Patterns of violence in the Kandy area (Sri Lanka).

An analysis of 5,241 medicolegal cases (which include 744 deaths) seen in the Kandy area (Sri Lanka) by one of the authors between August 1983 and July 1989 and concerning offences against the person is presented. The incidence; times of occurrence; profile of victims (age, sex); individual versus group violence, and relationship between victim and offender revealed a pattern of violence which is as follows: a decrease in accidental deaths, a marked increase in homicides in the latter period of 1988 and through 1989 with a corresponding decrease in suicides. Grievous hurt showed a considerable increased incidence compared to non-grievous hurt with an increased trend towards voluntarily caused grievous hurt and that caused in traffic accidents. As instruments of violence, the use of blunt weapons predominated while the use of sharp weapons remained roughly unchanged throughout. There was a significant use of firearms in violence in the concluding year of the study. The pattern supports the hypothesis of a village (rural) basis for the violence.

Cellular changes and time since death.

Based on a hypothesis that post-mortem cellular (chiefly nuclear) changes in the white blood cells could reliably be correlated with the time interval since death, (ti), serial observations were made on the counts (total, differential) and light-microscopically observable 'degenerations' of white blood cells obtained from 30 non-refrigerated cadavers (experimental group) and similar cells obtained from 200 hospital patients (control group). While neutrophils degenerated rapidly, lymphocytes did so slowly; the eosinophils and monocytes degenerated at rates between these extremes. In cadaveric blood total counts of identifiable leucocytes on average dropped to zero by 84 hours, identifiable eosinophils and monocytes were first to 'disappear' (by 60 hours), followed by neutrophils (by 66 hours), and finally lymphocytes: identifiable lymphocytes disappeared completely at or around 84 hours from the time of death. This 'differential degeneration' was surprising but useful. Based on the use of all four characteristics--total and differential white cell counts, differential degeneration and morphology of cells--a method for a reasonably exact estimation of ti is presented. The method is appropriate for ti up to 84 hrs (3 1/2 days). Zero white cell counts (total, differential) and bizarre morphology (unidentifiable white blood cells) indicate a ti > 84 hrs. Avenues for further research are indicated.

Teaching of medical ethics in Sri Lanka.

Medical ethics as taught by members of the Department of Forensic Medicine in three of five medical colleges in Sri Lanka is a 'rule ethic' ('normative ethic') based on 'traditional' or 'classical' ethics. Instruction includes the teaching of moral principles, illustrated with examples. Also included are aspects concerning the functions of the Sri Lanka Medical Council. The topic is evaluated in the essay, multiple choice question and oral components of the third MBBS (Part II) examination (end of fourth year). As presently taught the syllabus is thoroughly inadequate for dealing with modern (medical) ethical issues. The shortcomings and limitations in the present programme are pointed out and requisite improvements suggested. A case is made for an eclectic view of ethics, in which a 'situation ethic' would play a part. Finally, the training of a highly moral responsible medical professional is emphasized.

General intellectual ability of university entrants in Sri Lanka.

Students are admitted to university in Sri Lanka on the basis of aggregate marks above a certain cut-off point obtained at the GCE (advanced level) examination. On this criterion and on a district-quota basis operative for the whole island, high performers are admitted to the medical faculties. Those with lower aggregate marks are admitted to the other life science faculties. High performance at the GCE (advanced level) examination is considered to reflect high general intellectual ability and vice versa. A group of students who failed to obtain university admission on their relatively poor GCE (advanced level) examination performance was used for a preliminary study. This study revealed that several students were of high general intellectual ability. A similar study carried out on groups of new entrants to the life science courses at the University of Peradeniya (which included medical students) showed that the groups did not differ significantly in general intellectual ability from the non-University group. Students of high general intellectual ability were found distributed evenly in all the groups studied.