forensic medicine case studies

The American Journal of Forensic Medicine and Pathology

• Subscribe to journal Subscribe
• Get new issue alerts Get alerts

Secondary Logo

Journal logo, current issue.

June 2024 - Volume 45 - Issue 2

• Editor-in-Chief: D. Kimberley Molina, MD
• ISSN: 0195-7910
• Online ISSN: 1533-404X
• Frequency: 4 issues / year
• Ranking: Medicine, Legal 14/17; Pathology 67/76
• Impact Factor: 1.0

Colleague's E-mail is Invalid

Your message has been successfully sent to your colleague.

Save my selection

Current Issue Highlights

• Reviewer Thank You

Updated AJFMP 2023 Reviewer Thank You

The American Journal of Forensic Medicine and Pathology. 45(2):97, June 2024.

• Permissions

The Canceling of Excited Delirium

The American Journal of Forensic Medicine and Pathology. 45(2):98-102, June 2024.

• Original Articles

Homicide Manner-of-Death Classification in Arrest-Related Death

The American Journal of Forensic Medicine and Pathology. 45(2):103-110, June 2024.

• Abstract Abstract

Autopsy-Based Comparative Study of Gross and Histopathological Findings at Bone Fracture Surfaces Before and After Death

The American Journal of Forensic Medicine and Pathology. 45(2):111-117, June 2024.

Go to Full Text of this Article

• Review Article

A Narrative Review on the Clinical Relevance of Imaging the Circumventricular Brain Organs and Performing Their Anatomical and Histopathological Examination in Acute and Postacute COVID-19

The American Journal of Forensic Medicine and Pathology. 45(2):151-156, June 2024.

• Historical Review

Forensic Analysis of the Abraham Lincoln Assassination: An On-Site Study of the Presidential Box at Ford's Theatre

The American Journal of Forensic Medicine and Pathology. 45(2):157-161, June 2024.

• Technical Note

Technical Note: Removal of Circle of Willis During Autopsy

The American Journal of Forensic Medicine and Pathology. 45(2):162-166, June 2024.

• Case Reports

A Series of 8 Illicit Fentanyl Intoxication Deaths in Infants and Toddlers

The American Journal of Forensic Medicine and Pathology. 45(2):167-171, June 2024.

Self-Chiropractic Cervical Spinal Manipulation Resulting in Fatal Vertebral Artery Dissection: A Case Report and Review of the Literature

The American Journal of Forensic Medicine and Pathology. 45(2):172-176, June 2024.

• Firearm News

Lehigh Defense Xtreme Defense Penetrator Ammunition

The American Journal of Forensic Medicine and Pathology. 45(2):182-183, June 2024.

• Letters to the Editor

Update on Sodium Nitrite Poisoning: Can Certain Diseases Influence the Lethal Concentrations of MetHb?

The American Journal of Forensic Medicine and Pathology. 45(2):184-185, June 2024.

Re: “Muscular Hemorrhages Around the Scapula Provide Insight on the Manner of Asphyxia's Study: Concerns and Considerations”

The American Journal of Forensic Medicine and Pathology. 45(2):186, June 2024.

Follow Us on Social Media!

Featured Jobs

Latest articles.

View More Recent Articles

Forensic Medicine: Case 3

Author(s): flora campbell and ralph bouhaidar, for the purposes of this case study, imagine that you are the forensic histopathology trainee who has been set the task of formulating a likely cause of death., circumstances of death part 1 of 10.

Emergency services were called at 10:14 on the 20th August when a group of divers was seen in difficulty in the Sound of Kerrera. A coastguard helicopter, local coastguard teams and the Oban RNLI lifeboat were mobilised as part of a rescue operation.

The body of a 50-year-old man was recovered from the water.

Following their inquiries, you have been provided with a copy of the police report.

Police Sudden Death Report:

• The deceased’s unconscious body was recovered from the surface of the water approximately 30 minutes after fellow divers reported him missing
• The deceased was taken to a nearby hospital but died en route. Cardiopulmonary resuscitation was attempted.
• The deceased was an amateur diver.
• The dive profile downloaded from the dive computer showed the deceased ascended 29 meters in 20 seconds. The equipment was tested and no faults were identified.

General Practitioner (GP) Summary Part 2 of 10

Post mortem: external examination part 3 of 10, radiology part 4 of 10.

The patient has undergone a post mortem CT scan of his chest, abdomen and pelvis. The main findings are summarised below:

• Gas in the left ventricle and right middle cerebral artery
• Mediastinal emphysema
• Overdistended lungs with bullae
• Antero-lateral rib fractures
• No other injuries

Post Mortem: Internal Examination Part 5 of 10

Histology and toxicology part 6 of 10, routine tissue samples for histology and a sample of ilio-femoral blood ,  urine  and  vitreous humour for toxicological analysis are all negative., death certificate part 7 of 10.

Summary of Findings Part 8 of 10

Diving related deaths are complex. The cause of death is due to drowning in the majority of cases but the underlying aetiology of this is varied and includes fatigue, panic and reduced level of consciousness secondary to decompression illness, trauma, equipment malfunction or underlying natural disease.

Decompression illness encompasses arterial gas embolism and decompression sickness; these two entities present similarly but have distinct mechanisms. In decompression sickness, metabolically inert gases are dissolved in plasma and body tissues during descent as the pressure increases, as governed by Henrys law (the solubility of a gas in a liquid is proportional to its partial pressure) and if the diver is to return to normal atmospheric pressure too quickly, the dissolved gas will come out of its solution and gas bubbles can appear in the circulation, potentially causing gas emboli and give rise to infarction, this is sometimes referred to as ‘off-gassing’ and may occur passively post mortem. The clinical presentation of this is varied.

A more physical damage is that of volume changes when a sudden or rapid decompression occurs, known as barotrauma. Barotrauma is a consequence of pressure changes on the body and can occur on descent or ascent. According to Boyles law; pressure and volume of gas are inversely proportional at a constant temperature. With increased pressure during descent, gas volume in air containing body cavities such as the lungs is diminished. If the diver ascends too quickly or without equalising the pressure, the rapid decrease in ambient pressure increases gas volume and in the lungs the risk of overdistension can cause rupture of alveoli. In this case, air can leak into the arterial circulation (arterial gas embolism; AGE) or pass into different anatomical spaces causing pneumothorax, pneumomediastinum or subcutaneous emphysema. In arterial gas embolism (AGE), gas bubbles can reach organs via the systemic circulation and cause ischaemia, the most sensitive to this is the central nervous system and cerebral air embolism can be fatal.

Investigation into Scuba diving fatalities requires a multifaceted approach, with inquiry into a number of areas including; past medical and diving history, the circumstances of the dive (water conditions, dive profile, depth etc), equipment, events before and after the fatal incident as witnessed and the findings at post mortem. Pathologists play a central role in this and should be aware of the outcome of investigation into these areas. Difficulties encountered in the investigation of diving deaths include prolonged post mortem interval, inconsistent diving profile information and witness statements and equipment loss or damage.

In addition, body decomposition, predation damage and resuscitation related injuries make autopsy interpretation of decompression illness problematic and can cause false positive results on post mortem imaging.

The general consensus amongst pathologists is to perform a post mortem CT scan (PMCT) as soon as possible prior to undertaking an autopsy in order to look for intra and extra vascular air, which can be practically difficult to assess during autopsy.

Whilst drowning may be reported most commonly as the cause of death in divers, this is ultimately a terminal event and any investigation needs to identify underlying or precipitating  causes. AGE and pulmonary barotrauma represents the next largest group of fatalities after drowning. The history of the diver coming to the surface and quickly losing consciousness is classic, because of the loss of consciousness, evidence of drowning is often seen as an agonal event.

Intravascular gas, subcutaneous emphysema and pneumothorax can be seen in cases where resuscitation has been performed. Although CPR rarely results in cerebral air embolism, pulmonary vessels may rupture and findings at autopsy may include air bubbles present in the epicardial and cerebral vessels.

In our case, the history was suggestive of arterial gas embolism and the findings at on CT scan and post mortem also support this. Unfortunately, most cases are not this convincing and there may be no specific signs. It is important to look for underlying pathology as this may be a more significant contributing factor to the death.

Test yourself! Part 9 of 10

Take home points part 10 of 10, the cause of death is due to drowning in the majority of cases, underlying health problems need to be ruled out, arterial gas embolism is difficult to diagnose but post mortem ct scanning can help, resuscitation injuries and decomposition can give false positive results.

Please answer each of the following questions. All results are completely anonymous and used for quality assurance purposes only.

Q1. How would you rate the information on this particular page?

Q2. would you use this website again.

Yes No Maybe

Q3. Would you recommend this website to other people?

Q4. did you experience any problems viewing this page, answering the questions, or navigating the site.

• Medical Books

Sorry, there was a problem.

Download the free Kindle app and start reading Kindle books instantly on your smartphone, tablet, or computer - no Kindle device required .

Read instantly on your browser with Kindle for Web.

Using your mobile phone camera - scan the code below and download the Kindle app.

Image Unavailable

• To view this video download Flash Player

Forensic Pathology Case Studies 1st Edition

• Covers investigation techniques and interpretation of the results
• Provides valuable information for how to deal with skeletal remains
• Includes photos for most cases to clarify outcomes for the reader
• ISBN-10 0128242949
• ISBN-13 978-0128242940
• Edition 1st
• Publication date November 4, 2020
• Language English
• Dimensions 5.98 x 0.26 x 9.02 inches
• Print length 112 pages
• See all details

Editorial Reviews

About the author, product details.

• Publisher ‏ : ‎ Academic Press; 1st edition (November 4, 2020)
• Language ‏ : ‎ English
• Paperback ‏ : ‎ 112 pages
• ISBN-10 ‏ : ‎ 0128242949
• ISBN-13 ‏ : ‎ 978-0128242940
• Item Weight ‏ : ‎ 8.8 ounces
• Dimensions ‏ : ‎ 5.98 x 0.26 x 9.02 inches
• #259 in Forensic Medicine (Books)
• #1,706 in Forensic Science Law

Customer reviews

Customer Reviews, including Product Star Ratings help customers to learn more about the product and decide whether it is the right product for them.

To calculate the overall star rating and percentage breakdown by star, we don’t use a simple average. Instead, our system considers things like how recent a review is and if the reviewer bought the item on Amazon. It also analyzed reviews to verify trustworthiness.

No customer reviews

• About Amazon
• Investor Relations
• Amazon Devices
• Amazon Science
• Sell products on Amazon
• Sell on Amazon Business
• Sell apps on Amazon
• Become an Affiliate
• Advertise Your Products
• Self-Publish with Us
• Host an Amazon Hub
• › See More Make Money with Us
• Amazon Business Card
• Shop with Points
• Reload Your Balance
• Amazon Currency Converter
• Amazon and COVID-19
• Your Account
• Your Orders
• Shipping Rates & Policies
• Returns & Replacements
• Manage Your Content and Devices

• Conditions of Use
• Privacy Notice
• Consumer Health Data Privacy Disclosure
• Your Ads Privacy Choices

• Fingerprint Books
• Fingerprint Equipment
• Fingerprint News
• Fingerprint Research
• Fingerprint Videos
• Crime Scene Equipment
• Crime Scene News
• Crime Scene Research
• Crime Scene Videos
• Court Testimony News
• Case Studies

New Powder Suspension Formula for Fingerprint Development on the Adhesive Side of Tape

Are detectives discounting the associative value of fingerprints that fall short of an identification in their investigations, using the ncic bayesian network to improve your afis searches, dna decontamination of fingerprint brushes, accuracy and reproducibility of conclusions by forensic bloodstain pattern analysts, non destructive dna recovery from handwritten documents using a dry vacuum technique, simulating dead bodies could help calculate an accurate time of death, trees and shrubs might reveal the location of decomposing bodies, presenting fingerprint comparisons in court using forensic comparison software, assessing the reliability of a clothing-based forensic identification, u.s. justice department issues draft guidance regarding expert testimony and lab reports in forensic science, how making a murderer will change the way we think about justice, zodiac killer code cracked by australian mathematician samuel blake more than 50 years after first murder, when a dna test says you’re a younger man, who lives 5,000 miles away, you could be your cat’s favorite meal, claremont serial killings trial told ciara glennon fingernail dna find proved a major ‘turning point’, the 25 best true-crime documentaries on netflix.

• < Previous
• Next chapter >

B.1 C2.1 Clinical cases

• Published: June 2023
• Cite Icon Cite
• Permissions Icon Permissions

This chapter provides twenty-seven clinical cases and discusses how the forensic psychiatrist should approach these difference scenarios, with self-reflection questions and discussion included for each case. It begins with setting up the concept of a forensic case, and the use of behaviour without conviction with risk assessment, and risk assessment as a whole. It also includes cases on hospital-to-prison transfer, worked examples of structured risk-assessment, and location of the patient in the presence of psychosis, personality disorders, and substance misuse. It goes on to cases with brain injury, risk assessment in sexual offending, and associated transcultural issues, complex violence, cases where there are patient threats against staff, and how to manage requests for transfer to higher security. It also contains cases on the management of violent behaviour in the absence of current mental illnesses, management of self-harm, covert treatment of violence, and remission from hospital back to prison in the case of the prisoner with a life sentence. It closes with the cases relating to social and occupational therapies in forensic psychiatry, how to work with public protection arrangements, the professional relationship with the justice ministry, recall of CTOs, supporting a court diversion scheme via consultation, and how to make a professional judgement on whether prison or hospital would be a more appropriate setting for a patient.

Personal account

• Sign in with email/username & password
• Get email alerts
• Save searches
• Purchase content
• Activate your purchase/trial code
• Add your ORCID iD

Institutional access

Sign in with a library card.

• Sign in with username/password
• Recommend to your librarian
• Institutional account management
• Get help with access

Access to content on Oxford Academic is often provided through institutional subscriptions and purchases. If you are a member of an institution with an active account, you may be able to access content in one of the following ways:

IP based access

Typically, access is provided across an institutional network to a range of IP addresses. This authentication occurs automatically, and it is not possible to sign out of an IP authenticated account.

Choose this option to get remote access when outside your institution. Shibboleth/Open Athens technology is used to provide single sign-on between your institution’s website and Oxford Academic.

• Click Sign in through your institution.
• Select your institution from the list provided, which will take you to your institution's website to sign in.
• When on the institution site, please use the credentials provided by your institution. Do not use an Oxford Academic personal account.
• Following successful sign in, you will be returned to Oxford Academic.

If your institution is not listed or you cannot sign in to your institution’s website, please contact your librarian or administrator.

Enter your library card number to sign in. If you cannot sign in, please contact your librarian.

Society Members

Society member access to a journal is achieved in one of the following ways:

Sign in through society site

Many societies offer single sign-on between the society website and Oxford Academic. If you see ‘Sign in through society site’ in the sign in pane within a journal:

• Click Sign in through society site.
• When on the society site, please use the credentials provided by that society. Do not use an Oxford Academic personal account.

If you do not have a society account or have forgotten your username or password, please contact your society.

Sign in using a personal account

Some societies use Oxford Academic personal accounts to provide access to their members. See below.

A personal account can be used to get email alerts, save searches, purchase content, and activate subscriptions.

Some societies use Oxford Academic personal accounts to provide access to their members.

Viewing your signed in accounts

Click the account icon in the top right to:

• View your signed in personal account and access account management features.
• View the institutional accounts that are providing access.

Signed in but can't access content

Oxford Academic is home to a wide variety of products. The institutional subscription may not cover the content that you are trying to access. If you believe you should have access to that content, please contact your librarian.

For librarians and administrators, your personal account also provides access to institutional account management. Here you will find options to view and activate subscriptions, manage institutional settings and access options, access usage statistics, and more.

Our books are available by subscription or purchase to libraries and institutions.

• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Rights and permissions
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• v.14(7); 2022 Jul

Importance of Crime Scene Visits by a Forensic Medicine Expert: A Survey-Based Study

Binay kumar.

1 Forensic Medicine & Toxicology, All India Institute of Medical Sciences, Patna, Patna, IND

Nilabh P Singh

Nawal singh, nikhil goel.

This study is intended to compare the Indian system of inquests, which is conducted by nonscientific people like police and magistrate (who are compulsorily neither qualified in science nor in law), and the medical examiner system of the USA which is done by doctors specialized in forensic medicine/pathology.

The goal of this study was to see if bringing in a medical examiner system makes a difference in determining the cause, manner, and time of death as compared to the current system of conducting inquests and autopsies by two different agencies, namely, the police and forensic medicine experts.

Material and methods

In the present study, a peculiar case (in which the police were clueless and the autopsy surgeon was confused during the autopsy) was chosen for getting an expert opinion from 50 forensic medicine experts from different parts of the country in which police were not clear regarding cause, manner and time of death, but later after a crime scene visit by forensic medicine experts who had conducted the autopsy, it was clarified. Opinion regarding the cause, manner, and time since death was taken from 50 medico-legal experts in two steps. In the first step, only the autopsy finding and history obtained from police were provided and in the second step, additional information obtained from the crime scene visit by forensic medicine experts was provided.

The sampling method was purposive sampling.

In the cause of death, Cohen’s Kappa coefficient was 0.30% (z-statistic = 3.87, p-value = 0.0001), indicating a significantly low agreement between the first and second steps by the experts, as their decision changed after getting the evidence of the crime scene visit. In the manner of death, Cohen’s Kappa coefficient was 0.06% (z-statistic = 0.66, p-value = 0.2540) indicating a very low agreement between the first and second opinions by the experts as their decision regarding the suspected manner of death changed drastically after getting the evidence of crime scene. In the time since death, Cohen’s Kappa coefficient was 0.5531% (z-statistic = 7.25, p-value = 0.0001), which also indicates significant difference.

Therefore, in this study, the usefulness of the medical examiner system in the Indian setting has been proved beyond doubt expecting drastic improvement in criminal investigation by introducing the medical examiner system in India.

Introduction

Medicine and law have been linked in Egyptian society since 3000 B.C. [ 1 ]. The role of the medical man has been recognized at almost every stage of the crime/death investigation and trial, including body examination and evidence collection, history, interviewing witnesses, physical examination, autopsy examination, laboratory test, court depositions, and their interpretation and collaboration [ 1 - 2 ]. In the present day, several crime investigation procedures exist in many countries. Every system has advantages and disadvantages. As a result, there are debates taking place in various regions of the world to build a better system of criminal investigations.

Inquest is the term used to describe the initial investigation at the scene of the incident. The legal inquiry into the cause of death is known as an inquest. When information about a dead human body found in unnatural or suspicious circumstances reaches the authority authorized to hold an inquest, the concerned authority travels to the scene of the incident and conducts an investigation, after which they prepare an inquest report detailing the apparent cause and circumstances of death. The body is then sent to the nearest authorized autopsy center if an autopsy was required. Among the numerous systems, the following are important inquest systems [ 3 - 5 ]: police inquest, magistrate inquest, coroner system of inquests, medical examiner system of inquests, and jury system.

Only police and magistrate inquests are conducted in India under sections 174 and 176 Cr.P.C., respectively, and they are public servants with limited exposure to law and forensic science throughout their professional training, but they are scientifically lay individuals [ 6 - 7 ]. In India, the crime scene investigation is handled by a different agency while autopsy and other scientific investigations are handled by a different agency. And all of these agencies are functioning in isolation, with minimal coordination. Coroners, on the other hand, are elected officials in the United States who may or may not be qualified in medicine or law. However, under British control, India too had a coroner system, which was gradually supplanted by the police and magistrate system after independence and was eventually abolished on July 29, 1999, in Mumbai [ 8 ]. Coroners in India used to be qualified in either law or medicine or both. In 1857, Dr. Urquhart, a private practitioner and coroner of the city, was appointed as the first Professor of Forensic Medicine at Madras Medical College [ 3 - 5 , 9 ] coroners in India used to be the status of first-class magistrates [ 5 ]. The medical examiner system of inquests is widely used in the United States, Canada, and Japan, and medical examiners are trained in both medicine (forensic pathology) and law. This is widely regarded as the best inquest system in the world [ 3 - 5 ]. When the same individual visits the crime scene for an inquest, conducts an autopsy, and correlates laboratory findings, they are better able to correlate because they are both medically and legally qualified.

Materials and methods

Aim and objective of the study

The goal of this study was to see if bringing in a medical examiner system makes a difference in determining the cause, manner, and time of death as compared to the current system of conducting inquests and autopsies by two different agencies, namely, police and forensic medicine expert in India.

Methodology

In this study, the forensic medicine specialist who performed the autopsy also went to the crime scene and interviewed witnesses, drawing conclusions about the cause, manner, and time of death that the police investigation had not revealed. In the first step, autopsy findings and information received from the police during the autopsy were sent to 102 forensic medicine professionals on their WhatsApp contact numbers. They were then asked to comment on the cause, manner, and time of death by designing multiple-choice questions through a Google link. Out of them, 79 participants responded. Following that, the new information gathered by visiting the crime scene and questioning witnesses by the autopsy surgeon was shared with those 79 participants for a second time, and their opinions on the matter were sought once more. The opinions of the first 50 participants who responded the second time were included in the analysis. Thereafter, the results were evaluated to see how new information affects expert opinions through the same questions. The study was approved by the Institutional Research Committee vide ref. no AIIMS/Pat/IRC/2020/835, dated: 04/12/2021, and the Institutional Ethics Committee vide ref. no AIIMS/Pat/IEC/2020/835, dated: 04/12/2021, of All India Institute of Medical Sciences, Patna.

Sampling Method

Purposive sampling was used. The contact numbers of participants were obtained from various WhatsApp groups of forensic medicine experts in India. In the current study, most of the forensic medicine experts included are working in the department of forensic medicine & toxicology of reputed government medical institutions in India; however, a few are working in private medical colleges also. As previous such studies could not be found, the exact sample size was not calculated.

Statistical Analysis

After correct coding, all the data were loaded into Microsoft Excel 2019 (Microsoft Corporation, Redmond, WA). SPSS version 22 (IBM Corp., Redmond, WA) was used for the statistical analysis. The proportions of categorical variables were used. The chi-square test was used to determine the relationship between two categorical variables. On the first and second attempts, Cohen's Kappa coefficient was calculated to determine the extent of expert agreement.

In response to questions on the cause-of-death opinions, it was observed that in the first phase, when just autopsy findings and information accessible from police at the time of autopsy were presented, only 30% of participants offered the right answers and 70% gave incorrect answers. After presenting further information gathered from a crime scene visit and questioning witnesses by forensic medicine specialists who conducted an autopsy in the second stage, 56% of experts gave correct opinions and 44% supplied incorrect opinions. Table ​ Table1 1 contains information on various replies, which is illustrated in Figures ​ Figures1 1 - ​ -2. 2 . The percent agreement was calculated as only 50%. Cohen's Kappa coefficient was 0.30% (z-statistic = 3.87, p-value = 0.0001), revealing a considerable lack of agreement between the experts in the first and second steps, as their decision improved after seeing the evidence at the crime scene.

a = head injury, b = homicidal strangulation, c = accidental traumatic asphyxia, d = spinal cord injury

Pearson chi2 (9) = 49.1872; Fisher's exact = 0.000

a = head injury, b = homicidal strangulation, c = accidental traumatic asphyxia, d = spinal cord injury

Only 54% of specialists were able to correctly answer questions about the manner of death in the first phase while 90% were able to do so in the second. In terms of statistics, the percent agreement was calculated as 56% with a Cohen's Kappa coefficient of 0.06% (z-statistic = 0.66, p-value = 0.2540), indicating a very low agreement between the experts' first and second attempts as their decision regarding the suspected manner of death changed dramatically after receiving evidence of crime location (Table ​ (Table2) contains 2 ) contains information on various responses, which is depicted in Figures ​ Figures3 3 - ​ -4 4 .

Regarding time since death in the first phase, 38% of experts gave the correct response, whereas 54% supplied the correct answer in the second step. Percent agreement was found to be 68% with Cohen's Kappa coefficient of 0.5531 (z-statistic = 7.25, p-value = 0.0001). However, the difference of opinion is less in comparison to the other two opinions but is significant. Table 3 contains information on various responses, which is depicted in Figures ​ Figures5 5 - ​ -6 6 .

The main difference between the medical examiner system and other inquest systems is that in the medical examiner system, a significant portion of the criminal investigation, such as body examination and evidence collection at the scene of the crime, history, interviewing witnesses, physical examination, autopsy examination, laboratory test, toxicology, and their interpretation and collaboration, and the deposition in courts, is done or supervised by the same person, i.e. the medical examiner [ 10 - 11 ]. In other systems of the inquest, the job of the medical man is confined to the preparation of autopsy and injury reports, with the rest of the work such as the interpretation and collaboration of scientific studies, being handled by scientifically lay persons. In India, the situation of such highly specialized and expert jobs requiring painstaking work is the worst, and the lowest ranking police officers, such as assistant sub-inspectors or head constables, are frequently assigned for this. In every inquest, the initial professional assessment of the body and its surroundings at the scene of the crime is critical [ 2 ].

The current study clearly shows that, as is common in the medical examiner system, when a forensic medicine specialist visits the crime scene, interviews witnesses, and interprets the evidence, a greater picture of the incident's circumstances is gained. The fact that the conviction rate in Federal Court in the United States, where a medical examiner system is in place, is around 99.8% [ 12 ], whereas it is about 50.4% in India, demonstrates this [ 13 ].

To assess the system, a committee was formed in 2003 in Washington (DC) to organize a workshop on the Medicolegal Death Investigation System, and after the workshop, the following important recommendations or observations were given in the workshop summary listed in Table ​ Table4 4  [ 11 ].

Based on different circumstances and experiences, the coroner system in Washoe County was totally replaced by the medical examiner system by County Ordinance in 2007, and the Chief Medical Examiner was given the title of Coroner [ 11 ].

Limitations of the study

In this study, an interview was conducted only among forensic medicine experts. Magistrates and police officers who are currently conducting inquests should have been included in the study too for better comparison among different systems.

Conclusions

It is widely acknowledged that the medical examiner system is the most effective method of death investigation, in which the medical examiner performs a variety of tasks such as crime scene investigation, evidence collection, witness interviews, autopsy examination, and laboratory result interpretation. The findings of this study backed up the general consensus. Medical examiners must have a postgraduate or doctorate degree in forensic medicine or forensic pathology, as well as the necessary legal training. The system should be overseen and directed by the forensic medicine section of the medical institution of a particular region.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

Human Ethics

Consent was obtained or waived by all participants in this study. Institutional Ethics Committee, All India Institute of Medical Sciences, Patna (ECR/ 1387/Inst/BR/2020) issued approval AIIMS/Pat/IEC/2020/835, Dated: 04/ 12/ 2020. The Institutional Ethics Committee, All India Institute of Medical Sciences, Patna, reviewed & discussed your study titled "Importance of crime scene visit by Forensic Medicine expert - a survey based study". The proposal was approved by the Members online by circulating through mail. The IEC approves the study to be conducted in its presented form

Animal Ethics

Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.

651-263-6007

Case Studies

Both the medical and legal professions recognize that some human behaviors take place in the absence of consciousness and intent. When these behaviors arise within a criminal context, the absence of intent may lead one to infer the individual was not responsible for his or her actions. It is here that we grapple with the terms “automatism” and “unconsciousness.”

• Confusional Arousals
• Sleep Terrors
• Sleepwalking

• Skip to primary navigation
• Skip to main content
• Skip to primary sidebar

Forensics Digest

All about Forensics

The World’s Oldest Forensic Case – The Iceman’s Mystery

In the annals of forensic science, one of the most remarkable and oldest solved cases revolves around the mysterious death of a man who lived over 5,000 years ago. Discovered in the Alps in 1991, the ancient remains, aptly named “Ötzi the Iceman,” have provided an astonishing window into our distant past and offered valuable insights into his life, health, and the circumstances surrounding his demise. This case study delves into the fascinating story of Ötzi, the world’s oldest forensic mystery, and how modern forensic techniques unraveled the secrets of this ancient cold case.

Ötzi the Iceman was discovered in the Ötztal Alps, on the border between Austria and Italy, by hikers on September 19, 1991. The well-preserved mummy, encased in ice, is estimated to have lived around 3,300 BCE during the Copper Age. Initially thought to be a mountaineer who had met with a recent accident, further examination revealed a more complex and intriguing story.

Picture Credit

The Forensic Investigation

• Age and Origin: Initially, experts believed Ötzi was a modern-day accident victim. However, radiocarbon dating and other forensic techniques determined that the Iceman lived around 5,300 years ago, making him the oldest natural mummy in Europe.
• Cause of Death: Initial examinations suggested Ötzi might have died from exposure. However, further analysis revealed an arrowhead lodged in his shoulder, indicating foul play. He had also suffered a blow to the head, possibly from a fall or an altercation.
• Health Assessment: Detailed medical examinations unveiled a wealth of information about Ötzi’s health, diet, and lifestyle. Hair analysis was used to examine his diet from several months before. He had several health issues, including arthritis, tooth decay, and the presence of a parasite in his intestines. His diet consisted of cereals and meat, shedding light on the Copper Age diet.
• Clothing and Equipment: Forensic analysis of his clothing and equipment, including a copper axe, dagger, and quiver, provided insights into the technology and materials of his time. High levels of both copper particles and arsenic were found in Ötzi’s hair. This, along with Ötzi’s copper axe blade, which was 99.7% pure copper, has led scientists to speculate that Ötzi was involved in copper smelting.
• Genomic Studies: Ötzi’s DNA has been extensively sequenced, revealing his genetic heritage and distant relatives, and contributing to our understanding of human migration patterns.

The case of Ötzi the Iceman showcases the remarkable capabilities of forensic science to unravel mysteries from the distant past. Through a combination of radiocarbon dating, medical analysis, DNA sequencing, and other cutting-edge forensic techniques, experts have reconstructed Ötzi’s life, health, and the circumstances of his death. The legacy of the Iceman continues to be an invaluable resource for researchers, shedding light on ancient civilizations, human evolution, and the enduring power of forensic science to solve the most enduring mysteries.

Where to Watch ?

Students can watch these documentaries and films as they offer various perspectives on Ötzi the Iceman’s story, combining historical, scientific, and dramatic elements.

• “Iceman: The Last of the Neanderthals” (2021): This documentary, released in 2021, explores Ötzi’s life and the circumstances surrounding his death. It delves into the scientific research, including DNA analysis and forensic investigations, that has shed light on Ötzi’s world.
• “NOVA: Iceman Reborn” (2016): A PBS documentary, this program chronicles the story of Ötzi’s discovery and the scientific efforts to recreate a lifelike model of his appearance, based on forensic data and research.
• “The Iceman Murder Mystery” (2005): This documentary explores the forensic investigations that uncovered the violent circumstances of Ötzi’s death. It delves into the details of the murder mystery surrounding the world’s oldest-known homicide case.
• “Iceman” (2012): This is a dramatic film inspired by Ötzi’s life, though it takes artistic liberties. It’s a fictionalized account of Ötzi’s journey and the events leading to his death.

Share this post:

Reader interactions, leave a reply cancel reply.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Medical malpractice: a study of case histories by the Forensic Medicine Section of Bari

Affiliation.

• 1 Sezione di Medicina Legale, Dipartimento di Medicina Interna e Medicina Pubblica, Università degli Studi di Bari, Piazza G. Cesere n. 11, 70124 Bari, Italy. [email protected]
• PMID: 15166766
• DOI: 10.1097/01.paf.0000127387.62136.21

The learning objectives of this paper are to study the actual extent of medical malpractice, the medical acts at risk, and their impact on mortality. The number of suits filed against physicians for deaths resulting from alleged malpractice and autopsies ordered by the Judicial Authority in cases of possible therapeutic misadventures are rising. A major factor pushing this trend is public mistrust of healthcare providers and public and facilities. This mistrust is partly fueled by the mass media which, often to gain larger audience shares, sensationalizes single cases of real or alleged iatrogenic injury. Further, the potential for astronomic settlements, either from the single doctor or from the healthcare institution, has increased the number of legal proceedings that start on the basis of mere suspicion. In this context, the autopsy becomes an important instrument for shedding light on the situation, and it must be carried out by highly qualified and experienced professionals capable of ascertaining the cause of death, identifying any possible misconduct, and assessing its consequences. We reviewed the data regarding autopsies performed at the Forensic Medicine Section of the Department of Internal and Public Medicine of the University of Bari over 1991 to 2000. We culled the cases alleged malpractice and, from these, identified those in which the death had truly been caused by medical error. This study also allowed us to understand the incidence of lethal therapeutic misadventures and to identify the medical and surgical branches more frequently involved.

PubMed Disclaimer

Similar articles

• Medical malpractice: the experience in Italy. Traina F. Traina F. Clin Orthop Relat Res. 2009 Feb;467(2):434-42. doi: 10.1007/s11999-008-0582-z. Epub 2008 Nov 5. Clin Orthop Relat Res. 2009. PMID: 18985423 Free PMC article. Review.
• The medical malpractice in Milan-Italy. A retrospective survey on 14 years of judicial autopsies. Casali MB, Mobilia F, Sordo SD, Blandino A, Genovese U. Casali MB, et al. Forensic Sci Int. 2014 Sep;242:38-43. doi: 10.1016/j.forsciint.2014.06.002. Epub 2014 Jun 27. Forensic Sci Int. 2014. PMID: 25023215
• Medical malpractice as reflected by the forensic evaluation of 4450 autopsies. Madea B, Preuss J. Madea B, et al. Forensic Sci Int. 2009 Sep 10;190(1-3):58-66. doi: 10.1016/j.forsciint.2009.05.013. Epub 2009 Jun 12. Forensic Sci Int. 2009. PMID: 19524380
• Epidemiological case survey of medical malpractice in some medical and surgical specialties. Di Nunno N, Luigi V, Viola L, Francesco V. Di Nunno N, et al. Forensic Sci Int. 2005 May 10;149(2-3):139-42. doi: 10.1016/j.forsciint.2004.06.029. Forensic Sci Int. 2005. PMID: 15749354
• Medical malpractice claims and quality improvement program as viewed by a forensic pathologist. Noguchi TT. Noguchi TT. Nihon Hoigaku Zasshi. 2002 Sep;56(2-3):205-18. Nihon Hoigaku Zasshi. 2002. PMID: 12415828 Review.
• Mors Gaudet Succurrere Vitae. The Role of Clinical Autopsy in Preventing Litigation Related to the Management of Liver and Digestive Disorders. D'Errico S, Zanon M, Peruch M, Concato M, Padovano M, Santurro A, Scopetti M, Fineschi V. D'Errico S, et al. Diagnostics (Basel). 2021 Aug 9;11(8):1436. doi: 10.3390/diagnostics11081436. Diagnostics (Basel). 2021. PMID: 34441370 Free PMC article.
• When is a peri-procedural death iatrogenic in nature? Wang M, Lau G. Wang M, et al. Forensic Sci Med Pathol. 2012 Mar;8(1):23-33. doi: 10.1007/s12024-011-9254-5. Epub 2011 Jun 11. Forensic Sci Med Pathol. 2012. PMID: 21667170
• Search in MeSH

LinkOut - more resources

Full text sources.

• Ovid Technologies, Inc.
• Wolters Kluwer

• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

At the Smithsonian | June 27, 2024

What a 100-Year-Old Lie Detector and 150-Year-Old Arsenic Tests Tell Us About Forensic Science Today

An exhibition at the National Museum of American History examines how humans influence and judge investigation techniques

Arsenic tests for the Lydia Sherman trial of 1872

Brian Handwerk

Science Correspondent

Crime dramas like “CSI” are wildly popular—but the real stories of forensic science in the courtroom put our own beliefs on trial.

Forensic techniques and analyses, from hair to handwriting to DNA, have brought cutting-edge science into the American courtroom for over 150 years. But the history of forensic science isn’t just about technologies that can use traces of evidence like a fingerprint or a drop of blood to link a criminal to a crime.

The story of forensic science is also about the people who designed and created methods to uncover such scant evidence and turn it into convictions. And when evidence is in hand, the different ways that humans examine and judge forensic data are influenced both by their personal thoughts and by how other forensic cases have played out in the past.

These themes are explored in a new exhibition at the Smithsonian’s National Museum of American History, “ Forensic Science on Trial .” Opening Friday and running through next summer, the exhibition gathers artifacts from the museum’s extensive science collections, as well as special loans.

“You really get to see what the human hand is, in both making and understanding forensic science,” says exhibition curator Kristen Frederick-Frost.

Historically, many sexual assault cases have been a matter of one person’s word against another, with convictions hard to come by. In the 1970s, women’s rights advocate Martha “Marty” Goddard set out to change that. She pioneered a standardized system to increase the chances that perpetrators of rape and sexual assault would be caught and prosecuted. Goddard interviewed law enforcement, lawyers, hospital workers and others to learn how best to collect evidence of sexual assaults. On display is the kit she designed, the Vitullo Evidence Collection Kit for Sexual Assault Examination , which contains tools necessary to collect that critical evidence, such as a stylus for scraping under fingernails, combs, glass slides, swabs, evidence bags and instructions on how to best preserve the evidence for use in court.

“The kit was created when trace evidence was core in investigation and prosecution, before DNA was used,” explains Katherine Ott, a curator of medicine and science at the museum, alongside Frederick-Frost. “It was also a time when sexual assault was misunderstood, seldom reported and generally not taken seriously. Detectives, attorneys, and the nurses and doctors who dealt with it were not really talking with each other.”

DNA evidence is often key to such cases today, but it’s not infallible; DNA degrades and isn’t always present. “Other kinds of evidence, like fingerprints and shoe prints and the materials collected in Marty’s early version of the kit, are often key to solving the ‘he said, she said,’ problem,” Ott says.

While the sexual assault kit was an individual effort, the Central Records System Filing Cabinet and Index Cards, created around 1950 and on loan from the FBI, shows a large-scale initiative from the federal government to make a different kind of crime-fighting system. This widespread attempt to collect and organize fingerprint and other data in a central repository was used to try to match criminals to the trace evidence they left at crime sites.

“We pair these objects together because one of them is a grassroots effort to organize, and provide a solution for identification, while the other is a top-down effort,” says Frederick-Frost. “But in both cases, as always, you have to have buy-in to get people to think about what would be convincing evidence at any point in time.”

Though forensic evidence might seem like a matter of scientific facts rather than opinion, the way data is gathered, and the way it’s ultimately judged, has always been influenced by people’s personal beliefs. A 1921 polygraph on display was one of the first to be used to test for deception, created by a police officer and physiologist named John A. Larson. Larson’s device was designed to detect physiological responses to questioning, such as heart and breathing rate and blood pressure, that would indicate a suspect was lying.

But, because people react to interrogations differently, no one pattern of responses can actually indicate when someone is lying. Some people may be nervous even when being truthful, while practiced liars may not be particularly anxious while doing so. “With that polygraph, it kind of works best if you believe it works” Frederick-Frost says. “That’s fascinating to me, that your beliefs can impact what kind of data is produced.”

Human beliefs also took center stage in The People of the State of California v. Orenthal James Simpson (1994-1995). Investigators used DNA autoradiograph analysis to match blood from the crime scene to the defendant, O.J. Simpson, as well as bloodstains found on a sock in Simpson’s home to the murdered Nicole Brown Simpson. In the Simpson case, human judgments weren’t focused so much on how data was analyzed. Instead, they centered on confidence in the people and processes that provided that data to the lab. “Whether people believed the LAPD did or did not tamper with the evidence impacted how that data was received,” says Frederick-Frost.

While the history of forensics is one of advancing science, in which the latest and greatest technologies take center stage, the past often shapes how data is collected and presented for trial. During the 1860s and ’70s, all three of Lydia Sherman’s husbands and eight children—six of her own—died under suspicious circumstances. After an autopsy revealed that her last husband had been poisoned, Sherman was convicted of murder and sentenced to life in prison, largely on the strength of chemical analysis performed by George Frederick Barker.

Curiously, Barker subjected the organs of Sherman’s victims, some exhumed from the grave, to many different types of arsenic tests when one would have sufficed to identify the poison. Why? During the previous year a wealthy Baltimore widow named Elizabeth Wharton was accused of murdering General W. Scott Ketchum by poison but found not guilty. “She was able to bring in top medical experts to attack the evidence, and she did so successfully, and one of their lines of attack was that the antimony tests used for that trial were outdated,” Frederick-Frost notes. “Barker threw everything and the kitchen sink at the Sherman evidence,” she adds, “and he admitted later that he did that because of what had happened the year before.” The tests that helped convict Sherman are a focal point of the exhibition.

Few objects of forensic evidence are steeped in as much history as the pistol confiscated from Nicola Sacco, and a bullet that was recovered from the body of a victim who was allegedly killed by Sacco and Bartolomeo Vanzetti during an armed robbery in Braintree, Massachusetts, in 1920. The pair’s status as Italian immigrants and anarchists played a major role in their trial and subsequent appeals, which eventually ended with their execution and with widespread doubts concerning their guilt or innocence that linger to the present day.

“That particular bullet and that particular gun have been analyzed over and over and over again since 1921, using different techniques, with everyone thinking that the latest and greatest technique would be able to tell us definitely whether or not they did it,” Frederick-Frost says. Not one has been successful, and this contentious criminal case continues to inspire new ideas and theories.

“That case didn’t just occupy the imagination of the whole country, it was worldwide,” Frederick-Frost says.

Though few other cases have ever attained Sacco and Vanzetti stature, the exhibition notes other examples of the unique, enduring relationship between the media and forensic science. This includes the handwriting samples used to help convict Bruno Richard Hauptmann of kidnapping and killing the son of Charles Lindbergh, in a case that some dubbed a “crime of the century,” and a blood spatter head used in Showtime’s “Dexter.”

“Through the history of modern forensic science, dating from the 19th century, there has been kind of a back-and-forth trade-off between fiction and real life,” says Simon Cole , a criminologist at the University of California, Irvine, who specializes in the history and sociology of forensic science. “They are always kind of influencing each other.”

But unlike in fictional cases, which are often closed by forensic evidence without a shadow of a doubt, Cole warns that no matter how much technology advances, there is always a need for caution in real investigations. New techniques may be hailed as infallible, but time will show they have limitations. “To me the lesson is always, the next time someone tells you something is infallible, exercise some skepticism,” he says.

For Frederick-Frost, such limits on even the best techniques simply highlight the primacy of a human role in forensic science, from the development of forensic systems to the ultimate judgment of their value.

“In the end you always have to say either the data is good enough, or it isn’t good enough,” she says. “And that is a human judgment.”

“Forensic Science on Trial” is on view from June 28, 2024, through June 2025 at the National Museum of American History.

Get the latest on what's happening At the Smithsonian in your inbox.

Brian Handwerk | READ MORE

Brian Handwerk is a science correspondent based in Amherst, New Hampshire.