9-30-07: Post-Mortem
Knife Wounds
Q: In my novel,
a 35-year old man is killed by a blow to the back of the head.
Afterwards, in order to leave his signature, the killer repeatedly
knifes the victim. The knife used is a Randall Miniature Model
14 attack knife with a 3-3/4” blade made of stainless
steel, if that information is helpful. I need the killer to
mutilate his victim within a 2-hour timeframe of the victim’s
death. How much blood or fluid would leak from these wounds?
I would like there to be as little mess as possible. I need
for the victim to be knifed as early in the 2-hour time frame
as possible with the least cleanup necessary.
LDA, Grapeland, TX
A: If
the victim died from the knife injuries and the mutilation
wounds were inflicted after that, then there would be very
little if any bleeding. At death, the heart stops, the blood
ceases to circulate, no blood enters the wounds, and no bleeding
occurs. And the blood clots in 5 to 15 minutes. This means
that if your killer did his deeds 5 or so minutes after the
victim died there would be no blood from the wounds. And the
ME would use this fact to determine that the wounds were indeed
inflicted post-mortem.
Could there
be some bleeding from some of the wounds? Yes. If the victim did not die immediately
but only appeared dead, which could happen if he was in shock with a very low
blood pressure from internal blood loss from the knife wounds, then the wounds
inflicted before his heart actually stopped would bleed a little. Also any
wound inflicted within 5 minutes of death could ooze a very small amount of
blood simply by the effects of gravity. But this would be very little.
So, any
wounds inflicted on your dead victim after death would not bleed and the ME
would know that the wounds were post-mortem.
9-22-07: GSW to Spinal
Cord
Q: In
my novel, the main character is a homicide detective who is
shot in the back. The bullet becomes lodged between her
T11 and T12 vertebrae, cutting into her spinal cord and leaving
her paralyzed from the waist down. What would be a reason
for the doctors to remove the bullet immediately and how long
would she be in the hospital before rehabilitation was started?
Also, what type of rehabilitation would she face, how long
would it be before she could return home and what type of job
opportunities would the police department offer her?
DCooper, Sewell, NJ
A: Surgery
would be done to control any bleeding and to attempt to salvage
as much spinal function as possible. With this type of injury
there would be direct damage to the spinal cord by the bullet
and indirect damage from the fractured vertebrae in the area
and from pressure as blood accumulated into what we call a
hematoma. This is simply a mass of blood and it can apply pressure
to the cord and make things initially look worse than they
are. The surgeon would remove the bullet—if possible.
He might or might not since removing it could cause more injury
than leaving it in place. Usually though it is removed. He
would remove any hematoma that had collected, control any bleeding,
and repair the damaged vertebrae if possible. The surgery would
probably be done by a neurosurgeon and an orthopedic surgeon,
working together.
Recovery
is extremely variable and depends upon the exact nature of the injury, the
effectiveness of the surgery, the person it happens to, and luck. So you can
have it go almost anyway you want. Full recovery is possible, full hemiparesis
(paralysis below the waist) is possible, and anywhere in between. Rehab is
usually begun in the hospital a few days after surgery and continued after
discharge. She might be in an ICU for 3 or 4 days, a regular hospital surgical
bed for a week (here is where rehab would begin with simple range of motion
exercises as possible and passive movement of the limbs, etc), and then she
would be transferred to an in-hospital rehab unit for a few weeks. This is
all very general and depends upon what’s happening with the victim and
the state of the art of the hospital.
If she indeed
suffered permanent paralysis, she could perform any type of desk job such as
dispatcher, records custodian, that kind of thing. She could also begin a new
career in the crime lab. Many crime lab techs are previous police officers,
who then train on the job in such things as fingerprints, firearms, etc.
9-14-07: Drowning
Versus Nightshade Poisoning in 17th Century London
Q: My
plot takes place in 17th century London, where a young girl
is poisoned (probably with deadly nightshade), then left in
a lake to appear as a suicide by drowning. I need my detective
to be able to find out that the victim was already dead when
put in the water, or at least to see signs that would raise
that suspicion. The detective is a well-educated midwife and
would have some medical knowledge. I'm also not sure whether
at this time such a death would be investigated via an autopsy?
Frances, UK
A: As
with virtually all poisons, nightshade leaves no visible evidence
of its present in a corpse and must be found by toxicological
testing, which did not exist in the 17th century.
The evidence
of drowning is usually lungs filled with water and a froth in the mouth and
airways. This is from air being mixed with water as the victim tries to breath
while taking in water. The problem is with timing. If the corpse is found within
about 24 hours, then the examiner would expect to see the froth and lungs filled
with water if the victim did indeed drown. If he did not see these he might
suspect that the victim did not drown but rather was already dead. Longer than
24 hours or so that in the water and the froth can wash away and the lungs
can passively fill with water so that these clues---or their absence—is
no longer useful. Even today drowning is often difficult to determine.
So, have
the corpse found in less than 24 hours with relatively dry lungs and no froth
and your sleuth could believe that the victim was already dead when he went
in the water.
Yes an autopsy
could be done but at that time it likely wouldn’t be. Even though the
first true forensic autopsies were done in the 1200’s at the University
of Bolgna, the knowledge to do them wasn’t that widespread and the church
still held many taboos against dissections.
9-14-07: Leg Amputation by Veterinary Student
Q: I'm
curious. Could a veterinary student amputate a woman's leg?
How could they knock a person out without anesthesia? From
below the knee down? How hard would this be to pull off? How
much care would the woman need? How quickly could she be transported--say,
put on a plane and flown to Mexico? How long until she would
be up and around?
Joanna Slan
A: Yes,
a vet student who was well along in his courses could do it.
It’s not that difficult. The surgery is simply cutting
through the skin a few inches below the knee joint and peeling
the skin back—this will leave a skin flap to close the
wound. Then the ligaments of the knee joint would be cut through
and the lower part of the leg removed. The wound would be cleaned
and the flap would be sewn closed over the stump. She would
need pain meds and antibiotics but unless an infection set
in she would do well. Remember these have been done on battlefields
for centuries with great success---except for that little infection
problem in the pre-antibiotic era—before the 1940s.
As for anesthesia
there are a few options. Vets often use Ketamine in their offices for animal
anesthesia and this can be easily stolen and used. Tricky since too much and
the victim will stop breathing and die. But if he carefully gave a little at
a time, the person could be kept in a more or less twilight state and the surgery
could be done. Not without some pain, bit at least not as much as if fully
awake---which is the way it was done in war. More could be used if he also
stole a mask and Ambu bag---this is a football=shaped rubber bag that is attached
to a face mask and squeezed to breath for the person. It acts like a bellows
and each squeeze forces air into the mask and then into the person’s
mouth and lungs. This would have to be kept up until the anesthesia wore off—maybe
a half an hour or so.
Another
options would be a regional anesthesia. Also in the clinic there would be needles,
syringes, and the local anesthetic Lidocaine---it’s the stuff used before
you get stitches. An injection in the groin where the major nerves leave the
abdomen and pass into the leg would block these nerves and numb the entire
leg. It would wear off after about an hour or two. The surgery would be done
during its effective stage.
She would
be able to travel in 24 to 48 hours if necessary and would need pain meds and
antibiotics and keeping the wound clean for a couple of weeks. If all went
well she would be out of bed and on crutches in only 3 or 4 days.
9-12-07: Treatment
of Ulcer Disease
Q: I
plan on opening my story with the 25-year-old male main character
(in good health, but taking a lot of aspirin due to constant
stress from overwork) collapsing from a bleeding ulcer. He'll
be discovered within a half-hour and rushed to the hospital
in time...but I'd like to know the following regarding the
aftermath (and I understand time frames would be estimates,
since it's different for everyone!): Any possible reasons for
why drug therapy might not work and surgery would be required?
How long they'd probably try the drug therapy? How long after
surgery he'd be expected to stay in the hospital? If there
were any dietary changes he'd have to make while the ulcer
healed?
IC, Chicago, IL
A: This
is a big topic and impossible to cover completely, but I’ll
give you an overview of how this disease is treated. Peptic
Ulcer Disease (PUD for short med jargon) comes in many flavors.
One of these is bleeding. This can result from minor irritations
of the lining of the stomach or duodenum (very upper portion
of the small intestine) or from large ulcer craters in either
of these areas. And anywhere is between these two. Treatment
is with replacing blood via transfusion—if necessary
due to a large degree of blood loss—and the institution
of acid blocking drugs such as Tagamet, Prilosec, Protonix,
and the many others. If this works and if the bleeding stops
and the ulcer begins to heal, then great. But if the bleeding
is severe in the first place or if it doesn’t cease with
this more conservative treatment, then surgery is often necessary.
It can go either way and if often not predictable so you can
have it either way in your story.
The patient
would remain on these meds for several months at least whether he required
surgery or not. Some people stay on one or the other for many years. Drug treatment
is always preferred and would be used as long as needed. Surgery is always
reserved for emergent situations or as a last resort.
If he did
have surgery and if all went well he could go home anywhere from 3 or 4 days
to a couple of weeks. Again, this is highly variable and depends upon many
factors.
Diet therapy
is controversial since the data that shows that it helps is not very strong.
Patients are told to avoid aspirin and any other OTC anti-inflammatory meds—except
Tylenol which is OK---and alcohol. Also foods that cause indigestion or pain—and
this varies from person to person—should be avoided.
So, the
treatment, complications, and long-term effects of PUD are highly variable
but this info should help you construct your story.
9-7-07: What Happens
When a Meth User Dies in the Desert?
Q: A
character in my script is stranded in the desert. He is a Meth
drug addict. He dies of dehydration after walking miles without
water in a California desert. Temperature is 112-115
F. What possible, as well as probable, events take place as
the body shuts down? What are the visual characteristics on
the body? What differences need to be factored in for a companion
to survive?
Carla King, Los Angeles, CA
A: The
two factors that would lead to death are dehydration and heat
stroke. Dehydration is the loss of body water. The rate at
which we lose water depends upon several factors such as the
ambient temperature (the higher the faster the loss from sweating),
activity (water is lost through the lungs with each breathe
and exercise increases breathing), medications or drugs (alcohol
and diuretics both cause water loss through the kidneys), and
other factors.
The symptoms
of dehydration are thirst, fatigue, dry mouth, nausea, sleepiness, shortness
of breath, weakness, muscle cramps, a rise in body temperature (heat stroke),
delusions, delirium, hallucinations, loss of coordination and finally collapse,
coma, and death, more or less in that order of appearance. The rapidity with
which dehydration (and heat stroke) occurs will dictate how quickly these symptoms
appear and how severe they are. Organ damage is primarily the kidneys, which
can be severely and irreversibly damaged with severe or prolonged dehydration.
If left
untreated, dehydration can lead to heat stroke. This is when the elevated internal
body heat damages the brain. The body depends upon sweating and evaporation
to lower body heart. Dehydration lessens seating and thus body temperature
can’t be regulated properly. Eventually, the body core temperature will
begin to rise and this is a very dangerous situation. With the onset of heat
stroke, sweating ceases and the body temp rises dramatically---106, 108, 110.
This basically fries the brain and causes death.
In your
scenario, the dehydration would likely come on fairly quickly in view of the
very high temperatures you mentioned. In the Meth user it would come on much
faster than in the other person. The reason is that meth and other amphetamines
in and of themselves cause dehydration and elevated body temperature and these
effects work in concert with the environment to make the severity and rate
of progression of dehydration and heat stroke much greater.
How long?
It’s highly variable but it could be as little as a few hours or as mush
as a couple of days. So, have it your way. I’d give the meth user 4 to
8 hours and the other person a couple of days. That should work for your scenario.
Both would
be appear gaunt and drawn. Of course, one would look dead (more pale and waxy)
and the other alive (flushed and sunburned). Otherwise there would be no visible
difference.
A word about
mirages. Once the body temp gets above 103 or 104 or so, the mind isn't so
sharp. The victim will not be able to think well and may literally wander in
circles or hallucinate. Mirages can be seen as a result. Mirages are due to
the physics of light. The heat rising from a desert or a road bends light rays
due to changes in density of the air. The result is that you see blue sky below
the horizon and it looks like a body of water. Often a person who is dehydrated
and confused will rush blindly toward it, but can never reach it because it
doesn't exist and because the optical illusion keeps moving away from them,
so to speak.
Once your
surviving victim is found, treatment consists of re-hydration with water both
orally and intravenously (IV) and lowering the body temperature by spraying
or soaking the person with water and simple fanning with a towel or similar
object. The water acts like sweat and the fanning hastens evaporation, which
draws away heat. With heat stroke an ice bath might be used to rapidly lower
the body temperature.
8-27-07: Tampering
with Oxygen Mask to Kill Cancer Victim
Q: I've
got a man in his 60's who is dying (I gave him cancer, but
really it could be anything convenient for the scenario I'm
describing). He is being cared for at home by his wife and
his niece (who is a nurse), along with help from a local hospice
group. He has trouble breathing and sometimes needs a mask
put over his face (oxygen, I'm guessing), to help him out.
The oxygen is in a tank behind his bed.
One afternoon
he needs the mask, but when they put it on him, he dies anyway. His death seems
natural. It's not until autopsy that they realize he was murdered: There at
the end, he wasn't breathing oxygen through the mask at all but some other
substance that had been put into the tank (or that tank was switched out for
another) and the substance killed him.
What deadly
substance was substituted for the oxygen? Would it have a smell? How would
the autopsy reveal that this is what happened?
I'd like
the fatal gas to be as simple as possible, something easily attainable by any
of the 5 suspects. It would also be fine if someone could've just changed the
settings on the oxygen or some other gas that would be present anyway and that's
what killed him. The most important part of the scene is that they have to
think it was a natural death until autopsy (though a whiff of some strange
odor would be fine.)
Mindy Starns Clark
www.mindystarnsclark.com
A: There
are several possibilities but three that would be very easy
for your killer to employ.
1—Simply not turning on the oxygen
and having him continue breathing only room air. If he were
very ill with severe lung disease, and particularly if he
was taking pain meds, which would suppress his respiratory
drive, this alone could make him gradually slip into a coma,
stop breathing, and die.
2—If he had what we call Chronic
Obstructive Pulmonary Disease (COPD), which is basically
emphysema and similar diseases, he would be very sensitive
to high oxygen (O2) levels. The physiology here is complex
but the bottom line is that people with severe COPD can slow
or even stop their breathing if exposed to high levels of
O2. So your killer could turn up the oxygen. Normally these
tank masks combinations are set at a flow rate of 2 liters
of O2 per minute. If the valve on the tank were turned up
to say 10 liters/minute the victim would gradually slow his
breathing and eventually stop and die from asphyxia. This
could take anywhere for 15 minutes to a n hour so you have
a bit of leeway here.
If the gauges were returned to normal after the victim died
and before he was seen by investigators or other witnesses,
then the cause of death might never be determined since there
are no laboratory or autopsy findings in these situations.
3--Carbon monoxide (CO) would also work.
The killer could extend a small hose—or a garden hose—from
a car tail pipe in the garage or the driveway just outside
the window to the mask the victim was wearing. This is a
very deadly situation that comes from the unique chemistry
of CO.
CO is a
tasteless, odorless, colorless gas that is completely undetectable by humans.
It’s treachery lies in its great affinity for hemoglobin, the O2-carrying
molecule within our red blood cells (RBCs). When inhaled, CO binds to hemoglobin
producing carboxyhemoglobin. It does so 300 times more readily than
does oxygen and thus displaces oxygen. In other words, if the hemoglobin is
presented with both oxygen and carbon monoxide it is 300 times more likely
to combine with the CO. The result is that the blood that leaves the lungs
and heads toward the body is rich in CO (carboxyhemoglobin) and poor in 02
(oxyhemaglobin).
This strong
affinity of hemoglobin for CO means that very high blood levels can occur by
breathing air that contains only small amounts of CO. For example, breathing
air that contains a carbon monoxide level as low as 0.2 % may lead to blood
CO saturations greater than 60% after only 30 to 45 minutes. So, a faulty heater
or smoldering fire that produces only a small amount of CO becomes increasingly
deadly with each passing minute. Same for an idling car engine that produces
fairly large amounts of CO.
At autopsy
the ME would be able to determine the cause of death by looking at the color
of the body, the internal organs, and by measuring the carboxyhemoglobin level
in the victim’s blood and tissues.
Carboxyhemoglobin
is bright red in color and imparts this hue to the blood. When the ME performs
an autopsy and sees bright cherry-red blood, he will suspect CO poisoning as
the cause of death. This finding does not absolutely specific since cyanide
inhalation or ingestion can also result in bright cherry red blood and tissues.
Also, individuals dying from cold exposure or corpses exposed to very low temperatures
may show bright red blood. Livor mortis (lividity) in these situations may
also be red or pink rather than the usual blue-gray color.
The internal
organs in victims of CO intoxication are often bright red. Interestingly, this
color does not fade with embalming or when samples taken by the ME are fixed
in formaldehyde as part of the preparation of microscopic slides. At times
the presence of CO can be found in the blood as long as 6 months after death.
The actual
degree of exposure to CO is typically measured by determining the percent of
the hemoglobin that is carboxyhemoglobin. The signs and symptoms of CO toxicity
correlate with these levels. The normal level is 1 to 3%, but may be as high
as 7 to 10% in smokers. At levels of 10 to 20%, headache and a poor ability
to concentrate on complex tasks occur. Between 30 and 40%, headaches become
severe and throbbing and nausea, vomiting, faintness, and lethargy appear.
Pulse and breathing rates will increase noticeably. Between 40 and 60% the
victim will become confused, disoriented, weak, and will display extremely
poor coordination. Above 60% coma and death are likely. These are general ranges
since the actual effect of rising CO levels varies from person to person. Your
victim could have any or all of these symptoms or could simply stop breathing
and die.
In the elderly
and those with heart or lung disease, levels as low as 20 percent may be lethal.
Victims of car exhaust suicide or those that die from fire in an enclosed room
may reach 90 percent.
Your ME
would see the reddish lividity, the red coloration of the internal organs,
and finally find an elevated carboxyhemoglobin level and would know the victim
died of CO toxicity.
8-12-07: How is a
Glass Laceration of an Artery Treated in the Field?
Q: The
villain of the piece falls through a glass table, and sustains
injuries that would be fatal if he didn't receive immediate
first aid. The protagonist is a medical student, and does the
necessary to save his life, before phoning an ambulance (and
leaving the scene). What would be the best injury that combines
imminent risk to life with suitability for on the spot intervention?
Could skilled first aid treat a wound to the femoral artery?
Iain Rowan, UK
www.iainrowan.com
A: An
injury to any major artery would work for your scenario. The
femoral artery in the groin or the popliteal artery in the
leg—runs behind the knee—would each bleed profusely
if cut by the glass. In the arm, the brachial artery (upper
arm) or the radial artery (forearm, thumb side) or the ulnar
artery (forearm, little finger side) would also bleed if cut.
In any case the goal of treatment in the field is to control
the bleeding until help arrives or the victim can be transported
to help. Applying a tourniquet above the wound if possible
would help. This could be a rubber tube, a cord, a belt, a
tie, a bra, anything. Also direct pressure over the wound would
help stop the bleeding. Then the victim would have to get to
where a surgical repair could take place if he was going to
survive and save his arm or leg. Anyone with basic first aid
knowledge should know how to do this. And a medical student
surely should know. Whether they can or not depends upon them.
Some people freak in such situations while others do what’s
necessary.
7-28-07: What Happens
When Someone Dies from an Asthmatic Attack?
Q: A
character in the book I'm working on is 54 year-old, male,
a heavy smoker who has had asthma since he was a boy. Under
conditions of high stress, he suffers a fatal asthma attack.
I'd like your help describing what he would experience and
how it would appear to an observer.
Joel Goldman
http://www.joelgoldman.com
A: Asthma
is a disease of the airways where they spasm (reduce in diameter
due to the contraction of muscles around the small airways
in the lungs). This spasm can be precipitated by many things
such as smoke, pollution, allergies to pollen or anything else,
and indeed stress.
As air enters
the lungs, it passes through the trachea (windpipe), through the bronchial
tubes, through the bronchioles (very small bronchial tubes), and into the alveoli
(air sacs). It is in the alveoli that oxygen (O2) and carbon dioxide (CO2)
are exchanged with the bloodstream. In asthma, the tiny bronchioles spasm and
dramatically reduce the amount of air reaching the alveoli and thus the blood.
Breathing
involves inspiration and expiration. Inspiration is an active process, involving
contraction of the diaphragm and of the inspiratory muscles between the ribs.
Expiration is a more passive process that occurs due the elastic recoil of
the diaphragm, the chest wall, and the lungs. At rest anyway. With exercise,
the lungs must move air much more rapidly. To do this other muscles between
the ribs are activated. These are called the expiratory muscles. When a sedentary
person decides to take a run and develops pain in his ribs—slang would
be a stitch in the side—this is due to the use of these expiratory muscles
that is this case aren’t conditioned very well. They cramp from overwork
and the pain occurs. The medical term is Work of Breathing. At rest the work
of breathing is little. With exercise, it increases due to an increase in the
action of both the inspiratory and expiratory muscles.
The same
thing happens during an asthma attack. Here the air flow is restricted by the
spasm of the bronchioles so that the victim has to use great effort to draw
air in and get air out of the lungs. The work of breathing rises dramatically.
The analogy would be to place a clothes pin on your nose and a spool in your
mouth and try to climb stairs. The lungs would work very hard to draw air through
the spool’s tiny opening. Asthma is much like this.
So, during
an asthma attack, the supply-demand ratio drops. Less air enters the lungs
and the effort it takes to get air is dramatically increased. This leads to
a rapid decline in the amount of O2 in the blood and a rise in CO2. The elevation
of CO2 causes acidosis (a rise in the amount of acid in the blood) and this
can lead to a cardiac arrhythmia and death.
The symptoms
of an asthmatic attack reflect all these physiological derangements. The victim
would become short of breath and his breathing would become quicker. He might
also purse his lips in an effort to keep the airways open by applying some
back pressure. He would wheeze, which is the sound of the air being pulled
back and forth through the narrowed airways. He might experience a pressure
in his chest and “stitch” in is side. He would sweat since he is
working so hard to breath. He would quickly run out of energy as the O2 level
in his blood dropped. He would not be able to fight or run away and might sit
or lie of the floor and might even collapse. He would appear pale and then
would develop what is called cyanosis. This is a bluish tinge of the fingers,
toes, ears, and around the mouth. This is due to the dramatic drop in O2 in
the blood. Blood poor in O2 is purple as opposed to the red of blood rich in
O2. This causes the cyanosis.
As things
continued to spiral downhill, he would confused and disoriented and would lose
all coordination. Again, due to the decline in O2 in the blood. His gasps for
breath would progressively weaken—like a fish out of water--and he would
lose consciousness and die from either asphyxia or a cardiac arrhythmia.
7-27-057: Drum Stick
to the Throat (Not a Chicken Leg!!!)
Q: I
am working on a short story and when it opens my protagonist
finds a Nashville singer-songwriter dead in the upstairs writers’ room
at the Hog’s Breath Saloon – home of the KW Songwriters
Festival. He has had a drum stick, whittled sharp, stuck through
his throat from the front. My question is, how much will he
bleed? How badly would he bleed and how long will it take him
to die? Also, would he be able to remove the drum stick? A
friend with military intelligence (oxymoron) has told me the
vic would bleed profusely and still be able to attack the killer
before dying. If that is true, is there a way to make the drumstick
more deadly? I really want to keep it in the throat, driven
in an upward motion.
Michael Haskins, Key West, FL
www.michaelhaskins.net
A: Yes
a sharpened stick of any king, including a drumstick, can kill
if plunged into someone’s throat. If the stick went through
the trachea (windpipe) or larynx (voice box or Adam’s
Apple), then there would be some bleeding, but not a great
amount. Here the victim could die from asphyxiation as the
trachea or the larynx could collapse and block the passage
of air. Also, blood could enter the lungs and the victim could
essentially drown in his own blood.
If the stick
also punctured the thyroid gland, part of which passes over the trachea just
above the larynx, all the above would happen but there would be even more bleeding,
both externally and into the lungs.
Or, if the
stick punctured one of the carotid arteries, bleeding would be massive and
pulsatile and the victim could die very quickly. The two carotid arteries lie
on either side of the trachea and carry about 90% of the blood that supplies
the brain. When damaged, blood to the brain is blocked and this can lead to
loss of consciousness and death in seconds or a minute or so.
Or the victim
could survive any of these injuries. People are tough and are for the most
part hard to kill. So, yes, even with a stink in is throat the victim could
fight back or run away or do just about anything. He could pull the stink out
or leave it in place. He could get medical care quickly or not for hours and
could survive in either case. Or he could collapse and die very quickly. And
anything in between. Injuries such as this are very unpredictable.
7-27-07: Erectile Dysfunction After Head Injury
I am working on a novel in which my villain suffers from impotence
(Erectile Dysfunction). The scenario I am working on is that
as an adolescent he suffered a severe head trauma when he was
hit in the head by a turnbuckle on a fishing trawler. Can ED
in an adult be caused by a severe head trauma as an adolescent?
Vaughn C. Hardacker, Litchfield, NH
A: This
is very unlikely but possible. There is a medical condition
that can follow blunt head trauma that could cause ED. Rarely
a blow to the head will damage the pituitary gland. This is
called the master gland since it controls so many endocrine
functions within the body. It sits at the base of the brain
and is protected by a tiny---little finger-tip-sized—cup
in the base of the skull. This bony cup is called the Sella
Turcica. If the pituitary is damaged by the transmitted blow
its blood supply might be interrupted and the gland can essentially
die. This leaves behind and empty cup so ir called the Empty
Sella Syndrome. This can cause no problems whatsoever or the
person can have various types of endocrine (hormonal) problems.
One of these can be a reduction in sex hormone production by
the adrenal glands that sit above the kidneys on each side.
It’s very complex chemistry, but the bottom line I that
the victim could have very low sex hormones and could easily
be impotent as a result.
7-8-07: Peri-Mortem
Bruises
Q: How
long do bruises remain visible after death? With the added
complication that the victim -- cause of death was blunt force
trauma -- was bled out through the carotid almost immediately
after death. Would bruises from her final struggle still be
visible after she'd been autopsied and in the morgue a couple
of weeks?
D.L. Beltz. Topanga, CA
A: Bruises
occur whenever the small blood vessels are damaged by trauma
and blood leaks from them into the surrounding tissues. They
begin to form immediately after the trauma and are often immediately
visible. At other times they might not be visible for many
minutes, even an hour. This is the time required for the blood
to spread upward toward the surface of the skin. So, yes, your
victim, who was killed by blunt force trauma before being bled,
would have visible bruising in the area of the trauma. And
they would remain until the corpse decayed. Healing and fading
of a bruise requires that the victim be alive and the blood
be flowing into the area so the blood can be carried away from
the bruised tissues. After death, all this ceases and the bruise
remains fixed. So they would be easily seen at autopsy.
Also, for
your killer to bleed his victim he must do it fairly quickly---within 15 minutes
of death or less. The reason is that blood clots in 5 to 15 minutes after death
and after that bleeding isn’t possible. Embalmers remove blood by forcing
embalming fluid through the vascular system under pressure so if your killer
has such a set up he could force water of embalming fluid, etc into the veins
and wash the blood out that way. But simply cutting the carotids and hanging
the victim so that gravity will evacuate the blood won’t work unless
it is done almost immediately after death.
7-8-07: Stomach Contents in Decayed Corpse
Q: In
my book the two hit men attempt to make their victim’s
murder look like a suicide, using antidepressant tablets (amitriptyline)
and finishing off with an injection of heroin. The heroin is
the cause of death, the tablets used merely as distraction
for the investigating officers. The murderers force the victim
to take the tablets, wait two hours, and then inject.
I
understand that many tablets will still be in the stomach at the time of autopsy,
and that the tissues of face and neck would show bruising, but would this evidence
still be present if putrefaction were reasonably advanced (say three weeks
after death)?
And
if the victim managed to bite one of his assailants, would it be possible at
this time to find any evidence of this in the victim’s mouth?
Lina T, South West England
A: What
is found depends upon the degree of putrefaction of the corpse.
And this depends upon the ambient temperature and humidity.
The warmer and damper the area the faster the decay process
proceeds. So, after 3 weeks a corpse in Florida in august will
be severely decayed, perhaps even filly skeletonized, while
one in the Colorado mountains in April will be well preserved.
In a well-preserved
corpse, the ME might find undigested pills in the stomach, amitriptyline and
heroin (Actually mono-acetylmorphine-this is the molecule that heroin is converted
to almost immediately after injection and is what is tested for in suspected
heroin overdoses) in the blood, and the needle mark left by the injection.
If the corpse is severely decayed, he might find none of this. And anywhere
in between. So, it depends upon the location of the corpse and the season of
the year.
The same
is true for any biological materials (tissue or blood) that might be in the
victim’s mouth or on her teeth. If the body is well-preserved, then DNA
of her attacker might be found. If decayed, probably not as these tissues and
blood would also decay.
|
