Meatpie's Atlas of Forensic Medicine [Part 1]

Suicide contact wound of the left temple with powder tattooing and lead fragment stippling of the left side of the neck

 
Tears at the corners of the mouth from an intraoral gunshot wound



Contact wounds of the head are devastating, producing a bursting rupture of the head. Large irregular tears of the scalp radiate from the entrance site. Powder soot and searing are typically present at the entrance though in some cases, soot will be sparse. In some contact wounds of the head, the entrance may be difficult to locate because of the massive destruction. Large pieces of the skull and brain are typically blown away, with pulpification of the residual brain in the cranial cavity. Pieces of scalp may be sheared off. The skull shows extensive comminuted fractures. Such wounding effects are due partly to the large quantities of gas produced by combustion of the propellant, emerging from the muzzle under high pressure. This gas begins to expand as soon as it emerges from the muzzle of the weapon. If the gun is held in contact with the head, this gas follows the bullet into the cranial cavity, producing an effect that can only be described as explosive. If a rifle is discharged in the mouth, massive wounds from the gas and the temporary cavity occur. Not uncommonly, there are lacerations at the corners of the mouth, at the nasolabial folds, medial to the eyes, at the bridge of the nose, and along the nasal ridge.
 
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A pacemaker on a cadaver being dissected



This cadaver is being dissected by medical students. A pacemaker can be seen on the chest. The modern cardiac pacemakers have a smooth external case, with the manufacturer’s data and serial numbers. Leads emerge from one point on the device and pass onwards to the heart. At autopsy, most cases have the generator unit (box) cut free from the wires to allow easy extraction. If the device may have not worked adequately, the entire unit with wires and electrodes needs to be retrieved intact and sent for specialized analysis.
 
Autopsy on Hairy Young Man who Died from Covid

 
Super rare and amazing cases from forensic atlas first published in Germany in 1963.



 

Fatal Dragging Deaths with Soft Tissue and Bone Grinding Injuries




Vehicle versus pedestrian (and vehicle versus bicyclist/motorcycle/moped/scooter) collisions frequently result in skin injuries that can be described as “friction abrasions,” “brush burns,” or “road rash” . These injuries are often related to the victim making contact with a hard road surface. When the victim is actually overrun by a motor vehicle, the skin trauma may be related to contact with the roadway, the undersurface of the vehicle, or both. In such instances, the cutaneous injuries are typically severe, sometimes with associated underlying soft tissue or bone injuries. If a victim is actually dragged underneath the vehicle for a substantial distance, relatively characteristic “friction/grinding” injuries can be produced, involving skin, soft tissue, and sometimes bone. Death is a frequent outcome, and there are often many lethal injuries identified at autopsy, making the determination of whether or not the victim was conscious while being dragged under the vehicle difficult, if not impossible.

Although classic friction abrasions are common in vehicle versus pedestrian (and other) incidents, extensive grinding injuries related to the victim being pinned and dragged under the vehicle are less common, typically because drivers usually stop before driving great distances. This report presents two examples of friction/grinding/dragging injuries and addresses the difficulties incurred when faced with questions concerning consciousness, mechanisms of death, and timing of death.
 

Cadaver Head Holder for Transoral Surgical Simulation


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Cadaver-based simulation offers hands-on anatomical exploration to help surgeons practice and develop techniques in a realistic laboratory environment that can then be translated to the clinical setting. For teaching, research, and simulation of transoral robotic surgery (TOS) and transoral laser microsurgery (TLM) use of a cadaver head and neck unit by itself is not feasible due to difficulties in securing the head and providing the proper extension of the neck. As a result, a cadaver head and torso unit is required to provide the necessary stability and neck extension. This limitation adds further cost and storage requirements associated with the purchase and housing of the combined head and torso unit. In this report, a simple and cost-effective cadaver head-holding system is presented that provides the stability of the torso and adjustability for neck extension and head manipulation that accurately models the maneuvers required for operative laryngoscopy and other transoral procedures.
 
Dissection of the Head

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Fig.1

The head must be slightly raised with appropriate supports. There is no one correct device; each autopsy surgeon prefers his or her own method. A No. 22 blade on a long scalpel holder should be used to incise the whole scalp from the outside. Before the incision is made, a generous sample of hair should be cut from the vertex and preserved, should toxicological testing prove necessary at a later date (an empty red-top tube or even a glassine envelope can serve as a container). Once deposited in hair, drugs do not degrade, and can be detected and even quantified years or decades later.

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Fig.2

Begin the incision on the right side of the head, as low as possible just behind the earlobe, but without going below it. Then extend the incision to the same point at the opposite side of the head. This is the so-called bimastoid resection. When the incision is made in this fashion, it facilitates overturning the scalp. A big enough strip of tissue behind the auricle must be saved to allow for suturing the scalp back in place. After enough of the scalp has been incised to allow the prosector to grasp the two edges with the hands, the front and back halves of the scalp are overturned, anteriorly and posteriorly, respectively.


Fig.1 Variation of access to the face from an extended bimastoid resection.
Fig.2 Access to the skull and face in a case of suspected rhinoplasty surgery malpractice.
 
Suicidal asphyxiation by propane-butane mixture inside a plastic bag

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A 30-year-old male was found fully dressed lying on his right side on his sofa in his flat. He had put a blue plastic bag over his head and upper part of the body. Close to his upper part of the body, a 5-L propane/butane gas bottle was found, the upper part of the bottle under the plastic bag.

In the past, there had been severe arguments with his wife, as he had started relationships and sexual contacts with other men. However, in the basement, a rope was found at the stairway, from which it was concluded that the decedent had intended to commit suicide by hanging primarily.

Signs of progressive decomposition, especially head and arms, were present; there were no signs of external force in the skin of the neck region. There were no signs of external violence or underlying internal disease.

Propane-butane mixture, i.e. liquified petroleum gas leads to the depletion of oxygen in the air consequently causing hypoxia and anoxia, and therefore, unconsciousness and eventual death. The mechanisms of death in cases of volatile inhalation include cardiac arrhythmias, reflex cardiac vagal inhibition, and/or central nervous system depression. Similar mechanisms occur in cases of asphyxiation with a plastic bag.
 

An unusual case of suicide: Near decapitation by a modified table saw




Table saws are dangerous tools able to create severe injuries. In accidental injuries, the most commonly injured body parts are fingers (85.9%) while amputations occur in 10% of cases. Accidental neck or head injuries account for only 3.1% of all injuries. Table saws cause nearly half of all saw-related amputations. There are approximately 30,000 cases of table saw-related injuries in the United States annually, but only a few table saw-related suicides have been reported in the scientific literature. In regard to suicides, usually the head or the neck is targeted. Usually, only the soft tissues of the neck are injured because the blade height limits the cutting depth and the victim falls down from the table saw before complete transection. A rare case of suicide committed by a modified table saw that resulted in near decapitation is presented.

A man received an email from his 51-year-old brother that he was planning to commit suicide. He rushed to his brother's house, and as he looked through the window of the wooden outbuilding, he spotted the blood-soaked body of his brother lying with his head on a table saw. He called the emergency services and turned off the outside situated fuse thus stopping the rotating saw. The locked door of the building was opened by the arriving police officers.

The body of the victim was lying prone on a table covered with a white sheet, while his neck and head were lying on a table saw situated directly alongside the table . Apart from the blood, the sheet was clean. A large removable rectangular metal plate was missing from the surface of the saw near the blade, and an adjacent large non-removable aluminum piece was also cut out. A rectangular wooden lath was installed vertically into the place of the removed metal plate adjacent to the front end of the blade, and it was wired to the framing. A semicircle metal piece was also cut out from the side of the table saw (Fig.8) The victim's neck was positioned on the blade, and the neck was pressed against it with a bungee cord that was fixed with its hooks to the frame of the saw and positioned above the neck. The face was positioned downwards above the missing parts of the table saw. The green “power on” button was pushed in. The removed parts of the saw were found in the same building on a workbench.

No sign of struggle was found during the examination of the body at the death scene. Hypostasis and rigor mortis was not observed, while the rectal temperature was 35.3°C (95.5°F). The victim previously worked as a fireman, and he was injured in service four years prior to the suicide while sliding head-first down 10 stair treads. He suffered a concussion and developed peroneal paresis and back pain. His complaints were gradually increasing and he developed depression and chronic pain syndrome.

Five months before the suicide and during his last hospital admission, he complained about severe pain. The victim was living alone; he was mostly bedridden and had limited self-sufficiency. He was using crutches to move within the house, but he was not able to leave his home without help. The victim was diagnosed with depression three years before but was not under regular psychiatric treatment prior to his death (he had not sought medical care recently). Previous psychological evaluation showed mixed anxiety-depression disorder, somatization, and conversion mechanism.

In the present case, the injuries were much more severe and deeper because the modifications of the saw enabled deeper cutting and continuous contact between the blade and the neck of the victim. The modifications probably were made purposefully for committing suicide: removing that large part from the saw would not allow firm horizontal positioning of the timber thus making firm hold not possible, and the witnesses asked by the police did not observe these modifications previously. The modifications were sophisticated; the front and superior plate were removed which allowed enough space for deeper cutting of the head, the bungee cord continuously pressed the neck vertically onto the blade, and the wooden lath prevented the neck from sliding away from the blade.

The parallel cut marks seen on the vertebrae and at the left end of the wound illustrate how the cutting depth gradually increased with every rotation of the blade while the head gradually angled down. Apart from the email sent prior to the act, multiple findings support that the victim committed suicide: the arms of the victim were close enough to the power switch to turn the switch on; the presence of the crutch indicated that the victim went to the saw on his own accord; no injuries other than those caused by the saw were found during the autopsy, and the door of the building was locked from inside.
 
Postmortem examination of the teeth of a badly burned body



Postmortem examination of the teeth of a badly burned body, in order to assist in the positive identification of the decedent. The soft tissues of the face (lips and cheeks) have been cut away in order to maximize the visibility of the teeth. Because the destruction of burned victims of the third, fourth, and fifth categories is extensive, remains cannot be identified by common methods. In these cases, forensic odontologists are called in to assist the identification by comparing the postmortem records of the burned, charred, or incinerated individual teeth with the antemortem dental clinical history.

Dental identification is very vital tool because teeth may be the only body part that remains intact. Teeth are the hardest substance in the body and can endure extremely adverse conditions, including high temperatures up to 1600°C (2912°F). Teeth are the components of the body that often survive severe fires because of their highly resistant composition and they are protected by the soft and hard tissues of the face and other materials.
 
Girl killed in house fire. Traces of alcohol and drugs were found during the autopsy.

 
Early Adipocere Formation



On the night of 13th October 2007, Mr. X aged 35 years left his home at 11 o’clock along with three other people believed to be his friends, promising his wife to be back in a short while. Not finding him until the next morning, his wife lodged a complaint to the police. Police interrogation of the deceased friends confirmed the death of Mr. X, within an hour of leaving home by shooting with the help of a muzzle-loading shotgun and the body being disposed of in a nearby marshy pond.

The dead body was recovered on 16th October 2007 at 5 o’clock in the evening and was subjected for medico-legal autopsy. The dead body was identified by the police with the help of the wife of the deceased by examining the articles present on the body, clothing, contents of the wallet, and the physical parameters.

Post mortem findings: The body showed adipocerous changes over the cheeks, front and back of the trunk, upper limbs except for the hands, and lower limbs except for the feet. The adipocerous areas were yellowish-white in color, soft, greasy, and had a strong odor like that of ammonia. Artifacts produced by the aquatic animals were present over the peri-orbital areas, nose, ears, genitalia, and limbs. A circular lacerated wound with deposition of soot particles around it was present on the back portion of the chest (entry wound of gunshot). Another lacerated wound was present on the front portion of the neck (exit wound of gunshot). No projectiles were recovered from the body cavity (the whole body was radiographed to detect the projectiles prior to autopsy). Ribs were fractured along the para-vertebral area corresponding to the entry wound. The internal structures showed uniform reddish-brown discoloration with well-preserved architecture of the viscera.
 
Female Body Recovered from a Floodplain in the North of Italy



In mid-November 2010 a hunter walking on the Po river bank near Parma (Emilia-Romagna Region, in the north-east of Italy) informed the authorities of the presence of human remains in the mud, which were spotted from a distance. The floodplain area, of roughly 65 hectares, had drained naturally in the past 10 days, after flooding due to recent heavy rain. The depth and the soft consistency of the mud prevented the use of vehicles to reach the death scene. The police, the forensic team, and the recovery team eventually reached the scene by helicopter.

The human body remained untouched until the arrival of the pathologist at the scene, who described it as lying prone in the mud, completely undressed and covered by a large number of “dark” spiders, which were also swarming in the surrounding environment. The body was winched up to the helicopter, to be transported to the closest mortuary for post-mortem examination. While no trauma was evident on the body, the prosecutor’s office considered the case worthy of a full forensic investigation, to determine the identity of the deceased person, the cause, the manner and the time since death, and whether the floodplain was the primary death scene.

The human remains belonged to a Caucasian female, approximately 167 cm (5′5) tall, overweight, aging between 40 and 50 years old but looking consistently older due to overall poor health condition. The body was found completely naked, with no associated personal objects, such as rings, watch, jewelry, or dentures that could enhance a personal identification. The body was strewn with mud, leaf litter, small gravel, broken twigs, and colonized by immature insects and spiders which had not caused any visible damage. The mouth showed a completely edentulous inferior dental arch, with a few teeth in the superior dental arch. All teeth were in poor hygiene and health condition.

Besides the absence of traumatic findings (except for a few teeth), the external examination disclosed a light skin color, pierced ear lobes, and possibly light irises. Qualitative toxicological analysis was performed and gas-chromatography; results revealed the presence of psychoactive drugs (benzodiazepines and tricyclic antidepressants) in the liver parenchyma and in the abdominal putrefactive fluid. The cause of death remained undetermined, but the set of findings suggested suicide by drowning.

A facial reconstruction was achieved and provided to the media. The cause and time of death, although ruled as undetermined for the lack of unquestionable evidence and by the challenging environment, were most likely a suicide by drowning, committed by a clinically ill, depressed, and socially marginalized mature woman around the time of the latest flood (10 days before the body discovery).

Despite the combined effort between all the experts involved and media coverage of the case, to this day, neither the set of information obtained by forensic analyses, research of palmar prints on the police databases, or the facial reconstruction have led to any personal identification.
 
Suicidal Gunshot Wound to the Face

 
Man killed and dismembered by his spouse



In Germany, a 65-year-old woman told police that she killed her 71-year-old husband the previous evening and then dismembered the body that night. They both originated from Russia. The woman stated in the interrogation that there had been a dispute between her and her husband in the immediate run-up to the crime. The husband wanted to travel to Russia again and accused his wife that her brother-in-law would take advantage of this situation to visit her. She said he was insulting and condescending, he was very angry and had a knife in his hand. In a brief physical abuse, he injured his wife's hand with the knife. Afterward, the man calmed down again and sat quietly at the kitchen table. The wife was annoyed by her husband's behavior, but also scared, so she went to the basement and got an ax from there. She killed the husband, who was sitting at the kitchen table, with the ax with several blows to the head. He then collapsed.



The body parts were found in several garbage bags in the basement.
 
Raccoon Takes a Bite of a Human Corpse at Body Farm

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Self-ligature Strangulation by Utilizing a Recliner



South Korea. Most cases of ligature strangulation are generally homicides, and deaths due to suicide or accident are rare. Present here is a very rare case of a man using a recliner sofa as an aid for strangulation. The deceased, a man in his 50s, cut his wrists using an industrial cutter several times and placed his hands into a bathtub containing warm water, which, however, did not lead to death. His suicide attempt through self-ligature strangulation using a recliner in the living room finally resulted in his death. After considering the results of the scene investigation, testimony of the witnesses, and the autopsy findings, the cause of death was determined to be self-ligature strangulation, and wrist incisions were found to be a contributory cause of death.
 
Suicide with a Chainsaw

A 56-year-old man was found dead in the yard of his residence. A chainsaw that was connected to electricity was on the right side of the deceased. A suicide note was found on his mobile phone.



The deceased had several bruises on the face, accompanied by exfoliation located relatively parallel to the left cheek region and left side of the mouth region, below the mouth region, and above the chin region. A mild burn lesion was observed in the left auricle. No soft tissue bleeding was observed in the nose, cheeks, and chin areas. In the front of the parietal region, two skin excavations were observed, no fractures were seen in the skull, and no damage or disease was observed in the brain parenchyma. In the neck area, it was observed that the neck was cut by a fissure formed over the front and both sides of the neck area.

The fissure progressed relatively horizontally on the right and anterior sides of the neck. Among the wounded areas, both smooth and irregular parts of the skin had a tooth-shaped appearance. Among the wounds, the thyroid cartilage below the vocal cords, esophagus, carotid artery and jugular vein, cervical vertebrae, and spinal cord in the neck region was completely amputated in the soft tissue and internal organs, which are deeper injuries than the skin. Most of the findings were consistent except for the area where some skin and soft tissue loss occurred, and soft tissue bleeding was accompanied by soft tissue bleeding around the injured area.

White liquid content with a chemical odor was confirmed in the gastric contents. In drug and poison tests using blood and gastric contents, highly toxic neonicotinoid insecticide, moderately toxic phenoxy carboxylic acid herbicide, and low toxic glycine derivative Herbicide components were detected. The final cause of death was judged to be an injury to the neck from a chainsaw.

A chainsaw (or chain saw) is a portable gasoline-, electric-, or battery-powered saw. According to the shape and size, it can be classified into a circular cutter, a circular saw, and an electric chainsaw, and is widely used for logging, industrial sites. The use of a saw as a tool for suicide is rare, and there are only a few case reports in the field of forensic medicine. Commonly, the damaged area is the skin injury first contacted by the saw blade of the chainsaw and the soft tissue injury located directly below it.
 
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