Læknablaðið - 15.03.1980, Page 46

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LÆKNABLADID
up against a wall in a parking lot. He was a
lay-about and it was thought that he might
have been crushed by a reversing autobus.
Infra-red photography, however, of his cloth-
ing, revealed that he had been run over.
Not only the wheels may leave their mark
upon a pedestrian who has been run over but
also various parts of the underpart of a vehicle
leave their imprints, often heavily impregna-
ted with oil. A body that is caught up under a
vehicle may be dragged for varying distances
and receive deep abrasions and lacerations
from the roadway and these become heavily
impregnated with grit and dust from the road
surface.
The passage of a wheel over the victim,
especially if it passes over a limb, causes the
characteristic injury known as degloving. The
skin and subcutaneous tissues are stripped
from the muscle layers, not infrequently with
no break in continuity in the overlying skin. If
the victim survives and the condition is not
recognised by the surgeon he may find all the
skin sloughing from the injured part during
the immediate post-accident period.
A further complication of road accidents,
and especially those involving pedestrians, is
the chance that the victim may be struck or
run over by one or more vehicles not involved
in the original accident. In these cases the
pathologist may be posed certain questions
which it may not be possible for him to answar
with finality. The most important question of
course, which always arises, is: was the victim
dead when struck by the second vehicle?
We now come on to a very important
aspect of the investigation of road traffic
accidents — that is the contribution of drugs
or alcohol to the accident. The problem varies
from country to country, more so in respect of
drugs than alcohol. Let me say at once that 1
consider alcohol to be one of the major
contributory causes of road traffic accidents in
Great Britain. When we made it a statutory
offence to drive a motor vehicle with a blood
alcohol of over 80 mgms. %, there was an
immediate drop in the overall accident rate,
but'this has since risen.
I will not bore you with statistics but wish
merely to inform you of my personal observa-
tions. I compared the blood alcohol levels of
fatdlities before the act came into force in
1967 with the first hundred I examined after
the act and compared the figures. In the pre-
1967 group slightly more persons had been
drinking but in the post-1967 group the blood
alcohols of those who had been drinking were
of a higher average than the pre-1967 group.
As you are aware the attitude towards the
drinking driver varies in different parts of the
world. In some countries the mere presence of
alcohol in the blood is an offence and in others
levels of up to 150 mgms./lOO mls. are
permitted. The reasons for these wide varia-
tions are numerous. They include religious and
political considerations and sometimes reflect
the drinking habits of the population in
general.
It is the problem of drugs which has such a
world wide variation. In rny persona! experi-
ence, and I emphasise this, it has not been a
major factor. As a routine I always carry out
blood and urine alcohol levels and when a
victim is on medication for epilepsy all the
drug Ievels are noted. Beyond that 1 do not go
unless there is some indication. For a period I
had all fatalities between 14 and 50 years
screened for drugs, including antihistamines
and tranquillisers. It was an expensive and
negative exercise. I am, however, hearing of
increasing numbers of persons stopped by the
police because their road behaviour appears
abnormal, who have been taking Valium
(Diazepam) and a small amount of alcohol.
Persons addicted or habituated to drugs do
not pose the problem in Great Britain that
they pose elsewhere in the world, and again I
have no personal experience of drug abuse,
other than alcohol, contributory to a fatal
accident. Alcohol levels in drivers vary consi-
derably. Those habituated to alcohol may
drive their vehicles at levels lethal to the
average person. The highest level I have had
personally recorded in a driver was 640, but
this is no record.
Finally we come to the role of the patholo-
gist in the case of a fatal hit-and-run accident.
This is an extremely rare offence in Great
Britain. In thirty years of medico-legal work I
doubt whether I have seen on average more
than one case every two years. They are now,
however, showing a tendency to increase as a
result of the statutory offence of driving with
a level of over 80 mgm./IOO mls. The driver
may drive on after having been involved in an
accident and the following morning will go to
the police station and say that he found
damage to his car in the morning, but does not