In toxicology, international classification systems focus on single intoxicants as the cause of d... more In toxicology, international classification systems focus on single intoxicants as the cause of death. It is, however, well known that very few drug related deaths are caused by a single substance and that information concerning the drug concentrations as well as the combinations of drugs are essential in order to ascertain the cause of death. The aim of the study was to assess whether those prone to fatal intoxications differ significantly from chronic drug users - in terms of demographics and drug exposure patterns. Fatal psychoactive drug intoxications in Norway during 2012, where a forensic autopsy including toxicological analysis were performed, were included. Analytical findings in blood were compared with concentrations in blood from apprehended drivers under the influence of drugs and ethanol (DUID) during the same time period. The opioid and benzodiazepine concentrations were assessed as morphine and diazepam equivalents, respectively, in order to compare concentrations acr...
Petechiae in conjunctivae and in the palpebrae/skin of the eyelids are of particular interest for... more Petechiae in conjunctivae and in the palpebrae/skin of the eyelids are of particular interest for the forensic pathologist, because of their association with pressure on the neck. They have been described in the eyelids of intoxicated persons both in case reports and in text books of forensic pathology. We studied 590 deaths caused by intoxication, and 75 had petechiae either in the conjunctivae, the eyelids, or in both locations. We examined the influence of drugs and ethanol on the location of the petechial hemorrhages in these deaths. Deaths with ethanol in blood and in urine/vitreous humor more often had petechiae in both locations than those without. This association was statistically significant, independent of body position and livor mortis. No association between the location of petechiae, medicinal drugs, or narcotics was found. These results suggest that ethanol may contribute to the development of petechial hemorrhages in deaths from intoxication.
The objective of the study was to determine the unnatural manner and causes of death in older peo... more The objective of the study was to determine the unnatural manner and causes of death in older people, defined as individuals at least 60 years of age at the time of death. A series of medico-legally examined deaths in older people, who were examined between January 1, 1999 and December 31, 2003, and whose deaths were considered unnatural after forensic examination were studied. All deaths took place in western Norway, in two whole counties and the north part of a third county, including one large Norwegian city and one medium-sized city on the west coast of Norway. Of the 2425 forensic examinations performed in the time period, 1169 were 60 years or older at the time of death. Of these, 228 deaths were categorized as accidental, suicidal, or homicidal. Drowning was the most common lethal accident in elderly males, whereas fatal traffic accidents were more frequent in women. Alcohol intoxication was very common among male drowning victims, and none of the drowning victims had used a ...
During the five year period 1987-1991, 377 deaths among alcoholics were examined at The Universit... more During the five year period 1987-1991, 377 deaths among alcoholics were examined at The University of Bergen, The Gade Institute, Department of Forensic Medicine. There were 70 cases where suicide was considered the mode of death. Male alcoholics dominated the material. Relatively few suicides were seen among the very young and the old. Intoxication was the most frequent cause of death. The accessibility to drugs among alcoholics is considered to be an important factor. Factors of use in predicting suicide are discussed.
Virchows Archiv A Pathological Anatomy and Histopathology, 1987
Nine white leghorn chickens were injected i.m. with furosemide (10 to 60 mg/kg body weight) twice... more Nine white leghorn chickens were injected i.m. with furosemide (10 to 60 mg/kg body weight) twice daily for 18 days. The birds were then anesthetized with a combination of equithesin and diazepam and the kidneys perfused via the heart. Kidney tissue was sectioned serially and the granular epithelioid cells were counted in the juxtaglomerular apparatuses of the furosemide treated birds and in 3 normal chickens. Hyperplasia and hypergranulation of the epithelioid cells was found to occur in the juxtaglomerular apparatuses of both mammalian and reptilian type nephrons (with and without Henles loop) in the furosemide treated group. This finding was interpreted as an effect of hypovolaemia on the juxtaglomerular apparatuses. Furosemide caused an immediate stop in weight gain, an increase in the erythrocyte volume fraction and a sudden drop in blood pressure. The blood pressure later rose to subnormal levels. The heart rate was not altered. Plasma sodium and chloride fell significantly one day after furosemide administration and remained low throughout the experiment. Potassium fell during the second part of the experimental period. Captopril was injected after 18 days of furosemide treatment and lowered the blood pressure significantly. This was interpreted as indirect evidence for the presence of renin in the granular epithelioid cells and indicates the importance of the renin angiotensin system in maintaining the blood pressure in hypovolaemic conditions.
Fentanyl is a potent synthetic opioid used as a general anesthetic and analgetic. Fatal outcome f... more Fentanyl is a potent synthetic opioid used as a general anesthetic and analgetic. Fatal outcome from intravenous misuse of transdermal fentanyl is rare, and there are few such reports in literature. Here we report two cases of fatal intravenous injection of the content from fentanyl patches. Both were male drug addicts, found dead within a one week interval in the same apartment. Post-mortem femoral blood was screened for amphetamines, cannabinoids, cocaine, and opioids with immunological methods (EMIT II) and further with headspace gas chromatography for alcohol and with liquid chromatography mass spectrometry (LC-MS) for different drugs, including fentanyl. Confirmatory analysis of fentanyl and morphine was performed by gas chromatography-mass spectrometry (GC-MS). In the first case, the toxicological analysis revealed fentanyl (2.7 ng/mL), morphine (31.4 ng/mL), and ethanol (1.1 g/L) in postmortem blood and amphetamine, cannabinoids, morphine, and ethanol (1.4 g/L) in postmortem urine. In the second case, the analysis revealed fentanyl (13.8 ng/mL), 7-aminoclonazepam (57.1 ng/mL), and sertralin (91.9 ng/mL) in postmortem blood and a small amount of ethanol (0.1 g/L) in postmortem urine. Police investigation revealed that both the deceased had bought the patches from the same source. The present cases demonstrate the possibility of intravenous misuse of transdermal patches and the risk of fatal outcome.
: Three classic cases and one exceptional case are reported. The unique case of decapitation too... more : Three classic cases and one exceptional case are reported. The unique case of decapitation took place in a traffic accident, while the others were seen after homicide, vehicle‐assisted suicide, and after long‐jump hanging. Thorough scene examinations were performed, and photographs from the scene were available in all cases. Through the autopsy of each case, the mechanism for the decapitation in each case was revealed. The severance lines were through the neck and the cervical vertebral column, except for in the motor vehicle accident case, where the base of skull was fractured. This case was also unusual as the mechanism was blunt force. In the homicide case, the mechanism was the use of a knife combined with a saw, while in the two last cases, a ligature made the cut through the neck. The different mechanisms in these decapitations are suggested.
Inhalation of automobile exhaust gas often leads to death by CO intoxication. In some cases the m... more Inhalation of automobile exhaust gas often leads to death by CO intoxication. In some cases the measured carbon monoxide hemoglobin saturation level (COHb) is considerably below what is considered to be lethal. The death in such cases has been attributed to a combination of a high CO2 and a low O2 tension. In a recent case the deceased was found dead in a car equipped with a catalytic converter, with a hose leading exhaust from the engine to the interior of the car. Analysis revealed a moderately elevated COHb and a high methemoglobin saturation level (MetHb) in peripheral blood. No ethanol, narcotics or drugs were detected. Reports mentioning MetHb or methemoglobinemia in post-mortem cases are surprisingly scarce, and very few have related exhaust gas deaths to methemoglobinemia. High-degree methemoglobinemia causes serious tissue hypoxia leading to unconsciousness, arrhythmia and death. The existing literature in this field and the knowledge that exhaust fumes contain nitrogen oxide gases (NOx) that by inhalation and absorption can result in severe methemoglobinemia, led us to postulate that this death could possibly be attributed to a combination of methemoglobinemia and a moderately high COHb concentration.
A previously healthy 53-year-old man died suddenly and unexpected. The main finding at the post m... more A previously healthy 53-year-old man died suddenly and unexpected. The main finding at the post mortem examination was a large 4th ventricle subependymoma, a rare brain tumour related to the ventricles of the brain. The salient features of subependymoma are described with emphasis on the microscopic picture and distinction from subependymal giant cell astrocytoma, as the tumour harboured large, bizarre astrocytes. Coronary atherosclerosis and mild cardiac hypertrophy were present as the only pathologic changes outside the central nervous system. The cause of death is discussed in light of earlier reports on brain tumours and sudden fatal incidents.
Deaths from asthma investigated by the Department of Forensic Medicine, The Gade Institute, Unive... more Deaths from asthma investigated by the Department of Forensic Medicine, The Gade Institute, University of Bergen during the period 1977-1986 were recorded. There were 11 cases with information in the police report of the use of pressurised bronchodilating aerosols prior to death. Seven of the victims were found with the aerosol in the hand or close by the body. Overdosage due to excessive inhalation were suspected in several of the victims. The possibility of side effects due to overuse is discussed. Other mechanisms of death are also discussed.
The results from a study of bone strength in normal infants is presented. The fibular bones of in... more The results from a study of bone strength in normal infants is presented. The fibular bones of infants dying from SIDS were tested mechanically by a three-point bending test and the behaviour of the bony structure determined by measuring several variables. Correlations between these variables and infant age, length, weight and length of fibular bones were found and base-line values for bone strength established.
In toxicology, international classification systems focus on single intoxicants as the cause of d... more In toxicology, international classification systems focus on single intoxicants as the cause of death. It is, however, well known that very few drug related deaths are caused by a single substance and that information concerning the drug concentrations as well as the combinations of drugs are essential in order to ascertain the cause of death. The aim of the study was to assess whether those prone to fatal intoxications differ significantly from chronic drug users - in terms of demographics and drug exposure patterns. Fatal psychoactive drug intoxications in Norway during 2012, where a forensic autopsy including toxicological analysis were performed, were included. Analytical findings in blood were compared with concentrations in blood from apprehended drivers under the influence of drugs and ethanol (DUID) during the same time period. The opioid and benzodiazepine concentrations were assessed as morphine and diazepam equivalents, respectively, in order to compare concentrations acr...
Petechiae in conjunctivae and in the palpebrae/skin of the eyelids are of particular interest for... more Petechiae in conjunctivae and in the palpebrae/skin of the eyelids are of particular interest for the forensic pathologist, because of their association with pressure on the neck. They have been described in the eyelids of intoxicated persons both in case reports and in text books of forensic pathology. We studied 590 deaths caused by intoxication, and 75 had petechiae either in the conjunctivae, the eyelids, or in both locations. We examined the influence of drugs and ethanol on the location of the petechial hemorrhages in these deaths. Deaths with ethanol in blood and in urine/vitreous humor more often had petechiae in both locations than those without. This association was statistically significant, independent of body position and livor mortis. No association between the location of petechiae, medicinal drugs, or narcotics was found. These results suggest that ethanol may contribute to the development of petechial hemorrhages in deaths from intoxication.
The objective of the study was to determine the unnatural manner and causes of death in older peo... more The objective of the study was to determine the unnatural manner and causes of death in older people, defined as individuals at least 60 years of age at the time of death. A series of medico-legally examined deaths in older people, who were examined between January 1, 1999 and December 31, 2003, and whose deaths were considered unnatural after forensic examination were studied. All deaths took place in western Norway, in two whole counties and the north part of a third county, including one large Norwegian city and one medium-sized city on the west coast of Norway. Of the 2425 forensic examinations performed in the time period, 1169 were 60 years or older at the time of death. Of these, 228 deaths were categorized as accidental, suicidal, or homicidal. Drowning was the most common lethal accident in elderly males, whereas fatal traffic accidents were more frequent in women. Alcohol intoxication was very common among male drowning victims, and none of the drowning victims had used a ...
During the five year period 1987-1991, 377 deaths among alcoholics were examined at The Universit... more During the five year period 1987-1991, 377 deaths among alcoholics were examined at The University of Bergen, The Gade Institute, Department of Forensic Medicine. There were 70 cases where suicide was considered the mode of death. Male alcoholics dominated the material. Relatively few suicides were seen among the very young and the old. Intoxication was the most frequent cause of death. The accessibility to drugs among alcoholics is considered to be an important factor. Factors of use in predicting suicide are discussed.
Virchows Archiv A Pathological Anatomy and Histopathology, 1987
Nine white leghorn chickens were injected i.m. with furosemide (10 to 60 mg/kg body weight) twice... more Nine white leghorn chickens were injected i.m. with furosemide (10 to 60 mg/kg body weight) twice daily for 18 days. The birds were then anesthetized with a combination of equithesin and diazepam and the kidneys perfused via the heart. Kidney tissue was sectioned serially and the granular epithelioid cells were counted in the juxtaglomerular apparatuses of the furosemide treated birds and in 3 normal chickens. Hyperplasia and hypergranulation of the epithelioid cells was found to occur in the juxtaglomerular apparatuses of both mammalian and reptilian type nephrons (with and without Henles loop) in the furosemide treated group. This finding was interpreted as an effect of hypovolaemia on the juxtaglomerular apparatuses. Furosemide caused an immediate stop in weight gain, an increase in the erythrocyte volume fraction and a sudden drop in blood pressure. The blood pressure later rose to subnormal levels. The heart rate was not altered. Plasma sodium and chloride fell significantly one day after furosemide administration and remained low throughout the experiment. Potassium fell during the second part of the experimental period. Captopril was injected after 18 days of furosemide treatment and lowered the blood pressure significantly. This was interpreted as indirect evidence for the presence of renin in the granular epithelioid cells and indicates the importance of the renin angiotensin system in maintaining the blood pressure in hypovolaemic conditions.
Fentanyl is a potent synthetic opioid used as a general anesthetic and analgetic. Fatal outcome f... more Fentanyl is a potent synthetic opioid used as a general anesthetic and analgetic. Fatal outcome from intravenous misuse of transdermal fentanyl is rare, and there are few such reports in literature. Here we report two cases of fatal intravenous injection of the content from fentanyl patches. Both were male drug addicts, found dead within a one week interval in the same apartment. Post-mortem femoral blood was screened for amphetamines, cannabinoids, cocaine, and opioids with immunological methods (EMIT II) and further with headspace gas chromatography for alcohol and with liquid chromatography mass spectrometry (LC-MS) for different drugs, including fentanyl. Confirmatory analysis of fentanyl and morphine was performed by gas chromatography-mass spectrometry (GC-MS). In the first case, the toxicological analysis revealed fentanyl (2.7 ng/mL), morphine (31.4 ng/mL), and ethanol (1.1 g/L) in postmortem blood and amphetamine, cannabinoids, morphine, and ethanol (1.4 g/L) in postmortem urine. In the second case, the analysis revealed fentanyl (13.8 ng/mL), 7-aminoclonazepam (57.1 ng/mL), and sertralin (91.9 ng/mL) in postmortem blood and a small amount of ethanol (0.1 g/L) in postmortem urine. Police investigation revealed that both the deceased had bought the patches from the same source. The present cases demonstrate the possibility of intravenous misuse of transdermal patches and the risk of fatal outcome.
: Three classic cases and one exceptional case are reported. The unique case of decapitation too... more : Three classic cases and one exceptional case are reported. The unique case of decapitation took place in a traffic accident, while the others were seen after homicide, vehicle‐assisted suicide, and after long‐jump hanging. Thorough scene examinations were performed, and photographs from the scene were available in all cases. Through the autopsy of each case, the mechanism for the decapitation in each case was revealed. The severance lines were through the neck and the cervical vertebral column, except for in the motor vehicle accident case, where the base of skull was fractured. This case was also unusual as the mechanism was blunt force. In the homicide case, the mechanism was the use of a knife combined with a saw, while in the two last cases, a ligature made the cut through the neck. The different mechanisms in these decapitations are suggested.
Inhalation of automobile exhaust gas often leads to death by CO intoxication. In some cases the m... more Inhalation of automobile exhaust gas often leads to death by CO intoxication. In some cases the measured carbon monoxide hemoglobin saturation level (COHb) is considerably below what is considered to be lethal. The death in such cases has been attributed to a combination of a high CO2 and a low O2 tension. In a recent case the deceased was found dead in a car equipped with a catalytic converter, with a hose leading exhaust from the engine to the interior of the car. Analysis revealed a moderately elevated COHb and a high methemoglobin saturation level (MetHb) in peripheral blood. No ethanol, narcotics or drugs were detected. Reports mentioning MetHb or methemoglobinemia in post-mortem cases are surprisingly scarce, and very few have related exhaust gas deaths to methemoglobinemia. High-degree methemoglobinemia causes serious tissue hypoxia leading to unconsciousness, arrhythmia and death. The existing literature in this field and the knowledge that exhaust fumes contain nitrogen oxide gases (NOx) that by inhalation and absorption can result in severe methemoglobinemia, led us to postulate that this death could possibly be attributed to a combination of methemoglobinemia and a moderately high COHb concentration.
A previously healthy 53-year-old man died suddenly and unexpected. The main finding at the post m... more A previously healthy 53-year-old man died suddenly and unexpected. The main finding at the post mortem examination was a large 4th ventricle subependymoma, a rare brain tumour related to the ventricles of the brain. The salient features of subependymoma are described with emphasis on the microscopic picture and distinction from subependymal giant cell astrocytoma, as the tumour harboured large, bizarre astrocytes. Coronary atherosclerosis and mild cardiac hypertrophy were present as the only pathologic changes outside the central nervous system. The cause of death is discussed in light of earlier reports on brain tumours and sudden fatal incidents.
Deaths from asthma investigated by the Department of Forensic Medicine, The Gade Institute, Unive... more Deaths from asthma investigated by the Department of Forensic Medicine, The Gade Institute, University of Bergen during the period 1977-1986 were recorded. There were 11 cases with information in the police report of the use of pressurised bronchodilating aerosols prior to death. Seven of the victims were found with the aerosol in the hand or close by the body. Overdosage due to excessive inhalation were suspected in several of the victims. The possibility of side effects due to overuse is discussed. Other mechanisms of death are also discussed.
The results from a study of bone strength in normal infants is presented. The fibular bones of in... more The results from a study of bone strength in normal infants is presented. The fibular bones of infants dying from SIDS were tested mechanically by a three-point bending test and the behaviour of the bony structure determined by measuring several variables. Correlations between these variables and infant age, length, weight and length of fibular bones were found and base-line values for bone strength established.
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Papers by Inge Morild