One hundred and seven cases of sudden death in bathtubs, bath-death, were reviewed from the records of inquest by the Naruko Office of Miyagi Prefectural Police from 1984 to 1997. Eighty-four cases were of visitors staying at hot-spring hotels and 33 cases were of local residents. The number of cases of local residents increased by 1.8 times in the latter 7 years as compared with that of the first 7 years of the period investigated, probably because of aging of the population. The annual number of bath-death cases among visitors varied on a large cycle of over 10 years, seemingly in correlation with business conditions because it showed a strong correlation with the official discount rate. The average mortality rate of visitors was much higher than that of residents in the best business conditions and lowered to the same level as that of residents in the worst business conditions. One reason for such changes in mortality rate may be that while a majority of trips in the best business conditions were for pleasure, sometimes accompanying fatigue and stress of aged members including 85% or more of male, as business conditions became worse, the purposes of trips changed into recuperation and sightseeing. The number of bath-death cases among visitors increased every April and December, probably because of social customs such as new fiscal year parties, year-end parties, and so on. Bath-death cases occurred more frequently among those over 70 years, and were seen more at midnight, in winter, after drinking, at a bath temperature over 40 degree centigrade, and for a large temperature difference between the room and bath. Sixty-six percent of the bath-death cases were caused by cardiovascular diseases; 23%, by cerebrovascular events; and 11%, by other accidents.

The experience at the time of a patient’s death can affect the mental health of bereaved families. Performing death pronouncements is an important skill for end-of-life care. However, almost no educational content regarding death pronouncements is presently included in medical educational programs. We have created a guidebook for “Physician behavior at the time of death pronouncement” based on the results of a questionnaire given to the families of deceased patients that included several items related to this topic. The purpose of this research was to investigate the educational effect of using this guidebook. The guidebook was given to 4th-year medical students attending the Yokohama City University School of Medicine. A survey was then conducted to assess evaluations of self-practice and feelings of difficulty at the time of making death pronouncements both before and after the class. Among the 39 students who provided valid responses, the majority (89.5%) indicated that they had difficulty with the item regarding “the specific method of death pronouncement.” A significant improvement was observed between the responses obtained before and those obtained after the class. We concluded that our guidebook for physician behavior at the time of death pronouncement might be useful for the education of medical students.