Cadaveric spasm
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COMMENTARY
Cadaveric spasm James R. Gill
Accepted: 2 January 2013 / Published online: 10 February 2013 Ó Springer Science+Business Media New York 2013
In recent years, there has been increased interest in evidenced based medicine [1]. This scientific analysis of clinical treatment regiments is intended to assess which therapies are most effective for patient care. Some have applied this approach to diagnoses. In forensic pathology, interpretations of some autopsy findings have little scientific support. The Bedford-Tsokos paper examines cadaveric spasm [2]. In a 1975 episode of Columbo, an old popular crime drama in the United States, a retired actress shoots her sleeping husband in the head and places the gun in his hand to make it appear to be suicide. When the coroner examines the body, he tells Columbo: ‘‘Lieutenant, if it wasn’t suicide, how did he experience cadaveric spasm?’’ He continued ‘‘The moment Dr. Willis shot himself, spasm occurred in his fingers. Now that could only take place if the deceased’s fingers were on the trigger at the moment the bullet made impact with his brain.’’ If only that coroner could have read the Bedford-Tsokos paper on cadaveric spasm [2], perhaps the case would not have taken a full hour to solve. Interestingly, the writers for Columbo understood the theory of cadaveric spasm better than Stedman’s Medical Dictionary which incorrectly defines it as ‘‘rigor mortis occurring irregularly in the different muscles, causing movements of the limbs’’ [3]. Due to research limitations and the nature of death investigation, forensic pathology contains ‘‘diagnoses’’ based purely on observation and experience which sometimes become codified in textbooks as fact. Only after additional scientific investigation and further consideration J. R. Gill (&) Department of Forensic Medicine, New York University School of Medicine, 520 First Avenue, New York, NY 10016, USA e-mail: [email protected]
of these long held beliefs, are their liabilities sometimes seen. The antiquated ‘‘signs’’ of asphyxia were dispelled by Adelson while Ely and Hirsch put the nail in the coffin on hypoxia causing petechiae [4, 5]. This paper on cadaveric spasm is another example of the maturation of forensic pathology. As Bedford and Tsokos note, the scientific basis for cadaveric spasm is lacking and their ‘‘examples’’ are reasonably explained by position and circumstance. Unfortunately, there are still some who believe in cadaveric spasm and that it can be a decisive factor in investigations. The Bedford-Tsokos review of the forensic literature found statements such as ‘‘cadaveric spasm being virtually diagnostic of suicide’’ [2]. In the larger view, whether cadaveric spasm exists or not, essentially becomes moot for death investigation and certification. Hopefully few, if any, forensic pathologist would actually make a determination of suicide or homicide based simply on the concept of cadaveric spasm. From the time of Sir Bernard Spilsbury, some pathologists have relied more on celebrity than science to proclaim defin
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