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Discrepancy of clinical symptoms and prognosis of a patient — forensic significance of “talk and die” head injury
(Legal medicine, 2000) Ng'walali, Paul M.
Deaths of patients who had talked after sustaining a head injury and were then assumed clinically to be recovering from the head trauma raise medicolegal questions about the precise causes of deaths. A forensic autopsy on a 77-year-old man who had been talking after a road traffic accident and died on the sixth day showed slight subdural hematoma, bifrontal cerebral contusions and diffuse axonal injury. No natural diseases or delayed complications of injury were found. The cause of death was certified as head injury due to a traffic accident. This is a case of “talk and die” head injury. Forensic autopsy is important in patients with “talk and die” to clarify the causal relation to the head trauma in relation to any further forensic dispute.
[Ethanol concentrations in multi-site sampling blood in forensic autopsy cases--a retrospective analysis over a period of six years (1994-1999) in Kumamoto University].
(The Japanese Journal of Legal Medicine, 2002) Ng'walali, Paul M.
Ethanol and n-propanol concentrations in forensic autopsy cases determined in Department of Forensic Medicine, Kumamoto University School of Medicine were reviewed retrospectively. Out of 388 autopsies in 6 years (1994-1999), ethanol was positive in 88 (22.7%) cases. Higher positive rates were observed in bleeding and burning cases compared to other cases. Histograms of the blood ethanol concentrations in all ethanol positive cases had two peaks at 0.1 mg/ml to 0.5 mg/ml and 1.5 mg/ml to 2.0 mg/ml ranges, which indicated that not only an intermediate but also a weak drunkenness level could be a risk factor of being involved in forensic fatalities. There were no differences in mean ethanol concentrations in the blood samples of the right, left and whole heart blood collected from each victim. The femoral blood, however, was slightly higher than those of heart blood. N-Propanol, an indicator for postmortem ethanol production, was detected in 14.7% of stomach contents samples as early as 6 to 12 hours of post mortem intervals, whereas it was not remarkable in urine and femoral vein blood.
Fatal intussusception in infancy: an experience in forensic autopsy
(Legal medicine, 2003) Ng'walali, Paul M.
Intussusception, although a common cause of pediatric surgical emergencies, is a rarely fatal condition. A 7-month-old infant who was discovered in her cot was unresponsive and pronounced dead after 2 h of uneventful cardiopulmonary resuscitation in an emergency hospital. Forensic autopsy which was performed in order to clarify the circumstances surrounding the death revealed intussusceptions at two sites of the ileum. Although morbidity and mortality rates from the condition have progressively declined in recent decades but avoidable deaths still occur as was experienced in the present case. The forensic pathology significance in this case was the occurrence of ‘painless intussusception’ whereby the affected child clinically exhibited no discomfort or characteristic features of acute abdomen until death. In summary, the present case has exhibited an uncommon fatal occurrence and demonstrated the importance of forensic autopsy in such unexpected sudden infant deaths.
The forensic exhumation and human remain identification of an individual with albinism
(Forensic Science International, 2022-06-06) Ng'walali, Paul M.
This article reports on an exhumation of an individual identified to be a victim of albinism from a trench dug for a well on 16 April 2018, Ukonga, Dar es Salaam, Tanzania. The skeletal remains were sent to the Forensic Bureau of the Tanzania Police Force for further investigation. Ante-mortem and postmortem information, the deoxyribonucleic acid (DNA) and skeletal diagnosis were used in the identification. Skeletal diagnosis suggests that the victim was a young African male aged between 19 and 26 years old with stature of 157–166 cm. Ante-mortem trauma suggest that the individual was wounded with a sharp object on the left shoulder resulting in severe infection. The victim had a problem with acute dental caries suggesting the existence of biochemical reaction. He also had porosity lesions on cranium and vertebral column which is indicative of chronic malaria infection or anemic condition. The distal end of the tibia exhibited a peri-mortem pilon fracture on the articular surface of the malleolus. This signifies he fell into that long edge trench either intentionally or accidentally or pushed by people and that is the circumstances of death. This article also provides a general picture of challenges facing people with albinism in Africa. People with albinism have been victimized in many ways such as restricted right of self-expression, deficiency of freedom, being hunted or repudiated to death, and deficiency of medical treatment. They also are suffering from dermal diseases, injuries and infections that can easily lead to skin cancer and skeletal diseases due to their disability. In fact, this problem requires urgent resolution for health departments and those involved in the protection of civilians, especially the security agencies. It is an intolerable life; therefore, African governments should take serious measures to curtail atrocities committed to people with albinism.
Forensic exhumation and human remains identification: A gap between the Inquest Act 1980 and medico legal education in Tanzania
(Forensic Science International, 2022-07-30) Ng'walali, Paul M.
This article discusses the gap between the Inquest Legislation of Tanzania and the medical practitioner's teaching curriculum which also covers the medico-legal field. The Tanzanian law clearly states that ‘any Government medical practitioner’ may be given the responsibility of exhumation, provision of post mortem order and then examination of the corpse where there are ample circumstances requiring an inquest to assist police investigation and the Judiciary in determining whether the cause of death was natural. However, the medical training curriculum in Tanzania for many years did not offer any courses of forensic exhumation and identification of human skeletal remains. Therefore, there has been a gap between the legal entities and the curriculum organization of medical practitioner: a condition that leads to medical practitioners failing to fully support the criminal investigation departments and the judicial system. The article highlights the existing gap and its challenges, shortage of experts in the field of forensic science services and provides some suggestions on how to address these challenges where the proposed methods can be applied to both short- and long-term plans.
Mob justice in Tanzania: a medico-social problem
(African health sciences, 2006) Ng'walali, Paul M.
Objective: To investigate the magnitude of mob justice and associated factors. Background: Mob justice is a social and public health problem that has grown in Tanzania in recent decades that has negative effects on social and health of the country, communities, and families. Materials and Methods: A four-year autopsy study was conducted at the Department of Pathology, MUCHS. Information on the cases was obtained from police, the relatives, friends and other witnesses if available. Results: 1249 persons were killed by mobs in Dar es Salaam during the period of 5 years (2000-2004). The alleged offense ranged from a serious crime like theft or murder to a mere violation of local customs or religious beliefs. The mode of the killings were mostly burning (48.11%) and stoning (49.96%). Other modes accounted for only 3.0% of the cases. The pattern of injuries ranged from skull and other skeletal fractures to viscera rupture. Conclusion: MJ is a social, legal and public health problem in Tanzania that needs immediate attention. Unemployment of youth and perceived economic inequalities should be addressed. As long as the judicial system doesn't work and corruption is not punished, people will continue to organize their own trials and judge their suspects in the street. These must be tackled in order to reduce the growing incidences of mob justice, hence saving life. It must be ensured that criminals do not violate the freedom, dignity and respect of each and every human or member of the society. African Health Sciences Vol. 6(1) 2006: 36-38
Neuropathological diagnosis of Alzheimer's disease in forensic autopsy of elderly persons with fatal accident
(Legal medicine, 2002) Ng'walali, Paul M.
Cognitive dysfunction in Alzheimer's disease may lead to accidental deaths in the elderly. Neuropathological diagnosis of the disease is, therefore, an important issue in forensic autopsy to determine the causal relation to accidents. To evaluate the suitability of the current histopathological diagnostic criteria for Alzheimer's disease by Khachaturian and Mirra et al. in elderly persons dying from accidents and coming for forensic autopsy, we studied the brains of nine demented and 12 non-demented persons by silver stain and immunohistochemistry. When the density of senile plaque was applied to the criteria, only four out of nine demented persons met the criteria for definite Alzheimer's disease. The demented persons had significantly higher density of diffuse plaque and higher frequencies of amyloid angiopathy, neurofibrillary tangle and neuropil thread than the non-demented persons. These results indicated that the current diagnostic criteria do not always diagnose Alzheimer's disease in forensic autopsy of elderly persons with fatal accident. The presence of abundant diffuse plaque, neurofibrillary tangle, amyloid angiopathy and neuropil thread may help to diagnose Alzheimer's disease in forensic autopsy.
Pink spots of Hedley-White in the brain. Evaluation of the significance in the forensic autopsy
(Legal medicine, 2000) Ng'walali, Paul M.
Pink spots are sharply demarcated round to oval discolorations with a white center in the deeper areas of the formalin-fixed brain. In 152 forensic autopsies with neuropathological examinations, the authors observed pink spots in three of 16 patients with bacterial infectious diseases. Pink spots could not be found in 136 patients without bacterial infectious diseases. These results verify the concept that pink spots correlate with bacterial infections. The presence of pink spots will be used as an indication of infectious diseases in the forensic autopsy.
Self-destruction by multiple methods during a single episode: a case study and review of the literature
(African health sciences, 2010) Ng'walali, Paul M.
Background: Although the prevalence of suicide in the world is not clear, however, the reported rates of suicides are consistently higher among men tan women regardless of age group. Methods: A case employing multiple methods during a brief time of self-destructive behavior is presented. A 44-year-old postmaster who was under criminal investigation by his head office for embezzlement, leaped down a high river cliff and drowned after an initial attempt to commit suicide by hanging from the bridge over the river. The autopsy and scene investigations were both employed and very helpful. Results: Three different methods of suicide were apparent in this instance: hanging, leaping down the cliff and drowning as was evidenced by the autopsy and positive diatom test. The complexity of this case was the planned protection against the failure of one method employed to commit suicide. The methods used were all highly lethal ones. There was neither history of previous suicide attempts nor psychiatric disorder. Conclusion: Although the cause of death may appear clear at autopsy in cases of self-destruction by multiple highly lethal methods during a single episode, scene investigation is important for the forensic pathologist to understand the whole story of the case and determine the manner and actual cause of death. Scene investigation and autopsy is emphasized as part of the whole postmortem investigation of death in cases of unusual suicide using multiple methods of self-destruction.
Sexing contemporary Tanzanian skeletonized remains using skull morphology: a test of the walker sex assessment method
(Forensic Science International, 2021) Ng'walali, Paul M.
Determination of sex in a burial or comingled assemblage is an essential element in forensic human skeletal identification. Establishing the sex of individual skeletal remains using skull landmarks is one of the traditional human osteological methods. This study sampled 86 skeletonized skulls of contemporary Tanzanians to test a popular sex assessment technique developed by Walker's cranial nonmetric approach. The sex estimate was scored from Walker's Log Regression equations involving nuchal crest, mastoid, glabella, mental eminence and supra orbit ridge characters. Basing on the formula, females display feature scores of 1–3, and males typically display individual feature scores of 3–5. At the same time, mastoid and glabella were the best features of sex determination after the evaluation. Also, the test displayed a high overlap between males' and females' characteristics of mental eminence, nuchal crest, and supraorbital ridge. Generally, the Walker sex estimation method using cranial features on current skeletonized Tanzania population failed to provide concrete sex assessment results, thus justifying the suggestion that; we need a modified population-specific approach.
Traumatic Basal Subarachnoid Hemorrhage Due to Rupture of the Posterior Inferior Cerebellar Artery
(Neurologia medico-chirurgica, 2000) Ng'walali, Paul M.
A 20- year-old male presented with traumatic basal subarachnoid hemorrhage after being involved in a fight. Antemortem clinical examination could not exclude the possibility of rupture of abnomal blood vessels because of the absence of the external injuries.Careful postmortem of examination of the head and neck regions and histological examination of the intracranial arteries demonstrated traumatic rupture of the left posterior inferior cerebellar artery due to a fist blow to the jaw.This case indicates the need for careful autopsy examination for the differentiation of traumatic and non traumatic basal suburachnoid hemorrhages
Unusual homicide by air gun with pellet embolisation
(Forensic science international, 2001) Ng'walali, Paul M.
A homicidal case by an air gun involving a 73-year-old woman who was found dead in her home is described. At autopsy, two gunshot wounds were observed on the left anterior chest and the right back. There was neither exit wound nor powder burns. The fatal pellet, 0.9 g and 5.5 mm diameter, penetrated the left anterior chest and the heart to cause cardiac tamponade (200 ml) before lodging in the left subclavian artery. Death was due to cardiac tamponade. This case has exhibited two rare phenomena: homicide by an air gun and pellet embolisation. This is the first homicide case by use of air gun in Japan and demonstrates that although it may be rare, air guns can be used as potential homicidal weapons. This experience will alert our society and others on the potential hazards of air guns we have tended to regard as toys.

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