E. Koops

Autopsy features relevant for discrimination between suicidal and homicidal gunshot injuries

Abstract. A total of 624 consecutive gunshot autopsies from the Institutes of Legal Medicine in Münster and Hamburg was investigated retrospectively. In a subsample of 284 suicides and 293 homicides (n=577), a large variety of features such as firearm, ammunition, number and site of entrance wounds, shooting distance and direction of the internal bullet path were recorded and binary logistic regression analysis performed in the case of bullet paths. Females constituted 26.3% of the homicide victims and 10.6% of the suicides. Short-barrelled firearms outnumbered long arms in homicides by 6:1 and in suicides by 2:1. More than 1 gunshot injury was found in 5.6% of the suicides (maximum 5 gunshots) and in 53.9% of the homicides (maximum 23 gunshots). The suicidal gunshots were fired from contact or near contact range in 89% while this was the case in only 7.5% of the homicides. The typical entrance wound sites in suicides were the temple (36%), mouth (20%), forehead (11%) and left chest (15%) but uncommon entrance wound sites such as the eye, ear, and back of the neck and head were also encountered. In suicidal gunshots to the right temple (n=107), only 6% of the bullet paths were directed downwards and only 4% were directed from back-to-front. In gunshots to the left chest (n=130), bullet paths running right-to-left or parallel occurred frequently in suicides (75%) and infrequently in homicide victims (19%). From 61 suicides who fired the gun inside their mouth, only 1 pointed the gun downwards. Consequently, some bullet path directions cannot be considered indicative of suicide: downwards and back-to-front in gunshots to the temple, left-to-right in gunshots to the left chest and downwards in mouth shots. The isolated autopsy findings can only be indicative of suicide or homicide but the combined analysis of several findings can be associated with a high probability.

Skin and soft tissue artifacts due to postmortem damage caused by rodents.

Five cases of postmortem bite-injuries inflicted by rodents are presented (five males between 41 and 89 years; three cases caused by mice, one case by rats, one case of possible mixed rodent activity by rats and mice). The study presents a spectrum of phenomenological aspects of postmortem artifacts due to rodent activity to fresh skin and soft tissue: the majority of the injuries have a circular appearance. The wound margins are finely serrated with irregular edges and circumscribed 1-2 mm intervals within, partly showing protruding indentations up to 5 mm. Distinct parallel cutaneous lacerations deriving from the biting action of the upper and lower pairs of the rodents incisors are diagnostic for tooth marks of rodent origin but cannot always be found. No claw-induced damage can be found in the skin beyond the wound margins. Areas involved in the present study were: exposed and unprotected parts of the body, such as eyelids, nose and mouth (representing moist parts of the face); and the back of the hands. Postmortem rodent activity may occasionally be expected on clothed and therefore protected parts of the body. The phenomenon of postmortem rodent activity to human bodies can be found indoors especially under circumstances of low socioeconomic settings; outdoors this finding is particularly observed among fatalities among homeless people.

Proof of air embolism after exhumation

Abstract The detection, storage, and analysis of gas taken from the heart ventricle is necessary to diagnose a fatal air embolism and this requires special precautions during autopsy. When the results of gas analysis correspond to the criteria defined by Pierucci and Gherson [1] the diagnosis “air embolism” is justified. In cases showing putrefaction the diagnostic value of gas analysis was negated [2]. In a series of 15 patients who were assumed to have been killed by air injection in a peripheral vein the corpses were exhumed and a full medico-legal examination was carried out including gas analysis. In 8 cases results could be obtained indicating a mixture of embolised air and gases of putrefaction. In two control groups comprising 10 exhumed bodies and 30 cases showing advanced putrefaction, gas analysis showed putrefaction gases except in 5 cases with gas volumes less than 5 ml in the right ventricle. Therefore gas analysis can be helpful to diagnose fatal air embolism even in cases showing putrefaction while the diagnosis of putrefaction gases only does not exclude this diagnosis.

Halskompression und arterielle Obstruktion

SummaryLiterature dealing with the obstruction of neck arteries induced by strangulation is referred to. Two types of strangulation are applied to ten human corpses, i.e., hanging and strangulation by ligature. The neck arteries are isolated at their origins from the thoracic vessels. After removal of the brain the arterial openings at the skull base are observed of their flow through. Tap water is perfused through the vessels under four pressures, i.e., 100, 200, 300, and 170 mm Hg. By using strangulation tools of three different diameters, various strangulation experiments are performed under controlled conditions imitating strangulation by ligature as well as atypical hanging. The most relevant results were:(1)In strangulation by ligature with the rope running horizontally round the neck it is possible to bring about obstruction to the carotid arteries by the same forces as in experimental hanging. Depending on the tool and on the arterial pressure, these forces vary between 2.5 and 10 kg. There are relations between the necessary forces, the diameter of the strangulation tools and the arterial pressures. Even by applying tractive forces in the range between 30–40 kg or by enhancing with a manual draw we did not succeed in bringing about an obstruction of the vertebral arteries. With the rope running obliquely round the neck as it does in typical hanging it is possible by minor tensile forces (between 8 and 17 kg) to obstruct these vessels as well.(2)In experimental hanging using a typical position of the tool, obstructions of all arteries occur between 5 and 15 kg. In types of hanging with an anterior suspension point above the level of the chin it was possible to occlude at least two vessels by application of intermediate forces.(3)In strangulation by ligature, the site of the appliance seems to have some influence. Infralaryngeal strangulation need somewhat greater tensile forces than a supralaryngeal course of the rope.(4)An additional longitudinal extension of the neck (maximal 80 kg) does not influence the obstruction forces in horizontal strangulation. Extreme bending of the neck does not impede the free passage of water, whereas with rotation and lateral flexion there could very well result obstructions of the arterial passage of the neck if physiological move of the head is reached or slightly overstepped.Some individual parameters of the corpses used (neck girth, rigor mortis, arteriosclerosis) did not have any influence on the powers obstructive to the carotid arteries.ZusammenfassungDie Literatur über die Behinderung der arteriellen Kopfdurchblutung bei Strangulation wird referiert. In eigenen Experimenten werden die isolierten Halsarterien von zehn Leichen unter verschiedenen Drucken perfundiert. Die experimentelle Strangulation erfolgt mit verschiedenen Strangwerkzeugen und in unterschiedlicher Lokalisation. Dabei werden die zum Gefäßverschluß erforderlichen Kräfte bestimmt. Weiterhin werden verschiedene atypische supracervicale Erhängungsformen simuliert und der Einfluß verschiedener Kopfhaltungen untersucht.Die wesentlichen Ergebnisse sind:(1)Bei horizontaler Drosselung gelingt es unter Anwendung der gleichen Zugkräfte wie beim Erhängen, die Carotiden zu verschließen. Es bestehen direkte Beziehungen zwischen Strangwerkzeugdurchmesser, intraarteriellem Druck und zum Verschluß erforderlichem Kraftaufwand. Es gelingt auch mit mehr als 40 kg Zugkraft nicht, die Vertebralarterien zu verschließen. Bei schräger Drosselung dagegen erfolgt der Verschluß beider Gefäßgruppen mit den gleichen Kräften wie bei typischer Stranglage beim Erhängen.(2)Bei den Experimenten mit supracervicaler Stranglage gelingt auch bei kleinem oder mittlerem Kraftaufwand der Verschluß zumindest von zwei Gefäßen. Diese experimentellen Ergebnisse entsprechen denen Rauschkes (1957).(3)Auch eine maximale Halsextension (80 kg) ist ohne Einfluß auf die bei horizontaler Drosselung ermittelten Werte. Extreme Beugung allein ist nicht geeignet, einen Durchblutungsstopp zu verursachen, während bei Rotation und Lateralflexion sehr wohl Behinderungen der arteriellen Kopfdurchblutung bei Überschreiten der physiologischen Kopfhaltung erfolgen. Individuelle Parameter wie Halsumfang, Arteriosklerose und Leichenstarre sind ohne erkennbaren Einfluß auf die zum Verschluß der Carotiden erforderlichen Kräfte.Die Literatur uber die Behinderung der arteriellen Kopfdurchblutung bei Strangulation wird referiert. In eigenen Experimenten werden die isolierten Halsarterien von zehn Leichen unter verschiedenen Drucken perfundiert. Die experimentelle Strangulation erfolgt mit verschiedenen Strangwerkzeugen und in unterschiedlicher Lokalisation. Dabei werden die zum Gefasverschlus erforderlichen Krafte bestimmt. Weiterhin werden verschiedene atypische supracervicale Erhangungsformen simuliert und der Einflus verschiedener Kopfhaltungen untersucht. Die wesentlichen Ergebnisse sind: Individuelle Parameter wie Halsumfang, Arteriosklerose und Leichenstarre sind ohne erkennbaren Einflus auf die zum Verschlus der Carotiden erforderlichen Krafte.

Red Cell Enzyme Polymorphisms in a Northern German Population

From a random northern German sample, gene frequencies of five red cell enzyme polymorphisms are calculated. For acid phosphatase (n = 7,059) the gene frequencies are estimated to be: pa =

Fatal aviation accidents in Lower Saxony from 1979 to 1996

So far no national or regional studies have been published in Germany regarding the number of fatal aviation accidents and results of autopsy findings. Therefore, we evaluated all fatal aviation accidents occurring in Lower Saxony from 1979 to 1996. A total of 96 aviation accidents occurred in this period involving 73 aeroplanes. The crashes resulted in the death of 154 people ranging in age from 19 to 68 years. The greatest number of victims in a single crash of an aircraft was (n=7). Other types of fatal accidents were crashes of aircraft and helicopter while on the ground (n=5), hot-air balloons (n=2), parachutes (n=10), hang glider accidents (n=5) and the striking of a bystander by a model airplane. Autopsies were performed on 68 of the 154 victims (44.2%), including 39 of the 73 pilots (53.4%). Some of the autopsies yielded findings relevant to the cause of the accident: gunshot wounds, the presence of alcohol or drugs in blood and preexisting diseases. Our findings emphasize the need for autopsy on all aviation accident victims, especially pilots, as this is the only reliable method to uncover all factors contributing to an accident.

Bakterielle Meningitis als Ursache des plötzlichen Todes – Phänomenologie, Histomorphologie und Erregerspektrum

Unter den im Zeitraum von 1992–1999 am Institut für Rechtsmedizin der Universität Hamburg durchgeführten 8305 gerichtlichen und wissenschaftlichen Obduktionen fanden sich 20 Fälle (männliches Geschlecht n = 10, Durchschnittsalter 49,2 Jahre; weiblich n = 10, Durchschnittsalter 53,4 Jahre) erst autoptisch diagnostizierter bakterieller Meningitiden. Dies entspricht einer Häufigkeit von 0,23% im untersuchten Sektionsgut. In 8 Fällen befanden sich die Verstorbenen kurz vor dem Tode wegen unklarer Beschwerden in ärztlicher Behandlung, in 10 Fällen konnte der Verlauf retrospektiv als perakut eingeordnet werden. Erkrankte im Alter < 40 Jahre verstarben weit häufiger im Krankenhaus als Erkrankte des Alters > 60 Jahre, die überwiegend zu Hause verstarben. Erkrankte im Alter zwischen 40 und 60 Jahren zeigten signifikant häufiger Kopfschmerzen und Unwohlsein als initiale Symptome als Erkrankte mit einem Alter von < 40 Jahren und > 60 Jahren. Ein postmortaler Erregernachweis von Abstrichen der Leptomeninx gelang in 12 von 14 diesbezüglich untersuchten Fällen (Streptococcus pneumoniaen = 8; Neisseria meningitidis, Kapseltyp C n = 2; Staphylococcus aureusn = 1; Streptococcus pyogenesn = 1). Häufigste autoptisch festgestellte Begleiterkrankungen waren eitrige Tracheobronchitis, Pneumonie und eitrige Sinusitis, wobei eine definitive Feststellung der Eintrittspforte der Erreger am Autopsiematerial in der Regel nicht möglich ist. Histomorphologisch dominierte der Typ der Haubenmeningitis mit vorwiegend gemischtzelliger Entzündungsreaktion. Bei der forensischen Beurteilung von Meningitistodesfällen kann neben der Verkennung der Erkrankung vor dem Hintergrund evtl. unzureichender ärztlicher Diagnostik insbesondere der Prognose in Abhängigkeit vom Zeitpunkt der korrekten Diagnosestellung unter straf- und zivilrechtlichen Aspekten Bedeutung zukommen. Auch wirft die Anamnese eines vorausgegangenen Schädel-Hirn-Traumas aus rechtsmedizinischer Sicht Fragen hinsichtlich des Kausalzusammenhangs auf.Between 1992 and 1999, 20 cases of a previously undiagnosed meningitis (10 males, mean age 49.2 years; 10 females, mean age 53.4 years) out of a total of 8305 autopsies were identified, corresponding to a frequency of 0.23% in the reviewed autopsy material. In 8 cases, the deceased seeked medical advice shortly before death due to unspecific complaints. In 10 cases, a peracute course of the disease was considered retrospectively. Affected persons under 40 years of age frequently died in hospital whereas persons over 60 years of age died more often in their domestic environment. At the onset of symptoms, persons between 40 and 60 years of age complained of headaches and indisposition significantly more often than persons under 40 years or over 60 years of age. Postmortem swabs of the leptomeninx resulted in cultural growth of pathogenetic germs in 12 out of 14 cases examined (Streptococcus pneumoniaen = 8; Neisseria meningitidis (capsular type C) n = 2; Staphylococcus aureusn = 1; Streptococcus pyogenesn = 1). Most frequent concomitant diseases diagnosed at autopsy were acute tracheobronchitis, pneumonia and purulent sinusitis but in general a definitive identification of the entry site of bacteria is not possible postmortem. Histomorphologically, the predominant type was tegmental meningitis with a mixed polymorphonuclear cell infiltrate. In the forensic elucidation of fatalities due to meningitis, questions concerning medical malpractice can be raised (e. g. misdiagnosis, late diagnosis). In cases with preceding craniocerebral trauma, the forensic expert is confronted with the question of causality between trauma and death.

Investigations on the decay of acid phosphatase types in stored blood stains and blood samples

SummaryA method is given for determining red cell acid phosphatase types in stored blood stains and blood samples. The time limits for determination in stored blood stains (20–25° C) vary from 6–8 weeks. In stored blood samples (4° C) the periods for determination were found to be approximately 15 months. The devised method has some advantages compared with conventional methods.ZusammenfassungEs wird eine Methode beschrieben für den Nachweis der Typen der sauren Erythrocytenphosphatase aus gelagerten Blutspuren und Blutproben. Die Grenzen des zeitlichen Nachweises aus gelagerten Blutspuren (20–25° C) variieren — je nach Spurenträger — zwischen 6–8 Wochen. Aus gelagerten Blutproben (4° C) ließen sich die Typen noch nach 15 Monaten nachweisen. Hinsichtlich der erforderlichen Spurenmenge und der zeitlichen Nachweisgrenzen ist die gewählte Methode vorteilhafter als die bisher angewendeten Techniken.

Zur Abblassung der Livores unter definierten Druckbedingungen

SummaryIn 28 cases of sudden death, the corpses were tested for the effect of different storage temperatures (5°C, 14°–15°C, 25°C) regarding the reaction of livor mortis to known pressure conditions (force and duration of pressure). The reaction is dependent on the storage temperature but there is no linear relationship. At certain storage temperatures the postmortem lividity reaction is dependent on the amount and duration of the pressure. In addition, at defined storage temperature and pressure conditions, there are large interindividual differences in the estimation of time of death.ZusammenfassungAn 28 Leichen, ausschließlich plötzlichen Todesfällen, wurde die Wegdrückbarkeit der Totenflecke unter definierten Druckbedingungen (Druckamplitude, Druckdauer) bei unterschiedlicher Lagerungstemperatur (5°C, 14–15°C, 25°C) überprüft.Die Wegdrückbarkeit der Totenflecke ist entscheidend von der Lagerungstemperatur abhängig. Dabei besteht keine lineare Charakteristik.Bei bestimmter Lagerungstemperatur ist die Wegdrückbarkeit von Prüfdruck und Druckdauer abhängig. Auch bei definierten Druckbedingungen und Berücksichtigung der Lagerungstemperatur ergeben sich große interindividuelle Variationen der Todeszeitabhängigkeit.

Vitale Reaktionen bei akutem Verbrühungstod

SummaryAfter a boiler explosion on a ship 12 men with cutaneous scalding of 90–100% of body surface were found dead. 15 other fatalities occured after different intervals. This investigation deals with the histomorphologic changes in those 12 cases of instantaneous death. The most important findings consisted of:1.Thermal injuries of the skin with multiple subcutaneous and corial bubbles, intravascular heat coagulation, and edema in the transitional zone to the undamaged submucosa.2.Coagulation necrosis of the tracheal and bronchial wall extending to alveolar ducts in central parts of the lung. Marked congestion and edema in the deeper layers of the mucosa. Hemorrhagic alveolar and interstitial edema of the lung. Striking congestion of the pleura parietalis saving up the recessus diaphragmaticus.3.Acute nephron-nephrosis and periglomerular microangiopathy. Interstitial edema of the myocardium, degeneration of myofibrils. Acute vacuolar degeneration and swelling of hepatocytes. Phagocytosis of detritus by the RHS.4.Swelling of endothelium and edema of the vascular walls. Intravascular fragments of erythrocytes, platelet aggregation and fibrin thrombi. The fatal cours in these cases is considered to be due to a fulminant shock syndrome.ZusammenfassungNach einer Dampfkesselexplosion in einem Schiffsneubau starben insgesamt 27 Arbeiter. 12 Opfer wurden bereits tot aus dem Kesselraum geborgen. Sie wiesen Verbrühungen der Körperoberfläche von 90–100% auf.Die vorliegende Untersuchung konzentrierte sich auf die Histomorphologie bei den sofort Verstorbenen. Die wichtigsten Befunde waren:1.Sämtliche Grade der thermischen Hautschädigung mit multiplen corialen und subcutanen Hitzeblasen, Hitzethrombosierung der Gefäßinhalte; beginnendes Ödem am Übergang zur morphologisch intakten Haut.2.Thermische Atemwegsläsionen bis in die subpleuralen Bronchialbaumverzweigungen mit Epithelzellquellung, thermischer Koagulationsnekrose der oberen Schleimhautschicht, reaktiver Schleimhauthyperämie und reaktivem Schleimhautödem. Besonders in den zentralen Lungenarealen massives intraalveoläres und interstitielles hämorrhagisches Ödem. Fehlende pulmonale Fettembolie. Auffällige Gefäßinjektion der Pleura parietalis mit Ausnahme des Recessus diaphragmaticus.3.Akute Tubulo-Glomerulonephrose mit periglomerulärer Mikroangiopathie. Interstitielles Ödem des Myocards, akute Herzmuskelfaserdegeneration. Akute vakuolige Hepatocytendegeneration. RHS-Zellaktivierung.4.Gefäßwandquellungen, Gefäßwandödem, Endothelzellquellungen. Gefäßinhaltsveränderungen mit disseminierten oder aggregierten Anreicherungen von fragmentierten Erythrocyten und gemischten Mikrothromben unterschiedlicher Zusammensetzung. Als Todesursache ist bei den akuten Todesfällen nach dem pathohistologischen Organstatus ein foudroyantes Schockgeschehen anzusehen.