Clive Cooke

Death by hanging in Western Australia

&NA; We present a review of the circumstances and medical findings of 280 fatalities due to hanging in Western Australia (WA) during the 5 yr period 1988–1992. Two hundred and forty one (241) of the cases were examined prospectively; the completed Coroners files of a further 39 cases, from rural WA, were examined retrospectively. Most of the 280 deaths were in males (88%), and most were in the age range of 15–35 yrs (56%). Seven cases occurred in children aged 15 or less. There was one homicide, 14 cases thought to be accidental, and 261 suicides; in 4 cases the manner of death could not be determined. In one‐third of the cases there was a medical history of a psychiatric condition. The majority occurred in or around the decedents home (71%). The most commonly used ligature was a rope (59%). Alcohol was the most commonly detected drug following post mortem analysis (30%). In WA then, there is one hanging death every 6.5 days, the majority being suicides, in men of young adult age, typically occurring in or around the home.

Autoerotic deaths: four cases

&NA; We describe the circumstances and post mortem medical findings of 4 unusual fatalities where death occurred during autoerotic practice. Three cases occurred in young to middleaged men — hanging, electrocution and inhalation of a zucchini. The manner of death in each was accidental. The fourth case was an elderly man who died of ischemic heart disease, apparently whilst masturbating with a vacuum cleaner and a hair dryer.

The pathology of hanging deaths in Western Australia

&NA; We present here the results of a prospective study of the pathology of 233 fatalities due to hanging in Western Australia (WA). The deaths occurred during the 5 year period 1988–92. Post mortem examination of these cases was undertaken according to a standardised protocol by forensic pathologists of this office. Post mortem findings of a further 37 cases examined by medical practitioners in rural WA are also reviewed, making a useful comparison. Petechial hemorrhages, as a hallmark of asphyxiation, were present in 113 of the 233 cases (48%). An observable ligature mark to the skin of the neck was seen in 230 cases (99%). Injury to the tissues of the neck was identified in 122 cases (52%), more commonly with complete suspension of the body (62%) than incomplete suspension (46%). Neck injury was essentially equally prevalent with a slip‐knot (58%) or a fixed knot (60%). Other fresh injuries besides the neck injury were present on the deceaseds body in 80 cases (34%). In the 37 non‐metropolitan cases, an observable ligature mark to the skin of the neck was recorded in 30 (81%). Petechial hemorrhages were described in 3 cases (8%). Internal neck injury was apparently observed in 10 cases (27%), although precise detail adequately identifying the site of injury was given in only 2 cases (5%).

Campomelic dysplasia with sex reversal: morphological and cytogenetic studies of a case

&NA; Morphological and cytogenetic studies undertaken in a case of sex reversed campomelic dysplasia revealed the presence of primary follicles within the dysgenetic gonads and a familial balanced chromosome translocation t (5;8), a hitherto unreported combination of unusual findings.

Giving the evidence

The output of the work of a forensic pathologist could be distilled into the delivery of information to a range of justice agencies and in particular to the forum of a court or other judicial or quasi judicial tribunal. The increasing complexity and knowledge base of forensic and medical science and the growing emphasis on ‘evidence based medicine’ poses significant challenges to the delivery of technical oral testimony in legal proceedings. Indeed these issues also raise problems in the production of medico-legal reports that suitably demonstrate the results of the tests undertaken in a medico-legal death investigation. New technology in the form of autopsy CT and MRI scans as well as superimposition techniques in anthropology and dentistry present particular challenges when raised in evidence, not so much in their acceptability by the court, although this is an ongoing issue, but with regard to how such virtual 3D data can be admitted and subjected to legal scrutiny through the process of cross examination. How juries receive and comprehend such evidence is also an unknown quantity. Are they overawed by the technology so that they assume the pathologist must be correct or are they confused by it and therefore dismiss it. This joint session culminating in a ‘Hot Tub’ expert panel will review the state of the law with regard to expert evidence and these new technologies and further explore the way in which pathologists can use visual aids to assist in getting their message across to the Judge and Jury. The various linguistic perils of delivering oral testimony will also be discussed together with the risks associated with uncertainty, ‘just my opinion’ and getting it wrong! Quality assurance systems now mandatory in all medical laboratories to assure the quality of the laboratories results have yet to find an official place with respect to forensic pathology testimony. Given the new technologies now being implemented in forensic pathology how long can this state of affairs continue?

Post-blast injury interpretation

Post-blast injuries may be seen by a forensic pathologist in both routine case work and as part of mass casualty events. These types of injuries can be extreme and, thus, make identification and interpretation difficult for the pathologist. Therefore, recognition and proper interpretation of these types of injuries should assist with reconstruction of the incident. The presenters will give an introduction to types of explosives, the dynamics of explosions and the terminal effects of blast on the human body. A detailed description of explosive injuries will also be discussed.

Recognising a suicide bomber as part of the disaster victim identification process

Mass casualty events, where a suicide bomber is involved, usually result in widescale injuries and fragmentation. Following these incidents, identifying the bomber carrier is a primary objective of any investigation. The application of the principals of Disaster Victim Identification (DVI) at the scene and in the mortuary will ensure that all human remains are optimally recovered and examined with respect to the identification of the deceased and the investigation of the crime. A recent DVI/post-blast exercise completed in Western Australia will be used to illustrate the nature of typical ‘suicide bomber’ injuries and how proper application of the DVI process is vital to locating and identifying these types of offenders. Drawing on published accounts and their own recent experiences, the presenters will describe the typical features of explosive injuries, particularly as they relate to contact injuries typically seen in a suicide bomber.

E-anthropology and pathology: satisfying cultural and budgetary sensitivities

Skeletalised remains are commonly referred to forensic mortuaries for examination. The most frequently referred cases are historical indigenous skeletal remains and those of non-human origin. These types of remains are usually of no immediate Coronial interest. Remains of this nature are often located in country regions, remote from the mortuary. Consequently, unnecessary transportation is expensive and time consuming. Additionally, disturbance of historical indigenous remains is usually undesirable due to cultural sensitivities. To overcome these issues, a triage system utilising digital image assessment has been instituted in Western Australia since 2004, with digital images being examined in Perth by a forensic anthropologist and pathologist. To ensure accuracy and quality of the assessments, a protocol and Scene Assessment Sheet (which meet NATA standards) have been developed. Results of this initiative show the number of mortuary admissions of historical indigenous skeletal remains has decreased significantly and non-human remains have shown a steady decline. Controlled trials have confirmed the accuracy of the method. Additionally, areas of potential misinterpretation, such as pseudo-injury, have been identified for consideration. It is anticipated this electronic assessment system may be useful Australia-wide, in remote policing districts, as a means of meeting the financial, logistical and cultural requirements of these cases.