Medicine,Science and the Law

After a major disaster, identification of the victims may have to be performed by comparison of the ante-mortem and post-mortem dental records. Ante-mortem records often contain errors and these must be identified, and compensated for in some way.

A computer system for the comparison of large numbers of ante-mortem and post-mortem dental records has been developed, using algorithms which are able to compensate for errors in the records.

Data has been collected on the prevalence of errors in dental charts. These were found in 45% of a sample of 50 records.

Since matches found by the system may be due to coincidence, a score is computed for each record based on its “uniqueness”. This allows a confidence limit to be placed on any matches found between the ante-mortem and post-mortem records.

I studied 25 cases of suicide in people diagnosed as having the acquired immunodeficiency syndrome (AIDS) or who thought that they had that disorder, during 1985–1989. Case reports are presented. A discussion ensues concerning the occurrence of this phenomenon and the medical examiner's role in AIDS' public health situation in general.

In a sample of 61 male Special Hospital patients, 11 (18%) were identified as having alcohol-related problems prior to admission. Ten of these alcohol-abusers were interviewed to gather further information about their drinking, offending, and the relationship between the two. Alcohol abusers showed more serious criminality than non-abusers, having significantly more previous convictions and being responsible for a disproportionately high number of offences of murder and manslaughter. Alcohol-related problems appear to have developed quickly in adolescence culminating in the index offence at around 30 years of age. At this time, the mean self-reported weekly alcohol consumption was 240 units (one unit = 8.5gm alcohol). All but one man admitted to a relationship between alcohol and crime, and most showed motivation to change their future drinking behaviour.

Measurement provides numerical information, usually to assist in some decision process. Quality control is fundamental to the measurement process if the results are to provide confidence to the decision maker. The degree of quality control required depends on the context and purpose of the measurements. Quality control is particularly important in the forensic measurement of breath alcohol in light of the significant consequences involved.

Control charts are an important and widely used tool in quality control for both measuring and manufacturing processes. They help evaluate measurement variability and provide a visual assessment of the system's state of statistical control. Control charts can be developed and applied in a variety of different ways. Several examples are illustrated that apply control charts to breath alcohol measuring systems. Application of these methods should result in improved process monitoring in addition to improved confidence for forensic purposes.

The study comprises all complaints which patients have made to the Danish National Board of Health in 1984–1985. The Board has disciplinary powers over physicians and advises the public prosecutor in cases of gross negligence that are to be brought before a court.

There were 531 complaints on average per year. The frequency of complaints was 1.0 complaint per 10,000 population. A large part of the complaints concerned cases where no physical harm occurred (45%), and in only a small portion (16%) were there serious injuries. The Board found that negligence had occurred in 21% of the complaints, and 1% of the cases were considered to be gross negligence. There were appeals against 17% of the rulings, and of these 9% were either wholly or partly upheld.

The clinical, criminological and demographic characteristics of a Special Hospital population of male patients convicted of homicide are described. The results confirm much previous work on mentally abnormal homicide. Typically the patients come from a disadvantaged social background with poor employment records, a prior history of aggressive behaviour and a diagnosis of schizophrenia. Victims were usually known to the patient and often came from within his circle of family and friends. Only 25% of the patients were receiving treatment at the time of the offence. These findings are discussed in the light of the current literature.

Using a sample of 306 consecutive referrals, the interactions were investigated between factors relating to patients, referral agencies, assessments and courts. Both the variations in referral rates of diagnoses and the psychiatric histories indicated that the service was being used largely for second opinions on the mentally ill, but for those with neurotic disorder or exacerbations of personality disorder it was more akin to a general psychiatric service. Those thought to pose a sexual risk to adults were particularly likely to have histories of violence, but the opposite was true for those considered a sexual risk to children. Reports initiated by the court are more likely to contain a treatment recommendation and are also more likely to be implemented than those in defence reports. Both the likelihood of a treatment recommendation and its acceptance by the court increased with the severity of diagnosis, with psychiatrist and court reaching full concordance in cases of mental illness. As many as 20 per cent of those seen in prison had mental illness and this was nearly seven times the out-patient rate. Forensic outpatient work was found to be independent of the provision of secure care. These and other findings are examined to help explore the nature of the service.

This article extends upon material presented in a previous issue of this journal (Med. Sci. Law, 1990, 30, 39–44). Three groups of respondents were asked to comment upon the degree to which they considered psychopathic disorder to be a treatable condition. The modest findings suggest that although few clear cut views exist as to the best treatment modality there are firmer indications as to those thought to be unhelpful.

We report, from the aspect of “acting” capability, an autopsy case of suicide by hanging in which multiple deep stab wounds were observed in the neck and chest.

A 49-year-old man was found dead in a state typical of hanging. His car was found about 100m away with a blood-stained climber's knife on the seat. Multiple incised and stab wounds were in the neck, with a lesion of the right inner jugular vein. Three penetrating stab wounds of the chest punctured the lungs, with pooling of about 500ml of blood in the left thorax and about 100ml in the right. Two other shallow stab wounds were in the chest. All the above wounds were explainable as self-inflicted. From the autopsy findings and the circumstantial evidence, it was concluded that he walked approximately 100m after stabbing his neck and chest and finally committed suicide by hanging

Thrombosis of the internal carotid artery is an unusual complication of neck compression, and even more infrequently observed in manual strangulation. It is important in such cases to exclude spontaneous thrombosis which may result from atherosclerotic narrowing of the vessel.

Suffocation by plastic bag is not common. The finding of a body at the scene of death with a plastic bag in situ could be diagnostically valuable to the pathologist. Otherwise the pathologist may be hard put to arrive at a firm opinion as to how the deceased met his/her death; in fact, in three of the cases reported in this paper, the local pathologist could not give a cause of death when the initial autopsy was performed.

Plastic bags could be accidentally placed over the head; put there to help in the inhalation of volatile substances; with homicidal intention; or simply as an effective suicidal method.

The object of this paper is to study the cases where bodies were found with a plastic bag over the head, and in particular the cases where the cause of death was due to plastic bag suffocation.

A young lady was alleged to have died due to accidental burns from a kerosene pressure stove. The dying declaration read that the deceased caught fire accidentally. Evaluation of physical evidence present at the site of the incident, the dying declaration and examination of the body refuted accidental burning from the stove. It proved to be a case of suicide with assistance from the accused due to delivery of insufficient dowry. The accused was convicted on the basis of the physical evidence collected from the scene and evaluated by the forensic experts.

The medico-legal significance of anogenital warts as a marker of sexual abuse in children is unclear. This review article presents three case reports and discusses the possible modes of transmission of papilloma virus in children. Although genital warts can indicate sexual abuse, non-sexual transmission may also occur.

This short paper discusses the implications of Trichomonas vaginalis infection of the genital tract in children with respect to suspected child abuse. Two case reports are described to illustrate the problems that can arise in the investigation of such cases. T. vaginalis is usually transmitted sexually but the potential for non-sexual transmission does exist.

A fatal case of Neuroleptic Malignant Syndrome (NMS) affecting a middle-aged woman is presented. Most of the signs and symptoms described for NMS were present and death occurred three hours after the onset of hyperpyrexia. Laboratory and postmortem findings were non-specific. The uses and risks of Haloperidol and Phenelzine on a patient with severe liver impairment are considered. Finally, the medico-legal implications in the context of sudden unexpected death are mentioned.