List of Contributors ix
Foreword xvii
Preface xix
Chapter One: Expert evidence and healthcare professionals 1
Introduction 1
The adversarial system of justice 2
Expert reports 3
Evidentiary exclusionary rules 3
Pre-trial preparation for expert witnesses 5
Appearance 6
Timeliness 7
Giving of evidence 7
Managing cross-examination 10
Summary 14
References 14
Chapter Two: Forensic investigation of biological weapon use 17
Introduction 17
A choice of words 17
Threat assessments 18
Presenting features 22
Forensic microbiology or microbial forensics? 25
Assembling evidence from emerging infectious disease biology 26
Current constraints 34
References 34
Appendix 37
Chapter Three: The paediatric hymen 43
Introduction 43
Studies of normal anatomy 44
Studies of genital findings in sexually abused girls 49
Studies of acute injuries as they heal 54
A consideration of test reliability 56
Putting it all together 58
References 59
Chapter Four: Assessment and interpretation of bone trauma in children 63
Introduction 63
How should I evaluate suspected bone trauma in children? 64
What radiological investigations identify bone trauma? 68
How do X-rays detect fractures? 69
How does ultrasound detect bone injury? 73
How do nuclear medicine scans detect bone injury? 74
How does MRI detect bone injury? 75
How are medical images presented and shared? 78
What forces cause bones to fracture? 79
Are some bone injuries diagnostic of child abuse? 80
What do we know about bone healing in children? 82
What tests detect fragile bones? 83
Neonates with fractures: what are the special considerations? 85
Can the time of bone injury be determined? 87
Why might an X-ray be reported as normal when bone trauma exists? 87
Why might an ultrasound appear normal when bone trauma exists? 87
Why might a nuclear medicine scan appear normal when bone trauma exists? 88
Why might an X-ray appear abnormal when no bone trauma exists? 88
Why might a nuclear medicine scan appear abnormal when no bone trauma exists? 89
How do I deal with correctly interpreted but discordant imaging findings? 90
A. Why might an X-ray appear normal and bone scan ‘hot’ when bone trauma exists? 90
B. Why might a fracture seem obvious on plain X-ray but bone scan is ‘cold’ when bone trauma exists? 90
When and why should I repeat X-rays? 91
How does the process of forming a forensic medical opinion differ from the process of diagnosis in clinical medicine? 91
Why do I need to be aware of my level of confidence in my medical diagnosis? 91
What factors should I consider when forming a diagnostic opinion about the cause of a child’s fracture? 92
References 93
Chapter Five: Adult sexual assault 95
Introduction 95
Sexual assault settings and characteristics 96
Findings after sexual assault 101
Toxicology and sexual assault 116
Forensic science and sexual assault 116
Treatment after sexual assault 117
Summary 118
References 118
Chapter Six: The ethical and medical aspects of photodocumenting genital injury 123
Introduction 123
Sexual assault 126
Imaging the body in the history of medicine 126
Photography 128
The evolution of the photography of genital injury 129
A particular Australian’s experience 132
Ethics of care 140
Why no ethical objection to children being photographed? 141
The difference that being a child makes and its relevance 142
Advancing the question of best ethical practice 143
Clinical forensic medicine and sexual assault 150
Conclusion 152
References 153
Appendix 157
Chapter Seven: The photography of injuries 159
Introduction 159
The image 160
Equipment 161
Illumination 163
Polarizing filters 164
Forensic scales 164
The photography of an injury 164
The colour control or reference 166
Cross-polarized photography 167
Reflected ultraviolet 172
Infrared 181
Long wave ultraviolet-induced fluorescence 184
Imaging file format 188
The audit trail 189
Conclusion 190
Acknowledgements 191
References 191
Further reading 191
Chapter Eight: DNA analysis: Current practice and problems 193
Introduction 193
DNA collection and storage 194
DNA extraction 196
DNA quantification 196
DNA amplification 199
DNA separation and detection 200
DNA genotyping 201
Standard loci sets and commercial STR kits 202
Statistical evaluation of a DNA match 203
Assessing STR profiles 208
Mixtures of DNA 213
Degraded DNA 217
Low-template DNA 217
Other genetic markers 221
Tissue identification 228
Use of DNA in the criminal justice system 229
References 231
Chapter Nine: Injury interpretation: Possible errors and fallacies 239
Injury visualization 241
Nomenclature 244
Photography 245
Aging of injuries 248
Force of injury 253
Medical limitations and considerations 255
Genito-anal injuries in the adult 255
Child abuse 258
Self-inflicted injury 262
Other specialist opinions 263
Opinions 266
How to avoid errors 267
References 268
Chapter Ten: Self-inflicted injuries and associated psychological profiles 273
Introduction 273
Forensic aspects of self-harm 273
Psychiatric aspects of self-harm 280
Epidemiology 281
Classification of self-harm 282
The clinical dilemma 284
Management 285
Long-term outcome 286
Conclusion 286
References 288
Chapter Eleven: Bite marks 291
Introduction and cautionary remarks 291
Animal bites 291
Other injuries mimicking bites 294
Bites in foodstuffs 295
Examination of injuries in the dead 296
Examination of the living 300
Examination of the suspect 301
Trends in bite-mark analysis 303
Acknowledgement 306
References 306
Further reading 307
Chapter Twelve: Aviation disasters: The role of the forensic pathologist 309
Introduction 309
The scene 309
The autopsy 311
Establishing the cause of death 314
Circumstances surrounding death 317
Forensic pathology report 320
References 321
Index 323
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