| Table of Contents |
| 1. | Introduction | 1 |
| | Selected References and Further Reading | 11 |
| 2. | The External Postmortem Examination | 13 |
| 2.1. | Tasks and Duties of Care at Medical External Examination | 16 |
| 2.2. | Legal Considerations Relating to External Examinations | 17 |
| 2.2.1. | The Concept of the "Dead Body" and Ordering an External Postmortem Examination | 17 |
| 2.2.2. | Timing of the External Postmortem Examination | 19 |
| 2.3. | Collecting Evidence at the Scene of Discovery | 20 |
| 2.4. | Abnormal Findings and Information at External Postmortem Examination | 21 |
| 2.5. | Duty of Due Diligence at External Postmortem Examination | 23 |
| 2.6. | Second External Postmortem Examination at the Crematorium | 28 |
| 2.7. | The External Postmortem Examination and Recording Causes of Death/Fatal Injury | 28 |
| 2.8. | Duty to Bury | 30 |
| | Selected References and Further Reading | 31 |
| 3. | Thanatology | 33 |
| 3.1. | Death | 34 |
| 3.2. | Brainstem Death and Brainstem Death Diagnosis | 35 |
| 3.3. | State of Apparent Death | 35 |
| 3.4. | Supravital Reactions: Early Postmortem Changes | 36 |
| 3.4.1. | Mechanical Excitability of the Skeletal Muscles | 36 |
| 3.4.2. | Electrical Excitability of Skeletal Muscles | 37 |
| 3.4.3. | Pharmacological Excitability of the Iris Musculature | 38 |
| 3.4.4. | Livor Mortis (Postmortem Lividity/Hypostasis) | 38 |
| 3.4.5. | Rigor Mortis (Postmortem Rigidity) | 40 |
| 3.4.6. | Reduced Body Temperature | 41 |
| 3.5. | Special Postmortem Changes | 47 |
| 3.6. | Animal Scavenging | 47 |
| 3.7. | Advanced Postmortem Changes | 48 |
| 3.8. | Forensic Entomology | 51 |
| 3.9. | Forensic Estimation of the Time of Death and Postmortem Interval | 52 |
| | Selected References and Further Reading | 54 |
| 4. | Autopsy (Syn. Postmortem Examination, Necroscopy) | 57 |
| 4.1. | Situations Calling for Autopsy and Types of Autopsy | 57 |
| 4.1.1. | Clinical Autopsy in the Pathology Department | 58 |
| 4.1.2. | Autopsies Ordered by an Authority | 58 |
| 4.1.3. | Special Medicolegal Autopsies | 58 |
| 4.2. | Basic Principles of Autopsy Techniques at Medicolegal Autopsy | 59 |
| 4.2.1. | Back, Arms, and Legs | 60 |
| 4.2.2. | The Head and Head Cavity | 61 |
| 4.2.3. | Opening the Chest and Abdominal Cavities | 65 |
| 4.3. | The Autopsy Report | 71 |
| 4.4. | Dealing with Specimens Taken at Autopsy | 72 |
| | Selected References and Further Reading | 73 |
| 5. | Exhumation | 75 |
| 5.1. | Macroscopic Findings on Exhumation | 75 |
| 5.2. | Histological Findings on Exhumation | 79 |
| 5.3. | Chemical--Toxicological Analysis Following Exhumation | 79 |
| 5.4. | Exhumation of Mass Graves | 83 |
| | Selected References and Further Reading | 83 |
| 6. | Establishing Identity | 85 |
| 6.1. | Visual Identification by Relatives | 86 |
| 6.2. | Identification Using Personal Effects | 86 |
| 6.3. | Body Modifications and the Results of Medical Treatment | 86 |
| 6.4. | Forensic Odontostomatology | 88 |
| 6.5. | Comparative X-Ray Analysis | 89 |
| 6.6. | Skull--Photo Comparison | 89 |
| 6.7. | Fingerprinting | 91 |
| 6.8. | Large-Scale Disasters: Disaster-Victim Identification (DVI) | 93 |
| 6.9. | Photographic Identification | 93 |
| | Selected References and Further Reading | 94 |
| 7. | Vital Reactions | 97 |
| 7.1. | Vital Reactions: Hemorrhage | 99 |
| 7.2. | Vital Reactions: Embolisms | 100 |
| 7.3. | Vital Reactions: Findings in the Respiratory and Gastrointestinal Tracts (Acute Pulmonary Emphysema, Aspiration, Inhalation, Erosions of the Gastric Mucosa) | 102 |
| 7.4. | Other Vital Reactions: Skin Reactions, Wound Healing, Fat and Muscle Tissue, and Biochemical Vital Reactions | 106 |
| 7.5. | Postmortem Manipulation | 107 |
| 7.6. | Signs of Vitality: Indications of Preserved Capacity to Act Posttrauma | 107 |
| | Selected References and Further Reading | 108 |
| 8. | Blunt Force Trauma | 111 |
| 8.1. | Injuries: General Forms, Descriptions, and Causes of Death | 111 |
| 8.2. | Types of Blunt Force Trauma | 117 |
| 8.3. | Injuries to Internal Organs | 122 |
| 8.4. | Forensic Neurotraumatology: Brain Injury | 130 |
| | Selected References and Further Reading | 133 |
| 9. | Pointed, Sharp, and Semi-sharp Force Trauma | 135 |
| 9.1. | Stab Wounds | 137 |
| 9.2. | Incised Wounds | 141 |
| 9.3. | Fatal Stab/Incised Wounds: Differentiating Between Suicide and Homicide | 141 |
| 9.4. | Semi-sharp Force Trauma | 143 |
| 9.4.1. | Chop Wounds | 143 |
| 9.4.2. | Saws | 143 |
| 9.4.3. | Chain Saws and Grinders | 144 |
| 9.4.4. | Bite Wounds | 144 |
| 9.5. | Pointed, Sharp, and Semi-sharp Force Trauma to the Bone | 146 |
| 9.6. | Causes of Death in Pointed, Sharp, and Semi-sharp Force Trauma | 146 |
| 9.7. | Medicolegal Aspects of Death Due to Pointed, Sharp, and Semi-sharp Force Trauma | 150 |
| 9.7.1. | Inferences About a Particular Weapon or Instrument | 150 |
| 9.7.2. | Sharp and Semi-sharp Force Trauma: Differentiating Between Self-inflicted Injuries and Injuries Inflicted by Others | 150 |
| 9.7.3. | Ability to Act Following Pointed, Sharp, and Semi-sharp Force Trauma | 151 |
| 9.7.4. | Antemortem vs. Postmortem Injuries in Pointed, Sharp, and Semi-sharp Force Trauma | 152 |
| | Selected References and Further Reading | 152 |
| 10. | Gunshot and Blast Wounds | 155 |
| 10.1. | Firearm Laws | 156 |
| 10.2. | Types of Firearms and Ammunition | 156 |
| 10.3. | Entrance Gunshot Wounds | 158 |
| 10.4. | Exit Gunshot Wounds | 160 |
| 10.5. | Range of Fire | 162 |
| 10.6. | Special Gunshot Wounds | 163 |
| 10.7. | Criminological Aspects of Gunshot Wounds | 168 |
| | Selected References and Further Reading | 169 |
| 11. | Neck Trauma | 171 |
| 11.1. | Non-compression Trauma to the Neck | 172 |
| 11.1.1. | Stab Wounds and Incised Wounds to the Neck | 172 |
| 11.1.2. | Birth-Related Neck Injury | 173 |
| 11.1.3. | Carotid Sinus Syndrome | 174 |
| 11.2. | Compression Trauma to the Neck | 174 |
| 11.2.1. | Hanging | 176 |
| 11.2.2. | Manual Strangulation | 183 |
| 11.2.3. | Ligature Strangulation | 185 |
| | Selected References and Further Reading | 189 |
| 12. | Thermal Injury | 191 |
| 12.1. | Heat: Burns and Scalds | 191 |
| 12.1.1. | Signs of Vitality in Burns and Scalding | 197 |
| 12.1.2. | Postmortem Findings and Thermal Injury | 199 |
| 12.2. | Heat Disorders | 205 |
| 12.3. | Hypothermia, Cold, and Frost | 206 |
| | Selected References and Further Reading | 211 |
| 13. | Electricity, Lightning, and Gases | 213 |
| 13.1. | Fatal Electrocution | 214 |
| 13.2. | Lightning | 219 |
| 13.3. | Electric Shock Devices and Taser Guns (Stun Guns and Remote Electrical Discharge Weapons) | 221 |
| 13.4. | Gas Fatalities | 223 |
| | Selected References and Further Reading | 225 |
| 14. | Asphyxia | 227 |
| 14.1. | General Pathophysiology of Asphyxia | 228 |
| 14.2. | Particular Constellations in Asphyxial Deaths | 230 |
| 14.2.1. | Positional Asphyxia (Physical Restraint) | 230 |
| 14.2.2. | Autoerotic Accidents | 234 |
| 14.2.3. | Aspiration | 235 |
| 14.2.4. | Gagging | 235 |
| 14.2.5. | Other Forms of Asphyxia | 237 |
| | Selected References and Further Reading | 240 |
| 15. | Water-Related Deaths | 243 |
| 15.1. | Drowning and Homicidal Drowning | 245 |
| 15.1.1. | Postmortem Interval | 245 |
| 15.1.2. | Osmolality of the Drowning Medium | 248 |
| 15.1.3. | Diagnosing Death by Drowning | 249 |
| 15.2. | Immersion Syndrome and Atypical Drowning | 253 |
| 15.2.1. | Immersion Syndrome (Hydrocution) | 253 |
| 15.2.2. | Atypical (Dry) Drowning | 255 |
| 15.2.3. | "Near Drowning" and Mycotic Infection | 255 |
| 15.2.4. | The Detection of Diatoms in Death by Drowning | 256 |
| 15.3. | Suicide and Homicide in Water | 257 |
| 15.3.1. | Suicide in Water | 258 |
| 15.3.2. | Homicide in Water | 258 |
| | Selected References and Further Reading | 258 |
| 16. | Death by Starvation and Dehydration | 261 |
| 16.1. | Death by Starvation | 262 |
| 16.1.1. | Starvation and Death by Starvation in Adults | 262 |
| 16.1.2. | Starvation and Death by Starvation in Children | 264 |
| 16.2. | Death by Dehydration | 266 |
| 16.3. | Causes of Death | 266 |
| | Selected References and Further Reading | 267 |
| 17. | Clinical Forensic Medicine | 269 |
| 17.1. | Self-inflicted Injuries in Suicides and Attempted Suicides | 275 |
| 17.2. | Self-Harm and Self-Mutilation | 276 |
| 17.2.1. | Differentiating Between Self-Inflicted Injury and Injury Inflicted by Others in the Case of Alleged Assault | 277 |
| 17.2.2. | Self-Harm and Psychiatric Disorders | 277 |
| 17.2.3. | Self-Harm in Custody | 278 |
| 17.2.4. | Body Modification | 280 |
| 17.2.5. | Self-Harm and Insurance Fraud | 280 |
| 17.3. | Fitness to Undergo Questioning, Be Held in Custody, Stand Trial, and Receive a Custodial Sentence | 282 |
| 17.4. | Radiological Diagnosis | 283 |
| | Selected References and Further Reading | 284 |
| 18. | Child Abuse | 287 |
| 18.1. | Introduction | 287 |
| 18.2. | Blunt Force and Child Abuse | 290 |
| 18.2.1. | Blows and Parallel Contusions | 291 |
| 18.2.2. | Fist Blows | 291 |
| 18.2.3. | Other Forms of Blunt Force | 291 |
| 18.2.4. | Bite Marks | 293 |
| 18.2.5. | Throwing or Dropping an Infant or Toddler | 294 |
| 18.3. | Thermal Injuries and Child Abuse | 294 |
| 18.4. | Shaken Baby Syndrome | 296 |
| 18.5. | Special Forms of Child Abuse | 299 |
| 18.6. | Differential Diagnoses | 301 |
| 18.7. | Child Neglect | 302 |
| 18.8. | Female Genital Mutilation | 303 |
| | References | 306 |
| 19. | Child Sexual Abuse | 309 |
| 19.1. | Introduction | 309 |
| 19.2. | Examining an Underage Victim of Violence | 310 |
| 19.3. | Anogenital Examination Findings | 312 |
| 19.4. | Sexually Transmitted Diseases and Child Sexual Abuse | 313 |
| 19.5. | Behavioral Syndromes and Psychopathological Aspects of Child Sexual Abuse | 316 |
| 19.6. | Expert Medical Appraisals in Child Sexual Abuse | 316 |
| | Selected References and Further Reading | 317 |
| 20. | Infanticide and Neonaticide | 321 |
| 20.1. | Neonaticide | 322 |
| 20.2. | Shaken Baby Syndrome: Non-accidental Head Injury | 326 |
| 20.3. | Sudden Infant Death Syndrome (SIDS), Munchausen Syndrome by Proxy (MSbP), and Infanticide | 330 |
| 20.4. | Physical Neglect Resulting in Death | 330 |
| 20.5. | Causing Death by Gross Blunt Trauma | 332 |
| 20.6. | Suicide in Childhood | 334 |
| | References | 334 |
| 21. | Traffic Medicine | 337 |
| 21.1. | Traffic Accidents | 338 |
| 21.1.1. | Reconstructing Traffic Accidents | 339 |
| 21.1.2. | Isolated-Vehicle and Vehicle-to-Vehicle Accidents | 340 |
| 21.1.3. | Pedestrian--Motor Vehicle Accidents | 343 |
| 21.1.4. | Two-Wheeled Vehicle-Motor Vehicle Accidents | 349 |
| 21.2. | Fitness to Drive and Suitability to Drive | 350 |
| 21.2.1. | Unsuitability to Drive Due to Disease | 352 |
| 21.2.2. | Unsuitability to Drive Due to Character Deficits | 352 |
| | Selected References and Further Reading | 354 |
| 22. | Forensic DNA Analysis | 357 |
| 22.1. | DNA Analysis | 359 |
| 22.1.1. | STR Analysis | 359 |
| 22.1.2. | DNA Databases | 360 |
| 22.1.3. | Probability of Identity | 361 |
| 22.1.4. | Calculating Probability of Identity | 361 |
| 22.1.5. | Gonosomal STR Loci | 363 |
| 22.1.6. | Mitochondrial DNA (mtDNA) Analysis | 363 |
| 22.1.7. | Single-Nucleotide Polymorphisms | 364 |
| 22.1.8. | Biallelic Deletion/Insertion Polymorphisms (DIPs) | 364 |
| 22.2. | Applications | 365 |
| 22.2.1. | Perpetrator Identification | 365 |
| 22.2.2. | Microscopic Investigations | 368 |
| 22.2.3. | Identifying Deceased Persons | 370 |
| 22.2.4. | Parentage Testing | 372 |
| | Selected References and Further Reading | 374 |
| 23. | Forensic Osteology | 377 |
| 23.1. | Discovering Bones | 378 |
| 23.2. | Human Specificity | 379 |
| 23.3. | Postmortem Interval | 384 |
| 23.4. | Forensic Osteological Identification | 386 |
| 23.5. | Indicators of Identity: The Biological Profile | 388 |
| 23.5.1. | Sex | 388 |
| 23.5.2. | Body Height | 389 |
| 23.5.3. | Age (Age at Death) | 389 |
| 23.5.4. | Origin | 391 |
| 23.5.5. | Healed Injuries | 392 |
| 23.6. | Population Dependence and Reevaluation | 392 |
| 23.7. | Establishing Identity | 393 |
| 23.7.1. | Forensic DNA Analysis of Bones | 393 |
| 23.7.2. | Dental Status | 393 |
| 23.7.3. | Comparative X-Ray Analysis | 393 |
| 23.7.4. | Skull--Photo Comparison and Forensic Facial Reconstruction | 394 |
| 23.8. | Traces of Injury | 394 |
| 23.8.1. | Postmortem Changes | 394 |
| 23.8.2. | Antemortem Changes | 394 |
| 23.8.3. | Perimortem Changes | 395 |
| | Selected References and Further Reading | 396 |
| 24. | Forensic Radiology | 399 |
| 24.1. | Postmortem X-Rays | 400 |
| 24.2. | Postmortem Computer Tomography | 401 |
| 24.3. | Postmortem Magnetic Resonance Tomography | 404 |
| 24.4. | Imaging in Clinical Forensic Medicine | 406 |
| 24.5. | Identification | 410 |
| 24.6. | Forensic Radiological Age Estimation | 411 |
| | Selected References and Further Reading | 413 |
| 25. | Special Case Constellations in Natural, Unexplained, and Unnatural Deaths | 417 |
| 25.1. | Deaths in Police Custody | 418 |
| 25.2. | Deaths in Inpatient Psychiatric Institutions | 418 |
| 25.3. | Deaths in Prison | 418 |
| 25.4. | Deaths in Private Homes | 418 |
| 25.5. | Deaths in the Bathroom | 419 |
| 25.6. | Deaths During Sports and Sexual Activity ("Mors in Actu") | 419 |
| 25.7. | Pregnancy-Related Deaths | 419 |
| 25.8. | Fatal Occupational Accidents | 420 |
| 25.9. | Discovering Multiple Bodies | 421 |
| 25.10. | Deaths in Alcoholics and Drug Users | 422 |
| 25.11. | Sudden Unexpected Natural Deaths | 423 |
| 25.11.1. | Coronary Sclerosis and Myocardial Infarction | 423 |
| 25.11.2. | Coronary Anomalies | 424 |
| 25.11.3. | Valvular Disease and Endocarditis | 424 |
| 25.11.4. | Myocarditis | 426 |
| 25.11.5. | Cardiomyopathies | 426 |
| 25.11.6. | Hypertension and Cor Pulmonale | 427 |
| 25.11.7. | Vascular Causes of Sudden Death | 427 |
| 25.11.8. | Respiratory Tract and Pulmonary Embolisms | 429 |
| 25.11.9. | Diseases of the Central Nervous System | 430 |
| 25.11.10. | Gastrointestinal Tract | 431 |
| 25.11.11. | Diseases of the Endocrine Organs | 432 |
| 25.12. | Sudden Infant Death Syndrome (SIDS) | 434 |
| | Selected References and Further Reading | 436 |
| 26. | Torture | 439 |
| 26.1. | Norms and Institutions | 440 |
| 26.2. | Physical Torture | 442 |
| 26.3. | Psychological Torture | 445 |
| 26.4. | Physician Participation in Torture | 445 |
| | Selected References and Further Reading | 447 |
| 27. | Forensic Psychopathology | 451 |
| 27.1. | Custody | 452 |
| 27.2. | Diminished or Nonexistent Criminal Responsibility | 452 |
| 27.3. | Ability to Make a Will | 453 |
| 27.4. | Crimes of Passion | 455 |
| 27.5. | Psychopathological Abnormalities: Personality Disorders, Mobbing, Stalking, Narcissism, and Querulousness | 455 |
| | Selected References and Further Reading | 457 |
| 28. | Medical Malpractice | 459 |
| 28.1. | The Concept of "Medical Malpractice" | 459 |
| 28.2. | Handling Medical Malpractice Claims in Forensic Medicine | 462 |
| 28.3. | Conduct in the Event of a Medical Malpractice Claim | 463 |
| 28.4. | Error Prevention Strategies | 463 |
| 28.5. | The Structure of a Forensic Appraisal in Medical Malpractice Claims | 464 |
| | Selected References and Further Reading | 464 |
| 29. | Forensic Alcohology | 467 |
| 29.1. | Alcohol Detection (Screening) | 467 |
| 29.2. | Toxicokinetics of Alcohol | 469 |
| 29.2.1. | The Absorption Phase | 469 |
| 29.2.2. | Distribution Phase | 470 |
| 29.2.3. | The Elimination Phase and Biotransformation (Metabolism) | 470 |
| 29.2.4. | The "Blood Alcohol Curve" | 471 |
| 29.2.5. | Controversial and Actual Variables Influencing the BAC | 472 |
| 29.2.6. | Calculating Blood Alcohol Concentrations from Data on Alcohol Consumption (the Widmark Formula) | 475 |
| 29.2.7. | Retrograde Extrapolation of BAC to the Time of the Offense Using Blood Samples | 476 |
| 29.2.8. | Sample Calculations | 477 |
| 29.2.9. | Post-Offense Alcohol Consumption and Double Blood Sampling | 478 |
| 29.2.10. | Markers of Alcohol Consumption | 480 |
| 29.3. | Analysis | 481 |
| 29.3.1. | Blood Sampling | 481 |
| 29.3.2. | Analysis Methods | 481 |
| 29.3.3. | Determining Alcohol Concentrations in Other Samples | 482 |
| 29.3.4. | Congener Analysis | 482 |
| 29.4. | Establishing Suspicion and Evidence Recovery | 484 |
| 29.5. | Toxicodynamics of Alcohol | 485 |
| 29.5.1. | Traffic Medicine Aspects | 486 |
| 29.6. | Clinical-Toxicological Aspects | 488 |
| 29.7. | Forensic Aspects | 488 |
| 29.7.1. | Assessing Fitness to Drive (Driving Safety) | 488 |
| 29.7.2. | Assessing Criminal Liability | 489 |
| 29.7.3. | Alcohol and Medication | 490 |
| 29.8. | Alcohol-Related Histopathology | 490 |
| 29.8.1. | Alcoholic Liver Pathology | 490 |
| 29.8.2. | The Pancreas | 490 |
| 29.8.3. | Alcoholic Cardiomyopathy | 491 |
| 29.8.4. | Other Alcohol-Related Histopathological Findings | 492 |
| | Selected References and Further Reading | 492 |
| 30. | Forensic Toxicology | 495 |
| 30.1. | Information and Basic Principles | 495 |
| 30.2. | Important Pharmaco- and Toxicokinetic Parameters | 496 |
| 30.2.1. | Classifying Poisonings | 497 |
| 30.2.2. | Symptoms and Syndromes | 497 |
| 30.2.3. | Classifying Poisons | 502 |
| 30.2.4. | Therapeutic Margin | 503 |
| 30.2.5. | Therapeutic Strategies | 504 |
| 30.2.6. | Postmortem Toxicology | 505 |
| 30.2.7. | The Diagnostic Value of Individual Sample Types | 507 |
| 30.2.8. | Sampling Strategies and Quantities | 509 |
| 30.2.9. | Analytical Detection and Determination Methods | 511 |
| 30.2.10. | Quality Control and Plausibility | 515 |
| 30.2.11. | Toxicology of Special Substances and Groups of Substances | 517 |
| 30.2.12. | Dependence and Abuse | 517 |
| 30.2.13. | Threshold Values in Drug Consumption | 518 |
| 30.2.14. | Major Drugs and Substances | 518 |
| 30.2.15. | Other Narcotics | 526 |
| 30.2.16. | Medicinal Drugs and Other Substances of Particular Relevance in Forensic Toxicology and Traffic Medicine | 528 |
| 30.2.17. | Anorganic and Organic Substances | 532 |
| 30.2.18. | Gases, Solvents, and Industrial Chemicals | 535 |
| 30.2.19. | Organic Solvents | 536 |
| 30.2.20. | Food and the Environment | 537 |
| 30.2.21. | Doping Agents | 537 |
| 30.2.22. | Knockout Drugs | 538 |
| | Selected References and Further Reading | 540 |
| | Appendixes | 543 |
| | Index | 565 |
