Introduction to

Forensic Science
Forensic Pathology

The autopsy provides forensic

evidence.
Forensic Pathology is the branch of
medicine which analyses victims of
crime scenes medically.
They are the last physician for the
deceased and their role is to discover
and interpret the evidence left during
the autopsy.

Forensic Pathology
Pathology, the study of disease, is the
broadest of the medical specialties.
Pathologists dont treat patients nor do
surgery themselves- they consult with
primary care and specialist physicians.
Forensic Pathologist is a medical doctor
with 10-15 post secondary training.

Anatomic Pathology
Diagnosis of disease and injury by
the gross and microscopic
examination of tissue specimens:

Biopsies
Organs
pap smears
bone marrow aspirates
blood smears.

The anatomic pathologist is also the

one who performs autopsies.

Clinical Pathology
Clinical pathology deals with the
medical laboratory where the
pathologist serves as medical
director.
The pathologist bears ultimate
responsibility for medical laboratory
test results.

Role of the Pathologist

Determine type of wound
Measure the dimensions (length, width,
depth)
Position relative to anatomical
landmarks
Determine initial location if wound
involves cutting, slashing, etc.
Determine height of victim, other
contributing factors like heart problems.

Analysis of Wounds
Not every crime victim is murdered.
Pathologists can contribute to proof of
the severity of a crime or that a crime
actually occurred in some cases for a
living victim.
Some victims are too young to testify
and some are too severely injured to
remember the crime.
Wounds provide evidence of the crime.

Wound Categories
Bruises (or contusions)
Abrasions (or grazes or scratches)
Lacerations
Incised wounds
Puncture (or stab) wounds
Gunshot wounds

Gunshot Wounds
This will be discussed with
ballistics talk

Bruises
A bruise is "a hemorrhage into
tissues produced by the escape of
blood from blood vessels".
Bruises may be found in the skin,
muscles, and internal organs.

Bruises
Bruises are typically produced by a
blunt force impact, such as a blow or a
fall.
They may also be produced by
squeezing or pinching, where the force
is applied gradually and then
maintained.
Hickies or "love-bites" are superficial
bruises.

Natural Bruises
Bruises may occur in a variety of natural
diseases in which there is an abnormality
of the clotting mechanism of the blood,
e.g. scurvy (vitamin C deficiency),
leukemia, alcoholic liver disease.
This bruising is "spontaneous" because the
injury which produces it is so insignificant
as to typically pass unnoticed.
The presence of such natural disease will
exaggerate the bruising effects of any
trauma.

Problems with Skin Bruises

Delayed appearance
Ageing (relative)
Site of Trauma
Shape of object
Degree of force
Post-mortem bruises
Post-mortem lividity

Classic Causes of Bruises

Finger pad bruises: battered babies,
manual strangulation
Different ages: repeated assaults
Shoulders and arms: forceful restraint
Wrists and ankles: dragging
Inner thighs: forceful intercourse
Chest: resuscitation
Bruising is uncommon in Suicides

Bruises
The extent of bruising is inversely proportional
to the sharpness of the impacting object.
Bruises may be associated with other blunt
force injuries such as abrasions and
lacerations.
As a general rule bruising is not associated
with incised wounds or stab wounds where
there is a free flow of blood from the cut blood
vessels rather than leaking into the tissues.

Site of Trauma
In contrast with abrasions, the
location of a bruise does not
necessarily reflect the precise point
of injury.
Leaking blood will follow the path of
least resistance and gravity.

Delayed Appearance
Deep bruises may have delayed appearance
at the skin surface. Deep bruises may
require as long as 12 or 24 hours to become
apparent, and some may never do so
The more superficial the source of bleeding,
the sooner the discoloration will be seen on
the skin surface.
In a living victim, a second examination in
one or two days may show bruising.
In the dead, a further examination one or
two days after the original autopsy may
show bruises which were not previously
seen and reveal previously faint bruises.

Autopsy and Bruising

Bruising in Deep Tissue
1. Possibly life-threatening
2. Sometimes no external injury
3. Revealed in autopsy

Documenting Bruising
1. Photography
2. Notes

Degree of Force
The size of a bruise is an unreliable
indicator of the degree of force
causing it.
However, a heavy impact is likely to
produce a large bruise and a light
impact to produce a small bruise.
If bruising is slight, it is reasonable to
assume that the degree of violence
was slight.

Determining Degree of Force in

Bruise Patterns
Location:
Some areas of the body bruise more easily
than others. The face bruises more readily
than the hands.
Bruising occurs more readily in loose
tissues and where there is a large amount
of subcutaneous fat
Bruising is less apparent where the skin is
strongly supported by fibrous tissue or if
the muscle tone is good.

Determining Degree of Force in

Bruise Patterns
Age

Infants and the elderly tend to bruise more

easily than young and middle aged adults.
Infants have loose and delicate skin, and the
abundant subcutaneous fat.
Elderly have degenerative changes in the
tissues which support the small blood vessels of
the skin and subcutaneous tissues.

Gender:

Women bruise more easily than men because

they have more subcutaneous fat and this is
particularly true of obese women.

Natural Disease
Skin color

Causitive Object
The shape of the bruise is most likely
to reflect the shape of the causative
object when the object is small and
hard and death occurs soon after
injury

Causitive Object
A doughnut bruise is produced by an
object with a rounded contour (e.g.
baseball).
Two parallel linear bruises result from
a blow with a rod or stick
Bruises can follow rounded contours
if they are caused by a flexible object
like a lash

Causitive Object
Bruises produced by fingerpads as a
result of gripping are usually larger
than the fingerpads themselves.
The pattern and location suggests
the mechanism of causation:
On the neck in throttling
On the upper arms in restraint.

Such bruises are referred to as

patterned.

Aging of Bruises
Color changes a bruise goes
through can give a rough
estimate of time of injury
Colors result from breakdown
of hemoglobin from tissues
Dark blue/purple (1-18 hours)
Blue/brown (~1 to 2days)
Green (~ 2 to 3 days)
Yellow (~3 to 7 days)

This rate assumes person is

healthy, however.

Aging Bruises
While accurate estimation of the age of a
single bruise is not possible, a fresh bruise
can be distinguished easily from one which
is several days old.
Establishing that bruises are of different
ages may be of medical importance where
there is an allegation of repeated assaults:
Child abuse
Wife beating
Where pre-existing injuries need to be
distinguished from those produced by a recent
assault like a chronic alcoholic who was
assaulted.

Post Mortem Bruises

Bruising is a phenomenon of living
tissue- since it usually requires
circulating blood to push the blood
from the veins.
It isnt possible to tell bruises that
occurred causing death from those
that occurred minutes earlier. You
can only say they occurred at or
about time of death.

Post Mortem Bruises

It requires considerable violence to produce
a bruise post mortem or after death.
These bruises are smaller relative to the
degree of force used.
Post mortem bruises are most readily
produced in areas of hypostasis (post
mortem lividity, livor mortis) or where
tissues can be forcibly compressed against
bone.
A bruise can develop on the head after the
body is left lying on the back.

Post Mortem Lividity

(hypostasis, livor mortis)
The settling, after death, of blood within the
blood vessels under the influence of gravity.
This results in a purplish discoloration of
parts of the body that are lower while
sparing areas of pressure contact - contact
pallor.
The pattern and distribution of lividity
distinguishes it from bruising.
A body found on its back has livor mortis on
the dorsal (back) side with pale areas where
the bone contacted the floor.

Decomposition
Post mortem decomposition with its initial
green discoloration of the anterior abdominal
wall is readily distinguished from bruising.
Putrefactive lysis of blood cells within the
vessels and decompositional breakdown of the
vessel walls results in diffusion of lysed blood
into the adjacent tissues.
Existing bruises are enlarged by this process.
Later, putrefactive hemolytic staining of tissue
may mask ante mortem bruising (e.g. in the
neck muscles in case of choking).

Patterns of Injury
Bruises to the knuckles of the hands,
together with bruises of the eyelids, bridge
of the nose, cheeks and lips, suggest a fist
fight.
Bruising around the eyes (spectacle
bruises) may be produced by direct blows,
but also commonly result from a fracture of
the base of the skull, e.g. in vehicle
collisions or gunshot wounds to the head
They may also follow blunt impact to the
forehead producing jolting of the eyeballs
in their sockets with tearing of small orbital
blood vessels.

Patterns of Injury
Bruising of the genitalia and around the anus
suggests sexual assault.
Severe bruising of the genitalia, with or
without laceration, can be produced by kicks.
Counter-pressure bruising, with or without
abrasion, to the back, (shoulder blades,
sacrum and pelvis) suggests pressure against
a firm surface as in forceful restraint on the
ground.
Similar bruising may be seen on boney
prominences of the front of the pelvis.

Patterns of Injury
In kicking assaults with the shod foot,
bruises are invariably associated with
multiple abrasions and lacerations.
Gangs, individuals without weapons
The bruises and abrasions may be patterned
by the boot.
Bruising is typically extensive and targeted
on the face, neck, ears, groin, and kidney
area.
Internal bruising is usually severe.

Patterns of Injury
Bruises are painful and therefore not
commonly self-inflicted; extensive
bruising creates a presumption of
assault.
Accidents generally are unforeseen
and the injuries they produce tend not
to follow a recognizable pattern.
Some places bruise easily accidentally
though: shins and hips.

Patterns of Injury
Injuries in motor vehicle collisions
almost invariably include abrasions
and lacerations as well as bruises.
Patterns of injury may allow
reconstruction of incidents involving
pedestrians or allow distinction
between driver and front seat
passenger.

Participation Question
Give me an example of forensic
usefulness of analysis of bruises.

Abrasions
Friction injury removing skin or tissue

Abrasions
Side impact produces a moving abrasion:
Indicates direction.
Trace material (e.g. grit).

Direct impact produces an imprint abrasion:

Pattern of causative object.

All abrasions reflect site of impact (in

contrast with bruises).
Assessment of age of abrasions is difficult.
Post-mortem abrasions - Brown, leathery

Incised Wounds (Cuts, Slashes,

Stab)
Stab wounds or puncture wounds are
penetrating injuries whose depth
within the body is much greater than
the dimensions of the wound on the
body surface.
Breach of the full thickness of the
skin due to contact with a sharp
edge.

Stab Wounds
Forensic Importance
Reflects sharp edge, not weapon type
No trace evidence
Bleeds profusely
Hemorrhage and air embolism
They can be produced by any long thin object
which impacts the body with sufficient force
to penetrate.
The typical instrument is a knife, but any
sharp pointed, or keen-edged object will work.

Stab Wounds Should be

Described at Autopsy:
Site relative to local anatomical landmarks as
well as its distance from the midline and above
the heel (or below the crown of the head).
Shape and Size including the dimensions with
the wound edges closed back.
Direction (approximately) in three dimensions.
Depth of the wound track at autopsy.
Damage to tissues and organs along the wound
track.
Effects of damage described above.

Stab Wounds: Shape of

Weapon
A knife blade with a double edge will normally
produce a symmetrical elliptical wound with
both ends pointed, clean cut edges and without
any associated bruising or marginal abrasion.
A knife with a single-edged blade may show
relative blunting ("fish-tailing") of one end of the
entry slit. A single edged blade can produce a
wound with two pointed ends, mimicking an
injury from a double edged blade.
A bayonet, which has a ridge along the back of
the blade with a groove along each side, may
produce a slit like an elongated letter "T".

Stab Wounds: Shape of

Weapon
Stab wounds produced with relatively blunt
instruments such as pokers, closed scissors
and files, tend to bruise and scrape the wound
margin.
These blunter instruments also tend to
lacerate, as well as cleanly penetrate, the skin;
the blunter the point of the instrument and the
thicker its shaft, the more likely is the entry
hole to become a ragged, often cross shaped
split.
Forensic Pathologist sometimes practices
wound type: The Body Farm.

Stab Wounds: Degree of

Force
The most reliable estimate of blade
width is made from the deepest wound
with the shortest skin surface length.
It is easy to over-estimate the amount
of force required to produce a stab
wound.
The depth of a wound is not generally
an indication of the degree of force
used.

Stab Wounds: Degree of

Force
The most critical factor is the
sharpness of the point of the
instrument; relatively little force is
required to produce a stab wound
provided a knife with a sharp point.
After clothing, the skin offers the
greatest resistance to penetration;
once this is overcome, then the blade
easily cuts into deeper tissue.

Stab Wounds: Degree of

Force
The penetration of bone does imply a
significant degree of force.
The tip of the blade may break off when
driven into bone and should be
recovered for matching with the weapon.
In estimating the force exerted by an
assailant, consideration should be given
to the possibility of counter pressure by
the victim, e.g. running or falling
forwards.

Stab Wounds: Length of

Weapon
The depth of the wound (the length of the
wound track, provides some indication of
the length of the stabbing instrument).
The wound track length may be less than
the length of the instrument if the
weapon was not thrust into the body to its
full length.
The wound track can be longer than the
knife if there is force compressing tissues.

Stab Wounds: Clothing

Cuts on the clothing should be noted and
correlated with injuries to the body.
More than one cut on the clothing may
correspond with a single injury to the body as
a result of folds in the clothing.
Cuts to the clothing may not exactly overlie
corresponding wounds to the body.
There may be stab or slash marks on the
clothing without corresponding injuries to the
body, e.g. "defense"-type slashes to the arms.

Stab Wounds: Clothing

Blood flow patterns on the clothing may
indicate the position of the victim at the time
of the stabbing.
Blood drops on the tops of the shoes from a stab
to the chest in a victim standing upright.
Blood flow direction can change with movements
of the body.

Wound track can be indicated by

undercutting and beveling of the external
wound.
Extrapolation from the direction of wound
tracks to an opinion on the relative positions
of an assailant and victim should be, since
two potentially moving objects are involved.

Stab Wounds: Cause of

Death
Most deaths from stab wounds are
homicides.
Homicidal stab wounds are usually multiple,
since most wounds leave the victim capable
of some resistance for a measurable time
during which the thrusts are repeated.
Single homicidal stabbings are often
associated with drugged, drunk, sleeping,
or otherwise partially incapacitated victims
and are almost always aimed at the heart.

Stab Wounds: Cause of

Death
Homicidal stab wounds to the chest are
all likely to be deep, penetrating the
chest wall, and more than one may be
lethal.
Stabs in the back strongly suggest
homicide.
In cases of multiple scattered stabs, the
larger the number the greater the
certainty of murder.
There is often a sexual motive to deaths
with this type of "over-kill".

Defense Stab Wounds

"Defense wounds" are the result of the
immediate and instinctive reaction of a
victim to ward off anticipated injuries
and may be seen in both homicidal
and accidental deaths.
Defense wounds result from raising
the arm to ward off the attack or
attempts to grasp the weapon.
The resulting injuries may be stabs or
slashes or both.

Defense Stab Wounds

Attempts to grab the knife results in deep
cuts to the palm of the hand and the palm
side of fingers.
With the hand in a gripping position the
palm skin is loose and folded so that
resultant cuts appear irregular and ragged.
They may be duplicated by the thrust and
withdrawal of the weapon.
Penetration of the hand or arm is also a
defense wound.
The absence of defense wounds does not
exclude homicide since the victim may be
incapable of effective defense.

Suicidal Stab Wounds

Suicide by stabbing is distinctive. The
wounds, if multiple, have a location and
direction accessible to the victim and are
typically grouped in the "pit" of the
stomach.
Use of one hand is indicated by a consistent
direction of penetration.
Multiple wound tracks extending from the
same slit in the skin reflects partial
withdrawal of the weapon and further
thrusts (possibly trial feelers), and suggests
possible suicide.

Suicidal Stab Wounds

Typically a suicidal stabbing is to the bare
skin and the clothing may be removed or
pulled aside to effect this.
Defense wounds do not occur in suicide,
although the sharpness of a knife may be
tested by running the blade across the tips
of the fingers.
Multiple scattered wounds weighs against
suicide unless there was serious mental
illness.

Suicidal Stab Wounds

Fatalities from a single stab wound can be
difficult and such a wound may be homicidal,
suicidal, or accidental.
Autopsy findings should always be interpreted
in the light of information concerning the
circumstances and scene of death.
If the stab wound was inflicted during a fight
then the usual defense is that it was
accidental, the victim having ran or fallen on
to the weapon.
The position and direction of the wound may
help resolve the issue.

Stab vs Slash
Stab wounds are deep and not wide.
Slash wounds are wide and not deep.

Penetrating Wounds
(Punctures)
Breach in full skin thickness and
depth is greater than length
Long, thin, sharp or blunt object.
If sharp object then equals "stab
wound".

Lacerations (Tears, Splits)

Splitting of the skin by the direct
crushing of blunt trauma.
Typically over bone, e.g. scalp,
eyebrow, cheekbone.

Lacerations
Distinguished from incised wounds by:
Adjacent abrasion/bruise
Ragged edge
Tissue bridges in depth

Forensic Importance

Not related to object shape

Trace evidence
Relatively little blood loss (except scalp)
Rarely suicidal

Lacerations
Typical Examples
Stellate pattern from poker end
Circles/crescents from hammer
Y-shaped from metal rod
Inside lips from blow to mouth.
Stretching lacerations in vehicular
accidents.

Bite Marks
Double crescent of abrasions and
bruises
Early Examination, loss of definition
Swab for saliva, photograph
Comparative value
Child abuse, sexual assault.

Assault
Any type of wound, combinations
Scattered, multiple directions,
uniform force
Defense injuries
Several potentially lethal
Clothing
Secondary injuries

Order of Infliction
Tentative or scattered first
Fatal and grouped last
Distant shots before close shots.

Accidental
Any area, single, clothing
Defense injuries
Secondary injuries
Check history (suicide attempts,
assaults)

Blood Spatter
Bruises and abrasions, none
Lacerations, not much
Incised and stab wounds, often
profuse.

Strangulation
Strangulation implies pressure to the neck,
and deaths due to strangulation are
therefore of immense forensic importance.
It can be defined as a circumferential
squeezing of the neck that is independent
of the gravitational weight or suspension
of the head.
Manual strangulation
Ligature strangulation
Choke holds

Signs of Strangulation
Obstruction of jugular veins with
impaired venous return to the heart,
leading to cyanosis (blue color),
congestion (tissue swelling), and
petechiae.
Obstruction of carotid arteries.
Stimulation of baroreceptors in the
carotid sinuses and carotid sheaths.
Elevation of larynx and tongue, closing
the oropharynx.

Petechia
Very small hemorrhages (ranging in
size from a pinpoint to a pinhead),
which occur in tissues, may be
described as petechia, or petechial
hemorrhages (from the Italian
petecchia, which has the Latinized
plural petechiae).
These hemorrhages may also be
described as punctate (from the Latin
punctum, a point).

Manual Strangulation
Usually caused by men against
women, and rarely against another
man since a large disparity in
physical strength between the
assailant and victim is needed.

Signs of Manual
Strangulation
Disc-like finger-tip bruises
Abrasions
Linear finger-nail scratches (from
victim or assailant)
Often limited signs of suffocation as
fingers are more likely to probe
deeper neck structures and cause
reflex cardiac arrest

Signs of Manual
Strangulation
Sustained pressure may cause
congestion and blueness of the tongue,
pharynx and larynx
Hemorrhage under the skin of the neck
and bruising of the strap muscles
Damage to the larynx - particularly the
superior horns of the thyroid cartilage,
and the greater horns of the hyoid bone

Ligature Strangulation
Where a constricting band is
tightened around the neck, there is
usually gross congestion, cyanosis
and petechiae in the face if the
pressure is maintained for more than
about 20 seconds.
The ligature mark is a vital part of the
evidence, as it often reproduces the
pattern and dimensions of the ligature
itself.

Ligature Strangulation
If the assailant has removed the ligature
from the scene, and is subsequently
arrested, possible ligatures found on the
assailant or in his home can be compared
with the mark on the victim's neck.
Some modern techniques involving
computer imaging are being developed to
assist in this comparison process.
A rising peak indicating a suspension point,
is seen in cases of hanging or suspension.
Victims may struggle less than manual
strangulation.

Choke Holds
These include the so-called 'carotid sleeper'
and 'bar arm' choke holds that are sometimes
used in law-enforcement situations, although
they are increasingly being outlawed in many
jurisdictions.
There is often little or no external neck injury
visible, while hemorrhages in the strap muscles
can be more extensive and broader in nature.
If the bar arm hold has been of sufficient
strength, the airway may have been
obstructed, leading to 'air-hunger', and lead to
violent struggling on the part of the restrained
person.

Asphyxia
Smothering - the covering of the mouth or nose
(or external occlusion) e.g. by a plastic bag or in
overlay deaths (may see abrasions etc in a
homicidal smothering if the victim could put up a
struggle)
Gagging - the tongue is pushed backwards and
upwards, and the gag becomes saturated with
saliva and mucus causing further obstruction.
Foreign body obstruction (those at risk being
children/ infants, the intoxicated and those with
neurological difficulties with swallowing etc)
Swelling of the airway lining (anaphylactic
hypersensitivity reactions, or thermal/ heat injury).

Carbon Monoxide
Carbon monoxide poisoning is a form of asphyxia
that results when CO is breathed.
Poorly ventilated houses with faulty heaters,
housefires, and motor vehicle exhaust are the most
common sources.
Even small atmospheric concentrations of CO are
dangerous, because CO binds to hemoglobin 200
times more avidly than oxygen.
Drowsiness and headache occur at
carboxyhemoglobin concentrations between 10 and
20%.
Levels from 20 to 30% can be fatal to persons with
pre-existing cardiac or respiratory disease.
Levels above 30 to 40% can be fatal to anyone.

Note the bright "cherry red" or

bright pink lividity to the hand.

Drowning
Drowning may not produce extensive findings.
In 10 to 15% of cases, intense laryngospasm
may even prevent water from entering the
lungs.
In some cases, some of the plant material in
the water is aspirated into a bronchus, as seen
through microscopic examination.
A frothy fluid may exude from mouth and
nose.
Prolonged immersion may produce skin
wrinkling and slippage.

Drowning
Decomposition is some times held back by
a phenomenon known as saponification:
the process where certain soft tissues are
said to saponify or literally to make soap.
The process of saponification begins after
decomposition has loosened and even
partially removed a layer of skin. The
underlying fatty layer is then exposed. This
fat, in a warm, moist environment,
undergoes a process called hydrolysis.
These fatty acid tails from the fat layer
combine with calcium and ammonium to
form insoluble soaps.

Drowning
Adipocere is made from the adipose layer
of fat lying just under the skin.
Adipocere appears as a grey-white waxy
substance and its formation of adipocere
inhibits further decomposition.
Dry environments and the presence of
oxygen inhibit adipocere formation.
Adipocere usually indicates a postmortem
interval of a least several months duration.

Role of the Forensic Pathologist

in an Autopsy
Cause of Death
medical diagnosis denoting disease or injury
Proximate vs. immediate.
Mechanism of Death
altered physiology by which disease/injury
produces death (arrhythmia, exsanguination,
blood loss)
Manner of Death
Homicide
Suicide: Not always easy to determine
Accidental: may involve human negligence
Natural Causes: disease or old age

Participation Question
What is rigor mortis?

Normal Postmortem
Changes

rigor mortis
livor mortis
desiccation
putrefaction
autolysis

Rigor Mortis
Stiffening of muscles seconds or minutes
after death
Rigor mortis results when [ATP]
concentrations fall
ATP = relaxed muscles
No ATP = contracted muscles

Rigor mortis stops when muscles begin to

decompose ~ 36 hours after death
Rigor mortis is used to estimate time of
death (more discussion later)

Livor mortis
Livor mortis purplish discoloration of
the body and organ surfaces
Becomes visible 30 minutes to 2 hours
after death
Results from breakdown of hemoglobin
heme leaking into extravascular
tissues
Livor mortis is also used to estimate
time of death.

Other Normal Postmortem

Changes
Desiccation mucous membranes (lips,
eyes) shrivel and look darkly colored
time depends on location of the body,
environmental conditions

Putrefaction
Greenish discoloration of skin
Growth of bacteria unchecked by immune
system causes gas production which may swell,
rupture organs or make soft tissue appear
swollen
time again depends on environment of body
(few days to weeks if colder)

Normal Postmortem
Changes
Autolysis cells begin to break open
and ooze contents
Liquefaction of soft tissues
Proteins break down into amino acids
which are further degraded by
bacteria into biogenic amines
this is what smells (putrescine,
cadaverine)