State of the Body

The state of a body found dead at the scene of a fire varies. The body can be relatively undamaged. Areas of the body covered by clothes are relatively protected, and only exposed areas are covered by soot. Burns have been classified as first-degree or superficial partial thickness (reddening or erythema); second-degree or deep partial thickness (i.e., extending deeper into the dermis and characterized by blisters); and third-degree or full thickness (i.e., necrosis of epidermis and entire thickness of dermis, imparting a leathery appearance; see Heading 6. and ref. 38). Extensive charring and disintegration of the body occurs (39). This loss of bodily integrity can be exacerbated by fire department personnel at the scene, particularly if the body is "unrecognizable" and its presence is not appreciated during fire suppression.

In studies of undissected bodies of elderly individuals cremated at temperatures between 670°C and 810°C (1240°F and 1490°F), the degree of destruction was related to the duration of cremation (35,40,41). After about 10 min, the bodies showed a "pugilistic" posture resulting from heat contraction of the more bulky flexor muscles (Fig. 4). Charring of the face and extremities occurred by about 20 min. After 20 min, fissures appeared on the exposed outer table of the skull. The coronal or sagittal suture separated owing to increased intracranial pressure from steam (34). The skin of the head, torso, and extremities was consumed, resulting in charring of the underlying exposed muscle. Bones of the extremities became visible. The hands were either destroyed or severely burned and connected to the arms only by charred soft tissue. At approx 30 min, fractures had widened in the calvarium and extended to the inner table. In some cases, the outer table had disintegrated into fragments (34,35). At this point, the brain was superficially charred. The thoracic and abdominal cavities were open, with destruction of the sternum and calcination of the anterior rib ends. As a result, internal organs were charred and shrunken. The distal forearms were destroyed, and soft tissue was largely absent from the distal lower extremities. Exposed long bones displayed heat fractures. After 40 min, the calvarium was destroyed and the facial bones fragmented. The lower arms were destroyed and the humeri were exposed. After 50 min, the arms were completely gone and the femoral bones reduced to burned bone stumps. The face had disintegrated, and the base of the skull was exposed. The vertebral bodies were calcined. After 60 min, only central facial bones and skull base remained, and, in some instances, the torso was headless. The internal organs were reduced to ash. The extremities were completely gone. By 1.5 h, the torso had fragmented. Almost complete incineration occurred after 2 to 3 h of cremation (Fig. 5). The body of a child can be reduced to calcined bone within 2 h in a heated stove at a temperature of about 500°C (930°F [36]). Clothes burn when temperatures reach 225°C (440°F [4]).

Temperatures in residential fires can approach those reached in crematory ovens, but complete charring is unusual in outdoor or house fires (35,36). Intervention by fire-fighting personnel and lack of sufficient fuel to maintain the fire mean that most fires are not of sufficient duration to allow complete consumption of the body (35,36). The implication for the pathologist is that, in most cases, the necessary steps for identification,

Fig. 4. Burn artifacts. (A) Flexed arm owing to heat effects. Skin splits on scalp (arrow; courtesy of the Office of the Chief Medical Examiner, Chapel Hill, NC). (B) Another example of heat flexion of arm and skin splits on chest (courtesy of Dr. E. Tweedie, London Health Sciences Centre, London, Ontario, Canada).

examination of internal organs and tissues to assess the presence of disease and injury, and the collection of body fluids for toxicological analysis are possible (Fig. 5; ref. 40). Unlike a cremation oven, where flame is distributed continuously and evenly on the body under constant conditions, temperatures in a typical fire fluctuate and parts of the body not directly exposed to flame (e.g., pressed against a hard surface), are relatively protected (35,40). In most cases, charring is much less on the side of the body not

Fig. 5. Examples of severely charred bodies. (A) Charred torso. Despite the extensive burning, internal organs were relatively preserved and toxicology samples obtained (courtesy of the Office of the Chief Medical Examiner, Chapel Hill, NC). (B) Calcined remains (courtesy of the Office of the Chief Medical Examiner, Chapel Hill, NC).

Fig. 5. Examples of severely charred bodies. (A) Charred torso. Despite the extensive burning, internal organs were relatively preserved and toxicology samples obtained (courtesy of the Office of the Chief Medical Examiner, Chapel Hill, NC). (B) Calcined remains (courtesy of the Office of the Chief Medical Examiner, Chapel Hill, NC).

exposed to the fire; however, in some cases, complete charring still occurs (40,42). Clothed bodies can be destroyed more quickly than naked ones (43).

In some cases, the pattern of charring reverses, i.e., there is destruction of the torso with relative preservation of the extremities (43,44). Because there is usually minimal fire damage to the surroundings, speculation has arisen about "spontaneous human combustion" (43-45). Typical victims are overweight elderly females (43). These individuals collapse from a disease process, and they are found close to usually obvious external ignition sources (e.g., cigarettes, open fireplaces, candles, stoves, room heaters; see Subheading 4.1. and refs. 43 and 45). If burning of clothing or fabrics near the body (e.g., carpet) occurs for at least 15 min, then splitting of skin allows release of melted subcutaneous fat (44). Fat is the most combustible tissue (43). If the fat is absorbed into porous fabric, which acts like a wick, then flame can persist (44-46). Such fires are unlikely to exhaust O2 present in a room and do not produce enough heat to ignite adjacent combustible structures by radiant heat (44). Although human fat burns at about

Fig. 6. Identification of fire victims. (A) Soot-covered skin can be wiped off to reveal distinguishing features (e.g., tattoo). (B) Partly burned body. Draining cutaneous sinus (arrow) because of osteomyelitis, a consistency with the medical history.

250°C (480°F), the wick effect allows burning of fat at temperatures as low as 24°C (75°F [45]). The distal limbs, because they contain less fat compared with the obese torso of these victims, do not burn, while the torso smolders (44).

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