Can Birth Trauma Be Confused for Abuse?

Abstract: An unexpected infant death is usually investigated with a complete autopsy. If evidence of prior trauma is found at autopsy in these cases, suspicion is raised for nonaccidental trauma. In a young infant, the residua of trauma received during birth has the potential to be incorrectly interpreted as nonaccidental trauma. We report a the findings of a 4 1/2‐month‐old‐infant that died unexpectedly with a healing linear skull fracture and a circular lesion over the calvarium found at autopsy. Though this lesion was concerning, the remainder of the autopsy and the histological findings did not support a diagnosis of recent trauma. Review of the literature describing birth injuries made the diagnosis of healing, residual birth trauma more convincing in this case.     

Reasons for Lack of Consensus in Forensic Pathologist Interpretation of Photographs of Patterns of Injury of the Skin,

In a previous study, a survey‐based analysis of pathologist diagnoses of patterned injury in which participants were asked makes diagnoses from photographs in the absence of history or context. The level of consensus was low. A follow‐up survey was created to ask those who responded to the first survey why they answered as they did or why they were unsure of their answers. The most common reason for lack of consensus was that the lesion was nonspecific. Responses invoking ambiguity were more common than those that indicated a confident difference in diagnosis. There were differences between demographic groups, with age and experience being most prominent. These findings suggest that differences in image interpretation do not generally reflect firm differences in diagnosis as much as differing ways of dealing with ambiguity in the absence of history and context. A third survey will study the effect of the addition of contextual information.     

Book reviews

John R. Davis, Britain and the German Zollverein, 1848-66 (London: Macmillan, 1997). x + 238 pp. £45. ISBN 0-333-67828-1.

Martin Thomas, Britain, France and Appeasement: Anglo-French Relations in the Popular Front Era (Oxford and New York: Berg. 1996). xi + 268 pp. £29.95 hb; £12.95 pb. ISBN 1-85973-192-9.

Peter Lowe, Containing the Cold War in East Asia: British Policies Towards Japan, China and Korea, 1948-53 (Manchester: Manchester University Press, 1997). xii + 288 pp. £40. ISBN 0-7190-2508-7.

David M. Barrett, Uncertain Warriors: Lyndon Johnson and His Vietnam Advisers (Lawrence, Kansas: University of Kansas Press, 1994). xii + 279 pp. £11.95 pb. ISBN 0-7006-0631-9.

Rhodri Jeffreys-Jones, Changing Differences: Women and the Shaping of American Foreign Policy, 1917-1994 (New Brunswick, NJ: Rutgers University Press, 1997). x + 275 pp. £14.50 pb. ISBN 0-8135-2449-0.

Philip M. Taylor, Global Communications, International Affairs and the Media Since 1945 (London & New York: Routledge, 1997). xx + 248 pp. £45 hb. ISBN 0-415-11678-3; £15.99 pb. ISBN 0-415-11679-1     

Suicide by fire in a car trunk: a case with potential pitfalls

We present an unusual case in which an adult female committed suicide by fire while enclosed in the trunk of her vehicle. A finding of suicide was reached only because several key investigative facts were uncovered. Without these discoveries the case may still remain open as a suspicious death. Fire is rarely used as a mechanism of suicide in Western culture, and, as such, similar cases should be reported to advance our recognition of this phenomenon.     

Death by obstruction: sudden death resulting from impromptu ingestion of drugs

Over an 18-month period, the department of Forensic Medicine and Science at the University of Glasgow investigated four rather unusual drug-related deaths. In all cases, death was due to the obstruction of the airway by a foreign body after an attempt to evade arrest. In all cases, the obstruction was drug packages of various shapes and sizes. Results of toxicology revealed levels of drugs that may have had a significant respiratory effect on the deceased in three of the cases. Rupturing of the packages and hence leakage of drugs being conducive to death was obvious in only one case.     

The problem of peace: understanding the ‘liberal peace’

To remember Hiroshima is to commit oneself to peace. Pope John Paul II, 1 ?1. Pope John Paul II, 25 February 1981. View all notes 1981

Pax Invictis2 ?2. ‘Peace to the undefeated’ or the victor's peace. Inscribed on the Tomb of the Unknown Solider in St Mary's Cathedral, Sydney, Australia. View all notes

Virtue runs amok. Attributed to G.K. Chesterton     

The use of vitreous humor as an alternative to whole blood for the analysis of benzodiazepines

In postmortem drug analysis, the most commonly used sample matrix is whole blood. However, postmortem changes can denature this matrix, resulting in a loss or degradation of drugs, thus biasing analytical findings. Vitreous humor is thought to be less affected by these changes and should, therefore, have the potential to provide a more reliable estimation of antemortem drug concentrations. To assess the usefulness of vitreous humor for the analysis of benzodiazepine drugs, vitreous humor and whole blood were obtained postmortem in 27 cases. Three benzodiazepine drugs were investigated-temazepam, diazepam, and desmethyldiazepam. For temazepam and diazepam, some correlation was found between the matrices (R2 = 0.789 and 0.724, respectively). However, for desmethyldiazepam, no correlation was observed (R2 = 0.068). Regression analysis on plots of vitreous humor versus blood concentrations produced gradients of less than 1.0 showing that, in general, levels in blood are higher than the corresponding levels in vitreous humor.     

Reinventing the Treasury: Economic Rationalism or an Econocrat’s Fallacy of Control?

The 1994 Fundamental Expenditure Review (FER) of the UK Treasury was a radical overhaul of organization that had major implications for the way the Treasury conducts its business. This article examines the origins and implications of FER, paying particular attention to the 'strategic' philosophy of controlling public expenditure encapsulated within it. Ostensibly an expression of modern economic rationalism overturning outmoded administrative practices, the FER approach to public spending control might alternatively be interpreted as a manifestation of a recurring 'econocrat's fallacy of control' which aims to remove redundancy, random search mechanisms and external veto points from control systems.