One day after getting married last February, Kathleen Daneker took an over-the-counter cold medication and slumped to the bathroom floor. The Sudafed capsule had been laced with cyanide.
Daneker was one of several poisoning victims in the Tacoma, Wash. region who died before authorities discovered the tainted capsules, issued public warnings and removed the medication from store shelves.
In cases like this, finding the cause of death and warning the public could save many other lives. In other cases, determining whether a fatal car crash was an accident or a suicide may not matter to the public, but could hold a great deal of interest for a life insurance company.
The detective work that goes into such cases is the responsibility of medical examiners, people trained in the skills of tracing in detail the departure of life from a human body.
Medical examiners are the modern version of coroners, the officials appointed by English kings to investigate suspicious or mysterious deaths. The term "coroner," which first came into use during Norman times, derives from the word "crown," probably because this official was charged with representing the crown's interest in determining the cause of death. In cases of murder or manslaughter, the government must prosecute the perpetrator. Or, in those days, if the cause of death was suicide the king could claim the estate.
The coroner system was transplanted to this continent through the English settlers, and it's still in use in some parts of the country. But old-style coroners have severe limitations, since determining the cause of death is a medical mystery that non-physicians elected or appointed for political reasons are not always qualified to solve. As Dr. Brian D. Blackbourne, medical examiner for San Diego County, observes, when governments use a non-medical system to certify causes of death, death investigations can be rather "haphazard."
In the 1870s, Massachusetts became the first state to adopt a more scientific approach by replacing coroners with physicians. To distinguish the two, Massachusetts referred to its officials as medical examiners. Today, that term is still preferred by physicians who hold such posts, although some states and localities have retained the term coroner even when they require a medical degree for the position.
In general, however, anyone with the title of medical examiner is a licensed physician, while that may or may not be the case for a coroner. Like Dr. Blackbourne, most medical examiners are forensic pathologists -- which means they have four years of training in pathology and an additional year of intensive training in forensic pathology.
Medical examiners don't certify all deaths -- often that task is performed by the physician who was treating the deceased. Rather, they usually get involved only when the death is sudden, violent, suspicious or unexplained, or when there is no other physician available to certify the death.
As Dr. Blackbourne notes, that mandate puts medical examiners on the front line of epidemics -- whether it's measles, cholera or AIDS.
Yet as important as this work is, it is still vulnerable to the political winds. Dr. Blackbourne, who headed the Massachusetts medical examiner system for seven years, quit more than a year ago and took the San Diego job when it became clear that Massachusetts would not continue to fund the program at an adequate level.
Now, after some major budget cuts, the medical examiner system in that state is in such disarray that criminal prosecutors are saying that murder in Massachusetts is going undetected. Medical examiners are often the law's only "safety net" in detecting discreet crimes.