日常診療と法医学

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  • Useful Knowledge of Legal Medicine for Clinical Physicians.
  • トクベツ コウエン ニチジョウ シンリョウ ト ホウイガク

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1. Postmortem examinations are conducted to judge the cause and circumstances of death. The investigation is not only for the confirmation of death but also to establish the date, manner, and cause of death and identification of the person.<BR>Causes of death that require a medical examination are:<BR>1) Natural deaths which fall within these parameters;<BR>a. death without consultation of physician<BR>b. death with unknown cause despite physician's consultation<BR>c. death under medical condition different from that during treatment<BR>d. unusual circumstance at onset of the disease and death e.g. acute sudden death<BR>sudden death of an apparently healthy person death suspicious of accident or overworking unusual circumstances<BR>2) All cases suspected of external causes such as drowning, hanging, traffic accident, suffocation, burn and cold<BR>3) Unclear deaths, either natural or unnatural<BR>4) Cases found dead<BR>2. Causes of death: statistical trends Since 1967 the number of natural deaths has taken the lead and now accounts for 65% of all examinations.(natural deaths over 65 years old have amounted to over 40%). Current statistics reflect a rapid progress of the aging society.<BR>In 1999, the frequency of the natural death was 64.3% of all medical examiner cases in Tokyo. Most frequent causes of deaths were the diseases of circulatory system (66.9%), that was ischemic heart failure (62.8%) such as myocardial infarction, cerebrovascular diseases (19.8%), such as cerebral haemorrhage, subarachnoid haemorrhage.The next were those of gastro-intestinal tract (11.5%), especially alcoholic liver disease, liver cirrhosis and those of respiratory system (8.2%) such as pneumonia, bronchial asthma.<BR>3. Child abuse, usually committed by parents, causes abrasions, burns, fractures, hypodermal bleedings, internal injuries, and in the worst cases, death of children. It is also referred to as “Battered Child Syndrome”.<BR>Since there are abuses conducted not only by parents but also by other guardians or teachers who are responsible for child health and safety, it has been also comprehensively called maltreatment syndrome.<BR>Maltreatment syndrome includes child abuse and child neglect. Child abuse includesphysical abuse, sexual abuse, and mental abuse, whereas child neglect includes not feeding, not giving appropriate medical treatment, and neglecting safety.<BR>1) Japanese Society of Legal Medicine's survey shows that cases involving a biological mother often tends to be triggered by her mental problem, a child's intellectual handicap, or her lack of affection toward her own child. On the other hand, many cases involving a father occurred during times he was stressed by his family troubles or achild's continuous crying. Recently financial worries, bad residential environments, and children's defiant attitudes have been added to the contributing factors of abuse.<BR>2) Main means of child abuse include punching and kicking, throwing a child, burning by cigarettes or incense sticks, not feeding, choking, and so on. It is important for doctors to see any suspicious cases very carefully and to diagnose them as soon as possible, which will lead to prevent further cases.<BR>4. When a pedestrian was hit by a bonnet-type vehicle, we frequently found that the head injuries, by collision with a bonnet of the car, and the lower thigh injuries, by the bumper, are easy to occur. Primary impact injuries were more serious than that acquired after falling down to the ground. In particular, a pedestrian sometime suffered serious injury in collision with hard parts of the vehicle, such as an A-pillar, and indirect collision with some parts of strong components under the bonnet such as shock - tower and battery, etc. If the car hit the pedestrian with a speed of more than 40 km/h, the frequency of the fatal injury sustained to a victim is increased.

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