[Self-deliverance or infanticide?]. / Selbsthilfe bei der Geburt oder Tötung des Neugeborenen?

Self-deliverance by a woman in labour is nowadays a very rare event. The authors report the case of a 24-year-old primipara and a newborn of 49 cm length and 2484 g body weight with a complex pattern of injuries on the head, neck, shoulder and back who had breathed for at least 15 to 30 minutes after birth and died from massive craniocerebral trauma and lesions in the oral and cervical region. As one of the experts considered it possible that the skull fractures were exclusively due to the self-deliverance, the woman was acquitted of the charge of manslaughter. This hypothesis is critically discussed on the basis of the presumable course of the delivery and the literature.

Unassisted childbirth or homicide--different appraisals of severe injuries in a newborn.

A case of a 24-year-old woman who gave birth to a mature newborn is reported. Many injuries at the head, neck and shoulders, back, mouth and throat which at least partly indicated unassisted childbirth were observed during autopsy. Some injuries, especially the different scull fractures were discussed controversially on trial. One expert postulated a coaction of unassisted childbirth and blunt head trauma to be responsible for the exitus. The other expert considered it possible that all injuries could originate from unassisted childbirth. The court consented to the opinion that all injuries could be the consequence of unassisted childbirth and the woman was exculpated from the accusation of manslaughter.

[Automutilation with indistinct underlying disease--difficulties of care in the community]. / Selbstverstümmelung bei unklarem Grundleiden--Schwierigkeiten der ambulanten Weiterversorgung.

INTRODUCTION: Self-mutilation is well-known in various psychiatric diseases and represents a challenge for forensic pathologists as regards the differentiation of accidental versus self-inflicted injuries, especially when a criminal charge is likely to emerge. METHOD: A case of extraordinarily severe self-inflicted injuries is presented as well as the related implications concerning clinical and ambulatory care for patients, whose underlying motivation remains unknown. RESULTS: A 60 year-old worker exhibited an open scull fracture and 14 abdominal wounds with protrusion of small intestine, from which a part of 160 cm length was completely removed beforehand. The patient claimed the wounds having been caused accidentally. When examined by a psychiatrist, disturbances in orientation, unrest and ill concentration were found, but no symptoms related to psychosis, depression or suicidal behaviour. DISCUSSION: Although the need for more detailed examination seemed to be clearly evident, the medical authorities did not take action. Consequently, no further psychiatric treatment was initiated. The implications of this case on the background of the literature are discussed.