Forensic pathology

Anatomy or system affected: All

Definition: A science that brings medical knowledge to bear to resolve legal issues, usually through the performance of an autopsy.

Science and Profession

Forensic medicine is probably best known to most people because of the work of forensic pathologists, principally for the autopsies that they perform as coroners and medical examiners. Other experts—anthropologists, histologists, odontologists, psychiatrists, serologists, toxicologists, police officers, and specialists in trace evidence—are also key participants in the field. Except for the forensic psychiatrist, who determines the sanity of an accused individual and, thus, that person’s fitness to stand trial, these specialists generally do not become involved in the work of forensic medicine until a death occurs other than from natural causes.

In the United States, a forensic pathologist is a medical doctor who typically will spend three to four years preparing in that field after graduating from medical school and two or so years beyond that before being certified by the American Society of Clinical Pathologists. Other forensic specialties generally require a four-year college degree as well as specialized training after that.

Forensic medicine is not a crowded field. Indeed, there is a shortage of trained and qualified people because most such jobs are in the public sector, where salaries are good but not as high as similar skills and knowledge will command in the private sector. Those who choose careers in forensic medicine, however, find the work more exciting, intellectually challenging, and personally satisfying than most private-sector jobs.

Duties and Investigative Techniques

As a general rule, the coroner, supported by one or more of the specialists listed above, will become involved in a death when a person dies by suspected criminal or violent means, by suicide, suddenly when in apparent good health, or in any suspicious or unusual manner. In such a case, the coroner is typically charged by law with determining the cause, mode, and manner of death, with each of those terms having a specific meaning. The physical cause of death is purely a medical determination. Legal considerations, on the other hand, are broader and more inclusive.

Medical and legal aspects, however, are so interrelated that they cannot be separated. For example, to determine the physical cause of death, it would be sufficient to show a penetrating wound to the heart. To determine the mode of death, however, it would be necessary to establish whether the wound was caused by a bullet or a sharp instrument. An autopsy would reveal the mode of death. The next question is legal: What was the manner of death? In other words, how was the wound inflicted? Was it self-inflicted? If it was, was it intentional (suicide) or accidental? If it was inflicted by another person, was it an accident, or was it homicide? Investigation of the scene where the injury was sustained, examination of the evidence found there, and statements of witnesses would furnish information as to the circumstances of the incident.

The actual autopsy involves the dissection and examination of a dead body—surgery performed postmortem. It begins with what is called a gross examination—that is, a visual examination with the naked eye, first externally and then internally. For the internal examination, a Y-shaped incision is made beginning at each shoulder, running down to and meeting just below the sternum or breastbone and continuing as a single cut down to the lower portion of the abdomen just above the genital area. Rib cutters are used to expose the thoracic area. The internal organs are removed and examined. Fluids are drawn for laboratory tests, and tissue samples are taken for microscopic examination. Access to the brain is gained by using a small power saw to remove the top part of the skull. The third portion of the autopsy involves the toxicological examination of body fluids, including blood, urine, and the vitreous humor of the eye. After examination, the body is restored, and the incisions are carefully sewn.

Perspective and Prospects

Probably the first well-known person to be the subject of a postmortem examination was Julius Caesar. A physician named Antisius determined that of the twenty-three wounds that Caesar sustained, the one that perforated the thorax was the cause of death. The sixth-century Justinian Code of the Byzantine Empire required the opinion of a physician in certain circumstances and often is credited as the first recognition of the correlation of law and medicine in effecting legal justice. By the sixteenth century in England, investigations were being made by a representative of the king, who had the title of Custos Placitorum Coronae (guardian of the decrees of the crown), from which comes the word “coroner.” It is believed that William Penn appointed the first coroner in the American colonies. In the nineteenth century, forensic medicine became established as a distinct specialty and continued to mature into the advanced and sophisticated field it is in the twenty-first century.

The capabilities of and advances in forensic medicine traditionally are tied to those of science in general and applicable medical specialties. They set the pace for the development of forensic medicine. The future should prove no different. The advances in overall knowledge of deoxyribonucleic acid (DNA), the development of scanning electron microscopy, improvements in spectrographic analysis, and advances in computer graphics capabilities, for example, occurred outside the field of forensic medicine and subsequently were adopted by it.

Bibliography

Bell, Suzanne. Forensic Science: An Introduction to Scientific and Investigative Techniques. 5th ed., CRC Press, 2019.

Browning, Michael, and William R. Maples. Dead Men Do Tell Tales: The Strange and Fascinating Cases of a Forensic Anthropologist. Main Street Books, 1995.

Camenson, Blythe. Opportunities in Forensic Science Careers. Rev. ed., McGraw-Hill, 2009.

Evans, Colin. The Casebook of Forensic Detection: How Science Solved One Hundred of the World’s Most Baffling Crimes. Berkley Books, 2014.

Genge, N. E. The Forensic Casebook: The Science of Crime Scene Investigation. Random House, 2002.

Joyce, Christopher, and Eric Stover. Witnesses from the Grave: The Stories Bones Tell. Little, Brown, 1991.

Klawans, Harold L. Trials of an Expert Witness: Tales of Clinical Neurology and the Law. Little, Brown, 1998.

Maeda, Hitoshi, et al. "Forensic Molecular Pathology of Violent Deaths." Forensic Science International, vol. 203, no. 1–3, Dec. 2010, pp. 83–92.

Miller, Hugh. What the Corpse Revealed: Murder and the Science of Forensic Detection. St. Martin’s Press, 1999.

Pollanen, Michael. "Forensic Pathology and the Miscarriage of Justice." Forensic Science, Medicine & Pathology, vol. 8, no. 3, Sept. 2012, pp. 285–289.

"What is a Forensic Pathologist?" The University of New Mexico, hsc.unm.edu/omi/about/faq/forensic-pathologist.html. Accessed 25 July 2023.