Muti or ritual murder.

Ritual or muti murders are a form of human sacrifice practised by some African tribes. The murder is carried out after body parts are removed while the victim is still alive. This case report describes the methods of identification of a young child who was murdered by a traditional healer (isangoma) in Cape Town, and the practice of the traditional healer.

Congenital stenotic arteriopathy with medial dysplasia of aorta, pulmonary artery, and their major branches.

This report describes the morphological findings in a young child with congenital stenotic arteriopathy who died suddenly following arteriography. Hyperplasia of all of the medial components had produced severe thickening of the wall of the aorta (mean number of lamellar units = 133 in the thoracic aorta and 125 in the abdominal aorta), the pulmonary artery, and their major proximal branches, resulting in significant luminal narrowing. Bilateral renal artery stenosis, attributable mainly to intimal longitudinal smooth muscle hyperplasia associated with fibroelastosis, was the cause of her systemic hypertension. The left ventricle showed healed subendocardial infarction.

Fatal Capnocytophaga canimorsus (DF-2) septicaemia. A case report.

A 45-year-old man died 2 months after being bitten on the hand by a dog. He developed the rare but characteristic clinical picture of fulminant septicaemia and peripheral gangrene caused by a Gram-negative bacillus, Capnocytophaga canimorsus, previously known as dysgonic fermenter type 2 (DF-2), which is an occasional commensal in the oral flora of dogs and cats. This disease must be anticipated and dog bites appropriately managed to avoid the mortality associated with infection by this micro-organism. Initial treatment includes appropriate prophylactic antibiotics and debridement, while early exchange transfusion and emergency amputation may be of value in fulminant cases.

Oesophageal mucosa in a population at risk of oesophageal cancer: post-mortem studies.

We performed post-mortem studies of oesophageal mucosa from 513 consecutive autopsies of cases who died from unnatural causes or from diseases not related to the oesophagus. Of these, 170 cases were rural blacks from endemic high-risk areas, 98 were urban blacks at high risk, 158 were coloureds at moderate risk and 87 whites at low risk for oesophageal carcinoma. Oesophagi were studied macroscopically and histologically to determine malignant and precursor lesions. A prevalence of 1.0 to 1.8% of squamous carcinoma and 7 to 7.5% of mucosal dysplasia was detected in cases older than 30 years from high-risk urban and rural population groups. These results are in accord with our previous cytological and endoscopical screening studies. No significant differences in the prevalence of oesophagitis, glycogenic acanthosis and atrophy were found in the groups studied. A study of oesophageal melanocytes showed a 3% prevalence, unrelated to dysplastic and malignant lesions, and suggested that these cells were of little if any practical significance as precursor lesions.

Poisoning with a traditional remedy containing potassium dichromate.

A fatal case of potassium dichromate ingestion is documented. A retrospective review of serum and organ levels of chromium demonstrates that charcoal haemoperfusion, peritoneal and haemodialysis are ineffective therapies for the toxin. Other treatments for this poisoning are reviewed, the poor prognosis of dichromate ingestion, and the paucity of effective therapy underlined. The application of dichromates in traditional medications is briefly discussed; this is a toxin which may be more prevalent than previously thought. It is proposed that the exposure limits of dichromate be more widely publicised.

Acute dichromate poisoning after use of traditional purgatives. A report of 7 cases.

Seven cases of dichromate poisoning after the use of purgative solutions obtained from nyanga (traditional township healers) are reported. The patients all presented in established renal failure requiring dialysis, and all had abnormal liver function tests. One patient who took dichromate orally died from massive gastro-intestinal haemorrhage. Six patients took dichromate solutions as rectal enemas, 2 were left with impaired renal function and 1 required a permanent colostomy as a result of extensive peri-anal necrosis. The clinical presentation of acute renal failure, gastro-intestinal haemorrhage and hepatocellular dysfunction should alert the physician to the possibility of dichromate poisoning. The diagnosis, management and the role of dialysis in dichromate poisoning are reviewed.

Homicide in Cape Town, South Africa.

All autopsies performed on homicide victims at the Salt River police mortuary, Cape Town, in the first 6 months of 1986 were reviewed. Most of the homicides that had occurred in Cape Town were as a result of stab wounds to the chest. Smaller, but significant, numbers of homicides were as a result of stab wounds to the head and neck, blunt injury to the head, or gunshot wounds. Homicidal burning also has occurred in civil unrest situations. Infanticide was rarely encountered. Alcohol was detected in the homicide victims in 62.9% of cases; 8.4% had a blood alcohol concentration higher than 0.30 g/100 ml. Our figures confirm that Cape Town has one of the highest homicide rates in the world (56.9/100,000 per annum for 1986). Homicides in Cape Town are characterized by assaults with sharp instruments, usually knives, although "pangas," or cane knives, are also commonly used.

Fatal head injuries in Cape Town.

Between 1 July 1983 and 30 June 1985 there were 563 cases of fatal head injuries in people over the age of 15 years recorded at the Salt River Police Mortuary, Cape Town. The demographic character of these cases was reviewed according to: (i) age, race and sex; (ii) date, day and time of injury; (iii) cause of death; and (iv) positive blood alcohol test. Assaults and transport-related accidents in association with a positive blood alcohol test in coloured males aged 40-60 years were a major characteristic.

Effect of civil unrest on the incidence of violent and non-natural deaths.

The unrest situation in South Africa since September 1984 has led to the escalation of violence and numerous incidents of confrontation between security forces and unruly crowds. The failure of routine law enforcement methods to alleviate the situation resulted in declaration of a State of Emergency in various parts of the country on 21 July 1985 and in the Western Cape area on 26 October 1985. The possible effect of civil unrest on the incidence and nature of underlying violence and crime in society leading to non-natural deaths is analysed from data for a 10-year period obtained from the official Death Register of the South African Police mortuary draining the Greater Cape Town area. Yearly and monthly trends in the incidence of non-natural deaths are also compared with those for death from natural causes. Attention is given to the incidence of homicidal sharp and blunt injuries and specifically to fatal gunshot injuries resulting from civilian shootings compared with those resulting from police or security force action. Mortality and general unrest figures associated with the situation in the Greater Cape Town area are finally compared with national figures for 1985 and the first months of 1986. Some effects of lifting of the State of Emergency in the whole country on 7 March 1986 on mortality and unrest figures are presented. In conclusions, some recommendations are made for alterations to riot control methods in an attempt to prevent or reduce fatalities.