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The Investigation of Events that followed the death of Cyril Mark Isaacs
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| This chapter describes the arrangements that were in place between 1985 and 1989 to collect brains from Prestwich mortuary in which the Coroner's office had a central role. | |
Sources of information |
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| The chapter is based on the recollections of staff in the Coroner's office, Prestwich mortuary and Manchester University. | |
Collection systems that influenced the procedures adopted for the joint programme |
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| Dr Deakin and Dr Cross had both worked at the Clinical Research Centre (CRC). The CRC's procedures for collection of brains are outlined in Chapter 9 and are also described more fully in Chapters 31 and 32. The Corsellis collection, Chapter 33, had provided control brains for the CRC programme. | |
| The Cerebral Function Unit in the Department of Neurology had collected brains from hospitals in the Manchester area for its research programme since 1982. | |
The brain collection system for the joint programme described in the first application to NWRHA |
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| The brain collection methodology has been described in Chapter 9 and is also set out in Appendix 17. Three points should be noted: | |
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The collection system as it evolved at Prestwich mortuary |
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| Between November 1985 and May 1987 the brains of only three cases were obtained from hospital or 'brain only' post mortems at Prestwich mortuary. The other 40 brains all came from Coroner's cases. Eight of these were deaths of patients in Prestwich Hospital reported to the Coroner. The remaining 32, including Mr Isaacs', were deaths in the community. | |
Involvement of the Coroner's office |
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| The links that were in place before 1985, through which brains had been transferred from Prestwich and other mortuaries in North Manchester to the brain bank at Cambridge, are described in Chapter 7. | |
| The link between the Coroner's office in Rochdale and the identification of suitable cases for the joint programme is illustrated by one of the first entries in the brain books, dated 30 January 1986. This entry includes the telephone number of the Coroner's office in Rochdale, and Mrs Langan's name. The relevant death had been referred to the North Manchester Coroner (2). | |
| Earlier entries in the same brain book show that between 1 November 1985 and the end of January 1986, five brains of patients with a diagnosis of schizophrenia or other psychiatric diseases had been obtained from Prestwich mortuary. | |
| 1986 |
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| During 1986 the brains of 26 patients from Prestwich mortuary were obtained by the joint programme from post mortems ordered by the Coroner. Six of these were on inpatients. Three brains were obtained from hospital post mortems with which the Coroner's office had no involvement. | |
How the system at Prestwich mortuary worked |
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| Early in the investigation it became clear that the Coroner's office in Rochdale was centrally involved in identifying suitable brains for the joint programme in its early years. The arrangements were described during separate meetings with Mrs Langan, three other staff members of the Coroner's office, Mr Walkden, Dr Farrand, and by Dr Slater and Dr Simpson who was a member of the Department of Physiology from 1985. | |
| When the death of a patient with Alzheimer's disease, schizophrenia or other psychiatric disorder was notified to the Coroner for the North Manchester Police District, Mrs Langan, the senior member of the office staff, would herself telephone the Department of Physiology at Manchester University, or ask another staff member to do so. The message conveyed was that a brain that might be suitable for the research programme would become available later in the day. | |
| The Rochdale Coroner's office held for this purpose two telephone numbers. The first number was Dr Slater's extension; if unanswered, the call would be transferred to the neurochemical laboratory in the Department of Physiology. Dr Deakin's extension number was held as a reserve. However, the Coroner's office staff report, and Dr Deakin has confirmed, that he was rarely telephoned. | |
| Once a call had been received in the Department of Physiology, Dr Slater or one of his staff would telephone Prestwich mortuary to ask Mr Walkden, the mortician, when the brain would be ready for collection. | |
| Mr Walkden would notify the pathologist that the brain was to be retained for the joint programme. Most of the Coroner's post mortems at Prestwich were undertaken by Dr Farrand. Once the brain had been removed, Mr Walkden would place it on ice in the mortuary refrigerator where it would remain until collected. | |
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Mr Walkden would also complete a short note giving basic details of the deceased, including name, age, date, the time of death, the time the brain was removed and the cause of death. The name and address of the general practitioner of the deceased would be included if this was known. |
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| At Prestwich mortuary these particulars were always written on a piece of thin, pale yellow paper of A5 size. Copies of these notes are still held in the brain books and are characteristic of brain referrals from Prestwich mortuary. | |
| Dr Slater, sometimes accompanied by another member of staff, would visit Prestwich mortuary to collect the brain. If Dr Slater was unavailable, another member of staff or the University courier would be sent. Whoever went to the mortuary would take a cold box designed to transport the brain safely. | |
| On some occasions the Coroner's office would inform the mortician, Mr Walkden, before letting the Department of Physiology know there was a brain to be collected, but this was more unusual. | |
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All the staff involved in the Coroner's office, and Dr Farrand, Mr Walkden, Dr Slater and Dr Simpson all described these arrangements in similar terms. I have no doubts about the reliability of their descriptions. |
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Investigation of the origins of the arrangement with the Coroner's office |
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| I have been unable to discover when and how the first contact was made between the joint research team and the North Manchester district Coroner's office in Rochdale as there is no agreement between the recollections of those directly involved at the time. | |
| Both Mrs Langan and Dr Slater confirm there were a number of telephone calls between them and a visit by Dr Slater to the Coroner's office in Rochdale, but their detailed recollections differ. | |
| What is certain is that in the autumn of 1985 there must have been some contact between the University and Mrs Langan. Mrs Langan recollects telephone calls received from Dr Slater before any brains were identified. The first two brains, regarded as part of the joint programme, were both from Coroner's cases and were collected on 1 November 1985 from Prestwich mortuary. Three other brains were collected during 1985 from Prestwich mortuary, all from Coroner's cases. All five were from deaths outside hospital. | |
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Mrs Langan's recollection |
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| Mrs Langan is clear that Dr Slater initiated the first telephone calls to the Coroner's office and that these were made before any cases were identified to the joint programme. Mrs Langan's recollection is that Dr Slater's visit to the Coroner's office in Rochdale was not as early as 1985 and could have been much later. What is clear is that Mr North was not in the office at the time of Dr Slater's visit and a letter was left for him, which Mrs Langan had typed for Dr Slater. The letter was then placed on Mr North's desk. | |
| Mrs Langan is also clear that the letter was a request to the Coroner to agree that brains from suitable cases, whose deaths had been referred to the Coroner, could be made available for the joint research programme. | |
| Mrs Langan states that in keeping with the procedures at the time, she and other members of the Coroner's office staff would have taken no action without the agreement of the Coroner. Mrs Langan assures me that no cases were identified to the joint programme following the telephone calls she had received from Dr Slater until Mr North had indicated his agreement to Dr Slater's telephoned requests. | |
| Dr Slater's recollection | |
| Dr Slater agrees that he made telephone calls to the Coroner's office and that he had probably made the first call on behalf of the joint programme. He is unsure of the date. Dr Slater is convinced that the identification of suitable cases to the joint programme began as a result of the telephone calls and before his visit to the Coroner's office in Rochdale. | |
| Dr Slater's recollection is that his visit to the Coroner's office was certainly not in 1985 but later, perhaps as late as 1988. The visit was, he recalls, 'on the spur of the moment' when he was in Rochdale to collect a brain from the public mortuary. The brain in question had been identified through the arrangements with the Coroner's office. Dr Slater also believes this was not the first brain that he had collected from Rochdale public mortuary. | |
| As there were only three brains collected from Rochdale public mortuary in the first five years of the joint programme, Dr Slater's recollection would pinpoint his visit to the Coroner's office on 30 January 1986, 16 October 1986 or 19 October 1988. | |
| Dr Slater recollects that, during his visit, he left a letter and confirms that this was typed for him by Mrs Langan. Although he never received a reply, the referral of suitable cases continued. | |
| Other recollections |
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| The Coroner, Mr North, states that he was unaware of the arrangement and has no knowledge of Dr Slater's phone calls or of Dr Slater's visit to the Coroner's office in Rochdale. | |
| Apart from Mrs Langan, the other members of Mr North's office staff remember that Dr Slater had visited the office in Rochdale. They confirm that Mr North was not in the office at the time, but no one can remember the date of the visit. Their recollections tend to support those of Mrs Langan. | |
| There are no documents or correspondence about the origin of the referral arrangements, or other information that helps to date Dr Slater's visit. The present staff of the Coroner's office have searched for any relevant papers but have found nothing. | |
| Visit to Prestwich Hospital and mortuary | |
| Dr Deakin, Dr Cross and Dr Slater visited Prestwich Hospital and mortuary in 1985. Dr Deakin suggests the date was either 19 or 22 April, although this date is unconfirmed. The visit was intended to meet the consultant psychiatrists at the hospital and explain the research programme to them. The team also visited the mortuary. They did not meet Dr Farrand, the pathologist who undertook most of the Coroner's post mortems at Prestwich in the late 1980s, but did see the mortician Mr Walkden. The visit is also remembered by others who travelled in Dr Deakin's Vauxhall car(3). | |
| Collection of brains from 'normal' individuals | |
| While the collection system at Prestwich began with the intention of obtaining brains from patients who had died in Prestwich Hospital from neuropsychiatric conditions, the records of the programme and the entries in the brain book show that from February 1986, brains of 'normal controls' were also being collected from Prestwich mortuary. In that year at least 18 brains, described as 'controls', were obtained from Prestwich mortuary. | |
Professor Deakin's comments in 2001 on the origin of the system |
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In a letter dated 11 June 2001 to the General Medical Council, Professor Deakin set out his recollection of the start of the brain collection system(4): |
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| 'Dr Slater initially set the system up for Alzheimer's disease but I began collaborating with him with schizophrenia sometime afterwards. The local mortuaries and coroner's offices would telephone Dr Slater's laboratory if possible cases of Alzheimer's disease or schizophrenia were undergoing post mortem and also if non-psychiatric control subjects were. | |
| This system continued an earlier one in which brains from all over the country were supplied to The Medical Research Council Brain Bank at Addenbrooke's Hospital. My understanding is that in Coroners' cases of non-patient deaths in the community, consent was not routinely sought in the 1970s and early 80s. In contrast, where deaths occurred in hospitals, removal of tissue could not happen without written consent of the relatives. We continued existing practise (sic) in the NW. As far as I could see, this did not differ from practises (sic) in the previous research institute where I trained or from practice in other hospitals at that time'. | |
| Chapters 31 and 32 describe the brain collection arrangements at the CRC, where the collection of Coroner's cases was authorised under Coroners Rules 9 and 12, which are not mentioned anywhere in the documents of the joint programme. | |
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Brains collected through Prestwich mortuary |
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November 1985 - May 1987 |
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| Five brains were collected in 1985, all from Coroner's cases. | |
| The collection of brains from Prestwich mortuary was brisk throughout 1986 and continued until May 1987 when the whole collection programme for the joint programme came to a halt. No further brains were collected from any mortuary until 29 February 1988. When brain collection resumed, this was mainly from North Manchester General Hospital (NMGH), Chapter 13. | |
| 1988/89 until the closure of Prestwich mortuary | |
| There were only five further brains collected from Coroner's cases in Prestwich mortuary when the programme restarted. The last brain was collected on 18 July 1989. Three of these five cases were inpatient deaths referred to the Coroner. The remaining two were categorised as 'controls'. | |
| Prestwich mortuary closed for post mortems in August 1989 but continued for hospital use. Any post mortems required on patients who had died in Prestwich Hospital were carried out at Fairfield Hospital, Bury. | |
| Mr Walkden, the mortician at Prestwich, transferred to Fairfield Hospital in 1988. | |
1986-1996 - Bury, Rochdale and Oldham mortuaries |
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| Although brains for the programme obtained from these mortuaries were mainly taken in the later years of the programme, these mortuaries are discussed in this chapter as the office of the North Manchester Coroner was involved. | |
| Discussions with Mr Walkden on the arrangements since his transfer to Fairfield Hospital, Bury, and with Mr Paul Owen, the mortician at Rochdale mortuary, indicate that between 1986 and 1996 the same arrangements that operated originally at Prestwich had continued until 1996. Six Coroner's cases were referred from Oldham mortuary, 34 from Rochdale and 27 from Bury. | |
| A difference was that these Coroner's cases had almost all suffered from psychiatric illnesses. Only three 'control' cases were referred from Rochdale mortuary in 1994. After 1989 no 'controls' were referred from Bury or Oldham mortuaries. | |
| The last brains from Coroner's cases were collected from Bury mortuary in July 1996, from Rochdale mortuary on 5 September 1996 and from Oldham mortuary on 5 November 1996. | |
| I have considered the possibility that some of the deaths of patients with neuropsychiatric disease were referred to the Coroner in order that the brain could be obtained for the joint programme. However, I have found no evidence that any of the deaths were inappropriately referred to the North Manchester Coroner in any of the cases where the post mortem examination was undertaken at Bury, Oldham or Rochdale mortuaries. | |
Request for brains from patients with epilepsy |
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Another feature at Rochdale is the letter dated 1 June 1994 signed by Mrs Joyce Langan to Dr Menon, Consultant Pathologist in Rochdale, which indicates plans for widening the brain collection programme to include brains from those who had been treated for epilepsy. Mrs Langan is certain that she would have cleared this letter with Mr North 'to keep him in the picture'. |
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| Chronology of brains collected from Prestwich Mortuary | |
| May 1985 |
First
application
to
the
NWRHA
by
the
joint
programme
for
research
funding
|
| October 1985 |
NWRHA
funding
awarded
|
| 1 November 1985 |
First
brain
collected
from
Prestwich
mortuary
|
| 15 January 1986 |
Salford
EC
approval
of
research
protocol
submitted
by
Dr
Deakin
and
Dr
Soni
|
| 17 July 1986 |
Date
of
signature
of
research
protocol
later
submitted
to
North
Manchester
and
other
Ethics
Committees
|
| 26 February 1987 |
Mr
Isaacs'
death
|
| 27 February 1987 |
Post
mortem
examination
at
Prestwich
mortuary
|
| 16 March 1987 |
Inquest
into
Mr
Isaacs'
death
|
| 23 March 1987 |
Mrs
Isaacs'
first
letter
to
Mr
North
|
| 16 April 1987 |
Mrs
Isaacs'
further
letter
to
Mr
North
|
| 18 May 1987 |
Collection
of
brains
for
the
joint
programme
halted
from
all
mortuaries
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| 29 February 1988 |
Brain
collection
for
the
joint
programme
restarts
with
collection
of
a
brain
from
NMGH
mortuary
|
| 14 April 1988 |
Restart
of
brain
collection
from
Prestwich
mortuary
|
| 18 July 1989 |
Collection
of
last
brain
from
Prestwich
mortuary
|
| August 1989 |
The
last
post
mortem
at
Prestwich
mortuary
|
| Date uncertain (probably 1989) |
Closure
of
Prestwich
mortuary
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Summary |
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| The plan for brain collection described in the original research application of the joint programme and in subsequent documents recorded that brains would be collected after consent had been obtained from the relatives. | |
| The collection programme was planned to be similar to that in use in the Cerebral Function Unit and to the procedures of the Clinical Research Centre, Northwick Park Hospital. | |
| Professor Deakin in his letter of 8 November 2001 to me states that the brain collection system was set up to follow the practice that had been in operation in other centres in the 1980s(5). The collection of brains of Coroners' cases did not, however, follow the procedures under Coroners Rules 9 and 12 that had been in place at the Clinical Research Centre. | |
| When the programme started, an arrangement with the Coroner's office in Rochdale identified the great majority of the brains that were obtained. | |
| It was the Coroner's office in Rochdale that identified suitable cases from Prestwich mortuary for the joint programme and later continued to do so from Coroner's cases at mortuaries in Bury, Rochdale and Oldham. | |
References |
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| 1. Case papers at the Cambridge brain bank. | |
| 2. Entry in the first brain book of the joint programme. | |
| 3. Letter from Professor David Gordon dated 1 March 2002. | |
| 4. Letter from Professor Deakin to Ms Alexandra Nall at the General Medical Council dated 11 June 2001. | |
| 5. Letter from Professor Deakin to Dr Metters dated 8 November 2001. |