Question one
Lessons from the first dissection video
The video is a lesson by British pathologist, Professor Lee, and German anatomist, Von Hagens. The lesson is about the functioning of the cardiovascular system and system failures that can lead to instant death or progressive morbidity, which will eventually lead to death. The cause of death being examined for in the 84-year-old woman is atherosclerosis. Atherosclerosis is the narrowing and hardening of blood vessels attributed to fat deposition in the walls of the vessels.[1]
The introduction of the lesson is in two parts. First, Lee seems to emphasize the key systems whose function must be compromised for death to occur. He identifies these systems as the cardiovascular system, the respiratory system, and the central nervous system. In the second part, Lee and Von Hagens, emphasize the importance of the cardiovascular system. Lee says that the cardiovascular system is a series of tubes on which life hangs. The two agree that impaired function of these tubes can lead to death.
The autopsy then starts. The autopsy pays special attention to the heart and the blood vessels. The abdominal wall and the loops of the intestines are reflected to access the abdominal aorta. At this point, water is pumped into the body to remove blood. The body is then re-perfused with a dye that can illuminate in ultraviolet light. Before reperfusion, the coronary artery is identified and clumped to demonstrate the effect of atherosclerotic narrowing of coronary vessels – coronary heart disease. A section of the mesentery is also clumped to ligate the blood vessels supplying a loop of the small bowel. The fluorescent dye that Von Hagens terms as artificial blood is conspicuously absent in the regions of heart and bowel to the clumps. Lee illustrates this better by showing that indeed fluid moves through a narrowed tube at a slower rate than in a tube with a wider lumen. This means that in atherosclerosis, the blood vessels are narrowed and, therefore, perfusion of organs supplied by those organs is reduced. This is called ischemia.[2] Severe ischemia leads to necrosis or infarction.[3]
Von Hagens confirms atherosclerosis in the subject’s coronary vessels by dividing one of the coronary arteries. The artery reveals several atherosclerotic plaques especially around the ostium, which opens into the aorta. Examination of several other aortas reveals that the atherosclerotic plaques have a tendency to grow in size.
Figure 1: Von Hagens showing the various stages of atherosclerosis is aortas derived from patient of different ages as Professor Lee looks on.[4]
The growth of the plaque physically narrows the lumen of the vessels and effectively weakens the wall of the vessel.[5] This weakening can lead to aneurysm formation especially in the abdominal aorta.[6] Aneurysms can grow in size to become tumor-like as one of the aortas shown by Von Hagens reveals. Stasis of blood in an aneurysm can lead to thrombosis.[7] The thrombi formed can be propagated and dislodge and travel to other sites; this is called embolism.[8] Von Hagens uses an artificial thrombus to demonstrate how the propagation of thrombi occurs.
Figure 2: Von Hagens trying to establish just how far his artificial thrombus had been embolised by the dye.[9]
Thrombi formed in aorta or heart can be embolised to arteries of a smaller calibre where they block the arteries hence ischemic injury to organs supplied by those vessels. Lee explains that patients with atherosclerosis are at a higher risk having another form of thrombosis – venous thrombosis. This mostly occurs in the lower limbs.[10] Emboli from such thrombi often end up in the lungs where they block pulmonary arteries. This, pulmonary thromboembolism is one of the relatively few causes of sudden death.[11]
Von Hagens further explains exactly how atherosclerosis affects the heart. He shows an infracted heart with weakened and dilated chambers and compared it to a normal heart. From his illustration, we realize that myocardial infarction cannot only lead to intramural thrombi, but also to rupture of heart chambers. Below is a picture of Von Hagens explaining how a ruptured coronary vessel can cause hemopericardium, which can cause death.
Von Hagen identifies the things one can do to prevent dangerous progression of atherosclerosis. He says, “a little alcohol and regular exercise can allow your aorta to look like this at 60.” At this point, he is referring to an aorta derived from a 50-year-old patient. The aorta shows few atherosclerotic plaques that can progress. Kumar et al., suggest lipid profile, age, and genetic predisposition as the other factors that determine one’s chances of getting progressive atherosclerotic disease.[12]
Question Two
Autopsy of a young woman
Shape of initial autopsy incision
The initial autopsy incision is a medium depth incision across the chest and extending inferiorly to a point near the pubis symphysis. The incision takes the form of a Y shape.
Figure 3: Autopsy Incision. [13]
The points through which the incision is made are carefully selected to avoid damage to any organ that may be examined during the autopsy. However, the main reason for this shape of the incision is to allow for adequate exposure of all body cavities but at the same time allowing for an open casket burial by the family of the deceased.
Importance of locating appendix
Locating the appendix is important; first, for orienting the body and determining if the deceased might have had congenital abnormalities of the gut like situs inversus.[14] Secondly, especially for a patient who is suspected to have died of poisoning as is the case here, the appendix is a good specimen for testing.
Condition of Kidneys
The right kidney has normal size and surface consistency. The left kidney is markedly shrunken and roughened on the outside. The kidneys generally look haemorrhagic. On dissection, the left kidney reveals marked scarring, which is indicated by a white coloration and marked thinning of the cortical tissue. In some points, the medullary tissue is also shrunken. As the pathologist discovers in the video, the right kidney shows normal colour, consistency and size of the cortex, the medulla, and the renal pelvis.
Examination of pulmonary artery
After identification, the pulmonary artery is examined first by palpation. When palpating, the pathologist tries to identify if there are any blood clots within the artery. The artery is then dissected to remove the clots if any and ascertain whether they are ante mortem or post-mortem clots. The former are usually harder in consistency and of brighter colour compared to the latter, which are friable and dark red in colour.[15] During dissection, the pulmonary valve is also examined to find out the number of cusps and the general condition of the valve. The inner wall of the artery is then examined for any atherosclerotic streaks.
Location of adrenal gland
The adrenal or suprarenal gland was located just superior to the kidney and outside the tough renal capsule in the video. This is the exact location of the gland as described by Drake et al.[16]
Finding in heart and lungs
The heart was of normal size and shape and generally looked healthy. The pathologist located the right, left coronary arteries, and took sections of the artery. The sectioning was meant to identify any narrowing or obstruction of the arteries and to identify any gross evidence of atherosclerosis. None of the arteries showed gross narrowing or blockage and there was no gross evidence of atherosclerosis. However, sections were taken for microscopic examination to confirm the gross findings. The other examination of the heart involved examining the gross condition of the valves and heart muscle. Everything else looked normal.
The right lung was examined extensively. The main bronchus was opened and its main ramifications examined to check for any physical obstructions. No obstructions were identified. The three lobes of the lungs were then examined for consistency, which seemed normal.
Findings in fallopian tubes, ovaries, and cervix
The fallopian tubes looked normal and were of normal length and girth. The two ovaries looked normal in shape, size, and colour. One ovary had a conspicuous yellow coloured corpus luteum on dissection. This showed that the woman was in the luteal phase of her menstrual cycle; a seemingly haemorrhagic endometrium proved this.[17] The cervix was of normal shape and size. The external cervical os was an approximately one-centimetre slit. This size of the os was evidence of past parity.
Brain findings regarding atherosclerosis
The blood vessels at the base of the brain were examined for any gross evidence of atherosclerosis. The arteries did not show any evidence of luminal narrowing and wall hardening, which are characteristics of cerebrovascular atherosclerosis as indicated by Burke and Tavora.[18]
Question Three
Wound Injuries
Contusions
Contusions are injuries caused by trauma by blunt objects in which the skin is not broken. In such injuries, internal organs are often damaged. As the narrator reveals, the extent of damage of internal organs cannot be predicted accurately by looking at the extent of the contusion wound. The video suggests that the size of a contusion is often larger than the extent of the initial trauma and, therefore, it is hard for one to predict the kind of weapon, which inflicted the contusion by looking at the lesion. From the video, we realize that contusion injuries are rare in suicide cases and are more likely to occur in homicide cases.[19] Moreover, evidence of repeated contusions can be a sign of domestic violence like child battering. The video suggests that child battering is most common in children aged between two months and five years and is evidenced in an autopsy by several contusion injuries of different ages. Mitchell and Anglin conclude that the age of the injury is indicated by the colour; the latest injuries are red due to erythrocytes, earlier lesions are purple to bluish due to haemostasis, even earlier lesions appear greenish due to biliverdin while oldest possible lesions appear brown due to hemosiderin.[20]
Bullet wounds
Bullet wounds are mainly classified as entrance or exit wounds. Entrance wounds are frequently smaller than exit wounds except where the exit wounds are multiple. Multiple exit wounds usually occurs where the projectile splits. Entrance wounds can further be classified as contact wounds, close range or distant wounds. Contact wounds usually have a clear impression of the muzzle of the weapon used and often take a star shape. They are most common in suicide cases.[21] Close range wounds usually reveal ash and ammunition around the bullet wound. They are common in homicide cases.[22] The amount of dispersion of the ammunition around the wound reveals the distance from which the shot was taken. Distant bullet wounds usually reveal no evidence of ash, ammunition of muzzle impression. Wounds inflicted by short guns are very characteristic as the gun usually releases several projectiles causing several wounds round the main wound or one massive wound.
Figure 4: A short gun wound.[23]
Knife wounds
They can either be incisional wounds or stab wounds. Incisional wounds are usually reducible clean cuts; they are seen in both suicide and homicide cases.[24] It is hard to tell the weapon used to inflict an incisional wound even by approximation. Stab wounds are deep. Sometimes abrasion on the margins of the stab can give a clue about the weapon used. The depth of a stab can only be determined after an autopsy.
Aspect of evidence collection
The most striking aspect of evidence collection that I noticed from the video was the importance of the environment in giving clues as to the cause of injury or death. Carefully examination of the environment even before touching the victim can easily tell one whether the victim was alone or had company and whether there was some sort of struggle before the victim was finally overpowered. The environment can also give a clue as to whether the cause of injury or death was accidental or deliberate. From this, I learned that in primary evidence collection, it is important not to tamper with the environment of the victim before closely examining it for any clues about the incident leading to death or injury of the victim.[25] Moreover, in examining the environment, though difficult, it is important to distinguish between cover-up techniques and real events that might have led to the death of the victim.
Question Four
Young Boy Autopsy
Dennis Craig Jurgens’ biological mother exhumed his body for a repeat autopsy almost two decades after his death following a relentless quest for justice. To the surprise of the examiners, the body was well preserved and the lesions on the body were still clear. Examination of the body and review of the records of the initial autopsy revealed that Dennis’s death was homicidal and not from an infection – peritonitis – as had earlier been concluded.
The pictures from Dennis’s initial autopsy reveal several contusion lesions on the skin in the face and the abdomen is markedly distended. The skin lesions appear haemorrhagic and fresh. A close look at the pictures of the torso reveal lesions that look like older bruises even though the picture is a black and white picture. Bruises of various ages on a child aged between two months and five years are often evidence of repeated child battering. Fresh bruises appear red and haemorrhagic; older ones might be purplish, green or brown depending on age. Moreover, centrally located lesions are usually most frequent in battered children.[26] As Robert Jurgens later confirms in the video, he and Dennis were victims of frequent battering from their foster mother. Further evidence of child battering is found in the fingerprints on the back of Dennis’s ears, which reveal that Dennis had been pinched severally. Even more dramatic is an evident bite wound at the tip of the boy’s penis. The boy’s foster mother could have bitten him as they struggled.
On autopsy, the examiner, Dr. McGee was able to identify a lesion on the bowel that could have led to Dennis’s death. The lesion was a perforation of the small bowel that could have caused spillage of non-sterile intestinal contents into the peritoneal cavity hence the distended abdomen and the initial diagnosis of peritonitis.
Figure 5: Intestinal lesion identified by Dr. McGee.[27]
Other diseases such as inflammatory bowel disease and cancer of the bowel can cause bowel perforation. However, inflammatory bowel disease is ruled out simply by Dennis’s age; the onset of the forms of the disease classically occurs after twenty years of age. Moreover, the areas of the bowel around the lesion do not reveal any pathologic evidence of either form of inflammatory bowel disease for instance cobblestone appearance, pseudopolyps or adhesions.[28] The lesion identified does not reveal any features of a fungating, ulcerating or even flat infiltrative tumor: This in effect rules out cancer of the bowel as a cause of bowel perforation that could have led to Dennis’s death.
This leaves trauma as the only possible cause of the bowel perforation that led to Dennis’s death. The haemorrhagic and lacerated nature of the identified lesion is evidence of trauma. The history and the evidence given by Robert in addition to other findings on examination of the mummified body confirm that homicidal trauma is the likely cause of Dennis’s death. The traumatic blow most likely originated from the anterior abdominal wall and pressed the particular loop of bowel against the bony spine hence the laceration seen on the lesion. The pressure affected the bowel by the bony spine and the blow cause it to lacerate hence perforation. Bowel perforation definitely causes bleeding and release of non-sterile bowel contents in a usually sterile peritoneal cavity, which usually causes overwhelming infection and inflammation of the peritoneal lining that is characterised by extreme abdominal pain and abdominal guarding and abdominal distension called peritonitis.[29] This is probably why the initial examiner, after missing the traumatic lesion on the intestine concluded that Dennis had died of peritonitis.
From the video, it is evident that a medical examiner should always look to marry the available history to the physical findings of the intact body and the autopsy findings like Dr. McGee did in order to obtain a correct diagnosis. The initial autopsy had concentrated on findings within the peritoneal cavity and probably the character of body fluids hence the diagnosis of peritonitis. Even though Dennis’s peritoneum might have been inflamed, the origin of this inflammatory stimulus had been totally missed in the initial examination.
Question Five
Chain of Custody
Chain of custody refers to the series of individuals or authorities who are in possession of the crime scene material or probable evidence from the time the sample is collected at the scene to the time the sample arrives in the courtroom. It is also called a chain of evidence.[30] As the facilitator in the related video puts it, an unbroken chain of custody is key to the acceptability of a sample as evidence in a courtroom. Mostly, the chain of custody is represented in a duly filled form. In medico-legal cases, the chain of custody involves three major steps: the collection of samples at the crime scene, laboratory procedures done on the sample, and handing the sample to authority or the police for presentation in a court of law.
At the crime scene, it is important not to tamper with anything before ascertaining its medico-legal importance. As a way of ensuring this, it is prudent for an investigator to take pictures of the crime scene as they found it before touching anything.[31] These photographs are a proof that indeed the specimens presented were derived from the scene of crime or the body of the victim.
Figure 6: Facilitator explaining about photography at crime scene. [32]
Well-taken notes and other documents like x-rays can be of great value here. If there is a body of a victim, it is advisable for the investigator to examine the clothing on the body before removing it. Clothing could give clues about death like the weapon used and the direction and range of firing in case of gunshot wounds.[33] Moreover, the clothing should not be cut or altered. Anything in the clothing ranging from identification documents through shopping receipts to money should be kept well. It is also key not to tamper with defects in the clothing. At this point, the investigator should look to collect adequate samples and store them in clean containers. One sample container should contain only one article.[34] Medicinal and any other suspicious substances at the crime scene should be handled with care.
Proper labelling of samples makes laboratory examination easy. In the lab, photographs of their positions before sampling and photographs of the scene after sampling and a duly filled chain of custody form should accompany the specimen.[35] Request forms detailing procedures to be done should also accompany the samples.[36] After examination, the remaining body fluids should remain in airtight glass containers and preserved for any future reference. At autopsy, 1% sodium chloride is preferred preservative for blood; refrigeration then follows. All samples should also be kept in clean containers after examination and handed to the next authority for presentation in court. In the laboratory, it is important to examine all available samples including clothing recovered from the scene. Again, a properly written document of all transfers is kept.
The chain of custody sample form attached is universal for police departments in America. Each recipient of a sample must indicate what specimen he or she received, the time of reception, and whomever he or she received the item from.[37] The person releasing the specimen must sign against their name to confirm that they released the said specimen at the specified time. This is meant to ensure that the specimen are in the right hands in order to maintain their usefulness as evidence in the courtroom.
The chain of custody form has a column where the recipient of the sample can comment on the condition of the specimen. This can free such a person from allegations that they tampered with or entirely changed the specimen in question. In this column, the place of exchange can also be indicated.
Question Six
Forensic Medicine in the O. J. Simpson Case
Mistakes in gathering and preserving evidence
First, the detectives did not survey the crime scene to collect all available evidence. The detectives discovered later that a drop of blood on the gate had been missed and found it difficult to convince the defence team that the drop of blood was at the scene on the initial visit. It is important for one to survey the scene and collect all necessary evidence during the first visit. Second, one detective did not follow the protocol of handing the samples collected to the laboratory department immediately, rather he proceeded with Simpson’s blood in a vial in his pocket to Simpson’s residence – a move which fuelled the view that the police had framed Simpson. Third, the samples were not well preserved in a refrigerator to prevent the destruction of DNA within the samples. Fourth, the techniques used in the collection of dried blood samples allowed for the unnoticeable mixture of the samples hence confusing results.
EDTA
EDTA is a compound that is used in the laboratory to prevent collected blood from clotting. The compound does this by chelating calcium ions from the blood; calcium ions are important for blood coagulation.[38] EDTA is usually present in blood collection vials having a purple stopper.
Figure 7: A blood collection vial containing EDTA.[39]
EDTA is also present in a number of foods where it is used as a food preservative. One laboratory technician in the four-part video confirms that only 5% of ingested EDTA can be absorbed in a human alimentary canal; this means that only negligible amounts of EDTA can be detected in the blood of someone who has ingested food-containing EDTA. The blood on the sock in the suspect’s room was shown to be containing EDTA. This further fuelled the emerging conspiracy theory. According to the defence team, the only source of EDTA was a blood sample collected from Mr. Simpson. The prosecution team argued that the amount of EDTA on the sock was too little to have come from a blood collection vial; it must have come from food substances. Examination of the suspect’s body did not reveal any cuts on the lower limbs – this makes it unlikely that the blood from a cut on his finger would have reached the suspect’s sock. Moreover, blood clotting in the suspect’s small cut would have occurred long before the suspect arrived at his residence and removed the sock; the blood on the sock seemed too much to have come from the finger cut.
Bloody sock
The four-part video does not show the scene in the suspect’s bedroom with a bloody sock. The video by American justice shows that a bloody sock was recovered from the suspect’s bedroom. The blood on the sock matched with that of the victim according to DNA analysis. In the video by American justice, the prosecution team insist that the blood on the sock had been missed because of darkness in the room, something the jurors did not agree with.
Effects of blanket on the victim’s body
Blankets are effectively heavier and warmer than plastic bags, which are recommended for covering victims at crime scenes. Covering the victim with a heavy and warm material can cause faster biodegradation of important body fluids by encouraging bacterial growth hence reducing the value of such body fluids in forensics. In addition, it is not easy to ascertain the cleanliness of a blanket as is the case for a plastic bag. It is possible that the blanket used to cover the victim contained unnoticeable bloodstains, which could interfere with forensic evidence or containing microbiota, which would interfere with the condition of the body fluids of the victim hence their usefulness in forensics. Moreover, a blanket is more likely that a plastic bag to remove some valuable pieces of evidence from the victim’s body at the time the body was uncovered.
Question Seven
Forensic Medicine Failures Evident in the Simpson Videos
The first forensic medicine failure evident with the video is about storage of the collected the specimen. Ideally, blood and other body fluids are stored in 1% sodium chloride in glass tubes and refrigerated. In this case, however, the blood samples collected were not put within any preservative and were not refrigerated. Rather the vials with blood were placed within packets and put in the trunk of a closed vehicle on a sunny day. As one LAPD officer confirms, the inside of the vehicle was rather. This heat did not do any good to the specimen.[40] The warmth encouraged bacterial growth within the sample. Bacteria consumed the DNA in the blood, which is the forensic evidence that was to be found in the blood. Refrigeration prevents such bacterial growth and, therefore, maintains the forensic evidence there is in the sample.
Figure 8: Wrong blood collection technique.[41]
The second pitfall was in the collection of the samples. As the forensic scientist in the video proves, it is prudent to use a different pair of gloves when handling dried blood samples that are suspected to have come from different individuals. It is possible that particles of blood containing DNA can remain on the investigator’s glove and contaminate the other blood sample, which might not be containing sufficient DNA. As the experiments prove, blood that has been dried without any preservatives may have the DNA in it depleted; investigators can introduce different DNA in such a sample when they handle it with the same gloves that they have used to handle fresh blood. Apart from the conspiracy theory, contamination of the blood samples recovered at the crime scene with blood that had been freshly drawn from Simpson was the other explanation that the defence team gave for the blood samples at the crime scene, which matched with Simpson’s blood.
After recovery from the crime scene, all forensic medicine samples are to be handed over to the laboratory department and a chain of custody form filled duly. However, this was not the case in the Simpson’s case. An officer proceeded with Simpson’s blood to his residence. The magnitude of this forensic failure is emphasized by the conspiracy theory that was fuelled by this move; the defence team maintained that the officer poured part of this blood on a second glove at Simpson’s residence and probably on the sock that was recovered in the suspect’s bedroom. Such conspiracy was further fuelled by the fact that the blood on the sock was shown to have EDTA in it. The officer should have handed the blood vial to the laboratory department immediately after it had been drawn. If the laboratory department was not available at the scene at the time, the officer should have recorded exactly when the blood sample had been taken and call for the laboratory department, he should have waited for them at the crime scene. He had the option of taking the vial with the blood to the laboratory where a chain of custody form would be duly filled. Leaving with the vial containing the suspect’s blood to the suspect’s residence was a gross mistake – it nullified the legality of any evidence recovered from the suspect’s residence.
Documentation is key in forensics.[42] Poor documentation was a major pitfall in the medical forensic procedures in the Simpson’s case. Poor documentation was evident at the crime scene as samples were being collected and at the laboratory as tests were being run. Most notably, there existed unexplainable gaps in the chain of custody. For evidence to most useful in forensics, documentation should be detailed and done at every point.
The other major pitfall was poor survey of the crime scene by detectives. The detectives did not recover all forensic evidence that was available at the scene of the crime during their first visit. This made it difficult for later evidence to be admissible in a court of law and only fuelled the conspiracy theory further. It is important for investigators to survey crime scene and collect every important piece of forensic evidence that is available at the scene of the crime.
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[1] Burke, A., & Tavora, F. (2011). Practical cardiovascular pathology: an atlas. Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins. 471
[2] Kumar, V., Abbas, A. K., Aster, J. C., & Robbins, S. L. (2013). Robbins basic pathology. Philadelphia, PA, Elsevier/Saunders. 16
[3] Kumar, V., Abbas, A. K., Aster, J. C., & Robbins, S. L. (2013). Robbins basic pathology. Philadelphia, PA, Elsevier/Saunders. 18
[4] Autopsy Life and Death episode 1 Diseases. (2013). YouTube. Directed by Lee; Von Hagens. New York, USA: LiveLeak.
[5] Kumar, V., Abbas, A. K., Aster, J. C., & Robbins, S. L. (2013). Robbins basic pathology. Philadelphia, PA, Elsevier/Saunders. 342
[6] Burke, A., & Tavora, F. (2011). Practical cardiovascular pathology: an atlas. Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins. 479
[7] Kumar, V., Abbas, A. K., Aster, J. C., & Robbins, S. L. (2013). Robbins basic pathology. Philadelphia, PA, Elsevier/Saunders. 346
[8] Kumar, V., Abbas, A. K., Aster, J. C., & Robbins, S. L. (2013). Robbins basic pathology. Philadelphia, PA, Elsevier/Saunders. 90
[9] Autopsy Life and Death episode 1 Diseases. (2013). you tube. Directed by Lee; Von Hagens. New York, USA: LiveLeak.
[10] Kumar, V., Abbas, A. K., Aster, J. C., & Robbins, S. L. (2013). Robbins basic pathology. Philadelphia, PA, Elsevier/Saunders. 87
[11] Kumar, V., Abbas, A. K., Aster, J. C., & Robbins, S. L. (2013). Robbins basic pathology. Philadelphia, PA, Elsevier/Saunders. 90
[12] Kumar, V., Abbas, A. K., Aster, J. C., & Robbins, S. L. (2013). Robbins basic pathology. Philadelphia, PA, Elsevier/Saunders. 337
[13] Autopsy on young female. (2013). You Tube. Directed by Jo Jo. USA: Department of Pathology.
[14] Blegen, H.M., 1949. Surgery in situs inversus. Annals of surgery, 129(2), p.244.
[15] Kumar, V., Abbas, A. K., Aster, J. C., & Robbins, S. L. (2013). Robbins basic pathology. Philadelphia, PA, Elsevier/Saunders. 83
[16] Drake, R. L., Vogl, W., Mitchell, A. W. M., Gray, H., & Gray, H. (2010). Gray’s anatomy for students. Philadelphia, PA, Churchill Livingstone/Elsevier. 365
[17] Becker, K. L. (2001). Principles and practice of endocrinology and metabolism. Philadelphia, Pa. [u.a.], Lippincott, Williams & Wilkins.
[18] Burke, A., & Tavora, F. (2011). Practical cardiovascular pathology: an atlas. Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins. 387
[19] Halari, M.M., 2012. MSc in Forensic Medical Sciences Homicide-Suicide: Epidemiology, Characteristics, Psychology and Prevention in Society (Doctoral dissertation, QUEEN MARY UNIVERSITY OF LONDON (UNITED KINGDOM)).
[20] Mitchell, C., & Anglin, D. (2009). Intimate partner violence: a health-based perspective. Oxford, Oxford University Press. http://www.123library.org/book_details/?id=1962.
[21] Halari, M.M., 2012. MSc in Forensic Medical Sciences Homicide-Suicide: Epidemiology, Characteristics, Psychology and Prevention in Society (Doctoral dissertation, QUEEN MARY UNIVERSITY OF LONDON (UNITED KINGDOM)).
[22] Halari, M.M., 2012. MSc in Forensic Medical Sciences Homicide-Suicide: Epidemiology, Characteristics, Psychology and Prevention in Society (Doctoral dissertation, QUEEN MARY UNIVERSITY OF LONDON (UNITED KINGDOM)).
[23] Autopsy Documentary – Crime Scene Autopsy – Autopsy Examination Part II. (2014). you Tube. Directed by Wevideostube. USA: USA Department of Defense.
[24] Halari, M.M., 2012. MSc in Forensic Medical Sciences Homicide-Suicide: Epidemiology, Characteristics, Psychology and Prevention in Society (Doctoral dissertation, QUEEN MARY UNIVERSITY OF LONDON (UNITED KINGDOM)).
[25] Stout, S.A., Uhler, A.D., Naymik, T.G. and McCarthy, K.J., 1998. Peer Reviewed: Environmental Forensics Unraveling Site Liability. Environmental science & technology, 32(11), pp.260A-264A. 261
[26] Davis, J.W., 2008. Domestic violence: the “rule of thumb”: 2008 Western Trauma Association presidential address. Journal of Trauma and Acute Care Surgery, 65(5), pp.969-974. 971
[27] A Mothers Instinct – New York state Medical Examiner. (2013). You ATube. Directed by Juz Cuz. New York: New York State Medical Examiner.
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