “Reasons to lie”
a. Misattributed paternity 5-14%
b. Pregnancy
4. Put victim on trial
a. Jokes about rape
b. Burden of proof

C. It was consensual
1. Drugs and alcohol
2. People will lie.

D. It wasn’t the defendant
1. “SODDI” Some Other Dude Did It

IV. Date rape etc.
A. Date rape
1. Use of alcohol or drugs to lower inhibitions

B. Statuatory rape
1. Intercourse below age of consent (16)
2. Intercourse between persons >4 years apart

C. Abuse of power
1. Quid pro quo—tit for tat
2. Power differentials
a. Student-teacher
b. Prisoner-guard
c. Doctor-patient

V. “Rape kit”
A. External examination
1. Look for abrasions, contusions, lacerations
B. Forensic evidence
1. Pubic hair, DNA, Spermatazoa
2. Sperm lasts days
3. DNA Male inside, female inside

VI. Sex homicides
A. Asphyxial games
1. Choking

B. Homosexual homicides
1. Overkill
2. Multiple stabbings

Graduate School–Environmental Issues

What Environmental things cam lead to cancer?

I. Introduction
Chemical and environmental hazards
Environments
Heat
Cold.

II. Heat
A. Summer
Heat and Humidity
Compromised individuals
1. Children
2. Elderly
a. Don’t drink
3. Breathing disorders
4. Maine nursing homes
5. W. Jones, Atlanta GA, 115.7 F. Endothelal damage, DIC, shock

B. Microenvironment
1. Automobiles

C. Bodies attain temperature of the environment
Be careful with a body in a 120 deg. car.

III. Cold
A. Conditions
1. Not confined to outdoors
2. Aged, infirm, young
3. 50’s, draughts, damp clothing,
4. Depression, hypothyroidism

B Temperatures
1. 37-32 feeling cold
2. 32-24 LOC, bradycardia, hypotension
3. record 60.8F

C. Frostbite
1. First degree—cold erythema
2. Second degree—blisters
3. Third degree—freeezing gangrene

C. Autopsy findings
1. Pinkness of livor
2. Gastric ulcers
3. Pancreatitis
4. Strips of hemorrhageing in iliopsoas
5. Acetonemia

D. Paradoxical undressing
1. Hide and die

IV. Starvation
A. Elderly, Infirm, Young
1. People who can’t take care of themselves
2. Dependency is bad
3. Children aren’t small adults
a. They have different nutritional needs.
b. No one-size fits all diet
i. Vegan cat
ii. Elderly tea-and-toast
iii. Headache in 8-year-old

B. Bottom line
1. 1500-2000 calories to maintain weight
2. 40% weight loss life threatening
3. 50-60 days no food BUT with water
4. 10 days without water

C. Conditions
1. “Failure to thrive”
a. Poor feeding
b. Depression (adults)
c. Dementia
2. Situation
a. At home vs. in institution

D. R/o Natural disease

Asphyxia

I know, you were waiting breathlessly for this one…

Asphyxia

I. Introduction
A. Anoxia vs. ischemia
B. Neck compression
1. Hanging
2. Ligature strangulation
3. Manual
C. Smothering
1. Burking
2. Pillow
3. Grain elevators
D. Choking
1. Bolus of food
2. Young or incapacitated
E. Positional (mechanical asphyxia)
1. Unable to make respiratory movements
2. Crushing of chest
3. Crucifixion
F. Poisonous environments
1. Manure pits, coal mines, gas ovens
2. Near dry ice
3. Freezers
H. Chemical asphyxia
1. CO
2. CN

II. Anoxia vs. ischemia
A. Anoxia lack of oxygen
B. Ischemia lack of blood flow
C. Ischemia worse
1. Re-perfusion injury
2. Lack of metabolic substrates
3. “Starve and strangle”

III. Cervical Compression
A. Hanging
1. Pressures
a. Venous 5#
b. Carotids 12#
c. Airway 40#
d. Vertebrals 65#
e. “Vascular hanging” impede outflow
f. Tardieu spots

Asphyxia p. 2

2. Suspension is not necessary
a. Complete noose
b. U-shaped
c. Chair or bet

3. “hangman’s fracture”
a. Short drop
b. Long drop
c. Cruel ones (piano wire)

IV. Strangulation
A. Ligature
1. below larynx
2. Homicidal, accidental suicidal
3. Spanish windlass
4. Belt as control

B. Manual
1. Pattern injuries, ♀ by ♂

V. Smothering
A. Block off air with soft object
1. Pillow over face
2. Final exit suicide.
3. Avalanche

B. Torn frenulum
Broken teeth

VI. Choking
A. Café coronary
B. Victims
1. Impaired. Alcohol.
2. Young
3. No teeth.

VII. Positional asphyxia
A. Pressure on chest
B. Industrial accidents
C. Crucifixion

Asphyxia p. 3

VIII. Exclusion of oxygen
A. Gases
1. Manure pit
2. Hiding in ice cream truck
3. CO2 heavier than air
4. Canary in coal mine

B. Dangerous environments
1. Refrigerators

IX. Chemical asphyxia
A. CN
1. Poison electron transport chain.
2. Cyanide is natural.

B. CO
1. Irrevocably bind to hemoglobin
2. Smoke, auto exhaust, smoker
a. Smoke inhalation 90% in healthy
b. Fatal 40-90 depending on disease
c. Car 40-60%
d. Smokers 10%
e. Non-smokers 1-5%
f. Don’t put gurney behind the ambulance

X. Drowning
A. Sweet water

B. Salt water

C. Retardation of decomposition

D. Diatoms

Burns and Electrocutions

Shocking that this is so late…
Burns, Explosions, Electrocutions
I. Thermal injuries
A. Classification of burns
1. First degree—sunburn, superficial
2. Second degree—blistering
3. Third degree—full thickness burns
No pain, scar
Contractutres and keloids
4. Fourth degree burns—charring
5. Severity—
a. Intensity of heat
b. Duration of exposure
c. How hot object conducts heat/density
Cell injury 65 C 149 F protein denaturati0n, burn toxins.
Early death shock, late (week) uremia
B. Rule of nines
1. Head 9 %
2. Trunk 18%
3. Back 18%
4. Arms 9%
5. Legs 18%
6. Gentials 1%
7. Different for kids

C. Incineration of bodies
1. Cremation 1.5h at 1500 F $8.00 natural gas
2. House fire under 1300 F
3. Obesity adds fuel,
4. Clothes may protect or act as wicks
a. Mr. Roberts shirts
b. Polyester melts
5. Rayon “Mother-in-law silk”

D. Fire artifacts
1. Heat fixation
2. Heat desquamation
3. Pugilistic attitude
4. Skin splits
a. follow muscle fibers
b. perpendicular due to trauma
5. Epidural
a. blood boils in brain out of saggital sinus
6. Heat fractures
7. Decomposition delayed, cooking

E. CO
1. Flash fires
a. Granger road accident
b. Self-immolation
2. Can be quite high
3. Higher CO, better health of victim

F. Soot below larynx

G. Scalding
1. Liquids over 120F
2. Mouth more resistant than skin
3. Palm more resistant than face,
4. Duration 20 s 131 F, 1s @ 150 F
5. Clothing worsens damage

II. Bombs
A. Identification & reconstruction

B. Blast
1. “overpressure”
2. Burst eardrums, hollow viscera
3. Injury to lungs
4. Trauma

C. Fire
1. High order explosions
a. Liberate lot of energy
b. Conversion of chemical to thermal energy

2. Incendiary
3. Napalm
a. 1800 F
b. Jellied gasoline Napthitic and palmitic acids (detergent)
c. Sticks and burns
d. Asphyxia flash and inhalation
4. Magnesium, Phosphorus
a. Burn really hot
b. Burn on contact with water

D. Projectiles

E. Home made bombs
1. Molotov cocktails
2. Practice grenades
3. Smoke grenades
4. Pipe bombs
5. 1 pint of gasoline energy of 2 sticks of dynamite
6. Plastique

Graduate School # 12 Sharp Force Injuries

The parts of a knife. How to evaluate and describe forensically a knife wound.

Spontaneous Human Combustion

It doesn’t exist. Really, truly, Mr. Dickens, it does not happen. At all. Ever. No matter what this Coroner in Galway says.

Sheesh. What happens in “Spontaneous Human Combustion”–three things are necessary. 1. the human needs to be drunk or drugged. 2. the person was probably smoking, or had a candle or some form of open flame. 3. The person was fattish, with clothing that can act as a wick. When fat gets hot, it melts. When human fat gets hot and runs onto absorbent fabric, what you have is a wick. Put the wick on a stuporous individual, and let it smoulder, eventually the person will go away and then go out.

I wouldn’t make a cunning plan on it happening, but remember that very fat people have set crematoria on fire (grease fires). It’s not so good a story as spontaneous combustion, but since the human body is 70% water, it’s much more likely.

Graduate School #9

Blunt Force Trauma. The basics. This will go on all week.
Blunt Force Injury
I. Definitions
A. Blunt impacts
1. Striking or being struck
2. Severity depends on:
a. Nature of the surface (flat vs. narrow, brittle vs. hard)
b. Amount of body surface (concentration)
c. Amount of force KE= ½ mv2
d. Time
B. Injuries
1. Abrasions (scrapes)
2. Contusions (bruises)
3. Lacerations (tears)
II. Abrasions
A. Scrape.
1. Destruction of surface skin
a. Rough surface
b. Sliding or compression
2. Heal without scarring
3. Pre-vs.-post mortem
a. Premortem red brown
b. Postmortem yellow
4. Types
a. Scrape (scratches, sliding)
b. Brush burn (road rash) large area
c. Impact force perpendicular crushing skin
d. Patterned pattern of the object
5 Healing
a. Scab-epithelial regeneration-granulation-resolution
III. Contusions
A. Bruise
1. Bleeding into tissue
2. Rupture due to pressure–overstress elastic stress
3. Skin or organs
4. May not be associated with impact
5. May be hard to see in dark skinned individuals
B. Focal collection of blood–hematoma
C. Associated with fracture–ecchymosis
1. Battle’s sign
2. Fracture hematoma may be only sign of rib fractures.
D. Factors that influence contusions
1. Age of victim–old people bruise easily
2. Sex Women bruise more easily than men
3. Heath of victim
a. Obese bruise easier
b. Muscular bruise less
c. Bleeding diathesis
d. Loose tissue vs. firm
e. Can be inflicted after death
i Eyebank
E. Colour changes
1. Not reliable for dating.
2. Progression
a. Purple/red/blue minutes to hours
b. Green hours to days
c. Brown
d. Yellow days to months
e. Hemoglobin broken down
IV. Lacerations
A. Laceration is a tear
1. Caused by BLUNT force
2. Tissue stretched, crushed, or sheared
3. Over bony prominence
4. Organs can be lacerated as well as skin
5. Tissue bridges differentiate from incised wound.
6. Long thin objects linear lacs., flat objects irregular lacs.
V. Chest
A. Can have massive injury without external injury
1. Clothing
2. Deformability of the chest
B. Fractures
1. Rib
a. Iatrogenic (CPR)
i. accompanied by sternal fractures
ii. left > right
iii. Check that resuscitation happened
b. Direct
i. Simple, displaced, compounded
ii. Underneath point of impact
iii. May only be seen by hematoma
iv. 1-3 trachea and great vessel injuries
v. 10-12 diaphragm, liver spleen injuries
c. Indirect
i. Squeezing of chest
ii. Front-to-back lateral rib fractures
iii. Back-to-front posterior rib fractures
iv. Side-to-side spine and sternum
v. Big enough everywhere
d. Complications
i. Flail chest
ii. Hemothorax
(a) intercostal arteries
(b) lungs
iii. Pneumonia
iv. Impaling wounds of heart and lungs
2. Sternum
a. Direct trauma
b. Transverse
c. A-P compression
C. Heart & vessels
1. Resulting from
a. Direct force (blows) steering wheel
b. Deceleration
c. Compression (crushing)
d. Blast (over pressure)
e. Indirect force (pressure on abdomen)
2. Severity
a. Nature of trauma
b. Blood in heart
3. Contusions
a. Anterior
4. Laceration
a. Incompressible blood in heart
b. Lead to tamponade
c. Acute 150-300 ml of blood cause death
d. Chronic compensation
e. Increases intra pericardial pressure, inadequate filling
f. Valve lacerations
5. Cardiac concussion
a. Commotio cordis
b. Blow mid-anterior chest
c. Ventricular fibrillation
6. Aortic injuries
a. Vehicle
b. Lacerations–transverse rib or vertebral fractures
c. Site-descending aorta distal to l. subclavian artery
d. Tethered above,
e. Acceleration/deceleration
f. Rule out natural disease
i. Syphilis
ii. Cystic medial necrosis
iii. Atherosclerosis
D. Lungs
1. Secondary to rib fractures
a. Punctures of lung tissue
b. Hemothorax, pneumothorax, hemopneumothorax
i. Open under water
c. Emphysema–gas in tissue
i. Tissue crepitus
ii. Pneumomammary
2. Contusions and lacerations
3. Existing disease
a. Makes things worse
b. Decrease elasticity
E. Diaphragm
1. Lacerations due to rupture
2. Associated with other injuries
3. Stuff is where it shouldn’t be
4. More common on the left
VI. Abdomen
A. Can have massive internal injury without external injury
1. Clothing
2. Deformability
3. Organ consistency
a. Spleen vs. Stomach
b. Distention
c. Tycho Brahe
4. Disease
a. Enlarged spleen with mononucleosis
5. Kind of injury
a. Diffuse (car)
b. Localized (kick)
c. Homicides localized

B. Liver
1. Most frequently injured
2. Right lobe more common than left
3. Severity
a. 27-34 ft/lb capsular tears
b. 106-134 ft/lb crevices of organ
c. 285-360 ft/lb burst and pulped the liver
d. Major vessels and ducts intact
C. Spleen
1. More protected
2. Force against left upper abdomen
3. Disease states
a. Mononucleosis
b. Malaria
c. Typhoid fever
d. Leukemia
D. Pancreas
1. So very well protected
2. Massive abdominal trauma
E. GI
1. Flexible and floppy
2. Distended by food problem for stomach
a. Anterior wall
b. Mostly esophogastromalacia
3. Duodenum
a. Ligament of Treitz
b. Contusions
c. Perforations
4. Colon unlikely
VII. Genito-Urinary
A. Kidneys
1. Rare, location, fat pad
2. Punching
3. Car accidents
4. Train wrecks
B. Bladder
1. Location
2. Pelvic fractures, distention
3. Not a good thing
C. Male genitals
1. External
a. Amputation, crushing
b. Fracture of erectile tissue
c. Cutaneous abrasions, contusions
2. Internal
a. Severity
b. Contusions, lacerations, hematomas
c. Can cause asystole (rarely)
d. Torsion
D. Female
1. External
a. Sexual assault
b. Car crash
2. Internal
a. Rare in non-pregnant
b. Pregnancy
i. MVA
ii. Fall
iii. Assaults
iv. Pelvic fractures
VIII. Skeleton
A. Causes & Kinds
1. Direct trauma
2. Indirect trauma
3. Simple, compound, comminuted

B. Direct
1. Focal fracture
a. Small force striking a small area
b. Transverse
2. Crush
a. Great force striking large area
b. Comminuted
c. Tissue damage
3. Penetrating
a. Great force, small area
b. GSW
C. Indirect
1. Force acting distant from fracture sire
2. Traction-bone pulled apart
3. Angulation-bone bent until snaps
4. Rotational-bone twisted “spiral fracture”
5. Compression fracture
D. Vertebral column
1. Cervical-lumbar-thoracic
2. Where it moves
3. Anterior compression fracture at or near the thoraco-lumbar junction
E. Pelvis
1. Great force
2. Open book spring the symphysis
3. Vertical shear fractures one hemipelvis moves
IX. Extremities
A. Cutaneous
1. Abrasions, contusions, lacerations
B. Deep
1. Muscle, bone, vessels
C. MVA
1. Regular
2. Avulsions
3. Specific to MVA
D. Assault
1. Upper extremity
2. Defense wounds
3. Offensive wounds
a. Hands
b. Contusions of knuckles, fractures of metacarpals
X. Head and neck
A. Scalp
1. Contusions, lacerations, or abrasions
2. Need to shave the scalp
B. Subscalpular tissue
1. Potential space
2. See better than the surface
C. Skull
1. Presence or absence does not correlate with cerebral injury or LOC
2. Begin at point distant to impact
3. 33-75 ft/lb required to make linear skull fracture hard
4. 268-581 ft/lb soft surface (29-45 mph)
5. High velocity penetrating or depressed
6. Low velocity linear, nondisplaced
D. Hemorrhages
1. Epidural
a. Potential space
b. Fracture
i. Squamous temporal bone
ii. middle meningeal artery
c. Lucid interval
i. Symptoms 4-8 hours
ii. Immediate LOC 25%
d. Increased ICP, herniation

2. Subdural
a. Actual space between brain and dura
b. Shearing force on bridging veins
i. Acceleration-deceleration injuries
ii. Brain atrophy
iii. Venous bleeding
iv. Falls or assaults
c. Can be chronic
i. Rebleeding
d. Increased ICP, herniation
i. Acute 50 ml
ii. Chronic weeks
iii. Organization
iv. Can be used for tox.
3. Subarachoid
a. Leakage of blood from capillaries
E. Brain
1. Contusions
a. Location
i. Frontal
ii. Temporal
iii. Anterior cranial fossae
b. 6 types
i. Coup
ii. Contre-coup
iii. Fracture
iv. Intermediary
v. Gliding
vi. Herniation
2. Lacerations
a. Children more often than adults
b. Usually associated with massive skull trauma

3. Diffuse axonal injury
a. Immediate prolonged coma (6 hours w/o ICH or mass lesion)
b. Sudden acceleration-deceleration injury shearing of axons
c. Rotational injury
d. Axonal bulbs
4. Concussion
a. Mild to severe
b. Severe: LOC, amnesia
5. Cerebral edema
a. The killer
b. Herniation

Troy Davis

The Liberty Papers has a very good essay on the Troy Davis kefuffle in Georgia. Go thou and READ.

Graduate School #7 Tattoos

The history of tattoos. Malignant ones vs. benign ones. The most common tattoo in the world is still Mom.

The various styles and kinds of tattoos, and some tattoo rules (#1 never get a name tattoo unless it’s your child. #2 never get a facial tattoo. #3 don’t get a tattoo in Chinese or Kanji unless you can actually READ Chinese or Kanji. Otherwise you risk getting the Chinese ideogram for “dumbass” tattooed on your skin.