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DEAD CAN TELL TALES:Raudha's Dead Body Tells The Truth Of Her Death

Modern science and research in the field of Forensic medicine has enough documented evidence to prove the extent to which this is true.  Dead can speak and speak the truth; we only need a patient and discerning mind to ‘hear’ and understand what they speak” is valid.

The old saying that “dead cannot speak” is incorrect. They do speak and speak the truth; we only need a patient and discerning mind to ‘hear’ and understand what they speak. It has been proved innumerable times that reliable information, based on scientific facts, can be derived from the dead; but only if we know “when, where, what & how” to look for the facts.

The following is a case investigated at department  of Forensic Medicine and Toxicology,Govt. Medical College Hospital, Chandigarh, India.

Depressed Signature Fracture
on top of the skull in the right parietal bone.

The  case was exhumed 11 months after internment. The accused had, after killing the victim, some how convinced the victim’s family that he had died after being bitten by a snake. This, in turn proved his nemesis, as the deceased’s kin buried him instead of cremating his body (an age-old belief among North Indians that people dying of snake bite should not be cremated).

Later following objections raised by some relative the body was exhumed and taken for a second post mortem investigation.. A sealed packet submitted by the investigating agency, containing human skeletal remains recovered on exhumation 11months after burial was studied at the department of Forensic Medicine and Toxicology, Govt. Medical College Hospital, Chandigarh.

The following post mortem findings were made:

The mandible was broken into 3 pieces. A Depressed Signature Fracture measuring 3.5cm x 2.5cm x 0.5cm was present on top of the skull in the right parietal bone, 2cms above the right parietal eminence.

From the upper angle of the depression, a fissure fracture was extending to join the saggital suture at the vertex, followed by sutural separation of the saggital up to the Bregma and then to the left limb of the lambdoid suture. Separation of the left temporo-parietal suture was also present. The depressed fracture of the skull pointed towards the cause of death.

A careful and thorough examination of bones may yield a wealth of information, which if properly interpreted, may tell a lot about the individual during his life. The case  investigated  here, however, point towards a definite cause of death-Blunt force impact to head leading to Cranio-cerebral Damage. This is particularly true of the  case, where the depressed signature fracture on the right parietal bone, even 11 months after internment, gave the following information:

1. That the weapon of assault (probably a hammer like object) had an oval striking face of about 3.5 x 2.5cms.
2. That the assailant was to the left of the victim at the time of assault and
3. That he was positioned relatively higher than the victim i.e. the victim was either kneeling /crouching / or sitting, etc, while the assailant was standing.

The dimension of the depression on the left supraorbital region was the almost same as that on the right parietal area, implying thereby that the victim was struck twice with the same weapon.

In all medico-legal cases, the investigation of a deceased body involves two major methods of approach. One is the examination of the body details of a cadaver or skeletal remains in comparison with the ante-mortem details of the suspected victim. Formal records like dental charts, x-rays, medical records, passports and photographs, etc, along with personal effects like family photographs, personal belongings and news paper clippings are some of the important means of comparative identification.

Forensic expert guides the investigating officer using his expertise in defining important physical and morphological features of the person or the dead body with which the investigating officer is not acquainted but which are of great significance in establishing the identity. The medico-legal expert or specialist in Forensic Medicine is not a detective.

One of his important functions is to furnish the investigating agencies with specific information on matters of which he has specialized knowledge. He sees the case as a whole; he observes, infers and even speculates. To him, because of his special knowledge, a non-medical clue may have a significance that even an astute policeman may not be able to grasp. His peculiar experience and talents may enable him alone to deduce the correct interpretation of the facts .

Raudha's Dead Body Tells The Truth Of Her Death

The Islami Bank Medical College at Rajshai  alledge that they found Raudha Athif hanging from the celing fan of her hostel room at the college. The investigation of a hanging case starts with crime scene findings and police inquest report and most importantly from the observations that were made based on ligature mark and material.

There were bruise marks of manual strangulation on Raudha’s neck and chin ,and contusions on her ankles. The ligature mark of her neck  does not match with a ligature mark of hanging and that of ligature material which consist of two shawls tied together.

There were cadaveric spasms in her hands. The condition is not part of rigor mortis, which is characterized by a progressive rigidity of the deceased body due to bio-mechanical changes in muscles occurring 10-12 hours after death. It has been argued that cadaveric spasm is most likely associated with high muscular exertion prior to death and often it is associated with violent deaths.Cadaveric spasm is a persistent occurrence when it happens, and the individual will continue to hold that pose from death until putrefaction allows for decay of the affected limb.

The college officials are trying their best to hide the real truth oh her death but the injuries and the external postmortem findings clearly indicate the cause of her death as homicide. It is to be noted that Rajshahi Executive Magistrate court rejected the case of Raudha death which was filed by Rajshahi metropolitan police as a case of unnatural death by suicide suspecting foul play. Therefore how much the college officials trying to stage her death appear as suicide or how the three member autopsy team prepared a fabricated autopsy report which even the court has refused to accept, the injuries and the signs on Raudha’s body speaks the truth of her death.

Identification means determination or establishing the individuality of a person. A dead body is evidence, evidence to be photographed, X-rayed, described, analyzed in depth and correlated with circumstances. The objective is to search thoroughly for crucial information that enables one to judge what did happen and did not happen to the decedent [1].A forensic expert, with his specialized knowledge, would be able to deduce - who was the person, what happened, and what evidence indicates the presence or the absence of culpability? This is essential to establish the Corpus Delecti, which in cases of homicide consists of three parts-a) the identity of the victim, b) determination that death was not natural, and c) the death resulted from the criminal act of another person.

Standard protocols for medico legal autopsies were not followed by the 3 members autopsy team who conducted Raudha’s autopsy.

 Adequate photographs are crucial for thorough documentation of autopsy findings.

Photographs should be in color (transparency or negative/print), in focus, adequately illuminated, and taken by a professional or good quality camera. Each photograph should contain a ruled reference scale, an identifying case name or number, and a sample of standard grey. A description of the camera (including the lens "f-number" and focal length), film and the lighting system must be included in the autopsy report. If more than one camera is utilized, the identifying information should be recorded for each.
Photographs should also include information indicating which camera took each picture, if more than one camera is used. The identity of the person taking the photographs should be recorded. Photographs should be comprehensive in scope and must confirm the presence of all demonstrable signs of injury or disease commented upon in the autopsy report.

But there were no proper external examination and identification of Raudha’s body and proper photographic or video recording of the positive and negative forensic findings were not performed. Serial photographs reflecting the course of the external examination were not performed.

Documentation of any skeletal system or soft tissue injury by X-ray or CT or MRI was not done.

The internal examination for internal evidence of injury should clarify and augment the external examination. The internal findings did not match the external injuries on her body. Histological examination of the skin was not performed. There was no attempt to describe and document injury patterns to differentiate manual, ligature and hanging strangulation. The ligature mark does not match with ligature material and ligature knot.

The ligature mark and gross features only may not be necessarily the deciding factors. Similar ligature mark as of hanging can also be produced by means of fabrication by applying a ligature within 24 hours or even later after death of an individual. Thus, any kind of mark may not be conclusive evidence to that – the hanging took place during life [2]. Hence, a detailed internal examination of neck structures (soft tissue, bones & cartilages) and histopathological examination of the mark and internal neck structures gives additional and necessary information.

In these cases the histopathological examination reveals the presence of effusion of red cells, congested blood vessels, hemorrhages, tissue reaction etc., in cases of ante mortem hanging.But histopathological examination of the mark and internal neck structures were not performed. . A low hanging is more likely to lead to asphyxia and there may be some facial congestion and a purple protruding tongue. But these findindigs were not on Raudhas’s dead body.

Validity of the old saying that “dead can speak and speak the truth; we only need a patient and discerning mind to ‘hear’ and understand what they speak” being proved with certainty in one case but only partially in the other validates yet another old saying that “all possibilities can not be ruled out beyond reasonable doubt.

   01.Sir Smith S,Mostly murder.Dorset Press.NewYork.1988 pp35.
   02 . Taylor, A.S. Principles and Practice of Medical Jurisprudence.
Edited by Keith Mant A. 13thed (1994) 316.

Raudha’s autopsy not consistent with Bangladesh Human Right Commission recommended standard protocol for autopsy

The Bangladesh National Human Right Commision’s Recommendation on Autopsy Protocol states that the dead body should be radiographed before it is removed from its pouch or wrappings and also X-rays should be repeated before and after undressing the body and document any skeletal system injury by X-ray.

When Raudha was found dead at her hostel room there were marks of manual strangulation on her neck apart form a non continuous ligature mark which did not match with the ligature found at her room. But the forensic  doctors led by Professor Dr. Mansur Rahman who conducted  Raudha’s first autopsy did not conduct the radiological investigations of her body .They did not conduct even the most basic X-rays of the neck AP and lateral and Chest radiograph.

The board led by Prof Mansur Rahman of Barind Medical College includes former teacher of Rajshahi Medical College( RMC) Prof Emdadur Rahman, who is currently working at the Islami Bank Medical College, and Enamul Haque, a lecturer at the RMC.

When they shared the first post mortem autopsy findings with the media I met the forensic doctors Prof Mansur Rahman and  Prof Emdadur Rahman and Islami Bank Medical college Principal Dr. Nazrul Islam and asked them why X-ray of the neck was done then Prof Dr.Emdadur Rahman told that it is not required.

But when they conducted the second post mortem of Raudha they included  Dr. Hafizur Rahman, associate professor of the radiology and imaging department of Rajshahi Medical College to conduct radiological investigations.

The first autopsy  report shows the differences in what the forensic team  found and what the police of Rajsahi Metroplotian Police found in their inquest report of Raudha.Their findings have now become a case of debate among some senior doctors at Rajshahi Medical College.The second autopsy report is still pending.

Primary signs in a case of manual strangulation:subcutaneous and intramuscular hemorrhage.a: Contusion in the subcutaneous fatty tissue above the right mandibular angle (axial
STIR MR image, TR 2580 msec, TE 14 msec, TI 130; arrow). This type of injury is
characteristic of manual strangulation and results from pressure on the mandibular angles
during the assault. b: The same region at autopsy, after incision of the subcutaneous fatty
tissue. The lobules of fat tissue were contusioned and hemorrhagic. c: Intramuscular
hemorrhage (arrows) depicted in the left sternocleidomastoid muscle by axial T2-weighted
fat-saturated MRI (TR 4000 msec, TE 90 msec). The muscle shows hyperintensities and
swelling in comparison to the right side. d: Moderate intramuscular hemorrhage at autopsy
 X-ray should be done in nearly all strangulation victims and patients with a mechanism consistent with hanging. It is useful to detect fractured hyoid bone and for evaluation of sub cutaneous emphysema due to fractured larynx. Fractures of the cervical vertebrae are extremely rare in strangulation injuries unless there has been a hanging with a free-fall drop of the body.

Osseous injury in a case of suicidal
hanging. a: MSCT showing a fracture of the left
hyoid bone (small arrow). The strangulation
mark appeared as a deep impression of the
skin on both sides of the neck (large arrows). b:
3D reconstruction of MSCT data clearly depicting
the deviation at the fracture site. c: Left
hyoid bone specimen after the maceration procedure.
Even after maceration of the bone, the
fracture was hardly detected (arrows). d: Electron
microscopic examination ( 29, 4 kV)
demonstrating the fracture line through the
entire diameter of the hyoid bone.
CT scan is indicated to detect hyoid bone and laryngeal fractures, injury to carotid arteries and other soft-tissue abnormalities that may not be apparent on plain radiographs. CT head is done to evaluate neurological status. CT is more sensitive for bony injuries, subcutaneous emphysema, soft-tissue edema, and internal hemorrhage. Multi slice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) are appropriate options for diagnostic investigations of the neck and throat following strangulation. MRI is the most useful imaging modality for the majority of such victims because of its highest sensitivity for deep soft-tissue injury including the larynx and vessels.

The benefit of such techniques includes the ability to create a permanent record, for the purposes of investigation and judicial usage. Doctors within all fields are also familiar with the technique and examining the developed films through its numerous clinical applications, although definitive reporting of the film should be undertaken by a consultant radiologist with experience in examining roetgenograms of adult and childhood trauma, as well as postmortem changes.

Lymph node injury following manual
strangulation. a: A hyperintense lymph
node was detected on the left side of the neck
(large arrow) on a coronal T2-weighted fat-saturated
MR image (TR 4000 msec, TE 98
msec). The left shoulder showed contusioned,
hyperintense subcutaneous fatty tissue (small
arrows). b: Forensic-pathological correlation at
autopsy. The lymph nodes appear dark red
(arrow). c: Histological specimen ( 25) demonstrating
extensive hemorrhage (large arrows)
in the lymph node. A layer of erythrocytes in
the connective tissue surrounding the lymph
node (small arrows) confirmed the traumatic
genesis of the finding.
The application of radiological investigations in cases of medicolegal
interest originated within months of Wilhelm Conrad Roentgen’s discovery of
X-rays (known commonly, although incorrectly, as an “X-ray”) in 1895; a case of injury through negligence was pursued in a British court. Despite witness and medical testimony, the radiological evidence proved crucial in swaying the jury as to the extent of damage inflicted. Subsequently, the first description of radiological evidence’s use in a murder trial was recorded the following year when the new technology revealed the presence of intracranial metal projectiles as a consequence of an ultimately fatal gunshot injury.

X-ray is the most common, basic and essential imaging method used in forensic medicine. Apart from  X-ray  computed tomography and magnetic resonance imaging, are more and more applied in forensic medicine. Their application extends possibilities of the visualization the bony structures toward a more detailed imaging of soft tissues and internal organs. The application of modern imaging methods in postmortem body investigation is known as digital or virtual autopsy. At present digital postmortem imaging is considered as a bloodless alternative to the conventional autopsy.

Horizontal fracture of the thyroid cartilage caused by hanging. Axial (A) and coronal (B) bone window 2D MPR show fractures of the superior horns of the thyroid cartilage (arrows) without associated soft tissue emphysema. Note that in (A) only the left fracture line is seen, whereas in B, involvement of both superior horns is readily appreciated (arrows). Right lateral (C) 3D VR of cartilages and hyoid bone (yellow), and of airways (blue) show an abnormal anterior tilting and inferior displacement of the hyoid bone (dashed arrow). This abnormal position is caused by the action of the infrahyoid muscles. It strongly suggests associated injury of the suprahyoid muscles
Primary signs in strangulation by suicidal hanging. a: Coronal STIR MR image (TR 3000 msec, TE 14 msec, TI 120) showing subcutaneous desiccation in the strangulation mark area (small arrows) and a deep impression of the skin in the lateral neck parts (larger arrows). Subcutaneous desiccation underneath the strangulation mark results from compression of the skin and subcutaneous layers due to the strangulation mechanism, and is seen as a hypointense signal in this STIR MR image. b: At autopsy, band-like subcutaneous desiccation is present in the region of the strangulation mark.