Charles Darwin's coffin, and its maker.
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BACKGROUND: Inequalities in the health of different sections of populations are well recognized but were difficult to demonstrate before death registration was introduced in 1837. In the early years of civil registration, geographical and sex differences in mortality were clearly recognized, as were occupational hazards, but socio-economic differences were barely explored in the Annual Reports of the Registrar General. Tynemouth General Cemetery (TGC) was established in 1833 as a private cemetery with unusually detailed records. METHODS: A total of 2610 records from 1833 to 1853 were analysed. Variables used included sex, dates of death and burial, age at death, depth of burial, cause of death, place of residence and occupation. As no denominator population is available, median age at death has been used for comparisons. RESULTS: Depth of burial relates well to a hierarchy of specific occupations and so is used as a marker for socio-economic status. The median age for the burials was 12 years. People of higher socio-economic status survived longer. The people of North Shields, and especially the males, died younger than those from surrounding areas. Males outnumbered females in most age groups. CONCLUSION: Socio-economic, geographical and gender inequalities in mortality are clearly demonstrable in the early nineteenth century, without the use of registration data.
A review of the activities and beginnings of the U.S. Army Quartermaster Corps Graves Registration Service is presented to broaden existing knowledge of how the remains of military casualties were processed and identified. The focus is on the activities of this service in France after World War I. The processing and other problems faced by this organization are often identical to those experienced by the forensic pathologists or other medicolegal investigators who are confronted with remains of an unidentified person.
Among the most difficult cases for law enforcement and medicolegal investigators to investigate are those in which victims have been deliberately burned to cover up a crime, or those in which cremation has resulted from an accident or suicide. This difficulty arises from the fact that the bodies may be destroyed or fragmented. The major objective in these investigations are twofold: The first task is to identify the body using every means available, including the aid of such experts as forensic pathologists, forensic anthropologists, dentists, toxicologists, and serologists as well as fire investigators, who can contribute to the investigation by providing information about the course of the fire.
Severely burned or cremated human remains (i.e., cremains) are among the most challenging cases investigated by forensic pathologists, odontologists, and anthropologists. Exposure to extreme heat of long duration destroys all organic components of the body, leaving only the inorganic component of the skeleton. The numerous calcined osseous or dental fragments that remain after the cremation process rarely convey useful information to the investigator. In most cases, it is associated nonosseous artifacts that provide evidence of the decedent's identity. In a case investigated at the University of Florida's C. A. Pound Human Identification Laboratory, as well as in several cases examined during data collection for a research project, several fragments were identified as calcined plaque tubules from sclerotic blood vessels. These tubules provide direct evidence that the cremated individual had a variety of arteriosclerosis.
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Exposure to traumatic death is a risk factor for posttraumatic stress disorder. For some groups, anticipation of such exposure may contribute to traumatic stress. We studied the anticipated stress of working in the Operation Desert Storm mortuary in two groups prior to the arrival of the dead. We examined those who would handle remains (mortuary workers, N = 386, 330 men and 56 women) and those who would not (support workers, N = 87, 67 men and 20 women). These two groups were a mixture of volunteers and nonvolunteers as well as persons with and without experience in handling the dead. The mortuary workers had higher levels of preexposure distress than support workers; nonvolunteer mortuary workers had higher levels of distress than volunteers. Female mortuary workers had higher levels of distress than males, although this effect was modest. Experienced mortuary workers reported fewer intrusive and avoidant symptoms than did inexperienced workers. Those persons at highest risk for generalized distress as well as intrusive and avoidant symptoms were inexperienced nonvolunteer mortuary workers.
Little is known of the specific effects of exposure to traumatic death, an important dimension of many disasters. This study examined acute and long-term intrusive and avoidant symptoms, depression, and posttraumatic stress disorder (PTSD) in disaster workers exposed to traumatic death after the USS Iowa gun turret explosion. Fifty-four volunteer body handlers were assessed at 1, 4, and 13 months. They were compared with 11 non-body handler disaster worker volunteers. The Impact of Events Scale, Zung Depression Scale, Symptom Checklist-90-Revised, and a multi-method assessment of PTSD were used. Intrusive and avoidant symptoms were elevated at 1, 4, and 13 months, and decreased over time. Probable PTSD was present in 11% at 1 month, 10% at 4 months, and 2% at 13 months. The frequency of depression was not increased. Single body handler disaster workers reported more avoidance (times 1 and 2) and somatization (time 1) than did married workers. Body handlers reported more intrusion, avoidance, hostility, and somatization at 1 month than did non-body handler volunteers. These results indicate that exposure to traumatic death increases intrusive and avoidant symptoms, hostility, somatization, and the risk of PTSD and that symptoms can persist for months.
High levels of distress were found in military mortuary workers prior to the arrival of the human remains from the Persian Gulf War of 1991. To better understand the stress of anticipating the handling of remains, we performed stepwise multiple regression analyses to identify the best predictors of intrusive thoughts and avoidant thoughts and behavior, two of the primary symptoms of posttraumatic stress disorder. After volunteer status and sex were controlled, fear and discomfort with mutilation and the grotesque, as measured by the Mutilation Questionnaire, and defensiveness or denial, as measured by the Marlowe-Crowne Scale, were significant predictors of intrusion and avoidance in the inexperienced group. In the experienced group, only the Mutilation Questionnaire predicted intrusion and avoidance. Results have implications for selection, training, and interventions for mortuary workers and other disaster workers whose job includes exposure to human remains.
Exposure to the dead has been an important subject for traumatic stress research, considering that such exposure is a risk factor for posttraumatic stress disorder (PTSD). Individuals required to handle the dead from war are exposed to multiple stressors. No previous studies, however, have examined pre- and post-responses to traumatic death. We studied the pre-post responses of 352 military men and women who worked in the mortuary that received the dead from the Persian Gulf War (Operation Desert Storm) in 1990 to 1991. The respondents were volunteers and nonvolunteers for assignment to the mortuary; some had prior experience in handling the dead and some did not. Symptoms of intrusion and avoidance were measured before and after exposure. Four groups were examined based on the degree of exposure to remains. Age, sex, volunteer status, and prior experience handling remains were statistically controlled. Post-exposure intrusion symptoms increased significantly for all groups exposed to the dead. Increased post-exposure avoidance symptoms were present in the two groups with the greatest exposure to remains. There were no significant increases in intrusion or avoidance in the unexposed group.
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OBJECTIVE: The objective of this article is to examine the relationship between exposures to the dead and the development of somatic symptoms. METHODS: We studied the pre-post responses of 352 military men and women who worked in the mortuary that received the dead from the Persian Gulf War (Operation Desert Storm) in 1990 to 1991. Symptoms of somatization were measured before and after exposure to the dead. The respondents were volunteers and nonvolunteers for assignment to the mortuary; some had prior experience in handling the dead and some did not. Four groups of participants were examined based on the degree of exposure to remains. Age, sex, volunteer status, prior experience handling remains, and preexposure measures of depression and mutilation fear were statistically controlled. RESULTS: Postexposure somatic symptoms increased significantly over preexposure levels for the two groups with the most exposure to the dead. CONCLUSIONS: These results provide additional evidence that exposure to the dead is related to somatic distress.
In a study of the mortality of Ontario undertakers, a cohort of 1,477 men first licensed during 1928 through 1957 was followed up until the end of 1977. Numbers of observed and expected deaths were determined for the period 1950 through 1977, using mortality rates of Ontario men as the standard. In all, 319 persons had died, compared with 322 expected. Ontario undertakers were not at increased risk of death from cancers at sites of contact with formaldehyde. Cirrhosis of the liver (standardized mortality ratio, 238) and chronic rheumatic heart disease (standardized mortality ratio, 199) were the only causes of death found to be significantly in excess. The data are discussed in the context of current epidemiologic information on the mortality experience of persons exposed to formaldehyde.