INTRODUCTION OF

FORENSIC MEDICINE
DR IZEIN NARUGAYAM CLAUDIUS
DEPT. OF ANATOMICAL PATHOLOGY
NIGER DELTA UNIVERSITY
AMASSOMA
 OUTLINES
— DEFINITIONS
— HISTORICAL PERSPECTIVES
— SUBDIVISIONS
— FORENSIC AUTOPSY
— INDICATIONS FOR FORENSIC
AUTOPSY
— DEATH INVESTIGATIONS
— MANNER AND CAUSE OF DEATH
— FORENSIC PATERNITY
DEFINITIONS
— Forensic Medicine - The interaction of
medical science with the law. (aka legal
medicine, medical jurisprudence)
— Forensic Pathology – Is the branch of
medicine that applies the principles &
knowledge of the medical sciences to
problems in the field of law.
DEFINITIONS
— Forensic Pathology Cont.– It is the study
and application of the effects of violence or
unnatural conditions in its various forms in
or on the human body in determining the
cause and manner of death in cases of
violence, suspicious unexplained,
unexpected, sudden and medically
unattended deaths.
DEFINITIONS
— Legal medicine – application of
medical knowledge to aid with the
administration of justice.
— Medical jurisprudence – legal
responsibilities of the physician with
particular reference to those arising
from physician-patient relationship –
eg medical negligence, consent,
serious professional misconduct,
medical ethics
 HISTORICAL PERSPECTIVES
— Pre-Forensic science era – confessions
and testimony
— In 3000 BC – China information about
poisons, aconite, arsenic and opium
— 2900 BC – The Egyptian Imhotep- said to
be medico-legal expert
— In 2200 BC - Hammurabi King of Babylon
formulated code of medical ethics – criminal
and civil liability of medical man.
 HISTORICAL PERSPECTIVES

— In 3000 to 1000 BC India –formulated laws

of forensic import.
— In 460 – 384 BC – Greece, Hippocrates
established the lethality of wounds.
— 44BC – Roman Antistius examined Julius
Caesar and concluded one wound of the 27
wounds was fatal.
HISTORICAL PERSPECTIVES
— First recorded case Xi Yuan Lu 1248 BC –
use of medicine and entomology to solve
criminal cases
— In 1394 AD first recorded medico-legal
autopsy in Italy (Pavia), cease of
suspected poisoning
— 1556 – first exhumation in Bohemia after a
week
— In 16th Century Francois Immanuele Fodere
wrote on Forensic Medicine and Public
Health
— Later Johann Peter Frank wrote The
Complete System of Police Medicine.
HISTORICAL PERSPECTIVES
— In 1784 in Lancaster, John Toms tried and
convicted for murder after powder and balls
used in gunshot injuries.
— 1816 Warwick form laborer case.
— In 1773 – Carl Wilhelm Scheele discovered
detection of arsenic oxide in corpses
— 1n 1806 German scientist Valentin Ross
showed how to detect the arsenic on the
stomach linings
— In 1832 James Marsh used powerful Marsh
test for detection of arsenic.
— In 1835 Henry Goddard ballistics – proved
the gun used in firing a particular bullet
having noticed an indentation on the bullet
and comparing with a defect in the gun.
— Forensic anthropometry, 1882 - French
police officer Alphonse Bertillion (father of
forensic medicine) applied physical
measurements for identification and not just
name or photograph.
— 1854 – 1905 fingerprints
— 1960 Uhlehuth tests(antigen_antibody
precipicin test) – differentiate human from
animal blood
— DNA - 1984
SUBDIVISIONS
— Criminalistics – analysis of acquired
evidence in relation to case. (eg tyre
tracks, controlled substances, ballistics
etc)
— Forensic toxicology – effect of
poisons an drugs on body
— Forensic anthropology – skeletonized
human remains-
— Forensic Cryptography – criminal
profiling through handwriting studies
— Forensic dactyloscopy - study of
SUBDIVISIONS
— Forensic DNA analysis – application
of DNA in identification, assaults
paternity etc
— Forensic engineering – relating
structure and damage to humans
— Forensic entomology
— Forensic odontology
— Forensic psychology – criminal
profiling
— Forensic Photography – CSI
FORENSIC AUTOPSY
AUTOPSY.
— Greek: Autopsia – To see for oneself.
Autos - Oneself.
Opsis - Eye. See;
Post mortem; Necropsy
— Forensic Austopsy, Syn Medicolegal
autopsy, coroner autopsy
— Post-mortem examination to establish cause
and manner of death in a suspicious case.
FORENSIC AUTOPSY
TYPES OF AUTOPSIES
 Hospital/Clinical autopsy.
 Coroner’s; Medico-legal; Forensic autopsy.
 Family autopsy.
 Anatomical/Academic autopsy.
 INDICATIONS
1. Death known or suspected to be caused by
apparent criminal violence
2. Unexpected or unexplained death in an
infant or child
3. Death associated with Police action
4. Custodial death
5. Acute workplace injury causing death
6. Apparent electrocution
7. Death by intoxication with alcohol, drugs or
poison
8. Death caused by unwitnesed or suspected
drowning
9. Death involving unidentified body
10. Skeletonized, or charred body
Indications by CAP (1988)
— Unanticipated death
— Death occurring while the patient is being
treated under a new trial regimen
— Intraoperative and intra-procedural death
— Death occurring within 48 hrs after surgery or
an invasive diagnostic procedure
— Death related to pregnancy or within 7 days of
delivery
— Death during a psychiatric admission
— Death in admitted infants and children with
congenital malformations.
Who should perform the
forensic autopsy?
— Licensed physician who is a forensic
pathologist
— Physician who is a forensic
pathologist-in-training (resident/fellow)
— Medico-legal autopsy could be
performed by at least 2 physicians of
whom at least one should be qualified
in forensic pathology
Authorizing Bodies
— Police Inquest
— Magistrate inquest
— Coroner system
— Medical examiner system
Coroner vs. Medical Examiner
— Coroner – a public official, appointed
or elected, who makes inquires into
deaths & completes death certificates
◦ Determines cause/manner of death
◦ Decides if foul play
◦ May or may not have medical training
Coroner vs. Medical Examiner
— Medical Examiner – a physician,
evaluates medical history & physical
exam of deceased to determine cause
& manner of death
◦ Must receive special training to become a
forensic pathologist
◦ Forensic Pathology – unnatural or
suspicious disease or injury
– In most instances, the medical
examiner is required to be a forensic
pathologist
DEATH INVESTIGATIONS
Two Main Categories
1. Persons who die suddenly when in
apparent good health, those who are
unexpected to die, or those who are
without medical treatment for
fatal/terminal diseases.
– Public Health Threat (bacterial meningitis)
– Death in public places ( prison, schools, camps
e.t.c.electrocution in public place)
– Maternal Death
– Death outside of medical facility i.e BIDs
DEATH INVESTIGATIONS
2. Deaths caused by unnatural causes
Examples:
◦ Acts of violence
◦ Drug related
◦ Trauma / Asphyxiation
◦ Weather; extreme heat/cold
◦ Vehicular accident
DEATH INVESTIGATIONS
— Special Categories: legal requirement
and depend on jurisdiction
◦ Under 18
◦ Death of an individual under legally dependent
care
◦ Death in correctional facility
◦ “24 hour death report” law
◦ On aircraft or ship
— MURDERS ARE THE SMALLEST
NUMBER OF DEATHS INVESTIGATED!
Three facets of guilt
— Motive
— Means
— Opportunity
Medical Examiners’ Duties and
Responsibilities
— To determine the cause and manner
of death
— To identify the deceased if unknown
— To determine the time of death and
injury
— To collect evidence from the body that
can be used to prove or disprove an
individual’s guilt or innocence and to
confirm or deny the account of how
the death occurred
Medical Examiners’ Duties and
Responsibilities Cont.
— To document injuries or lack of them
— To deduce how the injuries occurred
— To document any natural disease
present
— To determine or exclude other
contributory or causative factors to the
death
— To provide expert testimony if the case
goes to trial
Medical Examiner’s Duties:

— Review eyewitness statements

— Examine crime scene
— Autopsy
— Photography
— Report
— Testimony
 Factors used in Determination
of Time of Death
— Livor mortis
— Rigor mortis
— Algor mortis (Body temperature)
— Degree of decomposition
— Chemical changes in vitreous
— Flow-cytometry
— Stomach contents
— Insect activity
— Scene markers (papers, letters, clothing, televisions,
TV schedules, etc.)
 MANNER AND CAUSE OF
DEATH
— Mechanism – biochemical or
physiological abnormality produced by
the cause of death that is incompatible
with life
— Manner of Death –
— How the cause of death came about
◦ homicide, suicide, natural causes, accidental
or undetermined
— Cause – disease or injury that initiated
the lethal chain of events that lead to
 Manner of Death

— Homicide
— Suicide
— Accidental – trauma occurring from acts
NO REASONABLE person
would have felt have a high probability
of injury or death
— Naturalcause
— Undetermined
 Determination of Cause of
Death
— One can die of a massive hemorrhage (the
mechanism of death) due to a gunshot
wound through the head (the cause of
death) as a result of being shot (homicide),
shooting yourself (suicide), dropping the
gun and it discharging (accidental), or not
being able to tell how it occurred
(undetermined).
— All of which are manners of death.
Examples of Causes of Death
— A gunshot wound to the head
— A stab wound to the chest
— Adenocarcinoma of the lung
— Coronary atherosclerosis
 FORENSIC PATERNITY
DEFINITION
— Forensic Paternity testing is used to determine the
father-child relationship, utilising the DNA
(genetic fingerprinting) as a tool.
USES
 Child support
 Welfare benefits
 Immigration
 Inheritance
 FORENSIC PATERNITY
— DNA Profiling/Testing is the determination of
the characteristic genetic make-up of the
individual; it is unique except for identical twins.
First developed for forensic use by Sir (Prof.)
Alec Jeffreys in 1985.
— Complete (Full) Genomic Sequencing ~ 99.9%
— Variable repetitive segments ~ 0.1% -
— Variable Number Tandem Repeats (VNTR)
— Short Tandem Repeats (STRs)
 SOURCES OF DNA SAMPLE
 Buccal smear
 Blood
 Semen
 Saliva
 Muscle
 Bone
 Root of the tooth
 Pulled hair
 Toothbrush, Shaver.
ANALYTICAL METHODS
 Restriction Fragment Length Polymorphism
(RFLP). Restriction enzymes, Gel
electrophoresis, Nitrocellulose filter (Southern
blot), Denatured fragments are radiolabeled
and exposed to X-ray.
 Polymerase Chain Reaction (PCR). Uses
small or degraded sample which are
Amplified at specific regions. Up to million-
fold or more increase in <2hrs.
ANALYTICAL METHODS
 Short Tandem Repeats Analysis (STR). Highly
polymorphic regions are used utilising
sequence-specific primers that target specific
loci on the chromosome. The fragments are
separated by electrophoresis. 13 Loci used.
 Amplified Fragment Length Polymorphism
(AmpFLP)
 Y-chromosome analysis.
 Mitochondrial DNA Analysis
THANKS FOR
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