Lester Adelson

Violent death in a metropolitan county. Changing patterns in homicide (1958-74).

Analysis of homicide patterns in Cuyahoga County, Ohio (metropolitan Cleveland), for 1958-1974 discloses the following major trends: a dramatic rise in overall homicide rates in the city (320 per cent) and suburbs (200 per cent); an increase in justifiable homicide; a doubling of the percentage of homicides incident to other felonies; a markedly increased incidence of homicide among younger persons; a conspicuous rise in firearm killings (now 81 per cent of all homicides); and a continued preponderance of intraracial homicide, with the highest rates among nonwhite males in the city. The trends in Cuyahoga County are consistent with those in other United States metropolitan counties. Homicide is responsible for a major part of the decreased life expectancy among young, urban, non-white men. The factor most consistently associated with these trends is the increased use of handguns.

Pedicide revisited. The slaughter continues

Pedicide, a reliable indicator of interpersonal violence and severe child abuse, has risen in Cuyahoga County (Metropolitan Cleveland), Ohio, U.S.A., over the past quarter of a century, paralleling or exceeding the increase in adult homicide. However, neonaticides have decreased, a phenomenon mirroring a marked fall in fatal maternal criminal abortions. As previously noted, modalities of lethal violence in pedicide are significantly determined by victim age. An increasing proportion of pedicide victims, like their adult counterparts, have been killed by firearms. Pedicide victims are much more apt to be killed by close relatives than are adult homicide victims. Similarly, perpetrators of pedicide are much more likely to commit suicide than are their adult-slaying counterparts. Fatally “battered‘’ children, the victims of multiple, metasynchronous traumata, represent a significant fraction (22%) of the overall pedicide population and constitute a segment of the victims with a potential for being saved by intervention. Overall, pedicide remains a challenge to our profession and a threat to society as a whole.

Pulmonary embolism and unexpected death in supposedly normal persons. A second look.

To determine the effect of the introduction of oral contraceptive agents on the occurrence of deaths from pulmonary embolism the cases of unexpected death due to pulmonary embolism from 1951 through July 1962 were compared with those during the years from 1963 through 1969. The medicolegal jurisdiction was Cuyahoga County Ohio. During the first 12 years of the survey 28 cases of unexpected death due to pulmonary embolism were found 10 in men and 18 in women. 5 of the women were pregnant. During the span between 1963 and 1969 there were 17 such cases 5 in men and 12 in women 2 of whom were pregnant. 1 nonpregnant woman in the second group was known to have been taking contraceptive pills at the time of her death. Whether this was true of the other women could not be ascertained. When tested by the chi square method there was no significant difference between the frequency of death from pulmonary embolism in men and nonpregnant women during either period. There was no significant difference in the death rate of nonpregnant women when the 2 periods were compared. The authors suggest that a survey of a larger geographic area might have revealed some increase in the rate of lethal pulmonary embolism. The data presented indicate that the effect of oral contraceptive therapy on the frequency of pulmonary embolism is not dramatic

A comparison of post-mortem ethanol levels obtained from blood and subdural specimens

Post-mortem subdural ethanol levels have been proposed as a useful test in certain forensic cases involving head trauma, particularly when the time interval from injury to death may have caused a lowering of the blood ethanol concentration to insignificant or undetectable levels. This study of 75 autopsied persons from whom both blood and subdural ethanol levels were obtained, shows the usefulness of the subdural ethanol level, especially where there is a prolonged or unknown post-traumatic time interval. Use of such a test is recommended in these situations.

A Suicidal Gunshot Wound of the Back

An 18-year-old woman committed suicide by shooting herself in the right temple, presternal region, and lower thoracic back. The anatomic and other investigative data on this case are reported and discussed in the perspective of our experience with suicides by firearms.

A study of racial difference, seasonal variation, and temporal variation in hip fracture-related mortality, Cuyahoga County, Ohio, 1958–1962, 1968–1972☆

Abstract Approximately 2000 hip fracture-related deaths were examined with respect to racial differences, seasonal variation of fracture occurrence, and increasing incidence. The mortalities constituted all cases of death investigated by the Cuyahoga County Coroners office during 1958–1962 and 1968–1972 in which death occurred within six months of the hip fracture. Analysis showed that blacks over 80 have rates of fracture significantly lower than their white counterparts. No significant differences existed in the lower age groups. The data failed to provide evidence in support of any significant consistent seasonal pattern or of a general increase in incidence.

The Forensic Pathologist: Family Physician to the Bereaved

THE FORENSIC pathologist occupies a unique position in the field of laboratory medicine. The major portion of his uniqueness derives from his case material and courtroom activity as he participates in the investigation and adjudication of unexpected, violent, and suspicious deaths. A rarely mentioned but important difference between him and his clinical counterpart (the hospital pathologist) resides in their relationship with and responsibility to the families and friends of the decedents who come within their purview. Hospital and Forensic Pathologist Comparisons Germane to the present discussion is the fact that the results of the hospital pathologists studies are invariably passed on only to the attending physicians. Said differently, the hospital laboratorian communicates the fruits of his professional labors solely to other professionals. It is the clinical attendant who shares relevant diagnostic or prognostic information with those who have a right to know these facts, serving as an intermediary between the

Sudden Death From Coronary Disease—the Cardiac Conundrum

Five hundred sudden deaths ascribed to coronary sclerotic heart disease after complete autopsy have been studied and analyzed. A broad range of morbid cardiovascular and anatomic changes was observed. Approximately one-third of the hearts showed “new” disease in the form of acute thrombotic coronary occlusion, acute myocardial infarct, or both. The remainder of the victims died suddenly of the chronic disease without the participation of any recent recognizable change in the heart. A physiologic mechanism based on differential myocardial oxygenation is postulated as the death factor in these instances. The frequent finding of an entirely normal myocardium with “fatal” coronary disease raises the issue of “hearts too good to die” and points up the advisability of instituting positive action to restore the heart beat.

Acute fatal intranasal narcotism: Report of two fatalities following narcotic “snorting”*†

Abstract The anatomic and toxicologic aspects of two fatalities following narcotic inhalation are described, and explanations are offered for the pathogenesis of the lethal train of events.

Justifiable Homicide: A Study of the Application of Nonculpable Deadly Force in Cuyahoga County (Cleveland), Ohio, 1958–1982

Justifiable Homicides (JHs) which occurred during a quarter century in a metropolitan community were studied with respect to four points: characteristics of the victims; type of assailants, that is, civilians or law enforcement personnel (LEP); temporal patterns; and circumstances surrounding the fatal incident. Victims were overwhelmingly “city” males age 15 and older, with higher homicide rates for nonwhite victims. The great majority of the victims were slain by solitary civilians of their same race, one fourth of whom were women. Those slain by LEP were younger, more often unmarried, and less likely to be under the influence of alcohol. Long-term temporal patterns were reflected in changing rates of homicides in general. Rates of JH were compared and contrasted with those of culpable homicide (CH). Similarities were observed between overall and age-specific rates of JH and CH. Short-term temporal patterns were indicated by the time of occurrence of the homicidal incidents. Similarities were observed between JH and CH with respect to hour of day, day of week, and month of year. Most JHs by civilians occurred during or immediately following a quarrel. The majority of JHs by LEP were in self-defense when the victims were committing a crime or resisting arrest. The percent of JH in the overall homicide toll decreased throughout the 25-year interval. Inasmuch as JH by civilians remained a relatively constant fraction of all homicides until the final years of this study, the decline in percent of JH in the overall homicide toll largely reflects decreased JH by LEP.