[Fatal incidences during arrest of highly agitated persons]. / Tödliche Zwischenfälle bei der Festnahme höchstgradig erregter Personen.

We report on four cases of sudden circulatory arrest during the physical restraint of extremely excited and repugnant men by the police. Three persons died, and one became apallic. The excited states resulted from acute schizophrenic disorder in one case, from intoxications (ethanol and drugs including cocaine respectively) in two others, and from encephalitis in the fourth case. In only one case one of the police officers was condemned for involuntary mansloughter, responsability was excluded in the remainder. Similar lethal events in "excited delirium" are given in the American literature, the main etiologic factors being acute psychosis and cocaine intoxication. Most of these events occurred, differing from ours, under "hogtying" which is a technique of physical restraint in a prone position with the wrists and ankles bound behind the back. These events are thought to be cardiac in origin and to result from oxygen-consuming motor hyperactivity, excessive catecholamine release, and impaired breathing. Police officers are recommended to restrict all measures of restraint to a mininum in extremely excited persons, and to avoid any compression of the trunk or neck. A continuous monitoring for vital signs is postulated in order to recognize a medical incident as quick as possible.

Insulin- or morphine-injection? Immunohistochemical contribution to the elucidation of a case.

Two autopsy cases of an elderly couple who died on the same day will be used to underline the importance of immunohistochemistry of forensic practice. At first unexplainable injection marks on the upper arms of the corpses and the possibility of a closely related physician injecting insulin and certifying a natural death made it important, considering suspect insulin concentrations in the blood, to exclude insulin injections in these marks. Further, the statement that morphine had been injected for the analgesia of tumour pains, was reinforced by immunohistochemistry.

[Criteria for evaluating free will in suicide]. / Kriterien zur Beurteilung der freien Willensbestimmung beim Suizid.

Site-related categories of suicide enable certain characteristics to be worked out which speak both for, as well as against, a voluntary decision, and can generally be viewed as indicative. However, taking other site-unrelated factors into account, there are necessarily differences which can only be conditional to the particular case in question.

[Severity of injury of alcohol intoxicated pedestrians in street traffic]. / Zur Verletzungsschwere des im Strassenverkehr getöteten alkoholisierten Fussgängers.

The evaluation of 251 autopsy cases of pedestrians who suffered fatal accidents in road traffic documents that the influence of alcohol entails an additional risk of injury for pedestrians in motor car accidents. In particular, severe trauma to the head, thorax and abdomen occur, whilst injuries to the pelvis and limbs are generally not more serious than in sober pedestrians. In the classical collision constellation of the pedestrian at the front end of cars, the upper part of the body is evidently especially endangered in the further movement phase. This phenomenon might be connected above all with the impairment of the voluntary reaction capacity due to alcohol during the sequence of evidents in the accident.

[Urinary alcohol content/blood alcohol content quotient with reference to bladder filling]. / UAK-/BAK-Quotient unter Berücksichtigung der Harnblasenfüllung.

The blood alcohol concentration, the urinary alcohol content and the urinary volume were determined in 245 autopsy cases. Irrespective of the bladder filling, a large variation of the UAC/BAC ratios could be detected in BAC values of up to about 1 g/kg. The ratios were very much more stable at higher blood alcohol concentrations, but showed a certain dependence on the degree of bladder filling. With the increase of urinary volumes, the mean ratio rose. Provided that blood alcohol concentrations were in excess of 1 g/kg, the UAC/BAC ratio was 1.3 at a volume of less than 5 ml, about 1.4 at up to 100 ml, between 1.4 and 1.5 up to 200 ml and about 1.5 with a volume in excess of 200 ml. The differences can be explained by the real-life conditions with regard to drinking behavior and micturition. Accordingly, the urinary volume is also to be taken into consideration for practical purposes.

[Comparative studies of the degree of trauma and cause of death in male and female traffic accident victims]. / Vergleichende Untersuchungen über den Traumatisierungs-grad und die Todesursache bei männlichen und weiblichen Verkehrsunfallopfern.

Comparison with regard to the degree of injury, the survival time and the cause of death in 318 male subjects killed as pedestrians in road traffic as compared to 220 female accident casualties revealed appreciable sex-specific differences in some cases. The injuries suffered were less serious in relative terms in the women. Traumatizations of the ISS classes 10 to 20 and 20 to 30 were most prominent (about 20% in each case). In men, deaths predominated at ISS 75 with 30% to 40%. About 40% of the men died of a craniocerebral trauma, between 15% and 20% of a multiple or trunk trauma, just under 10% of pneumonia and between 5% and 10% of embolism or shock. In women, fatal craniocerebral trauma was very much rarer (26%), whereas secondary causes of death were present in more than 40%. In particular, the raised risk of embolism is to be emphasized (18% as compared to 7%). The results can be interpreted in the following terms, namely that women are more gravely endangered quod vitam in the presence of comparable accident injuries.

[Age-dependent injury tolerance exemplified by fatal pedestrian accidents]. / Altersabhängige Verletzungstoleranz am Beispiel tödlicher Fussgängerunfälle.

The evaluation of forensic autopsy material from pedestrian accident casualties comprising more than 500 cases confirms that the tolerance of injuries greatly depends on age. Slightly to moderately severe injured persons with ISS values under 30 have a very much lower risk of death from comparable traumatizations in the third and fourth decade of life as compared to children and above all compared to elderly persons. In the case of 20 to 30 year olds, only just under 10% with such accident injuries die as compared to the percentage of deaths in infants is almost 30% and more than 50% in casualties over 70 years old. Longer survival times determine the fatal course. In casualties under 50 years old, the rate of complications (10%-15%) is relatively low, whereas it is about 40% in those over 50 years old. Embolism, pneumonia and protracted shock are at the forefront. The relative intolerance of injuries in elderly traffic accident casualties is essentially due to secondary complications.

[Errors and hazards: fatalities through sternal puncture]. / Fehler und Gefahren: Todesfälle durch Sternalpunktion.

Iatrogenic cardiac injury due to diagnostic sternal puncture occurred in 5 patients, 2 women and 3 men, aged 14 to 37 years. Four cases ended fataly but 1 patient survived after immediate thoracotomy and suture of the damaged heart. Perforation of the anterior wall of the right ventricle resulting in pericardial tamponade was present in all patients. All fatalities resulted in conviction, under criminal law, of the clinician who carried out the puncture (Paragraph 222 StGB--causing death through negligence).