Yes, a flame burn can cause first degree burns, which are superficial (on the outside of the skin), second degree burns (which go deeper into the skin) and third degree burns (which go all the way through the outer layer of skin and can char or blacken the edges of the skin and singe the hair). A steam burn does not singe the hair or char the skin. Steam has a temperature of 212 degrees Fahrenheit or more and can cause burns of the outside of the skin. But steam most seriously affects the inside of the air passages. In the steam deaths that I've seen, the causes of death have largely been burns of the air passages, (the mouth, the windpipe, the air passages in the lungs). When super heated air, vapors and steam are inhaled into the body, the exposure can cause very rapid death. With steam, the outside of the skin is burned but not singed or charred.

More common than steam burns are scald burns, which we see most often when a caregiver dips a child into a tub of water that is over 130 degrees Fahrenheit. In twenty seconds the child can suffer severe burns. At 158 degrees severe scald burns can develop on a child in one second.

Normal household water goes up to about 130 to a 140 degrees. We medical examiners in this country see scald deaths that could have been avoided if the temperatures of the water coming into the bathtub was no more than 120 degrees Fahrenheit. Usually the ones we see burned in this manner are children. But we also see it in the very elderly, who get into a tub and then can't get out when the water's too hot; or in the mentally ill who also can't get out of harm's way. As a medical examiner, I think that if household water temperature could be lowered to 120 degrees Fahrenheit, accidental and intentional scald burns of children and the elderly would be far less likely.

When someone dies from radiation poisoning what exactly is it that causes death?

Radiation poisoning, which can be from the effects of an atomic bomb like at Nagasaki or Hiroshima, or from radiation treatment for cancer, damages the dividing cellular DNA. Those cells that divide fastest are hurt the most, and they're the ones in the bone marrow; bone marrow cells are constantly growing and dividing. Radiation poisoning kills these cells, so they can't make red blood cells, platelets and white cells and leads to diseases like aplastic anemia, leukemia and lymphomas.

What effects does submersion on water have on the appearance of lividity?

When a body is found in water, even though the water's buoyant, gravity will cause the red blood cells to settle. So one still sees lividity in the lowest portions of the body: on the back when they're floating face up or, more commonly, when the person's floating face down, the settling of the blood will be on the front of the body.

Even in cases of babies who die in utero, (inside the mother's womb) the water in the amniotic fluid will cause lividity based on the position of the baby in the womb.

Can bullets ricochet inside a person's skull?

Yes. It's been reported -- and I've seen a number of cases -- where a bullet enters the skull and strikes the back part of the skull, but instead of going through the skull, it strikes the bone at a very sharp angle and ricochets. Then the bullet continues around the inside of the skull. This does happen, although it's not very common. It usually happens with smaller caliber bullets, like twenty-two caliber bullets. Most bullets, ninety-eight percent of the time, go in a straight line.

And even when the bullet strikes bone it can be deflected a little bit, but not very much. Not all skulls are the same hardness and thickness; some skulls are an eighth of an inch thick, some are a half an inch thick. And that has an effect on the bullet's path. The thicker the skull, the more likely the will strike the bone and go off at a tangent, almost going three hundred and sixty degrees around the inside of the skull.

How many cases, in addition to the Boston Strangler case, have you worked on with James Starrs? What are some of them?

James Starrs is a professor of law and forensic science at George Washington University in Washington, DC. He's a very smart, witty and articulate curmudgeon who has done some marvelous work in applying new developments in the forensic sciences to old mysteries.

I've been involved with him on a few cases. One of them was the investigation into the death of J. Edgar Hoover. We were trying to determine whether some questions about the causes of Mr. Hoover's death could have been resolved if an autopsy had been done. These were questions as to how he died and the cause of his death, which remain unanswered because an autopsy was not done.

I was also involved in the York, Pennsylvania episodes some decades ago in which there were riots and a police officer and a black citizen were killed. Professor Starrs is reinvestigating this case and I was involved with autopsying one of the victims there.

But the most notorious of Professor Starrs' cases, with which I was involved, is the reinvestigation of the Boston Strangler murder case. That case occurred back in the early sixties in Boston. Albert De Salvo claimed to be the Boston Strangler and then recanted, but was murdered in prison before he could explain his actions.

In the early 1960's, right around the time that Kennedy became president, Boston was paralyzed by a series of thirteen murders that remained unsolved for a number of years -- until Albert De Salvo confessed to the crimes. When he confessed, the media and government officials immediately accepted what he claimed, although there was no proof of any kind that linked him to any of the murders. De Salvo was murdered in prison after recanting his confession but common wisdom was that he had committed all the murders.

A few years ago the family of Mary Sullivan, the last victim attributed to the Boston Strangler, consulted with Professor Starrs about answering their concern that it wasn't De Salvo who had committed that murder. Mary Sullivan's family felt that she had been killed by a boyfriend, or by a boyfriend of her roommate.

The Boston Police Department would not share any information -- they have DNA specimens from the crime scene -- with Mary Sullivan's family. The police have semen samples from the crime scene that have never been analyzed for DNA, never checked to see whether or not the DNA matched De Salvo's.

So the family came to Professor Starrs in an attempt to nudge the process along; to find out whether or not De Salvo was really the Boston Strangler. They arranged to have Mary Sullivan and Albert De Salvo exhumed. I did the autopsy exhumations, but it was really a team effort,with about a dozen different criminalistics experts Ð DNA, hair, and dental experts. The team had to make sure that the bodies were the right ones, which required the services of forensic anthropologists, forensic photographers and forensic radiologists.

The forensic radiologists used portable X-ray machines to do total X-rays of the bodies, in order to evaluate any abnormalities that might be present in the bones, for purposes of identification, and to detect any injuries that might be present.

The DNA expert, Dr. Foran, was able to find clumps of material on Mary Sullivan's pubic hairs that resisted the embalming preparation. This was because pubic hairs aren't scrubbed in an embalming process and so these clumps on the pubic hairs contained DNA that was still identifiable after almost forty years.

This DNA did not match De Salvo's, and it was not from Mary Sullivan. So the investigation now depends on comparing DNA from other suspects, who are still living, to the semen specimens that were collected during the first autopsies in 1964 and from the bedspread in Mary Sullivan's apartment. There were also cigarette butts at the scene -- cigarette butts with very nicely preserved DNA. Mary Sullivan didn't smoke, and her roommates didn't smoke, so presumably the cigarette butts came from the perpetrator.

Presently, the status of the investigation depends on how cooperative the Boston Police Department will be. When Professor Starrs first contacted them about looking at the evidence that had been kept over the years, he was told that it was a closed case; they said they have too many current cases to be bothered with an old one and refused to grant access. Later, when the media and the families put pressure put on the authorities, their position changed: they said it's an open case, therefore we can't give you any information.

I think that it would be easy to resolve whether or not De Salvo was the Boston Strangler if the authorities would permit DNA analysis of the evidence that was collected back in 1964. And that evidence is still present, in the custody of the Boston City Police Department.

What were your findings?

Whenever the issue of exhumation is raised the police -- or other agency involved -- want to know from the medical examiner what the condition of the reamins will be. So we have to tell the police, or the district attorney's office, that we can't tell until we actually see the body. This is because once buried, some bodies deteriorate very quickly and others deteriorate over long periods of time, depending on how much water (rainwater or ground water) gets into the casket. And we just can't know that until we disinter the body and have a look.

In this instance, after almost forty years, the body was in good condition. The soft tissues of the extremities had deteriorated a great deal, but the organs had been put into a plastic bag after the first autopsy. (That practice often happens today as well.) Even though there was no preservative put into the plastic bag, over the years the organs remained in excellent condition. This is because water and bacteria were not able to get to them. The organs have remained in very good condition and so we were able to do various kinds of microscopic analysis.

My specific role as a forensic pathologist was to be involved in the disinterment and to perform the autopsy on the remains. It was also my job to collect any trace evidence in and on the body. Part of the trace evidence that I was able to turn over for further analysis was the DNA that turned out not be the decedent's or De Salvo's.

I was also able to compare the injuries on the body to the injuries that would have been produced by De Salvo if he had done what he confessed. He confessed to strangling Mary Sullivan very hard with his hands, beating her about the head and face, and biting her. But there were no bite marks on the body at either the second autopsy or at the first autopsy and there were very few bruises and injuries to the head. In addition, there was no evidence of any damage to the neck organs, specifically to the hyoid bone. The hyoid bone is a little U-shaped bone right on top of the Adam's apple, which is often -- not necessarily always, but often -- fractured in manual strangulation. Finding the hyoid uninjured doesn't exclude manual strangulation, but it would not support manual strangulation of the manner De Salvo said he had committed. So all in all, the autopsy findings tend to cast doubt about the accuracy of De Salvo's confession.

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