Postmortem: Establishing the Cause of Death

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9781554072200: Postmortem: Establishing the Cause of Death
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How forensic professionals determine the cause of an unnatural or violent death.

Just how realistic are the autopsy scenes in television's CSI? Using full-color photographs and detailed illustrations, Postmortem provides an exhaustive exposé of what really goes on in the autopsy room. The authors draw on 20 real-life case studies to describe the postmortem team of experts, the procedures they perform and the ways in which evidence is collected and interpreted. There are profiles of all the experts involved, including the scene photographer, the ballistics expert and the forensic toxicologist.

The entire postmortem process is described in step-by-step detail, from photographing the body to weighing the organs and testing body fluids and tissue samples. Postmortem takes the reader on a fascinating journey to the truth that covers:

  • The death scene investigation
  • Determination of identity
  • Autopsy room protocol
  • Determination of the cause and manner of death
  • The external examination
  • The internal examination

The case studies cited highlight extraordinary real-life situations, including death scenes that challenged investigators, botched autopsies, and initial examinations that puzzled pathologists and led them down the wrong path.

Postmortem is a gripping story, perfect for true crime and forensics buffs.

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About the Author:

Steven A Koehler, MPh, PhD, is head of the Forensic Epidemiological Department at the Allegheny County Coroners Office in Pennsylvania. He teaches epidemiology at the University of Pittsburgh.

Cyril H. Wecht, MD, JD, is one of the leading forensic pathologists in the United States. He is the author of several cutting-edge forensic books, including Grave Secrets and the highly successful Crime Scene Investigation, and has frequently appeared on television.

Excerpt. Reprinted by permission. All rights reserved.:

Introduction

Cyril H. Wecht, MD, JD
Former Coroner, Allegheny County
Professor of Forensic Medecine, University of Pittsburgh

The majority of people die relatively peacefully, either in hospital or at home, having received recent attendance from a doctor. Though these deaths are sad or even tragic for the deceased's next of kin, they are readily explained by naturally occurring medical conditions and bodily processes. However, not every death is so straightforward. Sometimes life ends surrounded by mystery, open to suggestion and inference or even in circumstances that lead to outright suspicion. It is in these cases that forensic specialists will take authority over the body of the deceased for the purpose of a postmortem examination.

The postmortem examination, also known as as an autopsy, is a detailed medical and legal examination of a deceased person. Postmortems of one sort or another have been conducted for thousands of years, but it is only in the last century or so that scientific and medical knowledge has been applied to the process.

The coroner is the legal figure who has authority over postmortem examinations. The position of coroner (from the Latin corona meaning "crown") originated in medieval England, where it was first set forth in Article 20 of the Articles of the Eyre in September 1194. At that time the coroner was a representative of the king or queen, who conducted inquests over dead bodies, inspection of an individual's wounds, heard appeals for justice, recorded accusations and, where it seemd that a serious crime had been committed, had the power to arrest a suspect. The coroner was also authorized to arrest witnesses for further questioning and to appraise and safeguard any lands or goods that might later be forfeited by reason of guilt of the accused.

The first formal use of physicians in connection with the workings of the coroner's office occurred in Maryland in 1860. Since that time, there has been a gradual movement in the system of death inquests toward greater medical professionalization. One aspect of this is that many jurisdictions now have a medical examiner or chief medical examiner, who must be a qualified doctor, holding authority over the investigation of suspicious or violent deaths.

In general, approximately 20 percent of deaths now undergo a postmortem examination. The coroner is responsible to make rulings on the cause and manner of death in those cases that come under his jurisdiction, including violent, sudden, unexpected or suspicious deaths; deaths involving drugs and toxic substances; deaths during medical treatment; deaths during employment; deaths during interaction with law enforcement agencies; and those cases in which a physician is not present during the time of death.

When there is an apparent victim of foul play, death investigations will be initiated. Many homicide victims are discovered by members of the public taking a walk in the woods, or the mail carrier noticing the mail and newspapers piling up, or a neighbour noting a foul odor from the apartment next door. Once a body is discovered, a large number individuals, each with special functions and duties, become involved in the investigation. The coroner's office will be contacted to initiate the steps toward a postmortem examination of the corpse.

About this book

This book will take the reader to crime scenes and detail the role of the death investigators as they collect information and evidence, and prepare reports of the circumstances surrounding the death. The roles of other forensic specialists will also be described, including forensic pathologists, photographers, toxicologists, serologists, dental examiners, anthropologists, entomologists and epidemiologists.

Leading the forensic team is the coroner or medical examiner, and this role has two main parts: to make a positive identification of the victim and to determine the cause and manner of death. The methods of positive identification range from simple photo identification to sophisticated, computer-enhanced, three dimensional facial reconstruction. The condition of the body determines the methods of determination used. The simplest method is comparing the body on the examination table to a picture on a driver's license. However, in cases of a plane crash or where only fragments of the body remain (for example, this was largely the case after the September 11 terrorist attack), identification can only be made through DNA matching. This book explains the different methods that pathologists have available to determine the positive identification of an unknown body.

The second role of the coroner is the determination of the cause and manner of death. This determination is made by first conducting an external examination of the body and then, if necessary, conducting an organ-by-organ internal examination. Occasionally, even the most meticulous examination may not reveal the cause of death. In such cases, the forensic pathologist relies on the experience of other forensic scientists. These include the forensic toxicologist who analyses body fluids for drugs, the serologist who analyses physical evidence and the firearms expert who analyses projectiles.

The culmination of the postmortem examination is the death certificate, which is a brief document, but one of great legal significance. The death certificate is an official declaration by the coroner regarding the cause and manner of death, and may play a crucial role in any criminal or civil proceedings that eventuate. Where the most gruesome crimes have been committed, the determination of homicide on the death certificate will be a key legal foundation for bringing about a conviction for murder.

In a court-room setting, forensic pathologists and other specialized forensic experts will often be called up to give testimony as expert witnesses, presenting their scientific findings in a readily understandable form before the judge and jury to help ascertain guilt or innocence.

Without the methods of the modern postmortem, we would have no means of achieving legal justice for the dead, no way of establishing the facts of violent crime and, ultimately, no way of establishing the truth about how some lives end.

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