A significant number of medicolegal deaths involve ethanol. Deaths may be related to the acute, intoxicating effects of ethanol, either in decedents or within persons responsible for causing the deaths of others. Additionally, deaths may be related to chronic alcoholism. A chronic alcoholic may display characteristic external features which allow an observer, such as a forensic pathologist or other physician, to conclude that he/she is probably an alcoholic. Herein, the authors report two decedents with a rare condition known as "multiple symmetric lipomatosis" (MSL), which has a strong correlation with chronic alcoholism. Identification of the peculiar features associated with MSL should prompt the forensic pathologist to consider chronic alcoholism as a probable diagnosis.
Homicide investigations represent an important function of death investigators. Although recognizing nonobvious homicides is crucial, an equally important role involves the identification of cases that initially present as possible homicides, but are ultimately discovered to not represent homicides. Failure to recognize such cases results in wasted time, squandered resources, false allegations, and potential life-altering consequences. The authors review a series of cases wherein initial investigation suggested a possibility that the deaths represented homicides. By carefully considering additional information, including scene findings, history, and postmortem examination, each was determined to represent an accidental traumatic death. In addition to highlighting the importance of recognizing accidental traumatic deaths that initially present as homicides, the cases serve to highlight the fact that forensic pathology cannot be practiced without knowledge of appropriate ancillary information. Although guarding against cognitive bias is important in all forensic disciplines, including forensic pathology, access to vital case-related ancillary information is an essential component of practicing medicine as a forensic pathologist.
As forensic scientists and physicians, forensic pathologists are duty-bound to perform their examinations with integrity and professionalism. The practice of medicine requires knowledge regarding the history and presentation of the patient. In forensic pathology, the history includes scene and other investigative information, and the decedent's medical and social history. Such information is important for the correct certification of the cause and manner of death. Herein, the authors present a case originally thought by police and death investigators to represent a sexual-assault-related homicide, as an elderly female's body was found partially nude, and apparently beaten, on the muddy floor of her horse barn. At autopsy, some of the injuries were determined to be postmortem and caused by horses. Additionally, gastric Wishnewsky spots indicated hypothermia as a probable mechanism of death. Finally, an acute hip fracture was identified, which explained why she was incapable of moving from her potentially dangerous environment.
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