OFFICE OF THE MEDICAL EXAMINER
COUNTY OF OAKLAND, MICHIGAN
AUTOPSY PROTOCOL
NAME OF DECEASED: SHERRY A. MILLER
CASE NUMBER: 91-2752
AUTOPSY NUMBER: 621
AGE: 43
RACE: White
SEX: Female
LOCATION OF DEATH: Oakland Township
DATE OF DEATH: October 23, 1991
PRONOUNCED DEAD: October 23, 1991
TIME OF DEATH: Unknown P.M.
DATE OF AUTOPSY: October 24, 1991
TIME OF AUTOPSY: 10:10 A.M.
CAUSE OF DEATH: POISONING BY CARBON MONOXIDE
MANNER OF DEATH: HOMICIDE
EXTERNAL EXAMINATION:
The body clad in a mauve color sweater, yellow T-shirt, patterned pants,
knee-hi nylon stockings, and a diaper is that of a 4'11", 89 pounds,
under-nourished white female reported to be 43 years of age. Rigor mortis is
well-developed in the cold body and livor mortis is dorsally distributed,
cherry-pink in coloration and unfixed. The scalp hair is brown and partly
gray, measuring up to 7" in length. The irides are brown, the corneae are
clear, and the sclerae and conjunctivae are unremarkable. The external
auditory canals are free of foreign material and abnormal secretion. The
external nares are without note. The nasal skeleton is palpably intact. The
lips are without evident injury. There is natural dentition n present in the
upper and lower jaw. The neck and anterior torso is without note except for
striae present in the areas of both left and right breasts and the lower front
abdominal wall. A scar is present in the area of the left iliac crest. The
external genitalia are without note. The posterior torso and the anal orifice
are unremarkable. There is atrophy of the muscle bulk of all four extremities.
Finger clubbing and peripheral edema are absent. The body hair in the area of
the left armpit is shaved off while the body hair from the right armpit is not
shaved.
EVIDENCE OF INJURY:
There is deep pink-cherry coloration of the skin of
the decedent in the areas where livor mortis is present. There is a fresh
needle puncture wound in the right cubital fossa surrounded by an area of
subcutaneous bleed. Two additional needle puncture wounds are present in the
right cubital fossa with no evidence of accompanying subcutaneous bleed. There
is a fresh needle puncture wound on the back of the right hand surrounded by an
area of recent.
INTERNAL EXAMINATION:
HEAD:
The scalp is reflected after making the usual intermastoid
incision and is free of subcutaneous and subgaleal hemorrhage. The calvarium
is intact. The external meninges are unremarkable, without epidural or
subdural hemorrhage. The 948 grams brain is covered by glistening transparent
leptomeninges and the cerebrospinal fluid is clear. The vessels at the base of
the brain pursue their usual anatomic courses and are patent. The overall
appearance of the brain is one of moderate atrophy without evidence of
structural change of the cortical ribbon. The brain is fixed in formaldehyde
together with the spinal cord prior to the examination. The bones at the base
of the skull are without evidence of fracture. The spinal cord is removed and
placed in formaldehyde fixative prior to examination. Coronal sectioning of
the brain after fixation reveals a moderate number of multiple sclerosis
plaques distributed in the centrum semiovale adjacent to the wall of the
lateral ventricles. There is moderate dilatation of the ventricular system due
to loss of the white matter and retraction of the gliotic tissues in those
area. Parasagittal sectioning of the cerebellum reveals focal small multiple
sclerosis plaques generally distributed in the subcortical locations.
Transverse sections of the brain stem and the spinal cord reveal evidence of
multiple small plaques involving the white matter of the structures of the
neuraxis at various levels. There is evidence of gross lower thoracic spinal
cord atrophy.
NECK:
There is no evidence of injury to the soft tissues or bony
structures of the neck. The laryngeal cartilages, hyoid bone and cervical
spine are intact. The lumen of the larynx an trachea is free of foreign
material and abnormal secretion. The mucosa shows pink coloration, but is
otherwise unremarkable.
BODY CAVITIES:
The body cavities are entered in the usual manner. All
cavities are fee of excess or abnormal fluid accumulation and adhesions. The
organs are in their usual anatomic locations. The lungs are expanded. There
is no internal evidence of blunt force of penetrating injury to the chest
cavity or abdominal cavity.
CARDIOVASCULAR SYSTEM:
The 145 grams heart has a glistening epicardial
surface. The tan-brown myocardium is without evidence of diffuse or focal
lesion. The endocardium and heart valves are without note. The coronary ostia
are patent and the coronary arteries show no evidence of atherosclerotic
change. The aorta and its major branches are without evidence of significant
compromise. The vena cavae and pulmonary arteries are free of antemortem
thrombus.
RESPIRATORY TRACT:
The right lung weighs 239 grams and the left lung
weighs 207 grams. Their pleural surfaces are smooth and glistening. The
parenchyma is a cherry-red in color but otherwise without evident diffuse or
focal lesion. The bronchi and their major branches are unremarkable.
LIVER, BILIARY TRACT, SPLEEN AND PANCREAS: The 835 grams liver has a
glistening capsular surface with sharp anterior margins. On sectioning, the
tan-brown parenchyma is of the usual consistency and free of focal lesion. The
gallbladder contains approximately 35 mls of bile and the bile passages are
patent. The 130 grams spleen has a glistening intact capsule and an
unremarkable parenchyma. The pancreas is without external sectioned
abnormality.
GENITO-URINARY SYSTEM:
The left kidney weighs 64 grams and the right
kidney weighs 72 grams. Their capsules strip with ease to reveal a smooth
cortical surface, except for a small pitting scar on the surface of the right
kidney. On sectioning there is a good cortico-medullary definition and the
calyces, pelves and ureters are unremarkable. The urinary bladder contains
less than 50 mls of urine. The mucosa is without gross lesion. The uterus,
tubes and ovaries are present and without abnormality.
GASTRO-INTESTINAL TRACT:
The tongue is without evident recent injury.
The pharynx and esophagus are unremarkable. The stomach contains approximately
150 mls of green dark fluid with no identifiable solid food particles. The
mucosa is without note. The duodenum and remainder of the small and large
bowels are without evident abnormality. The appendix is present.
ENDOCRINE SYSTEM:
The thyroid, pituitary and adrenal glands are
unremarkable.
MUSCULOSKELETAL SYSTEM:
The skeletal muscle is showing a decreased
muscle bulk with is particularly prominent in the skeletal muscles of the lower
extremities. The long bones of the extremities, the bony thorax and vertebral
column are without evidence of fracture.
MICROSCOPIC EXAMINATION:
UTERUS: No pathological diagnosis.
OVARIES: No pathological diagnosis.
LIVER: No pathological diagnosis.
KIDNEY: No pathological diagnosis.
HEART: No pathological diagnosis.
PANCREAS: No pathological diagnosis.
ADRENAL GLAND: No pathological diagnosis.
THYROID: No pathological diagnosis.
LUNGS: Congestion and mild edema.
CENTRAL NERVOUS SYSTEM:
Multiple sclerosis with plaques present at all
levels of the neuraxis, with the preponderance in the lower spinal cord.
DIAGNOSIS:
1. Poisoning by Carbon Monoxide.
2. Multiple sclerosis.
3. Multiple recent needle puncture wounds of right arm.
OPINION:
This 43 year old white female, Sherry A. Miller, died as a
result of poisoning by carbon monoxide administered by a facial mask connected
via a tube to a commercial pressurized carbon monoxide tank. In consideration
of the circumstances surrounding this death, examination of the scene of death,
the autopsy findings, and the toxicological findings, the manner of death is
homicide.
L.J. DRAGOVIC, M.D.
CHIEF MEDICAL EXAMINER
FRONTLINE / WGBH Educational Foundation
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