Læknablaðið - 15.03.1980, Side 42

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LÆKNABLADID
the driver, who had been treated for coronary
thrombosis, sustained another attack and went
off the road into a deep ravine, killing his
three passengers. The Coroner implied in his
remarks, according to the press reports, that
persons with coronary heart disease should
not be allowed to drive. If all persons with
coronary occlusion were banned from driving,
large numbers of persons over 50 would be
affected. This would be disastrous in economic
terms to many of this group. A number of
surveys have already been carried out on the
hazard of sudden death at the wheel, notably
by Herner and others in Sweden (I), Voigt in
Denmark (II), and by Fisher (III), Di Maio (IV),
Petty (V) and Baker (VI) in the United States.
In these series, autopsies had not been carried
out on every death, the cause of death having
been deducted from the medical history. Each
series confirmed my observation that a man
or woman sustaining a fatal collapse whilst in
charge of transportation rarely did any signifi-
cant damage to property or caused physical
injury either to themselves or some other
person. 1 decided to take a hundred consecu-
tive cases of death from natural causes whilst
in charge of road transportation, irrespective
of the type of transport, and assess the
damages of such collapses. The age and sex
distribution is shown in figure 1. (VII)
Although the majority were driving auto-
mobiles, several other means of transport are
represented, fig. 2. I have had one case not
included in this series of the fatal collapse of
the driver of a horse-drawn vehicle!
Of these 100 deaths, 84 were due to cardio-
vascular disease, of which 77 were due to
coronary occlusion, an actual thrombus having
been identified at autopsy in 72 of these cases.
In over half the cases of coronary occlusion
there was evidence of a previous myocardial
infarct. When the medicaal history of several
others was examined in retrospect there was
often a history of indigestion or minor chest
pain which could be attributed to myocardial
ischaemia. The actual number of persons who
were or had been under treatment for the
dise’ase which killed them was 37.
In this series 26 of the drivers failed to stop
before they collapsed. Only 7 of these sus-
tained any personal injury and 4 of these
were either riding bicycles or mopeds.
In only one case in this series did the fatal
collapse cause the death of another person. In
this case a man of 46, with no relevant medical
history, developed his first attack of asthma
and crossed the central reservation of a
divided highway and collided with a goods
vehicle, killing both himself and his passenger.
In another case a man of 22 years, appar-
antly fit — he had been playing football until 6
weeks before his death — was seen to be
driving erratically by a following car. He then
swerved across the road into a iamp standard,
which crashed through the roof of the car and
inflicted a fatal head injury. As a child he had
been in hospital with rheumatic fever. At
autopsy his heart was 461 grams. There was
early mitral stenosis and a smouldering myo-
carditis consistent with a chronic rheumatic
process.
Even where natural disease is present it
may not be possible to decide whether it was
contributory to the accident. When a person
who has severe natural disease and has also
under 30 31-40 41-50 51-60 61-70 over71
Age group
Fig. 1. Natural death in control of transportation.
Sex — Age
70
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Motor Pedal Motor Goods Taxi Invalid
cars cycle cycles vehicles cabs carriages
etc
Fig. 2. Natural death control of transportation.
Vehicle type — Sex