Charles S. Petty

Occult cervical spine injuries in fatal traffic accidents.

Post-mortem radiographs as well as careful inspection at autopsy of 100 consecutive traffic accident victims revealed an incidence of cervical spine injury of 24%. All but four of the 24 fractures and/or dislocations were localized to the level between the occiput and the axis. One half of the cases were not clinically suspected of having spine injuries before the detailed postmortem search. Seventeen of the 24 cervical spines were resected en bloc and the pathologic anatomy of the injuries was determined. The high incidence of cervical spine injuries and the anatomic findings at dissection have clinical implications for physicians who manage multiply traumatized patients. The need for immobilization and early radiographic evaluation of patients with cervical spine injuries is emphasized.

Incidence of drugs and alcohol in fatally injured motor vehicle drivers.

All motor vehicle accident fatalities occuring in Dallas County during a 1 1/2-year period were studied to determine drug usage at the time of death. Blood samples obtained at autopsy or at the time of hospital admission were analyzed for the presence of drugs and alcohol. Of the drivers, 70% were positive for alcohol or drugs. Ethyl alcohol alone was detected in 52%, drugs in 9%, and both drugs and alcohol in another 9%. Seventy-six percent of the drivers determined to be at fault in their respective accidents had alcohol or drugs detected compared to 41% for not-at-fault drivers. The minor tranquilizer diazepam accounted for over half of all positive drug findings, while barbiturates, antihistamines, methaqualone, propoxyphene, and pentazocine were each detected in more than one instance.

Sudden death caused by embolization of trophoblast from hydatidiform mole.

A 16-year-old pregnant female presented to a hospital emergency room with vaginal bleeding and uterine cramping. She underwent a hysterotomy and curettage and, during the procedure, her pulse dropped from 130 to 30 beats/minute, her pO2 fell to 10 mm of mercury, and she could not be resuscitated. At autopsy, she was found to have massive pulmonary embolization of syncytiotrophoblast from a hydatidiform mole of the uterus. This is the sixth reported case of trophoblastic embolization from a hydatidiform mole ending in death. This fatal termination may occur after a period of respiratory symptoms and may occur regardless of the mode of treatment.

Interpretation of Unusual Wounds Caused by Firearms

The interpretation of the range of fire of gunshot wounds requires coordination of information and observations from the autopsy surgeon, scene investigator, and laboratory analyst. Opinions based on incomplete information often lead to misinterpretation of the wound. The effects of interposed targets such as clothing, windows, and body parts are discussed. Case examples are given for interposed targets that cause confusing patterns and even lead to misidentification of the points of entrance and exit of the projectile in the body. The splitting of tissue in areas of bony prominence can be mistaken for evidence of discharge of a firearm at close range.

Death by Poisoning: A Ten-Year Survey of Dallas County

From 1971 through 1980, 1115 deaths were ascribed by the Dallas County Medical Examiners Office to poisoning of some type. An analysis of these deaths, with emphasis on the substances involved, is the purpose of this study. Relatively few agents or groups of agents accounted for 87% of these deaths: carbon monoxide, barbiturates, propoxyphene, narcotics, tricyclic antidepressants, ethyl alcohol, and inhalants (gases and solvents). Twenty-five percent of the deaths were classified as mixed intoxications, resulting from combinations of agents. Two major trends were observed: in the second five-year period, barbiturate-induced deaths decreased considerably (58%) and deaths from tricyclic antidepressants increased more than four times as compared with the first five-year period. Yearly statistics have been compiled for deaths from each agent.

An experimental study of powder tattooing of the skin.

Test firings were conducted on specially prepared live rabbits to determine the approximate maximum ranges at which powder tattooing occurs for different forms of gunpowder. For .38 caliber, powder tattooing from cartridges loaded with flake powder disappears at a range of 18 to 24 in. (0.4 to 0.6 m). Powder tattooing with flattened ball powder extends to 36 in. (0.9 m), while that due to ball powder extends to 48 in. (1.2m) of range. In .22 caliber, powder tattooing was observed out to 24 in. (0.6 m) with flake powder and 18 in. (0.4 m) with flattened ball. Attempts to reproduce the animal powder tattoo patterns on paper revealed that the paper patterns are consistent with skin tattoo patterns only up to 18 in (0.4 m) of range.

Fatal Iatrogenic Iodine Toxicity in a Nine-Week-Old Infant

BACKGROUNDnPovidone-iodine has been used since the 1950s for various labelled uses as a topical antiseptic. The toxicity of an excessive dose in internal use is described in this case report.nnnCASE REPORTnA 9-week old infant was treated for colic by a pediatric gastroenterologist with loperamide and the elimination of nonhuman milk. Without improvement he was hospitalized and given an enema of 50 mL of povidone-iodine diluted in 250 mL of a bowel irrigant. The enema was promptly expelled and 50 mL of the described solution was given hourly for three doses by nasogastric tube. The infant was found lifeless three hours after the last dose and resuscitation was unsuccessful. Autopsy showed a corroded and necrotic intestinal tract, serous fluid in body cavities, a blood total iodine of 14,600 micrograms/dL, protein-bound iodine of 3,400 micrograms/dL and inorganic iodine of 11,700 micrograms/dL.

ELISA HIV testing and viral culture in the screening of corneal tissue for transplant from medical examiner cases

The spread of AIDS and its association with a retrovirus, commonly called T-lymphotropic virus type III (HIV) has produced great concern among those involved in transplantation about the possibility for transmission of this disease through tissue and organ transplant. Isolation of the virus from conjunctiva and tears further heightened this concern for corneal transplants. This review of medical examiner (ME) cases, a population in which high numbers of transplant corneas are retrieved, has revealed positive serologic tests for HIV in serum from 5 cases in 205 screens. These represent potential donors based on other standard medical criteria available at the time of collection. This tissue was also submitted for viral culture, and virus was recovered from the corneal tissue in McCarey-Kaufman (MK) media. These findings and case reviews are discussed.

Gunshot wounds: visual and analytical procedures

Visual examination of clothing and tissue from gunshot wounds provides information pertaining to the range of discharge of a firearm. Identification of powder grains or soot is evidence of close range discharge by a handgun. Analyses of tissue by EDX and FAAS technics are shown to supply corroborating data to visual examination in estimation of range. These methods are of particular value in differentiating contact and distant wounds when decomposed bodies are examined and when multiple layers of clothing are present.

The Legacy of Nixon—and Quincy

Perhaps it began with Watergate: the precipitating of confidence into the abyss of disbelief. Tolerance of citizens for the small errors of their government was shattered by their realization of major deceit on the part of their highest elected official. The mood of the people affected even the medicolegal officials, both elected and appointed. Citizens and the media alike now deemed it necessary and appropriate to question the determination and decisions, the rulings and resolutions of the many questions relating to death investigation.