Fitzgibbons, John P.

Among 210 deaths in infants aged 2 weeks to 2 years in Olmsted County, Minnesota, during the 20-year period 1946 through 1965, review of the clinical and pathologic reports disclosed 37 instances of sudden, unexpected, unexplained death (SUUD). The incidence rate was 1.2/1,000 live births. The death occurred between midnight and noon in 90% of cases, and all but one of the children were found dead in bed. Some seasonal variation was noted. Autopsy was done in 75% of the 210 instances, including 86% (32) of the SUUD cases. More than two thirds of the cases of SUUD coming to autopsy had some evidence of an infectious disease, but these findings were minimal and in no case sufficient in themselves to cause death. Therefore, it was concluded that a second factor is necessary to initiate the sequence of events that leads to death, although the specific trigger mechanisms are unknown and may be quite variable.

The records of the Mayo Clinic have been used as the primary basis for the study of stroke in the population of Rochester, Minnesota, from 1945 through 1954. The incidence rate for first stroke of all types was 1947/100,000/year. The rates increased with age, and at age 65 to 74 years, about 1% of the population was affected annually. No significant differences were noted between men and women. The rate for cerebral thrombosis was 146/l00,000/year for all ages. Cerebral hemorrhage represented less than 10% of all strokes and occurred in less than 15% of those who died; this is contrary to what is published in the U.S. Mortality Statistics . The prevalence rate was 547/100,000 on January 1, 1955. Twenty-one percent of these persons who had previously had a stroke were functioning with no incapacity on the date of prevalence determination and only 3% were bedridden. Death certificates were reviewed for all those who died after a stroke. Among those who died within a month after a stroke, some type of stroke was noted as the underlying or an associated cause of death in 91%. However, among those who died more than a month after a stroke, only 54% had such a diagnosis recorded. Probability of surviving after each type of stroke was determined and compared with survival in a normal population. The curve showing probability of surviving from cerebral thrombosis diverges throughout its course from that of the expected survival but diverges more sharply in the first several months. Among those patients with stroke who died, 41% died of causes related to the acute stroke and 10% died of a subsequent stroke. Heart disease was the cause of nearly twice as many deaths as was a subsequent stroke among those who survived the initial stroke. Autopsies were performed on approximately 50% of those persons who died following a stroke, and information from these studies confirmed the high degree of accuracy of the clinical appraisals.