Forensic toxicology

Deborah Blum has written an entertaining book (The Poisoner's Handbook) on the development of forensic medicine at the newly created Office of Chief Medical Examiner, New York City - under the guiding steer of Dr Charles Norris - and of forensic toxicology during Prohibition in the 1920s.

Alexander Gettler, the toxicologist at Norris' right-hand, worked tirelessly to identify poisonous substances in cadavers at a time when the techniques necessary to do so were either non-existent or unreliable.


The 'Father of Toxicology' - Mathieu Joseph Bonaventure Orfila (1787–1853) - attempted to bring chemistry into forensic medicine as often as possible and, on the matter of the detection of arsenic at exhumation he argued that arsenic in the soil around graves could be drawn in to the body and be mistaken for poisoning.

Orfila-related resources available online include:

• Chemistry, Medicine and Crime. Bertomen-Sanchez JR, Nielo-Galan A (Eds) 2006
• On the detection of poisons. Orfila M The Lancet 1831; 16(398):72-76
  
• National Library of Medicine - Visible Proofs exhibition website
  

Additional resources regarding early forensic science pioneers, autopsy practice and forensic pathologists are available here. (http://forensicpathologist.webnode.com/autopsies-at-the-turn-of-the-20th-century/)

New website - forensic pathologists in history

A new website is currently under construction by me, providing resources on famous forensic pathologists in history, and their notorious cases.

The website will cover Sir Bernard Spilsbury, Professor Keith Simpson, and Dr Francis Camps initially, but will expand in due course to include Professor Bernard Knight, Sir Sydney Smith and others.

Forensic pathologists old and new revisited

A recent BBC4 programme - Watching the dead - considered how the portrayal of forensic scientists and pathologists in 'crime dramas' had changed over the past 30 or so years, and in doing so presented a clip of Professor Keith Simpson teaching some students at Guy's Hospital, and being interviewed for the Horizon programme in the 1970s. The programme also featured Professor Bernard Knight explaining how he had tried to inject some realism into those forensic dramas on which he acted as advisor, with little success!

With one nostalgic eye on the past, a read of Andrew Rose's book on Sir Bernard Spilsbury - Lethal Witness - starts one thinking about how one's own work will be judged in the future. As forensic pathological evidence and theory changes over time, it is inevitable that opinion given decades ago will now seem untenable, but that is the nature of 'scientific evidence'. Perhaps we shouldn't view the 'old guard' of forensic pathology so harshly?

Coroners and Justice Bill

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The long-awaited Coroners and Justice Bill has been published, having finally been included in the Queen's speach in December.

The Bill repeals the Coroners Act 1988, and Part 1 sets out the duty on Coroners to investigate certain deaths (where the Coroner has reason to suspect that the deceased died a violent or unnatural death, or where the cause of death is unknown, or where the deceased died in custody/ state detention).

Of great interest in the UK is the introduction of reforms of the death certification process, and the Bill sets out a new duty on Primary Care Trusts (England) and Local Health Boards (Wales) to appoint 'medical examiners' to scrutinise, and enquire into, deaths in which doctors have issued Medical Certificates of Cause of Death - a function proposed in a Department of Health consultation last year.

A new duty on medical practitioners to notify the Coroner of a death 'of which they are aware' is also included in the Bill, following a consultation last year by the Ministry of Justice. Regulations detailing the circumstances in which such a death should be reported will apparently follow after enactment of the Bill.

The Bill creates a new Chief Coroner (to be a judge of the High Court or a Circuit judge) who will lead a new national Coroner Service.

The Bill's progress through Parliament will be eagerly followed by practitioners in the UK, and a new post will follow when the Bill receives Royal Assent.

Paediatric forensic pathology

The death of a child or infant in suspicious circumstances is one type of case that has the potential for being particularly contentious for forensic pathologists, and the evidence base upon which opinions are based is weak in certain instances, not least those involving alleged 'shaken baby syndrome' or 'short distance falls'.

The Goudge Inquiry into paediatric forensic pathology services in Ontario, Canada demonstrates how 'bad things can get'. Aspiring forensic pathologists are recommended to visit the website for this Inquiry, which provides a unique insight into current thinking on the contentious issues, with transcripts of witnesses called to give evidence at the Inquiry, as well as some extremely interesting documents prepared by forensic pathology and legal experts for the Inquiry.

Of particular note are 'Paediatric forensic pathology: Limits and controversies', by the Victorian Institute of Forensic Medicine, Australia, 'Medical mistakes and miscarriages of Justice' in the UK, 'Paediatric forensic pathology as forensic science', and 'Demonstrable reliability and expert forensic pathology evidence'. In addition, there is an excellent paper, again from the Victorian Institute, on 'A model Forensic Pathology Service', which gives more general guidance on how a modern forensic pathology service should operate.

All authors highlight the lack of 'evidence-based forensic pathology', particularly in those areas of paediatric practice that are commonly in dispute at trial. The Welsh Child Protection Systematic Review Group is attempting to address this need, and have performed systematic reviews of the literature for abusive bruising, fractures, burns and oral injuries/bites, as well as currently finalising a review of non-accidental head injury, and undertaking a review of retinal haemorrhages. It remains to be seen whether such evidence makes its way into expert opinions and court proceedings.

Fire deaths

One category of death that often causes interpretative problems for forensic pathologists is the fire death.

A useful summary of the issues raised by such deaths has been recently published, highlighting the need to establish the deceased's identity and, in the pathological assessment of the body, to determine whether the deceased was alive at the time of the conflagration, why they could not extract themselves from the fire, and what the cause (and manner) of death appears to be.

In England and Wales, fire deaths are often investigated by coroner's pathologists with little (or no) training in forensic pathology; the approach taken in some cases rests on the assumption that there are no attendant suspicious circumstances, and it is only when the post mortem blood carboxyhaemoglobin level is returned from the laboratory as zero % that a review of the post mortem findings indicates some other cause of death than 'exposure to fire smoke and fumes'.

Whether this situation would occur in jurisdictions in which forensic pathologists perform all such post mortem examinations is unclear, but it behoves the autopsy-performing pathologist to consider the possibility that their 'fire death' is not related to exposure to the products of fire but is, in fact, a concealed homicide, and that the pathological assessment - and documentation of the findings - is capable of scrutiny should the 'worst-case scenario' unfold later in the course of the investigation.

Medicolegal misconceptions

The public is exposed to a wealth of forensic pathology in the media, particularly in TV programmes such as Silent Witness (UK) and CSI. However, these representations are rarely accurate.

Dr Charles Petty identified popular medicolegal misconceptions (the 'devil's dozen') in an article in 1971;

• that the time of death can be precisely determined by the examination of the body
• that the autopsy always yields the cause of death
• that the autopsy can properly be carried out without a 'history'
• that the autopsy is over when the body leaves the autopsy room
• that embalming will not obscure the effects of trauma and disease
• that only true and suspected homicide victims need examination
• that the cause and manner of death are the only results of the autopsy
• that any pathologist is qualified
• that the autopsy must be immediate
• that the poison is always detected by the toxicologists
• that all physicians are good death investigators
• that the medicolegal autopsy is criminally or prosecution oriented

These are still valid misconceptions today, again illustrating the fact that 'nothing is new under the sun', and that forensic practitioners will always be struggling to disabuse the police and others involved in the administration of justice that forensic pathology does not provide all of the answers in any investigation.