References Pgi
1. Conference of the Police Complaints Authority at the Synod. Police Complaints Authority, London, UK, 2002. 2. Rogers, D. J., Stark, M.M., Davie, M. Medical complications associated with the use of rigid handcuffs a pilot study. J. Clin. Forensic Med. 5 34-37, 1998. 3. Haddad, F. S., Goddard, N.J., Kanvinde, R. N., et al. Complaints after handcuffs should not be dismissed letter . Br. Med. J. 318 55, 1999. 4. Stopford, J. S. B. Neuritis produced by a wristlet watch. Lancet. 1 993, 1922. 5....
Cocaine and Crack
Cocaine occurs naturally in the leaves of the coca plant Erythroxylum coca, which grows predominantly in South America. Cocaine hydrochloride is a white powder that is usually snorted but can be taken orally. Crack is prepared by mixing cocaine hydrochloride with sodium bicarbonate and water and heating it. The cocaine base precipitates out and forms small rocks as it cools. Crack may be smoked in a pipe or heated on foil with the vapor inhaled. Both crack and cocaine may be injected. The...
Dental Impressions
Dental impressions taken from the potential biter by the dentist or appropriately qualified person after a thorough dental examination will be cast into hard dental models. Dental impressions taken of an individual in custody are intimate samples and require the appropriate authority and consent for your jurisdiction. Transparent overlays of the biting edges of the Fig. 13. Photograph showing bite mark on back, with scales. Individual tooth detail is visible. Northumbria Police. Used with...
Shotgun Wounds 1
When a shotgun is discharged, the lead shot emerges from the muzzle as a solid mass and then progressively diverges in a cone shape as the distance from the weapon increases. The pellets are often accompanied by particles of unburned powder, flame, smoke, gases, wads, and cards, which may all affect the appearance of the entrance wound and are dependent on the range of fire. Both the estimated range and the site of the wound are crucial factors in determining whether the wound could have been...
CoercedCompliant False Confessions
Coerced-compliant false confessions are typically elicited during persuasive interrogation the person perceives that there is some immediate instrumental gain from confessing. The suspect does not confess voluntarily but comes to give into the demands and pressures of the interrogators. He or she is fully aware of not having committed the crime of which he or she is accused, and the confession is usually retracted once the immediate threat is gone. Gudjonsson 52 suggests that the four main...
Police Interview Techniques
Numerous American manuals detail the way in which coercive and manipulative interrogation techniques can be employed by police officers to obtain a confession 40,41 , with similar techniques being advocated by Walkley 42 in the first such manual written for British officers. The authors of these manuals propound various highly effective methods for breaking down a suspect's resistance while justifying a certain amount of pressure, deception, persuasion, and manipulation as necessary for the...
Rifled Weapons
Rifled weapons are characterized by having parallel spiral projecting ridges or lands extending down the interior of the barrel from the breach to the muzzle. This rifling causes the projectile, in this case a bullet see Fig. 9B , to spin as it is ejected from the weapon and thus impart gyroscopic stability along its flight path. The rifling also leaves characteristic scratches and rifling marks that are unique to that weapon on the bullet surface. There are three common types of rifled weapons...
Rifled Weapon Wounds
Intact bullets penetrating the skin orthogonally, that is, nose-on, usually cause neat round holes approx 3-10 mm in diameter. Close examination reveals that the wound margin is usually fairly smooth and regular and bordered by an even zone of creamy pink or pinkish red abrasion. A nonorthogonal nose-on strike is associated with an eccentric abrasion collar, widest at the side of the wound from which the bullet was directed see Fig. 10 . Atypical entrance wounds are a feature of contact or near...
Medical Evidence 1
Because a significant proportion of the population performs consensual fellatio, anecdotal accounts from oral surgeons suggest that palatal lesions consequent to such acts are rarely identified during routine casework, although this may be a result of the rapid resolution of the injuries. Nevertheless, several case reports have documented palatal lesions after fellatio. Areas of pete-chial hemorrhage and confluent bruising have been described on the soft palate and at the junction between the...
Hymen
The hymen must be examined in detail after an allegation of a nonconsensual penetrative act. When the hymen is fimbriated, this assessment may be facilitated by the gentle use of a moistened swab to visualize the hymenal edges. When the hymenal opening cannot be seen at all, application of a few drops of warm sterile water or saline onto the hymen will often reveal the hymenal edges. Foley catheters are also a useful tool to aid hymenal visualization in postpubertal females 138 . A small...
Thermal Injury
Burns and scalds to children can be inflicted, occur accidentally, or follow neglect. The injury can be superficial or partial or full-skin thickness, depending on the temperature and duration of exposure. 3.2.1. Types of Thermal Injury For further information, see ref. 23. Scalds immersion, pouring or throwing a hot liquid onto a child. The affected skin is soggy, blanched, and blistered. The shape of the injury is contoured. The depth of the burn is variable. Contact burns direct contact of a...
Late 18th Century Onward
Beginning in the latter part of the 18th century, several books and treatises were published in English concerning forensic medicine and medical jurisprudence. What is remarkable is that the issues addressed by many of the authors would not be out of place in a contemporary setting. It seems odd that many of these principles are restated today as though they are new. In 1783, William Hunter 9 published an essay entitled, On the Uncertainty of the Signs of Murder in the Case of Bastard Children...
Head Injuries
Any suspected head injury should receive a detailed assessment 15 . The time, place, and nature of the injury should be ascertained from the detainee or from any witnesses who were present. The duration of any loss of conscious- Head Injuries Indications for Hospital Assessment A patient with a head injury should be referred to the hospital if any of the following are present a head injury is defined as any trauma to the head, other than superficial injuries to the face Impaired consciousness...
Incisions
These wounds are caused by sharp cutting implements, usually bladed weapons, such as knives and razors, but sharp slivers of glass, the sharp edges of tin cans, and sharp tools, such as chisels, may also cause clean-cut incised injuries. Axes, choppers, and other similar instruments, although capable of cutting, usually cause lacerations because the injury caused by the size of the instrument e.g., axe head overrides the cutting effect of the tool. Mixed wounds are common, with some incised...
Dating Fractures
Resolution of soft tissues 2 to 10 days. Early periosteal new bone 4 to 21 days. Loss of fracture line definition 10 to 21 days. Soft callus 10 to 21 days. Hard callus 14 to 90 days. Remodeling 3 months to 2 years. For further information, see ref. 31. Detecting occult injury is particularly important in the younger child and infant and recommended indications for a skeletal survey include the following 17,25,28,32 Any child younger than 2 years when there is a suspicion of physical abuse. Any...
Intracranial Injury
There is a high incidence of mortality and morbidity after inflicted head injury, and it is the most common cause of traumatic death in infancy 34 . It has been generally accepted from research evidence that serious or fatal injury from accidental injury, other than that sustained in road traffic accidents or falls from major heights, is rare in children under 2 years and that simple skull fractures in accidental trauma have a low risk of intracranial sequelae 26 . The major acute intracranial...
Reporting Gunshot Wounds
In September 2003, the GMC published new guidance, Reporting Gunshot Wounds Guidance for Doctors Working in Accident and Emergency Departments, developed in conjunction with the Association of Chief Police Officers. The guidance may be obtained from the GMC and viewed on its Website at www.gmc-uk.org. In summary, it states that The police should be told whenever a person has arrived at a hospital with a gun shot wound, but at this stage identifying details, such as the patient's name and...
CS Malononitrile and CN
CS, or tear gas, is used frequently by the military and law enforcement as a method of controlling both individuals and crowds. The military also uses it during exercises to train personnel in the use of protective equipment. CN, known by its common name, Mace , is the oldest of the crowd-control agents. CS was developed in the 1950s, and it has largely replaced the use of CN. CS and CN are both lacrimating agents. CS is usually mixed with a pyrotechnic compound for dispersal in grenades or...
Firearm Injuries
The examination of fatal firearm injuries should be left to an experienced forensic pathologist however, it is not unusual in cases of nonfatal injuries for a hospital clinician or forensic physician to be asked to comment on the nature of the wound or wounds 8 . As with all injuries within the forensic setting it is essential in these nonfatal cases that the initial appearances of the injuries be accurately described and the wounds photographed. This is particularly important because...
Contributors
Kari Blaho-Owens, PhD Research Administration, University of Tennessee Health Science Center, Memphis, TN Jack Crane, mb bch, FRCPath, dmj Clin amp Path , FFPath, RCPI The Queen's University of Belfast and Northern Ireland Office, State Pathologist's Department, Institute of Forensic Medicine, Belfast, Northern Ireland, UK Judith A. Hinchliffe, bds, DipFOd School of Clinical Dentistry, University of Sheffield, Forensic Odontologist, General Dental Practitioner, and Honorary Clinical Lecturer,...
Abdominal Injuries
Visceral manifestations of NAI are uncommon and considered to contribute 2-4 of injuries in NAI 37,38 . However, visceral injuries carry a high morbidity and mortality estimated mortality of 40-50 and are the second most common cause of fatal child abuse because of the shear force of trauma, delay in recognition of injury because of frequent lack of signs and symptoms, and delay in recognition of NAI 38,39 . Injuries arise mainly from blunt trauma punching, kicking, trampling, or stamping or...
Types of Injury 31 Bruises
The terms contusion and ecchymosis have been used to differentiate between different types of injury that can more simplistically be called bruising. These terms have been used variously to describe different injury sizes but do not enhance understanding of either causation or mechanism of injury and should no longer be used. A hematoma is best used to refer to a collection of blood forming a fluctuant mass under the skin and may be associated with substantial trauma. The difference between...
Incubation Period and Symptoms
Following an incubation period of 10-21 days this may be shorter in the immunocompromised , there is usually a prodromal flu-like illness before the onset of the rash. This coryzal phase is more likely in adults. The lesions typically appear in crops, rapidly progressing from red papules through vesicles to open sores that crust over and separate by 10 days. The distribution of the rash is centripetal i.e., more over the trunk and face than on the limbs . This is the converse of small pox. In...
Bite Mark Injuries 71 Introduction
The term bite mark has been described as a mark caused by the teeth alone, or teeth in combination with other mouth parts 10 . Biting is a dynamic process, and bite marks are complex injuries. Recognition, recording, analysis, and interpretation of these injuries are the most intriguing challenges in forensic dentistry. Biting can establish that there has been contact between two people the teeth being used for offense or defense. When individual tooth characteristics and traits are present in...
References Adu
1. Bays, J., Chadwick, D. Medical diagnosis of the sexually abused child. Child Abuse Negl. 17 91-110, 1993. 2. Heger, A., Emans, S. J., Muram, D., eds. Evaluation of the Sexually Abused Child. Oxford University Press, New York, NY, 2000. 3. Royal College of Physicians. Physical Signs of Sexual Abuse in Children. RCP, London, UK, 1997. 4. General Medical Council. Intimate Examinations. GMC, London, UK, 1996. 5. Hicks, D. J. Rape Sexual assault. Am. J. Obstet. Gynecol. 137 931 935, 1980. 6....
Stab Wounds
Stab wounds are caused by sharp or pointed implements and wounds with a depth greater than their width or length. They are usually caused by knives but can also be inflicted with screwdrivers, pokers, scissors, etc. Although the external injury may not appear to be particularly serious, damage to vital structures, such as the heart, liver, or major blood vessels, can lead to considerable morbidity and death, usually from hemorrhage. In those individuals who survive, it is common for little...
Anatomy
The external female genitalia vulva includes the mons pubis, the labia majora, the labia minora, the clitoris, and the vestibule which incorporates the openings of the urethra and the vagina . The hymen is the tissue that partially or completely surrounds the opening of the vagina. It appears that all females have hymenal tissue present at birth 91 . The hymen may be annular encircling the vaginal opening , cres-centic present at the lateral and posterior margins , fimbriated frilly edged , or,...
Lacerations
Lacerations are caused by blunt force splitting the full thickness of the skin see Fig. 6 most frequently when the skin and soft tissues are crushed between impacting force and underlying bone. Boxers classically develop lacerations when a boxing glove presses on the orbital rim. As with abrasions, the injury site is indicative of the impact site. Lacerations can bleed profusely, particularly on face and scalp. When inflicted deliberately, the force may cause the assailant and weapon to be...
Anal Sphincter Tone
The forensic practitioner may be asked about the effects that a single episode or repeated episodes of anal penetration have on anal sphincter tone and subsequent continence of feces. In terms of single anal penetrative acts, partial tears and complete disruptions of the anal sphincters have been described after a single traumatic sexual act 187,188 one case was caused by pliers and the others by brachioproctic intercourse fisting . However, it is not clear from these case reports whether the...
Anal Fissures Tears and Lacerations
The most frequent injuries that are documented after allegations of nonconsensual anal penetration are anal fissures, tears, and lacerations. Use of these different terminologies is confusing and makes comparing the different data impossible. A consensus should be reached among forensic practitioners worldwide regarding what terms should be used and what they mean. Clinically, an anal fissure refers to a longitudinal laceration in the perianal skin and or mucosa of the anal canal. Anal fissures...
Oleum Capsicum
OC selectively stimulates nociceptors in exposed mucous membranes, releasing substance P, bradykinin, histamine, and prostaglandins. The physiological effects of these mediators' results in vasodilation, increased vascular permeability, pain, and altered neurotrophic chemotaxis. Other common symptoms are listed in Table 2. Table 2 Common Clinical Findings With Exposure to Crowd-Control Agents Table 2 Common Clinical Findings With Exposure to Crowd-Control Agents a Initial response believed to...
Method of Sampling Nvh
Two samples must first be obtained from the perianal area. Just as when sampling the skin elsewhere, if the perianal skin is moist, the stain should be retrieved on dry swabs. If there is no visible staining or the stain is dry, the double-swab technique should be used 28 . The forensic practitioner should use as many swabs as are necessary to remove any visible stain repeating moistened swab followed by dry swab . If no stain is visible, two swabs will suffice the first wet, the second dry ....
Abrasions
An abrasion or a graze is a superficial injury involving only the outer layers of the skin and not penetrating the full thickness of the epidermis. Abrasions exude serum, which progressively hardens to form a scab, but they may also bleed because occasionally they are deep enough to breach the vascular papillae that corrugate the undersurface of the epidermis in which case frank bleeding may be present at an early stage. More superficial abrasions that barely damage the skin with little or no...
Injuries From Handcuffs
Injuries from handcuffs either reflect relative movement between the cuff and wrist or are the result of direct pressure from the cuff to the tissues of the wrist. It is important to remember that injuries may be unilateral, especially where there has been resistance to their application. The most common injuries found are erythema, abrasions, and bruising, particularly to the radial and ulna borders of the wrist 2 . The erythema is often linear and orientated circumferentially around the wrist...
Types of Injuries See Chapter 4 31 Soft Tissue Injuries 311 Bruising
A bruise is an escape of blood into the skin, subcutaneous tissue, or both, after the rupture of blood vessels by the application of blunt force 14 . The initial color of the bruise is the product of the child's natural skin pigmentation, the color of the pigments in the extravasated blood, and any color added by the inflammatory reaction. The color of the bruise changes as the extracellular hemoglobin breaks down into various pigments 15 . Factors affecting the appearance of a bruise include...
Toluidine Blue
Toluidine blue stains nuclei and has been used on the posterior fourchette to identify lacerations of the keratinized squamous epithelium that were not apparent on gross visualization 128,129 . Use of toluidine blue increased the detection rate of posterior fourchette lacerations from 4 to 58 in adult older than 19 years complainants of nonconsensual vaginal intercourse, from 4 to 28 in sexually abused adolescents 11-18 years old , and from 16.5 to 33 in pediatric sexually abused patients 0-10...