Rib fractures in children--resuscitation or child abuse?

The autopsy reports of 233 babies and children aged between 5 days and 7 years, including 190 cases of non-traumatic and 43 cases of traumatic death, were reviewed. In 94 out of 190 cases of death due to natural causes, attempted resuscitation (closed-chest massage) was performed and only in 2 cases could fractures of the ribs localized on both sides in the midclavicular line be observed. In 15 of the 43 cases of death due to traumatic events, fractures mainly of the posterior ends of the ribs occurred. These observations support the published findings of other authors which indicate that fractures of ventral parts of the thorax can occur during resuscitation. Fractures localized in particular in dorsal parts of the chest wall of infants without metabolic bone diseases, however, must be interpreted as a strong indication of physical child abuse. It was observed that relevant injuries due to resuscitation are caused much more frequently or almost exclusively by physicians than by non-medical persons. This finding refutes any possible claims that rib fractures were caused by inexpert resuscitation in a panic-like reaction.

[Breath alcohol in relation to blood alcohol: problem with deviant values]

We report 23 cases of considerable differences of the results of breath alcohol analyses and the corresponding blood alcohol analyses observed by seven Institutes of Forensic Medicine in Germany and Austria. The usefulness of breath alcohol analysis on forensic casework at the courts will have to be evaluated on the bases of the possibility of such grave deviations.

National characteristics of dental treatment in disaster victim identification

In this age of mass tourism it is necessary to identify repeatedly a great number of casualties. In otherwise hopeless cases of identification dental alloys can be broken down by energy-dispersive X-ray microanalysis and an scanning electron microscope to furnish valuable clues as to the country of their origin.

Effects of ethyl alcohol on the electrooculogram and color vision

Color vision tests and electrooculography (EOG) were performed in 6 male and 2 female healthy young trichromatic volunteers between 60 and 130 min after finishing consumption of ethyl alcohol leading to blood levels of approximately 0.07% to 0.16%. The average number of errors in the desaturated Panel D-15 arrangement test rose from 0.86 to 2.0; the average error score in the Farnsworth-Munsell 100-Hue test rose from 26 to 79. The axis of errors in both tests was clearly tritanopic and tetartanopic, pointing to a specific effect of ethyl alcohol on the function of blue-sensitive cones and/or their interaction with longer wavelength-sensitive cones. Ethyl alcohol decreased the size of the light-peak, apparently in a dose-dependent fashion, in each of the 16 eyes by values between 3% and 79%. The effect of alcohol on the EOG light peak was stronger between 30 and 95 min (23% decrease in average) than between 95 and 130 min (14% decrease) after the finish of alcohol administration.

[Perceptual disorders of the peripheral visual field caused by alcohol. Studies with the automatic Octopus perimeter]

The present paper reports on examinations of temporal visual field perimetry with the Octopus computer-controlled automatic perimeter (Program 51). Nine subjects were tested under normal conditions and after consumption of alcohol. The Octopus represents a static examination method employing the grid perimetry principle. Under the influence of alcohol 7 subjects with blood alcohol concentrations of over 1 0/00 had visual fields which were concentrically restricted to various degrees, with relative scotomata centrally to the concentric restriction. In paired comparisons, reductions in sensitivity to light were found which were statistically highly significant. Previous investigations, conducted exclusively with kinetic perimeters, were unable to demonstrate the subjectively perceived concentric restriction of the visual field ("tunnel vision") following consumption of alcohol.

On the estimation of lay-time by measurements of rigor mortis

Measurements of the torgue to overcome rigor mortis on the legs of 101 male human cadavers at 5 degrees C are reported. There seems to exist an upper limit, which is dependent on the lay-time, above which no value occurs, but below which every value may be found. By calculating the 90% tolerance limits for lay-times grouped at 12-hourly intervals, this upper limit was found to decrease exponentially with lay-time. This may be used for the estimation of maximum lay-times from rigor mortis measurements.

[Suicide in Bavarian prisons (author's transl)]

The rate of suicides of prisoners in Bavaria from 1945-1974 was investigated. It was shown that only for prisoners awaiting trial was the rate higher than in the normal population or of soldiers of the Bundeswehr. A much higher risk of suicide was found for the first day of imprisonment. The most common method was by hanging in solitary confinement. A sure prevention by confinement with more prisoners is not possible.

[The legal status of medical students during practical training in hospitals (author's transl)]

The most important change in the qualification regulations in force at the present time is the provision for the practical training of medical students, which occurs not only in university hospitals but also in "teaching hospitals" outside the university. The realization of the practical year is problematic according to the actual conditions because of the difficulties and financial investment necessarily associated with it. Furthermore, the legal status of the students during the practical activities differes from that of earlier medical assistants, because according to the present law the legal provisions for employment and social insurance such as the determination of division of labour, working hours and remuneration and also for third party and accident insurance do not apply.

[Measurements of rigor mortis on human skeletal muscles in situ (author's transl)]

The torque, necessary to break the rigor mortis of arms and legs at 17 female and 35 male cadavers stored at a temperature of 4 degrees C was determined. The values show differences between male and female cadavers to an extent, that both groups have to be treated separately. Relating the torque to the diameter or the cross section of the limb does not eliminate the differences: Frequently considerable differences between left and right limbs were obtained, however, without preference of one side over the other. There is no direct functional relationship between post mortem time and the intensity of r.m., but the values occasionally allow estimates on the maximum time post mortem.