A retrospective review of fatal electrocution cases at Tygerberg Forensic Pathology Services, Cape Town, South Africa, over the 5-year period 1 January 2008 - 31 December 2012.

BACKGROUND: Electrocution as a cause of death has been discussed extensively in the international literature. However, research on this topic in South Africa (SA) is scarce. OBJECTIVES: To address the need for further research in this field and emphasise the necessity for preventive measures by determining the demographic and pathological profile of fatal electrocution cases seen in the Tygerberg Forensic Pathology Services, Western Cape Province, SA. METHODS: The study was a retrospective and descriptive case series of all the cases of death secondary to electrocution referred to the study facility from 1 January 2008 to 31 December 2012. RESULTS: A total of 39 cases were included. Ten victims (25.6%) were aged <13 years. The geographical area most affected by electrocution deaths was the informal settlement Khayelitsha (56.4% of cases). The primary injuries described were mainly burn wounds (34 cases, 87.2%) and abrasions (4 cases, 10.3%). Most injuries were to the upper limbs. Unfortunately, the results pertaining specifically to the pathology of electrical burn wounds were inconclusive. CONCLUSIONS: In view of discrepancies found in the reporting of electrical burn wounds, a standardised system for classifying these wounds is suggested. Although electrocution-related mortality is not a leading cause of death in high-prevalence areas, awareness should be raised.

The medico-legal investigation of sudden, unexpected and/or unexplained infant deaths in South Africa: where are we--and where are we going?

Sudden Infant Death Syndrome (SIDS) has been reported to be the leading cause of death in infants under 1 year of age in many countries. Unfortunately, a paucity of published research data exists in South Africa, with regard to the incidence of and investigation into the circumstances surrounding Sudden Unexplained Deaths in Infants (SUDI) and/or SIDS. Currently, even though most academic centers conform to a protocol consistent with internationally accepted standards, there exists no nationally accepted infant death investigation protocol in South Africa. It is the aim of this study to review the current practice of infant death investigation in two representative but geographically and demographically distinct centers. Retrospective case audit over a five-year period (2000-2004) was conducted at two large medico-legal mortuaries in Pretoria (Gauteng) and Tygerberg (Cape Town). Case files on all infants younger than 1 year of age were reviewed. The outcome measures included number of deaths, demographic details and the nature and final outcome of the post mortem examinations. A total of 512 cases were identified as possible SIDS cases and of these, 171 was classified as SIDS. The study showed marked inter-case and inter-divisional variation in terms of the investigation of infant deaths at the two institutions. It is envisaged that this study will focus attention on the current lack of usable data regarding sudden/unexplained/unexpected infant deaths in South Africa, and aid in the formulation and implementation of a practical (yet internationally accountable) infant death investigation protocol, which could facilitate comparisons with other countries and initiate further structured research in this field.

Forensic pathology--a different perspective: investigative medicolegal systems in the United States.

The author's experience and impressions of the proceedings of the Office of the Medical Examiner, Cook County, Chicago, Illinois, United States of America are discussed. This experience demonstrates the limitations of the South African medicolegal system, particularly its lack of credibility among the greater proportion of the community. The medical examiner's office in the United States, being independent, enjoys credibility and the confidence of the community at large and of the courts, without alienating the police or other law enforcement agencies. These organizations feature in the medical examiner system by courtesy of the chief medical examiner. In the United States two types of investigative medicolegal systems coexist, sometimes in the same state or adjacent country: the coroner system (unlike the English coroner system) and the medical examiner system. Of the two, the coroner system is the older, is not always headed by a medically trained person, and is a political appointment. This system has been accused of lacking autonomy and scientific objectivity.