Cases Of Natural Death Research Articles

Electrical excitability of skeletal muscle postmortem in casework

The paper gives a review of the development of methods of postmortem electrical excitability of skeletal muscle for determining the time since death. For practical application in casework, the following method can be proposed: position of electrodes in the orbicularis oculi muscle, stimulation by rectangular impulses of 10 ms duration, 30 mA in a repetition rate of 50/s. The muscular reaction on excitation is graded in 6 degrees according to the spread of movement and the intensity of contraction. To each degree a time information is corresponding (95%-limits of confidence). These 95%-limits of confidence were proved to be valid for cases of sudden natural or traumatic deaths. Exclusions: deaths after chronic lingering diseases (shorter times), fatal hypothermia, haematomas, emphysemas of the eyelid (longer times). The practical application in casework together with the temperature method (Henssge 1988, 1) is described. Applying both methods the death time estimation in the early postmortem interval may be much more precise and accurate than using one method alone.

The most severe chronic organ findings in official public health autopsies--a medico-sociologic contribution

At the Vienna Institute, in the year 1986, 79 carcinoma findings were recorded in 1736 cases of natural death. The most common were carcinomas of the respiratory and gastrointestinal tracts. Seventeen unidentified tumors were found to have been the cause of death. Public health autopsies, therefore, contribute to the clarification of tumor disease and thus to cancer statistics. Although diagnosed fatal cancer cases correspond to only 0.33% of all cancer deaths in Vienna, the question arises why a patient with very advanced cancer is not under medical care and why the affliction is revealed only in autopsy, the purpose of which is to elucidate sudden, unexpected deaths. The comparatively few individual cases should nevertheless give cause for reflection and are discussed from a medicosociological view, taking into consideration the statistical and epidemiological data relating to cancer diseases.

Evaluation of sudden death in epilepsy.

Records of the Office of the Chief Medical Examiner of the State of Maryland were reviewed for all cases of natural deaths due to epilepsy occurring in 1981 and 1982. Cases involving unclear seizure history, alcoholism, or other superimposed disorders were excluded. Twenty-nine cases were accepted and analyzed with respect to age, race, sex, circumstances of death, neuropathology, and anticonvulsant therapy. Most cases involved black males, the median age at death was 26 years, and the vast majority died in bed or in the bedroom. Less than half of these individuals had neuropathological lesions. Most had detectable levels of anticonvulsants in post-mortem blood; more than half the decedents with detectable levels of phenobarbital showed therapeutic levels of this drug.

Lactic Acid Concentrations in Vitreous Humor: Their Use in Asphyxial Deaths in Children

Lactic acid concentrations in brain tissue of humans have been shown to increase with an extended agonal period. Infants and children dying from various causes are undergoing different stress conditions terminally and the postulate of this study is that natural death cases and traumatic asphyxia cases are characterized by varying agonal periods, the former being somewhat prolonged with the latter being rather brief. One-hundred-and-two cases of infants and children were examined for vitreous humor lactic acid concentrations. They were divided into two major categories, Sudden Infant Death Syndrome (SIDS) and non-SIDS cases. SIDS was further divided into SIDS without additional findings and SIDS with secondary findings which contributed to death. The non-SIDS category included traumatic asphyxia cases as well as those dying from blunt trauma, known respiratory diseases, and other causes. Categorical mean values and standard deviations were calculated. The vitreous humor lactic acid mean value for traumatic asphyxia was significantly lower than the mean value for SIDS. Also the mean value for known respiratory diseases was statistically lower than the mean value for SIDS with secondary findings. These findings are probably suggestive of agonal time differences and may be a reflection of the various mechanisms of death.

Cause of ill health and natural death in badgers in Gloucestershire.

During the period 1973 to 1976 inclusive, 1206 badger carcases were examined for evidence of tuberculosis and other diseases. Tuberculosis was the major cause of natural death, killing 39 per cent of the natural death cases, followed by bite wounding and starvation. Road traffic accidents were the greatest single cause of death.

Sudden death in infants

Summary An analysis has been made as tothe causes of death in 1,267 infants and young children 4 years and under, reported to the office of the Chief Medical Examiner in Richmond over an eighteen-month period from Jan. 1, 1952, to July 1, 1953. In the same period there were about 5,400 deaths in the entire State. This study, then, represents about 23 per cent of the total deaths for the same age group. The greatest number of deaths occurred in the group classified as “unknown natural” (729 cases). Onehundred and four of these cases were autopsied and twenty-seven cases were found to fit into a pattern variously classified as interstitial pneumonitis or overwhelming infection. A closer analysis has been made of these twenty-seven cases plus five additional cases from my own series. A classic symptomatology for these deaths can be given, namely, a child, usually under 6 months, in previous good health, who is found dead in bed. Given that history, it is possible to state what will be the usual autopsy findings. In addition, it was pointed out that many of the unautopsied cases of natural or accidental deaths variously diagnosed as pneumonia, upper respiratory infection, asphyxia, and aspiration of vomitus give the above history and undoubtedly are cases of the same process. The various factors known to date concerning these deaths have been briefly discussed. It is pointed out that in my opinion, and in the opinion of others in the State who have had an opportunity to see or review these cases, that a satistactory explanation as to the cause of death has not been given. Finally it is suggested that it is better to sign these children out as cases of “unknown natural” when other known factors can be eliminated than it is to state that these children die from suffocation, prematurity, asphyxia, aspiration of vomitus, or even interstitial pneumonitis. This is important for two suggested reasons. A diagnosis of suffocation carries a psychological impact which may give a family a guilt feeling of neglect lasting a lifetime. It is felt that it is better to make a diagnosis of “unknown natural” in these children, for it suggests that we do not actually know what has killed them. From this it is hoped will come a further search for the fundamental process which is occurring and which kills these infants with such rapidity that it is both startling and distressing.

Sudden and unexpected natural death: II. Coronary artery sclerosis

Among 2,030 cases of sudden and unexpected natural death autopsied over a six and one-half-year period in the Borough of Manhattan, New York City, in 45 per cent, death was attributed to diseases of the heart and aorta. Of these, two-thirds (30.4 per cent of the 2,030 cases) were caused by coronary arteriosclerosis. This percentage of coronary artery disease in the cardiac and aortic group corresponds almost exactly with that reported from Berlin, Germany, over an eight-year period. Sudden death from coronary artery sclerosis occurred most frequently in white men (90 per cent). The three decades between 44 and 74 years contributed one and one-half times their percentage share of the population, but sudden death from this disease began to appear in the third decade. Death took place under no specific circumstances. In almost three-fourths (75.5 per cent) of the hearts, coronary artery sclerosis, and not fresh thrombosis, was responsible for vascular occlusion. In the remaining cases, a not always fresh thrombosis was encountered and an underlying sclerosis, usually of severe grade, was always present. It is incorrect to attribute death to coronary thrombosis without indicating the underlying primary sclerotic disease of the arteries. Cardiac hypertrophy was found in 117 (66 per cent) of the 163 subjects whose deaths were analyzed during a two-year period. It was more prominent in the presence of myocardial fibrosis.