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The paper presents selected evident opinionating errors committed by experts in the field of forensic medicine who issued medico-legal opinions in criminal cases, aiming at determining causes of death. The authors analyze the causes of such errors and possibilities of avoiding them, as well as the impact of the said errors on the course of criminal proceedings and the legal position of the suspects or victims. The report emphasizes the potential effect of these opinions on the fate of individuals who have been found suspected or guilty based on such opinions should they be accepted by the court without verification by summoning another expert.

In cases of post-mortem dismemberment, the main medicolegal task apart from the identification and assignment of body parts to one or several individuals is the determination of the cause of death and the course of events. Notably in cases of offensive postmortem dismemberment, the medicolegal findings on the victim may be of special importance also for the psychiatric evaluation of the suspect. In a case of offensive post-mortem dismemberment, parts of the body were found in a stone quarry and in the apartment where the victim and the suspect had lived together. Since the suspect refused to make a statement, the medicolegal findings were of great relevance for the psychiatric evaluation. In the first trial, in which the psychiatric expert was not present when the forensic pathologist gave his opinion, the Regional Court acquitted the suspect of murder and committed him to a psychiatric hospital. The accused successfully appealed on points of law, as the form and content of the psychiatric expert opinion did not comply with the requirements of procedural law and the forensic psychiatric state of the art. In a second trial, additional psychiatric experts were summoned. In that hearing, the task of the medicolegal expert was to reconstruct the course of events as far as possible to create a reliable basis for the psychiatric evaluation, as the suspect refused to make a statement both with regard to his personal circumstances and the facts of the case and did not agree to a psychiatric exploration either. The motivational and morphological criteria of the medicolegal classification as offensive post-mortem dismemberment with a cannibalistic background are discussed. In addition, some issues to be answered such as the detection of bloodstains on nonporous surfaces by means of leucocrystalviolet and the time of heat exposure of burned body parts are dealt with.

The majority of experts in the field of forensic medicine maintain that the minutes of the medicolegal autopsy should be taken by the forensic pathologist. The authors argue that it is the public prosecutor who is obliged to draw up the minutes, whereas the forensic pathologist issues the expert opinion. To support their stance, the authors make frequent references to several provisions of the Criminal Procedure Code of 1997. The authors also imply that due to organizational reasons and the ratio legis of the aforementioned code, the forensic pathologist should not be assigned the role of the minutes-taker, despite the lack of a specific exclusion rule governing such a case. Possible consequences caused by the lack of the properly drawn up minutes are briefly discussed as well.

In Germany, approximately 8 million people suffer from diabetes mellitus, of which over 90% have type 2 diabetes. Worldwide, there are around 246 million people with diabetes mellitus. As diabetes is often symptomless for a long time, around 2.5% of the population have diabetes without knowing it. Diabetic coma is a life-threatening complication, which affects up to 1.2% of all diabetics annually and is associated with a mortality rate of 20-25%. Since in 25% of patients the diabetic coma is the first manifestation of the disease, a valid post-mortem biochemical method for the diagnosis of the metabolic crisis is very important. The article presents cases from the authors' own autopsy material showing that the analysis of the vitreous humour is indispensable for the reconstruction of the events leading to death even in cases in which the cause of death is seemingly clear.

Pursuant to Section 78 German Criminal Code, criminal offences under Section 220a (genocide) and Section 211 (murder) are not subject to a statute of limitations. To the extent that prosecution is subject to a statute of limitations, the period of limitation is thirty years in the case of acts punishable by imprisonment for life. After the expiration of the period of limitation, evidence and investigation records relevant for the offence may no longer be available. Once a homicide is statute-barred, main proceedings may be opened only, if the elements of murder are present. The problems arising from the statute of limitations are discussed on the basis of a case on which the author had to give an export opinion. The homicide was committed in Amsterdam in 1967. In 2004, after the period of limitation had expired in The Netherlands and--as far as manslaughter is concerned, also in the Federal Republic of Germany--a meanwhile 60-year-old man accused himself of having committed the offence (manual strangulation of a tied male). After the expiration of the statute of limitations the results of the police investigations and the autopsy report were no longer available. How the offence might have been committed and whether the elements of murder were present therefore had to be discussed on the basis of still available photographs of the crime scene and the victim. After studying these pieces of evidence, the criminal court decided that the accused had actually committed a voluntary homicide, but that it was no longer ascertainable, if the elements of murder were fulfilled. The issues relevant to legal medicine are presented against the background of the problems associated with the statute of limitations.

The underground hard coal-mining sector demonstrates one of the highest rates of fatal accidents, in spite of a decline in coal-mining over the last few years. Post-accidental investigations, including forensic medical expertise, continue to present a significant problem. The objective of the research was to evaluate the role, tasks and usefulness of medico-legal determinations in post-accidental procedures in traumatic deaths in hard coal-mining industry. The study was carried out retrospectively by investigating files and autopsy reports, with attention focusing on the scope of necessary activities and medico-legal examinations in order to determine the cause and manner of death, and on identification of fatalities, especially in the cases of collective occupational accidents. Complex medico-legal determinations (identification, autopsy), supplemented by additional investigations (toxicology, histopathology and hemogenetics) provide a valuable source of evidence for legal authorities and post-accidental commissions. Mutual cooperation of the experts representing various branches of science is the basis of executing appropriate procedures after a traumatic death in the coal mine.

Section 87 subs. 2 of the German Code of Criminal Procedure stipulates that a forensic or court-ordered autopsy shall be performed by two physicians. One of them must be a "forensic medical officer" (in German "Gerichtsarzt") or the head of a public forensic or pathology institute or a physician of such an institute entrusted with this task and having specialist knowledge of forensic medicine. Recently, it has been suggested to amend Section 87 subs. 2 StPO to the effect that self-employed specialists in forensic medicine can also be entrusted with court-ordered autopsies. The authors object to such privatization of forensic autopsies for legal and factual reasons and recommend to keep the present regulation according to which one of the physicians conducting the autopsy is not only required to have the necessary professional qualification, but must also hold a public position as defined in the law.

Self-deliverance by a woman in labour is nowadays a very rare event. The authors report the case of a 24-year-old primipara and a newborn of 49 cm length and 2484 g body weight with a complex pattern of injuries on the head, neck, shoulder and back who had breathed for at least 15 to 30 minutes after birth and died from massive craniocerebral trauma and lesions in the oral and cervical region. As one of the experts considered it possible that the skull fractures were exclusively due to the self-deliverance, the woman was acquitted of the charge of manslaughter. This hypothesis is critically discussed on the basis of the presumable course of the delivery and the literature.

The examination of a deceased person is an important duty for physicians. It comprises the certification of death, the certification of the identity of the deceased, a thorough examination of the body, an estimation of the moment of death and ends with the decision, if death was caused by a certain or possible violent cause in which case it must be reported to the authorities. Problems and pitfalls are discussed on the basis of practical case presentations.

A coroner's inquest is the most likely court a district nurse is going to be required to attend during the course of their career. Courts and inquests remain shrouded in the rituals and traditions of the legal system and appearing at an inquest can be a daunting experience. It is important that district nurses are aware of the role and function of an inquest including, the types of death that require an inquest, the conduct of an inquest and the role of witnesses before and during the inquest. In this way you will be better prepared to fulfil your role as a witness and contribute effectively to the coronial process.

Objective: To analyze cause of medical accidents and actuality of technical identification in medical tangle., Methods: 32 cases (17 death, 15 survive) of medical tangle by technical identification (according to sex, age, mostly diseases, sequel) and identified results (whether or not mistake, cause and effect connection, duty degree) have been studied., Results: 13 cases of 32 medical accidents have been determined.19 cases have been attributed to no medical accidents. Causes of medical accidents were most due to negligence of sense of duty., Conclusion: The incidence rate of medical accidents can be decreased by strengthen colligated stuff of medical affairs personnal. We suggest that our state bring out more perfect legislation of autopsy in order to gain positive effect of technical identification in medical tangle. The medical mistake among grade of medical accidents should be added so that justice of identification could be improved.

Autopsies from 34 fatalities in nursing homes covering a 10-year period (1991-2000) were retrospectively analyzed with regard to criminal investigative issues, causes of death and relevance of the forensic medical findings for the outcome of the criminal investigations. The material consisted of 22 females and 12 males, with the ages ranging from 62 to 102. The allegations to be investigated comprised wrongful death, improper nursing, medical maltreatment, suspicion of poisoning and the causal relationship between falls and the occurrence of death. The manner of death, respectively cause of death encountered included 21 deaths from natural cause (coronary insufficiency, pneumonia), 9 accidental deaths (hypothermia, choking, scalding burns and injuries due to fall) and 4 cases which remained undetermined. In 30 out of 34 cases, the cause of death was unequivocally established. In every case, the medicolegal investigation provided adequate evidence for the legal assessment. Of particular significance was the exclusion of a causal relationship between falls and the occurrence of death. Without exception, all investigations failed to uncover criminal causes for death in this sample.

The retrospective analysis of the autopsy records of 50 homicides showed that the Injury Severity Score (ISS), a numerical scoring system initially developed to quantify the severity of injuries sustained in road traffic accidents, can also be useful for objectively describing and ranking the overall severity of trauma with regard to forensic issues. The present case report illustrates to what extent the ISS can help to assess the contribution of each assailant in homicides committed by several perpetrators. In the case presented the court was convinced that one perpetrator had inflicted four deep stab wounds to the victim's face (each with bony lesions), 2 stabs to the chest piercing the right lower pulmonary lobe and causing a haemothorax of 200 ml, an abdominal stab wound without involvement of a parenchymatous organ as well as multiple defence wounds of the arms. Thereafter, a second perpetrator was thought to have inflicted several heavy blows with a full water bottle causing severe contusions on the right side of the forehead, the chin, the left side of the face and a spider's web fracture of the frontal bone. Using the ISS an injury severity score of 24 was assigned to the first complex of injuries and a score of 10 to the second complex. The forensic conclusions with regard to prognosis and lethal outcome are discussed.

Virtually all forensic experts deal not only with criminal, suspicious, accidental and suicidal deaths, but are also confronted with a wide range of deaths where a significant natural element is revealed at autopsy. The assaulted victim that dies suddenly or unexpectedly from a stroke during or immediately succeeding the receipt of some non-fatal injuries, or otherwise suffers a clinically unexplained death, can pose far greater difficulties over causation than a gun-shot or a stabbing. This paper presents an analysis of the problem and an approach for determining the cause of death in cases of concurrent trauma with heart disease, and in cases with a substantial natural element of disease but exclusion of trauma. Relevant cases with history, autopsy findings, histopathological findings and toxicological findings are presented in order to illustrate the issue from a practical angle.

3 fatalities shortly after discharge from police custody are reported. Case 1: A 55-year old alcoholic was discharged from police custody after taking a blood sample under violent conditions and found dead in his flat 2 days later. Cause of death: arrhythmia due to acute coronary insufficiency or alcoholic cardiomyopathy. Case 2: A 27-year-old alcoholic was met highly intoxicated twice in the course of one day, was put in the family's care and was found dead the next morning. Cause of death: alcohol/drug intoxication with agonal aspiration. Case 3: A 32-year-old man known to be prone to seizures and to become aggressive under the influence of alcohol was left by the police in medical care confined to a litter in a "hog-tied" fashion with the help of 3 belts. Cause of death: cerebral hypoxia after respiratory and cardiac arrest of unknown reason. A causal relationship with positional restraint is discussed. The cases reported underline the duty of the police to examine prior to discharge from custody with the appropriate lot of care whether the person held in custody has recovered from the helpless state due to disease, injury or intoxication or if medical treatment is required.

Using the example of a recent case, we examine the possibilities of trace analysis and fire protection techniques in the investigation of fire deaths. The effective cooperation between forensic pathologists and fire inspectors is presented and we discuss the mathematical-physical uses of fire simulation calculations. We review the trace analysis results and discuss the variety of technical possibilities of modern engineering techniques for fire protection.

If the order to carry out an autopsy has been neglected, exhumation is the only possibility to obtain findings which allow conclusions on the manner of death, cause of death and chain of events. The quality of findings will however be influenced by advanced states of putrifaction. In spite of identical legislature the number of exhumations carried out at the institutes of legal medicine in München and Münster differs considerably, as demonstrated by a comparison of the data from the years 1993-1996. As previously described by other authors, there is a reciprocal correlation between the number of autopsies and the exhumation rate. The frequency of autopsies which are ordered can be explained by the varying application of the statutory framework by the investigation procedure. In some cases where an exhumation has been carried out, it was difficult to comprehend why an autopsy was not originally ordered.

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.

Fatalities due to gunshot injury by hunting firearm or during hunting, that had been investigated in the Institute of Legal Medicine of Hamburg University during the last 20 years, were retrospectively analyzed from the view points of epidemiology, morphology, criminology and ballistics. Thirteen accidents, 23 suicides and 13 homicides were included in this study. Female victims were observed in only 2 cases. In the accidents, the age of the most victims ranged from 30 to 60 years. Seven of 13 accidental victims killed themselves; remaining 6 were shot by other hunters. Nine accidents happened during hunting. The most frequently used firearm in cases of suicide and homicide was a shotgun whereas accidents preferably occurred with rifles. In some homicidal cases pistols were also used. The entrance wound was localized mostly in the head, neck or breast. Shooting in the mouth was observed in many suicidal cases. Although many victims were shot in the hunting ground, 15 of 23 suicides were performed at home. In 3 homicides which occurred in the hunting ground, the murderer committed another crime with the robbed hunting firearm of the victim. Three accidents occurred during training in the shooting-gallery. Blood alcohol concentration (BAC) was determined in 28 cases. Different degrees of drunkeness were observed in 2 self-inflicted accidents, 5 suicides and 2 homicidal cases. No BAC determinations were performed on the shooters. Ten case histories are presented. The discussion concentrates on the effect of the kind of firearm and ammunition on the appearance of the wound, prevention of accidents, and the principles of reconstruction, especially concerning the differentiation accident/suicide. The forensic expert investigating gunshot injuries during hunting should have personal experience in this field. The most frequent cause of accidents was careless handling of the loaded firearm and violation of invulnerable rules for safety during hunting.

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.

In ten cases of soft part phlegmons resulting in death (8) and amputation (2) respectively, various types of medical malpractice were evident. The diagnosis was missed, or the disease was correctly diagnosed but underestimated. Typical therapeutic mistakes were the omission of bacteriological investigations and of the proper antibiotical therapy, a delayed hospital admission, or a delayed or insufficient surgical intervention. These errors however could never be proved to have caused the unfavorable outcome in view of the doubtful prognosis of soft part phlegmons even under proper treatment. Thus, evident malpractice never resulted in a condemnation for bodily injury or involuntary manslaughter.

A basic duty of coroner's inquest is to ascertain whether death was due to an internal or external cause or cause of death remains unclear; economic constrains and less effort for the coroner's inquest lead to blunders on several levels: the physician's level, the level of judicial inquiry and the Land governments. Typical negative and positive marks as well as intermediate stages on each of these levels are pointed out, perspectives are shown.

Forensic physicians are often called upon by the courts and the public prosecutor's office to give expert opinions and carry out post-mortem examinations, e.g. to determine blood groups or cause of death. The expert is simply aiding the court within the framework of its function of hearing evidence. The court, after considering the evidence, must determine whether an allegation is true or false. Since, for example, the determination of cause of death demands qualified specialized knowledge and a high sense of responsibility, the expert should be both scientifically and personally autonomous in order to preclude wherever possible any conflict of interest. The not-too-distant past has demonstrated that justice, even here, can often be miscarried. This is why the autonomy of the expert is of prime importance. The readjustment to section 87, para. 2, clause 2, StPO may represent an infringement of the principle of autonomy, for in addition to calling on forensic physicians or the heads of forensic or pathology institutes to perform autopsies, as required before the 1975 amendment, these heads are now permitted to delegate their assignments to doctors in their own institutes. In compliance with the decisive trial commentary Loewe-Rosenberg, it should be pointed out that the presence of two pathologists is required by the law, one of whom must be a forensic physician or head of a forensic or pathology institute, and that the court presumes that the participation of delegated doctors will be the exception to the rule.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

Circumstances of death and results of four autopsies after death abroad and return of the bodies to the Federal Republic are discussed. In two cases an exhumation was necessary since the bodies had been buried without any further formalities. The demand for an official second examination of the bodies after death abroad is strengthened.