Forensic Sci Med Pathol DOI 10.1007/s12024-014-9543-x

LETTER TO THE EDITOR

Is histological examination always necessary to determine a cause of death? Of course it is! Fabio De-Giorgio • Giuseppe Vetrugno

Accepted: 10 February 2014 Ó Springer Science+Business Media New York 2014

The reflections of Fronczek et al. [1] on the role of histology in medico-legal investigations aimed at answering specific questions usually raised with regard to suspicious deaths, or in any event those of interest to the criminal police, can at least claim to have attracted the attention of those who interpret medico-legal matters on an issue that is obviously still open to debate. Is histological examination just an ancillary test carried out at autopsy and one that can justifiably be forgone in cases in which the cause of death is macroscopically evident during the ‘‘visual’’ evaluation carried out by the pathologist, or does it also provide an indispensable and comprehensive element of a medico-legal investigation that should be sought in even the simplest of cases because, in any event, it strengthens the evidence gathered by the pathologist with his own eyes during the autopsy itself? The writers are inclined toward the second point of view for two reasons that they would like to put to the authors of such an interesting piece [1]. The first deals with the issue from the point of view of the police investigation in that, if the conclusion of the autopsy is to be used in evidence, it must meet the usual standards set by the courts regarding the admissibility of technical/scientific proof. In a hypothetical court case, surely the pathologist cannot testify on the basis of evidence that is purely subjective [2], which is what a basic F. De-Giorgio (&) Institute of Public Health, School of Medicine, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy e-mail: [email protected] G. Vetrugno Medical Directorate, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy

autopsy would provide. Is not additional, objective [3] and reproducible confirmation of his macroscopic observations also needed? A histological examination would certainly provide that [4]. The second deals with the need for uniformity in the way forensic investigations are performed on behalf of the police. The importance of the guidelines set out in the 1984 Coroner’s Rules regarding the working methods to be used by forensic pathologists in cases of post-mortems carried out in England and Wales for medico-legal reasons cannot be ignored. Mention must also be made, however of, Recommendation no. R of the Committee of Ministers of the Council of Europe dated 1999, aimed at reconciling the manner of carrying out medico-legal autopsies in the EU, which sets out a ‘‘basic sampling scheme’’ that ‘‘should include specimens from the main organs for histology in all autopsies’’ [5]. Even if the data set out by Fronczek et al. [1] seem to assign histological examination a secondary role in the identification of the biological cause of death, we do not think that we can agree with their suggestion that the use of histology be decided on a case by case basis, as allowing the forensic pathologist such discretion would not only be contrary to the position happily adopted by the Council of Europe, it would also introduce a degree of uncertainty that would be hard to reconcile with the need for the courts to be able to fully trust all evidence presented in order to protect the innocent.

References 1. Fronczek J, Hollingbury F, Biggs M, Rutty G. The role of histology in forensic autopsies: is histological examination always necessary to determine a cause of death? Forensic Sci Med Pathol. 2014;10:39–43.

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Forensic Sci Med Pathol 2. Dulohery K, Papavdi A, Michalodimitrakis M, Kranioti EF. Evaluation of coronary stenosis with the aid of quantitative image analysis in histological cross sections. J Forensic Leg Med. 2012;19:485–9. 3. Tagliaro F, Smith FS, Tedeschi L, Castagna F, Dobosz M, Boschi I, Pascali VL. Criteria for acceptance of new science in court. J Chromatogr Libr Elsevier Science BV. 1998;60:950–3.

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4. de la Grandmaison GL, Charlier P, Durigon M. Usefulness of systematic histological examination in routine forensic autopsy. J Forensic Sci. 2010;55:85–8. 5. Madea B. Histology in forensic practice. Forensic Sci Med Pathol. 2012;8:64–5.

Is histological examination always necessary to determine a cause of death? Of course it is!

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