The forensic medical diagnosis of death-cup poisonings

Comparative analysis and evaluation of all modern methods used for medicolegal diagnosis of poisoning with Amanita phalloides are presented. Imperfection of methods used for laboratory diagnosis of such poisonings requires extensive experimental control using the designed method of liquid chromatography for amanitine and phalloidine assay in the cadaveric organs and tissues.     

Homicidal poisoning. A dying modality of lethal violence?

Review of the experience of the Cuyahoga County (Cleveland, Ohio and its suburbs) Coroner's Office with homicidal poisonings over the past 3 1/2 decades reveals that this modality of felony homicides constitutes but a tiny fraction of the total case load and small percentages of overall homicides and drug- and chemical-caused deaths of all types. These findings are representative of selected medicolegal establishments across the country, as well as in the United States as a whole. Precise definition of the several types of felonious homicidal poisonings is suggested in the interest of clarity and accuracy of statistical data.     

Acute nonfatal poisonings by drug preparations]

Acute non-lethal poisonings with drugs within the period of 10 years according to archives data of Toxicological center and medicolegal department of victims' examination in Leningrad medicolegal expert Bureau were analysed. Number of drug poisoning cases increased two-fold and formed 76% of all poisoning cases. Tranquilizers, then antihistaminic, neuroleptic and hypotensive (clofelin) agents were used most often. Drugs were taken with suicidal attempt or with the aim of getting "alcoholic" effect. Poisonings among women were registered three times more often than among men.     

Mass deaths by gas or chemical poisoning. A historical perspective

This review chronicles the characteristics of deliberate and accidental mass poisonings that occurred in World Wars I and II, in Bhopal, and in other historical cases up to and including modern wars. It also considers approaches to the investigation of such cases from the medicolegal as well as general standpoints.     

Trends in domestic animal medico-legal pathology cases submitted to a veterinary diagnostic laboratory 1998-2010*

Abstract: Pathologists at veterinary diagnostic laboratories receive medico‐legal cases from a variety of animal species for postmortem examination. A search of computerized records of the Animal Health Laboratory, University of Guelph, Guelph, Ontario, Canada from 1998 to 2010 identified 1706 medicolegal cases. These were categorized according to the history as criminal investigations, anesthetic‐related deaths, insurance, litigation, malpractice cases, and regulatory cases. Statistically significant linear trends in the proportion of medicolegal cases for all animals and criminal cases for companion animals were identified over the 12 year period. Companion animals had significantly greater odds of being a medicolegal case in all categories except for insurance and regulatory cases, compared to noncompanion animals. Based on pathology reports for the 271 criminal cases, 43.1% were consistent with neglect, 29.2% were compatible with non‐accidental injury, 4.80% were poisonings, 10.7% were deemed to be due to natural disease, and 11.43% were inconclusive.     

Origin and development of forensic medicine in India

CONTEXT:: The medical profession is one of great antiquity in India. However, the history of medicine and, in particular, the role of medicine in the administration of justice in India has not been discussed very much. The present paper attempts to fill in this lacuna and traces the medicolegal practice from ancient times to British India. SOURCE:: This paper is based on archival materials collected from the Tamilnadu State Archives, Chennai, and Madras Medical College Library, Chennai, and University of Madras Library, Chennai. MAIN OBSERVATIONS:: The medical men in ancient India were considered as men of wisdom, and one of the ancient Tamil hymns equates the doctor-patient relationship to that of the dedicated love of a devotee to God. Kautilya's Arthashastra gives a list forensic evidence for establishing the cause of death and describes the necessity of autopsy in establishing the cause of death.In British India, the early incidence of custodial death and its certification by medical practitioners, issuance of medical certificate and wound certificate, and medicolegal autopsy are documented. The most outstanding contribution of India to legal medicine during this period is modern dactylography. It is recorded that there was a high ratio of homicidal poisonings in India.     

Medicolegal practice in Samoa: an inside view

Samoa, considered the heart of Polynesia, has a medicolegal system with some limitations. There is a need to build a well-organized medicolegal service. The authors briefly outline the medicolegal system in Samoa from its beginning to the present and discuss future improvements.     

Forensic medicine in Great Britain. II. The origins of the British medicolegal system and some historic cases

The British medicolegal system, which today is largely based on the Coroner's Act of 1887, developed slowly, beginning with the election of county coroners in the 12th century. The duties of the medieval coroner included the collection of revenues due to the Crown, recordkeeping, presiding over inquests, and overseeing juries in cases of sudden or unnatural death. However, by the 14th century, the influence of the coroner had diminished and the office fell into disrepute. The practice of forensic medicine in the United Kingdom can be dated from the 17th century, when the first autopsy was recorded. However, the first original textbook on this subject did not appear in Britain until the early 19th century. Around the same time, due to a wave of homicidal poisonings, toxicology emerged as an important discipline. A number of historical cases of homicidal poisoning, as well as several cases of homicide by external wounding, are discussed herein. In the present day, with the passage of various laws, the British coroner deals only with sudden and unnatural death and treasure trove.     

The Fatal Poisoning Pattern of Ankara (Turkey) and Nearby Cities from 2007 to June 2011: A Retrospective Study in Forensic Autopsies

We aimed to obtain an outline of the nature and number of fatal poisonings which still appear to affect widely the population in Turkey. A total of 5921 forensic autopsies were performed between 2007 and 2011 in Ankara and nearby cities and 366 of them were fatal poisonings (219 male, 147 female). Most of the cases were between 41 and 60 years old (n = 84). Most of the fatalities were reported during winter months (48.1%). Carbon monoxide exposure was the most common reason (66.7%) within all the causes followed by medicine and narcotics (13.9%). Postmortem blood alcohol concentrations in ethyl and methyl alcohol poisonings were 385.1 ± 61.9 and 206.8 ± 138.9 mg/dL, respectively. The most common location of deaths was home (71.3%). Fatal poisonings have been a growing global problem because of some shortcomings about the socioeconomic conditions and increasing illicit drug abuse. The level of education, socioeconomic conditions, and legal approaches are very important for the prevention fatal poisonings.     

Fatal alcohol poisoning: medico-legal practices and mortality statistics

Compilation of mortality statistics from death certificate data is based on international and national conventions which in certain situations result in the underlying cause-of-death other than that established and reported by the physician. The present study compares all fatal alcohol poisonings in 1997 as registered on forensic toxicological grounds at the accredited central laboratory and as presented in the national cause-of-death statistics, according to the underlying cause-of-death, by applying international statistical rules and principles in ICD-10. Four groups were formed, and case frequencies in each group were obtained from forensic toxicological data, group "T51" for acute poisonings due to alcohol alone, and group "Comb" for acute alcohol poisonings combined with some drug, medicament or other biological substance, and from cause-of-death statistics data, group "X45", for deaths from alcohol poisoning, and group "F102" for those medico-legal fatal alcohol poisoning deaths which at the statistics office were inferred to be due to alcoholism. The study shows that in Finland the officially compiled statistics on fatal alcohol poisonings, when compared with medico-legal statements based on forensic toxicological examinations, were underrepresented by 31.4% in 1997. About two-thirds of this underrepresentation is explained by preferring, as the underlying cause-of-death, alcoholism to acute alcohol poisoning, and about one-third by preferring, in cases of acute combined poisonings, the drug component to the alcohol. From 1998 onwards, more emphasis has been put on the alcohol component when coding medico-legally proven accidental deaths from simultaneous poisoning with alcohol and a medicinal agent. This change in coding practices presumably explains the subsequent decline in the annual underrepresentation rate of alcohol poisoning in mortality statistics to the level of 15-16%. It is concluded that the present ICD rules inevitably lead to underrepresentation of alcohol poisonings in the mortality statistics, and conceptual and practical proposals for future procedures are made.     

The interfaces of law and medicine.

The relationship between the legal and medical professions is improving, but many problems remain. There has been been and continues to be substantial growth in medicolegal organizations of various kinds. Better medicolegal investigative methods are being developed, and medicolegal teaching programs are on the increase. The two professions have worked together successfully on such problems as human heart transplantation and drug abuse. On the other hand, several problem areas continue to cause difficulty and friction, including medical experimentation on humans, the legal definition of death, abortion, euthanasia, and medical malpractice. The author calls on the existing medicolegal organizations to apply their expertise and influence to define and resolve these problems.     

法医学鉴定质量评价与控制研究

目的探讨法医学鉴定质量评价与控制的有效途径。方法根据法医学鉴定的要求,选择评价指标、评价等级以及确定权重指数,应用模糊数学综合评判的方法,对法医学鉴定质量进行评价与控制,并结合实例分析如何应用模糊数学综合评判的方法对法医学鉴定质量进行评价与控制。结果该方法对法医学鉴定质量具有有效的评价与控制。结论模糊数学综合评判可作为法医学鉴定质量评价与控制的有效手段。     

An analysis of the medicolegal autopsies performed in Adana, Turkey, in 1983-1988.

Data on 1,000 medicolegal autopsies have been compiled by the Morgue Department of the Adana branch of the Council of Forensic Medicine of Turkey, and have been reviewed to determine the local differences in causes of death, as well as age and sex distributions of decedents, in medicolegal deaths in this region. This is the first report on this subject in this region of Turkey. Unusual categories of death and incidences of death are also discussed. The results of this study show that the number of medicolegal autopsies and the rate of natural death in Adana are quite close to those of some other cities of Turkey and some foreign countries. Contrary findings are revealed in the frequencies of the causes of death.     

Forensic-medical aspects of dermatoglyphics of the hands and feet

Issues on possibility of using capillary patterns of hands and feet in medicolegal examination of unidentified dead bodies and unknown persons, in cases of disputed paternity and maternity and child substitution are considered. Up-to-date theories on inheritance of dermatoglyphics features, their racial, sexual, age and occupational variability as well as interrelationship with some genetic diseases are analysed. Ways of researches in the field of dermatoglyphics of hands and feet for expert practice are outlined.     

The forensic medical expertise of acute local radiation trauma]

Informative diagnostical criteria of medicolegal evaluation and prognosis of corporal lesion gravity in case of acute local radiation trauma as well as algorithm of medicolegal diagnostical process concerning these lesions with reference to external radiation exposure, kind of injuring factor, differential-diagnostical signs of acute local radiation trauma are suggested. They make it possible to formulate medicolegal diagnosis and can form the basis for developing diagnostical programmes.     

Assessment of hemorrhagic syndrome of the digestive tract in acute poisoning evaluation

Morphologic features and differential diagnostical signs of hemorrhagic syndrome variants in the digestive tract in acute poisonings are described. Medicolegal value, conditions of occurrence as well as some possibilities to prevent gastro-intestinal hemorrhage occurring due to defects when providing medical care in case of poisoning are presented.     

A suicide decision as a motive for murder--an airplane as the murder weapon

It is supposed that some fatal aviation accidents of "cause unknown" especially of light and private airplanes are possibly intended by a suicidal act. However it is difficult to prove this suggestion. A case of a light aircraft accident is reported in which the medicolegal autopsy and the police investigation revealed, unexpected, a simultaneous homicide and suicide caused by a stabbing attack on the pilot. This paper stresses the importance of autopsies of the victims in aircraft accident investigation and discuss the medicolegal and psychopathological aspects of the case.     

Transsexualism in medicolegal limine: an examination and a proposal for change

This article investigates transsexualism and our creation of a state of medicolegal limine for transsexuals. The article addresses transsexuality as it is currently defined and explores our dichotomization of sex and gender. The author discusses both the social construction and the praxis of transsexuality, highlighting the medicolegal implications resulting from our current approach to transsexuality. The author argues that the creation of a medicolegal limine essentially prevents transsexuals from ever integrating fully as a member of one sex or gender, while simultaneously preventing the larger society from reconsidering its definitions of sex and gender. The article concludes with a summary of current challenges to our model of transsexualism and with suggestions for the resolution of this liminal medicolegal phase.     

Recent status of the medical examiner system in Japan: demographic variation of medicolegal deaths in Hyogo Prefecture and uncertainty in medicolegal investigations conducted by medical practitioners.

The medical examiner system has been steadily abolished in Japan. Instead, medicolegal investigations are entrusted by the police to medical practitioners, who are not permitted to perform autopsies. The necessity for the medical examiner system was assessed through inquest records in Hyogo, one of the three prefectures which still have medical examiner systems. Standardized mortality ratios (SMRs) for accidents and suicides were negatively associated with population density, being high in rural areas with a large proportion of elderly citizens, while the SMR for natural deaths was high in urbanized areas and associated with the proportion of inquests to total resident deaths. The high proportion of inquests, however, did not always mean that inquest records were of good quality. Significant differences in the quality of medicolegal investigations seemed to exist between medical examiners and medical practitioners. That is, in order to certify the cause-of-death, medical examiners performed autopsies in about half of their cases, while only 2% of medical practitioner cases were subjected to autopsies. Medical practitioners, who certified the cause-of-death as "heart failure" without advising an autopsy, were regularly entrusted with inquests. It is likely that the causes-of-death for medicolegal cases may be questionable since more than 85% of all medicolegal deaths were investigated by medical practitioners, which may cause inaccuracy in at least 3-7% of mortality statistics. It is necessary to educate medical practitioners concerning the importance of mortality statistics and ICD and on the validity of autopsies, in order to obtain accurate mortality statistics from medicolegal cases.