Medico-Legal Journal

We present a retrospective study of prostitutes’ homicide in the Milanese area over a 26-year period (1993–2018), and compare the results with general women’s homicides: 294 women were killed of whom 71 were prostitutes. In the general population, the type-victim is an Italian woman aged between 31 and 40 years suffering from no particular pathologies or drug dependence. Prostitutes are 10 years younger, mostly Italian, suffering from pathologies probably related to their activities. Prostitutes remain at high risk of violence, due to gaps in the crime prevention system.

The introduction of new rotas, rota gaps, poor handover arrangements, the junior hospital doctors’ strike, the imposition of a new contract after a four-year period of contract negotiation, the Bawa-Garba case, the abolition of the “Firm”, poor rest facilities and bullying have all contributed to eroding the morale of junior doctors. The retention of newly registered doctors is falling. Recent evidence shows that in 2010 83% of Foundation Year 2's went straight into training compared to 38% in 2018. This study was undertaken to assess the extent to which the plans and intentions of current Foundation Year Doctors have been influenced by recent history. With the large volume of complaints and their associated costs on the NHS, the study included questions to identify whether junior doctors feel prepared to deal with the medico-legal issues.

Bipolar disorder is a chronic, relapsing illness characterised by recurrent episodes of manic or depressive symptoms, with intervening periods that are relatively (but not fully) symptom-free. Studies have found higher rates of psychiatric disorders in homicide offenders than in the general population. The insanity defence is a legal construct that, under some circumstances, excuses defendants with mental illness from legal responsibility for criminal behaviour. Here we report two cases of family murder by the mother of the family caused by bipolar disease. The role of the forensic psychiatrist in diagnosing insanity during the commission of a crime is very important as these patients should be diagnosed, treated as soon as possible, and monitored. Public education through social media should be considered to reduce crimes in societies. Diagnosing insanity during the commission of a crime is very important and requires high precision forensic psychiatry. Public education through social media should be considered to reduce crimes in societies.

Pin-prick injuries which prove not to be infected may still cause fear and distress, but allow the victims, who are often young women, no opportunity for redress. These attacks are causing panic among the targeted population who fear AIDS.

Whiplash is the most common injury reported in low-velocity impact road traffic accidents, but claimants report a range of other soft tissue injuries and we looked at the prevalence of these and any patterns. We retrospectively reviewed reports from the medico-legal practice of an orthopaedic surgeon. We collected data on 609 claimants. Sixty-two per cent were women (p < 0.0001). Majority (90.3%) reported an injury to at least one other area than neck, and 48% of claimants reported shoulder pain. Hand/wrist injuries were almost exclusive to drivers (p = 0.0013). Those with knee injuries were older than those without (p = 0.001). There was a significant difference in the age of patients with different spinal injury patterns (p < 0.0001). Occupational status did not appear to influence the pattern of injuries (p = 0.06). Psychological symptoms were associated with a greater number of body parts injured (p < 0.01). Our data confirm a strong association between these soft tissue injuries and psychological symptoms.

Violence against women breaches women’s human rights and is a global public health issue that can cause devastating life-long damage. This study considers the characters of victims, abusers and traumatic bonding in heterosexual couples from a medico-legal and psycological standpoint. After considering the devastating effects on women’s health, and with the objective of preventing future violence, it illustrates the weaknesses and strengths of new Italian guidelines related to violence against women in emergency departments including the use of “Brief Risk Assessment for IPV in the Emergency Department – DA5”.

Chronic venous insufficiency is generally not lethal, but massive bleeding from ruptured varicose veins can be fatal. A 79-year-old woman was found dead in her apartment in Rome. Pools of blood and contact pattern bloodstains were observed around the body. She lived alone and suffered from vascular dementia. On the medial aspect of the right leg, a circular ulcer communicating with the lumen of a varicose vein was noted. Death was attributed to hypovolemic shock caused by bleeding from the rupture of the varicose vein. Our case confirms that varicose veins rupture is a potentially fatal medical emergency. Conditions such as dementia may lead to failure to understand the gravity of the bleeding and to seek help. Recognition of this issue is important especially when the care of people suffering from mental illness is involved.

We present the case of a 60-year-old male, with a long history of epilepsy, who was discovered submerged and unconscious in a small thermal whirlpool bath. The circumstances were forensically reviewed to include examination of clinical data and an autopsy with toxicological analysis. The conclusion was that “warm” hydro-therapy had contributed more than “hot” mud-therapy to the onset of epilepsy which led to accidental drowning, notwithstanding the deceased’s treatment with the long-lasting, poly-drug antiepileptic therapy. Further, we analysed the Italian medical indications of wellness centres for patients with epilepsy or other diseases.