Causes of death of patients in an institution for the developmentally disabled

The causes of death of 53 severely to profoundly developmentally disabled patients who died in an intermediate care facility were reviewed. Respiratory disease, predominantly pneumonia and aspiration, accounted for 72% of deaths. Seven patients died of nonrespiratory causes, and in 8 patients, no cause of death could be determined, even after a complete autopsy or investigation. The median age at death was 20 years. The weights of these patients' organs at autopsy were lower than those for normal individuals of the same age. The lifespan of these severely impaired individuals continues to be significantly shortened, even with improved methods of care.     

The investigation of alleged insecticide toxicity: a case involving chlordane exposure, multiple sclerosis, and peripheral neuropathy

A man with no previous medical problems had two documented exposures to an insecticide containing the organophosphorous compounds chlordane and heptachlor. Six months to one year later, he began to experience neurological symptoms which progressed until his death. At autopsy, his brain showed classic findings of multiple sclerosis, and he had a severe peripheral neuropathy. Review of the literature indicates that the findings are not compatible with chlordane toxicity. Some of the factors to be used in determining the casual relationship between toxic exposure and disease processes are discussed.     

The spectrum of neuropathologic findings in deaths associated with seizure disorders

The pathologic and neuropathologic findings in 90 autopsied cases of death associated with a seizure disorder or complication thereof were reviewed. Most (69%) of the deceased individuals were between 21 and 40 years of age; two thirds were male. In 58% of patients, no cause of death other than seizure disorder was found. The ultimate cause of death in those patients was assumed to be a cardiac arrhythmia or respiratory arrest. Drowning accounted for 19% of deaths, and 17% of patients died of other contributory causes such as suicide, exposure, or atherosclerotic coronary vascular disease. Aspiration was found in the remaining 6%. Tongue lacerations or bite marks were observed in only one third of cases. The brain was normal in approximately two thirds of cases, with no focus for the origination of seizure found on neuropathologic examination. In the remainder of cases, a variety of lesions was found, with cavitary lesions, contusions, and dural lesions being the most common ones.     

The Supreme Court and the Federal System: Federalism from Warren to Burger

The question of the relation of the states to the federal governmentis the cardinal question of our constitutional system. It cannotbe settled by the opinion of any one generation, because itis a question of growth, and each successive stage of our politicaland economic development gives it a new aspect, makes it a newquestion.¹     

Medicolegal aspects of necrotizing fasciitis of the neck

Necrotizing fasciitis of the neck (NFN) is a relatively rare, fulminating infectious process of the cervicofacial tissues which may cause sudden and unexpected death. Although often the result of a dental infection, injuries of the soft tissues of the neck may also initiate rampant cellulitis, and recognition of the underlying etiology of such cases is necessary to determine properly the manner of death. Five cases of NFN are presented with a review of the causative factors and usual bacteriology, and specific factors of medicolegal interest are addressed.