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When accidental death results from dangerous techniques of sexual self-stimulation, family members are always puzzled and often find the victim's behavior incomprehensible. When the dangerous technique involved bondage, suspension, complex [...]

• Of 638 reported assaultive and disruptive incidents in 1979 in a maximum security hospital, 221 (34.6%) were batteries. Whether an incident was a battery or not was a function of time and location. Preludes to battery were noted by staff in only 23.1% of cases and were high-frequency behaviors with low predictive value. Impact and injury to patients and officers occurred through both batteries themselves and efforts to subdue the batterer. With length of hospitalization controlled, the distributions of preadmission criminal charges were not significantly different between batterers and controls. Policies that alter patterns in the timing and location of interaction among patients and in the response of officers or other personnel to batteries in progress offer promise for reducing incident and injury rates.

• Violent offenders who pushed or attempted to push victims onto the subway tracks in New York City during the 17-year period from 1975 through 1991 were studied. Forty-nine incidents involving 52 victims were identified during this period. Of 36 perpetrators who acted alone, 25 (69%) were referred for psychiatric evaluation and treatment, as was one member of an offending gang. Data concerning 20 of these 26 offenders and their crimes were collected. At the time of the offense, 19 (95%) of these offenders were psychotic, and 13 (65%) were homeless. Most of these offenders had extensive histories of psychiatric hospitalization and several prior arrests and convictions, often for violent crimes. The offenders had extensive mental health and criminal histories. The victims of these crimes were always strangers. Half of the offenders killed or seriously injured victims. Since 1986, the incidence of this offense has increased, and offenders accounting for the increase are mostly psychotic and homeless.

FIREARMS are a major source of death and injury in the United States. The most recent available figures from the National Center for Health Statistics show that in 1982, firearms killed 33,000 people in the United States (1,756 unintentional, 16,575 suicides, 13,841 homicides, 276 legal action, and 540 intent undetermined). Firearms are second only to motor vehicles as the most important cause of injury deaths. There are currently 15 firearm-related deaths per 100,000 US population per year compared with about 20 per 100,000 US population for motor vehicles. Firearms are responsible for two of three homicides and four of seven suicides.1 Despite the magnitude of this problem, we know remarkably little about the ways in which firearms impair the health of the public. Most of what we do know has been pieced together from mortality data because of the accessibility and completeness of vital records. Mortality alone, however, does