1. A 61-year-old gentleman was well known to his neighbors as a friendly man who liked to drink too much. Over the course of 4-6 weeks, the neighbors noticed a change in the man’s personality. He was less friendly, seemed not to remember their names, when he did talk he complained of headaches (of which he had not complained before), and they even talked among themselves as to the unsteady gait and dragging foot they saw when he would leave his apartment. Speculation ranged from drinking yet more, to his excessive alcohol consumption just catching up with him, to a simple function of premature aging.
When the neighbors didn’t see the man for several days, they called the police. Unable to get any response, officers made entry, finding the man in bed, lying on his side, with his face hanging down toward the floor. He was dead. An open wound was noted just above the eyebrow, approximately 2 inches long, with undermining of its superior edge; tissue bridges were seen, as were areas of abrasion above the wound. Apparent black eyes were also noted bilaterally. Blood was noted on his shirt.
a. Given this history and physical description, what injuries or other conditions do you anticipate might be demonstrable at autopsy? Why?
b. Of those possible pathologic findings, which do you believe is the most likely cause of this patient’s death? Why?
2. The forensic pathologist loves to teach, and knows you took courses in Forensic Pathology as part of your Masters in Forensic Science degree. He turns to you, and says “Before I open the head and body, based upon the history we just heard, what is the most likely cause of this poor boy’s death. What is your best assessment of what happened to him, anatomically and physiologically?”
3. The body of a 19-year-old male is found on the roadway, alongside a vehicle that hit a tree. Three of the four doors of the vehicle have popped open. 2 other bodies are also found at the scene. On examination at the Morgue, the decedent above referenced is found to have minor abrasions of his chin and right cheek, and his jaw appears slightly distorted. However, upon palpation of the mandible, it is found to be grossly unstable, with subsequent X-Ray demonstrating 19 distinct fractures of the jaw between the Right and Left Mandibular Rami. At autopsy, his trachea is found to be filled with vomitus. No other injuries are demonstrable, although there is some fluid residue found in the stomach, smelling of alcohol.
a) Given these findings, what are the possible causes of death? Which do you believe to be the most likely cause of death?
b) Is it obvious from the injury pattern where the decedent was sitting in the vehicle? If not obvious, where do you believe it likely the decedent was sitting, and why? How would you go about investigating his location to confirm or refute your impression as to his location in the vehicle?
4. Two guys, ages 27 and 17, met 2 girls, aged 16, at a lakeside resort, asking if the girls would like to take a ride in their jeep. Welcoming the opportunity the girls jumped in, not knowing or not caring that the fellas had been drinking all afternoon. Driving around curving mountain roads at a high rate of speed, the jeep went off a cliff, coming to rest some 100 feet below. The 2 males were dead at the scene, the 2 females unconscious but alive. En route to the hospital by ground ambulance, one of the females suffered cardiorespiratory arrest approximately 20 minutes before arriving in the Emergency Department. A resuscitative effort of 1 hour, including CPR and Advanced Cardiovascular Life Support in the ambulance, was to no avail.
At autopsy, both males were found to have distended urinary bladders (a potential indication of their state of intoxication—alcohol is a diuretic, thus the full bladder; alcohol is also an anesthetic, thus the reason the bladder was not emptied via urination—voluntary or otherwise!).
The first body is that of a 17-year-old male, with no obvious external trauma. Examination of the body is essentially negative. Examination of the skull and brain reveals intracranial hemorrhage.
The second body is that of a 27-year-old-male with no obvious external trauma. Examination of the body reveals 1) atrioventricular bisection of the heart, without significant blood loss, and 2) traumatic rupture of the spleen, again without significant blood loss. Examination of the skull and intracranial contents reveals a hinge fracture of the skull base, extending from one ear to the other, and minimal evidence of intracranial bleeding.
The third body is that of a 16-year-old female. She is noted to have ecchymosis of the Right eye, deep scalp laceration extending from the hair line to just above the Right eyebrow, complete tear through the liver, with approximately 3600 ml of blood suctioned from the abdominal cavity (someone her size probably had a total blood volume of approximately 4000 ml). Her bladder was empty.
a) Please write, in appropriate format, cause of death statements for each of these decedents, and explain your reasoning.
b) Based on the findings reported, can you state where the decedents were likely seated in the jeep? How would you further investigate these deaths to make definite that determination? What other findings of significance would you search for?
c) The bladder of the female was not distended with urine. Does that mean she did not drink a significant amount the day of the Motor Vehicle Collision? Why or why not?
5. I will show you a diagram of this death scene in chat this week:
You are called to investigate the death of a 23-year-old female. She was found in her bedroom by her boyfriend upon his return from work, the victim of agunshot wound to the head. The boyfriend states the decedent has been depressed over the past several months over their relationship. Upon questioning, he insists he did not touch her nor disturb anything in the room, because he could see that his girlfriend was obviously dead.
Examination of the room reveals a bed positioned against the wall, oriented in a North-South direction.A .38 caliber handgun is found in about the mid-position of the bed—vertically and horizontally. Blood and brain matter are noted on the center of the bed, and some blood is also noted on the North wall to the right side of the bed.
The body of a well-developed and nourished female appearing the stated age of 23 is found on the floor to the right side of the bed. She is wearing a robe, which is neatly closed in front. Her Right arm is at her side, and her Left arm is extended above her head. Her left leg is found flat on the floor, bent at the knee like one side of an “M,” and that leg goes behind a post of the bed (upslope of the “M,” bend in the knee, lower leg behind the bed post and extending beyond the lower end of the bed). Post mortem lividity is present, but is not fixed. Rigor mortis is not present. There is a gunshot wound of the Left Temple and another GSW of the Right Temple, each covered with blood, and thus difficult to fully inspect.
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