Sudden and Unexpected Natural and Violent Deaths in Females in Comparison to Deaths in Males

A medico-legal autopsy study in the province To my family 5 CONTENTS Acknowledgements 7 1. Introduction 9 2. Review of the literature 9 2.1. Medico-legal investigation of death in different countries 9 2.2. Investigation of causes of death in Finland 11 2.3. International comparison of causes of death in the year 1985 12 2.4. Discrepancies in diagnosis before and after autopsy 13 2.5. Definition of sudden death 15 2.6. Frequency of sudden death 16 2. My special thanks to Tarja Ruotsalainen for her great help and skilful assistance in performing the statistical analysis and producing the figures, and not least for her encouraging support during all these years. My warmest appreciation goes to the staff of the department of Forensic Medicine, University of Helsinki for their excellent technical assistance. I am sincerely grateful to Jean Margaret Perttunen and to Carol Norris of Helsinki University for author-editing the language of this thesis. I want especially to thank Carol Norris for her sense of humour and her unforgettable remarks. I want to thank my colleagues and friends in Finland, Russia, and during the last years also in Sweden for their interest in and curiosity about my work. My appreciation goes to the National Board of Forensic Medicine in Sweden and especially to the staff of the Stockholm department for giving me the opportunity to finish my work in Finland. Last, but not at all least, I am deeply grateful to my family, companions in my life, and my parents, for their support and patience and to all my great children, who have been growing up with this work. 9 1. INTRODUCTION Sudden and unexpected deaths in Finland are very often examined in the medico-legal system. According to a Finnish law from 1973, the police have to investigate cases of death whenever the cause of death is not known to be a disease or when the deceased has not attended a doctor during the last illness, and if the death is otherwise unexpected. Thus, because of legislation in Finland, sudden and unexpected deaths are an important part of forensic pathology. In most cases of sudden and unexpected death in Finland, a complete medico-legal autopsy including appropriate toxicological and other examinations is performed. Owing to different legislation and systems for investigating deaths in many other countries, the causes of death are often established by doctors who are not specialists in forensic medicine, for example …