List of Contributors xix
Series Foreword xxi
Preface xxiii
Acknowledgements xxv
1 The Legal System, Courts, and Witnesses 1
Peter Vanezis
1.1 Introduction 1
1.2 British courts 2
1.3 The Supreme court of the United Kingdom 2
1.4 English and Welsh courts 3
1.5 Scottish Courts 4
1.6 Northern Ireland Courts 6
1.7 Other courts 6
1.8 Types of witnesses and evidence 7
References 11
2 Investigation of the Deceased and Their Lawful Disposal 13
Peter Vanezis
2.1 Introduction 13
2.2 Certification of details of death by the Registrar of births and deaths and lawful disposal of the body 13
2.3 Death certificate 14
2.4 When may a doctor issue a death certificate? 14
2.5 The form of the certificate in England and Wales 14
2.6 Legal procedures in the coroner system 14
2.7 Deaths abroad 19
2.8 Inquests 19
2.9 Registration of death 21
2.10 Burial 21
2.11 Cremation 21
2.12 The Human Tissue Act 2004 and Human Tissue (Scotland) Act 2006 24
2.13 Exhumation is discussed in detail in Chapter 5 25
2.14 Legal procedures in death investigation: Other systems 25
References 27
3 The Duties of a Registered Medical Practitioner and the General Medical Council 29
Peter Vanezis
3.1 Medical Acts 29
3.2 Role of the GMC 30
3.3 Consent 32
3.4 Decisions involving children and young people 33
3.5 Consent and capacity 34
3.6 Medical confidentiality 35
3.7 Consent for disclosure 35
References 36
4 General Principles of Scene Examination 37
Peter Vanezis
4.1 Concept of the scene 37
4.2 Scene investigation and Locard's principle 38
4.3 Scene location and associated problems 40
4.4 Type of incidents 46
4.5 The forensic pathologist and other medical personnel at the scene 47
References 52
Further reading 53
5 The Medico-legal Autopsy 55
Peter Vanezis
5.1 Introduction 55
5.2 Historical background 55
5.3 Types of autopsy 57
5.4 Types of autopsy in the Coroner system 58
5.5 Autopsy procedure 60
5.6 Examination of the exhumed body 67
5.7 Safety in the mortuary and dealing with high-risk cases 69
References 70
Further reading 71
6 Interpretation of Injuries: General Principles, Classification, and Age Estimation 73
Peter Vanezis
6.1 Introduction 73
6.2 General aspects 73
6.3 Timing of bruises 77
6.4 Colour measurement of bruising 80
6.5 Differentiation from artefacts and other post-mortem appearances 82
6.6 Decomposition 85
References 86
Further reading 87
7 Blunt Impact Trauma 89
Peter Vanezis
7.1 External surface injuries 90
7.2 Types of incidents in which blunt impact trauma is the predominant feature 97
References 110
8 Sharp Force Trauma 111
Peter Vanezis
8.1 Introduction 111
8.2 Characteristics of sharp force trauma scenes 112
8.3 Incised (slash) wounds 113
8.4 Stab wounds and their assessment 116
8.5 Glass injuries 124
8.6 Injuries from other sharp objects 127
References 127
9 Firearm and Explosion Injuries 129
Peter Vanezis
9.1 Firearm injuries 129
9.2 Types of firearms 129
9.3 Recoil 130
9.4 Handguns 130
9.5 Rifles 131
9.6 Shotguns 132
9.7 Wounds from firearms and other missile injuries 134
9.8 Investigation of firearm injuries 135
9.9 Wounds and range of discharge from rifled firearms 137
9.10 Entry and exit wounds from single bullets 141
9.11 Shotgun Wounds 143
9.12 High-velocity rifle wounds 146
9.13 Modified projectiles 147
9.14 Air-gun injuries 147
9.15 Injuries from humane veterinary killers, industrial stud guns, and blank cartridge guns 147
9.16 Injuries from rubber and plastic bullets 147
9.17 The effects of being shot 147
9.18 Explosions 148
9.19 Effects of an explosion 148
9.20 Explosion injuries 149
9.21 Investigating the cause of the explosion 152
References 152
Further reading 153
10 Forensic Aspects of Asphyxia and Drowning 155
Peter Vanezis
10.1 Non-mechanical asphyxia 156
10.2 Mechanical asphyxias 158
10.3 Types of mechanical asphyxias and related conditions 161
10.4 Drowning 174
10.6 Diatoms and their use in the investigation of drowning 177
References 178
11 Forensic Medical Aspects of Human Rights Issues 181
Peter Vanezis
11.1 Torture 181
11.2 Development of Humanitarian Law and the Geneva Conventions 189
11.3 Responses to torture and its eradication 191
11.4 Physician participation in torture 191
11.5 Physician participation in Capital punishment 192
11.6 The investigation of mass graves/multiple deaths related to armed conflict 194
References 197
12 Sexual Offences 199
Philip Beh
12.1 Introduction 199
12.2 Sexual offences 199
12.3 Responding to sexual offences 201
12.4 Attendance at scenes of sexual violence 203
12.5 Examination for injuries in sexual assault 204
12.6 Interpretation of findings 208
12.7 Examination of Fatal Sexual Assault 209
References 211
Further reading 211
13 Paediatric Forensic Medicine 213
Philip Beh and Peter Vanezis
13.1 Introduction 213
13.2 Stillbirth/neonatal deaths 213
13.3 Sudden death in infancy syndrome 214
13.4 Child abuse 216
13.5 Types of child abuse 217
13.6 Management of child abuse 228
References 231
14 Sudden Natural Death 233
Peter Vanezis
14.1 Introduction 233
14.2 Sudden/Unexpected deaths where findings at autopsy are non-specific 234
14.3 Deaths involving different body systems 237
14.4 Sudden death in Schizophrenia 240
14.5 Respiratory causes 240
14.6 Gastrointestinal causes 242
References 243
15 Heat, Cold, and Electricity 245
Peter Vanezis
15.1 Deaths from the effects of heat 245
15.2 Deaths from the effects of cold 253
15.3 Deaths from electricity 255
15.4 Lightning 259
References 259
16 Diagnosing Death and Changes after Death 261
Peter Vanezis
16.1 Introduction 261
16.2 Is the person really dead? 262
16.3 Types of death 264
16.4 Diagnosis of circulatory death 266
16.5 Diagnosis of brain death 267
16.6 Diagnostic tests for brain stem death 268
16.7 Organ donation 268
16.8 Early Indications of Death 270
References 283
17 Identification: General Principles, including Anthropology, Fingerprints, and the Investigation of Mass Deaths 285
Peter Vanezis
17.1 Introduction 285
17.2 Reasons for identification 286
17.3 Reasons for identification in deceased individuals 286
17.4 Reasons for identification in living persons 286
17.5 Approach 286
17.6 Biological (general) identification (what type of individual are we trying to identify?) 287
17.7 Personal identification 288
17.8 Victim identification and management in disasters (mass fatality incidents) 292
17.9 Practical procedures for identification 296
17.10 Identification of buried human remains 305
17.11 The use of fingerprints in identification 305
References 310
18 Use of DNA in Human Identification 311
Denise Syndercombe Court
18.1 DNA fingerprint discovery 311
18.2 Identification using DNA 312
18.3 The National DNA database 316
18.4 Forensic analysis 319
18.5 DNA mixtures 324
18.6 Lineage markers 328
18.7 Mitochondrial analysis 329
18.8 Kinship testing 330
18.9 Missing persons investigations 330
18.10 Disaster victim identification 331
References 333
19 Forensic Odontology and Human Identification 335
Philip Marsden
19.1 The human dentition 335
19.2 The dental identification process 336
19.3 Post-mortem procedure 338
19.4 Dental ageing 339
19.5 Dental reconciliation 340
19.6 Identification outcomes 340
19.7 Bite Marks 341
References 342
Further reading 343
20 Crime and Mental Health/Forensic Psychiatry 345
Vivek Khosla and Orlando Trujillo-Bueno
20.1 Introduction 345
20.2 Mental disorder 346
20.3 Mental Disorder and Criminal Behaviour 347
20.4 Organic disorders 348
20.5 Substance Misuse Disorders 349
20.6 Mood Disorders 349
20.7 Psychotic Disorders 349
20.8 Neurotic and Anxiety Disorders 350
20.9 Personality Disorders 350
20.10 Learning Disabilities 351
20.11 Sexual Offending and Mental Disorders 351
20.12 Mental Health Legislation 352
20.13 Section 48: transfer of unsentenced prisoners 353
20.14 Section 41: restriction order 353
20.15 Section 49: restriction direction 353
20.16 Specific psychiatric issues during criminal proceedings 353
20.17 Serial Killers 357
20.18 Clinical Forensic Psychiatry 357
20.19 Secure Forensic Mental Health Services 359
20.20 Conclusions and final thoughts 360
References 361
21 Maternal Deaths 363
Mahomed Dada
21.1 Introduction and definitions 363
21.2 Causes of maternal deaths 366
21.3 The autopsy in maternal death 366
21.4 Specialised pathology in pregnancy 368
References 369
22 The Examination of Detainees and Death in Custody 371
Peter Vanezis
22.1 Defining death in custody 371
22.2 Ministerial Council on Deaths in Custody 372
22.3 Deaths in custody in England and Wales 373
22.4 Management of detainees in police custody 374
22.5 Role of the Independent Office for Police Conduct 375
22.6 Deaths related to restraint 376
22.7 Excited Delirium Syndrome/Acute Behavioural Disturbance 377
22.8 Conflict resolution (De-escalation) 377
22.9 Methods of restraint 378
22.10 Addendum 380
23 Forensic Toxicology: Clinico-pathological Aspects and Medico-legal Issues 383
Nadia Porpiglia, Chiara Laposata, and Franco Tagliaro
23.1 Introduction 383
23.2 Biological samples collected for toxicological analysis 383
23.3 Interpretation of toxicology results 385
23.4 Interactions between drugs 387
23.5 Assessing the cause of death 388
23.6 Alcohol 389
23.7 Alcohol withdrawal syndrome 401
23.8 Alcohol interaction with other drugs 402
References 402
24 Illicit Drug Use 405
Giovanni Serpelloni and Claudia Rimondo
24.1 Definitions 405
24.2 Type of substances 407
24.3 The legal scenario of drug use 412
24.4 The drug scene today 416
24.5 Consequences of drug use 420
References 434
Index 443
