Book Review:
San Francisco Coroner's Office-A History 1850-1980

Terence Beckington Allen, MD
Redactors' Press San Francisco 2002

Reviewed by Steve Walsh, MD

It is unusual for a psychiatrist to review a book by a pathologist about the history of the San Francisco Medical Examiner-Coroner's Office. However, this monograph by Dr. Terence Allen, son of past SFMS president Dr. David Allen, is of significant interest to all of us who are fascinated by San Francisco history and the history of our local medical traditions. The early medical traditions of San Francisco weave in and out here in many a tale to be enjoyed by those who love this place and its unique history.

Dr. Allen published this book in serial form in San Francisco Medicine in 1982-83. He wrote this history while working as a forensic pathologist resident-in-training and as an assistant medical examiner in the San Francisco Coroner's Office from 1977 through 1982. This third edition is a more complete history with cited references that had not before been published. Dr. Allen is currently a general physician on the staff of Eastern State Hospital, Medical Lake Washington.

In his introduction, Dr. Allen tells us that few have considered the history of death in San Francisco. "Coroners and their deputies have penetrated the streets at all hours to peer into squalid sick beds and dark alleys, seeing the effects of violence and catastrophe," he writes. "The work of the coroner and his agents is not always pleasant but always human. A History of San Francisco's Coroners' work is one history of the City."

Some of the most fascinating history presented in this book is that concerning the early relationship between the colorful Dr. Beverly Cole and Dr. Hugh Toland, adversaries in the 1860s in a notorious double murder case. Apparently not holding a grudge, Dr. Toland in 1870 appointed Dr. Cole Dean of the Toland Medical School, the predecessor to the UCSF School of Medicine. Cole went on to be instrumental in locating the San Francisco County General Hospital on Potrero Street and became president of the American Medical Association in 1895.

Dr. Allen includes interesting information regarding San Francisco's 1906 earthquake deaths, including several gunshot deaths of looters. One looter is described by the coroner as "so burdened with plunder that he could not make his way out of the debris and sank exhausted and died."

Dr. Allen also explores the developing interest of the Coroner's Office in public health issues in the 1900s, and in later chapters he describes the controversies surrounding the coroner's offices' functions in such California events as the Watts riots in Los Angeles in 1965. He also details the relationship of the San Francisco Coroner's Office to the UCSF School of Medicine over the years. Many original contributions to forensic medicine were made by physicians associated with the Coroner's Office and UCSF, including the "most unique" discovery that death by air embolism could occur with cunnilingus when air was blown into the vagina. In another contribution careful autopsy studies of the vessels in young adults and children in landmark study showed that atherosclerosis can begin at an early age. Others are described as well.

Dr. Allen's monograph describes in detail the personalities, quirks, and significant achievements of those who have inhabited the Medical Examiner-Coroner's Office over 130 years of San Francisco history. As a nonpathologist physician, I found it far more interesting and entertaining to read than I would have imagined. Dr. Allen's history of death in the City by the Bay is in many ways as interesting as the history of life in this unusual and very special place.

Graceful Passages: A Companion for Living and Dying
An Audio Resource for Spiritual Support

Michael Stillwater

When our family physician told us that my father's condition was likely terminal, I asked him if he had given Dad the news. He hesitated a moment, then told me he wasn't comfortable with such a communication. When I reminded him of the many years of trust which had been shared, and asked why such hesitation, tears came to his eyes. He confessed that his own fears of dying got in the way, yet he agreed to speak to my dad in spite of himself. Although it was difficult for him, his willingness to work through his own fear helped to create a more accepting atmosphere during the last months of my father's life.

What emerged within me was a desire to help ease the fear of dying-not only for physicians, but for anyone. As a musician, I chose music as the vehicle-music combined with words which address the issues surrounding our fears of dying. Together with Gary Malkin, an Emmy-award winning composer, we developed Graceful Passages: A Companion for Living and Dying.

A 2-CD/giftbook set containing music with spoken messages from a variety of wisdom traditions, Graceful Passages provides a forum for contemplating such issues as letting go, appreciating the present moment, forgiveness, and continuity of spirit.

Early in the development of the project, we asked Dr. Ira Byock, author of Dying Well and director of the Palliative Care Service in Missoula, Montana, for his response. He writes in the Introduction, "Graceful Passages is a unique resource for people who are facing the prospect of dying. This CD makes the wisdom of experienced clinicians, counselors and spiritual advisors available to anyone who is confronting life's end, either themselves or within their circle of family and friends. In contrast to our medical response to people who are dying, the listener's feelings need not be pathologic before Graceful Passages would have value, nor must this soothing resource be prescribed. Instead, Graceful Passages offers anticipatory guidance that is appropriate for anyone who is interested in exploring their personal mortality. I can attest to the power of the words and music to comfort, build confidence, and connect listeners with their own inner wisdom."

While the first CD contains spoken messages set to music, the second CD contains music alone creating a peaceful atmosphere which both invites personal reflection and encourages dialogue between listeners.

Studying Graceful as curriculum for medical school courses in spirituality, Dr. Christina M. Puchalski, Founder/Director of the George Washington Institute of Spirituality and Health, comments, "I recommend Graceful Passages for patients, family members, physicians and other healthcare providers. It is a wonderful tool to help people touch the healing power of their spirit and inner resources".

We receive calls and letters also from those who are not personally connected with the immediacy of dying, yet are profoundly moved by the spiritual depth of this work. Author Dr. Christiane Northrup believes that because dying is a shared experience, the message is not just for some of us. "Everyone needs Graceful Passages now!" she says.

Reflecting an artistic and spiritual perspective drawing a variety of faith traditions, Graceful Passages is meeting a need seldom discussed, yet shared by all concerned-the capacity to address, with an open mind, the fear of death itself.

Michael Stillwater is a spiritual educator using music as a medium for connection and renewal. Together with Emmy-award winning composer Gary Malkin, he is co-producer of Graceful Passages: A Companion for Living and Dying. For more information on how to order this resource, contact Companion Arts Foundation at www.gracefulpassages.com, 415/209-9408.