Medicaid and access to child health care in Chicago.

In this article we examine how increasing the reimbursement of physicians and expanding Medicaid eligibility affect access to care for children in Cook County, Illinois, which overlies Chicago. Using Medicaid claims and other data at the zip-code level, we compare the places where Medicaid children live with the places where all the physicians who treat children and those who accept Medicaid patients have their practices. Our findings suggest that the recent changes in legislation are unlikely to benefit extremely poor children, who are more likely to live in depressed inner-city areas, where there are few physicians. "Near-poor" children whose homes are dispersed throughout the county, who are now eligible for Medicaid as a result of the recent changes, are likely to see improvements in their access to care. Further changes in policy, aimed at enhancing the capacity of institutions providing care, could improve access for the children of the inner city.     

Complications following cell therapy

So far, the law in the Federal Republic of Germany still allows the injection of fresh-cell preparations from animals as a roborant to increase the vitality of the organism and to strengthen the body's immune defense system. The use of "sicca-cell" preparations was provisionally forbidden in 1987 by the Federal Health Organization (Bundesgesundheitsamt; BGA). Prohibition of fresh-cell injections would have exceeded the authority of this office, although the same serious reservations also applied in the case of this treatment method. Several publications that have appeared since 1955 have reported serious complications of this therapy, some life-threatening and some even lethal. Two further cases are now added: (1) A woman aged 69 had been receiving treatment with cell injections for 9 years. Immediately after an injection of sicca cells she collapsed and was hospitalized; 7 days thereafter she developed an ascending paralysis with increasing inability to swallow or breathe. She died 25 days after the injection as a consequence of central and peripheral respiratory failure. Autopsy revealed the alterations typical for acute Landry-Guillain-Barré-Strohl syndrome. (2) A 76-year-old healthy woman had been receiving treatment with fresh-cell preparations for several years. After an injection of cell suspensions a painful local swelling was observed. The symptoms were interpreted as the consequence of an iatrogenic local hematoma, and repeated punctures were performed to obtain blood. The patient was transferred to a surgical department for further therapy. Two days after the injection she suddenly died with signs of acute cardiovascular failure. Autopsy revealed the signs of a fulminating clostridial infection and also the characteristic signs of Landry-Guillain-Barré syndrome with involvement of the autonomic nervous system. In both cases the development of an inflammatory process in the peripheral nervous system could be interpreted as an immune-mediated allergic disease, related to the repeated injection of heterologous antigenic material containing nervous tissues. This hypothesis would also explain the two other cases already published and would be consistent with the observed perivenous leukoencephalopathy of the central nervous system. The human disease pictures correspond to the well-established animal models of EAEM (experimental allergic encephalomyelitis) and EAN (experimental allergic neuritis). The pathogenesis is discussed; the major role of the central and peripheral nervous system is stressed, with special reference to the risk of acute autonomic failure. The need for specific autopsy techniques for the investigation of the entire nervous system, including spinal cord, roots, spinal ganglia and peripheral nerves with sympathetic chains, is raised.     

Injuries of the large arteries of the brain and vital reactions. An electron microscopy study

In 90 forensic autopsies (Craniocerebral injury, gunshot, stabbing, blow, strangulation, etc.), semithin sections of great arteries were prepared from around 770 Epon blocks and checked for vital reactions at the mural and intimal ruptures. In 21 cases in which death had occurred immediately or soon after the trauma, with three exceptions, there was a subsequent electron microscopic investigation. In all six mural ruptures and in five of ten intimal ruptures, thrombocyte aggregates were found at the rupture margins. In five intimal ruptures, the possibility of the occurrence of preparations injuries had to be considered. In five cases, the results of the histological study were negative. The success rate is limited in principle in such a screening test since there are technical difficulties in preparing serial sections on long vessels. Death was rapid and the thrombocytes were observed to adhere to the injured wall sites immediately after the trauma. The "thrombocyte sign" is thus of substantial importance as the earliest local vital reaction. In two control cases (strangulation), thrombocyte aggregates were found at intimal ruptures of the basilar artery, which were regarded as the results of stretching via the vertebral arteries during attacks to the neck. The healing processes of intimal ruptures and traumatic medial necrosis in incomplete ruptures occurring later in life are discussed. Even if a cadaver is a few days old, the histological findings at the level of the thrombocytes can be evaluated.     

The cutaneous ink sign: a tipoff to suicide or suicide notes

The presence of smeared or unsmeared ink on the skin resulting from the writing process has been observed in a number of suicide victims who have left suicide notes. The authors report a case of a palmar "cutaneous ink sign" and discuss its forensic science import.     

Reviews

Rajan Menon, Soviet Power and the Third World. New Haven and London: Yale University Press, 1986, ix + 261 pp. £18.50.

Georgi Arbatov, Cold War or Detente? The Soviet Viewpoint. London: Zed Books, 1983. xviii + 219 pp. £16.95, $30.00 h/b; £4.95, $8.95 p/b.

Jonathan Steele, World Power: Soviet Foreign Policy under Brezhnev and Andropov. London: Michael Joseph, 1983, xii + 287 pp. £14.95.

Imre Vincze, The International Payments and Monetary System in the Integration of the Socialist Countries, The Hague: Martinus Nijhoff, 1984, ix + 185 pp. £20.50, $32.00.

M. M. Kostecki ed. The Soviet Impact on Commodity Markets, London: Macmillan, 1984, xl + 271 pp. £25.00.

Gerhard Fink ed. East‐West Economic Relations Now and in the Future: Die Ost‐West‐Wirtschaftsbeziehungen heute und morgen, Vienna: Springer‐Verlag, 1985, 100 pp. DM 34,00.

András Köves, The CMEA Countries in the World Economy: Turning Inwards or Turning Outwards, Budapest, Akadémiai Kiadó, 1985, 248 pp. £18.25.

Ger P. van den Berg, The Soviet System of Justice: Figures and Policy, Martinus Nijhoff, Dordrecht, Boston, Lancaster (series Law in Eastern Europe No. 29) 1985, xiii + 374 pp incl appendices, indices and references, £56.95, $71.50.

Eugene Huskey, Russian Lawyers and the Soviet State. The Origins and Development of the Soviet Bar, 1917–1939. Princeton: Princeton University Press, 1986, xii + 247 pp. £19.00.

David Lane, Labour and Employment in the USSR. Brighton: Wheatsheaf Books (distributed by Harvester Press), 1986, 280 pp. £28.50.

Martin McCauley and Stephen Carter, eds. Leadership and Succession in the Soviet Union, Eastern Europe and China. London: Macmillan, 1986, xiii + 256 pp. £27.50 h/b, £8.95 p/b.

Leslie Holmes, Politics in the Communist World. Oxford: Oxford University Press, 1986, xi + 457 pp. £25–00 h/b, £9.95 p/b.

Peter Kenez, The Birth of the Propaganda State: Soviet Methods of Mass Mobilization, 1917–1929. Cambridge: Cambridge University Press, 1985. xi + 308 pp. £27.50, $39.50 h/b, £9.95, $12.95 p/b.

Joseph J. Collins, The Soviet Invasion of Afghanistan: a Study in the Use of Force in Soviet Foreign Policy. Lexington, Mass.: Lexington Books, 1986, xv + 197 pp. £22.50, $31.25.

Leszek Buszynski, Soviet Foreign Policy and Southeast Asia. London: Croom Helm, 1986, 303 pp. £25.00.

William J. Kelly, Hugh L. Shaffer and I. Kenneth Thompson, Energy Research and Development in the USSR: Preparations for the Twenty‐First Century. Durham, North Carolina: Duke University Press, 1986, xvi + 417 pp. £62.50.

Gregory D. Andrusz, Housing and Urban Development in the USSR, London: Macmillan in association with CREES, University of Birmingham, 1985, xix + 354 pp. £30.00.

Jane Ellis, The Russian Orthodox Church: a Contemporary History, London & Sydney: Croom Helm, 1986. 531 pp. £27.50.

Edward Acton, Russia: The Present and the Past, London and New York: Longman, 1986, xiii + 342 pp. £17.50 h/b, £8.95 p/b.

Robert Service, Lenin: A Political Life. Vol. 1. The Strengths of Contradiction. London: Macmillan, 1985, x + 246 pp. £25.00.

Abbott Gleason, Peter Kenez and Richard Stites, eds., Bolshevik Culture. Experiment and Order in the Russian Revolution. Bloomington: Indiana University Press, 1985, xii + 304 pp., $27.50.

Josef Garlinski, Poland in the Second World War, London: Macmillan, 1985, xxi + 387 pp., £25.00

Andreas Dorpalen, German History in Marxist Perspective. The East German Approach. London: I. B. Tauris & Co., 1985, 542 pp., £24.50.

Walter Parchomenko, Soviet Images of Dissidents and Nonconformists. New York: Praeger, 1986, xv + 251 pp., $33.95.

Soviet Armed Forces Review Annual. Vol. 9 (1984–1985). Edited by David R. Jones. Gulf Breeze, Florida: Academic International Press, 1986. x + 313 pp., $69–50.     

The writings of Sir Bernard Spilsbury: Part I

This is a two-part historical feature, highlighting the rare writings of Sir Bernard Spilsbury, the recognized leader of British forensic medicine in the first half of the 20th century. Parts I and II were compiled from the publications of the Medicolegal Society of Great Britain, where Sir Bernard Spilsbury served as President in 1933. Although his profile was presented previously in this Journal (vol. 2, no. 2, 179-182, 1981), it is felt that much of Sir Bernard Spilsbury's personality comes out in his writings and recordings of his speeches in the Medicolegal Society publications. Part I includes his lecture on "The Medico-Legal Significance of Bruises," presented before the Medicolegal Society in 1938; and a short case report read before the Medicolegal Society in 1924. The subject of the case report was sudden death from inhibition. Part II will contain two papers from the Medicolegal Society publications.     

Interest in political campaigns: The influence of question order and electoral context

A split-ballot experiment shows that, when people are asked how interested they are in following political campaigns, their response depends not only on the order in which the question is asked, but also on the broader electoral context in which it is posed. When asked how interested they were in following the political campaigns immediatelyafter a question about whether or not they voted in the (1982) election, people were more likely to think they were interested in the campaign, especially if they claimed to have voted, than if they were asked about it immediatelybefore the question on whether or not they voted. This order effect, however, appears to depend onwhen the questions are asked. If asked within a few weeks after the election, there is little or no order effect. But later, as the memory of the campaign fades, the order of the questions makes a sizable difference in the results. This order effect also seems to be more pronounced among better-educated respondents, suggesting that they are more likely to feel pressured by a social norm to vote and to express an interest in political affairs, not only in real life, but in the survey interview as well. The paper concludes with a brief discussion of the implications for the design of the interview schedule used in the American National Election Studies.The research reported in this paper was supported by a grant from the National Science Foundation (SES81-11404).