The Thabo Bester case has unleashed a fascination for forensic science. Bridget Hilton-Barber speaks to one of South Africa's foremost forensic pathologists about the vital role of autopsies and what they tell us about the state of our nation.

Even though the dead cannot speak, they have a lot to say, says Professor Ryan Blumenthal, senior specialist forensic pathologist at the University of Pretoria. Forensic pathologists are medical detectives in white coats, whose job it is to determine cause and manner of death, collect evidence from the body and deduce how injuries occurred. To them, the dead body represents a crime scene containing clues about the cause of death, and an autopsy is the only way to uncover these clues.

It’s Monday morning and Blumenthal is in his work gear, three coffees down, visibly exhausted and dealing with "a normal" start to his week. "Today there are 30 bodies on our mortuary list," says Blumenthal. "Including road traffic fatalities, death from gunshot wounds, death from stabbings, suicides by hanging, deaths from domestic violence – the list goes on and on." The aftermath of a typically violent South African weekend. 

"I can tell you a great deal about what's happening in South African society from the autopsy table," says Blumenthal. "I can tell a new gang has moved into the area, if there's a new or emergent drug or disease.

"I can tell you the health of the nation. I can even tell you that hangings are really trending at the moment and that buying a rope from a hardware store really should require a licence." 

Professor Blumenthal believes the dead have much to teach the living

During the pandemic, Blumenthal says he saw an increase in deaths from il7licit drugs, suicide, domestic violence and road accidents. "It sometimes feels like the Wild West out there. I've done forensics on so many taxi drivers who have been shot in the so-called taxi wars. My colleagues and I are seeing an incredible rise in multiple shootings – 'multi multiples', sometimes up to 70 gunshot wounds in one body. That's an enormous amount of bullets. That's an enormous amount of work." 

A leading expert on the country's biggest weather killer

Blumenthal has performed more than 10 000 autopsies, many of which have helped bring criminals to book. He got into the field, he says, because he couldn't tolerate injustice and wanted to help real victims. "There are so many laws, yet so little justice," he says. In his opinion, there is no other field in medicine that offers the intellectual challenge of forensic pathology. One needs to understand non-medical fields like criminology, engineering, highway design, forensic science and the broader community's folkways and religions. 

Blumenthal has been studying for more than 23 years, written numerous academic articles and published widely in the field of suicide, trauma and lightning. He did his doctorate on lightning-related injury mechanisms and his website, www.lightingpathology.com, is a great resource for those wanting to know more about South Africa's biggest weather killer. The eight-part documentary Lightning Pathologist, on the People's Weather TV channel, highlighted some of his cases and was viewed by more than 2.2 million people.

Blumenthal has written articles and textbooks on lightning and electrothermal injuries, and has helped generate national and international standard operating procedures and guidelines for lightning strike fatality and electrocution victims. "It's a very topical subject if you look at what is happening with regard to climate change," he says. 

I met Blumenthal at a hotel in Limpopo in 2020, just after he released his first book, Autopsy: Life in the Trenches with a Forensic Pathologist in Africa (Jonathan Ball), which has become a non-fiction best-seller. He has boundless enthusiasm and energy, and is a born raconteur. He is also an honorary game-ranger, a keen birder, a mountain biker and a sleight-of-hand magician. And he has a wicked sense of humour. 

"Look here," he said excitedly, showing me the room where he and his partner had slept. He had used pillows to fashion the shape of a body under the duvet. I do this at every hotel I stay, before departure," he chuckled. 

Autopsy is a galloping read, written with astonishing clarity. It deals with all those typically tabloid questions you've wanted to ask – what is the perfect murder, what are the worst smells in medicine, what's it like doing an autopsy on a VIP, a celebrity, a president, what is the difference between a murder and a suicide, and what's the quickest and most painless way to die?

‘We are all forensically equal in death’

It is also filled with fascinating case studies, including the chilling occasion on which Blumenthal went to attend to the death of a 26s gang general in a maximum-security prison, and the poignant story of how he connected with the survivors of a famous lightning strike in 1994 when a group of young girls went camping in Modimolle with two adults and seven dogs. There are high-profile deaths, mass disasters, people killed by wildlife, people found dead on their kitchen floors and no fewer than three instances of a groom-to-be dying at his bachelor party. 

Blumenthal's philosophy is a compassionate one – we are all forensically equal in death. "I will perform an autopsy on a famous person the same as I would a homeless vagrant," he says. 

Blumenthal recently returned from the 10th meeting of the Africa Society for Forensic Medicine (AFSM) in Rwanda. He was among keynote speakers at the March event, attended by eminent global forensic experts. He and his colleagues won the bid to host the 2025 ASFM conference in South Africa. 

One of the biggest challenges Africa faces is a lack of resources. In the US, for example, there is a state-of-the-art medicolegal laboratory which cost $95m (about R1.7bn), Patricia Cornwell, best-selling crime writer and creator of the medical-examiner character Kay Scarpetta, donated the money for what is known as Scarpetta House at the facility, a large room designed to give future forensic investigators a space to practise their crime scene analysis skills. 

In Africa, however, medicolegal laboratories are rare, Blumenthal asks: "If you think we are not equal in life, wait until death. Is this fair? Is this just? 

"One of the problems we have in Africa is that we often have no history when a body is admitted to the mortuary. For instance, when a person is found dead, we often do not know their nationality, identity or background medical history. 

Dealing with death, daily

"There are also many risks and hazards in the field of forensic pathology. I have been present when a cocked and loaded gun fell out of a victim's trousers and I have found sharp knives, needles and even screwdrivers on the bodies. We also have the added stress of performing autopsies on high-profile cases. A normal, low key day in the life of an African forensic pathologist is probably beyond comprehension for the layperson. It's definitely a calling, imagine waking up, going to work and having to deal with a beheading case, a multiple gunshot wound case and a multiple stab wound case with associated rape. Now imagine doing this day after day."

So how does he deal with being exposed to death daily?

"If you are properly trained, you will be able to manage most situations and not suffer post-traumatic stress disorder. This is what is known as professionalism. In fact, most of the forensic pathologist I know are extremely positive and optimistic professionals. 

Blumenthal believes the dead have much to teach the living. "I believe that much of the unhappiness in this world is preventable." This is the thrust of his new book due for release in July. Risking Life for Death, to be published by Jonathan Ball, concentrates on "Locard's Exchange Principle",  which holds that the perpetrator of a crime will bring something into the crime scene and leave with something from it.  Every contact leaves a trace. The principle is named after Dr Edward Locard (1872 -1966), a pioneer in forensic science who was known as the Sherlock Holmes of Lyon, France. "That single strand of hair or that tiny droplet of blood is the silent witness at any crime scene," says Blumenthal. "With contact between two items, there will be an exchange." 

He takes the subject further and applies it to the living. From reading countless suicide notes, Blumenthal says there are three main themes connected to why people take their own lives: work, health and relationships. "Almost all human stressors can be slotted into one of the three battlefronts, from your in-laws to your hay fever." 

‘Choose your contacts wisely’

On the relationship battlefront, he advises people to be discerning with whom and what they come into contact. "If you hang out with the wrong kind of people or unhappier people, they will surely infect you. If you are the cleverest person in the room, you are in the wrong room," he cautions. His advice is to "infect yourself" with wiser, happier and healthier people and things. 

Conversely, he warns, beware of social isolation. "Do not wall yourself off from life, do not entomb yourself in your own mental vault. Open some of those windows and doors. Instead of building a wall around yourself, build a bridge to other people". 

On the work battlefront, he believes boredom is as dangerous as stress, and on the health front, he cites the many reasons we get sick or die, ranging from infections, chemicals and trauma to psychological or genetic ailments. 

"Using Locard's Exchange Principle, you come to a striking conclusion," he says. "You are the end result of all your contacts in life. Every contact really does leave a trace on you. Your family, your friends, your work, your culture, your subculture, your private life, what you are watching, what you are reading, what you are listening to, what you are eating, what you are drinking have all touched you and left their mark." 

"Choose your contacts wisely," he advises. By doing so, you will become a wiser, healthier, happier human, you will grow old better – and we forensic pathologist will have less work." 

This article first appeared Sunday Times on 30 April 2023.