Mary Case - Forensic Pathology of Child Death: Autopsy Results and Diagnoses

STMLearning, Inc.

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Mary Case, MD

Professor Emerita of Pathology

St. Louis University School of Medicine

Chief Medical Examiner

St. Louis, St. Charles, Jefferson,

and Franklin Counties

St. Louis, Missouri

Elizabeth M. Kermgard, MD

Pediatric Nephrology Fellow

Childrens Hospital Los Angeles

Los Angeles, California

Publishers: Glenn E. Whaley and Marianne V. Whaley

Graphic Design Director: Glenn E. Whaley

Acquisitions Editor: Glenn E. Whaley

Associate Editor: Marika Betker

Book Design/Page Layout: Jennifer M. Jones and Glenn E. Whaley

Print/Production Coordinator: Jennifer M. Jones and Glenn E. Whaley

Cover Design: Jennifer M. Jones and Glenn E. Whaley

Color Prepress Specialist: Kevin Tucker

Developmental Editor: Marika Betker

Copy Editor: Marika Betker

Proofreader: Samantha Koester

Copyright 2021 STM Learning, Inc.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

Printed in the United States of America.

Publisher:

STM Learning, Inc.

Saint Louis, Missouri 63033

Phone: (314) 434-2424

Library of Congress Cataloging-in-Publication Data

Names: Case, Mary, MD, author. | Kermgard, Elizabeth, 1990- author.

Title: Forensic pathology of child death : a color atlas / Mary Case, Elizabeth Kermgard.

Description: St. Louis, MO : STM Learning, Inc., [2020] | Includes bibliographical references and index.

Identifiers: LCCN 2020010667 (print) | LCCN 2020010668 (ebook) | ISBN 9781936590421 (paperback) | ISBN 9781936590810 (epub)

Subjects: MESH: Forensic Pathology--methods | Child Abuse | Wounds and Injuries | Cause of Death | Child | Atlas

Classification: LCC RA1063.4 (print) | LCC RA1063.4 (ebook) | NLM W 17 | DDC 614/.1083--dc23

LC record available at https://lccn.loc.gov/2020010667

LC ebook record available at https://lccn.loc.gov/2020010668

At least 2000 children die each year from some form of child maltreatment. With this book, Drs. Case and Kermgard provide a rich and well-organized approach to better understanding what has happened to these children and how to know. While some cases are obvious, there are too many in which the abuse happened in secret, and the pathologist is in a vital position to unravel the truth.

Key clusters of injuries help to define abuse in the absence of admission by the perpetrator. In the legal arena, lawyers, judges, and juries want to know what the evidence is and how they can be sure. By systematically showing injuries at all levels and types, it becomes clear how abusive trauma occurs and what happens to the child when it does.

Like accidental trauma, fatalities most commonly occur to the head. Chapter 4 goes in depth to help readers better understand the ways in which caregivers hurt children and how this manifests grossly and microscopically. Because abusive head trauma is probably the most contested abuse diagnosis in court, this chapter provides an unparalleled view of what is currently known.

As usual with STM Learning books, this text provides detailed pictures that are rarely seen elsewhere. For students and teachers, having such high-quality photographs brings to light what words alone cannot appreciate.

One of the major advantages of this text is the case studies, which vividly illustrate key points in the pathological evaluation of suspected child abuse. They help to cement concepts about trauma around the narrative of what has happened to the child. When children cannot testify for themselves, it is through the dedication of these professionals that honor can be brought for each child by determining the truth.

Forensic Pathology of Child Death will be a key resource for those seeking to understand the details of abusive trauma and how to make such important diagnoses.

Randell Alexander, MD, PhD

Professor and Chief

Division of Child Protection and Forensic Pediatrics

University of Florida

Jacksonville, Florida

My vision for this atlas was to illustrate many of the cases of child deaths that I have autopsied or otherwise encountered over a very long career as a forensic pathologist, neuropathologist, and medical examiner. I began doing medical examiner cases in February 1975 in St. Louis County, Missouri, a suburban metropolitan area with a population of approximately 1 000 000. I did not see a child abuse fatality in St. Louis County until 1981, but then the number of abusive fatalities gradually increased over the following years. In 1977, I began working as a medical examiner in the St. Louis City Medical Examiners Office, which had just transitioned from a coroners office to a medical examiners system. St. Louis City is an urban inner city that had a population of 486 000 in 1977. The population has since declined to 310 000 in 2019. As soon as I began doing medical examiner cases in the City of St. Louis, I was struck by the large number of fatal child abuse cases we encountered in our work.