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Cause of death among passengers on the Titanic

2003; Elsevier BV; Volume: 361; Issue: 9355 Linguagem: Inglês

10.1016/s0140-6736(03)12423-3

1474-547X

MR Shetty,

Neuroscience of respiration and sleep

I would like to re-examine the cause and manner of death among the passengers on the Titanic. On April 14, 1912, at 2340 h, the ship struck an iceberg and sank off the Newfoundland Coast in the North Atlantic ocean. The temperature of the water was –2·2°C. There were 2201 people aboard, and all 1489 people who fell into the water were recorded as having drowned. There were 3560 lifebelts aboard the ship, so presumably all those who died were wearing lifebelts; 712 people were able to leave the ship in lifeboats. The rescue ship Carpathia arrived at the site in 1 h 50 min. The crew were able to rescue everyone on board the lifeboats, but all the others were left for dead, even though they were presumably floating with their heads above water. Keatinge1Keatinge WR Survival in cold water. Blackwell Press, Oxford1969Google Scholar states that, in the official report, the cause of the ship's sinking took precedence over the question of cause and manner of death. Orlowski2Orlowski JP Drowning, near drowning and ice water submersions.Pediatr Clin North Am. 1987; 34: 86-89Google Scholar has found 17 cases of good outcome after drowning and hypothermia when appropriate resuscitative measures, including rewarming and cardiopulmonary resuscitation, were available. Full recovery is possible in many who have been ruled as dead, even after submersion of up to 40 min.3Forgey WM Wilderness medicine, beyond first aid. ICS Books, Merrillville, IN1994: 185Google Scholar The Titanic passengers were only exposed to hypothermia and not to cold-water inhalation into the lungs. Aspiration might have occurred after they became unconscious. Therefore, the primary cause of death was immersion hypothermia with its attendant consequences, and not drowning as recorded in the official report. The current consensus of opinion is that patients should not be considered dead until they return to near normal core temperature and do not respond to cardiopulmonary resuscitation.3Forgey WM Wilderness medicine, beyond first aid. ICS Books, Merrillville, IN1994: 185Google Scholar Many of the presumed dead were probably alive. The above factors must be incorporated into decision making before pronouncing dead someone who is pulled out of the water in any circumstances. Finally, using the International Classification of Diseases,4Hart AC Hopkins CA International Classification of Diseases, sixthedn. St Anthony Publishers, Reston, VA2003Google Scholar I hereby reclassify the cause and manner of death in the victims of the Titanic disaster as “accidental hypothermia” (code 991.6) and “accident to water craft causing submersion” (code E830), respectively.