Forensic pathology

Forensic pathology is pathology that focuses on determining the cause of death by examining a corpse. A post mortem is performed by a medical examiner, usually during the investigation of criminal law cases and civil law cases in some jurisdictions. Coroners and medical examiners are also frequently asked to confirm the identity of a corpse. Also see forensic medicine.

Forensic medicine heart
The heart of a murder victim

Duties

Forensic pathology is an application of medical jurisprudence. A forensic pathologist is a medical doctor who has completed training in anatomical pathology and has subsequently specialized in forensic pathology. The requirements for becoming a "fully qualified" forensic pathologist vary from country to country. Some of the different requirements are discussed below.

The forensic pathologist performs autopsies/postmortem examinations to determine the cause of death. The autopsy report contains an opinion about the following:

  • The pathological process, injury, or disease that directly results in or initiates a series of events that lead to a person's death (also called the mechanism of death), such as a bullet wound to the head, exsanguination caused by a stab wound, manual or ligature strangulation, myocardial infarction resulting from coronary artery disease, etc.)
  • The manner of death, the circumstances surrounding the cause of death, which, in most jurisdictions, include the following:[1]

The autopsy also provides an opportunity for other issues raised by the death to be addressed, such as the collection of trace evidence or determining the identity of the deceased.

The forensic pathologist examines and documents wounds and injuries, at autopsy, at the scene of a crime and occasionally in a clinical setting, such as rape investigation or deaths in custody.

Forensic pathologists collect and examine tissue specimens under the microscope (histology) to identify the presence or absence of natural disease and other microscopic findings such as asbestos bodies in the lungs or gunpowder particles around a gunshot wound.

They collect and interpret toxicological specimens of body tissues and fluids to determine the chemical cause of accidental overdoses or deliberate poisonings.

Forensic pathologists work closely with the medico-legal authority for the area concerned with the investigation of sudden and unexpected deaths: the coroner (England and Wales), procurator fiscal (Scotland), or coroner or medical examiner (United States).

They serve as expert witnesses in courts of law testifying in civil or criminal law cases.

In an autopsy, the forensic pathologist is often assisted by an autopsy/mortuary technician (sometimes called a diener in the US).

Forensic physicians, sometimes referred to as "forensic medical examiners" or "police surgeons" (in the UK until recently), are medical doctors trained in the examination of, and provision of medical treatment to, living victims of assault, including sexual assault, and individuals who find themselves in police custody. Many forensic physicians in the UK practice clinical forensic medicine part-time, and they also practice family medicine or another medical specialty.

In the United Kingdom, membership of the Royal College of Pathologists is not a prerequisite of appointment as a coroner's medical expert. Doctors in the UK who are not forensic pathologists or pathologists are allowed to perform medicolegal autopsies, as the wording of the Coroners and Justice Act 2009, which merely stipulates a "registered medical practitioner": anyone on the General Medical Council register.

Investigation of death

Deaths where there is a unknown cause and those considered unnatural are investigated. In most jurisdictions this is done by a "forensic pathologist", coroner, medical examiner, or hybrid medical examiner-coroner offices.

Terminology is not consistent across jurisdictions

In some jurisdictions, the title of "Medical Examiner" is used by a non-physician, elected official involved in medicolegal death investigation. In others, the law requires the medical examiner to be a physician, pathologist, or forensic pathologist.

Similarly, the title "coroner" is applied to both physicians and non-physicians. Historically, coroners were not all physicians (most often serving primarily as the town mortician). However, in some jurisdictions the title of "Coroner" is exclusively used by physicians.

Canadian coroners

In Canada, there is a mix of coroner and medical examiner systems, depending on the province or territory. In Ontario, coroners are licensed physicians, usually but not exclusively family physicians. In Quebec, there is a mix of medical and non-medical coroners, whereas in British Columbia, there is predominantly a non-physician coroner system. Alberta and Nova Scotia are examples of ME systems[2][3]

Coroners and medical examiners in the United States

In the United States, a coroner is typically an elected public official in a particular geographic jurisdiction who investigates and certifies deaths. The vast majority of coroners lack a Doctor of Medicine degree and the amount of medical training that they have received is highly variable, depending on their profession (e.g. law enforcement, judges, funeral directors, emergency medical technicians, nurses).

In contrast, a medical examiner is typically a physician who holds the degree of Doctor of Medicine or Doctor of Osteopathic Medicine. Ideally, a medical examiner has completed both a pathology residency and a fellowship in forensic pathology. In some jurisdictions, a medical examiner must be both a doctor and a lawyer, with additional training in forensic pathology.

History

In German-speaking Europe, lectures on forensic pathology were regularly held in Freiburg in the mid 18th century and Vienna in 1804. Scientists like Auguste Ambroise Tardieu, Johann Ludwig Casper and Carl Liman made great effort to develop forensic pathology into a science based on empirics.

Forensic pathology was first recognized in the United States by the American Board of Pathology in 1959.[4]

In Canada, it was formally recognized in 2003,[5][6] and a formal training program (a fellowship) is currently being established under the auspices of the Royal College of Physicians and Surgeons of Canada.[7]

Education

In most English speaking countries, forensic pathology is a subspecialty of anatomical pathology. Training requirements differ from country to country.

Australia

There are currently three paths to qualify as a forensic pathologist in Australia. The first is to train solely in forensic pathology (although a significant amount of anatomical pathology knowledge is still required) and pass two examinations for forensic pathology only. The second is to commence training in anatomical pathology, and complete an initial anatomical pathology examination, which takes a minimum of three years; then go on to train solely in forensic pathology and complete a forensic pathology examination, which takes a minimum of two years. The third is to complete a minimum 5 years' training in anatomical pathology to qualify as a fellow in anatomical pathology, then complete a post-fellowship year in forensic pathology (a minimum twelve months further training plus successful completion of an examination).[8]

Canada

In Canada,[9] anatomical pathology is a five-year residency. Residents who wish to become forensic pathologists must then complete a one-year fellowship in forensic pathology. Forensic pathology is a sub-specialty by the Royal College of Physicians and Surgeons. Three schools that have training programs are the University of Toronto, University of Alberta, and Mcmaster University.

India

In India, the speciality is commonly referred to as Forensic Medicine and Toxicology or Legal Medicine. After completion of medical graduation (MBBS), one has to complete three years of study and training including thesis research, which leads to award of degree of MD (Forensic Medicine). One can also alternately pass the board examination conducted by National Board of Examinations, leading to awarding of Diplomate of National Board (DNB).

The majority of the specialists are attached to the Department of Forensic Medicine and Toxicology in various medical colleges. The classification of posts includes Assistant Professor (Lecturer), Associate Professor (Reader) and Professor. The work profile of the specialists includes conducting autopsies and clinical forensic examinations; apart from teaching the medical students. They have to regularly appear in the courts as expert witnesses. A typical department in a government institution conducts 100 to 5,000 autopsies a year depending upon the jurisdiction. Apart from this the clinical forensic examinations constitute a major part of the work and number of cases can run up to ten thousand a year in an average institution.

The largest association of the specialty is Indian Academy of Forensic Medicine [1] (IAFM), which also publishes its quarterly Journal of Indian Academy of Forensic Medicine [2] regularly. This association has a specialist member strength of more than 1000.

Indonesia

In Indonesia, forensic medicine, also known as legal medicine ("kedokteran kehakiman"), is a 3-year specialty program that can be taken directly after completing medical school. It is separate from anatomical pathology and clinical pathology. Upon completion of the program, a forensic medicine specialist will obtain the title Spesialis Forensik, or Sp.F. He or she may be addressed in public as Dokter Forensik ("forensic doctor"). Note that there is no pre-medicine program, making the total duration of formal education for one to become a forensic specialist 9 years.

Forensic medicine is also a mandatory round during medical school clerkship. Medical students assist the doctors on autopsies, and they may also be allowed to perform an autopsy under supervision, and to witness in the court.

United Kingdom

In the UK, anatomical pathology is a five-year residency. Successful candidates are eligible for inclusion on the specialist register of the General Medical Council (GMC) having obtained Membership of the Royal College of Pathologists (United Kingdom).

A specialist training (ST) post is applied for after the foundation year to enter a training program in Histopathology. Imminent changes as a result of the Tooke report may require two years or more to be fulfilled on general rotational placements before the option of histopathology arises. However, the Royal College have not yet issued their response to this matter. It is then necessary to obtain the MRCPath Part I examination in Histopathology, after which it is then possible to apply to one of few training posts in Forensic Pathology in the UK. Current approved centres include Belfast, Liverpool, Leicester, Cardiff, London, Sheffield, Glasgow and Dundee. Not all the posts are currently actively training. Following 3 years training in Forensic Pathology and completion of the FRCPath Part II slanted to Forensic Pathology a candidate may then obtain CCT (certificate of completion of training) and work as a Consultant Forensic Pathologist. Another option is to obtain the full FRCPath in general histopathology, followed by another 18–24 months of training in forensic pathology, which will qualify the candidates with either the Diploma of the Royal College of Pathologists in Forensic Pathology (DipRCPath (forensic)), or the Diploma in Medical Jurisprudence (DMJ). In England & Wales the candidate will also need to be Home Office Accredited, which will require checks of the training portfolio and completion of a security check and the Expert Witness Training Course run by the Forensic Science Service.

Foreign graduates and specialists need to apply to the GMC and the RCPath directly to practise Forensic Pathology in the United Kingdom.

United States

In the United States, forensic pathologists typically complete at least one year of additional training (a fellowship) after completing an anatomical pathology residency and having passed the "board" examination administered by The American Board of Pathology or The American Osteopathic Board of Pathology ("board-certified"). Becoming an anatomic pathologist in the United States requires completing a residency in anatomic pathology, which is on-the-job training one must perform upon completing medical school before one may practice unsupervised. Anatomic pathology (as it is called) by itself is a three-year residency. Most U.S. pathologists complete a combined residency in both anatomic and clinical pathology, which requires a total of four years.

In the United States, all told, the education after high school is typically 13–15 years in duration (4 years undergraduate training + 4 years medical school + 4–5 years residency [anatomic and clinical pathology combined] + 1-2 year forensic pathology fellowship). Generally, the biggest hurdle is gaining admission to medical school, although the pass rate for anatomic and forensic pathology board examinations (in the U.S.) is approximately 80-90 and 90-100 percent, respectively. The courts do not require American Board of Pathology certification in order for a witness to be qualified as an expert in the field of forensic pathology, and there are several "diploma mills" that give online certificates in the field.[10]

The University of Florida College of Medicine offers a Master of Science degree with a concentration in Forensic Medicine, which is the first fully online advanced degree program in Forensic Medicine in the United States. The program focuses on the application of medical knowledge to the investigation of crime, particularly in establishing the causes of injury or death. It is unique in that it emphasizes the practical application of forensic medicine to the forensic sciences and crime scene investigation. Particularly, the Forensic Medicine Program focuses on education based in casework – developed by industry-leading professionals currently working in their specialized fields – that students can directly apply to their current or future careers in the forensic sciences, including as a forensic pathologist.[11]

In popular culture

Pathologists are common characters in crime fiction. The following characters appear in television series. (The following entries are alphabetically by character.)

  • Jordan Cavanaugh M.D., is a forensic pathologist in the Massachusetts Office of the Chief Medical Examiner, in the series Crossing Jordan'
  • Dr. Max Debryn, Home Office forensic pathologist in detective series Endeavour and Inspector Morse.
  • Isabelle Lightwood, said to be the best forensic pathologist in New York the TV series, Shadowhunters.
  • Sven Nyberg, Ystad police department's forensic pathologist in the Swedish, and British, series Wallander.
  • Dr. Pasquano, Vigàta's local forensic pathologist in the Italian series, Inspector Montalbano.
  • Dr. R. Quincy, Chief medical examiner for Los Angeles County in the US TV series "Quincy, M.E.".
  • Dr. Samantha Ryan, the primary character in the British drama series Silent Witness.
  • Ambrose Spellman, coroner for the Spellman Sisters' Mortuary and main character in the Netflix supernatural horror series Chilling Adventures of Sabrina.
  • Dr. Daniel Harrow, Australian Television Program, Harrow

See also

References

  1. ^ DiMaio, Dominick. Forensic Pathology (2nd ed.). Florida: CRC Press LLC. pp. 3–6. ISBN 0-8493-0072-X.
  2. ^ The Coroner System. USW. http://www.usw.ca/program/content/3179.php Archived 2009-11-13 at the Wayback Machine. Accessed on: 7 June 2007.
  3. ^ Coroners' law resource. King's College London. http://www.kcl.ac.uk/depsta/law/research/coroners/canada.html. Accessed on: 7 June 2007.
  4. ^ Eckert WG (1988). "The forensic pathology specialty certifications". The American Journal of Forensic Medicine and Pathology. 9 (1): 85–9. doi:10.1097/00000433-198803000-00023. PMID 3354533.
  5. ^ Lett D (July 2007). "National standards for forensic pathology training slow to develop". CMAJ. 177 (3): 240–1. doi:10.1503/cmaj.070881. PMC 1930175. PMID 17664437.
  6. ^ Royal College of Physicians and Surgeons of Canada. Information by Specialty or Subspecialty. Available at: http://rcpsc.medical.org/information/index.php?specialty=417&submit=Select. Accessed on: 15 July 2008.
  7. ^ Two new pathologists to restart Ottawa forensic unit. cbc.ca. URL: http://www.cbc.ca/health/story/2008/01/11/ot-pathologist-080111.html. Accessed on: 15 July 2008.
  8. ^ RCPA website www.rcpa.edu.au. Accessed 30 January 2009.
  9. ^ Residency Training Programs. Dalhousie University. URL: http://pathology.medicine.dal.ca/anatomical.html. Accessed on: 7 June 2007.
  10. ^ Top 10 Things to Look For in Finding a Qualified Forensic Pathologist Expert Witness
  11. ^ "Forensic Medicine » Education Program » College of Medicine » University of Florida". forensicmedicine.med.ufl.edu. Retrieved 2018-04-03.

Sources

  • Bartos, Leah, "No Forensic Background? No Problem", ProPublica, April 17, 2012.
  • Burton, Julian N.; Rutty, Guy N. (eds.) (2010). The Hospital Autopsy: A Manual of Fundamental Autopsy Practice (3rd ed.). London: Hodder Arnold. ISBN 978-0-340-96514-6. OCLC 653083337.CS1 maint: Extra text: authors list (link)
  • Gorea, R. K.; Dogra, T. D.; Aggarwal, A. D. (2010). Practical Aspects of Forensic Medicine A Manual for Undergraduates and General Practitioners. New Delhi: Jaypee Brothers Medical Publishers. ISBN 978-81-8448-994-1. OCLC 729254521.
  • Payne-James, Jason (ed.; et al.) (2005). Encyclopedia of Forensic & Legal Medicine. Amsterdam; Boston: Elsevier Academic Press. ISBN 0-12-547970-0. OCLC 60834620.
  • Payne-James, Jason; Busuttil, Anthony; Smock, William S. (eds.) (2003). Forensic Medicine: Clinical and Pathological Aspects. London; San Francisco: Greenwich Medical Media. ISBN 1-84110-026-9. OCLC 51678652.CS1 maint: Extra text: authors list (link)
  • Saukko, Pekka J.; Knight, Bernard (2004). Knight's Forensic Pathology (3rd ed.). London: Edward Arnold (Publishers). ISBN 0-340-76044-3. OCLC 56440239.
  • Spitz, Werner U.; Spitz, Daniel J. (eds.) (2006). Spitz and Fisher's Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation (4th ed.). Springfield, Ill.: Charles C. Thomas Publisher. ISBN 0-398-07544-1. OCLC 56614481.CS1 maint: Extra text: authors list (link)
  • "The Real CSI, PBS Frontline documentary, April 17, 2012.

External links

Becoming a pathologist

Algor mortis

Algor mortis (Latin: algor—coldness; mortis—of death), the second stage of death, is the change in body temperature post mortem, until the ambient temperature is matched. This is generally a steady decline, although if the ambient temperature is above the body temperature (such as in a hot desert), the change in temperature will be positive, as the (relatively) cooler body acclimates to the warmer environment. External factors can have a significant influence.

The term was first used by Dowler in 1849. The first published measurements of the intervals of temperature after death were done by Dr John Davey in 1839.

Anatomical pathology

Anatomical pathology (Commonwealth) or Anatomic pathology (U.S.) is a medical specialty that is concerned with the diagnosis of disease based on the macroscopic, microscopic, biochemical, immunologic and molecular examination of organs and tissues. Over the last century, surgical pathology has evolved tremendously: from historical examination of whole bodies (autopsy) to a more modernized practice, centered on the diagnosis and prognosis of cancer to guide treatment decision-making in oncology. Its modern founder was the Italian scientist Giovan Battista Morgagni from Forlì.

Anatomical pathology is one of two branches of pathology, the other being clinical pathology, the diagnosis of disease through the laboratory analysis of bodily fluids and/or tissues. Often, pathologists practice both anatomical and clinical pathology, a combination known as general pathology. Similar specialties exist in veterinary pathology.

Defense wound

A defense wound or self-defense wound is an injury received by the victim of an attack while trying to defend against the assailant. Defensive wounds are often found on the hands and forearms, where the victim has raised them to protect the head and face or to fend off an assault, but may also be present on the feet and legs where a victim attempts defense while lying down and kicking out at the assailant.The appearance and nature of the wound varies with the type of weapon used and the location of the injury, and may present as a laceration, abrasion, contusion or bone fracture. Where a victim has time to raise hands or arms before being shot by an assailant, the injury may also present as a gunshot wound. Severe laceration of the palmar surface of the hand or partial amputation of fingers may result from the victim grasping the blade of a weapon during an attack. In forensic pathology the presence of defense wounds is highly indicative of homicide and also proves that the victim was, at least initially, conscious and able to offer some resistance during the attack.Defense wounds may be classified as active or passive. A victim of a knife attack, for example, would receive active defense wounds from grasping at the knife's blade, and passive defense wounds on the back of the hand if it was raised up to protect the face.

Devon colic

Devon colic was a condition that affected people in the English county of Devon during parts of the 17th and 18th centuries, before it was discovered to be lead poisoning.

The first written account of the colic comes from 1655. Symptoms began with severe abdominal pains and the condition was occasionally fatal. Cider is the traditional drink of Devonians, and the connection between the colic and cider drinking had been observed for many years. The condition was commonly attributed to the acidity of the beverage.

William Musgrave's publication De arthritide symptomatica (2nd edn, 1715) included the first scientific description of "Devonshire colic" – it was later referred to by John Huxham and Sir George Baker.However, the precise cause was not discovered until the 1760s when Dr George Baker put forward the hypothesis that poisoning from lead in cider was to blame. He observed that the symptoms of the colic were similar to those of lead poisoning. He pointed out that lead was used in the cider making process both as a component of the cider presses and in the form of lead shot which was used to clean them. He also conducted chemical tests to demonstrate the presence of lead in Devon apple juice.

The publication of his results met with some hostile reaction from cider manufacturers, keen to defend their product. Once Baker's conclusions became accepted and the elimination of lead from the cider presses was undertaken, the colic declined. By 1818, Baker's son reported that it was "hardly known to exist" in Devon.

Goudge Inquiry

The Inquiry into Pediatric Forensic Pathology in Ontario, commonly known as the Goudge Inquiry, was created to address serious concerns over the way criminally suspicious deaths involving children are handled by the Province of Ontario in Canada. The inquiry was primarily the result of evidence that arose in regards to discredited pathologist Charles Smith.

Livor mortis

Livor mortis (Latin: livor – "bluish color", mortis – "of death"), postmortem lividity (Latin: postmortem – "after death", lividity – "black and blue"), hypostasis (Greek: hypo, meaning "under, beneath"; stasis, meaning "a standing") or suggillation, is the fourth stage of death and one of the signs of death. It is a settling of the blood in the lower, or dependent, portion of the body postmortem, causing a purplish red discoloration of the skin. When the heart stops functioning and is no longer agitating the blood, heavy red blood cells sink through the serum by action of gravity. The blood travels faster in warmer conditions and slower in colder conditions.

Livor mortis starts in 20–30 minutes, but is usually not observable by the human eye until two hours after death. The size of the patches increases in the next three to six hours, with maximum lividity occurring between eight and twelve hours after death. The blood pools into the interstitial tissues of the body. The intensity of the color depends upon the amount of reduced haemoglobin in the blood. The discoloration does not occur in the areas of the body that are in contact with the ground or another object, in which capillaries are compressed.

Medical examiner

A medical examiner is an official trained in pathology that investigates deaths that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdictions to initiate inquests.In the US, there are two death investigation systems, the coroner system based on English law, and the medical examiner system, which evolved from the coroner system during the latter half of the 19th century. The type of system varies from municipality to municipality and from state to state, with over 2000 separate jurisdictions for investigating unnatural deaths. In 2002, 22 states had a medical examiner system, 11 states had a coroner system, and 18 states had a mixed system. Since the 1940s, the medical examiner system has gradually replaced the coroner system, and serves about 48% of the US population.The coroner is not necessarily a medical doctor, but a lawyer, or even a layperson. In the 19th century, the public became dissatisfied with lay coroners and demanded that the coroner be replaced by a physician. In 1918, New York City introduced the office of the Chief Medical Examiner, and appointed physicians experienced in the field of pathology. In 1959, the medical subspecialty of forensic pathology was formally certified.The types of death reportable to the system are determined by federal, state or local laws. Commonly, these include violent, suspicious, sudden, and unexpected deaths, death when no physician or practitioner treated recently, inmates in public institutions, in custody of law enforcement, during or immediately following therapeutic or diagnostic procedures, or deaths due to neglect.

Ontario Centre of Forensic Sciences

The Centre of Forensic Sciences (CFS) is a laboratory providing forensic science services to law enforcement agencies in Ontario, Canada. It is part of the government of Ontario Ministry of Community Safety and Correctional Services public safety division.

Pallor mortis

Pallor mortis (Latin: pallor "paleness", mortis "of death"), the first stage of death, is an after-death paleness that occurs in those with light/white skin.

Pathology

Pathology is the study of the causes and effects of disease or injury. The word pathology also refers to the study of disease in general, incorporating a wide range of bioscience research fields and medical practices. However, when used in the context of modern medical treatment, the term is often used in a more narrow fashion to refer to processes and tests which fall within the contemporary medical field of "general pathology," an area which includes a number of distinct but inter-related medical specialties that diagnose disease, mostly through analysis of tissue, cell, and body fluid samples. Idiomatically, "a pathology" may also refer to the predicted or actual progression of particular diseases (as in the statement "the many different forms of cancer have diverse pathologies"), and the affix path is sometimes used to indicate a state of disease in cases of both physical ailment (as in cardiomyopathy) and psychological conditions (such as psychopathy). A physician practicing pathology is called a pathologist.

As a field of general inquiry and research, pathology addresses four components of disease: cause, mechanisms of development (pathogenesis), structural alterations of cells (morphologic changes), and the consequences of changes (clinical manifestations). In common medical practice, general pathology is mostly concerned with analyzing known clinical abnormalities that are markers or precursors for both infectious and non-infectious disease and is conducted by experts in one of two major specialties, anatomical pathology and clinical pathology. Further divisions in specialty exist on the basis of the involved sample types (comparing, for example, cytopathology, hematopathology, and histopathology), organs (as in renal pathology), and physiological systems (oral pathology), as well as on the basis of the focus of the examination (as with forensic pathology).

Pathology is a significant field in modern medical diagnosis and medical research.

Post-mortem chemistry

Post-mortem chemistry, also called necrochemistry or death chemistry, is a subdiscipline of chemistry in which the chemical structures, reactions, processes and parameters of a dead organism is investigated. Post-mortem chemistry plays a significant role in forensic pathology. Biochemical analyses of vitreous humor, cerebrospinal fluid, blood and urine is important in determining the cause of death or in elucidating forensic cases.

Post-mortem interval

Post-mortem interval (PMI) is the time that has elapsed since a person has died. If the time in question is not known, a number of medical/scientific techniques are used to determine it. This also can refer to the stage of decomposition of the body.

Post-mortem photography

Post-mortem photography (also known as memorial portraiture or a mourning portrait) is the practice of photographing the recently deceased. Various cultures use and have used this practice, though the best-studied area of post-mortem photography is that of Europe and America. There can be considerable dispute as to whether individual early photographs actually show a dead person or not, often sharpened by commercial considerations.

The form continued the tradition of earlier painted mourning portraits. Today post-mortem photography is most common in the contexts of police and pathology work.

Postmortem documentation

A project post-mortem is a process, usually performed at the conclusion of a project, to determine and analyze elements of the project that were successful or unsuccessful. The Project Management Body of Knowledge (PMBOK) refers to the process as lessons learned. Project post-mortems are intended to inform process improvements which mitigate future risks and to promote iterative best practices. Post-mortems are often considered a key component of, and ongoing precursor to, effective risk management.

Putrefaction

Putrefaction is the fifth stage of death, following pallor mortis, algor mortis, rigor mortis, and livor mortis. This process references the breaking down of a body of a human or animal post-mortem (meaning after death). In broad terms, it can be viewed as the decomposition of proteins, and the eventual breakdown of the cohesiveness between tissues, and the liquefaction of most organs. This is caused by the decomposition of organic matter by bacterial or fungal digestion, which causes the release of gases that infiltrate the body's tissues, and leads to the deterioration of the tissues and organs.

The approximate time it takes putrefaction to occur is dependent on various factors. Internal factors that affect the rate of putrefaction include the age at which death has occurred, the overall structure and condition of the body, the cause of death, and external injuries arising before or after death. External factors include environmental temperature, moisture and air exposure, clothing, burial factors, and light exposure.

The first signs of putrefaction are signified by a greenish discoloration on the outside of the skin on the abdominal wall corresponding to where the large intestine begins, as well as under the surface of the liver.

Certain substances, such as carbolic acid, arsenic, strychnine, and zinc chloride, can be used to delay the process of putrefaction in various ways based on their chemical make up.

Body farms are facilities which study the process of human decomposition as well as how environmental factors affect the rate of putrefaction.

Retrospective diagnosis

A retrospective diagnosis (also retrodiagnosis or posthumous diagnosis) is the practice of identifying an illness after the death of the patient (sometimes in a historical figure) using modern knowledge, methods and disease classifications. Alternatively, it can be the more general attempt to give a modern name to an ancient and ill-defined scourge or plague.

Rigor mortis

Rigor mortis (Latin: rigor "stiffness", mortis "of death"), or postmortem rigidity, is the third stage of death. It is one of the recognizable signs of death, characterized by stiffening of the limbs of the corpse caused by chemical changes in the muscles postmortem. In humans, rigor mortis can occur as soon as four hours after death.

Skeletonization

Skeletonization refers to the final stage of decomposition, during which the last vestiges of the soft tissues of a corpse or carcass have decayed or dried to the point that the skeleton is exposed. By the end of the skeletonization process, all soft tissue will have been eliminated, leaving only disarticulated bones. In a temperate climate, it usually requires three weeks to several years for a body to completely decompose into a skeleton, depending on factors such as temperature, humidity, presence of insects, and submergence in a substrate such as water. In tropical climates, skeletonization can occur in weeks, while in tundra areas, skeletonization may take years or may never occur, if subzero temperatures persist. Natural embalming processes in peat bogs or salt deserts can delay the process indefinitely, sometimes resulting in natural mummification.The rate of skeletonization and the present condition of a corpse or carcass can be used to determine the time of death.After skeletonization, if scavenging animals do not destroy or remove the bones, acids in many fertile soils take about 20 years to completely dissolve the skeleton of mid- to large-size mammals, such as humans, leaving no trace of the organism. In neutral-pH soil or sand, the skeleton can persist for hundreds of years before it finally disintegrates. Alternately, especially in very fine, dry, salty, anoxic, or mildly alkaline soils, bones may undergo fossilization, converting into minerals that may persist indefinitely.

Subspecialty

A subspecialty or subspeciality (British English) is a narrow field within a specialty such as forensic pathology, which is a subspecialty of anatomical pathology. A subspecialist is a specialist of a subspecialty.

In medicine, subspecialization is particularly common in internal medicine, cardiology, and neurology, and has grown as medicine has:

become more complex, and

it has become clear that a physician's case volume is negatively associated with their complication rate; that is, complications tend to decrease as the volume of cases per physician goes up.

Principles of pathology
Anatomical pathology
Clinical pathology

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