Search

Purpose: The aim of this study was to determine the causes of death in the very elderly., Methods: We reviewed 24,081 consecutive autopsies performed over 10 years (1989 to 1998) at the Institute of Forensic Medicine, Vienna, Austria. We focused on autopsies of people aged 85 years or older who died unexpectedly out of hospital., Results: The mean age of the 1886 patients (561 men and 1325 women) at the time of death was 88 +/- 3 years (range, 85 to 108 years). Thirty-one percent (n = 588) of those who died were described as having been previously healthy. Cardiovascular disease was the most common cause of death (n = 1465 [77%]). Thirteen percent (n = 246) died of respiratory illness, 5% (n = 94) of gastrointestinal disorders, and 3% (n = 53) of diseases of the central nervous system. Genitourinary and metabolic diseases were uncommon., Conclusion: Although this out-of-hospital sample is not representative of the entire elderly population, postmortem examinations emphasize the importance of cardiovascular diseases in causing unexpected deaths in older persons., (Copyright 2003 by Excerpta Medica Inc.)

Pumpguns are shotguns with pump action whose injuries and wound mechanisms have several special features: extremely high kinetic energy of the shot (2500 to 3500 J) frequent cases of "Krönlein shots" (exenteration of the brain) punchmark/imprint immediately adjacent to the entrance wound from the front of the pipe magazine exit wounds from buckshot may be similar to pellet entrance injuries from a distant shotgun discharge the use of various shotgun cartridges (plastic ammunition, slug bullet, various lead pellets) within the same weapon. The change in the Austrian gun law and the banning of the pumpgun in 1995 is also discussed in the article.

13 electric shock weapons were investigated. The authors measured the electrical output and observed the effects on corpses and test persons. The electric shock weapons produced only moderate pain and did not stop the disposing capacity. The electrocardiogram and the circulation parameters were not influenced. The electric shock weapons tested might have only a limited deterrent effect and might be able to cause fatal complications under circumstances. Drug use and heart disease might enhance the risk.

Premeditated murder of adults by drowning is rare and hard to investigate. Six cases are reported. If the aim of the killer is homicide by drowning to begin with (primary drowning), it is usually difficult to prove as morphological findings are missing of may be insignificant and ambiguous. If, on the other hand, the killer opts for drowning only as a conclusion to a primarily differently planned assault (e.g. strangling), the finding patterns are different, and their interpretation is usually easier (secondary drowning).

'Oral hygiene' is a routine nursing care procedure used in the treatment of critically ill patients. In the course of their confessions the women accused of the homicides at the Lainz Hospital in Vienna admitted having applied another form of 'oral hygiene'. About 250 ml of tap water was administered per os into the airways of severely ill and comatose patients, and death occurred about one hour later. Pathophysiological investigations have shown that this procedure is a suitable method of killing comatose patients with pulmonary impairment. Possible findings and the problems of detection on the corpse are discussed.

Report on many cases of murder (the indictment included 41 cases) in the Clinical Centre of Lainz in Vienna. Two of the accused nurses were sentenced to life imprisonment, the other two to 15 and 12 years respectively. The operating modes are presented: intravenous administration of flunitrazepam, so called "oral hygiene", which proved to be forced aspiration of water, and injection of insulin. Possibilities of preventive measures against murder in hospital are discussed.

"Weapons at hand" are tools of everyday life, which can be used as instruments for fighting. The investigation offers a survey concerning instruments, which were actually used for conflicting bodily injuries (cases selected from 1029 expertises) or for killing (cases selected from 474 autopsies). The findings are complemented by non-medical publications about self-defence. In the Austrian legal system the use of "weapons at hand" is interpreted like weapons in the technical sense.

We tested the accuracy of Alco-Screen dipsticks in comparison to the values of blood alcohol. The dipstick test is based on the reaction of alcohol-dehydrogenase, developing a green to blue color. Saliva as well as urine and liquor are easy to obtain at autopsies. We did not get any false-negative results. Interpretation of the change of color turned out to be a problem, because the tip appeared often to be inhomogenous. The dipstick could be used at autopsies and for emergency units, if a quick, semiquantitative result is required.

We describe a 19-year-old mentally retarded man who after severe starvation (criminally induced by his parents) presented with hypoglycemic coma and eventually experienced death. Biochemical findings and pathophysiology of starvation are discussed. The cause of death was hypoglycemia in combination with terminal infection. The importance of structural-functional conclusions and considerations for determination of the manner and cause of death is demonstrated.

The investigation of political motivated crimes and terrorist attacks requires also methods which include aspects of public relations. We present a simulation method which is useful for investigation of crimes and furthermore for giving evidence in court and also information to the public.

In January 1990 amnesty international stated a report concerning 128 cases of alleged torture by the police in Austria since december 1984. Our material consists of 31 cases, three case reports are given in detail. Problems of medical expertise are discussed. It may be difficult to rule out injuries which are caused by accident or self inflicted. Some methods of torture (certain kinds of asphyxia for example) may be impossible to trace.

Organizational and legal aspects of the blood transfusion are seen under the point of view of division of work. Interpreting the legal directions, people who are involved will be obliged to a duty of care, which is adapted to their position in the operation. A higher degree of responsibility will have to be demanded of the superior, in comparison to his subordinates.

56 x 45 mm Rota-ammunition was introduced to meet the requirements of security personnel at prisons. The Austrian military assault rifle (StG 77) can be used for this ammunition. The bullet consists of an X-ray dense plastic material with a weight of 1.6 g. Therefore the kinetic energy of this projectile is lower than that of the standard ammunition, also on its flight it loses velocity at a higher rate. Thus, this bullet has the advantage of being less dangerous over long distances (500 m versus 2500 m or more) but still offers at short distances (fe 10 m) a reasonable capacity of incapacitation. Tests concerning ballistics, penetration and shooting at gelatine and soap targets were performed. By means of these tests we compared the wounding capacity of the standard ammunition (5.56 x 45 mm S-cartridge) and the investigated Rota-ammunition.

Two cases of sudden unexpected death at home (girl 16 year-old, woman 26 year-old) are reported. Both persons suffered from anorexia nervosa. Morphological investigation revealed heart atrophy as well as atrophy of other organs (striped muscle, spleen, mammary glands, ovaries, skin). Also lipofuscin accumulation (myocardium, liver, spleen) was noted. Especially conspicuous was serous (gelatinous) atrophy of fatty tissue. Anorexia nervosa is a common psychiatric disorder, therefore legal consequences--especially treatment without patient's consent--have to be considered. The legal situation in Austria is discussed. Concerning the 16 year-old girl the authors think that medical malpractice and carelessness of the parents were involved.

In a case of shotgun-injury of the heart with complete rupture of both ventricles and lesion of the aorta the victim was able to move a few metres in approximately six seconds. Despite other opinions ability to move or act can be maintained in cases of severest injuries of the heart caused by missiles with high energy.

By means of continuous wave doppler the effect of two choke holds (Carotid sleeper, Nami-juji-jime) on the carotid and vertebral arteries was investigated. For both choke holds, which are characterized by pressure on lateral parts of the neck, we found an obstruction up to a complete stop of flow. The degree of obstruction depended on the direction of force. The vertebral artery can be compressed between the subclavian artery and the foramina transversaria, therefore it was most effective to press on the lower neck. Tensing the neck muscles can reduce the effect of choking.

In addition to existing, international database systems we started building up a forensic-medical database. Whereas the current systems offer a cross section of the newest medical knowledge, we wanted to reach a review over the most important journals specialized in forensic medicine, starting from their beginning. In this way one gets informations over empirical knowledge and casuistry, which are of great importance in forensic medicine. As technical basis we use a personal computer and the dBase III database system.

A court case lead to a quantitative determination of lead and antimony by atomic-absorption at distances 10 to 20 cm from the bullet hole. As a surprising result at first the area-concentrations of lead and antimony increased with rising distance from the muzzle and reached a maximum, after that maximum like expected a decrease was found. The phenomena is of general interest because otherwise misinterpretations in chemical determination of gunshot firing distances would be possible.

The report deals generally with ballistics and morphology of wounds caused by black powder muzzle loading guns. Two cases are reported.

Passive euthanasia, but also active indirect euthanasia is under observation of some assumptions in Austrian law unpunished. To find the dogmatic arguments to exclude any liability there are several ways. The preference is given to that ways, which are paraphrased by positive law. Possible abuse of euthanasia should lead to a permanent discussion including other branches of science.