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Cause of Death (Cont.)

Student Presentation: Death by Arsenic

20^th most abundant element on earth (a metalloid). Most arsenic-containing compounds are odorless and tasteless. It is ranked #1 on the list of hazardous substances.

How can it enter the body?

Arsenic can get into the body through inhalation and ingestion. It can also enter the body through environmental exposure (Bangladesh — water contamination). Also common through occupational exposure and intentional exposure.

There are two types of exposure: acute and chronic. Acute is a large dose in a short amount of time. It will result in the loss of enzyme function. Arsenate blocks ATP production and cell signaling. Chronic exposure is low doses over long periods of time. It blocks hormones by binding to hormone receptors in the body. It also affects heart cells. Symptoms are headaches, lightheadedness, stomach pains, vomiting, skin discoloration, blisters, delirium, increases cancer of lungs, bladder, etc.

Tests for Arsenic Poisoning

Tests for arsenic poisoning are urine tests (must be done right after poisoning) and through hair follicles and nails (because it binds to proteins and stays in the hair and nails). Toenails are the best because they have the least contact with the environment.

Cures for Arsenic Poisoning

Cures for arsenic poisoning: If you ingest arsenic, you should take 5 charcoal tablets and eat sulphur-containing foods such as eggs and onions. Dimercaprol can be used internally (also used for mercury and gold poisoning).

Products Containing Arsenic

Products with arsenic are used for agriculture, rat poison, embalming, taxidermy, cigarettes, etc. Arsenic was used as a cure for syphilis (Formula 605). Also used as a skin whitener, emerald green (paint used by impressionists), and as a recreational drug.

Famous People Consuming Arsenic

Napoleon Bonaparte had large quantities of arsenic in his body, but he died from a combination of bitter almonds and calendal (produced mercury cyanide in his stomach). They think he used arsenic for recreational purposes. King George III suffered from porphyria, prompted by arsenic use. Charles Francis Hall was an American explorer who was poisoned by arsenic (by the crew).

Dismemberment and Torture

There are lots of types of saws that can be used to dismember a person. Hand saws and power saws are both common depending on location. The best place to buy dismemberment tools is Home Depot.

Saws have teeth (tooth set) which causes a groove called a Kerf. You can create "false start" Kerfs if your saw jumps around when you start cutting. The other characteristic feature of saw marks is a breakaway spur.

Power saws have small teeth so they produce fine striae while hand saws have fewer teeth and more prominent, deep striae. The location of false starts (superficial kerfs and scratches) and breakaway spur show the direction of the cut. You may be able to tell the number of teeth and the blade width. The width is less than the intact kerf width.

Avulsed means that you can't go any further with a saw.

Ballistics and Gunshot Wounds

There are three types of projectile trauma: handgun and rifles, shotguns, and other projectiles like arrows, spears, etc. Caliber is the diameter of the bullet and/or the barrel. You can't tell from the bone what the caliber of the bullet would have been. Bone can expand and come back again so it will not truly reflect the caliber of the bullet. Shotguns we measure with a gauge (not caliber) and that is the weight of the pellets used in the actual shot.

Shotgun shells have many things in them (shotgun wad, etc) and you can usually find the cartridge case ejected at the scene. There are many gauges for lead, buckshot, and steel shot. Bullets can mushroom and if this happens on contact it will create a different diameter on an entrance wound than if it had stayed "undeformed." As a bullet enters into bone, it will leave particles so even if there is destruction you will see markings or opaque areas on an X-Ray.

GSW Wounds are round and oval in shape. They can also be irregularly shaped (depending on the distance, the velocity, and the angle at which the bullet hits the individual). There are also keyhole wounds. When the bullet comes in at an angle and enters and exits at the same time, you get a keyhole (entrance and exit wounds are the same).

Perforating wounds enter the body and penetrating wounds leave the body (an exit wound is present).

Distinguishing between large and small caliber is difficult. Depending on whether you have a jacketed/unjacketed/shotgun the wounds will appear differently. You can really only estimate the sequence of GSW wounds if you have overlapping skull fractures.

Contact Wounds in soft tissue will create an abrasion ring, muzzle imprint, grey black discoloration, and star shaped entrance wound. Keyhole wounds happen if the bullet enters at a weird tangent (creates that entrance and pops off a plug of bone) or an entrance and an exit at the same location.

High velocity bullet entrances will have radiating fracture patterns and a look of a lot of force. Low velocity will be a perfectly circular small entrance wound. Just like blunt force trauma we will have (with more than one) intersecting fracture lines which can indicate a sequence of events.

Wounds will be "neater and smaller" at the entrance and larger and messier on the exit.

Death by Asphyxia

Asphyxia death will be caused by a foreign object stuck in the throat, manual strangulation, postural asphyxia (passing out in a strange position can cut off your own airway or you can choke on your own vomit), and hanging. Manual strangulation and hanging would leave marks on the skeleton. Hyoid fractures occur by strangulation. If you die by hanging you break the C2 (dens).

If a person drowns there won't be any visible skeletal effects. However, if you have a person who is still alive when they drown they will breathe in water and diatoms. Diatoms will be present in the lungs and they will also be distributed through the blood stream quickly. They will enter into the medullar cavity of the long bones. After the soft tissue disappears through decomposition, diatoms are preserved well. The cellular walls are made of silica, which preserves well.

Every water body will have its own species of diatoms. There are 10 million genetic species, 50% marine and 50% freshwater.

Cause of Death

Reminder: THERE WILL BE A QUIZ NEXT WEEK »

There will be a quiz on spontaneous human combustion, shaken baby syndrome, The Ice Man, paraphilia, and the student presentations from tonight. The quiz will not be on cause of death (tonight's lecture topic).

Date: April 20, 2006.

Student Presentation: Death Penalty

The death penalty is the governmental use of execution as punishment for a crime. There are 38 states utilizing the death penalty.

Capital offenses include first degree murder, aircraft hijacking, rape of a minor, terrorism, treason, narcotics conspiracy (varies by state).

Methods of death penalty include electrocution, lethal injection, gas chamber, hanging, and firing squad.

Electrocution uses a large oak chair with restraints and a headpiece with an electrode. A wet sponge is placed between the scalp and the electrode. Volts will cycle from 2,300 to 1,000 until the offender is dead. New York was the first state to adopt this method. It was the most common method of execution until 1980.

Lethal Injection is done with three drugs applied intravenously. Oklahoma adopted this method in 1977.

The gas chamber has a container on the side of a chair and the cyanide pellets mix with the sulfuric acid.

Only three states utilize hanging as a method of execution.

For a firing squad, the offender is plaved in a chair with a pan beneath to catch blood. Three to six shooters per incident, one or more with blanks so nobody knows who fired the fatal shot. Also only used in three states.

Historically, people would be beheaded, hung-drawn-and-quartered, or broken on the wheel (offender placed on a platform and a wheel is used to roll over them and break their limbs). There was also burning at the stake (for witchcraft, heresy, atheism, and homosexuality). Other historical methods include crushing, impalement, stoning, and crucifixion.

Student Presentation: Death In The Workplace

Note: The accuracy of this information has been disputed, so please keep in mind that these were class notes and the information provided should not be used as a source without verification. These are notes from a college course on Forensic Anatomy and have not been verified outside of the classroom.

In 2004, 5703 people died on the job or due to their job in the US. The most common manner of death on the job is driving a motor vehicle (24%) and other forms of transportation (43% including motor vehicles). The next highest is contact with equipment/machinery. Also falls, violence, and exposure to hazardous substances are common manners of death.

Store supervisors and shift managers are most likely to die from homicide. Construction workers are most likely to fall (most fall to lower level i.e. more than a story). You are more likely to die of homicide if you are a retail worker than if you are a police officer.

The deadliest industries are construction, transportation and warehousing, agriculture, forestry fishing and hunting, and mining. The highest rates of death are logging, mining, and fishing.

OSHA has improved workplace safety and claim that they cut workplace fatalities by 60% when the work force has more than doubled in the same period of time.

If you die at work, the employer must pay for the funeral up to $7,000. Money also goes to the spouse and child up to $150,000. They also must provide ~80 credit hours of student fees to the surviving spouse if (s)he is unemployed. Employers (4+ employees) are required to pay worker's compensation for employees injured on the job.

Cause of Death (Skeletal Evidence)

There are certain things we can tell from the skeleton, including the instrument used, the time of assault, direction of assault, intent (accident vs. intentional), relative position of victim and assailant.

Pathologist or medical examiner make the ultimate decision on the cause of death, but the forensic anthropologist will help by recording:

• Location (anatomical terminology)
• Number of trauma incidents on the skeleton
• Size of each
• Shape of each
• Whether foreign matter is present
• Internal damage (what soft tissues might have been impacted)
• Whether the individual had previous pathologies (antemortem disease processes that could leave marks on the skeleton that mimic trauma)

There are different types of trauma that will leave specific marks on the skeleton.

• Blunt impact
• Sharp force trauma
• Firearms
• Burns
• Asphyxial wounds (hanging, strangulation)
• Drowning

TRAUMA

Blunt force trauma is inflicted by anything that can impart force from an object to the skeleton where you are not necessarily penetrating the skin with a sharp edge. You will have either flat or round surface but not a sharp surface. Baseball bat, hammer, mallet, golf clubs, car, frying pans, and anything else (not sharpe) you can swing with force can be used to inflict blunt force trauma. Things can also fall on you and you can fall and inflict blunt force trauma.

Sharp force trauma has to have an instrument with a point or a sharp edge. You will have force but also the point or sharp edge will perforate the skin and/or penetrate through the bone.

Projectile wounds include gunshot wounds or other projectiles (shrapnel, etc).

Child skull fracture

When you have a situation where you impart a lot of force from an object to a human skeleton you end up with fracture lines. There are two types: radiating (from the point of impact outwards) and concentric or hoop fractures (caused by inward and outward bending of the surface of bone).

Radiating lines will continue until there is something to stop them (e.g. suture lines in the skull or previous radiating fractures).

Impact Site: recognized by crushed and fractured bone with radiating fractures emanating from that site. You can also have an impact site that doesn't have radiating lines if the impact had less force.

Tool Mark: Identifiable trauma that may be used to discern a characteristic of the weapon.

Infraction: an incomplete fracture.

Displacement: when fractured surfaces no longer meet or meet at an unnatural angle. Typical if you are hit by a car (in the longbones).

Hinge Fracture: an infraction that is still attached at an unnatural angle.

Green Stick Fracture: breaks in bones without separation. The most common fractures that are seen in child abuse cases. Part of the reason is because they have a higher percentage of collagen in their bones compared to the mineral component.

Simple Fractures: Bones is broken into two different segments.

Comminuted Fractures: Multiple fragments. Happens if someone hits you with a car and your bone is in multiple pieces and needs plates/screws to be put back together.

Multiple skull fractures from great force

We may be able to tell the weight of the instrument used, but normally it is classified only as heavy or light. In some occasions you can tell the size of the weapon (length, width). You will look at a diffused area (a distinct area of impact is not visible) or a focused area (a clear impact but the imprint of the instrument is not clear).

You may be able to tell the shape of the weapon (its cross sectional outline and its longitudinal configuration). Round shapes are difficult, but angular weapons make it more likely to see characteristics which can identify the instrument.

Plastic deformation occurs when you have severe force. Major fracture lines can occur away from the impact site when there is enough force. Things get pulled apart and deformed during the act of trauma and the skull does not return to its original shape.

Patterned Injuries

You may be able to identify the causative instrument. The imprint of the impacting instrument is clearly visible on the affected tissue.

Estimation of Body Position

You may or may not be able to tell the direction of impact unless you are dealing with angulated fractures with tool markings. If you are going to estimate the number of blows and the sequence you need to be able to determine the site of impact. If the wounds do not overlap you cannot determine the sequence. You need wound patterns with specific radiating fracture lines coming off of them.

Deceleration Injuries

Plane and automobile accidents (inside the vehicle) and falls from heights will have deceleration injuries. You will have injuries to the joint surfaces.

SHARP FORCE TRAUMA

Sharp force trauma is a result of narrowly focused point of force with dynamic compression forces applied to the surface of bone. Characteristics depend on the direction, the focus, and the energy of the causative force. These will dictate the kind of trauma we see on the skeleton.

There are different classifications of sharp force trauma:

• Puncture wounds
• Incisions (cut through skin but only leave a mark on the bone)
• Cleft (cross-sectional v-shape)
• Additional discontinuities — fracture lines, hinge fractures, and chips of bone (wastage)

Most blunt force trauma affects the skull, but most sharp force trauma is aimed at the soft tissue areas (somewhere in the torso).

Punctures will be directed force in a small area. Weapons are usually coming down vertically in comparison to the bone surface. The shape of the wound is usually circular but can be oblong (dependent on direction and type of weapon). Because you have force coming down you may also have adjoining fracture lines or hinge fractures.

Incisions are defects that are longer than they are wide. How forces are applied will be different from the ones we've covered already. You usually do not have fracture lines or hinge fractures in this type of wound. Cuts can be thin lines or strongly V-shaped. Typical to a knife. These wounds typically occur in the torso.

With Clefts or notches there is usually a stronger, dynamic force and a large, long, sharp edge. You will still have v-shaped notches penetrating the interior of the bone. You may have fracture lines and hinge fractures because of the force.

We can look at the length and width of knives, as well as whether they are single/double edged and serrated or smooth.

DISMEMBERMENT

Often head and hands are dismembered to avoid identification of an individual. Dismemberment is the intentional separation of body segments. It prevents detection of manner of death and identity. It is a very difficult thing to do and often leaves behind a lot of evidence.

Student Presentations and Weird Death Things

Student Presentation: Shaken Baby Syndrome

Definition: An injury caused by someone violently shaking a baby. Force is usually equivalent to a baby falling off of a second story building.

Infant's neck muscles are not well developed and provide little support. The brain strikes the skull as it is shaken back and forth.

Clinical signs: Subdural Hematoma, Retinal Hemorrhages, Retinal Detachment (causes blindness). Cerebral adema is also a sign, causing pressure on the brain and the brain stem. Diffuse Axonal Injury is also a sign as well as "black brain" (wasting away of brain due to lack of blood supply).

Why does it happen? An infant can spend an average of three hours a day crying so usually the caregiver will become frustrated and shake the baby to make him stop. Click here for symptoms.

Statistics: It is estimated that every year nearly 50,000 children are shaken in the United States. The average age is six months and 60% of the victims are male. The perpetrators are 80% male, usually in their early 20s.

SBS is very difficult to diagnose and as a result minor cases become confused with cholic, etc. Doctors look for hemorrhages in the retinas of the eyes, skull fractures, swelling of the brain, etc.

Student Presentation: Spontaneous Human Combustion

Definition: the mysterious phenomenon of someone bursting into flames without explanation. There is no ignition source; flames begin in the person's own body and will reduce to ashes in a matter of minutes. This is hotter than any crematorium.

Characteristics: Complete combustion of body with exception of extremities. No apparent source of ignition. Greasy soot from 3 1/2 feet high to ceiling. Brown, oily residue remains. Objects above 3 1/2 feet show heat damage.

Non-fatal cases include mysterious flames, smoke, and burns found on the person. The survivor cannot explain what happened. The explanations include people who have been drinking or are mentally incapacitated.

Fatal cases are 3/4 of documented cases and are the most publicly recognized type, exhibiting all characteristics of SHC.

Theories: Divine punishment, result of excessive drinking (impossible), massive buildup of static charge (also impossible), electric fields in the body short-circuiting, chemical reactions of the digestive tract, geomagnetic fluctuations, poor diet (only happens to Westerners).

Student Presentation: The Iceman and Freezing Preservation

The Iceman was discovered by a vacationing German couple in 1991. There are many theories as to how he died — peaceful death, a fight before the death (misread x-ray), and an arrow. At this point, confrontation is most likely (they found an arrow head embedded in the scapula). There was another wound on his hand.

He was fully clothed with a cap, poncho, etc. He also had weapons, a medicine kit, and tools. He was part of the neolithic people, who were knowledgeable about the environment.

The rescuers were very careless because they thought he was just a regular person. But he is the oldest mummy and was found with neolithic valuables. A museum was built to educate people on the Iceman.

His body was frozen at a glacial temperature of about -20°C. He is currently in the Bolzano museum in Italy in a chamber at -6°C. The temperature and his environment slowed down decomposition. He utilized survival tactics before he died so all of these things make him very well preserved.

Cryogenics vs. Cryonics. Cryogenics is a branch of physics that deals with production and effects of very low temperatures, while cryonics is the freezing of a seriously ill or recently deceased person to stop tissues from decomposing; the body is preserved until new medical cures are developed that might bring the person back to life; "cryonics is more science fiction than serious science". Benjamin Franklin was a proponent of cryonics. Cryonics has been successful with tissues, embryos, and sperm.

Strange Things Dealing with Death

Paraphilia refers to "beyond normal." It's basically loving anything that is anything other than the societal norm. These people are social deviants.

Cannibalism (Again!)

The practice of eating one's own species (not just humans eating humans). In some species this is considered normal (lions, insects, hamsters). The Spaniards were notorious for reporting this activity. Reasons for cannibalism: aggression (towards enemies), affection (relationship with the person you are eating, religion), endocannibalism (within a group of individuals, affectionate), exocannibalism (eating outsiders, aggressive).

There is also nutritional cannibalism, which occurs when you are starving to death and consume another person out of desperation. There are also ritualistic reasons and of course pathological reasons for consuming one of your own species. The early inhabitants of Fiji practiced cannibalism for spiritual reasons.

Modern cannibalism is for two reasons: survival (nutritional) and pathological. E.g. Donner party and 1972 plane crash in the Andes were for survival. There is a group of pathological cannibals who practice this for sexual gratification (sexual cannibalism). This is considered to be a psychological or psychosexual disorder in the Americas. It involves a person sexualizing the consumption of another person's flesh (considered a form of sexual sadism, associated with necrophilia).

Shrinking Heads

Associated with religious ceremonies, proving that you killed a specific enemy, and acquiring power. The process of shrinking a head will preserve it for a long time. They can be souvenirs or for vengeance. In South America and Oceania and Scotland/Ireland during Middle Ages this occurs(ed). A shrunken head is just the skin (not the skull).

Procedure (Shrinking Heads)

1. The head is removed from the body near the trunk. The scalp and skin are slowly peeled off the skull (similar to in an autopsy). The face is difficult and must be cut off with a knife.
2. The scalp is attached to a vine and lowered into a pot of boiling water. Boiling kills bacteria microbes and "cooks" the skin, which shrinks it. It also helps to thicken the skin (partly because the boiling process changes the collagen, making it thicker).
3. The head is removed from the boiling water, attached to a stick, and left to cool.
4. Then they will go to a fire of heated stones and use the stones to burn off flesh and remove remaining blood.
5. They want to maintain a shape, so the fill it with hot sand and keep the scalp in motion and turn it so it starts to take back a round shape. This process is done for days or weeks.
6. The face is molded so that it takes back the characteristics of the human face and as it dries it will shrink.

Necrophilia

Obtaining sexual arousal and gratification by having sexual contact with dead bodies. There are different perspectives on necrophilia and psychiatrists say that there are different steps necrophiliacs will go through. It starts with an erotic attraction of corpses. Most common objective is to obtain possession of unresisting or non-rejecting partner.

The DSM-IV psychiatric diagnosis of necrophilia is "paraphilia, not otherwise specified." They are mostly male between the ages of 20 and 50. Most are heterosexual. Of these individuals, if they are caught or seek psychiatric help, about 60% are diagnosed with other personality disorders. Most commonly hospital orderly, morgue attendant, funeral parlor attendant, and cemetary employees. Most will fantasize about it before they participate in it. Some pay prostitutes to pretend to be dead or ask their girlfriends to do this sort of… ahem… role playing.

There are three types of necrophilia: Necrophilic homicide (killing to obtain a corpse), "regular" necrophilia (use of already dead corpses for sexual pleasure), Necrophilic fantasy.

Well-known homicidal necrophiliacs are Ted Bundy and Jeffrey Dahmer. One of the most famous female necrophiliacs was Karen Greenlee. She was the first person charged with desecrating a body for this activity.

Necrophobia

If you are a necrophobe, you have a fear of anything dead. Most of these individuals have a morbid aversion to corpses, and will have nausea, dizziness, chills, and extreme anxiety if they have to be near anything dead.

Central Nervous System

Student Presentation: Animal Death (Euthanasia and Slaughter)

Euthanasia means "good death." Three types of methods: inhalants, noninhalant (injectable), physical methods.

Three steps of slaughter: stun, shackle, and bleed.

Some ritual slaughter requires that the neck be cut while it is still conscious. This is known as shechitah from the Hebrew word meaning "to destroy" or "to kill". Another example is Halal slaughter (Muslim), wherein a prayer must be said before slaughter. Stunning is not allowed before slaughter unless it doesn't lead to death.

Central Nervous System

Brain and Spinal Cord.

The brain itself does not have any sensory neurons. There is no pain in the brain itself, but in the meninges. The primary job of the meninges is to protect the brain and to hold the cerebral spinal fluid. About 1/4 inch of fluid suspends the brain. The brain weighs about 3 pounds. Floating makes it essentially weightless and protects it against shock. The consistency of "fresh brain" will be like pudding. In order to dissect it properly, it is better to have it preserved. The brain is about 85% water, but blood is about 80% water.

Meninges are an outer covering between skull and brain and s.c. Contains cerebrospinal fluid (CSF).

Concussions are traumatic head injuries. Symptoms are change in hearing, sleep, pupilary reflex (light response — if you shine a light and the pupil doesn't get smaller there is a problem). The reason for the eye reaction is that if the brain begins to swell one of the first nerves pinched off is the octal and motor nerve. They may also be disoriented and not know their name or where they are. The meninges can bleed as a result of head trauma, which is called a hematoma. Trepanation is a hole drilled in the skull; the idea is to relieve the pressure. It is typically a half-inch hole.

Ventricles are fluid (CSF) filled spaces deep in the brain. These are continuous with the meninges. CSF is recycled to veins. Blackage in this system is going to lead to increased pressure → hydrocephalus. In adult hydrocephalus the ventricles are enlarged.

The brain stem has to do with consciousness and breathing/heartbeat. There are a certain number of reflexive actions involved in the brain stem: blinking, vomiting, sneezing, coughing, tracking.

Cerebral cortex (crust, outer layer — in a tree, it would be the bark). The outer 6mm (1/4 inch) of the cerebral hemispheres. Gray matter (a concentration of neuron cell bodies).

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The "business end" is going to be the soma or cell body (the 'o' in the little diagram above).

The cortex is divided into lobes (there are five of these per side/hemisphere). The lobes are frontal, parietal, occipital, temporal, and one more. They are the functional areas of the cortex.

Frontal — executive, personality, analysis, motor
Parietal — recognition, spatial analysis
Occipital — vision (in the back of the head)
Temporal — memory selection, smell, hearing, emotions, religion, art

Somatic motor is voluntary action in frontal lobes (both sides) and we will have contralateral (cross-over) and homunculus (map of body).

Somatosensory is sensory input but not special senses (taste, vision, smell, hearing). Most of somatosensory is touch or proprioception (sense of position), pain. Located in the parietal lobes.

Presentations (Abortion, MEs Office)

Student Presentation: Surgical Abortion

Dilation and Curettage: more commonly not an abortion but used to empty uterine cavity after a miscarriage or for diagnostic purposes (e.g. taking tissue sample to determine the cause of vaginal bleeding after menopause). A curette, which is like a small spoon on the end of a long instrument, is used to scrape out the contents of the uterus.

Induction Abortion: Starting labor and (unsuccessful) delivery during second and third trimester. Can be done a number of ways, including injecting drugs intravenously or directly into the amniotic sac (e.g. saline solution) to start contractions. Another form of induction abortion is draining a large amount of fluid from the amniotic sac. Procedures may be combined. From the "Forensic Pathology" text book, a baby aborted using a saline solution died 1.5 hours after the procedure and the manner of death was ruled unclassified.

Dilation and extraction: Intact fetus is removed from the wound via the cervix. Accounts for 0.17% of abortion (in 2000). This procedure is also known as a partial birth abortion. During this procedure, the fetus is delivered lower extremities first and brain matter is suctioned out with a catheter before the head is removed.

For the rest of the notes, please Download the PDF of the presentation (video not included).

Guest Presentation: Medical Examiner's Office

Job responsibilities include determining the cause and manner of death. Cause of death is typically easy to determine from the autopsy, but manner of death is a collaboration of law enforcement and medical examiner.

Three jobs at the ME's office: Medical examiner, Medico-legal death investigator, Forensic technician. Medical investigator and forensic technicians get paid between $30,000 and $40,000 a year.

Death investigators receive and screen death calls that come into the ME's office. Not all calls are medical examiner cases. They conduct a scene and body examination. MEs in this district do not typically go to the scene, so the death investigator must collect thorough evidence and photographs and document/inventory findings. They interview the next of kin for circumstances and medical information. They interact with law enforcement agencies, procurement agencies (organ donation), etc. They must attend court proceedings if they are subpoenaed. There are four forensic technicians at this district's office. There are eight full-time death investigators.

The forensic technicians do photography of the bodies, assist in the morgue in autopsy dissection, help in documentation and sketching, assist in the GSR kits, hair/fingernail/toxicology for the case. They assist in the collection of personal effects and document everything. They lift and handle corpses while assisting in autopsies.

Florida Statute 406 gives the medical examiner the power to determine the cause of death when a person dies from criminal violence, accident, suicide, sudden when in apparent good health, unattended by physician or practitioner, in any prison or penal institution, in police custody, in any suspicious or unusual circumstance, criminal abortion, poison, disease constituting public health threat, disease, or injury. They also give an "ok" to people brought into the state without medical certification, and before cremation or dissection, or burying at sea.

Florida Statute 406.12 states that if a death occurs you are required to report it and you are not permitted to touch, remove, or disturb the body or clothing (anything around it) — that goes for the police as well. The medical examiner is the only one allowed to touch the body.

In burn cases, dental records are used to identify the body, but you have to have an idea who the person is to get the dental records.

Skin

Epidermis is the top layers. Blood supply does not go all the way up into the epithelial layer. Scars are collagen spun out and frozen.

• Basal layer: single layer of cells (epithelial) and stem cells.
• Cell types: (1) keratinocites. Cell product is keratin (fibrous protein present in skin, hair, fingernails, etc). (2) Melanocites. Produce melanin (a brown pigment
• Genetic variability: for keratin (relies on age and location - feet vs. eyelids) and melanin (genes for skin color).
• Environmental variability: pretty much the same. Influence the color of your skin if you have jaundice, eat too many carrots, etc. Increase in keratin when you get a callous, etc.
• Basal layer
• Stratified layer: one to seven layers of keratinocites (they die and flatten and by the time they get to the top they are dead — apoptosis, programmed cell death — with nothing left but pigment and keratin).
• When you get a blister the stratified layer has separated but is intact so it will heal itself.
• Keloid is hyper-production of scar tissue. A collagen "plug" overforms and there is no way for the body to get rid of it.

The Dermis is deep to the basal layer. The dermis will end up being a matrix of collagen and elastin (literally spun out of the matrix). Embedded in this matrix there will be hair follicles, blood vessels, nerves, sweat glands, muscles (smooth *goosebumps), and sensory nerve endings. The dermis is about 1-2mm thick (thicker than the epidermis). Leather is simply dermis that has been pickled. You can leave the hair on and get cowhides, etc. It even looks like a matrix because it has protein.

Digestive System

Student Presentation: Drowning

Defined as death by submersion in liquid, usually water. Mammalian diving reflex — initial reaction is to hold breath, energy saving mechanism… Three things occur: bradycardia, peripheral vasoconstriction, and blood shift.

Carbon dioxide levels in the blood become too high and the larynx constrict and prevent access to lungs so water from the lungs cannot get out and air cannot get in. Water in lungs removes surfactant from alveoli.

Freshwater causes surfactant to wash away and lungs become unstable and cannot expand and salt water causes fluids to be drawn into alveoli diluting surfactant.

Loss of consciousness occurs within three minutes. Laryngospasm relaxes after loss of consciousness, allowing more water to enter lungs. Bodies will initially sink but once decomposition starts the body will float (because of gases).

Drowning is a diagnosis of exclusion — a combination of many non-specific findings where other causes of death are ruled out. Victims usually decompose rapidly because ATP is depleted while struggling to survive.

During the autopsy, someone who drowns will have white fluid in the mouth/airway, washerwoman hands and soles of feet (1-2 hours after body is in water), lungs enlarged taking up entire pleural cavity, water is in stomach, dilation of right ventricle, swelling of brain, hemorrhage of mastoid bone, and goose-flesh (goose bumps).

Tests for drowning (mentioned in book) are unreliable and not necessarily helpful in determining the cause of death. Examples of these tests are the getter chloride test and test for diatoms in tissues. Some say that diatoms definitely prove drowning, but you can have them in your body by inhalation and ingestion (toothpaste has diatoms, pool filtration systems).

Dry drowning happens when there is a laryngospasm when very little fluid enters the lungs and the victims cannot get air into their lungs.

Near drowning occurs when someone survives at least 24 hours afterwards. Depending on the amount of time they spent drowning they could have brain damage and neurological problems. 35-60% die in the E.R. Severe hypertension can occur during and after resuscitation; hypoxemia can contribute to several cardiac problems, ventricular disrhythmias (heart stops beating) and damage to myocardium.

6500 deaths by drowning in the US each year. Children under age 4 and males 15-19 are most likely to drown. Makes are four times more likely to drown than females.

People who are resuscitated will die because of pneumonia or secondary bacterial infection.

Student Presentation: Living Wills

A living will is a written statement of the kind of medical care you want to receive, etc. should you be unable to answer for yourself. Doctors must follow the wishes in the living will over the wishes of the family.

You may select a health care agent or proxy to express your wishes. You should choose someone in good health who will be able to handle conflicts between family, friends, and medical personnel.

You should re-examine your health care wishes after your wishes change, you are diagnosed with a terminal illness, etc.

DNR = Do Not Resuscitate. This is also called a "no code" or AND (allow natural death). Specific measures allowed to be used or withheld must be specified. There is also an Out-Of-Hospital DNR.

Digestive System

The alimentary canal can be described as a tube that runs from the mouth to the anus. There is a generalized structure to the alimentary canal. The inner layer is called the mucosa, which surrounds the lumen. This is an epithelial layer (single cell thick with high replication). The mucosa also has glands (mucous, enzyme secretion, etc).

The submucosa, a primarily connective (support) layer with collagen and elastin. There are blood vessels and nerves (autonomic) present in the submucosa.

The third layer is the muscularis (a smooth muscle layer) under autonomic control. Muscles are necessary for peristalsis, which is sequential rhythmic contractions that "milk" the tube pushing food through it. When you are scared, running, in emergency, etc. the sympathetic nervous system fires up and the parasympathetic nervous system slows down, slowing digestion. Opiates have the effect of stopping the autonomic nervous system, for example.

The final layer we will talk about is the serosa, the outer collagen sheet. It is transparent and very tough, and it secretes a lubricant.

Ulcers are erosions of the alimentary lining. A perforating ulcer burns all the way through the layers, allowing fluids to get into the abdominal cavity (very bad). Ulcers are caused by an increase in acid and decrease in mucous. The problem with the stress-causes-ulcers hypothesis is that the treatment is an antibiotic. In other words, the ulcer is fixed by killing a bacteria that is present. The stomach produces acids and mucous for protection. There is a bacteria called heliobacter pylori that lives in the stomach lining. About half the population has this bacteria present. The antibiotic targets this bacteria and has a 90-95% success rate. This has changed the way we think about this kind of disorder. There may be an environmental factor, but the idea that a behavioral chronic disorder can be treated with a pill may have effects on treatments for other diseases.

The idea with antibiotics is that you don't want to kill all of the bacteria but just enough to get rid of the symptoms yet still produce an immune response. Bacteria love hospitals because they can move from one immune-deficient person to the next. The next place bacteria love is apparently venereal diseases…

Serous membranes line inner surfaces, secrete lubrication (serous fluids). The first of these membranes is peritoneum, which lines the walls (pareital peritoneum) or the viscera (visceral peritoneum). Then you have mesenteries, which are double layers of serous membrane. They support the viscera, vessels and nerves.

Intestines — the large and small intestines make up the bowels. The large intestines are subdivided into the cecum and colon. Things automatically move through the small intestines, but you need to move around to make things move through the large intestines. You also need fiber (cellulose — the most common organic molecule on the planet), which absorbs water. We cannot digest it but bacteria can. Another fiber is pectin. 2/3 of "what comes out" is dead and undigestible matter. Certain carbohydrates produce gases, which are flammable. You should have high fiber in your diet because it stimulates the digestive system, moves it along, and absorbs toxins. Low mobility, low fiber, high fat lead to inflammatory bowel disease.

Embalming cont.

Student Presentation: Ghosts

Ghosts are non-corporeal manifestations of deceased persons (or animals). They are believed to be the spirit or soul of a person who is deceased. Usually ghosts are seen in human/animal form, and appear as shadowy or foggy figures.

In the West, we believe that ghosts are souls that are at unrest; the spirit is in "Limbo" between Heaven and Hell.

In the East, they believe that the ghost has unfinished business and can become a demigod or go through damnation. They also believe in what they call "ghost homicides" (ghosts can come back, especially when they have died through violent means). They have rituals wherein they burn valuable items (e.g. Hell Bank Notes) and pour wine on the graves of their dead ancestors three times during a day. They prepare a big feast and hide until the end of the day so that the spirits can consume the feast.

The movie 21 Grams (the loss of weight at death) "explains" that the loss of weight is the weight of the soul.

Types of Hauntings

"Noisy Ghosts" (Poltergeists) are invisible to the human eye and are caused by uncontrolled psychokinesis (Movie: Poltergeist).

Object Haunts can be any object of importance to a person that has died. They come back and leave their "psychic imprint" on the object.

Residual Haunts are not conscious spirits. They are like movies that play under the right conditions. You can't communicate with them (most famous example is Gettysburg, where "battles" are often reported).

Dopplegangers are ghostly doubles of living people, not often seen by their living double. If seen, it usually means a bad omen.

Crisis apparitions appear to loved ones during crisis or death, usually when very far away.

Ghosts can manifest themselves through sounds and lights (e.g. footsteps, lantern). Locally, "Oviedo lights" have been reported (usually explained as swamp gas).

Genuine Haunts are what we consider "real" ghosts, who don't know they're dead. They are conscious of others and wonder why humans don't notice them. Sometimes they seek the attention of the living (movie: The Others).

Ways to detect ghost presence

"Cold spots" are where temperature of room drops by 15°. Electromagnetic Field (EMF) Detector — humans emit small EMF reading. The energy from a ghost is a high peak. Also physiological sensations can indicate the presence of a ghost.

They may also be detected through photography (orbs, energy ribbon mist, reflection of spirit) or auditory (electronic voice phenomenon, heard only during playback) measures (movie: White Noise).

What skeptics have to say

Sightings occur when senses are impaired (dark, under stress, etc). People lie. EMF readings can be from other sources. "Apparitions" can be replicated in a lab. Lights can be attributed to swamp gas.

Student Presentation: Suicide and Homicide in Jails and Prisons

Differences between Jails and Prisons

Jails are local facilities where inmates are usually awaiting trial or sentenced to periods of 1 year or less. Prisons house inmates convicted and sentenced to 1 year or more.

Common Manners of Death: natural causes, executions, homicides, suicides (leading cause of death in jails and third leading in prisons), AIDS-related deaths (in 1995 they accounted for 100 per 100,000 people but in 2000 they only accounted for 15 deaths per 100,000).

Suicide

Much more common in jail because they are awaiting trial and don't want to be convicted and spend the rest of their life in prison. More likely to attempt suicide if the prisoner is segregated or in isolation.

Ways of committing suicide in jail: Hanging (self-asphyxiation via shoelaces, bed sheets, clothing); cutting wrists; drug overdose.

People most likely to commit suicide are 40 or older, homeless, history of psychiatric care, history of drug abuse, prior incarceration, violent offense, and gender (males more common).

White males are six times more likely to commit suicide than African Americans and three times more likely than Hispanics. 80% of suicides are committed in an inmate's cell.

Time of day, intelligence, and sentence length do not play a factor in the rate of suicide.

Suicide Prevention

Suicide rates have declined because of suicide prevention programs. When people are incarcerated, the USA has an obligation to protect those inmates. The ACA and NCCHC require intake screening and assessment. Problem: The profile of someone who would commit suicide is the same profile as someone who would be in jail, so it is hard to distinguish who is more likely to commit suicide.

Suicide prevention techniques are increasing training for correctional and mental health staff, architectural considerations, interaction techniques, and close supervision.

Homicide

Usually occurs with a group killing one person or a cellmate killing another cellmate. The person is usually beaten or stabbed, and the aggressors are usually placed in segregation. The inmate killed is taken to the hospital where they are pronounced dead.

Gang members are usually not deterred by police and will kill if they feel it is necessary. They are involved in homicide and drug trafficking.

In Florida, if a homicide or suicide occurs, it is investigated by the Department of Corrections and the Florida Department of Law Enforcement. They send a recommendation to the State Attorney's office, who determines the charges (same with charges of battery). This is different in every state.

Suicide and homicide rates are declining due to improved medical care, separation of violent offenders, advocacy groups (file lawsuits to improve prison conditions), suicide prevention programs, and increased staff.

The jail and prison population is steadily increasing, although the suicide/homicide rates are declining.

Suicide rate is higher in jail/prison than in the outside world, but homicide rate is higher in the outside world.

Student Presentation: The Process Following & Costs Associated With Death in Central Florida

After a loved one dies, you should contact a funeral director, locate important papers, contact the deceased's lawyer to help with the will, contact tax attorney or financial advisor, notify the post office, gather unpaid bills (often covered by life insurance), and make changes to or cancel ownership/registrations.

Preparation of The Body

First they place the body on an embalming table, which is made of porcelain. Porcelain doesn't react to any of the chemicals used in embalming. The arms are laid over the stomach and the body is washed and disinfected.

The eyes are closed and eye caps are placed under the eyelids to keep the eyes closed and maintain shape. The mouth is closed and a tack is placed in the upper and lower jaw. Attached to the tacks is a fine wire, which is twisted together to secure the mouth closed.

The embalming solution is prepared. Modern machines consist of a two-to-three gallon reservoirs and an electric pump. A solution of eight ounces of fluid (majoritavely formaldehyde and phenol) to one gallon of water is prepared.

An incision is made over the carotid artery and femoral artery.

Embalming Fluid

Acts as a fixer to cause chemical "fixation" of cell protein. Formaldehyde reacts with the soluble albumins in the cell and converts them to albuminoids or gels. Bacteria are destroyed, thus halting or at least delaying decomposition. The body can only be attacked by airborne bacteria and molds.

Embalming Difficult Situations

Autopsy cases can be very difficult to embalm because the circulatory system has been destroyed with the removal of organs. A six-point injection is made in the two femoral arteries, axillary vessels, and common carotids. The viscera is treated separately with cavity fluid.

The body is washed again and a cream is placed on the hands and face because they are most likely to be exposed during a viewing (stops dehydration). The cosmetologist will try to present the individual in the most close likeness to when they died. The body will be covered with a sheet until the family members decide what the individual will be buried in (clothing) and before he/she goes into the casket.

Cosmetics are applied to replace the natural color (color is removed by the embalming process).

Embalming is only required by law when an individual dies because of HIV/AIDS and other infectious diseases, when there is a prolonged period between death and burial, if there is a public viewing or wake, or if the body is transported on commercial flights. Sometimes refrigeration is okay to substitute for embalming.

Florida Statute 497.386 describes the requirements for storage, preservation, and transportation of human remains.

Green Burial

Natural burial grounds located around the US (also referred to as Eco-cemeteries, etc). They do not require individuals to be embalmed. There are green burial societies around the US. Vaults are not used and bodies are generally not embalmed.

Autopsy and Embalming

Student Presentation: Near Death Experience ("Scientific Explanations")

A near-death experience is a perception reported by a person who nearly died or was clinically dead and revived. Experiences may include body experience, visions of deceased relatives, etc.

Typical progression of NDE: Sensation of floating above body, passing through a tunnel, meeting deceased relatives, and meeting a being of light. Other experiences are buzzing sounds, peace and painlessness, reluctance of returning to life, etc.

Twenty percent of people who are revived from clinical death report experiencing NDE. The number of experiences is expected to rise as we become more able to bring people back from near death.

Two types of NDE: Pleasure (bliss, joy) and Distressing (emotional distress, fear, terror, loneliness, guilt). One possible explanation of the second is a negative frame of mind.

Spiritual implications — most people are convinced that it is an afterlife experience. Most people go through a major life change toward being less self-centered and living "a more loving life."

Dr. Raymond Moody coined the term "Near Death Experience" and is the most prominent parapsychological researcher. He has never had an NDE of his own.

Neurological explanations for what happens during an NDE: blood flow to the brain is cut off and the brain doesn't have enough oxygen. The brain releases endorphines, which explain the positive experience.

Space and time are distorted during an NDE. Most people report being in this experience for 20-30 minutes.

Ketamine ("Special K") — a dissociative psychedelic used medically as a veterinary and human anaesthetic. It is one of the few addictive psychedelics. The drug was first used on American soldiers during the Vietnam War, but is often avoided now because it can cause unpleasant out-of-body experiences. It is still used widely in veterinary medicine, and for select human applications.

Glutamate — the most abundant excitatory neurotransmitter in the nervous system. In the synaptic cleft glutamic acid binds to two type of receptors: ionotropic and metabotropic glutamic acid receptors. In excess, glutamic acid triggers a process called excitotoxicity, causing neuronal damage and eventual cell death, particularly when NMDA receptors are activated.

Autopsy

The word autopsy literally means "see for yourself." This did not start off for producing forensic results. A lot of the history was for medical and artistic purposes (e.g. Leonardo Da Vinci).

Medical versus Forensic Anatomy

The medical autopsy is usually performed in a hospital by a hospital pathologist. Medical autopsy must be done with the persmission of the family (next of kin). The answers to questions such as the identity, cause of death, and illness may or may not be known. The purpose is to understand the course and extent of a particular illness. This may have to do with medical research.

A forensic autopsy is performed by a forensic pathologist. A forensic pathologist goes through an additional residency over a medical pathologist. It took one medical examiner 13 years to become a forensic pathologist. In the US they can be accredited through the American Academy of Forensic Science.

Forensic autopsies are performed as a part of a legal investigation. This is required in Florida if death occurs outside the care of a medical practitioner. An autopsy will be performed, even against a family's wishes or for religious reasons. An exception is someone under Hospice care.

Forensic autopsies are done to understand the events leading up to death, cause of death, and to establish the identity of an individual. For those who cannot be identified, some states have potter's fields and others scatter ashes in the ocean. Place and time of death and collection of trace evidence are also purposes of a forensic autopsy.

Usually if someone dies in a state, the autopsy must be performed in that state.

We have both medical examiner's offices and coroner's offices. The coroner is a government appointed official, who doesn't have to be a medical doctor. This is common in small towns. This has a number of drawbacks, mostly including mistaken or purposely mis-ruled cause of death rulings. A lot of times, the coroner can be swayed to rule cause of death incorrectly, e.g. during the AIDS epidemic families would bribe or convince the coroner to ignore the real cause of death.

Medical examiners must be M.D.s who have gone through residencies in pathology and then in forensic pathology. Many have gone on to study the legal issues around death investigation.

Florida is a medical examiner state, with each of 27 districts having a medical examiner facility. Orlando's M.E. is district 9 (Orange and Osceola counties). Our medical examiner does an average of three autopsies a day, a low number compared to L.A., Chicago, Washington D.C., etc.

External

At the autopsy, there is a routine procedure in which everything is recorded. There is both an external and internal examination of the body. Before an autopsy (before clothes are removed) they do a full-body X-Ray to establish a record of the body before it was autopsied. Blood tests are also performed before the autopsy. The blood is used for a toxicology screening. Fingerprints are also taken (if possible) when decomposition hasn't proceeded too far. If there is any skin slippage, they will try to pull fingerprints off of that skin. For individuals with mummified or dried out hands, they can rehydrate the skin in a special solution to take proper fingerprints. Medical and dental records will help to establish if there is any pre-existing trauma, pathology, or disease before the person died.

An external examination is performed, recording the description, clothing, jewelry, and chaing of custody on an individual. If they remove anything from the body it goes into evidence (same goes for samples).

Superficial markings, scratches, etc. are recorded. Tattoos are photographed, documented, and described. Tattoos can help in IDing a body and associating a person with gangs, etc.

Previous medical treatments evident on the external surface of the body are noted, as well as external wounds. The person's biological description (weight, size, hair/eye color, etc) are recorded.

Visit HBO Autopsy.

Internal

Regions of importance in an autopsy are the head, chest, and abdominal cavity. The body is laid on a stainless steel table that has a hole to drain fluids into a sink or some other drainage mechanism. The head is usually propped up on a brace.

The Y-Incision. Image Source: Death Online.

Start off in the chest with a Y-Incision. The point is that it will expose all of the major organs in the upper chest and abdominal cavity. An incision is made near each shoulder and brought down to the top of the clavical and an incision will go from there down to the pubic bone. Scalpels are used to cut through the skin and a bone saw used to cut through the ribs.

Internal Organs Exposed.

Next they do an inspection of the internal organs. Position of the organs is important because irregular positioning of organs could be related to the cause of death.

They will then look at the walls of the body cavity, looking for potential manner of death (stab wounds, bullets, etc. not visible from the exterior). They will examine bones and tissues for pathologies (disease), injuries/trauma, etc. They will try to determine if it's related to the cause of death or whether it was something sustained beforehand.

Organs Are Weighed.

Organs are removed and weighed (are they too small/too big). An enlarged heart or liver could be an indication of cause of death. The M.E. will take samples of all internal organs using something that looks like a bread knife. Those are kept (sometimes tested, other times not) as evidence. The samples are usually pickled in a chemical that will preserve them.

After that, the abdominal cavity is sewn up and they move to the skull. The M.E. has to be careful with the skull (because of viewings, etc). They make an incision from the back of one ear to the other. You can pull the skin and hair down over the face exposing the entire top of the skull. The top of the skull (calotte) is removed, followed by the brain. The brain is not returned into the skull; they are kept and pickled along with the organ samples. A striker (vibrating) saw is used to remove the calotte. They are very effective for cutting bone but not skin and soft tissue.

Everything will go onto a report and go into public record.

Embalming

Embalming is an American phenomenon dating to the Civil War. North America and Western nations have a strong belief in embalming, particularly in the north. Bodies were preserved with rum, but they started developing other solutions.

Bodies were preserved for transport and waiting for burial. The first person to be embalmed in the "modern" way was Colenel Ellsworth. One of the people who saw his body was President Lincoln and his wife. Lincoln was then the first US President to be embalmed. One of the reasons was that his body took a two week tour so that everyone could pay their respects to him.

Dr. Thomas Holmes is considered the father of embalming. He went around to battlefields and did embalming in tents. Early embalming done with arsenic solutions. In the early 1900s they recognized that arsenic was a bad thing to use because of the health of the practitioners.

We still do embalming for a few major reasons. It is a fallacy that a decomposing body is a health risk. People get embalmed for preservation for the purposes of viewing and "restoration" to make them as life-like as possible in the event of a viewing.

Formaldehyde solutions were discovered in 1867 by a German scientist.

Embalming is a four part procedure.

1. Arterial embalming — the embalming fluid is injected into the carotid artery and blood is drained from the jugular vein. The embalming solution is then injected into those places.
2. Cavity embalming — Suction of internal fluids, injection of embalming chemicals into body cavities (aspirator and trocar), small incision just above the navel. Trocar int he chest and stomach cavities, puncture the hollow organs and aspirate their contents, fill cavities with concentrated chemicals, incision is sutured or a trocar "button" is screwed into place.
3. Hypodermic embalming — underneath the skin. Inject of chemicals under the skin as needed.
4. Suface embalming — supplements the other methods. Highly concentrated on areas that people will see (the face, neck, and hands).

Circulatory System

Student Presentation: SIDS

SIDS is the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy.

Approximately 3000-4000 deaths occur due to SIDS each year. The rate of SIDS has decreased steadily over the past 13 years.

There is no known cause for SIDS, but the risk factors are:

• Gender — males have a higher incidence
• Weight — premature babies may have underdeveloped organs
• Sleeping position — prone position is most risky
• Exposure to drugs and/or smoke during or after pregnancy
• Age — does not include first few weeks of life, and lasts until one year. Highest occurence between 2-4 months of age
• Ethnicity — two to three times higher for African and Native American infants
• Placenta Previa — placenta covers the cervix, and mother is usually put on bed rest during the last trimester. This usually causes severe bleeding and may result in an emergency C-Section.

How do you know it's SIDS?

It is SIDS when… A complete autopsy is done and the findings do not point to another cause of death. There is no gross or microscopic evidence of trauma or disease. All other causes of death (poisoning, drowning, dehydration…) are ruled out. Toxicology screening comes back negative. A death scene investigation and review of clinical history are negative.

Medical examiners should look for whether it is suffocation or SIDS. It is hard to tell the difference between accidental or intentional suffocation and SIDS. Repeated apnea and apparent life-threatening events occur in the care of a single person, death at age six months or older, and siblings who have died of SIDS increase the likelihood that it was intentional suffocation.

An autopsy is important in cases of child abuse. SIDS often looks similar to shaken baby syndrome. In Florida, you are not required to have an autopsy if you die in the care of a physician.

SIDS is sometimes called the "diagnosis of exclusion."

Theories About SIDS

One theory of the cause of SIDS is Long QT Syndrome (interval in the heart beat when the ventricle re-polarizes is abnormal) can occur during strenuous activity or exercise. This is inconsistent with the recommendation that babies sleep on their backs.

One other theory is toxic infection, namely the protein curlin which is caused by E. coli bacteria.

Another theory is DPT immunizations. In 716 SIDS cases, 40% had received the vaccine. Although it is a theory, there was no correlation between immunization and SIDS.

Finally, a predominant hypothesis is that the brain stem of the infant is underdeveloped. This part of the brain controls reaction to danger, such as an infant suffocating while sleeping on its stomach.

SIDS Prevention

Remove soft objects and loose bedding from the crib, do not expose the infant to smoke before or after delivery, have an infant sleep in parents' room but not in their bed, put infant in the crib on his back, use a pacifier (it seems to prevent the infant from going into a very deep sleep so they are able to wake up easier), avoid overheating the infant (keep room at comfortable temperature, don't give him tons of blankets), avoid "SIDS Monitors" (there is no proof that they work).

Complications

Positional Plagiocephaly, which is the flattening of the skull, happens because the infant's skull contains soft spots that make birth easier and allow for rapid growth during the first few months of life. Avoid this by rotating the position of the head, moving the crib to give them different things to look at, avoid excessive time in car seats, swings, and carriers. This can also be prevented with DOC bands, a non-surgical ($3000) helmet that is worn 23 hours a day for three months. This is a permanent fix.

Student Presentation: Donating to Science in the United States

Whole Body Donation

Bodies for dissection were originally obtained from executed murderers, but they did not meet the demand. This resulted in murder-for-profit and grave pillaging. Now, you must donate your body (not sell it).

You must be 18 years of age or older to donate your body, but most donated bodies are in their 70s and 80s. A next of kin may choose to donate your body after you die, or if you wish for your body to be donated and your family objects it likely will not be donated.

A person's family must pay for the preliminary embalming and transportation to the medical school (UF or UM in Florida). In Florida, you may have an open-casket funeral but in other states they will not allow it. Once the anatomical board gets the body they do further embalming with Formaldehyde, etc.

Once medical studies are complete the ashes will be returned to the family if requested. In Florida, the anatomical board will spread ashes over the Gulf of Mexico.

Donating a body to science is encouraged by most religious faiths.

Organ and Tissue Donation

Fun fact: First face transplant performed in 2005.

You cannot donate if you are HIV positive, actively spreading cancer, or have one (or more) of certain severe infections.

You can donate your kidney, liver, heart, heart valves, lungs, corneas, skin, etc. You may leave organs or tissues to specific people but not to specific races or religions. You cannot buy or sell your organs because it would create an imbalance where wealthy people get organs and poor people do not.

Organs are matched with patients based on a number of factors. Organs are removed in surgical type procedures and all incisions are sewn up so that open casket funerals are possible.

Click here for information about donating your organs in the state of Florida.

Circulatory System

Blood vessels

Image Source: Access Excellence

1. Structure (Generalized: Arteries and veins)
   1. Three Layers
      1. Tunica Intima — the inner lining. It's endothelial, epithelial tissue in a single layer.
         1. Lumen — Supposed to be very smooth with no friction or turbulence for liquids flowing through. These are in very good shape in young people, but deteriorate over time. Surrounded by Tunica Intima.
         2. Supported with connective tissue.
      2. Tunica Media — smooth muscle layer. Autonomic control (run by autonomic nervous system, which is involuntary). Could also be controlled by hormones, drugs, etc. Why would you want muscles in your blood vessels? Vasocontrol (vasodilation or vasoconstriction). Your body needs to be able to open or close muscles. You have very limited control over this.
      3. Tunica Adventicia — connective layer (support). Good for adhesion and the like. This is a thick layer of collagen.
   2. Arteries
      1. Thicker — more smooth muscle than veins. In dissection you see that arteries are more tubular, thicker, and deeper.
      2. Deeper — arteries tend to be embedded in muscles.
      3. Systolic Blood Pressure — the high side of your blood supply. As you pump blood out of the heart, that will be high pressure.
      4. Arteries can be defined as carrying (high pressure) blood away from the heart. They can control the amount of pressure and where the blood is going.
   3. Veins
      1. Thinner with low vasal control.
      2. Valves — allow one-way flow of blood. They are essentially flaps. As long as the blood is flowing in the correct direction (toward the heart), the valves stay open. If you try to reverse the pressure, the valves will flop closed.
      3. Low pressure — diastolic, towards the heart.
      4. The heart cannot "suck" the blood back through the blood vessels on its own. A person's activity helps the heart by massaging the veins and coaxing blood to keep moving in the correct direction.
   4. Artery types
      1. Elastic Arteries — the largest and closest to the heart. They have elastin. One example is the aorta.
      2. Muscular Arteries — 90% of named arteries.
      3. Arterioles — Less than 1mm in diameter (more like 1/10th mm.) These are not named arteries.
      4. Capillaries — 1 red blood cell in diameter. Precapillary sphincturs (shunting). Capillaries are endophelial (1 cell thick) and they leak. They are designed to leak tissue fluid (has no blood cells). The blood cells stay in the vessels but the fluid leaks out and bathes all tissues. *Some capillaries are designed not to leak (e.g. brain).
2. Lymphatic System
   1. Secondary circulatory system with no pump.
   2. One way (towards heart)
   3. Drains tissue fluids back to the heart. Sudden weight gain is generally lack of drainage in the lymphatic system.
   4. Fluid must move around the body and be drained on a regular basis. Exercise aids in this process and prevents you from literally drowning in your own fluids.

The Heart

Layers of the heart (and other notes):

1. Epicardium — outer, connective layer
2. Myocardium — muscle layer (cardiac muscle). Cardiac muscle is self excitatory. These cells will sit and beat all by themselves. As soon as they touch they start beating at the same pace.
3. Endocardium — the inner connective layer. It is an epithelial layer "glued" together with a connective sheet to hold it together.
4. Coronary vessels — Branches of the aorta that supply myocardium.
5. Ischemia means "low oxygen"
6. Infarction means tissue death (necrosis) from low oxygen
7. Myocardial infarction is, then, a heart attack. If a vessel gets clotted, the tissues below it will die.

Tissues

Note: The accuracy of this information has been disputed, so please keep in mind that these were class notes and the information provided should not be used as a source without verification. These are notes from a college course on Forensic Anatomy and have not been verified outside of the classroom.

Student Presentation: Grave Robbing — The pillaging of artifact and memory

Grave Robbing is the theft of artifacts or human remains for the sole purpose of profit or unjust ownership.

Artists pilfered coffins to study human anatomy for accurate drawings. Bodies were also used for medical fields. People were also buried with their most valuable possessions and people would pilfer their graves to sell these valuables.

Evidence of grave robbing dates back to ancient Egypt. Grave-diggers ("restrictionists") would pilfer grave sites for medicine, art, or monetary selfishness. In the 19^th century, fresh corpses were uncovered for dissection (education/medicine).

Some ways to prevent against grave robbing:

• iron coffins
• iron cages placed over the grave
• slabs of stone placed over the burial area
• night watchers with shotguns
• in extreme cases, waiting until decomposition set in before burying the individual (prevents grave robbing for dissection)
• location
• superstition and fear of disease

There have also been laws enacted to prevent people from grave robbing (1818 in the United States).

Vandalism at a grave site precipitated grave robbing. This occurred in cemetaries and also palaces and other burial sites.

People justify looting because what is buried is an "artifact." There is controversy over who owns what is buried. In Florida (particularly in Native American burial grounds) it is hard to protect a burial site because people will come in and pillage for flint knives, etc. which can be sold for profit.

Most recent instance of looting was in Iraq (Baghdad Museum). Many sites and prehistoric cemetaries were raided as well (for resale).

Grave robbing has been reduced significantly because the artistic/medical reasons for uncovering cadavers have diminished.

* The iron coffins were introduced around the time that there was hysteria over being buried alive. So there were two very different types of coffins developed for two very different reasons.

Class Notes: Tissues

What we will cover today:

1. Cells & Cell Size
2. Tissues
3. Stem Cells

Cells: Neurons are the longest cells in the human body. Human eggs are the largest cells in the human body (0.1mm) but on average, human cells are 0.01mm in size. (The laws of physics are very different for things of this size). There are approximately 200 different cell types in the human body.

Tissues: Cell communities. We are concerned with two basic tissue types: epithelial tissues and connective tissues.

Epithelial tissues cover surfaces, both internal and external. Epithelial tissues are single layers of cells with constant replication. These tissues constantly replicate because they constantly wear out and fall off (from environmental forces, stomach acids, etc). Blood cells are produced by epithelial tissues. Because these cells reproduce so rapidly, they are more prone to cancer. Epithelial tissues are "poor vascular" because the blood supply does not directly go to these epithelial tissues. So, if you cut yourself and you are bleeding, you have cut past the epithelial layer. However, all of your epithelial tissues are within 1mm of a capillary or the cells will die. Epithelial tissues have good innervation.

Connective tissues are characterized by low cell density. They secrete extra-cellular matrix (a.k.a. ECM). Blood cells produce hemoglobin; skin cells produce keratin; mucosa produce mucus; neurons may produce neurotransmitters; muscle cells produce actin and myosin. The extra-cellular matrix can cover a lot of ground if we broaden the definition:

• Proteins
  • Collagen (most common protein in the body): Filler, glue, structural, white in color, fibrous, triple helix, everywhere in the body, high tensile strength (engineering), flexible, like rope. It's what glues your skin onto your muscles. If you want to make bone, you secrete collagen and fill it in. It is secreted by fibroblasts.
  • Elastin: Dimensionally stable (like Spandex). You can stretch it and it comes back. It will be fibrous and gives ease of flexibility. It is great for things like tendons and ligaments. The body doesn't like to repair tendons and ligaments; if you sprain a muscle it is never quite the same again because the fibroblasts don't do their job.
• Ground substance — for lack of a better term, it's a gel. As such, they are water-absorbent. You may be familiar with the terms Glucosamine and Condroitin (Sulphate). These are components of cartilage.

We do NOT replace connective tissues as we do epithelial tissues. This is why a tattoo is permanent, and why skin gets worn out and wrinkly. Somehow we got into a discussion about eating leather…

Stem Cells are "blank" cells with more than one possibility for tissue growth. They have multiple destinies, and totipotent stem cells can become any of the 200 types of tissues. Totipotent stem cells come from the placenta. The big controversy over stem cells these days is that totipotent stem cells are the most beneficial and they are hard to obtain. With Dolly, scientists "convinced" a stem cell that it was a fertilized egg. Other avenues that stem cell research can take us down is turning cells on or off (cancer), growing organs for transplants, etc. This is illegal in the United States to use government money for stem cell research, but it is legal for private funding.