2nd Pathologist report

NAME:DAVID ANTHONY HARRIS0N
ADDRESS:
AGE / DATE OF BIRTH: OVER 21 OCCUPATION: CONSULTANT PATHOLOGIST TO THE HOME OFFICE
Who states:- This statement consisting of pages, each signed by me, is true to the best of my knowledge and belief and I make it knowing that if it is tendered in evidence I shall be liable to prosecution if I have wilfully stated in it anything which I know to be false or do not believe to be true.
DATED: (SIGNED)
Autopsy Ref.No: H/0 4-91
Supplementary Report
Anthony GORMAN (Deceased)
In view of the importance of any head injury in supporting the cause of death given by me following the conclusion of the post mortem examination I carried out on Anthony GORMAN on the 2nd March 1991, the fixed intact brain was at my request examined by Dr.W.R. TIMPERLEY, Consultant Neuropathologist at the Royal Hallamshire Hospital,Sheffield. I examined the brain externally at the time of the original autopsy and although there was no obvious injury, the brain appeared swollen and was heavier than normal. My conclusion that these facts indicated significant brain damage has subsequently been shown to be incorrect. Dr. TIMPERLEY'S view, and one with which I now concur, is that any brain swelling was minimal and likely to have been due to congestion due to cardiac failure, i.e. the changes I noted in the brain at autopsy were the result of the cardiac failure and not its cause. Since the head injury had been excluded as a cause of death it became necessary to examine the heart and lungs in greater detail as the underlying cause of death now appeared to primarily concern one or all of these organs. Dr.N.R.B.GARY, Consultant Pathologist at Papworth Hospital in Cambridge is an acknowledged expert in cardiopulmonary pathology, and at my request kindly examined tissue removed at autopsy. Taking into consideration the alleged circumstances surrounding the deceased's death my original autopsy findings and the stated opinions of the two experts, Dr,W.R. TIMPERLEY and Dr.N.R.B. CAREY, who have assisted in this case I should like to make the following comments.
1. During an altercation outside the night club Mr.GORMAN suffered a broken nose it is alleged as a result of a headbutt. The fractured nasal bones and swelling of the nasal bridge are in my opinion consistent with a head butt injury.
2. Rupture of small blood vessels occurring at the time the nasal bones were fractured resulted in blood trickling down the back of the nose and into the trachea, bronchi and smaller airways. The blood is seen in the trachea and bronchi in the post mortem photographs and confirmed to be in the small airways on microscopical examination of lung tissue.
3. The effect of the blood in the airways would be to reduce the efficiency whereby the lungs oxygenate the blood. The blood would therefore contain less oxygen than normal i.e. there would be a state of hypoxia.
4. The blood reaching the heart and all other body organs would therefore supply less oxygen to them, resulting in tissue hypoxia.
5. During episodes of pain, shock and stress the adrenal glands produce increased amounts of adrenaline which increases the blood pressure and causes the heart to beat faster and to contract more forcibly.
6. In certain circumstances, the increased adrenaline produced can have an adverse affect on the heart muscle and instead of causing the heart to work more efficiently, can cause the heart muscle fibres to contract irregularly (fibrillate). The heart then ceases to function as an efficient pump and in the absence of medical attention, death in cardiac failure ensues. This is particularly likely to occur under hypoxic conditions.
7. Following the altercation, which resulted in a broken nose, the deceased then walked and ran some 300 yards before a second attack occcured. During this time it is likely he was in an anxious state, in considerable pain and stressing his cardiovascular system. All these factors would tend to result in increased adrenaline production.
8. The fractured nasal bones are the only significant injury. Other injuries are relatively minor and none of the other injuries which occurred outside the night club or, shortly afterwards, at the scene where the deceased's body was found are in my opinion directly responsible for death.
9. Minor microscopic changes in the lungs are consistent with previous inhalation of foreign material although there is no obvious connection between these changes and the cause of death.
10. .As stated by Dr.CAREY it is possible that the deceased died as a result of a cardiac arrhythmia due to a combination of fright with massive release of adrenaline from the supra-renal glands, combined with increased alcohol and possibly combined with one or more drugs. The lung changes suggest that the latter may have been inhaled.
11. The anoxia produced by inhalation of blood from the fractured nasal bones would have potenated (10) above or may, in the presence of alcohol have been sufficient to cause death.
12. In conclusion, although there are several possible mechanisms by which death may have been brought about, it is evident that there is no obvious unequivocal cause of death in this case. Certainley, there is no evidence of brain injury sufficient to have caused death.
13. My original cause of death should now be disregarded and cause of death unascertained substituted.
D A HARRIS0N SIGNED