In modern society the medico-legal investigation of death is a prerequisite for the administration of justice and for the betterment of public health. These investigations require a high level of skill, professionalism and ethics and have far reaching effects. South Africa’s high level of unnatural deaths, combined with limited human and fiscal resources, specifically a scarcity in practicing Forensic Medical Practitioners, a lack of adequate training of Forensic Officers and members of the South African Police Service, discrepancies in available statistics and a lack of accreditation and quality control, to name a few, leave the South African medico-legal system overburdened. Death investigation needs to evolve and improve constantly and improvements in death investigation need to occur across a wide spectrum of parameters. In the United States of America, to combat systemic issues such as those experienced in South Africa, Death Investigators have been introduced in a supportive capacity and as an extension of services rendered by Forensic Medical Practitioners. These investigators, who are not medical practitioners but may have some level of training or vocational experience within the medical or investigative field, attend and help to analyse death scenes, collect relevant ante-mortem data, assist during autopsies, expedite special investigations, liaise with other stakeholders and provide testimony if warranted. Multiple benefits are associated with the introduction of these death investigators, with the collection of relevant (pre-autopsy) information which will assist and direct the Forensic Medical Practitioner probably being the most pertinent in the context of this research. The aim of this study was to assess the functionality and value of introducing such Death Investigators into forensic pathology service in South Africa. Specifically, this research focused on the nature and scope of information currently being provided to Forensic Medical Practitioners prior to conducting an autopsy and assessed whether the introduction of these investigators would improve the quality of pre-autopsy information. To determine this, participating Forensic Medical Practitioners were asked to evaluate the quality of information currently provided to them prior to conducting an autopsy and to evaluate the quality of information contained in a Death Investigator worksheet that was completed hypothetically for the same case, as an example of the type of information that would be collected by a Death Investigator. Additionally, the disposition of Forensic Medical Practitioners and external stakeholders to the proposed introduction of Death Investigators was assessed through a questionnaire process. Findings of this research showed that there is a significant deficit in the quality of pre-autopsy information being provided to Forensic Medical Practitioners at present. The current pre-autopsy information received an average information quality score of 21.4%. However, the Death Investigator worksheets received and average information quality score of 84.9% representing a marked improvement. Forensic Medical Practitioners had a favourable disposition to the proposed introduction of Death Investigators and agreed that Death Investigators would provide an improved knowledge and understanding of the circumstances and setting of the death, which in turn would , enhance their ability to strategise a post-mortem approach, to request appropriate special investigations and to better interpret their autopsy findings. Overall, the results of this research suggest that the introduction of Death Investigators would add value, specifically by improving the gathering of appropriate information and would be welcomed by Forensic Medical Practitioners. While this research was conducted in Pretoria, it was done on the premise that the poor-quality pre-autopsy information experienced in Pretoria, is probably, to a greater or lesser extent experienced in other medico-legal laboratories in South Africa. It is recommended, that a multi-centre audit of pre-autopsy information quality is undertaken to verify the results found at the Pretoria Medico-legal Laboratory. Furthermore, to facilitate the introduction of Death Investigators as a new professional category, it is recommended that a working group be convened to further interrogate the added-value potential of this introduction as well as to determine prerequisite educational requirements and acceptable recognised prior learning, and to develop guidelines and scope of practice documents. It is also recommended that should this introduction come to fruition, provision be made to accommodate such Death Investigators on a professional board affiliated with the Health Professions Council of South Africa, to guide training and qualification requirements, advise on best practice and professional standards against which Death Investigators can be held accountable. / Dissertation (MSc (Medical Criminalistic))--University of Pretoria, 2020. / Forensic Medicine / MSc (Medical Criminalistic) / Unrestricted

Muscle strength capabilities are a determinant in the ability to successfully accomplish everyday tasks. As such, the quantification of this aspect of human performance is of interest in many settings. Currently, the validity of muscle strength test results is reliant on the notion that during testing, the participant exerted an effort that is sincere, and that consisted of maximal voluntary contractions. Therefore, the ability to differentiate between maximal and non maximal muscular exertions is of importance. The purpose of this dissertation was to develop and validate probability-based decision rules for differentiating between maximal and non-maximal voluntary exertions of the knee and shoulder joint musculature during isokinetic dynamometry-based testing. For development of the decision rules, healthy participants performed a series of maximal and non-maximal exertions at different testing velocities through a prescribed range of motion. Two different theory-based approaches were subsequently used for decision rule development: the first approach was based on expected better consistency in strength waveform shapes and relative magnitudes during performance of maximal efforts in comparison to non-maximal efforts. The second approach was based on the known force-velocity dependency in skeletal muscles. In terms of discriminatory performance, several of the decision rules pertaining to the knee joint markedly improve upon those previously reported. In addition, a separate investigation demonstrated that the decision rules offer excellent discriminatory performance when applied to test results of participants that have undergone surgical reconstruction of their anterior cruciate ligament. As such, clinicians and researchers may be able to ascertain voluntary maximal effort production during isokinetic testing of the knee joint musculature with a high degree of confidence, and thus be able to rely on such scores for decision-making purposes With regards to the shoulder musculature decision rules, several methodological issues related to test positioning and signal processing need to be addressed prior to consideration of their use in the clinical domain. / Thesis (Ph.D, Kinesiology & Health Studies) -- Queen's University, 2013-06-19 01:12:53.454

Unidentified bodies in the forensic setting constitute a global problem. Though this should be of great concern to many governments, very little data on the extent of this phenomenon is available in international literature and few countries require that statistics on the number of unidentified deceased be kept. To determine the extent of this phenomenon in South Africa, a study into the number of unidentified deceased at the Pretoria Medico-Legal Laboratory and their demographic profile was undertaken. The study has indicated that between 7% and 10% of bodies remain unidentified at the Medico-Legal Laboratory in Pretoria. Publications further indicate that a total of 846 bodies remained unidentified at Medico-Legal Laboratories in Gauteng for the period January 2010 to August 2010. This number is very high when compared to international literature. Of great concern is the fact that these statistics do not include the cases in which persons die in hospital facilities from natural causes without an identity, which are not referred to the Forensic Pathology Service for investigation. The true extent of the problem may thus be far greater than imagined. Determining the true extent of this phenomenon in South Africa is therefore important, as these unidentified bodies have many social and economic consequences. Not only are families unaware that their loved ones have passed away, but they are also unable to bury and mourn them. Unidentified bodies at Medico-Legal Laboratory facilities also impacts on the service delivery capability of the government departments involved in the investigation of such cases. The drafting of additional legislation for the management of unidentified bodies is therefore required. A need to establish and enforce specific protocols to be followed in the event of unidentified bodies has also been identified. The creation of a National Unidentified Decedent website and DNA database is recommended as they will greatly assist in reducing the number of unidentified bodies throughout South Africa. It is however only through coordinated efforts and interdepartmental cooperation that these proposals will be successful. AFRIKAANS : Ongeïdentifiseerde liggame in die forensiese omgewing is ‘n wêreldwye probleem. Alhoewel dit ‘n bron van kommer vir meeste regerings behoort te wees, is baie min data oor die omvang van hierdie verskynsel beskikbaar in die internationale literatuur, met min lande wat vereis dat amptelike statistieke oor onbekende oorledenes versamel word. Om die omvang van hierdie verskynsel in Suid Afrika te bepaal, is ‘n studie na die aantal onbekende liggame by die Regsgeneeskundige Laboratorium in Pretoria en hul demografies profiel onderneem . Die studie het getoon dat tussen 7% en 10% van alle liggame wat deur die Regsgeneeskundige Laboratorium in Pretoria opgeneem word, onuitgeken bly. Publikasies dui ook aan dat 846 liggame ongeïdentifiseerd was by Regsgeneeskundige Laboratoriums vir die tydperk Januarie 2010 to Augustus 2010. Hierdie getal is aansienlik hoër as díe wat in die internasionale literatuur gesien word. ‘n Groot bron van kommer is die feit dat hierdie statistieke nie gevalle insluit waar die oorledene in ‘n hospitaal gesterf het as gevolg van natuurlike oorsake, sonder dat hul identiteit bekend is. Die ware omvang van die problem kan dus veel groter as geskat wees. Die bepaling van die omvang van hierdie verskynsel in Suid Afrika is belangrik, omdat ongeïdentifiseerde liggame beide sosiale en ekonomiese gevolge het. Nie net is families onbewus daarvan dat hul geliefdes gesterf het nie, maar kry hul ook nie die geleentheid om hul geliefdes te begrawe en oor hul afsterwe te rou nie. Ongeïdentifiseerde liggame by Regsgeneeskundige Laboratoriums het ook ‘n invloed op die diensleweringskapasiteit van die verskeie staatsdepartemente wat betrokke is by die ondersoek van sulke gevalle. Die opstel van addisionele wetgewing wat die bestuur van ongeïdentifiseerde liggame reguleer is dus nodig. Die behoefte aan spesifieke protokolle vir die hantering van sulke gevalle is ook geïdentifiseer. Daar word verder aangeraai dat ‘n Nasionale Onuitgekende Liggaam webwerf en DNS databasis geskep word in ‘n poging om die aantal ongeïdentifiseerde liggame in Suid Afrika te verminder. Dit is egter slegs deur middel van gekoördineerde pogings en interdepartmentele samewerking wat hierdie voorstelle sukses sal behaal. Copyright / Dissertation (MSc)--University of Pretoria, 2011. / Forensic Medicine / unrestricted

The fastest growing field of law is undoubtedly that of Medical Law with the civil and disciplinary cases flowing from it. Globalization, international communication, development and evolution of Law as well as Medicine, cause this worldwide rising medical litigation. Humanitarian rights, post-modern scepticism and even iconoclastic attitudes contribute to this phenomenon. Medico-legal litigation and disciplinary complaints rise (in South Africa) up to 10 per cent per year. To assist the courts and legal profession, in medico-legal issues, helping the parties where the plaintiff has the burden of proof and the defendant for rebuttal, a medical expert witness must be used. The dilemmas and pitfalls arise, in that although knowledgeable medical experts could be used to guide the courts to the correct decision, the lack of a legal mind setting, court procedure and legal knowledge could affect the relevance, credibility and reliability, making the medical evidence of poor quality. The legal profession, deliberately, could “abuse” medical expert witnesses with demanding and coercion of results, which have unrealistic and unreasonable expectations. “Case building” occurs, especially in the adversarial systems of law, making the medical expert vulnerable under cross-examination, when it is shown that the witness has turned into a “hired gun” or is unfair. Thus, lacunae develop, making reasonable cases difficult and a quagmire of facts have to be evaluated for unreasonableness, credibility and appropriateness, compounded by the fact that seldom, cases are comparable. The danger is that the presiding officer could be misled and with limited medical knowledge and misplaced values, could reach the wrong findings. Several cases arguably show that this has led to wrongful outcomes and even unacceptable jurisprudence. The desire to “win” a case, can make a medical witness lose credibility and reasonableness with loss of objectivity, realism and relevance. With personality traits and subjectivity, the case becomes argumentative, obstinate and could even lead to lies. The miasmatic, hostile witness emerges, leading to embarrassing, unnecessary prolongation of court procedures. The medical expert witness should be well guided by the legal profession and well informed of the issues. Medical witnesses should have legal training and insight into the legal and court procedures. At the time of discovery of documents, via arbitration or mediation, medical experts should strive to reach consensus and then present their unified finding, helping the parties fairly and expediting the legal procedure and processes. / Private Law / LLM

The fastest growing field of law is undoubtedly that of Medical Law with the civil and disciplinary cases flowing from it. Globalization, international communication, development and evolution of Law as well as Medicine, cause this worldwide rising medical litigation. Humanitarian rights, post-modern scepticism and even iconoclastic attitudes contribute to this phenomenon. Medico-legal litigation and disciplinary complaints rise (in South Africa) up to 10 per cent per year. To assist the courts and legal profession, in medico-legal issues, helping the parties where the plaintiff has the burden of proof and the defendant for rebuttal, a medical expert witness must be used. The dilemmas and pitfalls arise, in that although knowledgeable medical experts could be used to guide the courts to the correct decision, the lack of a legal mind setting, court procedure and legal knowledge could affect the relevance, credibility and reliability, making the medical evidence of poor quality. The legal profession, deliberately, could “abuse” medical expert witnesses with demanding and coercion of results, which have unrealistic and unreasonable expectations. “Case building” occurs, especially in the adversarial systems of law, making the medical expert vulnerable under cross-examination, when it is shown that the witness has turned into a “hired gun” or is unfair. Thus, lacunae develop, making reasonable cases difficult and a quagmire of facts have to be evaluated for unreasonableness, credibility and appropriateness, compounded by the fact that seldom, cases are comparable. The danger is that the presiding officer could be misled and with limited medical knowledge and misplaced values, could reach the wrong findings. Several cases arguably show that this has led to wrongful outcomes and even unacceptable jurisprudence. The desire to “win” a case, can make a medical witness lose credibility and reasonableness with loss of objectivity, realism and relevance. With personality traits and subjectivity, the case becomes argumentative, obstinate and could even lead to lies. The miasmatic, hostile witness emerges, leading to embarrassing, unnecessary prolongation of court procedures. The medical expert witness should be well guided by the legal profession and well informed of the issues. Medical witnesses should have legal training and insight into the legal and court procedures. At the time of discovery of documents, via arbitration or mediation, medical experts should strive to reach consensus and then present their unified finding, helping the parties fairly and expediting the legal procedure and processes. / Private Law / LLM

Mary Shelley’s Frankenstein is a prelude to the Anatomy Act of 1832, which indulged the anatomists’ scientific ambition, granting a legitimate and sufficient source of cadavers to dissect legally. When read in concert with the history of anatomy and the historical record of body snatching, including case law and anatomy legislation, Frankenstein exemplifies the issues in medico-legal history at the turn of the nineteenth century, for Victor Frankenstein and the Creature’s stories are set amid the context of anatomical study, grave-robbery, crime, punishment and the illicit relationship between medicine and murder. This thesis accordingly addresses the medico-legal history of anatomy, the anatomist’s ambition and complex inhumanity, and the mingled identity of the anatomical subject as illegitimate and criminal. This analysis demonstrates that Frankenstein sheds light upon the anatomist’s ambition, the identity of the human cadaver, and the bioethical consequences of meddling with nature.

Mary Shelley’s Frankenstein is a prelude to the Anatomy Act of 1832, which indulged the anatomists’ scientific ambition, granting a legitimate and sufficient source of cadavers to dissect legally. When read in concert with the history of anatomy and the historical record of body snatching, including case law and anatomy legislation, Frankenstein exemplifies the issues in medico-legal history at the turn of the nineteenth century, for Victor Frankenstein and the Creature’s stories are set amid the context of anatomical study, grave-robbery, crime, punishment and the illicit relationship between medicine and murder. This thesis accordingly addresses the medico-legal history of anatomy, the anatomist’s ambition and complex inhumanity, and the mingled identity of the anatomical subject as illegitimate and criminal. This analysis demonstrates that Frankenstein sheds light upon the anatomist’s ambition, the identity of the human cadaver, and the bioethical consequences of meddling with nature.

Magister Chirurgiae Dentium - MChD (Maxillo-Facial & Oral Surgery) / South African dentists have a legal and ethical obligation to maintain complete and comprehensive dental records. In addition to the legal and ethical requirements, dental records are also important in the case of medico-legal issues, quality assurance processes and forensic purposes. Valuable forensic evidence contained in dental records are used in the identification of victims of mass disasters, personal victim identification e.g. in severely decomposed or skeletonized remains where DNA or other biometric data are not available. The victim identification process is highly dependent on complete, legible and accurate dental records. A review of the literature however shows that dental record keeping practices are sub-optimal worldwide. There is a paucity of studies in South Africa regards to dental record keeping practices. The aim of this study was to assess the record keeping practices of a sample of private practicing dentists in Cape Town and surrounding towns, for forensic dental purposes. Knowledge and awareness regards to forensic odontology as well as adherence to the guidelines prescribed by the Health Professional Council of South Africa were also assessed. This was a cross-sectional descriptive study, employing a researcher-administered questionnaire and a dental checklist for forensic valuable items in the dental file. The results were entered in a MS Excel spreadsheet and statistically analysed using IMB SPSS Statistics. This study concluded that most of the dental records kept by Cape Town dentists are near to optimal and would be helpful during forensic odontology investigations. However, shortcomings in record keeping practices exists which may compromise the forensic accuracy of their dental records. The study also shows a significant difference in dental record keeping practices by dentists practicing in lower income areas in Cape Town, compared to those practicing in economic affluent areas. The dentists in this study adhered to most of the guidelines prescribed by the Health Professional Council of South Africa however, important medico-legal information was missing from most dental records. This study hopes to contribute to future comprehensive studies in the broader South Africa to determine the validity of dental records for forensic odontology purposes.

The universally controversial issue of deaths in custody is especially pertinent to South Africa. This study was prompted due to the increasingly diminishing ability for a concerted effort at tackling this issue by all parties involved. The 5 year retrospective, descriptive case audit performed at the Pretoria Medico-Legal Laboratory aimed to evaluate the current medico-legal investigation of deaths in custody in Pretoria, South Africa. Over half of the deaths (52%) occurred as a result of police action, 30% in police custody and 18% in correctional services custody. Gunshot wounds and hangings were the number 1 and 2 most common causes of death, respectively, with homicide and suicide being the 2 most common manners of death, respectively. The principal conclusion from the results is the presence of a flawed and malfunctioning medico-legal investigation system. The introduction of a formal protocol is urgently required to provide a framework for these investigations. / Dissertation (MSc)--University of Pretoria, 2013. / Forensic Medicine / MSc / Unrestricted

This review examines the factors that can influence an investigation into the unexpected death of a child before considering if using imaging techniques could be of benefit. Method A systematic search strategy was adopted to search databases using keywords, these results were then subjected to inclusion and exclusion criteria to filter and refine the evidence base further. Discussion More research is published on the use of MRI in comparison with other modalities. There is evidence in the case of MRI in particular that its use could be of benefit in identifying and ruling out potential causes of death in children. Conclusion More research is needed on the use of CT but the routine use of MRI in child death investigation could now be considered. Ethical considerations appear to be a barrier to research in this area and discussions as to how such considerations can be overcome is necessary.