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Current Practice in Forensic Medicine

John Gall (Editor), Jason Payne-James (Co-Editor)
ISBN: 978-0-470-74487-1
348 pages
February 2011
Current Practice in Forensic Medicine (0470744871) cover image
Although forensic medicine has been in existence for centuries in one guise or another, it is only with the recent growth in international research that it has begun to be acknowledged as a specific discipline in its own right. Many areas of progress are being made and this text aims to provide a unique, in-depth and critical update on selected topics that are of direct relevance to those practicing in the field including lawyers, police, medical and dental practitioners, forensic scientists and postgraduate/undergraduate medical students and undergraduate law students preparing for forensic medicine examinations.

This volume is designed to cover the wider aspects of forensic medicine, including the law, science, medicine (forensic pathology, clinical forensic medicine and forensic psychiatry) and dentistry. Topics covered include subjects of debate and/or uncertainty in areas where significant advances have been made and in those of current relevance to the forensic profession, Chapters provide a variety of approaches to the areas under discussion with reviews of current knowledge, information on significant changes and pointers to the future that the reader should be aware of.

Features:

  • An authoritative review, for forensic medicine practitioners throughout the world, from leading international experts in the field.
  • Provides critical commentary and updates on current practice.
  • Topics include: a guide to the presentation of forensic medical evidence, bioterrorism, the paediatric hymen, assessment and interpretation of bone trauma in children, adult sexual assault, genital photography, forensic photography, common errors in injury interpretation, self-inflicted injuries and associated psychological profiles, bite marks and the role of the pathologist in aviation disasters.
  • Includes a wealth of four colour figures to illustrate key points discussed within the text.
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List of Contributors.

Foreword.

Preface.

Chapter One: Expert evidence and healthcare professionals.

Introduction.

The adversarial system of justice.

Expert reports.

Evidentiary exclusionary rules.

Pre-trial preparation for expert witnesses.

Appearance.

Timeliness.

Giving of evidence.

Managing cross-examination.

Summary.

References.

Chapter Two: Forensic investigation of biological weapon use.

Introduction.

A choice of words.

Threat assessments.

Presenting features.

Forensic microbiology or microbial forensics?

Assembling evidence from emerging infectious disease biology.

Current constraints.

References.

Appendix. 

Chapter Three: The paediatric hymen.

Introduction.

Studies of normal anatomy.

Studies of genital findings in sexually abused girls.

Studies of acute injuries as they heal.

A consideration of test reliability.

Putting it all together.

References.

Chapter Four: Assessment and interpretation of bone trauma in children.

Introduction.

How should I evaluate suspected bone trauma in children?

What radiological investigations identify bone trauma?

How do X-rays detect fractures?

How does ultrasound detect bone injury?

How do nuclear medicine scans detect bone injury?

How does MRI detect bone injury?

How are medical images presented and shared?

What forces cause bones to fracture?

Are some bone injuries diagnostic of child abuse?

What do we know about bone healing in children?

What tests detect fragile bones?

Neonates with fractures: what are the special considerations?

Can the time of bone injury be determined?

Why might an X-ray be reported as normal when bone trauma exists?

Why might an ultrasound appear normal when bone trauma exists?

Why might a nuclear medicine scan appear normal when bone trauma exists?

Why might an X-ray appear abnormal when no bone trauma exists?

Why might a nuclear medicine scan appear abnormal when no bone trauma exists?

How do I deal with correctly interpreted but discordant imaging findings?

Why might an X-ray appear normal and bone scan ‘hot’ when bone trauma exists?

Why might a fracture seem obvious on plain X-ray but bone scan is 'cold' when bone trauma exists?

When and why should I repeat x-rays?

How does the process of forming a forensic medical opinion differ from the process of diagnosis in clinical medicine?

Why do I need to be aware of my level of confidence in my medical diagnosis?

What factors should I consider when forming a diagnostic opinion about the cause of a child’s fracture?

References.

Chapter Five: Adult sexual assault.

Introduction.

Sexual assault settings and characteristics.

Findings after sexual assault.

Toxicology and sexual assault.

Forensic science and sexual assault.

Treatment after sexual assault.

Summary.

References.

Chapter Six: The ethical and medical aspects of photo-documenting genital injury.

Introduction.

Sexual assault.

Imaging the body in the history of medicine.

Photography.

The evolution of the photography of genital injury.

A particular Australian's experience.

Ethics of care.

Why no ethical objection to children being photographed?

The difference that being a child makes and its relevance.

Advancing the question of best ethical practice.

Clinical forensic medicine and sexual assault.

Conclusion.

References.

Appendix.

Chapter Seven: The photography of injuries.

Introduction.

The image.

Equipment.

Illumination.

Polarizing filters.

Forensic scales.

The photography of an injury.

The colour control or reference.

Cross-polarized photography.

Reflected ultraviolet.

Infrared.

Long wave ultraviolet-induced fluorescence.

Imaging file format.

The audit trail.

Conclusion.

References.

Further reading.

Chapter Eight: DNA analysis: Current practice and problems.

Introduction.

DNA collection and storage.

DNA extraction.

DNA quantification.

DNA amplification.

DNA separation and detection.

DNA genotyping.

Standard loci sets and commercial STR kits.

Statistical evaluation of a DNA match.

Assessing STR profiles.

Mixtures of DNA.

Degraded DNA.

Low-template DNA.

Other genetic markers.

Tissue identification.

Use of DNA in the criminal justice system.

References

Chapter Nine: Injury interpretation: Possible errors and fallacies.

Injury visualization.

Nomenclature.

Photography.

Aging of injuries.

Force of injury.

Medical limitations and considerations.

Genito-anal injuries in the adult.

Child abuse.

Self-inflicted injury.

Other specialist opinions.

Opinions.

How to avoid errors.

References.

Chapter Ten: Self-inflicted injuries and associated psychological profiles.

Introduction.

Forensic aspects of self-harm.

Psychiatric aspects of self-harm.

Epidemiology.

Classification of self-harm.

The clinical dilemma.

Management.

Long-term outcome.

Conclusion.

References

Chapter Eleven: Bite marks.

Introduction and cautionary remarks.

Animal bites.

Other injuries mimicking bites.

Bites in foodstuffs.

Examination of injuries in the dead.

Examination of the living.

Examination of the suspect.

Trends in bite-mark analysis.

Acknowledgement.

References.

Further Reading. 

Chapter Twelve: Aviation disasters: The role of the forensic pathologist.

Introduction.

The scene.

The autopsy.

Establishing the cause of death.

Circumstances surrounding death.

Forensic pathology report.

References.

Index.

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John Gall is a forensic physician in private practice, Director of Southern Medical Services, Principal of Era Health and is a staff specialist Forensic Physician in the Victorian Paediatric Forensic Medical Service, located at the Royal Children's Hospital and Monash Medical Centre, Melbourne. He is a member of the International Editorial Board of the Journal of Legal and Forensic Medicine and Internet Journal of Forensic Medicine and Toxicology. He has published widely in the field of clinical forensic medicine and has spent many years teaching forensic medicine to undergraduates and graduates.

JASON PAYNE-JAMES is a forensic physician. He is Honorary Senior Lecturer, Cameron Forensic Medical Sciences, Barts & the London School of Medicine & Dentistry, University of London, UK. He is Director of Forensic Healthcare Services Ltd. He is external Consultant to the National Policing Improvement Agency and to the National Injuries Database in the UK. He is Editor-in-Chief of the Journal of Forensic & Legal Medicine. He has published widely in the field of clinical forensic medicine. He has also co-edited, co-authored and contributed to numerous books in the field including Black, Aggrawal and Payne-James: 'Age Estimation in the Living' 2010 (Wiley Blackwell).

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"This being said, given the challenges in locating an expert willing and able to be called by the defence on an issue involving forensic medicine, this text would certainly be a valuable addition to the criminal practitioner's library." (For the Defence, 2012)

"If you find this book up your street and valuable, as many of you will, look out for more: The editors intend there to be a follow up ‘regular multi volume text addressing recent advances in the practice of forensic medicine'." (Expert Witness Newsletter, 1 March 2012)

"All in all, a very useful book. I would highly recommend this book not only to all forensic physicians, but to everyone practicing in this field. I would imagine that his book would be highly useful for lawyers, police, medical and dental practitioners, forensic scientists. I would also recommend this book to all undergraduate and postgraduate law and medical students preparing for forensic medicine examinations." (Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology, 1 January 2012)

"Most of the topics are extremely useful for newly trained and in-training forensic pathologists. The book provides a concise summary of controversial topics with good references, although some chapters are less pertinent." (Doody's, 14 October 2011)

"The editors of this text have compiled an authoritative review of the topic, with contributions from leading international experts in the field. They provide enough detail about the forensic sciences to give practitioners some insight into these areas without attempting to turn them into experts." (Sydney Forensic Medicine and Science Network, 2011)

"Edited and written by leading international experts in the field, this in depth guide will provide an invaluable and authoritative, critique of topical areas of forensic medicine that are of key interest to practitioners throughout the world." (PR-Inside.com, 22 February 2011)

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