Sudden Death

Historical description of sudden unexpected death goes back to Pliny the Elder in the 1st Century AD in his book, Natural History in which he described affluent citizens of Rome dropping dead (Pliny). Lancisi, Roman physician, wrote a classic tome on sudden death at the commission of Pope Clement XI, who had become alarmed at a rash of such deaths in Rome starting in the spring of 1705. The Papal concern was that God had become displeased with the Romans. Lancisi studied the cases, performed autopsies, and analyzed the causes. He failed to exonerate entirely Roman sin and perfidy (Lancisi).

[The Lancisi Library is housed in the Ospidale Santo Spirito in Rome. That historic hospital also houses, even today, vast wards extending into distant mists pierced by brilliant light shafts from high transoms. An ancient peephole of ill fame can still be found in the eye of a mural figure in the upper reaches, far above the women’s ward, through which it is purported that monks of old satisfied their prurient interest.]

Lancisi’s theories on the causes of sudden death were traditional, having to do with the prevailing ideas about body humors; he only began to elaborate underlying causes. He, nevertheless, defined sudden and unexpected death and recognized many causes: sudden rupture of the vena cava, aneurysm of the aorta, aneurysm of the heart, specific aortic diseases, and various forms of stroke. And he made the observation that the apparent Roman epidemic had no universal cause; rather he sophisticatedly calculated that it was due in part to the diminution of other causes of death.

Otherwise, he attributed the apparent rash of sudden deaths to intemperance among the population, which he thought accounted for the predominant distribution of cases among men. Lancisi wrote: “… it left the other sex almost untouched, so that until this very day we have scarcely been able to list some few women who did die suddenly.” He attributed the freedom from sudden death in women to their more tempered life: “ … [women] were more continent in regard to food and drink and in their sexual life and had thus far kept themselves happily free from sudden deaths. On the other hand, the uncautious, the voluptuous, and the wine bibbers fell an easy prey to unexpected deaths.”

There was no reference to coronary artery disease, so it is not clear that Lancisi dealt with any coronary cases at all or that his speculations on the causes of the apparent cluster of sudden deaths in Rome have anything to do with the 20th century coronary disease epidemic.

We learned recently from our colleague, Alessandro Menotti of Rome that in the 1980’s another ancient book on sudden death was discovered in Italy, with provenance a century earlier than the famous one of Lancisi. The author was Paolo Grassi, a physician working in the Hospital of Correggio, a small town 20 miles west of Crevalcore, the birthplace of Malpihgi, the anatomist, and coincidentally, the site of a Seven Countries Study cohort.

Grassi’s book was published in Modena in 1612 with the title, “Mortis Repentinae Examen” (Dissertation on Sudden Death), with the exquisite subtitle: “Including a short method allowing those at risk to take some precautions!” The Latin script was discovered by a physician working in the same hospital three centuries after Grassi, then translated into Italian and distributed by an Italian charity promoting CVD prevention. It lacks the anatomical dissections of Lancisi’s book but described angina pectoris followed by sudden death and the accompaniment of specific arrhythmias identifiable in his descriptions of the pulse.

Among the possible causes of sudden death that he considered were, in 1612, sedentariness, excessive eating, eating fatty foods, and excess drinking, all the while recommending moderate wine consumption “for good health and good spirits.” One wonders that Lancini failed to refer to this earlier work. (Henry Blackburn)

Reference:

White, Paul D. and Boursey, Alfred V, 1971 Translation of De Subitaneis Mortibus (On Sudden Deaths)New York: St. John’s University Press.