Dark Side: Some Kind of Justice From Behind The Grave

Some pathologists, usually those not normally concerned with criminal and litigious cases, claim that an autopsy report should be a bare recitation of the physical findings, with no discussion or interpretation of the significance of those findings. This is an abdication of the pathologist's responsibility because, especially in criminal deaths, it is these condusions that are of most interest and use to che investigating officers, lawyers and courts. After the detailed description of the external and internal appearances, a short resume should be offered of the major positive findings and their relationship to the cause of death. In many cases this will be obvious, as in a gunshot wound of the head. Matters such as the probable type of weapon, the range, the direction and the likely rapidity of death, however, should also be discussed. When the findings are less clear cut, or are multiple, then the alternatives should be discussed, giving a differential diagnosis of the cause of death and detailing the possible sequence of events. If it is possible, a ranking order of probability of the various alternatives can be offered. Time of death and the limitations of accuracy in this particular case should be set out when the issue is relevant to the investigation.

What is really required is as full an interpretation as possible, without venturing into the undesirable fields of unwarranted speculation or overinterpretation, whch was the bane of forensic pathology in former years and is still practised too much even today, to the detriment of the good reputation of the speciality

Eye signs include loss of the corneal and light reflexes  leading to insensitive corneas and light reflexes  unreactive  pupils. Though the iris responds to chemical stimulation for hours after somatic death, the light reflex is lost as soon as the brainstem nuclei suffer ischaemic failure. The pupils usually assume a middilated position, which is the relaxed neutral position of the pupillary muscle, though they may later alter as a result of rigor. There may be a marked difference in the  degree of dilatation of each pupil, but this has no  significance as a diagnostic sign either of a brain lesion  or of drug intoxication. In conditions such as morphine  poisoning, where the pupils may be contracted during  life, dearh may allow this to persist or the pupils may  dilate to the 'cadaveric position'.

In addidtion to irregular size, the pupils may loose their circular shape after death as a result of uneven relaxation.  This is usually easy to differentiate from the more   obvious irregularity caused by ante-mortem abnormality of the iris. The eye globe tension decreases rapidly, as it is dependent upon arterial pressure for its maintenance. The eyeball feels progressively softer within minutes and the cornea soon loses its normal glistening reflectivity because of laxity and failure of lachrymal moistening.

The eyelids usually close, but this is commonly incomplete,  the flaccid muscles failing to the full occlusion  that occurs in voluntary closure: Where the sclera  remains exposed, two yellow triangles of desiccated  discoloration appear on each side of the cornea within a few hours, becoming brown and then sometimes almost black, giving rise to the name 'tache noire'. When viewed with an ophthalmoscope, the retina provides one of the earliest positive signs of death. This is the well known 'trucking' of blood in the retinal vessels, when loss of blood pressure allows the blood to break up into segments, similar to trucks in a railway train. This phenomenon occurs all over the body, but only in the retina is it accessible to direct viewing.

Post-mortem change in the eye, the so-called tache noire

The test is not easy to carry out, as the retina of a corpse seems far more difficult to visualize than in a living person. Many observers have described the agonal and early post-mortem appearances of the retina, though some of their accounts are rather contradictory and of little practical value, especially when they attempt tn llse them to estimate the time since death. One of the best investigations into the phenomenon was by Wroblewski and Ellis (1970), who studied retinal and corneal changes at dearh in 300 patients. About a third of the total exhibited trucking, most of them within an hour of death. Part of the difficulty in examining the remainder was that clouding of the cornea occurred in 75 per cent of patients within 2 hours of death. They concluded that segmentation was a purely post-mortem change and any intravascular movement of blood, however irregular, was an indication for continued resuscitation.

Confusion often arises about the distinction between the mode of death and its cause. This is particularly important in relation to the documentary certification of deaths, but the same confusion sometimes occurs among pathologists, especially those who are not habitually involved in medicolegal cases. The mode of death refers to an abnormal physiological state that pertained at the time of death: for example, 'coma', 'congestive cardiac failure', 'cardiac arrest' and 'pulmonary oedema'. These offer no information as to the underlying pathological condition and should not be used as the definitive cause of death unless further qualified by the more fundamental aetiological process.

To the forensic pathologist a number of post-mortem changes are of interest and potential usellness, mainly in relation to the estimation of the post-mortem interval, possible interference with the body, and an indication of the cause of death. Post-mortem hypostasis is known under a variety of older names, such as 'lucidity', 'staining' or 'cogitation', but the current title is most suitable as it indicates the cause. Hypostasis occurs when the circulation ceases, as arterial propulsion and venous return then fail to keep blood moving through the capillary bed, and the associated small afferent and efferent vessels. Gravity then acts upon the now stagnant blood and pulls it down to the lowest accessible areas. The red cells are most affected, sedimenting through the lax network, but plasma also drifts downwards to a lesser extent, causing an eventual post-mortem 'dependent oedema', which contributes to the skin blistering that is part of early post-mortem decay. The arrival of erythrocytes in the lower areas is visible through the skin as a bluish red discoloration, 'hypostasis'. It often begins as blotchy patches on both lateral and dependent surfaces, but also on the upper surfaces of the legs, especially thighs. These soon coalesce and slide down to the lowest areas. 

The pattern of hypostasis depends on the posture of the body after death. It is most common when the deceased body is lying on its back, with the shoulders, buttocks and calves pressed against the supporting surface. When the body lies for a sufficient time on the side or face, the hypostasis will distribute itself accordingly, again with white pressure areas at the zones of support.If the body remains vertical afier death, as in hanging, hypostasis will be most marked in the feet, legs and to lesser extent in the hands and distal part of the arms. In additionto pallor of the supporting areas, any local pressure can exclude hypostasis and produce a distinct pattern in contrastto the discoloured area. Examples include the irregular lin￾ear marks made by folds in rumpled bedlinen, the pattern of fabric from coarse cloth, the pressure of tight belts, brassitre straps, pants' elastic and even socks.

The usual hue is a bluish red, but variation is wide. This depends partly on the state of oxygenation at death, those dying in a congested, hypoxic state having a darker tint as a result of reduced haemoglobin in the skin vessels. This isan unsure indicator of the mode of death, however, and no reliance can be placed on a cyanotic darkening of the hypostasis to indicate a hypoxic death in the sense of 'asphyxia'. Many natural deaths from coronary or other disease have markedly dark hypostasis. Often the colour of  the hypostasis varies from area to area on the same body. Sometimes a rim of lighter colour may be seen along the margin of the lower darker area and sometimes there is a definite contrast between a bluish zone and a pink margin. This may appear and change as the post-mortem interval lengthens. Often the whole area of hypostasis is pink or bright red. When death has been due to hypothermia or exposure to cold in the agonal period, such as drowning, the colour may assist in confirming the cause of death; again this is relatively non-specific because bodies exposed to cold after death (especially in mortuary refrigeration) may turn pink after an initial stage of normal bluish-red tint.

Once hypostasis is established, there is controversy about its ability to undergo subsequent gravitational shift. If the body is moved into a different posture, the primary hypostasis may either:

Ø  -  remain fixed

Ø  - move completely to the newly dependent zones or

Ø  -be partly fixed and partly relocated.

Thus if a corpse is found with the hypostasis in an obviously inappropriate distribution related to the present posture, it must have been moved after death.

Just as blood settles in dependent skin, so it does in other  tissues and organs. The importance in forensic autopsy work is the differentiation of organ hypostasis from ante-mortem lesions. In the intestine, dependent loops of jejunum and ileum may be markedly discoloured and mislead the inexperienced pathologist into suspecting mesenteric infarction or strangulation. This hypostasis is discontinuous, however, revealing interrupted segments when the gut is laid out. Often loops in the pelvis are worst affected, because of their lower position. The lungs almost always show a marked difference in colour from front to back, the anterior margins being pale and the posterior edges lying in the paravertebral gutters being dark blue. This is often accompanied by an obvious difference in fluid content, congestion and oedema being more marked posteriorly. The myocardium often shows a dark patch in the posterior wall of the left ventricle that must not be mistaken for early infarction.

Fresh bruises may also be swollen and slightly raised above the surface. If a post-mortem pressure mark (such as from a belt or tight clothing) crosses an area of hypostasis, there will be a pale bloodless zone, but a bruise will not be affected. Hypostasis is in the most superficial layer of the dermis and any exuded blood can be wiped or washed away from the incised surface. A bruise is often deeper in the skin or underlying tissues and is fmed, being infiltrated through the tissues outside the ruptured vessels. An exception is intradermal bruising, but this is usually patterned or linear and rarely can be confused with hypostasis. Histological examination may be necessary finally to decide the matter.

Rigor mortis unlike hypostasis, the stiffening of the muscles after dearh has some relevance in determining the post-mortem interval. It has been known since antiquiry that immediately after death there is general muscular flaccidity, usually followed by a period of partial or total rigidity, which in turn passes off as the signs of decomposition appear. The timing of this sequence of events is so variable, however, that it is a poor indicator of the time since death.

 

There has been some controversy over whether rigor only stiffens the muscles or actually shortens them. Sommer, as long ago as 1833, claimed that muscles contracted after death and the changes were actually known as 'Sommer's movements'. There seems to be no doubt that some shortening does occur, but the noticeable effects are slight because both flexor and extensor muscle groups oppose each other across most limb joints. When fully established, rigor is 'broken' by forcible movements of the limbs or neck, then it will not return, a phenomenon utilized daily by mortuary staff and undertakers when preparing a body for a coffin. If rigor is still developing, it will continue in the new posture of the limbs after they have been stretched. 'Breaking' fully established rigor isan accurate description, as the rigid, inelastic fibres are physically ruptured -sometimes tearing the muscle insertionsfrom the bone. Rarely, rigor can assist in showing that a body has been moved between death and discovery. If an arm or leg is found projecting into free space without support, in a posture that obviously could not have been maintained during primary post-mortem flaccidity, then it must have been rolled over or otherwise moved.

It was shown in the earlier section on the biochemistry of rigor that marked depletion of glycogen stores in the muscle by violent exertion immediately before death can hasten the onset of muscular rigidity. Most cases of cadaveric spasm occur in similar circumstances and it was said to be particlarly common on the battlefield amongst soldiers slain in combat. In the civilian sphere it is most often seen in persons who fall into water or drop some distance down a precipitous slope such as a cliff. They may clutch at some nearby object, such as grass or shrubs, in an effort to break their fall and such material may be found held tightly in their fingers, even when the body is examined within a few minutes. Another possibility, more common in detective fiction than in practice, is the gripping of a pistol with the fingerstill tightly flexed on the trigger, as evidence of true suicide rather than a 'planted' weapon in a homicide where an attempt has been made to simulate self-shooting. Thechances of this actually being encountered by a pathologist are less than once in several professional lifetimes. If found in the victim of drowning, or of a slide from a height, it has some value in confirming that the person was alive at the time of the fall, thus excluding the post-mortem disposal of an already dead body. Of course the body must be examined before ordinary rigor might be expected to have developed, or the presence of cadaveric spasm cannot then be assumed.

The usual process of corruption of the dead body begins at a variable time after death, but in an average temperate climate may be expected to begin at about 3 days in the unrefrigerated corpse. Even in temperate zones there can be a wide range of ambient temperatures, from below freezing to near blood heat. In the tropics, far higher temperatures are commonplace, but in high latitudes or elevations, deep-freeze conditions can keep decomposition at bay indefinitely, as in the case of modern discoveries of prehistoric mammoths and medieval Esquimaux. It is therefore futile to attempt to construct a timetable for the stages of decomposition, except to point out salient markers for an undisturbed body in an 'average' indoor environment of about 18°C in temperate climates. From this approximate baseline the pathologist must then extrapolate for local variations appropriate to his climatic and geographical condition.

Whatever the time scale, the general order of corruption is similar, though the degree of advancement may vary between different areas-of even the same corpse. Usually the first external naked-eye sign is discoloration of the lower abdominal wall, most often in the right iliac fossa where the bacteria-laden caecum lies fairly superficially. Direct spread of organisms from the bowel into the tissues of the abdominal wall breaks down haemoglobin into sulphaemoglobin and other pigmented substances. This discoloration spreads progressively over the abdomen, which in the later phase begins to become distended with gas.

 

Marine predation in a body after 3 months in the North Sea. The victim was fiom an oil rig and hadfloatedon the surface in a life jacket. Much of the skin has been removed by crustaceans.

 

The usual posture of a freely floating body is face down, as the head is relatively dense, and does notdevelop the early gas formation in the abdomen and thorax. This lower position favours fluid gravitation and hence more marked decomposition, so that the face is often badly putrefied in an immersed body, making visual recognition dificult or impossible at an early stage. As stated, temperature is the major determinant of the rate of putrefaction.

The rate of decay of bodies buried in earth is much slower than of those in either air or water. In fact the process of putrefaction may be arrested to a remarkable degree in certain conditions, allowing exhumations several years later to  be of considerable value. In this respect the prospect of an exhumation should never be dismissed on the grounds that because of the lapse of time, it is bound to be worthless. It may turn out to be of little value, but this cannot be anticipated, and not infrequently the condition of the body may be surprisingly good.

The speed and extent of decay in interred corpses depends on a number of factors. If the body is buried soon after death, before the usual process of decay in air begins, putrefaction is less and may never proceed to the liquefying corruption usually inevitable on the surface. A lower temperature, exclusion of animal and insect predators, and lack of oxygen are important factors. Although most bacteria originate in the intestine, there is less access for secondary invaders and the restriction of oxygen inhibits aerobic organisms. If the body is rotting before burial then, although the process slows down, it will still severely damage the corpse, as enzymatic and bacterial growth have had initial encourage￾ment from a higher ambient temperature and free access of air.

 

When bodies are buried in coffins in vaults, rather than in earth, then again there can be a variable rate of decay. Some bodies may develop adipocere, others may wholly or partly mummify.

The most common chemical estimation performed on thevitreous fluid in the context of the post-mortem interval is that of potassium. There is a marked and progressive rise in the potassium concentration after death, the controversy revolving around whether this rise is simply linear or whether it is biphasic. The degree of confidence is also in dispute and the effect of variable factors is another contentious matter.

 

First, the potassium values from either eye often differ, sometimes by a considerable amount. The sampling methods are then critical, as small or marginal samples vary greatly; if aspiration is forcible or from too near the retina, cellular fragments distort the values, because the potassium reaches the vitreous by leaching out from the retina. The effect of temperature changes post-mortem is also undoubtedly important. In addition, different analytical techniques used to estimate the potassium give different results, the older flame photometric methods producing a different range of values compared with modern selective-electrode procedures.

To conclude the crime scene presents a large amount of information about the perpetrator’s actions. In order for the classification and linking of serial murderers’ offenses to be more than educated guesswork, conclusions must be based on empirical research of consistencies in criminal behavior and the relationship of those actions to aspects of an offender that are available to the police in an investigation. Therefore, a model of any violent crime, especially that of serial murder, should be built on the central hypothesis that offenders differ in their actions when committing crimes and that these differences reflect different interactions between the offender and victim. However, most published literature on variations in serial murderers’ behaviors have neglected victim/offender interpersonal actions that occur duringa crime. Rather, research has tended to combine accounts of crime scene actions with explanations of motivations, intentions, personality attributes, and other inferred offender characteristics.

Acknowledgements:

www.politie.nl  Politiekorpschef  @Janny Knol©

www.aived.nl    AIVD – @Erik Akerboom ©

www.politie.nl WEB Politie - @Henk van Essen©

https://www.police-nationale.interieur.gouv.fr/ @ Stephane Folcher ©

 

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