Biomedical subjects
Publications and source records attributed to R M Whittington.
CASE REPORT: Acetylene is a commonly found industrial agent that, when mixed with oxygen, is used for welding. This report outlines circumstances surrounding the death of a 40-year-old male with presumptive evidence of abuse of the substance and subsequent death. The article covers the uses of acetylene, the toxic effects attributed to the gas, and the circumstances of the incident.
OBJECTIVES: To determine the epidemiology and the underlying pathological conditions of natural deaths among motor vehicle drivers. Sudden death while driving may cause damage to properties, other vehicles or road users. Although the Medical Commission on Accident Prevention recommended restrictions to drivers at risk of sudden death due to their medical conditions, these restrictions are useless if they do not result in greater safety to the public. DESIGN: A retrospective study of natural deaths of motor vehicle drivers. SETTING: Natural deaths of motor vehicle drivers reported to the coroner for Birmingham and Solihull. SUBJECTS: 86 consecutive natural deaths of motor vehicle drivers in a five-year period between 1984 and 1988. RESULTS: Of the 86 fatalities reviewed, 80 (93%) sudden deaths were caused by ischaemic heart disease. Fifty vehicles were involved in collision with 32 properties, 20 other vehicles and six pedestrians. Fifty-one out of 80 cardiac deaths had past cardiac history and three had reported chest pain prior to the sudden death. CONCLUSION: An applied normative ethical assessment based on the basic moral principles of autonomy, justice, beneficence and non-maleficence are discussed. We conclude that medical screening of drivers has little benefit for the drivers or other persons.
Two cases are reported of individuals who committed suicide after they had been identified as being acutely at risk of killing themselves. Self-strangulation by a ligature fashioned from the subjects' clothes was the mechanism of suicide in both cases. One death occurred in a police station and the other on an acute psychiatric ward. These cases highlight the need for those formulating policies concerning the supervision of the suicidal individual to pay attention to the minutiae of detail. In particular, a case is made for those at risk of suicide to be prevented from sleeping with their head covered by blankets.
We undertook a prospective study of all consecutive deaths reported to the Coroner for Birmingham and Solihull in a 5 year period. We identified 52 sudden deaths associated with symptoms commencing during sport participation. We studied the characteristics of these individuals. The majority had been performing at accustomed levels of activity without symptoms for several years. The extrapolation of our findings to preventive strategies remains unclear but we wish to highlight the importance of recognizing premonitory effort-related symptoms.
The records for Coroner's Inquests in one district during a 6 year period were examined retrospectively to establish the number and nature of deaths which were due to errors in the prescription or administration of medicines, and those due to adverse drug reactions. The district has a population of 1.19 million (1991), and a total of 3277 inquests were opened during the period 1986-1991. Ten of the deaths were identified as due to errors of prescribing or giving drugs. During the same period, 36 deaths were caused by adverse drug reactions. These 46 deaths made up approximately one in 2000 of all deaths during the study period. About a fifth of deaths related to prescribing and administering drugs are due to errors and may be more easily preventable than deaths due to adverse reactions.
Isobutyl nitrite is a popular recreational drug among both homosexuals and heterosexuals as it is alleged to enhance sexual pleasure and prolong orgasm. In contrast to the ingestion of this volatile nitrite, inhalation is associated only rarely with serious sequelae, though symptomatic methemoglobinemia may occur. The case reported is the first documented fatality from inhalation of isobutyl nitrite. The widespread use of isobutyl nitrite is a cause for concern and physicians should be aware of the potentially fatal consequence of abuse, particularly in those with ischemic heart disease, and its management.
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The coroner's and hospital records of 57 consecutive in-patient or day-patient suicides were examined. There was a preponderance of males, but no difference between the sexes in violent deaths. The patients were generally chronically ill, and risk of suicide continued indefinitely after diagnosis. Risk was recorded in the medical notes for 16 patients and in the nursing notes for 12, but only six were under special observation. Half the patients were thought to be improving at the time of death. Psychiatrists and coroners should pay attention to aspects such as nursing and environmental factors in suicides in order to identify those at risk.
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Dextropropoxyphene has been increasingly prescribed as an analgesic in the UK, chiefly in the form of Distalgesic (dextropropoxyphene hydrochloride 32.5 mg and paracetamol 325 mg per tablet). After reports of sudden deaths from the misuse of this combination, prescribing is declining. Distalgesic remains the most common cause of fatal drug overdose in the West Midlands, UK. The 1983 Birmingham inquests are compared with those from the year 1976 to 1979. In comparison with other drug fatalities, death characteristically occurs rapidly, as little as 1 h after ingestion and usually before hospital treatment can be initiated. Toxicity is increased by alcohol which is also extensively abused. The fatal dose may be as small as 15 tablets or possibly less. Many victims are young and some never intended to take their life. Convulsions and respiratory failure precede death. The elderly and respiratory cripples may be more vulnerable to accidental death. Evidence suggests a liability to dependence or even addiction with dextropropoxyphene.
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Forty-one instances of active tuberculosis first identified after death by a coroner's autopsy are reported. These constituted 0.3 per cent of the coroner's postmortem examinations and 31 per cent of all deaths from tuberculosis in Birmingham during the five years 1977-81. Many of the deceased in this series had been attended by a general practitioner shortly before death without the true nature of the disease being recognized. The value of a coroner's autopsy in establishing the actual cause of death is emphasized, especially when death might have been prevented by treatment as in many cases of tuberculosis.
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Analysis of the evidence from 55 coroner's inquests concerning 51 separate motorcycle accidents is reported. Fatal injuries were frequently associated with excessive speed and alcohol consumption. High speed was more common with more powerful machines. Negotiating outside bends seemed particularly hazardous. However, the errors of other road users were the most significant individual cause of fatal accidents. All motorcycle drivers were male, with a peak age group of 17, and most accidents occurred in the summer, frequently in the late evening. Some measures to reduce this mortality are discussed.
An assessment was made of all deaths during 4 years attributed to Distalgesic (paracetamol 325 mg and dextropropoxyphene 32.5 mg), reported either to the Birmingham Coroner (thirty-five), or from elsewhere in the West Midlands (ninety-seven), when analysis was done by the West Midlands Home Office Forensic Science Laboratory. In this region Distalgesic has become the foremost cause of death by drug overdose. About fifteen tablets may be fatal. Potentiation by alcohol is confirmed. The danger of rapid death, before treatment is available, following impulsive overdose by young people, who seem to be particularly at risk, is emphasized.