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In clinical practice diagnoses can be found which are partially based on body measurements. By measuring body height and body weight the patient is categorised, for example by Body-Mass Index (BMI), in different adipose grades. Different diseases are associated with specific biometric parameters. Abdominal adiposity measured by waist circumference correlates with the risk of colon carcinoma and is one diagnostic criteria of the metabolic syndrome. An unhealthy waist-hip ratio (WHR) can cause a higher risk of a cardiovascular disease and dementia. By combining body measurement with cause of death found during the medicolegal autopsy, clinical relevant correlations can be uncovered. Research in medical databases (e.g. PubMed) was carried out to find studies showing possible associations between body measurements, their indices and morbidity or causes of death. This article is a selective survey of these published studies, current guidelines and the German Institute for Standardisation - Norm (DIN-Norm). We give a wide thematic overview and select relevant parameters, which should be taken during medico-legal autopsies in future. The ascertainment of those parameters and their adjustment with the findings of the medico-legal autopsies can be a key to finding predictors of history of disease and relevant morbidity risks in the institutes of forensic medicine. Such findings are very important in the assessment of risk for living patients and necessary preventive actions. Beside the measurement of waist and hip circumference mentioned in specific clinical guidelines in Germany, we suggest, after analysing the parameters, to measure the thickness of the subcutaneous fat on the anterior chest and the thigh circumference as well.

A careful investigation of fatal accidents is required due to the relevant financial consequences for the insured as well as for the insurance company. An evaluation of post-mortem cases handled by our institute from 1988 to 1998 showed that 16% of all fatal accidents were not initially classified as such; it was only possible to determine the cause by post-mortem and criminal investigation. The frequency of a relevant alcoholization varied with different types of accidents. Furthermore, of all fatal accidents, 3% were revealed to be deceptive. Those 42 cases in total, presenting themselves as fatal accidents at first glance, were later determined either to be natural deaths (n = 27), homicide (n = 11) or suicide (n = 4). In addition to this, autopsies showed 83 cases of death to be sequelae to accidents. Particularly in cases of a victim plunging out of the window or into water, it can be difficult to make the distinction between natural death--e.g. as a reason for falling--and suicide or homicide. Further difficulties can result from interpretations of the findings in cases of putrefaction, mauling by animals, defects caused by burning or severely deformed corpses. In these cases, the importance of patho-morphological findings from the autopsy must be emphasized. Indirect sequelae of accidents may be pulmonary embolism or pneumonia. The cause of death has to be classified as accidental if the chain of events is of traumatic origin. Mistakes can be avoided if the medical history is taken conscientiously. If no facts are available, the cause of death should be certificated as undetermined. Our evaluation only included autopsy cases from our institute. The concealed fatal accidents which were incorrectly certified as natural deaths or the cases dismissed by the police and the public prosecutor without performing an autopsy were not evaluated.

Gunshot residues on the hand are an important evidence of shooting. Different methods for sampling gunshot residues from the hands are presented and critically analyzed. The topographic methods-adhesive film and polyvinyl alcohol technique (PVAL)-have serious advantages over the cumulative methods like tape-lift or cotton swab. Case examples demonstrate the limited interpretation of results with cumulative methods. Negative results of tape-lifts or cotton swabs can also be explained by the presence of blood or dirt, positive results however don't prove shooting. The sampling method with the highest gain of gunshot residues is the PVAL technique which takes about 2 hours of sampling traces. Therefore PVAL is mostly applied post mortem. PVAL shows the distribution of gunshot residues also on bloody hands and is a powerful instrument for the reconstruction of the firing position. But the final differentiation between homicide, suicide or accident is not only based on gunshot residues, but requires a complex analysis of all findings in a case (scene, blood traces, autopsy, shot range).

Criterias for the differentiation between hunting accidents and suicides are explained and discussed. A thorough investigation of this kind should always include autopsy, examination of the firearm, determination of the shooting distance and examination of the scene including an effort to reconstruct the events. Typical findings in suicides are contact shots, entrance wounds of the head, chest or upper abdomen, downward trajectories and evidence (gunshot residue, backspatter) suggesting a hand had been used to steady the muzzle. Typical findings in hunting accidents are entrance wounds of the extremities, the lower abdomen or the back, worn out or defective safety devices, upward trajectories and trajectories that are incompatible with possible and intended positions of the firearm. Each case has to be examined individually and the findings should be interpreted as an entity.

Upon the discovery of two deceased persons in close proximity within a short period of time, a death by other than natural causes is first assumed, and only after the elimination of such a cause of death through police investigations as well as an autopsy can a death by natural causes be assumed. The existence of two different natural causes of death in close proximity within a short period of time is extremely rare. In the subject of our autopsy we made two such observations within a short period of time which are presented as casuistry.

In 16,216 autopsies 381 cases (2.35%) of pulmonary embolism were found to be the immediate cause of death. 53.8% of the cases were due to natural reasons and 44.6% were due to violence (preferably accidents followed by immobilisation). 149 persons died within the first three weeks of illness. In 63 cases the source of embolism could not be found. The frequency of pulmonary embolism in this study complies with other extensive researches. The practical and legal relevance of death caused by pulmonary embolism (kind of death, cause, sudden death, statistics of mortality, certainty of the diagnosis, medical postmortem examination, order of autopsy) are discussed.

By means of a retrospective study with an analysis of the data of 12,743 postmortem examinations over a period of 10 years 630 autopsy cases have been ascertained which had a connection to an insurer. Considerable differences in the reaction and behaviour in the event of damage have been found between public and private insurers. In the course of preliminary investigations by professional/trade associations or pension offices in general an immediate and consistent reaction for this group of insured persons--which has been recorded "purely accidentally"--is to be observed through initiating or analysing of postmortem investigations. Quite in contrast to these findings private insurers to only a small percentage made use of their contractual possibilities of a postmortem control and--if at all--mostly delayed, especially in those cases where the costs of such an investigation were to be debited to the insurer's account. In most cases private insurers made use of the results of postmortems by scientific organisations, courts or professional associations. According to the results of an examination following the rules of forensic medicine of postmortem findings an insurance contract conditions, in more than 50 p. c. of the cases the medical preconditions for the performance of the insurance contract had to be denied. A critical comment should follow: in quite a number of undisclosed cases a regulation of accident and life insurance claims is carried through in which unfounded decisions are taken without any postmortem controls.

The clinical autopsy serves the purpose of identifying the underlying disease as well as the immediate cause of death. It is the major instrument of quality control in the field of medical diagnosis and treatment. In addition, autopsies are of great importance with regard to the epidemiology of diseases, to the identification of hitherto unknown disease entities and to modified clinical courses of well-known disorders. Moreover, clinical autopsies have a significant impact on the medical education of students as well as of physicians. The description of the conditions permitting autopsies in the Federal Republic of Germany is followed by a review of the rules governing autopsy practice in the european countries. It is emphasized that the clinical autopsy and its practice should be regulated by a codified law. This law, however, should ensure that the autopsy's objectives may be realized and may indeed contribute to the well-being of the population, to the expansion of scientific knowledge and to the further development of the health care system.

Neither death-certificate nor inquest-certificate clearly state whether the coroner made his entry after having established the facts himself or after having considered speculations or statements made by other persons. For this reason they are without any probative value for criminal cases as well as civil lawsuits but also for underwriters. Completely unintelligible is the fact that the entries concerning the kind of death and the cause of death on the inquest-certificate as it is being issued now, serve as the basis for the cause-of-death-statistics which are of great socio-political importance.

39 deaths, in which medical malpractice was suspected and forensic autopsy therefore was carried through, were examinated. Among 22 cases with manifest malpractice not sufficient diagnosis, not adequate anamnesis and mistakes related with surgical treatment are dominant. If any deciding factors refer to medical malpractice, a specialists opinion of the respective discipline should be taken together with medicolegal opinion. In such cases it proved to be useful, when medicolegal expert has a coordinating function.