Homicidal intoxications by lye- and parachlorcresol-containing disinfectants.

In a nursing section for 54 senile, demented inpatients for the period of 3 months, a casual worker committed homicide in 11 cases and attempted homicide in 16 cases by peroral application of lye- and parachlorcresol-containing disinfectants. Autopsies had been performed in nearly all of the fatal cases without detection of the true causes of death. The fatal intoxications could be verified through reexamination of the lung slides and through gas chromatography/mass spectrometry of the formalin-fixed tissue specimens.

Questionable traumatic deaths and their assessment.

It is often difficult to assess cases in which the circumstances strongly indicate traumatic cause of death, while the autopsy reveals no life-threatening injuries. Such cases can be divided into three groups: 1) death explained by heart disease and emotional stress and/or physical exertion; 2) deaths by suspected traumatic vagal inhibition in which another cause of death is found or the cause of death remains obscure, sometimes depending on incomplete postmortem investigation; and 3) death established by autopsy, but difficult to ascertain if there is a connection between the cause of death and the trauma.

Small hemorrhages in the brain stem. A sign of injury?

Microscopic hemorrhages in the brain stem were studied in cases of known head injury and in cases where head injury was known not to have occurred. They were found to be either strictly limited to the perivascular space or to extend into the neuropil. Those limited to the perivascular space appear to be artifacts and should not be considered when determining the cause of death. Extravasations of red cells into the neuropil may be of traumatic genesis. Such hemorrhages may be absent, however, in cases of a fatal primary brain-stem injury.

[Trauma to the cervical spine (author's transl)]. / Trauma der Halswirbelsäule.

Thirty-five occupants fatally injured (despite the use of seat belts) in head-on collisions suffered severe injuries to the craniocervical junction (ring fractures of the base of the skull, fractures of the upper cervical vertebrae, or disruptions between the cervical vertebrae) if there was extensive trauma against the head or if submarining under shoulder belts took place. If three-point belts were used, few or no neck injuries were observed if there was only a slight impact between the head and some part of the car, and there was no instability of the cervical spine due to pathologic changes.

Spinal injuries in belt-wearing car occupants killed by head-on collisions.

In 34 post-mortem examinations of car occupants wearing seat belts and killed in straight or oblique head-on collisions, a thorough investigation of the spine was performed. The autopsy results were correlated with the findings in the cars in order to reconstruct the events when the occupant's body struck the interior of the car. In 2 cases the victims had worn lap belts, in 15 cases shoulder belts and in 17 cases combined shoulder-lap belts (three-point belts). In victims involved in head-on collisions while wearing lap belts, fractures of the neural arch of the axis were found which were probably due to flexion of the neck pivoting round the lower part of the impacting face and simultaneous stretching of the neck. Severe injuries to the cervical spine in those victims wearing shoulder belts were mainly due to the occupant sliding under the belt which then caught the neck and mandible. Such injuries were also caused by the impact of the head against forward parts of the car. In those wearing shoulder-lap belts injuries to the upper part of the cervical spine resulted from the impact of the head against internal parts of the car. When a slight impact of the head occurred minor injuries to the lower cervical spine were seen. Injuries to the thoracolumbar spine in the cases examined were the consequence of a violent extension between the upper part of the trunk held back by the shoulder belt and the pelvis restrained by the lap belt or by the knees striking the fascia panel. In front seat occupants this extension can be increased if either rear seat occupants without belts or heavy objects on the rear seat are projected forwards against their backs.

Influence of post mortem changes on experimental safety belt injuries.

Belt protected car occupants involved on head-on collisions do not seem to suffer as severe injuries as unembalmed cadavers subjected to comparable simulated head-on collisions. Therefore it has been questioned if cadavers constitute adequate test specimens for study of thoracic tolerances. This investigation compares injuries in safety belt wearing living and dead pigs which have been subjected to simulated head-on collisions on an acceleration tract. Tests were performed on all 20 pigs (10 living and 10 dead). The arterial side of the circulatory system of the dead pigs was infused. The force in the safety belts, the intraaortic pressure, the impact velocity and the deceleration of the sled were recorded. The tests were high speed filmed. Post mortem examination of the pigs revealed differences in injury severity. Dead pigs more easily suffered rib fractures. Deformation of the rib cage due to stripping of the periosteum and laceration of surrounding tissue occurred mainly in the dead pigs. Laceration of intrathoracic blood vessels was seen in dead pigs while isolated heart lesions were seen only in living animals. The main cause of these differences in tolerance level seems to be post mortem changes of the mechanical properties of the different tissues. The results are valid for pigs but indicate that great care has to be exercised when results obtained from cadaver experiments are evaluated concerning thoracic tolerance.

Rotational cerebral injuries near the superior margin of the brain.

Traumatic lesions near the superior margin of the brain frequently are caused by an anterior or posterior blow to the head. The injuries consist of disruptions of one or a few (with subdural bleeding) or of numerous or all (with instant death or immediate unconsciousness and later death because of simultaneous brain stem injuries) parasagittal bridging veins. Cerebral injuries close beneath the superior margin of the brain occur either alone or together with disruptions of parasagittal bridging veins. These injuries consist mainly of subcortical, perivascular or larger, hemorrhages and of injuries to the white matter. No extensive complete necrosis occurs. The lesions are most frequently found in the posterior part of the superior frontal gyrus and the central gyri and often are combined with brain stem injuries. By reconstruction of trauma events the injuries seem to be caused by a rotational acceleration of the head. By model experiments and simulations it is shown that a rotational acceleration of the skull leads to an "inner deformation" of the brain tissue. This deformation may be the explanation of the subcortical injuries, which are therefore designated rotational cerebral injuries (RC-injuries).

Injury patterns in traffic accidents and suggested preventive measures.

A short survey is given of the main patterns of injuries sustained in traffic accidents. The following injuries are accounted for: ruptures of the parasagittal bridging veins and gliding contusions of the brain, axis fractures, and aortic and pelvic injuries.