A 3-year old boy died suddenly for no apparent reason, and his body was sent for an autopsy to Thomas Andrew, MD, a forensic pathologist who was New Hampshire's medical examiner at the time.
The parents and other officials were grief-stricken but also mystified, because the boy hadn't been ill, and the child had no visible injuries.
During his autopsy, Andrew saw no outward signs of mistreatment, but "when the scalp was peeled back from the skull, there was a distinctly patterned contusion," he says. "The injury was above the hat line, which suggested it had been inflicted." The contusion did not kill the toddler, but it suggested that there might have been mistreatment, pushing Andrew to dig deeper. He then found iron-filled cells in the breathing sacs in the lungs, which could be a sign of repetitive asphyxia.
Police interrogated the toddler's caretaker, who admitted that when he cried, she squeezed him until he stopped crying, and sometimes he even passed out, Andrew says. This explained the signs of asphyxia. The last time the caretaker squeezed the toddler, he was asphyxiated long enough to die.
Andrew listed the ultimate cause of death as asphyxiation by compression of the chest. Faced with those serious charges, the caretaker agreed to a plea deal.
Similar cases occur throughout the nation. Looking objectively into the circumstances of death, forensic pathologists such as Andrew can uncover important evidence that helps police solve crimes.
In another case, Andrew recalls working on a torso found in the river in Manchester, New Hampshire. It was a woman's body with no head, arms, or legs—and eight stab wounds. Andrew first had to determine who she was.
Andrew was able to get DNA from her body, which eventually identified her and enabled police to determine that she was last seen leaving a bar with a man. The man worked in a poultry processing plant, and, according to his ex-wife, he had once said he would like to dismember someone.
Detectives found the man in Texas, and brought him back for interrogation. He admitted to picking the victim up at the bar and sleeping with her at his apartment. He recalled waking up next to her body, which was already stabbed to death, and not knowing what happened. He told police that in a panic, he decided to cut the body up and hide it.
The man led detectives to a wooded area where he had deposited the head and the legs. Andrew determined that the bone ends matched those on the torso. A miter saw in the man's apartment matched the pattern on the bone ends. The man was found guilty of murder and sentenced to life in prison.
A Misunderstood Role
Most forensic pathologists hold the title of medical examiner (ME) for county or state governments. They provide the cause of death to the dead person's family, law enforcement, and the courts, and their findings can also help public health authorities follow health trends.
But the general public mostly knows them for their role in solving crimes, especially since their work has been glamorized on television shows.
Andrew, who now runs a private consultancy, thinks forensic pathologists' role in solving crimes has been vastly exaggerated. "Our role is to provide information or clues that move an investigation forward and keep it on track," he says. Unlike in the toddler's death, "we rarely, if ever, actually solve the case."
"Forensic pathology is really tedious work," he says. "You have to put one foot in front of the other."
Of the TV shows, Andrews says that "they're so fictionalized that they're no fun to watch. On TV, they have that 'aha' moment in the autopsy, when you solve the case. It's not that easy."
Medscape Medical News © 2019 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Leigh Page. Clues to Mysterious Deaths: Doctors Who Help - Medscape - Nov 06, 2019.
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