Cause of Death

Percy Lawrence, a South London plumber, was a 50-a-day chain smoker. He had worked up to this forced-draft rate in the Royal Navy during World War II, and never tapered off. As Lawrence lost weight and complained of always being tired, Dr. Paul Frederick Lister advised him to cut down. Still he went right on smoking. Last August Dr. Lister did a bronchoscopy, found cancer of the lung originating in a bronchus (one of the main branches of the windpipe). In little more than two months the cancer killed Lawrence, 51, husband and father.

British doctors had been debating how to dramatize the cause-and-effect relationship between smoking and such premature deaths, and Dr. Lister knew just what to do. On the death certificate, on the line for "cause of death," he wrote: "Carcinoma (cancer) of bronchus due to excessive smoking." This was unheard of. The registrar harrumphed, refused to accept the certificate. That meant there had to be an inquest--before Coroner R. Ian Milne, a layman who happens to be an unreformed smoker, Cried Milne: "I would take issue with any doctor who used such a term as 'excessive' in a death certificate. [That] is to judge the habits of one's fellow men. That must be the province of the coroner." Coroner Milne's verdict: death from natural causes.

But Dr. Lister had made his propaganda point. His unprecedented notation got a big play last week in newspapers all over Britain.

. . .

When Nathan Louis Gordon, 73, died of heart disease during one of Los Angeles' bouts with low-descending smog, Dr. Peter Veger stated on the certificate that the smog was "a significant condition contributing to death." (The connection: difficulty in breathing may overstrain a weakened heart.) Snapped County Coroner Theodore J. Curphey: "Los Angeles smog is not a disease. We would be opening the gates to litigation against the Board of Supervisors if we accepted such a certificate."

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