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Neisseria lactamica was isolated from the genital tract of a young patient with a persistent vaginal discharge. Although infection with N lactamica occurs very rarely, the importance of complete biochemical identification of neisseriae is emphasised in view of the serious social and medicolegal consequences which could result from a misdiagnosis of gonorrhoea.
Forensic dentistry has become an integral part of forensic medicine over the past 100 years. This has been due to the dedication of people like Amoedo, Gustafson, Sognaes, Keiser-Nielsen and Suzuki, to name but a few. They established the essential role which forensic dentistry plays mainly in the identification of human remains. Dental hard tissues are extremely resistant to fire and are usually the only remains after an extended period of burial. If antemortem dental records are available for an individual then dental identification is as certain as those of fingerprints. In South Africa forensic dentistry had its beginning in 1969 during the Windhoek air disaster. Since then there have been several cases of interest throughout the country, one of which was the crash of the Helderberg off the coast of Mauritius. Other aspects of forensic dentistry are the examination of bite marks and the recognition of facial trauma especially in cases of child abuse; the determination of age, sex and race of skeletal remains; dental ethics and jurisprudence as well as malpractice also form part of the duties of the forensic dentist. The five dental schools in South Africa each have a forensic team which is consulted on a regular basis by forensic pathologists and district surgeons. Forensic dentists are active members of the medicolegal team and should be consulted on a regular basis especially in cases where identification is concerned.
The lungs of 136 persons dying as a result of road traffic accidents were studied retrospectively for the presence of fat and bone marrow emboli. Comparable investigations were made in 54 cases of acute myocardial failure reported to the medicolegal authorities and in 50 cases of fatal drug overdose. A further 50 cases of myocardial failure dying in hospital were studied for the presence of bone marrow embolism only. It was considered that despite occurrence of an occasional anomalous case, both fat and bone marrow emboli are related to injury but that the incidence and severity of bone marrow embolism in particular depends greatly upon the conditions of the accidental death. The occurrence of pulmonary embolic phenomena in cases of natural death was attributed to resuscitative measures rather than the underlying condition. The results indicated that the medicolegal significance attached to the findings should, by themselves, be limited to the positive identification of injuries sustained before or at the time of death in the individual case.
A Hispanic woman, 7 1/4, to 7 1/2 lunar months pregnant, was strangled to death by her common-law husband. After receiving information from an informant, a reporter uncovered the remains of the woman and fetus in a grave in a river bank near Eloy, Arizona. The remains were submitted by local law enforcement officials to the forensic pathologist for medicolegal examination. After this analysis, they were turned over to the consulting forensic anthropologist for positive identification of the mother and for fetal age determination to assess possible viability. During the 1970s and 1980s, viability for a fetus of this age was thought possible, although not probable. Prosecution of the common-law husband on the charge of first-degree murder of his wife was successful, whereas a comparable charge for the fetus was not sought. Many issues are raised, including gestational age estimation in relation to fetal viability. Fetal age is reassessed by means of measurements from diaphyseal lengths. These measurements allowed for comparability of fetal age estimations between published studies, with discussion of changing dates of fetal viability made possible through technologic advances. Because fetal viability changes with these advances, it is necessary to establish and update the guidelines for medicolegal practice.
Sudden unexpected death in epilepsy refers to sudden death of an individual with a clinical history of epilepsy, in whom a postmortem examination fails to uncover a gross anatomic, toxicologic, or environmental cause of death. Evidence of terminal seizure activity may not be present. One to two percent of natural deaths certified by the medicolegal death investigator are attributed to epilepsy. Detailed microscopic examination of the brain has increasingly afforded the identification of structural changes representative of epileptogenic foci. The authors present 70 cases of death attributed to sudden unexpected death in epilepsy. These cases were classified as follows: individuals who lacked a gross brain lesion, those who had a brain lesion demonstrable at autopsy, and those who lacked neuropathologic evaluation because of decomposition or because only an external examination was done. All of the subjects had a clinical history of seizures. The authors confirm that various microscopic findings, including neuronal clusters, increased perivascular oligodendroglia, gliosis, cystic gliotic lesions, decreased myelin, cerebellar Bergmann's gliosis, and folial atrophy, are present in a higher percentage of the brains of sudden unexpected death in epilepsy subjects than in the brains of age- and sex-matched control subjects.
Identification of the gender of an individual(s) from whom a bloodstain is derived represents important evidence in medicolegal cases. The efficacy of fluorescence in situ hybridization (FISH) using chromosome X and Y centromeric probes was tested to determine its ability to identify correctly the gender of extracted dried bloodstains. In this preliminary study, FISH correctly identified the gender of 2-week-old dried bloodstains in prepared mixtures of male-to-female blood as low as 1%. The technique is accurate, rapid, sensitive, easily performed and readily available. This application of FISH as a forensic laboratory technique holds great promise.
In the 25 years or so after the first clinicopathological descriptions of diffuse axonal injury (DAI), the criterion for diagnosing recent traumatic white matter damage was the identification of swollen axons ('bulbs') on routine or silver stains, in the appropriate clinical setting. In the last decade, however, experimental work has given us greater understanding of the cellular events initiated by trauma to axons, and this in turn has led to the adoption of immunocytochemical methods to detect markers of axonal damage in both routine and experimental work. These methods have shown that traumatic axonal injury (TAI) is much more common than previously realized, and that what was originally described as DAI occupies only the most severe end of a spectrum of diffuse trauma-induced brain injury. They have also revealed a whole field of previously unrecognized white matter pathology, in which axons are diffusely damaged by processes other than head injury; this in turn has led to some terminological confusion in the literature. Neuropathologists are often asked to assess head injuries in a forensic setting: the diagnostic challenge is to sort out whether the axonal damage detected in a brain is indeed traumatic, and if so, to decide what - if anything - can be inferred from it. The lack of correlation between well-documented histories and neuropathological findings means that in the interpretation of assault cases at least, a diagnosis of 'TAI' or 'DAI' is likely to be of limited use for medicolegal purposes.
Two cases of dissecting aneurysm of the left main stem and left anterior descending coronary arteries are presented. Both cases were discovered during routine medicolegal death investigations. Unusual aspects of one of our cases include the history of antecedent trauma and the precise identification of an intimal tear.
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Person identification depends on an immediate and competent evaluation in order to provide the investigating agencies with relevant information on whether the cause of death was suicide, homicide, murder, or accidental. Based on documented cases of corpse identification, an attempt was made to provide evidence for the importance of a dental evaluation in addition to the general medicolegal evaluation.
Data on 123 cut-stab wounds and 52 knives were examined in the course of medicolegal expert evaluation. It was found that 30 knives possessed heels which could have two forms: symmetric and asymmetric. Heel traces were seen in 16 expert evaluations (34%) in 31 wounds (25.2%) and in some of them particular features of knife blade heel were represented. Differences between butt end and heel trace according to series of signs were noted.
Dr. Wilton Marion Krogman was one of the major founders of physical and forensic anthropology in the United States. His extraordinary career spanned nearly six decades, and he was universally admired and respected for his scholarship, teaching, research, wit, and humanity. While studies based on human skeletal remains have long been used to assist the medicolegal system, the late Dr. Krogman can be credited with uniting these areas into the discipline of forensic anthropology. His "Guide to the Identification of Human Skeletal Material" (1939) in the F.B.I. Law Enforcement Bulletin became the foundation of this discipline; his monumental book The Human Skeleton in Forensic Medicine (updated with the author in 1986) solidified its establishment. The purpose of this paper is to pay tribute to this great man and outline his influence on the development and advancement of forensic anthropology.
The X-ray examination of corpses is a most useful tool in the field of medicolegal diagnosis. Sometimes the cause of death can already be seen before autopsy. The following modes of application are reviewed: search for foreign bodies, identification of poison, air-embolism, pneumothorax, air-filled lungs and gastro-intestinal organs in newborns, diagnosis of tuberculosis in corpses, visibility of hidden fractures, structure of bones as a factor of biomechanical load capacity, identification and determination of age and experimental research with corpses.
A method for proving the presence of semen has been established by utilizing chemiluminescence for an assay of choline, a nonprotein constituent of semen, and medicolegal testings were carried out to evaluate its effectiveness. The sensitivity of this method to choline was 3 nmol/ml, and as a result of assays of the choline content in semen and in several other human body fluids and secreta, the choline level in semen was found to be 10.88-26.78 mumol/ml (mean = 16.69 +/- 4.01 mumol/ml), which was markedly higher. The choline content in semen specimens from subjects with oligospermia or azoospermia was similarly as high. Although choline was also detected in samples of certain dairy products, vegetable juice, and fruit juice, whose stains are almost indistinguishable from semen to the naked eye, the choline content in these specimens was much lower than in semen. Further, even when human semen specimens were heated to 100 degrees C for 30 min and seminal stains were heated to 200 degrees C for 30 min, the choline content still retained 71.6% and 66.9% of the pre-heating value, respectively. As for specimens of semen and seminal stains that were stored at room temperature for 12 months, about 1/3 and 1/2 of the original choline level were detected, respectively. Also, the presence of intravaginal drugs was shown to have no large influence on the detection of choline. Choline even could be detected in aged seminal stains stored for 11 years, so that the presence of semen was demonstrated. Finally, the presence of semen in the vaginal contents, collected on medicolegal autopsy, could also be demonstrated by the detection of choline. Thus utilizing chemiluminescence for detecting choline is considered useful for establishing medicolegal proof of the presence of semen.
The process of providing emergency care is a difficult one. In pediatric emergency care, this process is complicated by a host of factors, including special legal considerations. A basic identification of these legal issues as discussed will enhance the ability of the emergency physician to feel more comfortable in an already complicated work environment. More important, a working knowledge of legal principles allows additional time during a crisis to focus on quality medicine rather than ponder legal considerations. When questions of law versus medicine conflict, it is best to consult competent legal authority. When time does not permit such access, it is imperative that proper medical care is pursued to the best ability of the physician provider. No matter what the legal outcome in a particular case, one must feel comfortable within professional practice standards and be able to live with oneself.
One of the medicolegal problems which arise in the criminalistic study of hairs is the determination of the date of its cut, which may be of importance for complementary identification when the date is known on which a suspect or a victim had his haircut for the last time before the criminal act or death occurred. The tips of 2,500 hairs were studied using scanning electronic microscopy (SEM), in which the date of the cut were known, varying between recently cut and from two months, and some from two years; those corresponding to males and females were studied independently.
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Bacterial infections are considered to be a major cause of sudden deaths. The recognition of infections caused by Neisseria meningitidis is an essential duty of medicolegal offices due to the risk of secondary cases. Since other microorganisms, such as Haemophilus influenzae and Streptococcus pneumoniae, are also involved in infectious sudden deaths, the identification of the pathogen responsible for death is essential in order to establish a positive diagnosis while also preventing secondary meningococcal cases. However, because of the unreliability of culture methods used for autopsy specimens and the fragile nature of the microorganisms, other techniques were used. In this study, the detection of specific antigens of N. meningitidis (serogroups A, B, C, Y and W135), H. influenzae type b, S. pneumoniae and Group B Streptococcus was undertaken in 40 samples from sudden death cases in legal procedures with a latex agglutination test. In addition, a meningococcus polymerase chain reaction (PCR) assay (ctrA, crgA and siaD genes) was also used as a corroboration method for positive N. meningitidis agglutinations. Eleven cases of sudden death were confirmed to be due to meningococcus while one case was confirmed to have been caused by H. influenzae type b fulminant epiglottitis. Rapid laboratory diagnosis of meningococcal infection allowed contacts management and notification to the health authorities. From the point of view of the authors, forensic diagnosis of unascertained deaths should include latex agglutination and meningococcus PCR when a fulminant infection by N. meningitidis or H. influenzae is suspected as well as in deaths where the cause is unclear.