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* A poor diet boosts the cancer and heart-disease numbers, and, especially, the stroke statistics.
* Alcohol courses freely through all the figures. "It can cause lung disease, liver disease, and heart disease," Davis says. "It can affect behavior and make people drive cars into trees and into canals. Forty percent of all homicides have alcohol aboard, 35 percent of suicides have alcohol aboard, and 60 percent of motor vehicle accidents are alcohol-related."
* The influence of drugs, too, is widespread. Bill Wilbanks, a professor of criminal justice at Florida International University, estimates that about a quarter of all Dade homicides are drug-related. The Dade medical examiners say many homicide victims test positive for illegal drugs, particularly crack cocaine. Drugs have also precipitated many natural deaths, from brain hemorrhage to heart failure, and have spared no age group. "Some of the perinatal fatalities are associated with drug abuse," says Dr. Eleni Sfakianaki, medical executive director of the Dade County Public Health Unit. "We find that many women using cocaine and crack, often at the same time, give birth to infants exposed to drugs in utero." HRS attributes 29 of Dade's accidental deaths to drugs, but medical examiners say illegal substances are responsible for a considerably higher number of fatalities.
In recent years, Dade County residents have taken some of these statistics to heart. Largely because of improved lifestyles and health consciousness, medical officials say, the rate of deaths attributable to heart or liver disease and stroke have dropped significantly in the past decade. Nonetheless, according to HRS statistics, the leading causes of death have not changed much from the late Seventies, and the top three killers in the state a dozen years ago are the top three killers in the state today.
Suicide rates have remained fairly constant, as well, both in Dade and statewide. As Chief Medical Examiner Davis puts it, "Suicide keeps marching on and on and on." While the number of suicides usually corresponds to the size of the population, he explains, the homicide rate reflects the dynamics within a population, such as drugs and economic discontent. In a statistically ideal world, Davis says, the suicide rate would be higher than the homicide rate. That is the case statewide, but Dade County produces more homicides than suicides and accounts for more than a quarter of all homicides in Florida.
That was not always the case, according to Davis. As recently as the Sixties, suicides exceeded homicides on the Dade death charts, but by the Eighties homicides surpassed suicides, with the peak of the killing curve in 1980 and 1981 at the height of the Mariel boatlift. Since then numbers have dropped generally, although homicide has continued to demonstrate a voracious appetite for a section of the population: young black males.
However homicide, like any other cause of death, does not always pick and choose by race or gender. Consider Dr. Mittleman's early-morning autopsy subject. It seems pretty clear what killed the 34-year-old woman: Her boyfriend had already admitted his culpability to a counselor, and his weapon of choice - a rusted, three-foot construction spike - fit the wounds perfectly. So why the autopsy? You can never be too sure, Mittleman explains. "What if I found nails in her stomach? What if he had forced her to eat nails?" the experienced pathologist posits. "No, that's a little far-fetched. How about if something was stuck in her rectum? What if a knife had been stuck all the way up her rectum, so far that you couldn't see it from the outside? Then obviously the boyfriend's lying and then the police would have to interview him again."
But the autopsy reveals nothing that would contradict the boyfriend's story, and Mittleman writes "blunt cranial trauma" as the cause of death on the murdered woman's death certificate. The corpse, out of the cooler for an hour and a half, has begun to turn a light shade of purple, an unmistakable outward sign of the inevitable decomposition. On deck are two more bodies: a 74-year-old man who threw himself into a pool with two household steam irons tied to his leg, and a three-month-old baby who died of sudden infant death syndrome. The lab technicians begin the quick procedure of restoring the body to some semblance of its former self and returning it to the cooler until it can be taken to a funeral home for embalming.
A lab assistant puts the woman's vital organs into a plastic bag, stuffs the package into the corpse's gutted torso, and, using thick cotton string, quickly begins suturing the incisions. "She can be put back together," Mittleman says, almost reassuringly. "It's not as bad as it looks.