Lividity Research Articles

Accidental Drowning of Toddlers in Buckets

To Editor.— The recent Brief Report by Jumbelic and Chambliss1provided some alarming statistics concerning drowning deaths in toddlers. However, my attention was caught by photograph in Fig 2, labeled Infant with head down in an empty 5-gallon plastic industrial bucket. I could not help but notice presence of livor mortis on midback and legs as well as prominent blanching of presacral area, buttocks, and both heels. Livor mortis is the reddish-purple discoloration found in dependent areas of body due to accumulation of blood in small vessels of dependent areas secondary to gravity.2Blanching is due to external pressure on dependent areas during this process. The external pressure compresses soft tissue, which prevents accumulation of blood, thus producing pale or blanched areas. With these facts in mind, one could postulate at least two different scenarios.

Accidental Drowning of Toddlers in Buckets-Reply

<h3>In Reply.—</h3> We agree with Dr Helmuth's astute observation that livor mortis is present on the back of the infant in the photograph in our article. Lividity was not seen at the time the infant was found in the bucket but developed after the body was placed in a supine position overnight. The photograph was taken the day after death to demonstrate the circumstances at the time of the infant's death. It also illustrates how these 5-gallon containers do not tip over with the infant inside, even when empty. As forensic pathologists, we are always suspicious of deaths in children, even in the context of apparent accidents. We investigate the circumstances of death and perform thorough autopsies. All of the infants in our study died of accidental drowning, with no evidence of homicide. We appreciate the comments of Dr Hyma and agree that these 5-gallon containers represent an unsuspected

Carbon Monoxide Poisoning in a Motel-Reply

In Reply.— Dr Harlan seems to have taken offense when none was given, but more unfortunately he has missed the central point of the article and its accompanying editorial. Both were meant to draw attention to a potentially preventable cause of morbidity and mortality. Carbon monoxide is responsible for almost half of all deaths from poisoning, and it is the most frequent cause of chemical asphyxiation. A major reason that several thousand people die every year from its effects is that carbon monoxide poisoning is not considered as often as it should be as a cause for unexplained coma. Dr Harlan illustrates that point when he says that after one person was found dead on the floor of a motel room with cherry-red livor mortis and another person lay a few feet away in coma, that carbon monoxide poisoning tended to be ruled out because they were found in an

Letting Go: DNR Orders in Prehospital Care

We have come full circle in the 20 years since Pantridge and his associates moved the practice of cardiac resuscitation from the hospital into the community. Many victims of out-of-hospital sudden death have been saved in the intervening time, and those involved in prehospital care understandably have focused on preserving life by rapidly providing care at the scene of the patient's collapse. This emphasis saves lives, and resuscitation, at first applied almost exclusively to patients with ischemic heart disease, is now attempted for nearly everyone collapsing in public. Giving paramedics guidelines for starting resuscitation is a problem. Many jurisdictions opt for legal safety by requiring resuscitation attempts in virtually all patients. Los Angeles paramedics are instructed to begin resuscitation in all cardiac arrest patients unless there is decapitation; massive crush injury or evisceration of heart, lung, or brain; incineration; rigor mortis; postmortem lividity; or decomposition. These criteria all address the

Cessation of livor in defined pressure conditions

In 28 cases of sudden death, the corpses were tested for the effect of different storage temperatures (5 degrees C, 14 degrees-15 degrees C, 25 degrees C) regarding the reaction of livor mortis to known pressure conditions (force and duration of pressure). The reaction is dependent on the storage temperature but there is no linear relationship. At certain storage temperatures the postmortem lividity reaction is dependent on the amount and duration of the pressure. In addition, at defined storage temperature and pressure conditions, there are large interindividual differences in the estimation of time of death.

Fuseli's nightmare.

To the Editor:— My own subsequent researches into the interpretation of the painting lead me to different conclusions. First, although I admit I find few who will readily agree with me, the victim of the nightmare lies not merely on a couch, but on what appears to be at least suggestive of a cadaver, showing fairly typical postmortem lividity. This cadaver's head and upper limb girdle are not shown, but his left leg and torso are clear, to me at least, inThe Journal'sreproduction. This observation led me to believe that Fuseli had, after all, painted a horror story in the same sense that many of his other paintings are Gothic tales, both those with and without titles or obvious symbolism. I was not convinced that one could ascribe any attempt at descriptive psychopathology to the painting. In an article about the painting, Dr. H. W. Janson of the