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A Physician's Guide to Clinical Forensic Medicine
  1. Jan Welch
  1. Department of Sexual Health, Caldecot Centre, London SE5 9RS

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    Ed Margaret M Stark. Pp 326; $79.95. Totowa: Humana Press, 2000. ISBN 0-896-03742-8.

    Forensic examination of those alleging sexual assault can be appropriately provided within sexual health services, but requires additional skills. The examinations are lengthy, detailed, frequently nocturnal, and often lead to an appearance at the Old Bailey. A distressed individual will need to be examined from head to toe, with every injury described, measured, and drawn. The correct samples must be taken, timed, labelled and bagged with due attention to the chain of evidence. Subsequently the doctor may need to interpret the findings for the police, write a detailed statement, and withstand the adversarial setting of the court.

    A Physician's Guide to Clinical Forensic Medicine covers areas relevant to general forensic medical examiners, but several chapters will be of particular value to those examining victims of sexual assault. The chapter on fundamental principles is a useful overview that includes consent as well as pertinent but brief advice on preparation of reports and attendance at court. The chapter on sexual assault examination is generally excellent, giving detailed descriptions of the methods for taking and handling samples, and summarising studies relevant to the interpretation of findings. Although most of the advice is clear, there are exceptions; for example, people frequently ask whether it is still worth taking forensic samples a week or more after the assault, and this information is hard to tease out from the section on persistence data. The chapter includes a succinct section on sexually transmitted infections which summarises current debate on prophylaxis against bacterial infections, hepatitis B, and HIV, but stops short of giving any recommendations for immediate care or later referral. It is a sign of how rapidly the field is moving that drug assisted rape, now so widely discussed in the media, is mentioned only briefly. The drugs γ-hydroxy butyrate and ketamine are discussed in the section on substance misuse, but not in relation to sexual assault.

    Doctors working in sexual health are often inexperienced in the interpretation of injuries, but such expertise is crucial for forensic work. Crane's chapter is authoritative and intelligible on common areas of difficulty—for example, the differences between abrasions, lacerations, and incisions, and the possible interpretations of these injuries.

    I was delighted to receive a review copy of this book. Otherwise I would certainly have bought one, and would recommend it to others with a medicolegal interest.