Knight's Forensic Pathology

Rating:
Summary: Very disappointing
Review: As a busy forensic pathologist who practices in North America, I eagerly anticipated the newest release of the Knight textbook.

The book, however, is a sad collection of re-hashed material from Knight's earlier works, confounded by new errors strewn throughout its substance. Where error does not exist, peculiar use of the English language makes reading it painful.

The gunshot wound chapter is particularly disappointing. Here, Knight's/Saukko's inexperience with these types of wounds is obvious. Their discussion is superficial, and in several places, of questionable practical value.

I am not at all able to recommend this book to anyone who actually practices forensic pathology.

Rating:
Summary: The most authoritative forensic pathology text on the market
Review: In the preface to the second edition, Knight advised readers to approach every autopsy with a critical attitude, pointing out the fact that there were several Appeals going through the English courts that emphasized the need for objective expert evidence in order to prevent miscarriages of justice.
Since 1996, the number of such cases has grown, and in particular there have been a number of recent high profile cases involving child deaths, where expert pathological evidence has been called into doubt. In the preface to this 3rd edition, the authors again stress the need for caution and the avoidance of over-interpretation, and the reader is reminded of the limitations of interpretation throughout the text.
For example, post mortem changes such as rigor mortis and lividity, as well as decomposition and temperature changes can be of use in formulating a post mortem interval. However, some experts have been dogmatic about the inferences that can be drawn from these phenomena, and Knight and Saukko attempt to provide evidence based conclusions about the utility of such findings.
The reader is left in little doubt that the range of autopsy findings can only give a very basic estimate of post mortem interval, and that there are so many variables in operation that previously held 'rules of thumb' can only be very broad 'guestimates'.
Knight advised his readers in the 2nd Edition Preface that his text draws on the writings of the 'great' pathologists and morbid anatomists, and each subject is meticulously referenced with the original papers that form the basis of modern forensic pathological principles. This principle is continued in this 3rd edition, although the style of the referencing has changed.
In the previous edition, references were to be found at the end of each subsection, allowing quick access to the relevant papers. Now they have been combined in a familiar manner at the end of each chapter.
Although this ensures that each chapter flows in more readable style, I do think that the new edition has lost some of the charm of its predecessors. However, the quality of the referencing remains formidable - one can still find the classic papers alongside newer evidence based articles, allowing comprehensive research of most topics presented in the text.
The style of this 3rd edition has undergone a complete revamp - and it looks stunning! Most of the illustrations are now in full colour, and there have been hundreds of new additions - both from Cardiff and Finland. Some familiar photographs have been retained, and there is now a collection of images that rivals most textbooks, and even most atlases.
The layout and style of the text is also more pleasant to the eye, and this edition has lost the 'bland' look and feel of the last edition.
A vast number of Coronial autopsies in England and Wales are carried out by hospital-based histopathologists, and the vast majority of those cases are sudden natural deaths. The inclusion of a fantastic chapter on the findings in such cases, and in particular the histological features of, for example early myocardial infarction etc, coupled with advice on cause of death formulation are of great value for non-forensic pathologists carrying out autopsies within a medico-legal framework.
The target audience of this book is invariably practicing forensic pathologists. However, there is such a wealth of information that hospital based histopathologists will frequently find themselves turning to this book as a source of authoritative guidance on what features to look for specifically in maternal deaths, epilepsy and asthma related deaths, and if they provide services to the Coroner at Public mortuaries, deaths involving immersion, fire and decomposed bodies.
Of use to trainee pathologists, there is also a wealth of practical information contained in this book on how to carry out autopsies, and how best to access certain structures, such as vertebral arteries etc.
I would also strongly recommend this text to medical students. Shorter texts such as 'Simpson's Forensic Medicine' cover similar ground but in a superficial manner, and without the capacity to stimulate further reading. This textbook, however functions well as both an introductory text and a detailed reference text, and as such should find its way onto the shelves of medical school libraries (the cover price may be a little too steep for those wishing to own their own text on forensic medicine).
The chapter on wound identification is excellent, and benefits from many new illustrations - including more clinically relevant images of wounds in the living. All students undertaking their emergency medicine and trauma rotations should read this chapter so that they can correctly distinguish a laceration from an incised wound.
In the current medical curriculum, forensic pathology, and forensic medicine receive scant attention, and the market for textbooks in this subject, previously examined by all medical schools as a matter of routine, has suffered in a similar fashion. This is shame, because there is much within this text that is of direct relevance to the current undergraduate curriculum, and all clinical medical students would benefit from this knowledge.
The second edition of this text enthused me to seek out some of the classic source articles referenced by Knight. After reading this present edition, I find myself once again enthused to review the evidence base for the underlying principles of forensic pathology.
Practitioners are often criticized for their approach to interpretation of injuries using a weak evidence base, or the 'n of one' technique. In this edition Knight and Saukko attempt to shake up these traditional beliefs and have drawn on the relevant evidence base with which to make their observations.
However, they repeatedly warn the reader of the consequences of over interpretation. The prescriptive didactic teachings of previous authors was dangerous to the justice system, and should now be consigned to history. Hodder Arnold have yet again added a triumphant forensic text to their stable, and are to be congratulated!