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C S Hirsch

Publications and source records attributed to C S Hirsch.

At least 19 recordsLinked to original sources
PubMed1992

The epidemiology of murder-suicide.

OBJECTIVE: To review the epidemiology, patterns, and major determinants of murder-suicide and to discuss the clinical and research strategies for identifying the individuals at greatest risk for this type of violence. DATA SOURCES: Data were obtained from English-language articles based on searches using MEDLINE (from 1966), PsychINFO (from 1967), and EMBASE (from 1974) programs. In addition, relevant articles, books, and monographs identified from the reference list of retrieved articles were reviewed. STUDY SELECTION: Case-control studies, descriptive epidemiologic surveys, and case series were chosen for review. DATA EXTRACTION: Because of the limited scope of the pertinent research literature, all data relevant to the incidence, demographics, circumstances, and precipitants of murder-suicide were summarized by the authors. DATA SYNTHESIS: Murder-suicide occurs with an annual incidence of 0.2 to 0.3 per 100,000 person-years and accounts for approximately 1000 to 1500 deaths yearly in the United States. The annual incidence of these events is relatively constant across industrialized nations and has not significantly changed over several decades. The principal perpetrators are young males with intense sexual jealousy, depressed mothers, or despairing elderly men with ailing spouses. The principal victims are female sexual partners or consanguineous relatives, usually young children. Clinical depression, specific motivations such as male sexual proprietariness or maternal salvation fantasies, and a history of previous suicide attempts are important in explaining underlying psychopathological mechanisms. CONCLUSIONS: Murder-suicide occupies a distinct epidemiological domain that overlaps with suicide, domestic homicide, and mass murder. These events may be categorized into one of only several phenomenologic typologies that share similar demographics, motivations, and circumstances. Despite the disruption of families and communities caused by murder-suicide, there are no standardized operational definitions, validated taxonomic systems, or national surveillance networks for these events, all of which are needed to develop prevention strategies.

Case-Control Studies↗
PubMed1989

Venous air embolism from head and neck wounds.

Air emboli in the chambers of the right side of the heart and in the pulmonary artery were documented in 16 autopsies representing shotgun and gunshot wounds of the head, traffic fatalities with head trauma, and one neck incision. The pathology of venous air embolism and its interpretation in the context of death investigation are discussed.

Adolescent↗
PubMed1987

The physician assistant as forensic investigator.

Physician assistants are employed as forensic investigators at the Office of the Medical Examiner, Suffolk County, New York. We describe the educational qualifications of physician assistants and their valuable role in forensic medicine in Suffolk County.

Forensic Medicine↗
PubMed1986

Sudden, unexpected death due to "pineal apoplexy".

A 20-year-old woman had a minute vascular malformation in the wall of a glial cyst of the pineal body. Bleeding into the cyst lumen caused rapid expansion of the pineal body, resulting in compression of the midbrain and her sudden, unexpected death.

Adult↗
PubMed1986

The "empty heart" sign.

Approximately 15% of victims of instantly lethal central nervous system trauma have an empty or nearly empty heart at autopsy. This article defines and discusses the "empty heart" sign.

Brain Injuries↗
PubMed1984

Postmortem diagnosis of myocardial disease by enzyme analysis of pericardial fluid.

The authors measured the activities of CK, LDH, and their isoenzymes in pericardial fluid to determine their usefulness in evaluating acute myocardial injury. Their prospective study reveals that these enzymes significantly are elevated in cardiac deaths in contrast to fatalities from noncardiac causes. Also, a group of healthy individuals who were victims of violent deaths and died from extracardiac injuries had enzyme elevations greater than those found in acute cardiac deaths, suggesting catecholamine-mediated myocardial injury (stress cardiomyopathy) as part of the physiologic response to trauma. Measurements of cardiac enzymes in pericardial fluid may prove useful in establishing the postmortem diagnosis of acute myocardial injury in instances when such injury is suspected but cannot be established by ordinary histologic methods. Studies such as this may help in defining the participation of myocardial injury as one of the lethal mechanisms in various causes of death.

Autopsy↗
PubMed1984

Never say never. Negligible carboxyhemoglobin in the victim of a smoldering mattress fire.

For many years, a high blood carboxyhemoglobin concentration has been used as a criterion for determining that a victim of conflagration was alive in the fire. We report a case in which a man died from the combined effects of burns and hypertensive cardiovascular disease. He had a negligible blood carboxyhemoglobin concentration, but the environmental evidence and autopsy findings are indicative of life in the fire, which arose in a smoldering mattress. We conclude that uncritical, rigid adherence to the requirement that fire victims have high carboxyhemoglobin concentrations can be misleading.

Adult↗
PubMed1984

Forensic pathology and the autopsy.

Questionnaires sent to representative medicolegal jurisdictions in the United States showed that medicolegal necropsies comprise a substantial proportion of the total number of autopsies performed. Qualitative differences between customary hospital autopsies and their forensic counterparts include autopsy bias, the importance of trauma, biological variability, and medicolegal logic. Because of these differences, medicolegal autopsies have an important role to play in the education of undergraduate and graduate medical students and should be incorporated into the training programs of academic departments of pathology.

Autopsy↗
PubMed1984

Talking to the family after an autopsy.

Few physicians have opportunities that can match the pathologist's to bring compassion and understanding to the bereaved by means of the postautopsy consultation with families. The emotional responses of survivors are often dominated by guilt. Practical guidelines for talking to the bereaved consist of the honesty , compassion, and common sense of the pathologist.

Autopsy↗
PubMed1979

Violent death in a metropolitan county: II. Changing patterns in suicides (1959-1974).

Suicide rates in Cuyahoga County (metropolitan Cleveland) rose from 10.2 in 1958 to 12.5 per 100,000 populations in 1974 (23 per cent increase) with the greatest rise among nonwhite males (from 5.9 to 13.1, or 122 per cent). Increased rates were observed in both the city (19 per cent increase) and suburbs (35 per cent increase). Rates increased among young non-white and white adults of both sexes aged 15--34 years, but decreased slightly among adults aged 65 years and older. These findings are consistent with national trends. Alcohol was present in the blood of one-fourth of the individuals who were "dead on arrival," and at intoxicating levels in 20 per cent. There were increasing percentages of victims with positive blood alcohol and with intoxicating levels during the study period. White male victims in the city had significantly higher frequencies of such findings than their counterparts in the suburbs. The rates of suicide committed by firearms rose among all race-sex groups, with the greatest increase among city nonwhite males (2.1 to 7.7, or 267 per cent). Suicide by chemical agents (roughly one-half being barbiturates) increased in all groups except city nonwhite males, with the greatest increase among white males and suburban white females. Firearms among males and poisoning among females displaced asphyxia as the leading modes of suicide.

Adolescent↗
PubMed1977

Violent death in a metropolitan county. Changing patterns in homicide (1958-74).

Analysis of homicide patterns in Cuyahoga County, Ohio (metropolitan Cleveland), for 1958-1974 discloses the following major trends: a dramatic rise in overall homicide rates in the city (320 per cent) and suburbs (200 per cent); an increase in justifiable homicide; a doubling of the percentage of homicides incident to other felonies; a markedly increased incidence of homicide among younger persons; a conspicuous rise in firearm killings (now 81 per cent of all homicides); and a continued preponderance of intraracial homicide, with the highest rates among nonwhite males in the city. The trends in Cuyahoga County are consistent with those in other United States metropolitan counties. Homicide is responsible for a major part of the decreased life expectancy among young, urban, non-white men. The factor most consistently associated with these trends is the increased use of handguns.

Adolescent↗
PubMed1977

Carboxyhemoglobin concentrations in flash fire victims: report of six simultaneous fire fatalities without elevated carboxyhemoglobin.

Eight people died in a traffic accident involving a tractor-trailer and ten autos. The accident caused a series of flash fires from ruptured gas tanks. Complete autopsies established that six of the victims died exclusively from thermal trauma; none showed an elevated blood carboxyhemoglobin concentration. Flash fire victims are exceptions to the axiom that elevation of blood carboxyhemoglobin is a sine qua non for concluding that a decedent recovered from the scene of a conflagration was alive in the fire.

Accidents, Traffic↗