Fatal accidental asphyxia in a jack-knife position.

Accidental death from postural or positional asphyxia takes place when the abnormal position of the victim's body compromises the process of respiration. Diagnosis is largely made by circumstantial evidence supported by absence of any other significant pathology or trauma explaining death. This case report is about a 50-year-old male who had been drinking the previous night and was found dead in the morning inside a tire repair shop. His jack-knifed body had been encompassed, buttocks-down, within the hollow core made by 3 big tires stacked on top of each other. The author was called to the scene of death and had hands-on encounter with the body in-situ where scene photographs were taken. Apart from a blood alcohol of 290 mg/100 ml, marked congestion of the face, petechial hemorrhages on the conjunctivae and lung edema and congestion, autopsy findings were unremarkable. Abrasions on shoulders, lateral aspects of arms and posterior aspects of lower legs indicated friction with internal rims of tires while slipping down. There were no other injuries or pathology to account for his death. Death was determined to be due to accidental postural asphyxia secondary to intoxication by alcohol.

Accidental fatal asphyxiation by sand inhalation.

A 36 year old laborer was pronounced dead by the casualty doctor on arrival to the hospital. To avoid blame, witnesses and fellow workers fabricated a scenario that resulted in the doctor certify death as due to myocardial infarction. The body was then taken to the mortuary of the Department of Forensic Medicine as a routine procedure to furnish a medico-legal report, which is a pre-requisite for bodies to be taken out of the country. No external injuries were found by the authors who noted deposition of sand all over the clothed body of the deceased. Some sand was also seen inside eyes, mouth and external ear canals. X-ray examination showed radio-opacities in pharynx, larynx, trachea, bronchi and esophagus. The forensic medical examiners (authors) requested permission for autopsy from the director of public prosecution. Autopsy demonstrated that death was due to asphyxiation due to inhalation and swallowing of sand. Consequent on the opinion of the forensic medical examiners the police opened an inquiry. It was established that the deceased was accidentally buried alive when a wheeled loading shovel emptied its load of sand over him at a construction site. The initial misdiagnosis was attributed to failure of the hospital doctor to realize the significance of the presence of sand in exposed orifices. The false account of the circumstances of death had also contributed to that misdiagnosis.

Accidental fatal inhalation of sulfuric acid fumes.

A man found dead with circumstantial evidence indicating exposure to sulfuric acid vapor. He had been applying a solution of concentrated sulfuric acid to a drain pipe in an attempt to clear a blockage. External examination showed moderate corrosive damage around his mouth and nose, on his forearms and tips of fingers of his left hand. Autopsy revealed congestion of the respiratory passages, as well as severe pulmonary edema. Traces of acid and sulfate compounds were chemically detected in his upper respiratory passages. Death was attributed to accidental inhalation of fumes of strong sulfuric acid during application to blocked drainpipes.

Distribution of dimethoate in the body after a fatal organophosphate intoxication.

Many organophosphate pesticides (OPs) such as dimethoate are used to eradicate household pests, and those occurring in agriculture and forestry sectors. Combinations of two or more different insecticides have been manufactured to increase their effectiveness. A case of death is presented as suspected organophosphates intoxication. Autopsy was unremarkable except for grayish fluid in the stomach, with garlicky odor. A systematic toxicological analysis on post-mortem specimens revealed high concentrations of dimethoate in blood 38 microg/mL, urine 0.47 microg/mL, brain 2.2 microg/g, myocardial muscle 7.6 microg/g, liver 4.6 microg/g, lung 7.6 microg/g, skeletal muscle 21 microg/g, kidney 55 microg/g and gall bladder 31 microg/g. Blood alcohol was 2.85 g/L, cyclohexanone and cyclohexanol were also detected in the blood but not quantified. The cause of death was determined as organophosphate intoxication.

Masking and bondage in suicidal hanging: a case report.

The body of a 35-year-old man was found hanging in a relatively isolated place outdoors. A vest was wrapped over his head, neck and lower part of the face. The hands were loosely tied in front of the body. The vest was tucked between the neck and the ligature, to act as a pad. Thorough scene examination and post-mortem examination excluded any evidence of foul play. Although bondage is usually associated with autoerotic practices in asphyxiation deaths, it was established that this case was a suicide. DNA was used as a supportive measure to determine that the handkerchief and vest belonged to the deceased.

Sexual crimes: different perspectives.

In this paper an attempt has been made to emphasize certain facts pertinent to countries in which the legal definition of sexual crimes includes consented heterosexual relations between unmarried adults (fornication). Relevant Articles of one such statute, namely the Libyan penal code, have been cited and discussed. Within that legal definition the presentation of the involved parties would obviously differ from the usual presentation in the Western world where the presence of a victim is almost always essential. Delayed presentation, being the rule rather than the exception, sometimes leaves the examiner no choice but to reflect on clinical examination alone. Although important clues may be obtained, especially from examining the hymen of the alleged virgins, it should only be considered with caution. Without the support of laboratory evidence, the forensic medical examiner's opinion is neither complete nor infallible. Making careful inferences based solely on the morphology of the hymen is sometimes essential, but excessive speculations without discernible grounds should not be a basis for a medico-legal opinion. Guidelines to that effect are also included for the forensic medical examiner to consider.

Homicide by strychnine poisoning.

Homicide by strychnine has become very rare during the last decades. Its bitter taste and the violent mode of death commonly aroused suspicion of poisoning and this, together with its ease of chemical detection, deterred criminals from using it. We present the case of an elderly woman who arrived at the hospital casualty department in extremis and with severe convulsions. Her death was certified nevertheless as due to natural causes and she was buried without the death being reported to the Director of Public Prosecutions. It was not until a month later that investigation led to the exhumation of the body. Biological samples were found to contain strychnine sulphate. The perpetrator was charged and later confessed.

Sleeping foetus?--Medicolegal consideration of an incredibly prolonged gestational period.

In Libya, sexual intercourse between an unmarried couple is unlawful even if it was consensual. The defendant in this case pleaded not guilty to the charge despite the fact that she delivered a baby 29 months after divorce. She imputed paternity of the child to her ex-husband, who denied the allegation on the grounds of the extremely long gestational period. Her claim was that the baby was conceived three months prior to divorce, but had ceased to grow for some time. Her plea was based on the widely accepted notion amongst lay people, the so-called 'sleeping foetus'. Following the medical opinion, the court dismissed the plea and the woman was convicted of unlawful sexual intercourse.

An objective study of two medicolegal Systems--Libyan and British.

This work presents important information about the medicolegal systems in two different countries through the author's personal experience during his work. In Libya, the Medicolegal Centres, attached to the Justice Department, receives all cases referred by the Director of Public Prosecution or by the Judge. These constitute a wide range of cases which include in descending order of frequency, age estimation, injuries, autopsies, sexual offences, criminal responsibility, medical mishaps, disputed paternity and nullity of marriage. In Scotland, the Department of Forensic Medicine and Science at the University of Glasgow receive only a proportion of the total number of cases investigated by the Procurator Fiscal in Glasgow. These are exclusively deaths that require medicolegal autopsies, which average 458 per year. The medicolegal Centre in Benghazi receives all referrals from the courts, which average 1780 cases per year, but autopsies constitute only 14.4% (256 cases per year). A total of 1144 autopsies performed in Glasgow during a period of 2.5 years, and 7121 medicolegal cases investigated in Benghazi during a period of 4 years (1022 of that were autopsies), are presented in 12 tables and duly discussed. The outstanding observation is the marked male preponderance in deaths from unnatural causes in Benghazi, (80% of the total), compared to less marked male preponderance in Glasgow, (60% of the total). This is explained by the fact that due to social custom in Libya, females have limited outdoor activities and lead a rather domestic life compared to females in Britain.