My final year elective at medical school was spent split between Guy's Hospital Forensic Medicine Department (now unfortunately closed), and the Office of Chief Medical Examiner (OCME), New York City.

Guy's Hospital Department of Forensic Medicine

At the start of August 2001 I began my elective at the famous Department of Forensic Medicine, Guy's Hospital, which was opened in 1957 by Dr. Keith Simpson (later Professor).

I spent my time shadowing 3 full-time forensic pathologists, and spent the mornings observing the Coroner's autopsies at Westminster Public Mortuary, Horseferry Road, London, as well as at various other public mortuaries in London including those operated by Hammersmith and Fulham Council, Lewisham and Greenwich Councils.

In addition to the 'routine' Coroner's cases, I observed the 'special' police post-mortems, carried out when there was a suspicion of criminal activity, or where the deaths were considered 'suspicious'. In a minority of these cases, I also attended the crime scenes along with the pathologist and the investigating police officers.

The pathologists operating out of the Guy's Department also provided services to Police authorities in some of the Home Counties, and so cases could come into the Department from as far away as Brighton and Hertford.

The workload was exceptionally intense, and I was able to supplement my pathological knowledge with a wide spectrum of deaths due to natural disease, as well as trauma due to road traffic and other transportation accidents.

Of the suspicious or overtly crime related deaths observed during this period were cases of manual strangulation, knife-related wounds, blunt force trauma and ligature strangulation. These cases reflected the predominant methods of homicide observed in the UK. (See the Office of National Statistics - Health Statistics Quarterly Autumn 1999 for statistics related to homicide rates and a comparison between homicide rates by country and methods).

When criminal cases in which the pathologists were giving evidence came to court, I also observed them giving evidence (at the Central Criminal Court (Old Bailey) and various Coroner's Courts). This gave me a wonderful insight into how highly technical evidence could be distilled in such as way as to be meaningful to a lay audience (e.g. the Jury).

After 5 weeks I traveled to New York City to complete a 4 week 'Sub-Internship' in forensic pathology at the Office of Chief Medical Examiner, Manhattan.

The OCME, Manhattan, New York City

Based at East 30th Street, 1st Avenue, this dedicated 6 storey complex was built in 1961 by Dr. Miltern Helpern, a contemporary of Dr. Keith Simpson. It was the first dedicated facility for medico-legal investigation/ forensic pathology in the States, and became a blue-print facility for many other US States.

In the first week of the 'Sub-Internship', myself and 2 other medical students from the UK (along with an American medical student and several 'interns') observed routine daily cases, which were the equivalent of the routine Coroner's autopsies in the UK. The system of medico-legal death investigation in New York City, however is based on that of a Medical Examiner system.

We attended daily 'ward rounds' in the autopsy suite with the Chief Medical Examiner, Dr. Charles Hirsch, and seminars on aspects of death investigation and forensic pathology. We also attended daily case conferences with the attending forensic pathologists and the Chief ME.

The OCME Building, Manhattan, New York City ...

The elective in New York took somewhat of a different turn in the second week, however, with the attacks on the World Trade Center complex...

Having heard from a technician about the first plane crash into one of the WTC towers, we were initially convinced that it had been a tragic accident, and that the crash had probably involved a light aircraft. These thought were dispelled, however, when the second plane crashed into the South Tower.

The OCME immediately went into disaster planning mode, and all routine cases were finished. As students we were about to be thrown into a full scale victim identification process, the likes of which had never been seen before.

For a full account of my experiences during the immediate aftermath of the attacks, read my articles which have appeared in the Guy', King's and St. Thomas' Gazette, the Journal of the Royal Society of Medicine and the Environmental Health Journal.

The OCME Victim receiving area on September 11th 2001

I feel extremely privileged to have had the opportunity to work alongside some extremely dedicated forensic pathologists and anthropologists who worked tirelessly to assist the relatives of those people missing in this tragedy in obtaining some kind of closure through gaining an identification of their loved ones. As a medical student we are rarely accepted so fully as part of the team, and this made my elective seem worthwhile to the OCME as well as to my educational experience.

If anybody has any interesting elective experiences to share, please email them to me! 

Forensic Medicine Electives map

Post Script:

The New York Murder Rate has now been reported for 2002 - and has fallen to 573 - the lowest it has been for 40 years. This compares to the high of 2,245 in 1990. Experts say that the arrest of over a million offenders on minor street crimes and the increase in police numbers (25,500 to 38,000) have contributed to this decline.

The US Armed Forces Institute of Pathology have exhibited at the National Museum of Health and Medicine, Washington DC on the identification of the victims of the Pentagon and Pennsylvania attacks on September 11th 2001. Details of this exhibition can be found at http://nmhm.washingtondc.museum/exhibits/911/index.html (an indefinitely running exhibition). A review of this exhibition by Wanda Reif can be found in the Lancet (Vol 360 Sept 7th 2002 pp.807-808).

Above is illustrated the collectioin of DNA evidence at an AFIP temporary mortuary.

Other websites outlining the emergency preparedness in the USA in response to September 11th 2001 are listed below;

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This site aims to provide educational resources for medical students in the fields of forensic pathology, clinical forensic medicine, forensic psychiatry and forensic science. All illustrations used are believed to be in the public domain, and royalty free. However, if this is not the case, and you are the copyright holder, I apologise, and will remove the relevant illustrations if required.