Question and Answer: In 1863, Could An Autopsy Accurately Determine the Cause of Death?

Q: I am a writer trying to figure out what, if anything, a 19th century physician (actually the book is set in 1863) in a provincial Canadian backwater might conclude about a dead body found in salt water, which had a caved in skull and no water in the lungs. Would they indicate possible foul play? Would they even examine the lungs at autopsy?

A: In 1863, there was essentially no forensic science available. Fingerprints hadn’t been discovered to be a form of identification, blood typing was nearly a half century away, and DNA was a full century down the road. Ballistic examinations were not done. Toxicology was in its infancy as a method for uncovering arsenic in the tissues of a corpse had been developed by Jean Servais Stas, a Belgian chemist, in 1851. So, there wasn’t much forensic science around.

But, there was the autopsy. The examination of corpses and the determination if any diseases and injuries were present dates back many, many centuries. Ancient Egyptians performed something like autopsies but the first true autopsies to gain medical knowledge were likely performed by Erasistratus around 250 BC. Galen, the great first century Greek physician, was the physician to the gladiators and had extensive experience in anatomy and wounds. He wrote extensively on these and many other subjects and his shadow fell over medical knowledge well into the 19th century. Not always for the good, since he was wrong about almost everything. In 1350, autopsies were done on victims of the Black Death in the hopes of finding a cause for the pandemic. Over the next seven centuries the autopsy became more common and more sophisticated.

So, by 1863, the autopsy was well ingrained into the practice of medicine. This means that your physician could easily have the knowledge to perform them. Or not. Since he is in an isolated area, he could be out of the loop on that so you can have it either way. If he had any experience at all, he could determine whether the blow to the head was enough to kill the victim or not. He would see a skull fracture or bleeding into and around the brain. If he saw these, he might conclude that this was the cause of death. If he saw none of this, but merely a scalp bruise, he might conclude that drowning was the cause of death. He might not look at the lungs but simply know that the victim was found in water and assume that a drowning occurred. Or if he did examine the lungs and found them to be dry, he might say that drowning had nothing to do with it and the victim must have been dead at the time he entered the water. With dry lungs and no significant head injury he might not be able to say what caused the death. This gives you several options for how you construct your plot.

I should point out that dry lung drownings can occur and that any corpse—drowned or not—that has been in the water longer than 12 or so hours will have lungs filled with water. This is simply due to water seeping in and forcing the air out. Like a sponge dropped into water. But this was not known in 1863 so dry lungs might have suggested to your physician that no drowning occurred. He might be wrong but who could argue with his conclusion?

 

Los Angeles Times Festival of Books this weekend

This weekend the Los Angeles Times Festival of Books will be held on the USC campus. I’ll be doing a pair of signings on Sunday, May 1st. Drop by and say hello.

This year is the 20th Anniversary of the FOR DUMMIES brand and as part of the celebration I’ll be signing FORENSICS FOR DUMMIES at the Wiley Booth (#745) at 2 p.m.

Then at 3 p.m. I’ll be signing STRESS FRACTURE and my other books at The Mystery Ink Booth (#370).

I hope to see many of you there.

 

Question and Answer: What Happens When Someone Is Hanged?

Q: I’ve got a couple of questions about hanging. I have a 140-pound man of slight build who has been hanged. His neck is not broken and thus he is strangling. His hands are bound. How long might he survive before death? Would he lose consciousness well before or shortly before death? If he is taken down before death, we would certainly see abrasion of the neck. What else would we see? If unconscious, would he revive quickly? Could his injuries be life-threatening? (I’m thinking of throat swelling here) I am looking at pre-modern society here. No ER or modern medicine.

A: In hangings, death results from asphyxia, which is the reduction of oxygen to the brain. Asphyxia in hangings results from the compression of the airways and the carotid arteries (the arteries on either side of the neck that carry blood to the brain) by a noose or other ligature that is pulled tight by the body weight. Thus, the victim must be completely or partially suspended.

 

Though the airway can be compressed and breathing can be interrupted, the real cause of loss of consciousness and death in most hangings is compression of the carotid arteries, which blocks blood flow to the brain. Except for judicial (legally directed) hangings, fractures of the cervical vertebrae (spinal bones of the neck) are uncommon. The reason is that these fractures require that the body drop a sufficient distance to break them. How far is this? The answer depends upon several factors. Individuals who are obese, have small neck musculature, or who have arthritis of the cervical spine may suffer neck fractures quite easily. Just the opposite is true for muscular, thick-necked persons. In judicial hangings, these factors are considered in gauging the distance of the drop. Too little drop and the condemned person is strangled to death, too far and he could be decapitated.

The neck markings seen after hanging depends mainly on the nature of the noose used. Soft nooses such as sheets may leave little of no markings. Bruises and abrasions are not common with softer devices. In fact, if the victim uses a soft noose and if the body is discovered fairly quickly and cut down, the ME may not be able to find any marks at all. A rope or cord may leave a very deep, distinct furrow in the victim’s neck. The longer the body hangs, the deeper the furrow. Abrasions and contusions are more common with these types of nooses. Occasionally the furrow and any associated bruising may reveal the braid pattern of a rope or the link configuration of a chain.

In hangings, the furrow and the bruising will follow a typical course. The pattern is that of an inverted V. The furrow tends to be diagonal across the neck with its high end where the knot is located. The knot is usually to one side. This means that if the knot is to the victim’s left side, the furrow will be lower on the neck and much deeper on the right side and will angle upward toward the left ear. Near the knot, the furrow may shallow and disappear. This pattern is due to the body hanging by the “bottom” of the nose.

Okay, enough about hangings, let’s get to your situation. Since the asphyxia is due to compression of the arteries and not the prevention of breathing, loss of consciousness occurs very quickly, usually in a minute or less and maybe as short as 20 seconds. The brain needs a continuous supply of blood and when this is interrupted, consciousness is lost quickly. Death may take from 1 to 5 or 6 minutes.

If your victim is found within 2 to 3 minutes, he would be unconscious but could wake up fairly quickly—a couple of minutes. Or not. Some people die in a minute while others can take many minutes. Go with a couple of minutes but not longer and you’ll be OK. He would probably have the typical V-shaped bruises on his neck and a furrow that would resolve over a half hour or so.

He could return completely to normal or be left with brain damage or even remain in a coma for hours, days, weeks, months, years, or forever. It all depends upon how long the brain was deprived of blood and luck. This varies from person to person.

 

Question and Answer: Could Death From Bleeding Be Delayed For Several Days After a Frontier Wagon Wheel Accident?

This is a question that appeared in my 2003 book Murder and Mayhem.

Q: My story takes place in a wagon train in the late 1800’s. My character is dragged by a horse while crossing a river. He hits rocks and is bounced off the back wheel of a wagon. Of course the horse’s hooves do damage as well. Three days later he dies from massive bleeding from his internal injuries. This three day delay followed by the sudden loss of blood is important to the story’s timing, but is it realistic?

 

A: The answer to your question is yes.

This type of accident could, as you can imagine, result in all types of injuries. Broken bones, skull fractures, neck fractures, cracked ribs, punctured lungs, and intra-abdominal injuries (injuries inside the abdominal cavity). This last type of injury might serve you well.

A ruptured spleen or lacerated liver or fractured kidney would bleed into the abdominal cavity. Death could be quick or take days if the bleed was slow. There would be great pain, especially with movement or breathing, and the abdomen would swell. Also a bluish, bruise like discoloration could appear around the umbilicus (belly button) and along the flanks. This usually takes 24 to 48 hours or more to appear. This occurs as the blood seeps between the “fascial planes.” The fascia are the tough white tissues that separate muscles from one another. The blood seeps along these divisions and reaches the deeper layers of the skin causing the discoloration. But, these injuries wouldn’t lead to external bleeding since the blood has no exit from the abdominal cavity.

However, if the injury was to the bowel, then external bleeding could occur. For blood to pass from the bowel, the bleeding would have to be within the bowel itself and not just in the abdomen somewhere. If the bowel were ruptured or torn so that bleeding occurred within the bowel, the blood would flow out rectally. But, blood in the bowel acts like a laxative so the bleeding would likely occur almost immediately and continue off and on until death, which in this situation would be minutes to hours to a day, two at the most. It would be less realistic for the bleeding to wait three days before appearing in this case. With one exception.

The bowel could bruised and not be ruptured or torn, and a hematoma (blood mass or clot) could form in the bowel wall. As the hematoma expanded it could compromise the blood supply to that section of the bowel. Over a day or two the bowel segment might die. We call this an “ischemic bowel.” Ischemia is a term that means interruption of blood flow to an organ. If the bowel segment dies, bleeding would follow. This could allow a 3 day delay in the appearance of blood.

In your scenario, the injuries would likely be multiple and so abdominal swelling, the discolorations I described, great pain, fevers, chills, even delirium toward the end, and finally bleeding could all occur. Not a pleasant way to die, but I would imagine this happened not infrequently in frontier days.

The victim would be placed in the bed of one of the wagons and comforted as best they could. He might be sponged with water to ease his fevers, offered water or soup, which he would likely vomit, and prayers would be said. They could have tincture of opium (a liquid) available and give him some. This would lessen the pain since it is a narcotic and would also slow the motility (movement) of the bowel and thus lessen the pain and maybe the bleeding.

Of course, during the time period of your story, your characters wouldn’t know any of the internal workings of the injury as I have described. They would only know that he was severely injured and in danger of dying. Some members of the wagon train might have seen similar injuries in the past and might know just how serious the victim’s condition is, but they wouldn’t understand the physiology behind it. They might even believe that after he survived the first two days that he was going to live and then be surprised when he eventually bleed to death. Or they might understand that the bouncing of the wagon over the rough terrain was not only painful but also dangerous for someone in his condition. The train might be halted for the three days he lived or several wagons might stay behind to tend to him while the rest of the column moved on.

The entire Table of Contents of Murder and Mayhem can be seen HERE.

 

Sweat Lodge Death Trial Begins

“You will feel as if you are going to die. I guarantee that.”

“You will have to get to a point where you surrender, where it’s OK to die.”

In an earlier post I talked about the hyperthermic deaths that occurred during the self-discovery sessions led by self-help guru James Ray. His sweat lodge ordeal ended in the death of three and hospital visits by nearly two dozen others. It appears that his trial is about to begin in Arizona.

I bet he now regrets the above words. Bet he’s sweating as if he were in his own sweat lodge.

The defense? Well, the participants were adults. They signed wavers. I wonder if those wavers mentioned the temperature and lack of ventilation and jam-packed conditions inside the lodge? Or that there would be no on site medical facility or personnel? Or that their 36 hour fast ended by a single meal just might leave the participants a bit dehydrated even before they entered the jerky factory. Brains, hearts, and kidneys don’t tolerate such conditions well.

Common sense, or as we say in the South “walking around sense,” seems to have flown the coop in this deal.

This one will be interesting to watch.

 

Games Children Play: The Choking Game, The Pass Out Game

Remember all the young and stupid things you did when you were young and stupid? Jumping off the garage with a pillowcase parachute? Swinging off a tree limb into the creek or pond without first testing the depth of the water? Building a ramp to jump over on your bicycle? Taking a ride while clinging to a car front fender? We all did these things yet somehow survived. Unfortunately young Brandon Stine didn’t.

There seems to be a game going around among children Brandon’s age, which was 11 at the time of his death. It goes by many names: the Choking Game, the Fainting Game, the Pass Out Game, Tap Out, Hangman, Elevator, and a few others. The goal is to lose consciousness. I remember in grammar school a similar game came around. The person would take 20 deep breaths and blow on their thumb and immediately become dizzy and lose consciousness. I never played this game but I saw it on several occasions. Somehow losing consciousness wasn’t very appealing to me. And of course now that I know the physiology behind it, it is not only unappealing it is frightening.

The current games are played two ways. The first is easy to understand and the second requires a little more complex physiology.

One form is simply to choke the victim until he loses consciousness. This is basically the choke hold police sometimes employ to control combative suspects. The purpose is to block blood flow to the brain by compressing the carotid arteries. This results in low oxygen levels in the brain, which in turn leads to loss of consciousness. It can also lead to death.

The second form results from self-induced hypocapnia. Hypocapnia is simply a big word for low carbon dioxide (CO2) levels in the blood.

The human body guards a handful of things very jealously. Some of these are the oxygen, CO2, and pH of the blood. The pH is a measure of the balance between acid and base (alkalinity) in the blood.

When oxygen levels are low, the brain sends out signals that increase the rate and depth of breathing as well as the heart rate and blood pressure. This brings more oxygen into the lungs and increases its transportation by way of the cardiovascular system to the body. When the level of oxygen in the blood is very high the exact opposite happens in that breathing will slow since there is no physiologic need to move more air.

Carbon dioxide works the same way, only in reverse. If the carbon dioxide levels are high, breathing will increase to “blow off” this extra CO2, which is an acid. Since CO2 is removed from the body through the lungs any increase in breathing rate and depth will remove more CO2 from the body and the acid-base balance (the pH) will be restored. If the CO2 is very low, this drive to breathe is suppressed so that more CO2 will accumulate within the blood and again restore the pH balance.

High CO2 levels elevate the amount of acid in the blood and this is reflected in a falling pH level. The lower the pH the more acidic the body is. A low pH adds to the drive to breathe more rapidly so that the CO2 level will drop and the excess acid is removed in this way. When the CO2 level drops, the pH rises and the drive to breathe is suppressed.

This is a thumbnail and does not take into consideration the many other derangements within the body that can alter the pH level.

In summary, a low oxygen level, a high CO2 level, and a low pH (excess acid in the system) tend to increase breathing so that more oxygen is supplied and more CO2 is removed from the body. When the oxygen level is high, the CO2 level is low, and the pH is elevated (excess alkalinity in the system) the driving force to breathe is suppressed.

When someone purposely hyperventilates by breathing rapidly and deeply for a minute or so they are increasing their oxygen and pH levels while lowering their CO2 levels. This in turn suppresses the need to breathe. This can lead to a period of slow or absent respiration, which tends to continue slightly longer than is needed. This overshoot is part of virtually all biological feedback systems. This can result in a rapid drop in blood oxygen levels to the point that the victim loses consciousness.

This drop in blood oxygen level is more dramatic and more rapid than is the restoration of normal CO2 levels that would accompany a cessation of breathing. This means that by the time the CO2 levels reach a point where they again drive respirations, the oxygen level has fallen very far. This is what leads to loss of consciousness and death. Or perhaps survival with permanent brain damage.

An identical situation arises when someone attempts an underwater swim across a pool. Or a free diver attempts to go to very great depths on a single breath. In each of these situations the person hyperventilates before taking the plunge and in so doing creates a situation where they could lose consciousness and drown during the swim or the descent.

If you, or anyone you know, has children who are playing this game, it’s time to sit down and have a chat. This is basically Russian Roulette where the bullets are the oxygen and carbon dioxide levels in the blood.

 

Manner of Death Can Be a Matter of Timing

There are five matters of death: natural, accidental, suicidal, homicidal, and undetermined. Natural deaths are not usually within the domain of the medical examiner and accidental and suicidal deaths are rarely addressed by his office. But if a death is determined to be homicidal, the full force of the medical examiner and police investigators are brought into play.

This is why, along with cause of death and time of death, the manner of death is one of the most important things the medical examiner must determine. His official statement as to the manner of death will determine what happens next. Will the police be involved or not?

An interesting but sad case in Santa Ana, California underscores this point. In 2006, just before his 16th birthday, Robert Flores was shot numerous times in what is believed to be a gang related shooting. Robert survived the shooting but was left quadriplegic.

Quadriplegia is a difficult and complex medical condition and people who suffer from this are plagued with many complications including pneumonia, urinary tract infections, bed sores, muscle wasting, and a host of other problems. Many of these can progress and become deadly. This is what happened with Robert. Four years after his shooting Robert died.

So what was Robert’s manner of death? I don’t know whether he died from pneumonia or a urinary tract infection or one of the other complications of quadriplegia but he did die from some medical problem related to his paralysis. Since his death was due to a medical problem would his manner of death be listed as natural? The answer is no. His manner of death would be homicidal. He was shot five times and this act started the cascade of events that led to his death. In other words, had he not been shot he would not be quadriplegic and would not have been subjected to the medical complications of this condition. It was not an automobile accident or a fall or some other injury that might cause quadriplegia but rather the criminal act of his being shot that began his decline to death and that is what makes his death a homicide rather than some natural or accidental event.

As of right now there are no suspects in Robert’s shooting but if suspects are ever identified they will likely be charged with homicide.

 

For more on the Cause, Time, and Manner of death take a look at my books Howdunnit: Forensics or Forensics For Dummies.

 

 

 

Q&A: Are There Food Combinations That Can Cause Death?

Q: In my story, somebody wants to kill a man by sneaking something into his food. The rest of the family ate the same food, but nobody else became ill. What combination of foods could he have eaten or could the family have eaten to change the outcome. He has no known allergies, but the person who wanted to make him suffer winds up tried for murder.

Diana Huston

A: There are no foods that will protect someone from the effect of other foods or toxins so that won’t work. And since you’ve ruled out a food allergy and a bacterial agent or toxic poison added to the food wouldn’t fit since it would effect everyone who consumed the food. To varying degrees, but still everyone would be effected in some way. Your best bet is to set up a situation where relatively common foods would harm an otherwise normal appearing person.

I would suggest having your character be on one of the Monoamine Oxidase Inhibitor (MAOI) drugs since these medications can have deadly reactions if certain foods are consumed. These meds are classified as psychotropic drugs (effect the psyche) and are typically used to treat depression. If your character had some degree of depression, his MD could prescribe one of these drugs and he could take it daily. The MAOIs tend to lessen depression and elevate the person’s mood. So far so good.

MAOIs alter the chemistry of the brain by blocking the enzyme monoamine oxidase, which normally breaks down norepinephrine and other neurotransmitters in the brain. Complex biochemistry and it’s not necessary to explain it. Just know that a person on a MAOI must not take certain other meds and must avoid certain foods. If not a Hypertensive Crises could ensue. In this situation the blood pressure (BP) abruptly shoots up and the person can suffer a stroke, heart attack, or sudden death.

Common MAOIs are: Nardil, Pamate, and Marplan.

Drugs that can cause a Hypertensive Reaction when taken in conjunction with one if these MAOIs include:

Ampehtamines
Diet Pills of all types
Many High Blood Pressure meds
Flexeril (Cyclobenzaprine)
Prozac (Fluoxetine)
Paxil (Paroxetine)
Zoloft (Sertraline)
Demerol (Meperidine)
Any Tricyclate Antidepressant such as: Elavil (amitriptyline), Sinequan (doxepin), and Tofranil (imipramine)
The list is very long but the above are a few common ones.

Foods to avoid are those that are high in the amino acid tyramine such as: certain cheeses, fava beans, smoked or pickled meats, fermented sausages (bologna, pepperoni, salami, and summer sausage), alcohol, and caffeinated drinks such as coffee, tea, colas, and chocolate. Again, the list is much longer but this gives you the idea and some choices.

If your character was taking one of the MAOIs for some mild depression, your villain could then slip him an amphetamine or a diet pill or a couple of Paxil tabs and wait.

In the food arena he could feed him one of the above foods or even more diabolical could make a caffeine broth, which he could slip into a bowl of spicy soup. This would be easy in the serving process. Finely ground coffee could be simmered for a while to leach all the caffeine out, the liquid could be boiled down to concentrate it, and then it could be strained. A couple of tablespoons of this potent liquid could easily be added to his bowl of soup—a spicy or very flavorful one to mask the bitter taste of the caffeine—and the killer could sit back and wait.

In a few minutes the reaction would occur. The victim’s blood pressure would shoot up, he would develop a severe headache, blurred vision, shortness of breath, and then collapse. He could or could not have a seizure with this. The elevated BP damages the brain and may even cause bleeding into the brain.

Or he could become short of breath and sweaty, perhaps clutch his chest and complain of chest pain, and collapse. This would look very much like a heart attack and indeed such elevated BP could precipitate a heart attack.

Of course, the ME would find caffeine in his system but if this occurred at a party where coffee and caffeinated soft drinks were available, he might assume that the victim drank some those and this in combination with his prescription medication did him in.

A similar scenario would work if he was unknowingly fed sausage or cheese. These could easily be added to some flavorful food so that he wouldn’t know he was consuming them.

 

King Tut and Sickle Cell Disease

Few deaths have generated more interest and confusion than that of King Tut, the Egyptian boy king. Some say he was murdered, others say he died of this injury or that disease, and still other says that he had multiple genetic disorders that did him in. Truth is that no one knows.

Back on March 2, 2010, I posted a note about King Tut and the fact that researchers had found DNA from malaria organisms and from this concluded that the young king had died from this very common disease. Now a German team of investigators have come up with another theory: Sickle Cell Disease.

In my original blog, I discussed how Tut had bony deformities of his legs, predominantly manifested as some form of clubfoot, as well as a cleft palate and some evidence that he may have had Marfan’s Syndrome. I also pointed out that his murky lineage might have been resolved by this DNA testing. It is entirely possible that his father Akhenaten might have bore the young king with Tut’s aunt, Akhenaten’s own sister.

Now, Christian Timmann and Christian Meyer of the Bernhard Nocht Institute have postulated another cause of death. They believe he might have had sickle cell disease and that this might have led to his death. Sickle cell disease is common in those of African descent and occurs more likely when inbreeding is present. With Tut being the son of a mating between brother and sister, and if each of them carried the sickle cell gene, it would be possible for the young man to have inherited the homozygous or worst form of sickle cell anemia.

In sickle cell disease the abnormal red blood cells often clog up small blood vessels, which in turn can reduce blood and oxygen supply to various portions of the body, including the bones. Sufferers of this disease often end up with bone damage and deformities from this reduced blood supply. Could this explain the young man’s boney abnormalities? Possibly but it would be hard to indict this cause for either a club foot or a cleft palate. Still some of his other musculoskeletal problems could easily be related to sickle cell anemia.

This will require further investigation and indeed studies are underway so hopefully we will have more information down the road.

 

Sickle Cell Disease and Death

Bennie Abram had a promising football career at the University of Mississippi. Until he was felled by his genetics. The 20-year-old junior was going through conditioning workouts when he suddenly collapsed and died. His autopsy has now been completed and the medical examiner has attributed his death to sickle cell disease.

Sickle cell disease occurs predominantly in those with an African ancestry. There is some evidence that this is the case because this genetic abnormality might afford some protection against malaria that is so common in the African continent. Regardless, it is not a rare problem in Americans of African descent.

So what is sickle cell disease?

It is a problem of hemoglobin, which is the molecule within our red blood cells (RBCs)that carries oxygen (O2) from the lungs to the tissues and brings carbon dioxide (CO2) from the tissues back to the lungs. It is essential for life. The type of hemoglobin that we have depends upon our genetic makeup. Our genes and our chromosomes are paired and we receive one of each pair from each of our parents. Normal hemoglobin is called hemoglobin A. The normal individual will receive a hemoglobin A gene from each parent and therefore his genetic makeup, as far as hemoglobin production is concerned, would be called AA.

Abnormal hemoglobin of the sickle variety is designated as S. An individual who received one normal hemoglobin gene and one sickle hemoglobin gene would then have a genetic profile designated as SA. A person who received a sickle gene from both parents would have no hemoglobin A but only hemoglobin S genes and would be designated SS.

Sickle cell disease comes in two varieties: Sickle Cell Anemia and Sickle Cell Trait. The former is associated with SS hemoglobin and is more severe than the latter which is associated with an SA genetic pattern. Sickle Cell Trait is the milder form of the disease and has fewer symptoms and fewer medical problems than someone with full blown Sickle Cell Anemia.

In sickle cell disease the red blood cells will often take on a sickled form in that they look like crescent moons. They are not round and plump like normal red blood cells but rather take on this unusual form and it is the physical shape of the red blood cells that causes the problems. These sickled cells can plug up blood vessels and block blood flow, which can then lead to ischemia — a big word meaning poor blood supply — in the organs affected. This could be the spleen and indeed the spleen can die and lead to a medical crisis where it would has to be removed are emergent basis. It can lead to plugging of vessels to the heart, the lungs, the kidneys, the liver, the joints, the gastrointestinal tract, and the brain. This can lead to extreme pain in the joints and even death from a heart attack or stroke. It can lead to severe kidney and liver damage and to an infarction (death of tissue due to lack of blood supply) of the bowel.

These episodes of vascular occlusion are called a Sickle Crisis and it is a true medical emergency. Treatment includes pain medications to relieve the discomfort and and large amounts of IV fluids to lessen the sludging of the sickled cells within the small blood vessels. Oxygen is also given since this helps supply more O2 to the tissues that are being deprived by the slow blood flow. Most of these crises last a few days to a week and then resolve. They resolved faster and with less complications if aggressively treated early on.

Any situation that leads to dehydration or an elevation of body temperature or if an infection is present within the victim’s body can lead to a Sickle Crisis. In the case of Bennie Abram, who apparently had Sickle Cell Trait, it is likely that the dehydration that accompanied his training session helped precipitate this event. These crises are unpredictable and occur in a seemingly random pattern. Staying well hydrated helps, but even then a crisis can occur. This is the reason Bennie had gone though similar training exercises in the past without problem. This time he wasn’t so lucky. That’s the unpredictable nature of this disease.

There’s a great deal of research underway regarding genetic therapy for this disease. If the genetic makeup of the individual can be altered to do away with the S hemoglobin gene and replace it with a hemoglobin A gene then this disease could be cured. Hopefully that won’t be far down the road.