Editor(s):Burkhard Madea
14 March 2014
Print ISBN:9780470979990 |Online ISBN:9781118570654 |DOI:10.1002/9781118570654
About this book
Forensic Medicine encompasses all areas in which medicine and law interact. This book covers diverse aspects of forensic medicine including forensic pathology, traumatology and violent death, sudden and unexpected death, clinical forensic medicine, toxicology, traffic medicine, identification, haemogenetics and medical law. Knowledge of all these subdisciplines is necessary in order to solve routine as well as more unusual cases.
Born from the need for justice, legal medicine has had to adapt to a succession of scientific, technological, sociocultural and legal contexts throughout history. As a branch of science, it has been in constant evolution and, as such, has proved a source of inspiration and change for the law, stimulating improvements, amendments and legislative innovations. Specialist forensic work involves delving into mysteries of the unknown, solving the enigmas of existence and seeking answers for the large (and small) questions of life. It is also about adding to reality, about reinventing the world that we have inherited.ย Legal medicine has a mission that is far from easy, a mission that has always been (and always will be) fundamental to the correct application of justice. On it depend the honour and freedom of people. Legal medicine brings us into contact with people who carry with them the traumas of a life struck by misfortune, people that sometimes have the smell of death imbued in their skin. Hearing the voices of the victims and their families, their silent screams of anguish and despair, pain and anger, we have to make a daily effort to help them and to not give up on the world. Legal medicine is a field of study riddled with doubts, uncertainties, distress and nightmares. However, associated with this, there are also moments of great fulfilment, of intense professional and personal realization โ as this is an activity that indisputably helps others. All who practise it have certainly had experiences with people and situations that have profoundly enriched their lives from a human and spiritual point of view.
ย
PART I: Duties of Forensic Medicine in Modern Societies
ย
1: History of Forensic Medicine
1.1 Definitions
1.2 Civilisations of the Near East and China
1.3 Justinian Enactments
1.4 Further Developments and Italian Town Charters
1.5 Forensic Medicine as a Book Science
1.6 Forensic Medicine as an Experimental Science
1.7 Current Problems
1.1 Definitions
1.2 Civilisations of the Near East and China
1.3 Justinian Enactments
1.4 Further Developments and Italian Town Charters
1.5 Forensic Medicine as a Book Science
1.6 Forensic Medicine as an Experimental Science
1.7 Current Problems
ย
2: Duties of Forensic Medicine
ย
3: Forensic Medicine and Human Rights
3.1 Human rights issues
3.2 Torture
3.1 Human rights issues
3.2 Torture
4: International Guidelines and Accreditation in Forensic Medicine
4.1 Introduction
4.2 Recommendations for Forensic DNA laboratories Based On ISO/IEC 17025
4.3 Recommendations for Forensic Toxicological Laboratories Based On ISO/IEC 17025
4.4 Recommendations for Forensic Pathology Based On ISO/IEC 17025
4.5 Recommendations for Clinical Forensic Medicine Based On ISO/IEC 17020
PART II: Medical Aspects of Death
5: Nature and Definition of Death
5.1 Death and Dying
5.2 Determination of Death
6: Certification of Death: External Postmortem Examination
6.1 Introduction
6.2 Cause of Death
6.3 Causes of Death as Shown by Cause of Death Statistics
6.4 Consistency between Cause of Death Diagnosis on the Death Certificate and Following Autopsy
6.5 Manner of Death
6.6 Special Constellations of Circumstances in External Postmortem Examination
6.7 Checklist for the External Postmortem Examination (according to Madea 2006)
6.8 Identification of the Corpse
6.9 Examination of the Corpse
6.10 Completing the Death Certificate
6.1 Introduction
6.2 Cause of Death
6.3 Causes of Death as Shown by Cause of Death Statistics
6.4 Consistency between Cause of Death Diagnosis on the Death Certificate and Following Autopsy
6.5 Manner of Death
6.6 Special Constellations of Circumstances in External Postmortem Examination
6.7 Checklist for the External Postmortem Examination (according to Madea 2006)
6.8 Identification of the Corpse
6.9 Examination of the Corpse
6.10 Completing the Death Certificate
7: Postmortem Changes and Time Since Death
7.1 Early Postmortem Changes
7.2 Later Postmortem Changes: Decomposition
7.3 Timing of Death
7.4 Basic Forensic Entomology
7.5 Postmortem Injuries
7.6 The Physician and the Crime Scene
8: Cremation
8.1 Short History of Cremation
8.2 Cremation in the Modern Day
8.3 Process of Cremation and Modification of the Corpse during Cremation
8.4 Remnants of Cremation
8.5 Conclusions
9: Autopsy
9.1 Introduction
9.2 Medicolegal Autopsy
9.3 Clinical Autopsy
9.4 Autopsy Report
9.5 Forensic Imaging
10: The Doctor, the Dead and Their Relatives
10.1 Pronouncing Life Extinct and Informing the Next of kin about a Death
10.2 Role of the Deceased
10.3 Respect for Taboos and Propriety
10.4 Manner of Death and Police Investigations
10.5 Dealing with the Relatives
11: Transplantation
11.1 Regulations and Procedures in Germany
11.2 Legal Prerequisites and Procedures in the UK
11.3 Criteria for the Diagnosis of Brain Death in the UK
11.4 Special Forensic Medical Aspects of Organ Donation and Tissue Retrieval
12: Anthropology and Osteology
12.1 Introduction
12.2 Preliminary Steps
12.3 Diagnosis of Species
12.4 Biological Profile: The Main Role of Anthropology
12.5 Facial Reconstruction
12.6 Geographical Origin
13: Mass Disaster Victim Identification
13.1 Introduction
13.2 International Cooperation
13.3 DVI Team Structure
13.4 Standardisation
13.5 Forensic Odontology Standards
13.6 Forensic Molecular Biology Standards
13.7 Radiology Standards
13.8 Chemical Biological Radioactive Nuclear Explosive Weapons
13.9 Documentation and Quality Management
PART III: Traumatology and Violent Death
14: Legal Aspects of Traumatology and Violent Death
14.1 Definitions
14.2 Basic Legal Principles
14.3 Conclusions
15: Traumatology and Criminology
15.1 Introduction
15.2 Homicide
15.3 Non-Homicidal Events
15.4 Suicide
15.5 Torture
15.6 Homicide, Suicide or Accident?
ย
16: Introduction to Some Biomechanical Principles
16.1 Introduction
16.2 Separation of Coherence Through the Impact of Tensile Stress
16.3 Separation of Coherence Through the Impact of Shear Stress
16.1 Introduction
16.2 Separation of Coherence Through the Impact of Tensile Stress
16.3 Separation of Coherence Through the Impact of Shear Stress
ย
17: Sequelae of Traumatic Injuries and Causes of Death
17.1 Introduction
17.2 Sepsis and Multiple Organ Failure
17.1 Introduction
17.2 Sepsis and Multiple Organ Failure
18: Vital Reactions and Wound Age Estimation
18.1 Vital Reactions
18.2 Wound Age Estimation: General Introduction and Methods
18.3 Wound Age Estimation: Molecular Biology
19: Mechanical Trauma and Classification of Wounds
19.1 Classification of Violence
19.2 Blunt Force Injury
19.3 Forensic Neuropathology
19.4 Sharp Force Injury
20: Forensic Ballistics: Injuries from Gunshots, Explosives and Arrows
20.1 Introduction
20.2 Firearms
20.3 Arrow Wounds
20.4 Explosive Injuries
21: Injuries due to Asphyxiation and Drowning
21.1 Asphyxiation
21.2 Drowning
21.3 Barotrauma and Diving-Related Accidents
21.4 Immersion Time
22: Injuries due to Heat
22.1 Introduction
22.2 Burns from Heat
22.3 Causes of Death from Heat
22.4 Scalding
22.5 Generalised Heat Damage and Hyperthermia
22.6 Diagnosis
23: Injuries due to Cold
23.1 Introduction
23.2 Pathophysiology
23.3 Clinical Phases of Hypothermia
23.4 Epidemiology
23.5 Morphological and Biochemical Changes
23.6 Criminal Aspects
24: Electrocution and Lightning
24.1 Electrocution
24.2 Lightning
25: Starvation and Neglect
25.1 Introduction
25.2 Clinical and Autopsy Findings in Starvation
25.3 Classification Systems
25.4 Death from Starvation
25.5 Physical Neglect
26: Infanticide
26.1 Introduction
26.2 Stillbirth
26.3 Neonaticide
26.4 Investigation of Mothers and Neonates
27: Death during Pregnancy
27.1 Analysis of Maternal Mortality
27.2 Pregnancy as a Physiological Process with Specific Risks
27.3 Maternal Death Directly Due to Gestation
27.4 Maternal Death Indirectly Due to Gestation
27.5 Iatrogenic Maternal Death
27.6 Maternal Death Not Due to Gestation
28: Auto-Erotic Death
28.1 General Aspects
28.2 Categorisation of Death Cases
28.3 Possible Mechanisms of Death
28.4 Typical Injuries to Male Genitalia and Special Cases
29: Death in Abnormal Positions: Physical Restraint
29.1 Custody and Restraint Death
29.2 Extrinsic Factors
29.3 Intrinsic Factors
29.4 Controversies: Excited Delirium
29.5 Investigation of Death in Custody: Restraint and Body Position
29.6 Certification of Death
30: Sexual Homicide
30.1 Introduction
30.2 Profiling Offenders in a Sex-Related Homicide
30.3 Crime Assessment
30.4 Conclusions
31: Medical Malpractice
31.1 Introduction
31.2 Definitions
31.3 Epidemiology
31.4 Value of Autopsies
31.5 New Approaches
31.6 Conclusions
32: Special Issues Regarding Expert Evidence in Violent Death
32.1 Priority and Order of Injuries
32.2 Physical Activity after Injuries and Survival Time
32.3 Postmortem Mutilation
32.4 Alcohol-Related Deaths
32.5 Death Due to Drug Addiction
32.6 Mafia-Related Deaths
PART IV: Sudden and Unexpected Death from Natural Causes
33: Natural Causes of Sudden Death
33.1 Introduction
33.2 Cardiac Causes of Sudden Death
33.3 Non-Cardiac Causes of Sudden Death
33.1 Introduction
33.2 Cardiac Causes of Sudden Death
33.3 Non-Cardiac Causes of Sudden Death
34: Postmortem Biochemistry as an Aid in Determining the Cause of Death
34.1 Introduction
34.2 Glucose Metabolism and Diabetes Mellitus
34.3 Alterations of Liver Function
34.4 Disturbances of Kidney Function
34.5 Water and Electrolyte Imbalances
34.6 High Excitation and Hypothermia
34.7 Chronic Alcoholism
34.8 Anaphylactic Shock
34.9 Genetic Alterations
34.10 Conclusions
35: Sudden and Unexpected Deaths in Infants and Sudden Infant Death Syndrome
35.1 Introduction
35.2 Sudden Infant Death Syndrome
35.3 Other Main Causes of Death in SUDI Cases and During Childhood
35.4 Practical Investigation of SUDI/SIDS
35.5 Conclusions
PART V: Clinical Forensic Medicine
ย
36: Sexual Abuse
36.1 Introduction
36.2 Examination of the Victim
36.3 Sexually Transmitted Infections
36.4 Toxicological Analysis
36.5 Legal Outcome
36.6 Juvenile Pornography
Appendix 36.1 Approach to Interpretation of Medical Findings in Suspected Sexual Abuse
Appendix 36.2 Reminder Checklist
36.1 Introduction
36.2 Examination of the Victim
36.3 Sexually Transmitted Infections
36.4 Toxicological Analysis
36.5 Legal Outcome
36.6 Juvenile Pornography
Appendix 36.1 Approach to Interpretation of Medical Findings in Suspected Sexual Abuse
Appendix 36.2 Reminder Checklist
37: Non-Sexual Abuse in Children
37.1 Non-Accidental Head Injury in Children
37.2 Child Abuse
38: Intimate Partner and Domestic Violence
38.1 Introduction
38.2 Causes and Reasons for Domestic Violence
38.3 Effects and Consequences of Domestic Abuse
38.4 The Cycle of Violence
38.5 Diagnostic Procedures
38.6 Human Immunodeficiency Virus and Domestic Abuse
38.7 Challenges Facing Older Women
39: School Violence
39.1 Introduction
39.2 Statistical Data from Various Countries
39.3 Motives and Reasons for School Violence and Its Identification
39.4 Prevention and Interventional Procedures
40: Violence Against Homosexuals
40.1 Introduction
40.2 Characteristics of Gay Violence
40.3 Violence in Straight Versus Homosexual Relationships
40.4 Problems with Statistical Data and Underlying Causes
41: Violence Against the Elderly
41.1 Introduction
41.2 Definition and Scope of Elder Mistreatment
41.3 Types of Abuse of the Elderly
41.4 Mimics of Elder Abuse
41.5 Clinical Evaluation in Living Patients
41.6 Medicolegal Investigations
41.7 Conclusions
42: Self-Harm
42.1 Definitions, Phenomenology and Underlying Causes
42.2 Historical Aspects, Epidemiology and Statistical Data
42.3 Classification and Phenomenology of Self-Harm Groups
42.4 Diagnostic Procedures
43: Age Estimation in Living Individuals
43.1 Introduction
43.2 Age estimation in adolescents and young adults
43.3 Influence of Ethnicity on Development
43.4 Expert Reports
43.5 Age Estimation in Child Pornographic Images
43.6 Age Estimation in Old Age Proceedings
43.7 Quality Assurance
PART VI: Forensic Psychiatry
44: Forensic Psychiatry
44.1 Definitions
44.2 Inquisitorial Versus Adversarial Legal Systems
44.3 Forensic Psychiatry Examinations
44.4 Civil law, Competencies and General Legal Competency
44.5 Competencies in Criminal Law
44.6 Criminal Responsibility
44.7 Forensic Security Hospitals
44.8 Formal Education in the Subspeciality of Forensic Psychiatry
44.9 Conclusions
Legislation (Codes and Statutes)
Landmark Court Cases (Rulings and Opinions)
44.1 Definitions
44.2 Inquisitorial Versus Adversarial Legal Systems
44.3 Forensic Psychiatry Examinations
44.4 Civil law, Competencies and General Legal Competency
44.5 Competencies in Criminal Law
44.6 Criminal Responsibility
44.7 Forensic Security Hospitals
44.8 Formal Education in the Subspeciality of Forensic Psychiatry
44.9 Conclusions
Legislation (Codes and Statutes)
Landmark Court Cases (Rulings and Opinions)
ย
PART VII: Toxicology
ย
45: Legal Aspects of Toxicology
45.1 Introduction
45.2 Administrative Issues
45.3 Abused and Controlled Substances
45.4 Postmortem Toxicology
45.5 Clinical Forensic Toxicology
45.6 Doping
45.7 Sabotage, Terrorism and Chemical Warfare
45.1 Introduction
45.2 Administrative Issues
45.3 Abused and Controlled Substances
45.4 Postmortem Toxicology
45.5 Clinical Forensic Toxicology
45.6 Doping
45.7 Sabotage, Terrorism and Chemical Warfare
46: Epidemiology and Adverse Drug Reactions
46.1 Introduction
46.2 Adverse Drug Reactions and Side Effects
46.3 Inherent Toxicity of a Substance
46.4 Epidemiology
46.5 Evidence Basis for Toxicity
46.6 Conclusions
47: Suspicion of Poisoning
47.1 Diagnosis of Acute Poisoning
47.2 Specimen Collection for Forensic Toxicology
47.3 Clinical Signs and Syndromes in Intoxication
48: Toxicological Analysis: Drug Screening and Confirmation
48.1 Introduction
48.2 Screening and Confirmation Tests
48.3 Isolation Step
48.4 Instrumentation Used in Forensic Toxicology
48.5 Analytical Methods
48.6 Method Performance
49: Issues Affecting Interpretation: Stability and Artefacts
49.1 Introduction
49.2 Definition of Stability and Common Causes of Instability and Artificial Formation
49.3 Stability of Drugs and Potential Artefacts
49.4 Sampling Artefacts and Measures to Increase Drug Stability
49.5 Influence of Storage
49.6 Instability of Drugs and Artificial Formation During Processing and Analysis
49.7 Procedures for Evaluating Stability and Artefacts
49.8 Conclusions
50: Toxicokinetics and Toxicogenetics
50.1 Introduction and the LADME Principle
50.2 Basic Kinetic Parameters
50.3 Toxicokinetics and Toxicogenetics in Forensic and Clinical Toxicology
50.4 Release
50.5 Absorption
50.6 Distribution
50.7 Metabolism
50.8 Excretion
50.9 Conclusions
51: Toxicology of Specific Substances
51.1 Alcohols
51.2 Illegal Drugs
51.3 Sedatives and Hypnotics
51.4 Narcotics and Other Analgesics
51.5 Toxic Elements
51.6 Solvents and Gaseous Poisons
51.7 Natural Poisons
51.8 Pesticides and Insecticides
51.9 Doping
PART VIII: Traffic Medicine
52: Driving Aptitude and Fitness to Drive
52.1 Introduction
52.2 Definitions and Operationalisation
52.3 Factors Influencing Driving Aptitude and Fitness to Drive
52.4 Assessment of Driving Aptitude and Fitness to Drive
52.1 Introduction
52.2 Definitions and Operationalisation
52.3 Factors Influencing Driving Aptitude and Fitness to Drive
52.4 Assessment of Driving Aptitude and Fitness to Drive
53: Effects of Cardiovascular Disease on Fitness to Drive
53.1 Introduction
53.2 Derivation of the Risk of Harm Formula
53.3 Coronary Heart Disease
53.4 Arrhythmias
53.5 Syncope
53.6 Heart failure
54: Effects of Vision and Visual Fields on Fitness to Drive
54.1 Introduction
54.2 Problems with Vision
54.3 Visual Field Disorders
54.4 Condition after an Eye Operation
54.5 Problems of Vision in Older Motorists
54.6 Effects of Visual Deficiencies
55: Effects of Epilepsy on Fitness to Drive
55.1 General Rules
55.2 Background
55.3 Legal Aspects
55.4 Epilepsy and General Road Safety
55.5 Outlook
56: Effects of Diabetes on Fitness to Drive
56.1 Classification of Diabetes
56.2 Stages of Diabetes
56.3 Driving and Treatment of Diabetes
56.4 Driving Performance and Diabetes
56.5 Therapeutic Aspects for Driving Safely with Diabetes
57: Epidemiology and Causal Factors in Fitness to Drive
57.1 Introduction
57.2 Epidemiological Methods
57.3 Examples of Epidemiological Studies
58: Effects of Alcohol on Fitness to Drive
58.1 Introduction
58.2 Medicolegal Alcohol Determination
58.3 Characteristics of Offenders
58.4 Amounts of Alcohol Consumed
58.5 Alcohol Consumption and Crash Risk
58.6 Alcohol Tolerance
58.7 Conclusions
59: Effects of Illegal Drugs on Fitness to Drive
59.1 Introduction
59.2 Problems Regarding Epidemiological Data
59.3 Effects of Drugs on Driving
59.4 Forensic Toxicological Analyses
60: Effects of Medicinal Drugs on Fitness to Drive
60.1 Introduction
60.2 Medicinal drugs that impair driving
60.3 Conclusions
61: Toxicological Markers of Chronic Alcohol Abuse
61.1 Introduction
61.2 Overview and Characteristics of Alcohol Biomarkers
61.3 Biomarkers of Alcohol Consumption
61.4 Detection of Chronic Excessive Alcohol Consumption
61.5 Control of Abstinence
62: Traffic Accidents
62.1 Road Traffic Accidents
62.2 Sudden Death While Driving
62.3 Suicide While Driving
62.4 Railway Accidents
62.5 Aircraft Accidents
62.6 Mass Disasters
PART IX: Identification
63: Forensic DNA Analysis
63.1 Stain Analysis
63.2 Paternity Testing
63.1 Stain Analysis
63.2 Paternity Testing
64: Forensic Anthropology
64.1 Introduction
64.2 Identification of Human Remains
64.3 Identification of the Living
65: Forensic Odontology
65.1 Introduction
65.2 Dental Charting
65.3 Age Estimation
65.4 Identification of an Unknown Person
65.5 Bite Marks
PART X: The Doctor and the Law
ย
66: The Doctor and the Law
66.1 Legal Relevance of Medical Treatment
66.2 Legal Aspects of Personalised Medicine
66.3 Assisted Suicide and Organised Medically Assisted Suicide
66.4 Research on Corpses
66.5 Legal and Ethical Aspects Concerning the Handling of Corpses and the Display of Human Remains
66.1 Legal Relevance of Medical Treatment
66.2 Legal Aspects of Personalised Medicine
66.3 Assisted Suicide and Organised Medically Assisted Suicide
66.4 Research on Corpses
66.5 Legal and Ethical Aspects Concerning the Handling of Corpses and the Display of Human Remains
PART XI: Insurance Medicine
67: Personal Injury Assessment
67.1 Introduction
67.2 Aim of Personal Injury Assessment and Reparation
67.3 General Aspects for Forensic Medical Assessment
67.4 Specifics of Forensic Medical Reports for Personal Injury Assessment
67.5 Conclusions
67.1 Introduction
67.2 Aim of Personal Injury Assessment and Reparation
67.3 General Aspects for Forensic Medical Assessment
67.4 Specifics of Forensic Medical Reports for Personal Injury Assessment
67.5 Conclusions
