Læknablaðið - 15.03.1980, Qupperneq 43

LÆKNABLAÐID
63
been drinking heavily, is involved in an acci-
dent, it becomes even more difficult to weigh
the various contributory factors.
Since documenting this series of 100 cases, I
have had three further cases where it would
appear that the natural disease found at
autopsy was the major contributory factor to
the accident. One case was that of a young
man with undiagnosed myocarditis. The se-
cond case was that of an uncontrolled diabetic
of 18 years. The third case illustrated how
involved such cases may become. The de-
ceased was a police driver. He had been
working long hours and had been to his
doctor with »indigestion«. He was clearly
suffering from considerable chest pain which
he was easing with alcohol. One night when
returning home after work, for no apparent
reason, his automobile went across the road
into an oncoming goods vehicle. Autopsy
revealed that he had had a recurrent coronary
thrombosis and a blood alcohol of 228 mgs.
per 100 mls. He had most extensive chest
injuries, including a complete rupture of his
thoracic aorta. There was only a little blood
in his chest and no haemorrhage around the
fractured sites. The Coroner’s jury decided
that he had died before he struck the goods
vehicle.
I have spent some time on the association
of natural disease and traffic accidents as I
have always considered it an important
aspect. From my limited series of cases the
persons who were involved in violent impacts
apparently as a result of natural disease were
suffering mainly from medical conditions
which would not be apparent on routine
medical check-ups. The vast majority were
suffering from myocardial insufficiency either
as a result of chronic occlusion or a sudden
acute coronary occlusion but were able to
bring their vehicles to a halt in most cases
before losing consciousness.
1 will move on now to the patterns of injury
which may be sustained by car occupants. The
distribution of injuries may lead to the identifi-
cation of the driver of the vehicle if this were
not known. I have had several cases where the
injured have been removed from the crashed
vehicle and in retrospect those who removed
the bodies could not remember from which
part of the vehicle the person was taken. Who
was driving the vehicle can naturally be of
great importance, especially if only one of the
occupants is insured to drive the vehicle and,
again, if one of the occupants was found to
have been drinking.
If the impact is very violent, the injuries
present on both the driver and the front-seat
passenger may be so similar that it is not
possible to say from the injuries alone who
was the driver. However, in cases where the
impact is not too violent the pattern of
injuries may enable one to separate the driver
from the front-seat-passenger without difficul-
ty. It is not only the distribution of injuries but
also the violence and the appearance of the
impact sites which enable this differentiation
to be arrived at with some confidence.
Figures 3 and 4 show the distribution of
injuries on both the driver and the front-seat
passenger. It will be seen that the differences
of distribution are not very great, the front-
seat passenger suffering more head injury and
the driver slightly more thoracic injury. (VIII)
When a frontal impact occurs, 80 % of
road traffic accidents are frontal, the unre-
strained occupants being thrown upwards
and forwards. The progress of the driver is