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Sudden and Unexpected Deaths

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Sudden and Unexpected Deaths TM Bzrnm 1 49490 xmmLOKAISDElommmi s~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~SrDDEN ADUEPCEAND UNEXPECTED DEATHS.ETS (FimB. :.299 ige. further study of the subject, to greater accuracy In posW.- morten work, and so to less conflict of medical evidenoe in cVu dibrezO criminal trigls; ON It is desirable, however, that the work and opinions of such examiner should not lead to any neglect in obtaining SUDDEN AND UNEXPECTED DEATHS. the evidence of any medical practitioner who has been In attendance upon a deceased person, or present at his death, DELIVEIRED BEFORE THE ST. PANCRAS AND ,SLINGTON or calledin after death, because my experience makes me DIVISION OF THE BRITISH MEDICAL ASSOCIATION, yearly more and more confident that the simultaneous By WM. WYNN WESTCOTT, M.B., consideration of both these evidences can alone obviate H.M. CORONER FOR NORTH-EAST erroneous conclusions, which may lead to most serious mistakes. Some recent attempts to supplant the medical I HAvE found great difficulty in selecting practitioner In forensic duties by a specialist have led to tamiliar to myself and likely to be of interest unfortunate results, due to the loss by medical men not in member of this Dilvision of the British Medical Associa- affluent circumstances of a source of income they have so tion. As, however, the majority of you are long enjoyed. It is, then, desirable, that any further medical practitioners, the sudden death of delegation-of poetnmortem work to special medical officers must always be a matter of concern should be authorized and regulated by new legislation, the reason for its occurrence a fitting subject and not undertaken' by any Individual public official, Investigation. however well-intentioned. As a coroner, my professional duty lies In the very proper desire to obtain accurate results there to solve the problem of the causes of in has been for many years what I conceive to have been an reported case, by means of general evidence exaggerated view of the importance of legal poet-morten relatives and casual friends as well as examinationsin cases of sudden and violent deaths. The observed by those present at or near the medicalprofe3sionappearstohavetaught the publicthatbya The Investigationis much simplifiedif of po8t-mortem examination alone could the causeaf any death a medical man conversant with the constitution of be ascertained, and that if an autopsy was made the cause of deceased person is available, and this is of still death was at once apparent. Unfortunately this viewis greater valueif there has been attendance deceased not In accordance with the facts, for In very many cases for ailments of recent date. However theP08t-mortem appearances will only show the presence may appear to be in any case,itis probable of so much disease or Injury as would render death a has been, perhaps long pre-existent probable event fromits existence. Or it may show so cognized, and quiteunknnown to any observer, flaw much disease orinjury as would certainly lead to deathin In the structure and In the action of the immediate future. It is In only a minority of cases organs. We all know we must die some that such a lesion is found as is incompatible with con- very different views of the best course In tinued life. In considering the diseases andinjuries conduct towards the coming change. Some persons to which man Is liable, Itis almost impossible to say careless, others are living daily in nervous whatcircumstances must be fatal. Take, for example, Some believe, and no doubt wisely, that the less allows what loss of blood isimposstble to be sustained; no one the mind to think of illness and death the can state the amount, or even the proportion of the total one's Insight and outlook remain. OR blood In the body. How much brain injury must kill, it there are many who have convinced themselves Is is vain to make any estimate; large areas may be ren- only by constant attention to the mode life-to diet, dered uselees by softening or haemorrhage without causing exereise, and regimen-that prolonged antici- a sudden death; whereas a puncturein the floor of the pated. Some bear in silence and gloom haunting fourth ventricle, orin a small area of the medulla of Infection and ultimate "cold gradations oblongata may causeinstant death. Some personsdie while others run about seeking advice medical suddenly from an angina pectoris, which the mere science or from quackery, In the belief valvular lesion in the heart may alone be found to explain. ingestion of drugs alone can health A man may die of a mere pinch of a healthy testicle, while Some people are haunted by fear of disease coming another may last for years with a cancerous tumour of the through an hereditary taint; others put testis, which may kill only by slow exhaustion. There In the knowledge of being descended from are hundreds of deaths from syncope or exertion, which lived ancestors. In the smallest community family cannot be explained by any cardiac or arterial lesion of circle even, we mayobserve almost every possible instantaneouso occurrence. Epilepsy, again, causes many tude of mind toward the approach of man's inevitable sudden deaths, and leaves no gross lesion In any organ by destiny. which it can be recognized, and the occurrence of a fit In the endeavour to account for a sudden death, cannot be proved In the absence of evidence of the events the items of evidence already referred of the hours before the death oecurred. monly thought that the results of a poet. mortem examina- By the interdependent healthy action of the brain, the tion may be relied upon to explain the causwe heart, and the lungs, life is maintained, said the great death.' In our cities and towns such Is French physiologist Bichat, and he added that death now made In almost all cases; but in country districts It begins at either the heart, lungs, or brain; 'this Is no is frequently neglected. It must be doubt true, especially when we refer to the appearances value of a poet-mortem examination seen at the hour of' death, but we are now in search of a depend upon the skill and experience more exact answer to the question, Why did this person In this country the local medical practitioner has die P known the deceased, the doctor who most We desire a definite answer for several reasons. First, recently, or the doctor who was called In for personal and family satisfaction, and In regard to life almost Invariably been chosen to make examination Insurance; secondly, for legal reasons, so as to be assured for legal purposes. On the Continent, that no person Is to be blamed for the death; thirdly, In In Scotand, this work Is entrusted order to secure accuracy In death registration; and, expert appointed by the judicial authorities lastly, to gAide survivors and their medical advisers In Such a doctor, having all the sudden their efforts to preserve the lives of other persons in the of the district brought to his personal community. soon become more able to reason correctly pos- There have been several definitions of a sudden death, mortem appearances than a private medical practitioner but it is not now my purpose to attempt any definition of who Is only called upon to investigate sudden the term, but rather to refer in general to such deaths as death as an exceptional incident. Again, It occur with little or no warning-, or are -preceded by no desrable that a doctor In geueal In midwifery such symptoms as have led to any anticipation of a fata prattise should -be occupied with poet-morte work. issue at the time when it occured.Dea1 i following Renee -we may observe a growing tendency -employ external wounds and injuries are not within the 'present upecialitsinmmorbid pathology to investigate the causies view. isIt ficult matter to offer -any classificationof of death.. is hoped hat the creation, of a, new public sudden deaths, either by means of the organ affected or and offi cer-a edical forme ei exaLmn er-.d w lead by symptoms preeediag death,i so t is proposedo tocefe r Tim Bitnm FinA., 29, 190g8.] SUDDEN AND UNEXPECTED DEATHS. LMNDIcAL Jou3rAI , 49g1 a to several groups of cases whichoome prominently before greatly excited by exertion orin very hot weather, and a the coroner's notice. heavy meal of solid food In old people may lead to a fatal Many fewer Inquests uponcases of sudden death ae fainting. held In oauntry districts than in London; first, because Syncope may also occur from sudden changes of so manyooroners will not hold inquests unlees there is pressure on the blood-vessels, such as occurs from- the some suspicion of foul play, and also becauee country tapping of a dropsy of the abdomen, or a pleuritic effasion, doctors are much more ready than London practttioners in or the quick emptying by a catheter of a greatJy over- poor neighbourhoods to offer a certificate of the cause of filled urinary bladder. death, basedupDn presumptton andhearsay, In the Sudden syncope is not uncommon after severe burns; in absence of observation during medical attendance. This thesecases we often find peritonitis from Inflammation laxtty of practice robs death registration ofits accuracy, and perforation of the duodenum. and may occasionally enshroud active criminality,as well Simple fatty degeneration of the heart muscle is the as negligence amounting to misdemeanour. only lesion foundin some cases of fatal syncope in From a tabulation of inquests held by me I have found delicate persons, whether obese or emaciated. Victims of that the chief factorin sudden deaths has been cardiac chronic alcoholism are extremely likely to die suddenly 60 per cent., cerebral 30 per cent., and pulmonary 10 per from a syncope; and this occurs during attacks of cent., so far as obvious symptoms and gross organic delirium tremens and also durlig the periods of exhaus- lesions can show, but such classificationis not very tion withnausea which follows drinking bouts, as well as definite, as cases- oocur in which It becomes uncertainin in the late and well-recognized stages of debility from whichoategory to place a death; forinstance,it a man liver and kidney disorganization which close the lives of die of syncope, exhaustion, haemoptysis, and phthisis, many drunkards.
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