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Cause of death
Public Health The Journal of The Society of Community Medicine (Formerly the Society of Medical Officers of Health) Volume 95
Number 2
March I981
Cause of Death Death is a fact. Its certified cause is only an opinion based upon current "' knowledge", belief and fashion. Differences between the opinions of the clinician and the pathologist are common. In less than 50~ of those deaths whose cause is checked by autopsy,are the views of the clinician and the pathologist in full agreement. It is often assumed that in such-cases, the pathologist is the 'more likely to be correct, but this may not be so. Unless the cause is one associated with visible change in appearance, the pathologist may well fail to find it. He will attribute the death to any abnormality which his examination reveals, though this may not in fact bear much relation to the true cause of death. The truth of this is best illustrated by looking at" Cot Deaths" as so many of these exhibit little obvious pathology. In the course of.one study of sudden infant deaths over a period of 30 years, clear changes in fashion were"discernible. Since "'Cot Death" has only been an accepted "Cause of Death" for a relatively short time, it was necessary to apply defined criteria to the selection of cases, and ignore both the pathologists" and the coroners" opinions. When this was done, the certi~,$edcauses ofdeath were seen to change dramatically with time, and with the appointment of new pathologists! The era of "status thymolympaticus" gave way to that of"suffocation by a soft pillow" and that in turn to "respiratory infection". Finally, Sudden Infant Death Syndrome became the fashionable "'diagnosis". After Professor Emery had shown by analysis of the vitreous humour that many Cot Death babies were hypernatraemic, this possibilitycame to be appreciated, but as this leaves no visible evidence, few pathologists have attributed deaths to it. In the U.S.A. some have been attributedto Infantile Botulism. More recently, hyperthermia has been suspected as a cause of cot death, but again this may not be recognizable post-mortem. Apnoea due to anomalous respiratory reflexes, anaphylactic reaction to "foreign" protein, and syncope, are also under suspicion as possible causes of some cot deaths, but leave little evidence for the pathologist. Those pathologists who undertake virological examinations frequently find pathogenic organisms, but can isolate these same pathogens with almost equal frequency from live infants. For research purposes, certified cause of death must always be suspect. We can be confident that those we have buried or cremated are indeed dead, but of little else!
Number 2
March I981
Cause of Death Death is a fact. Its certified cause is only an opinion based upon current "' knowledge", belief and fashion. Differences between the opinions of the clinician and the pathologist are common. In less than 50~ of those deaths whose cause is checked by autopsy,are the views of the clinician and the pathologist in full agreement. It is often assumed that in such-cases, the pathologist is the 'more likely to be correct, but this may not be so. Unless the cause is one associated with visible change in appearance, the pathologist may well fail to find it. He will attribute the death to any abnormality which his examination reveals, though this may not in fact bear much relation to the true cause of death. The truth of this is best illustrated by looking at" Cot Deaths" as so many of these exhibit little obvious pathology. In the course of.one study of sudden infant deaths over a period of 30 years, clear changes in fashion were"discernible. Since "'Cot Death" has only been an accepted "Cause of Death" for a relatively short time, it was necessary to apply defined criteria to the selection of cases, and ignore both the pathologists" and the coroners" opinions. When this was done, the certi~,$edcauses ofdeath were seen to change dramatically with time, and with the appointment of new pathologists! The era of "status thymolympaticus" gave way to that of"suffocation by a soft pillow" and that in turn to "respiratory infection". Finally, Sudden Infant Death Syndrome became the fashionable "'diagnosis". After Professor Emery had shown by analysis of the vitreous humour that many Cot Death babies were hypernatraemic, this possibilitycame to be appreciated, but as this leaves no visible evidence, few pathologists have attributed deaths to it. In the U.S.A. some have been attributedto Infantile Botulism. More recently, hyperthermia has been suspected as a cause of cot death, but again this may not be recognizable post-mortem. Apnoea due to anomalous respiratory reflexes, anaphylactic reaction to "foreign" protein, and syncope, are also under suspicion as possible causes of some cot deaths, but leave little evidence for the pathologist. Those pathologists who undertake virological examinations frequently find pathogenic organisms, but can isolate these same pathogens with almost equal frequency from live infants. For research purposes, certified cause of death must always be suspect. We can be confident that those we have buried or cremated are indeed dead, but of little else!