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From: "Marcia Oliver" <ma.oliver@mi*.co*>
To: "Bill Wolk" <BillWolk@ea*.ne*>
Cc: <cavers@cavers.com>
Subject: Re: Natural Causes = What Next?
Date: Tue, 23 Feb 1999 10:03:42 -0500


> 
> Bill Mee -- assuming hypoxia is the cause of death, wouldn't the body 
> show signs of cyanosis -- blue nail beds, lips, skin, etc. -- that are 
> detectable by the ME and which wouldn't be present if Dr. Kendall had 
> died from other causes?  

Let me start by saying that I know next to nothing about rebreathers, but
having been an assistant medical examiner for Newport News Virgina for a
year, I do know a bit about postmortem examination.

Unfortunately, after death from almost any cause, the majority of oxygen in
the blood is dissapated into cells, thus causing almost all dead bodies to
appear either "cyanotic" immediately after death if the heart pumps long
enough after the terminal event, or grey if the heart stops rapidly, or
after several minutes have past and blood begins pooling due to gravity . 
There are a few exceptions as death from CO poisoning, but aside from these
toxins it is not possible to determine by coloration whether a body became
hypoxic before or after death.  With extended hypoxia before death (greater
than 10 minutes or so) other lung findings may occur, most often pulmonary
edema--water in the lungs--but when the body is found in water, even with
regulator in place, this finding would not be considered reliable.

There is, however, a very reliable stain technique that can be applied to
heart tissue to see if a person had a myocardial infarction, commonly a
"heart attack" .  That is a blockage of an artery to the heart which caused
a piece of heart tissue to die.  Combining this with other examination, it
can be definitely determined if the direct cause of death was a "heart
attack" that could have occured in Wal-Mart.  Obviously, a stressful
activity like diving or becoming hypoxic is more likely to stimulate the
actual "attack" than is shopping, but the finding of a myocardial
infarction on a postmortem is not something that could be confused by amy
medical examiner, diver or not, with simple hypoxic death.

On the other hand, there can be sudden cardiac death from arrhythmias, for
which there is no special test and it is quite possible that in a case with
an apparently healthy older male, death could be erroneously attributed to
a "natural" arrhythmia as opposed to another less obvious cause that the
examiner had not considered.

Marcia Oliver, MD
AAFP
MRO

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