Profile of Unnatural Deaths; in Faisalabad. To find out the magnitude, manner and modalities of unnatural deaths among all cases brought to the Forensic Medicine Department PMC Faisalabad for post mortem examination. Place and Duration of Study: A total of cases of Medico legal deaths were brought for postmortem examination in the Department of Forensic Medicine, Punjab Medical College Faisalabad during one year study period.
Among homicidal deaths, Firearms were the predominant weapons of infliction A total of 64 Out of total cases, Males were The age group most commonly involved was years Our study concludes that Homicide was the most dominant manner of death among the unnatural deaths. Fatalities caused by Firearms were the commonest form of homicide; Road Traffic Accident was the commonest modality among accidental deaths whereas; the suicide was found as rare manner of death. Death is a tragedy in whatever form, at whatever time and in whatever way it comes1.
The death is natural when it is due to any pathology disease or ageing and is unnatural when caused prematurely against order of the nature by injury, poison or other means of violence. Unnatural deaths may be accidental, suicidal, homicidal or undetermined. The data of unnatural deaths may reflect the law and order situation in a particular area of jurisdiction 2.
The crime and violence exist in the society since long over the centuries but in this modern era there is an extreme aggravation of these problems4. In Pakistan, attempts have been made by the researchers to find out the magnitude, cause and manner of death as well as the sociodemographic background of the victims of unnatural deaths, at different centers from province of Baluchistan,4 Punjab, Sindh, KPK, and AJK Drawing public attention and awareness towards casualties is important to prevent unnatural deaths; this possibly could reduce the incidence of such cases.
This paper will not only find out the magnitude of unnatural deaths but also provide a snapshot of the demographic profile, manners and modalities involved in medico legal deaths, presented to the Department of Forensic Medicine Punjab Medical College, Faisalabad for post mortem examination. The finding of this study will create awareness among the people about deaths related to violence which is the important public health concern in the society.
It will also be helpful for law enforcement agencies to make the strategies for prevention of such incidences. There were males and females belonging to the ages from 0 to 90 years. The relatives and friends of the victims were also interviewed in suspected cases of suicidal deaths. The data entered on a Performa, statistically analyzed and the results were summarized in tables and charts.
Out of the total victims of Medico legal deaths, The detail is shown in Table 1 below: Showing distribution of manner of death in Medico legal fatalities n Age wise distribution of the victims revealed that majority of the deaths Both extremes of age were least presented.
Among cases of homicidal death, firearms were the weapon of choice used by the assailants in Manual strangulation was responsible to kill 09 3. Burning contributed in 02 0. Details are shown in Table 3. Showing age and sex wise distribution of Medico legal deaths n Among a total of 75 accidental deaths, 64 Death due to Railway track accidents occurred in 02 2.
The detail of distribution among accidental fatalities is shown in Table 4. Among total 23 suicidal deaths, hanging had higher incidence 13 KidStats was developed to calculate PIs using multiple predictor models and is able to estimate age at death and sex from subadult remains. Additional information regarding KidStats can be found at https: As age progresses, dental formation and epiphyseal fusion become more informative age indicators for subadults.
Methods that are often used in forensic and clinical settings include the use of hand-wrist radiographs and the scoring of the stage of fusion for the secondary ossification centers i.
While the pattern of fusion was consistent between the sexes e. The iliac crest was the last epiphysis to fuse in both males and females Lakha, Population differences and socioeconomic status are consistently recognized as intrinsic and extrinsic factors, respectively, which affect the rate of growth and development Cardoso, However, in the South African sample, no difference among ethnic groups or individuals from different socioeconomic statuses and epiphyseal fusion was observed Lakha, On completion of testing the accuracy of the methods, correction factors for dental age estimation methods were created, based on multiple South African population groups e.
Although several studies exist, the application of these studies to an unknown person is difficult on account of differences and lack of standardization in statistical methods and analyses. Additional validation studies and novel statistical analyses for dental age estimation are needed in South African subadults. Coroners and medical examiners are officials who are charged by law with the investigation of unnatural deaths sometimes limited only to homicides and suicides , medically unattended deaths, and cases in which no physician is willing to sign the death certificate.
In questionable cases, the medical examiner has the authority to decide if he or she has jurisdiction and whether an autopsy should be performed. Generally, both coroners and medical examiners are charged with the responsibility of investigating deaths of a suspicious nature, i. This involves answering the following questions:. What injuries are present type, distribution, pattern, path, and direction of injuries? Which injuries are significant and may have caused death major versus minor injuries, true versus artifactual or postmortem injuries?
The determination of cause of death is normally made during the course of an autopsy, and is presented as a portion of the autopsy report. It consists of a factual description of the condition or injuries responsible for the death.
Unnatural death is a category used by coroners or medical examiners and vital statistics specialists for classifying all human deaths not properly describable as. Circumstances and toxicology of sudden or unnatural deaths involving alprazolam was investigated in cases of sudden or unnatural deaths presenting to.
The determination of the manner of death takes into consideration the cause of death and other available information surrounding the death i. Accidental death resulted from an accident in which no individual or individuals can be held responsible or negligent. Undetermined the circumstances are not sufficiently clear to arrive at a decision of any of the above. Sometimes it is extremely difficult, even for an experienced forensic pathologist, to be certain about the manner of death.
A thorough and complete review and evaluation of all the investigative data in the case, correlated with the postmortem anatomic and toxicologic findings, must be performed before expressing final and official opinions and rulings in questionable cases. Hammers, in Cardiovascular Pathology Fourth Edition , Investigation of sudden cardiac death SCD , like all other sudden, unexpected or unnatural death relies heavily on a thorough and comprehensive investigation of the circumstances surrounding death, including a scene investigation, interview with family and friends regarding family history and social history, collection of any medical history from a treating physician, review of the medical records.
Interviews with friends and family regarding new or changed symptoms identified before death may be key to understanding the pathogenesis of death. Specifically regarding SCDs, a comprehensive report of the activities, complaints and behaviors before and during death are critical.
Many causes of SCD have no structural changes at autopsy on gross examination or even upon microscopic examination. Sometimes, it is the lack of findings that is significant and identifies the cause of death suspected from the circumstances at death.
The scene investigation should document the particulars of the body and the surroundings. The position of the body and any evidence of disruption of the surroundings should be noted.
Any medications including dosage, number of pills prescribed and number of pills remaining, drugs and drug paraphernalia, alcohol, and tobacco present at the scene should be thoroughly recorded. Any medical paperwork should be examined for diagnosis and physician information, and family members or friends present at the scene should be questioned about the decedent's medical history and treating physicians.
If death occurs in hospital, the pertinent medical records and emergency response reports should be sent with the body for review prior to autopsy. A summary of the pertinent events, diagnoses, laboratory testing, radiology imaging, and operative events while in hospital may be very helpful, particularly if the hospitalization course is prolonged. A thorough medical history should be gathered from all available resources, including family, friends, and treating physicians.
Asking detailed family history questions, rather than a general query into cardiac death, is likely to illicit the most useful information and give the most helpful clues to identify the cause of death. The social history, including use of drugs, alcohol, and tobacco will identify substances that may play a role in death and may suggest or refute the suspicion of SCD. Certain illicit drugs and prescription medications may elevate blood pressure or incite cardiac rhythm disturbances. Obtaining a comprehensive list of illicit drug use and prescription medication use and misuse will aid in ordering appropriate toxicology testing to identify the presence of these substances in the body at the time of death, understanding the extent of histology sections necessary for establishing a diagnosis and ultimately establishing the cause of death in a timely and accurate manner [ 1—3 ].
All unnatural deaths , whether definite suicides or not, must be reported to the statutory authorities — the Procurator Fiscal in Scotland and the Coroner in England and Wales. The police investigate the death on behalf of the Crown; a death certificate cannot, therefore, be issued and a postmortem examination is required. In Scotland the Mental Welfare Commission and the special health board NHS—QIS should be informed of all suicides among psychiatric patients, irrespective of whether or not they are detained under mental health legislation.
Psychiatrists should also provide details when requested to the National Confidential Inquiry into Suicides and Homicides by People with Mental Illness. Consideration must be given to relatives who have to cope with the untimely death and the inevitable statutory procedures and delays. Of course their emotional process is one of grief, but the nature and circumstances of the death predispose to extreme or atypical reactions, profound guilt or anger, and an increased risk of self-harm or suicide among the bereaved.
The family must be carefully handled, help being sensitive and responsive to their wishes. The emotional impact on the individual who found the body or inadvertently caused the death must also be borne in mind. Post-traumatic stress disorder PTSD may develop in these circumstances. The practice of giving staff who were involved in the care, discovery or attempted resuscitation of the victim an opportunity to share their experience may reduce the risk of PTSD.
Staff should be offered this debrief within 2—3 days, in a safe, non-judgemental environment — a task that is separate from the audit of such deaths and which should be a routine part of clinical practice. The audit, or suicide review, should take place 1 or 2 months later in a planned way, and preferably with an external chairperson, primarily to establish whether there are learning points.
A report should be prepared for management, statutory authorities and members of the team. Finally, consultants must be aware of the potentially stressful effect of a patient suicide on their trainees Yousaf et al and themselves. Histological sections made from multiple teeth of those victims revealed that the discoloration was confined to the dentin adjacent to the pulp chamber of the tooth.
Miles and coworkers were the first to suggest that the pink discoloration of the teeth was simply an artifact of the decomposition process, and not just a byproduct of homicide. This hypothesis marked a turning point in the way that the forensic field viewed the pink teeth problem. Over the years, pink teeth have been studied under a variety of case-based and experimental conditions. The appearance has been linked to three etiologies: In wet decomposition, Beeley and Harvey noted differential dentin staining and Van Wyk concluded that the roots of the anterior teeth are most vulnerable to coloration as a result of advanced decomposition.
In a similar manner, Brondum and Simonsen noted a high correlation between putrefaction, adipocere formation, and the occurrence of pink teeth. Clark and Law examined the phenomenon in drowned bodies and discovered differential staining on the left arcade of one victim with the left side of the head in a dependent position.
The outdoor Anthropological Research Facility at the University of Tennessee in Knoxville, Tennessee affords an opportunity to study postmortem decomposition. To assess whether pink teeth form in relation to gravitational lividity, five cadavers were positioned in head-dependent, face-down posture from April to December. Once teeth exhibited pink discoloration, they were documented, extracted, and thin sectioned for histological examination using standard petrographic technique.
All cadavers demonstrated some degree of dentin discoloration. This was documented through gross and histological examination. Thin sections revealed blood infusion into the dentin Figure A coroner is an an independent judicial officer, appointed and paid for by the relevant local authority. He or she is usually a solicitor or doctor of five years standing, although all new appointments now have to be legally qualified.
Their job is to investigate deaths that are violent, unnatural or of unknown cause with a view to determine who the deceased was, when and where they died and, crucially, how they died. And there are currently 96 separate local coroner areas, each with their own senior coroner. The failure of the coroner system in the Shipman case led to two reviews: Both reviews found an inconsistent approach between coroner areas, and both advised the government that an independent national coroner service was needed.
But the advice was ignored and we remain stuck with the remnants of an year-old fragmented system that has varied standards. We should expect two things from the process: