In Virginia, each of the four district offices has forensic pathologists who are medical doctors trained in pathology and the subspecialty of forensic pathology, training that involves ten years of postgraduate education, not counting three additional years if the forensic pathologist also wants a law degree. Forensic pathologists perform the autopsies, but it is the medical examiner – a physician of any specialty working part-time to assist the pathologist and the police – who is called to the scene of a sudden, unexpected, or violent death.
If Dr. Rees Ralph Llewellyn were employed in Virginia, he would have a private practice and serve part-time as a medical examiner for one of the four districts, depending on where he lived. If Mary Ann Nichols were murdered at the time of this writing, the local police would call Dr. Llewellyn to the scene, which would be cordoned off and protected from the public and bad weather. A tent would be set up, if need be, and there would be a perimeter of strong lights and spitting flares. Officers would be on the street to keep away the curious and divert traffic.
Dr. Llewellyn would use a clean chemical thermometer and insert it into the rectum – providing there was no injury to it – and take the temperature of the body; then he would take the temperature of the air. A quick calculation could give him a very rough idea of when Mary Ann was killed because a body under relatively normal circumstances, assuming an ambient temperature of about seventy-two degrees, would cool one and a half degrees Fahrenheit per hour for the first twelve hours. Dr. Llewellyn would check the stages of livor mortis and rigor mortis and carefully perform an external examination of the body and what is around and under it. He would take photographs, and collect any obvious evidence on the body that might be dislodged or contaminated during transportation. He would ask the police many questions and make notes. He would then send the body to his district medical examiner’s office or morgue, where a forensic pathologist would perform the autopsy. All other scene evidence collected and photography would be handled by police detectives or a police forensic squad.
Fundamentally, this is not so different from the way a homicide is handled in England today, except that a coroner’s court would hold an inquest at the conclusion of the scene investigation and examination of the body. Information and witnesses would be marshalled before the coroner and a jury, and a decision would be rendered by verdict as to whether the death was natural, an accident, a suicide, or a homicide. In Virginia, the manner of death would be the sole decision of the forensic pathologist who performed the autopsy. In England, the decision would rely on jurors, which can be unfortunate if a majority of them don’t comprehend the medico-legal facts of the case, especially if those facts are weak.
However, jurors can go a step further than the forensic pathologist and commit an “undetermined” case to trial. I think of the case of a “drowned” woman whose husband has just taken out a large life insurance policy on her. The medical expert’s job is not to make deductions, no matter what he or she privately believes. But jurors can. Jurors could convene in their private room and suspect the woman was murdered by her greedy husband and send the case to court.
The American way of investigating death was imported from England. But over the decades, individual U.S. states, counties, and cities have slowly been withdrawing from the notion of the “coroner,” who is usually a nonmedical person elected and invested with the power to decide how someone died and whether a crime was committed. When I first began working at the Office of the Chief Medical Examiner in Richmond, I assumed that other jurisdictions had the same medical examiner system that Virginia did. I was dismayed to learn this wasn’t true. Many elected coroners in other states were funeral home directors, which at best is a conflict of interest. At worst, it is an occasion for medico-legal incompetence and the financial abuse of people who are grieving.