Unexpected out-of-hospital deaths in persons aged 85 years or older: an autopsy study of 1886 patients.

Purpose: The aim of this study was to determine the causes of death in the very elderly.

Methods: We reviewed 24,081 consecutive autopsies performed over 10 years (1989 to 1998) at the Institute of Forensic Medicine, Vienna, Austria. We focused on autopsies of people aged 85 years or older who died unexpectedly out of hospital.

[Pump-gun as a weapon. Type of injuries, prohibition of weapons].

Pumpguns are shotguns with pump action whose injuries and wound mechanisms have several special features: extremely high kinetic energy of the shot (2500 to 3500 J) frequent cases of "Krönlein shots" (exenteration of the brain) punchmark/imprint immediately adjacent to the entrance wound from the front of the pipe magazine exit wounds from buckshot may be similar to pellet entrance injuries from a distant shotgun discharge the use of various shotgun cartridges (plastic ammunition, slug bullet, various lead pellets) within the same weapon. The change in the Austrian gun law and the banning of the pumpgun in 1995 is also discussed in the article.

Injuries due to letter bombs.

In Austria in late 1993 ten letter bombs were sent to outstanding persons who have been engaged in the care of foreigners. Four of these bombs detonated, when they were opened by the addressee. The remaining six bombs were discovered in time and could be deactivated by specialists.

Homicide by strangling or dumping with postmortem injuries after heroin poisoning?

During construction work, the corpse of a 33-year-old man, H.L., who had been missing for 2 years and 4 months, was found in the cellar of a house.

[Electroshock devices as weapon].

13 electric shock weapons were investigated. The authors measured the electrical output and observed the effects on corpses and test persons. The electric shock weapons produced only moderate pain and did not stop the disposing capacity.

[6 cases of premeditated murder of adults by drowning].

Premeditated murder of adults by drowning is rare and hard to investigate. Six cases are reported. If the aim of the killer is homicide by drowning to begin with (primary drowning), it is usually difficult to prove as morphological findings are missing of may be insignificant and ambiguous.

Fatal impalement injuries after falls at construction sites.

Three fatal accidents suffered by men at construction sites are reported. The victims fell from a considerable height onto metal construction rods and died from impalement injuries. The particular features of wound morphology are discussed.

'Oral hygiene'--a method of killing in a medical setting.

'Oral hygiene' is a routine nursing care procedure used in the treatment of critically ill patients. In the course of their confessions the women accused of the homicides at the Lainz Hospital in Vienna admitted having applied another form of 'oral hygiene'. About 250 ml of tap water was administered per os into the airways of severely ill and comatose patients, and death occurred about one hour later.

Assault and homicide by chop blows: a series of 11 cases.

In a series of robberies, 11 elderly women living alone were attacked by an assailant (HS) by means of chop blows directed primarily at the throat, but also at the head, neck, and thorax. 5 died of their injuries. 1 died immediately after the assault.

[Serial homicide in the Vienna-Lainz hospital].

Report on many cases of murder (the indictment included 41 cases) in the Clinical Centre of Lainz in Vienna. Two of the accused nurses were sentenced to life imprisonment, the other two to 15 and 12 years respectively. The operating modes are presented: intravenous administration of flunitrazepam, so called "oral hygiene", which proved to be forced aspiration of water, and injection of insulin.

[Death caused by hypoglycemia after starvation--pathophysiology versus morphology].

We describe a 19-year-old mentally retarded man who after severe starvation (criminally induced by his parents) presented with hypoglycemic coma and eventually experienced death. Biochemical findings and pathophysiology of starvation are discussed. The cause of death was hypoglycemia in combination with terminal infection.

[Medical and technical aspects of weapon effects on man. Part 5--Common weapons].

"Weapons at hand" are tools of everyday life, which can be used as instruments for fighting. The investigation offers a survey concerning instruments, which were actually used for conflicting bodily injuries (cases selected from 1029 expertises) or for killing (cases selected from 474 autopsies). The findings are complemented by non-medical publications about self-defence.

[Reliability of the Alco-Screen dip strips in evaluation of blood alcohol concentration for clinical or forensic studies].

We tested the accuracy of Alco-Screen dipsticks in comparison to the values of blood alcohol. The dipstick test is based on the reaction of alcohol-dehydrogenase, developing a green to blue color. Saliva as well as urine and liquor are easy to obtain at autopsies.

Shots fired with silencers--a report on four cases and experimental testing.

Four cases of homicide, in which silenced firearms were used, are reported and supplemented by data from experimental investigations regarding wound features, marks, traces, and ballistic behavior. Wound features are largely determined by the construction of the silencer. In one case, even a muzzle imprint was produced by a silenced weapon fired at contact range.

Gunshot wounds caused by Fiocchi Anticrime cartridges (plastic bullets).

The Fiocchi Anticrime cartridge (caliber 12/70) used for shotguns contains 15 plastic bullets that have a total weight (mass) of 15.2 g and feature a V4 of 302 m/s and an E4 of 694.7 J.

[Maltreatment by police officers?].

In January 1990 amnesty international stated a report concerning 128 cases of alleged torture by the police in Austria since december 1984. Our material consists of 31 cases, three case reports are given in detail. Problems of medical expertise are discussed.

[Medical and technical aspects of weapon effects. IV. Plastic bullets reduce the risk of the military assault rifle (StG 77)].

56 x 45 mm Rota-ammunition was introduced to meet the requirements of security personnel at prisons. The Austrian military assault rifle (StG 77) can be used for this ammunition. The bullet consists of an X-ray dense plastic material with a weight of 1.

[Simulation of terrorist attacks and incidents as an aid in investigating and reconstructing homicides of political significance].

The investigation of political motivated crimes and terrorist attacks requires also methods which include aspects of public relations. We present a simulation method which is useful for investigation of crimes and furthermore for giving evidence in court and also information to the public.

[Sudden death caused by anorexia nervosa].

Two cases of sudden unexpected death at home (girl 16 year-old, woman 26 year-old) are reported. Both persons suffered from anorexia nervosa. Morphological investigation revealed heart atrophy as well as atrophy of other organs (striped muscle, spleen, mammary glands, ovaries, skin).

[Physician's responsibility in blood transfusions].

Organizational and legal aspects of the blood transfusion are seen under the point of view of division of work. Interpreting the legal directions, people who are involved will be obliged to a duty of care, which is adapted to their position in the operation. A higher degree of responsibility will have to be demanded of the superior, in comparison to his subordinates.

[Unusual motor ability in gunshot injury of the heart caused by a shotgun].

In a case of shotgun-injury of the heart with complete rupture of both ventricles and lesion of the aorta the victim was able to move a few metres in approximately six seconds. Despite other opinions ability to move or act can be maintained in cases of severest injuries of the heart caused by missiles with high energy.

[Medical and technical aspects of the effect of weapons III. Black powder muzzle loading guns].

The report deals generally with ballistics and morphology of wounds caused by black powder muzzle loading guns. Two cases are reported.

[Determining gunshot distance without bullet entry--a new source of error in determining gunshot distance from point of entry].

A court case lead to a quantitative determination of lead and antimony by atomic-absorption at distances 10 to 20 cm from the bullet hole. As a surprising result at first the area-concentrations of lead and antimony increased with rising distance from the muzzle and reached a maximum, after that maximum like expected a decrease was found. The phenomena is of general interest because otherwise misinterpretations in chemical determination of gunshot firing distances would be possible.

[Forensic medicine literature databank. Goals and uses].

In addition to existing, international database systems we started building up a forensic-medical database. Whereas the current systems offer a cross section of the newest medical knowledge, we wanted to reach a review over the most important journals specialized in forensic medicine, starting from their beginning. In this way one gets informations over empirical knowledge and casuistry, which are of great importance in forensic medicine.