Forensic Pathology of Trauma: Common Problems for the Pathologist

By Michael J. Shkrum and David A. Ramsay, 648 pp, with illus, Totowa, NJ, Humana Press, 2007.Unlike some forensic science disciplines, the actual practice of forensic pathology rarely has dramatic developments, and coming up with fresh material for a first edition of a textbook can be a difficult challenge to undertake. In this first edition text, coauthored by a pair of Canadian-based forensic pathologists, they have more then stepped up and completed the challenge. The stated premise of the text is that it is meant as a guide to the interpretation of basic injury and wound patterns for the non–forensically trained pathologist who may be asked to perform a forensically oriented autopsy.The 10-chapter book begins with a section on the actual mechanics of the autopsy and autopsy report and contains valuable information that should be required reading for all first-year postgraduate trainees in pathology. Chapter 2, entitled “Postmortem Changes, The Great Pretenders,” which focuses on common postmortem changes that may be misinterpreted as acute trauma, is a natural extension of the preceding chapter. Chapters 3 through 7 tackle the topics of asphyxial deaths, thermal injuries, drowning-related deaths, and penetrating trauma, which is subdivided into separate chapters devoted to gunshot wounds and sharp force injuries. Chapter 8 broadly tackles the topic of blunt force traumatic injuries, with special attention accorded to motor vehicle and transportation-related fatalities. The final 2 chapters of the book are devoted to central nervous system–related injuries and sudden neurologic deaths.Unlike most forensic-oriented texts, the authors have prudently elected to subdivide every chapter into an outline form of organization, which makes for an easy and quick way to get at specific information, as opposed to having to sort through an entire text. The practical approach of this book is reflected in multiple subsections devoted specifically to performing the autopsy within the various patterns of injury, information that will be valuable to anyone without a great deal of previous hands-on experience. Should the reader desire a more in-depth discussion, more than 120 pages of text are devoted to reference citations. Other strengths of the text are the inclusion of applicable histologic correlates to specific injuries.The text is heavily illustrated with black and white photographs throughout, and the photographs selected for inclusion were done with an eye toward the practical approach to the autopsy. Forensic pathology is a very visually oriented discipline, and unfortunately the photographs themselves are the major weak point of the book. The variable quality of the photographs are not infrequently reflected by pictures that appear out of focus, are taken at the improper magnification, are underdeveloped, or fail to adequately illustrate the desired topic. The book does come with an accompanying CD that contains the color counterpoints of the black-and-white photographs; however, there is only a modest improvement with the color photographs.An improperly completed death certificate is the pet peeve of many a forensic pathologist, and I was somewhat disappointed by the lack of discussion on how to appropriately complete a death certificate, a default task that ultimately may be assigned to the pathologist following autopsy completion. Additionally, although 120 pages of references may benefit a small number of users, perhaps a more practical use of some of that space would have been to include examples of sample autopsy reports and gross and microscopic descriptions.Unlike other broad-based forensic texts, such as DiMaio's Forensic Pathology and Spitz and Fisher's Medicolegal Investigation of Death, which have traditionally been the mainstays of the general pathologist's bookshelf and which are frequently referenced by attorneys, criminalists, and mystery writers, the text in Forensic Pathology of Trauma is refreshingly and clearly geared toward the practicing pathologist, particularly the sections devoted toward neuropathology. Overall, the text flows smoothly from one topic to another, and editorializing is kept to a minimum.As a guide to the practical approach to the conduct of the forensic-oriented autopsy for the pathologist without much in the way of formal forensic training, this book can be thoroughly recommended, as it more then adequately succeeds in its stated goal. Additionally, I would highly endorse this text as a valuable reference for both the forensic pathology fellow and the established forensic pathologist.

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