|Prison Governors||Medical Advisers|
Mr. A.H. le Tessier
Mr. D. Kaene
Mr. I.V. Kolodnikov
Lt. Col. Menzies
Lt. Col. Wilkerson
Lt. Col. Koslikov
The body had been x-rayed after death, prior to my examination, and I was handed the x-rays and various papers (hospital notes) relating to the death by Colonel J.M. Hamer-Philip in the presence of the above gentlemen. In all there were eleven (11) large and eleven (11) small unreported radiographs (see infra).
It had been agreed that a closed-circuit television camera would be used during the autopsy but no still photography. At the commencement of the autopsy all, apart from the medical advisers and the officers of the Special Investigation Branch, Royal Military Police, left the mortuary.
Opinions expressed on the x-ray films at the time of the autopsy were subsequently confirmed by Dr. Maurice J. Turner, F.R.C.P., F.R.C.R., D.M.R.D., Consultant Radiologist, The London Hospital, London.
Skull: No abnormality was detected.
Cervical Spine: An endotracheal tube was in situ in some films. No fractures were seen but osteo-arthritic lipping, particularly of the left side with spondylosis of fifth and sixth cervical vertebrae being noted.
Chest: Elevation of the left dome of the diaphragm with adhesions to the left chest were noted. Recent fractures were detected in the 4th to 6th right ribs, inclusively, and the 3rd to 6th left ribs, inclusively, with a possible older fracture of the 7th right rib.
Abdomen: Gaseous distension of stomach - presumably as a result of resuscitation.
Extensive osteo-arthritic degenerative changes were noted in the lower thoracic and lumbar spine with scoliosis (curvature).
Pelvis: The presence of opaque foreign bodies - possibly old gut-shot residue - were observed in the soft tissues of the lower pelvic region and thighs.
Legs: An old fracture deformity of the left trochanteric region (upper left thigh/hip) and femoral shaft were noted. No fractures were observed in either tibiae or fibulae and apart from arthritic change in the metatarso-phalangeal joints no abnormality was detected.
Arms: No fractures were detected in either forearm, hand, or right humerus (upper arm), whilst the left humerus (upper arm) revealed two radio-opaque foreign bodies near the mid to upper shaft suggestive of an old gun-shot wound. No recent injuries were detected.
The deceased was dressed in a grey jacket, grey flannels with braces, white shirt, white "long johns" and white boxer shorts.
The body was that of a relatively well nourished elderly man, 5ft. 9in. (175 cms) in height, with bilateral inguinal herniae, the left being worse than the right. There were signs of recent hospital therapy to the left side of the neck, the thumb side of the left wrist and the back of the right wrist. There were marks on the front of the chest consistent with resuscitation, particularly over the outer side of the left chest, and over the midline of the chest. There was a circular bruised abrasion over the top of the back of the head and there was slight swelling (oedema) of the ankles. A fine linear mark, approximately 3in. (7.5 cms) in length and 0.75 cms in width was noted running across the left side of the neck, being more apparent when the body was viewed with ultraviolet light, as was an old scar on the left side of the chest, 126 cms from the heel, 7 cms from the midline. Apart from a minor abrasion of the upper lip, 1 cm from the right nostril, there were no other marks of recent injury or violence on the body. Petechiae (haemorrhagic spots) were noted in the conjunctivae of both eyes, particularly on the left side.
Head and Neck:
A sample of head hair was taken (Exhibit No. NL/6).
Reflection of the scalp revealed petechiae (haemorrhagic spots) on the undersurface of the scalp, as was a faint bruise of the right temporal muscle and deep bruising over the top of the back of the head, noted on external examination. There was no fracture of the skull. The membranes of the brain and the brain itself (which weighed 1305 grammes) was intensely congested and on section the brain revealed petechiae (haemorrhagic spots) in the white matter of the brain generally and of the brainstem. Moderate severe atheroma (degenerative change) affected the cerebral vessels but no evidence of natural disease, to the naked eye, that could have caused or contributed to death at that moment in time was noted.
The mouth was totally edentulous, with slight bruising consistent with resuscitative measures, being noted on the upper gum to the left of the midline.
Reflection of the skin from the neck confirmed bleeding into the tissues in the region of the strap muscles on the left side of the neck together with deep bruising over the left side of the angle of the jaw and over the left side of the inside of the back of the throat - that within the throat being consistent with resuscitation. The voice-box revealed excessive bruising in the upper part of the right side of the thyroid cartilage (voice-box) which showed a degree of mobility which subsequently necessitated macro radiography (see infra). The appearances were consistent with compression of the neck. Deep bruising was further noted behind the voice-box, particularly over the right side of the neck, as was deep bruising to the strap muscles on the left side of the neck.
Macro-radiography revealed no fracture of the hyoid bone but a fracture of the right superior corns (horn) of the thyroid cartilage (two (2) x-rays being taken).
Subsequent dissection of the larynx, after fixation of the specimen (Exhibit No. NL/17) in formalin to fix the tissues confirmed the marked bruising of the posterior aspect of both upper cornua (horns) of the thyroid cartilage, especially in the right which when dissected anteriorly revealed the presence of a fresh fracture with bleeding into the site and adjacent tissues. There was no bruising of any significance around the hyoid bone.
Reflection of the skin of the chest confirmed two areas of deep bruising over the centre of the front of the chest with an underlying transverse fracture of the breast bone (sternum) and severe deep bruising of the left side of the chest with multiple fractures of the ribs on that side consistent with energetic cardiac resuscitation. There was further bruising over the right side of the chest with three fractured ribs. The 2nd to the 7th left ribs, inclusively, were fractured in front of the armpit (anterior axillary line) and the 4th to the 6th right ribs, inclusively, in the same position. All fractures were consistent with having been caused at the time of resuscitation and had no bearing on the cause of death.
There was slight bruising of the lining of the lower air passages (trachea) consistent with resuscitative measures.
The right chest cavity was clear, there being no adhesions on the right side of the chest, with minimal sub-pleural (lung lining) petechiae (haemorrhagic spots) being detected. There was no evidence of natural disease, to the naked eye, other than congestion and minimal oedema affecting the right lung. The left lung, however, was firmly adherent to the chest wall and diaphragm with extensive old adhesions and resulting elevation of the left dome of the diaphragm. The left lung was x-rayed (five (5) blank test films and one (1) soft tissue x-ray plate) before being retained for fixation in formalin, revealed slight old scarring but no definite radio-opaque opacities. After fixation the lung (Exhibit No. NL/16) on examination apart from congestion. Merely confirmed old pleural and diaphragmatic adhesions.
The pericardium (heart sac) revealed little of note. The heart weighed 385 grammes with minimal fibrosis (scarring) of themyocardium (heart muscle). Early calcification of the aortic valve was noted, while the tricuspid valve was somewhat floppy. Atheroma, which was remarkably scanty for a man of that age, affected particularly the left coronary artery at its bifurcation. The right coronary artery, whilst tortuous, revealed minimal atheroma. There was slight unfolding of the arch of the aorta with severe atheroma (degenerative change) affecting that vessel particularly at its bifurcation with early medial dissection of its wall, but this had no bearing on the cause of death. The lower half of the oesophagus (gullet) was ballooned out but was otherwise normal.
The stomach was filled with a partly digested meal, of recent origin (500 mls) with no evidence of tablet debris being detected. There was no evidence of old or recent ulceration of the stomach or duodenum although there was minimal scarring with slight enlargement of the duodenal cap. The intestines were otherwise normal and the appendix was present. The pancreas was congested but normal. The liver, which weighed 1465 grammes, appeared small and the gall bladder was shrunken and firmly adherent to the hepatic (liver) tissue. The spleen was extremely soft and apart from minimal bruising around the right kidney, consistent with resuscitation, the kidneys were remarkably healthy, the capsules stripping with ease. A small cortical cyst was present in the lower pole of both organs. Apart from congestion, both adrenal glands appeared healthy. The bladder was moderately full of clear urine, with the prostate being slightly enlarged, and there were multiple trabeculae of the bladder wall. A right sided hydrocele was noted in the scrotum, about the size of a tangerine (small orange) and there were some adhesions to the left testicle but no other testicular abnormality was detected. Apart from congestion, there was no evidence of natural disease affecting the abdominal organs which could have caused or contributed to death.
Samples taken by me and handed to 24101454 WO 2 N. Lurcock, RMP ,SIB ,included:-
1. Sample of head hair - NL/6
2. Sample of urine - NL/7
3. Right kidney - NL/8
4. Left kidney - NL/9
5. Stomach contents - NL/10
6. Blood sample from heart (no anti-coagulant) - NL/11
7. Blood sample from right leg (no anti-coagulant) - NL/12
8. Blood sample from right leg(with anti-coagulant)- NL/13
9. Liver - NL/14
10. 2 x Containers Histology sample in formalin - NL/15 (see pp 6 & 7 of this report)
11. Lung tissue in formalin - NL/16 (see pp 4 & 7 of this report).
12. Throat tissue in formalin - NL/17 (see p 4 of this report).
Exhibits NL/6-14, inclusive, were returned to me intact at 1630 hours on 24th August 1987, and subsequently handed personally by me to Dr. P.A. Toseland, Bsc, PhD ,FRCPath , Department of Clinical Chemistry, Guy's Hospital, London, on 25th August 1987, for Toxicologic Analysis.
Results obtained revealed:-
Blood alcohol - nil.
Urine alcohol - nil.
Blood Carboxyhaemoglobin less than 2%.
There was no indication of any volatile substances, particularly there was no evidence of acetone.
The following drugs could be measured in whole blood:
(i) Verapamil = 78 micrograms per litre
(ii) N-desmethyl-Verapamil = 82 micrograms per litre
(iii) Isosorbide dinitrate = 27 micrograms per litre
(iv) Isosorbide mononitrate = 112 micrograms per litre.
Digoxin was not measurable.
A full screening service of the liver was applied for the detection of acidic, neutral and basic compounds. No compound could be detected that was not already detected in the blood, apart from 2 compounds that possessed the Verapamil structures and were probably O-demethylated compounds.
The urine showed both Verapamil and its N-desmethyl metabolite.
The arsenic content of the hair was 0.8 micrograms per kilogram. The normal arsenic content is anything less than 2, and toxic levels are greater than 5.
All the other drug levels are as one would expect, as normal therapeutic.
Microscopic sections (twenty-three - 23) were prepared, processed and stained from samples of tissue retained (Exhibit No. NL/15 and 16). Lt. Col. R.C. Menzies, MRCPath, DMJ (Path), Professor of Military Pathology, Royal Army Medical College, London, who was present at the autopsy and I are of the opinion that microscopic examination of this tissue revealed no evidence of natural disease that could have caused or contributed to death at that moment in time. The widespread severe passive venous congestion noted in all the organs was entirely consistent with an asphyxial death.
These findings were consistent with and confirmed the macroscopic (naked eye) finding at the autopsy, namely:-
All sections were essentially normal apart from marked passive venous congestion including some meningeal congestion. In addition, there was a little focal perivascular haemorrhage.
There was marked passive congestion of both ventricles with some very mild focal fibrosis (scarring) in the left ventricle, but this was of no functional significance.
Sections from the left coronary artery revealed that the anterior descending branch was narrowed by calcified atheroma to some 40% of original size. The circumflex branch also showed narrowing to approximately 60% of its expected size. The right coronary artery was clear of atheroma. In all three vessels there was passive venous congestion of the adventitia (vessel wall). These findings suggest that, from a microscopic point of view, the degenerative change in the coronary arteries (vessels supplying blood to the heart muscle) was slightly more marked that that noted on macroscopic (naked eye) examination at the autopsy. Such changes did in no way accelerate or play any part in the death.
Sections from near the lesion described as early dissection showed marked cholesterol deposition in the wall of the vessel associated with calcification (severe degenerativ change) and a little fresh haemorrhage. There was also marked passive venous congestion of the vasa vasorum (smaller blood vessels supplying blood to the wall of the vessel) and the vessels within the adventitia (wall).
There was widespread post-mortem loss of the mucosa (lining of the trachea) and the submucosal (deeper) tissues were markedly oedematous (swollen). There was quite marked bruising around the tracheal cartilaginous rings. Such changes were consistent with having been produced during resuscitation, there being no evidence of pre-existing natural disease.
The right lung showed very severe passive venous congestion with focal intra-alveolar and intra-bronchiolar haemorrhage. A little carbon (black pigment) deposition was noted, but there was no evidence of pre-existing natural disease.
The left lung (Exhibit No. NL/16) tissue is similar in microscopic appearance to that of the right. In addition, however, there is old scarring within the lung tissue. In some areas this is associated with occasional aggregates of chronic inflammatory cells; but there is no evidence of any active disease process. A small area of pleura (lung lining) is present on each slide and this also shows scarring and firm attachment to the diaphragm.
The basic hepatic architecture was normal, and there was no evidence of disease. There was, however, very marked passive venous congestion.
The organ appeared to have been previously normal.
Both were essentially histologically normal, but both showed severe passive venous congestion.
Both kidneys showed signs of severe passive venous congestion, but there was no evidence of any pre-existing renal disease.
This organ was very severely congested, but there was no evidence of any disease process.
Both testes showed senile atrophic changes, consistent with the age of the deceased. Both also showed marked passive venous congestion.