2016

i pdf http://www.med.nagoya-cu.ac.jp/legal.dir/lectures/newest/lecturenotes.pdf PDF html pl A TEX 2ε 2016 4 11 aokiy@med.nagoya-cu.ac.jp

iii 1 1 1.1................................ 1 1.2.................. 2 2 Postmortem changes 5 2.1................................ 5 2.2................................ 8 2.3..................... 9 2.4.................. 9 3 11 3.1.................................. 11 3.2................................. 11 3.3.................................. 12 3.4 abrasions........................... 12 3.5 bruise............................ 13 3.6 laceration..................... 13 3.7............................... 14 4 19 4.1 stab wound............................ 19 4.2 incised wound.......................... 22 4.3 chop wound........................... 22 5 25 5.1................................ 25 5.2..................................... 27 6 33 6.1 cause of death.......................... 33 6.2................................ 33 6.3............................. 35 6.4............................... 35

iv 7 37 7.1............................ 37 7.2................................ 39 8 43 8.1................................. 43 8.2.................................. 44 9 45 9.1................................. 45 10 51 10.1.................... 51 10.2................................. 53 10.3................................ 54 10.4 hanging.............................. 55 10.5 (ligature strangulation...................... 57 10.6 manual strangulation...................... 59 11 61 11.1 drowning............................. 61 11.2................................... 64 12 65 12.1..................................... 65 12.2................................... 68 12.3............................... 69 12.4................................... 72 12.5..................................... 72 13 77 13.1......................... 77 13.2..................................... 77 13.3.......................... 78 13.4................................ 78 13.5................................. 78 13.6.................................. 79 13.7 Munchausen s syndrome by proxy.................... 80 13.8 Whiplash shaken baby syndrome...... 80 14 83 14.1............................. 83

v 14.2............................. 84 14.3....................................... 84 14.4..................................... 84 14.5................................. 85 14.6............................... 85 14.7................................ 85 14.8..................................... 85 15 87 15.1................................ 87 15.2.................................. 87 15.3 unexplained sudden death........... 89 16 91 16.1.................................. 91 16.2.................................. 91

1 1 1888 1914 1.1 1. A. i ii a) b) c) B. i ii 2. A. B. DNA i ii 3.

2 1 1.2 1. forensic medicine forensic pathology forensic toxicology medico-legal forensic sciences 2. forensic pathology 3. forensic toxicology 4. forensic genetics 1985 Jeffreys DNA 1987 Mullis PCR DNA 5. forensic odontology, forensic dentistory DNA 6. forensic anthropology physical anthropology DNA 7. legal medicine forensic medicine medical jurisprudence (medico-legal aspects of medical practice)

1.2 3 Department of Legal Medicine 8. forensic entomology life cycle succession URI: http://www.forensicentomology.jp/ 9. forensic Sciences American Academy of Forensic Sciences AAFS: forensic sciences Forensic science is the application of scientific principles and technological practices to the purposes of justice in the study and resolution of criminal, civil and regulatory issues. AAFS 11 Criminalistics, Digital & Multimedia Sciences, Engineering Sciences, General, Jurisprudence, Odontology, Pathology & Biology, Physical Anthropology, Psychiatry & Behabioral Sciences, Questioned Documents, Toxicology Included among the Academy s members are physicians, attorneys, dentists, toxicologists, physical anthropologists, document examiners, psychiatrists, physicists, engineers, criminalists, educators, digital evidence experts, and others.

5 2 Postmortem changes decomposition 2.1 2.1.1 livor mortis, livdity, postmortem hypostasis hypostasis 1. dependent areas 2. A. Hb: reddish purple, B. HbCO: cherry red to pinkish C. HbO 2 : bright red D. HbCN: E. HbS:,

6 2 Postmortem changes 3. A. 2 8 12 fixed, maximum coloreation B. dependent area 4 5 2 dependent areas C. 24 36 4. p. 54 p. 63 5. internal livor mortis: autopsy imaging (AI) 6. p. 54 Tardieu s spots * 1 2.1.2 rigor mortis postmortem stiffening of the body ATP *1 Tardieu postmortem petechiae Tardieu s spots

2.1 7 1. 20 2 3 8 12 24 30 2 4 decomposition 2. 4 5 3. 4. ex. drowning 5. 6. cadaveric spasm : 2.1.3 body temperature 1. A. B. C. D. E. 2. rectal temperature 1 0.5 1 S reverse sigmoid curve 2 3. 2 PC

8 2 Postmortem changes 2.1.4 cloudiness of the cornea 1 2.2 autolysis putrefaction 2.2.1 cf: 2.2.2 Casper s law: 1 1/2, 1/8 1. discoloration : 1 2 HbS 2. marbling : hemoglobin 3. swellingvesicle formation 4. A. insect activity life cycle succession forensic entomology B. C. : 5. skeletonization scavenger

2.3 9 2.3 1. mummification A. B. 3 C. 2. adipocele Clostridium perfringens 3. 3 2.4 1. 2. 3. 4. 5. 6. 7. 8.

11 3 3.1 injury (wound) 3.1.1 3.1 3.2

12 3 1. blunt force injury A. abrasion B. bruise, contusion C. laceration 2. sharp force injury A. incised wound B. stab wound C. cut(chop) wound 3. gunshot wound: 3.3 impact, crush pressure scrape blunt force injuries 3.4 abrasions scrapecrush 1. scrape (brush) abrasion: graze (sliding) abrasion 2. impact (pressure) abrasion: patterned abrasion 3. A. 1 2 6

3.5 bruise 13 B. 1 3 C. 1 10 D. 2 vital reaction p.35 3.5 bruise 1. 2. 3. 4. patterned injury 2 tramline bruise 5. 3.6 laceration crush shear lacerattion variation (stretch striae)

14 3 3.2 1. 2. 3. tissue bridging 4. 5. A. B. C. 6. Decollement traumatique, avulsion, 3.7 3.7.1 1. direct fracture 2. indirect fracture, 3. 4.

3.7 15 child abuse 3.7.2 1. 2. commotio cordis 3. cardiac tamponade 4. LAD 5. steering wheel injurydashboard injury p.37 6. CPR 1. 2. 5 p. 77 3. 4. p.40 5. CPR 1. 2.

16 3 3.7.3 craniocerebral injuries impact injuriesacceleration/deceleration injuries 1. A. B. i bursting fracture diastasis a) bending fracture patterned fracture b) depressed fracture c) penetrated fracture: p.25 ii skull base fracture a) transverse hinge fracture motor cyclist s fracture) b) longitudinal fracture c) ring fracture (fall) (impact to the chin) [ ] black eye raccoon sign, ) ➀ ➁ orbital top ➂ gravitational seepage C. epidural hematoma lucid interval 100ml

3.7 17 D. traumatic subarachnoid hemorrhage i ii E. contusion i coup contusion ii contrecoup contusion iii iv v F. traumatic intracerebral hemorrhage 2. acceleration/deceleration injuries A. acute subdural hematoma,sdh i bridging vein ii iii epidural hematoma iv v vi p.77

18 3 B. traumatic axonal injury, TAI diffuse axonal injury, DAI 6 12 retraction ball 2/3 SDH DAI DAI

19 4 sharp force injuries 4.1 stab wound 1. A. B. C. D. E. 2. A. B. i Langer ii iii

20 4 iv guard mark v p. 14 C. incised stab wound D. E. (entrance) (exit) i ii 3. A. i guard mark ii 4.1 iii B. C. xcm ycm zmm xcm xcm ycm zmm D.

4.1 stab wound 21 4.2 E. F. G. 4. A. : B. : C. D. E. 5. A. B. C. defence wound

22 4 4.2 incised wound 1. A. B. C. D. 2. 3. 4. 4.3 5. 6. 7. A. B. 1 hesitation mark C. 4.3 chop wound

4.3 chop wound 23 1. A. B. C. D. E. 2. 3.

25 5 gunshot wound, GSW 5.1 small arms 5.1.1 handgun 1. A. swing-out B. break-top C. solid-frame single action double action single action type double action type 2. semiautomatics A. blow-back: B. recoil: firing 3. single-shot derringers inch mm

26 5 5.1.2 rifle barrel length 16 single-shot pump-action bolt-action autoloading ( ) lever-action rifling rifle mark Manufacturer twist number Colt left hand twist 6 S & W right hand twist 5 * right hand twist 5.1.3 shotgun smooth-bore choke (spread) single-shot lever-action over-and-under pump-action double-barrel autoloading bolt-action gage 10, 12, 16, 20, 28,.410) 1lb gage = bore 10gage = 0.775in 12gage = 0.729in 5.1.4 1. submachine guns. 2. machine guns. crew-operated 5.1.5 ammunition ➀ ➁ powder propellant) ➂ ➃ bullet projectile) smokeless powder lead bulletmetal-jacketed

5.2 27 bullet full metal jacket partial metal jacketed ➀ ➁ ➂ ➃ ➄ shot) birdshot pellets shotgun slug 5.1.6 E(J) = mv2 m (kg) v 2 E S 20J/cm2 S 3.5J/cm 2 25 250m/s 1000m/s 400 500m/s 5.2 temporary cavity entrance GSWexit GSW wound track perforating GSWpenetrating GSWgunshot wound shotgun wound SGW 5.2.1 contact woundsintermediate-range woundsdistant GSW near-contact wounds

28 5 contact wounds 1. hard contact 2. loose contact 3. angled contact 4. incomplete contact muzzle print near contact wounds intermediate-range wounds powder tattooing 10cm powder grain

5.2 29 38Special 4-in barrel powder tattoing powder grain frake powder: 45 60cm 180cm ball powder: 90 105cm 600cm distant wounds 5.2.2 entrance woundexit wound 1. (marginal abrasion, abrasion ring) A. excentric B. C. D. re-entry GSW 2. bullet wipe) 3. inward beveling outward beveling 1. 2.,, 3. 4. shored exit

30 5 5.2.3 1. (graze wound) superficial perforatiing wound inward beveling outward beveling (keyhole-shaped defect) 2. intermediate target 5.2.4 internal recochet X X 5.2.5 shotgun wound ( ) scalloping 1m petal mark

5.2 31 1m satellite pellet holes 2m 3m 5.2.6

33 6 6.1 cause of death 6.2 6.2.1 6.2.2 6.2.3 1/3

34 6 crush syndrome 6.2.4 6.2.5 1 2 100 250ml 80ml X 2 3 6.2.6 6.2.7

6.3 35 6.3 1 2 1 2 1 6.4 vital reaction

37 7 1. 2. 3. 1. 2. 3. 24 7.1 7.1.1 50km/h 50km/h 1.

38 7 A. B. C. 2. steering wheel injury 3. A. B. 3 seat belt abrasion 2 300km 7.1.2 7.1.3 whiplash injury

7.2 39 7.1.4 7.1.5 7.1.6 motorcyclists fracture fuel tank injury 7.2 1. 2. 3. 3

40 7 7.2.1 1. Messerer 2. 3. 7.2.2 30km/h 70km/h 100km/h 1. 2. 3. 4. 7.2.3 7.2.4

7.2 41 1. 2. 3. 1. 2. 3. 4. 12 5. 6. 7. 8. 7.2.5

43 8 8.1 8.1.1 1. 2. 3. 4. A. B. 5. 8.1.2 1. 2. 3.

44 8 8.1.3 6 1. 2. 3. 4. 5. 6. 8.2 8.2.1 1. 2. 3. 4. 8.2.2 2 1. (presumptive identification) 2. (positive identification) DNA X

45 9 9.1 9.1.1 1. 2. A. B. C. D. E. ) F. G. 9.1.2 1. cf. 2. 3. 9.1.3

46 9 9.1.4 50 17 30 2 3 Todd 1920 Suchey Brooks 1992 phase 1: ossific nodules phase 2: (ventral rampart) phase 3: phase 4: phase 5: phase 6:

9.1 47 Phase 1 17.6 1.9 18.3 3.4 2 22.0 3.8 22.1 2.6 3 30.8 5.2 32.0 6.0 4 43.0 10.6 47.8 12.2 5 53.5 14.1 57.8 16.6 6 69.2 11.9 71.2 11.6 35 1. 30 2. 30 50 3. 40 60 1. 18 21 25 2. A. 20 B. 30 C. 50 60

48 9 1. 2. 2 3. 5 6 1 12 15 4. 18 28 5. 20 30 30 40 60 6. cf. 9.1.5 99% 80 90%

9.1 49 9.1.6 9.1.7 9.1.8 1 cf. Casper s law p. 8. 9.1.9 ABO contamination 9.1.10 DNA PCR DNA STR 9.1.11 1. 2.

51 10 hypoxia anoxia (mechanical asphyxia chemical asphyxia (poisoning) suffocating gas 10.1 strangulation suffocation 10.1.1 SIDS p. 89 p. 52 10.1.2 3

52 10 carotid artery vertebral artery jugular vein trachea * 5kg* 30kg 2kg 15kg vertebral (internal) venous plexus 10.1.3, 10.1.4 10.1.5, positional asphyxia 10.1.6 10.1.7 O 2 CO 2 suffocating gus 8% 6%

10.2 53 hypoxia 10.2 10.2.1 10 10.2.2 anoxia, hypercapnia 1. A. B. 1 C. 2. A. B. C. anoxia, hypercapnia D. 2 3. A. hypercapnia B. C. 2 4. A. B. 1

54 10 10.1 10.3 10.3.1 visceral congestion hypoxia 10.3.2 petechiae anoxia 10.3.3 postmortem fluidity of blood anoxia plasminogen activator plasminogen plasmin fibrin

10.4 hanging 55 3 3 3 10.4 hanging ligature 10.4.1 1. 6 2. 3. sexual asphyxia, autoerotic asphyxia 4. 10.4.2 1. complete suspension 2. imcomplete suspension 10.4.3 3

56 10 ligature mark furrow V mirror image 2 2 1. 2. Tardieu spot p. 6 1. 2. 3.

10.5 (ligature strangulation 57 10.4.4 2 10.5 (ligature strangulation 10.5.1 1. 2. 3. 4. A. B. C. 2 5.

58 10 10.5.2 1. 2. 1 3. 4. 5. 6. 7. fingernail mark 1. 2. 1. 2. 1 anterior neck dissection 3. 4.

10.6 manual strangulation 59 1. 2. 10.5.3 1. 2. 3. 4. 10.6 manual strangulation 10.6.1 1. 2. 3.

60 10 10.6.2 1. 2. 3. 4. 5. 1. 2. 3. 4. 1. 2. 3. 1. 2.

61 11 11.1 drowning 11.1.1 1. 1 2. 11.1.2 1. hypoxemia 2. p. 54 3. 4.

62 11 11.1.3, emphysema aquosum, hemorrhagic pulmonary edema 2 1 2 3 4 contamination

11.1 drowning 63 1. 2. 3. goose flesh, cutis anserina 4. washerwoman s hands 5. 11.1.4 7m

64 11 10 2 15 1 20 4 25 2 40m 50kg 4 1 13kg 15 10m 1 21 68kg 26.4kg 26 5.5m 6 70kg 40kg 11.2 1 no panic syndrome PaO 2 PaCO 2 CO 2 PaCO 2 PaO 2 dry drowning

65 12 12.1 1. 2. / 3. 4. 1 3 12.1.1 50%

66 12 12.1.2 4 pugilistic attitude 1 2 p. 67

12.1 67 12.1.3 epidural thermal hematoma 12.1.4 X DNA 12.1.5 Burn and scalding thermal injuries (burn) (scald) p. 77 1 2 3 eschar

68 12 4 Wallace 9 3 1/3 Schmarts burn index 15 Burn index = 3 (%) 0.5 2 (%) 1 hypovolemic shock Curling s ulcer 12.2 12.2.1 (heat cramp) (heat exhaustion) heat stroke Na

12.3 69 p. 78 12.2.2 12.3 p. 77 12.3.1 1. 10 2. 3. 4. 5. 6. 7. 8. 9. 10. 12.3.2 1. 35

70 12 2. 33 3. 32 33 32 4. 30 5. 26 30 12.3.3 cherry red lividity paradoxical undressing hide-and-die syndrome (Wischnewski

12.3 71 12.3.4 12.3.5 chilbrain frost bite 1 3

72 12 12.4 dry type starvation dry type starvation 12.4.1 12.5 12.5.1 1. 100V 200V 400V

12.5 73 3,000-6,000V 20,000-270,000power transmission system 2. A. B. C. 24V 400V 3000V 10 V 35cm 1. 50Hz ) 60Hz 40-150 Hz 2. 50,000 Hz perception current 60Hz 1mA 5mA 45µA let-go current 60Hz 10 15mA 50 75mA 60Hz 50-80mA 100mA 1 2A 1. 100 200Ωcm 2 2. 10 100KΩ/cm 2 3. 100 1000Ω/cm 2 4.

74 12 1., 2. 3. 12.5.2 electric mark 1. Q(cal)=0.24I 2 RT I: (A), R: (Ω), T: 2. 3. paterned injury 4.

12.5 75 metallization electric burn, Joule burn arborescent burn 1. 2. 12.5.3 1. 2. 3. 12.5.4 (Lightning)

77 13 13.1 battered child syndrome 20 Caffey (1946) 6 Shilverman (1963) history Kempe (1963) battered child syndrome history 13.2 1. 2. neglect 3. 4. 2 impulse or angry homicide

78 13 1. 2. 3. 4. 5. battered child syndrome child abuse child abuse child abuse 13.3 1. p. 17 2. 3. 4. 5. X 6. 7. 13.4 13.5

13.6 79 1. medical (nutritional) negrect 2. physical negrect 3. safety negrect A. lack of supervision B. failure to protect 4. educational negrect 5. emotional negrect accident-prone child 13.6 1. 25 2. 2000 5 24 2006 6 7 3 5 2

80 13 3 6 2 25 3 1 14 2 13.7 Munchausen s syndrome by proxy 1977 Meadow Munchausen 13.8 Whiplash shaken baby syndrome 1972 Caffey 1. 2. 3. 4.

13.8 Whiplash shaken baby syndrome 81

83 14 neonaticide 199 212 216 218 219 190 perinatal abuse 1. 2. 3. 4. 5. 14.1 WHO 1. 2. 3. terminal bronchioli alveoli

84 14 4. (caput succedaneum 5. (hydrostatic lung test) 17 CPR 6. 7. 14.2 (2 7 ) 2 ) 3 4 3 7 7 14.3 22 14.4 1. suffocation physical sign 2. strangulation 3.

14.5 85 4. 5. lack of care 14.5 DNA DNA 14.6 14.7 14.8 4 4

87 15 sudden (unexpected) death WHO 24 6 15.1 CPAOA 15.2 1. Cardiovascular disease A. Coronary atherosclerosis 50% and/or

88 15 75% B. Coronary artery spasm C. Hypertensive cardiovascular disease coronary atherosclerosis D. Cardiomyopathy E. Myocarditis F. Valvular diseases G. Arrhythmogenic disorders conduction system disorders H. Aortic dissection 2. Intracranial lesions A. Subarachnoid hemorrhage berry aneurysms, AVM B. Intracranial hemorrhage hypertensive disease C. Epilepsy D. Primary brain tumors astrocytoma 3. Respiratory system diseases A. Pulmonary thromboembolism cf. economy class syndrome B. Asthma C. Pneumonia D. Pneumothorax 4. Gastrointestinal tracts A. Gastrointestinal hemorrhage B. Liver cirrhosis

15.3 unexplained sudden death 89 C. Acute pancreatitis 5. Urogenital tract Rupture of a tubal pregnancy 15.3 unexplained sudden death 15.3.1 SMDS cf. Idiopathic vf 15.3.2 Sudden infant death syndrome(sids) 1 2005 1983 NICHD 1989 The sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including the performance of a complete autopsy, examination of the death scene, and a review of the clinical history. Cases failing to meet the standards of this definition, including those without a postmortem investigation, should not be diagnosed as SIDS.Cases that are autopsied and carefully investigated, but which remain underesolved may be designated as undetermined, unexplained, or the like. Seatle, WA 1969 The sudden death of an infant or young child which is unexpected by history, and in which a thorough postmortem examination fails to demonstrate and adequate cause of death. 1 3 6 1 1,000 0.25

90 15 arousal response 1 SIDS SIDS 1. 2. 3. explained death judgement call gray zone

91 16 16.1 21 4 24 1994 1. 2. 3. 1 2 4. 5. 4 21 21 15 1560 2004 4 13 16.2 2

92 16 21 16.2.1 20 1. 2. 24 24 16.2.2

16.2 93 16.2.3