Category Archives: Cause & Manner of Death

Q and A: Can My Killer Hack the Victim’s Implanted Defibrillator and Cause His Death?

Q: How could a failing ICD kill someone? My idea is for the victim to be an older individual who has this kind of device implanted in him. The killer hacks the wireless device in a similar manner to this: According to this paper, the two attacks that seem most dangerous are to turn off therapy or to administer a V-fib shock intended for test purposes during the implantation procedure. How long would these take to kill someone? How healthy would someone be that had a pacemaker? How would this change if the victim had a mechanical cardiac pump?

Adam High, Marysville, CA

A: An AICD (Automatic Implantable Cardioverter Defibrillator) is a fancy pacemaker that has a defibrillator built in to it. It is used in people who have very severe and dangerous cardiac arrhythmias such as ventricular tachycardia and ventricular fibrillation, both of which are typically immediately deadly. These rhythms can occur in anyone. but are very problematic in those with severe coronary artery disease and/or severely damaged heart muscles, which we call a cardiomyopathy. These people are highly prone to death from these dangerous arrhythmias, so these are the types of patients who receive these devices. These are also the types of patients that are candidates for cardiac transplants and artificial hearts, or what are called left ventricular assist devices (LVADs). Since people who receive these assist devices have extremely damaged heart muscles and are at a very high risk of dangerous arrhythmias, they will also often receive an AICD at the same time.



An AICD basically monitors the cardiac rhythm, and when a dangerous rhythm occurs, they fire an electrical impulse which shocks the heart back to a normal rhythm. Sometimes it stops the heart and if so the pacemaker portion of the device will kick in. Some people have these devices implanted as a precautionary measure and never use them, while others have significant problems with arrhythmias and the device discharges more frequently. What this means is that turning off the defibrillator portion of the device will leave the victim a jeopardy but will not in of itself cause death. If he is one of those individuals that never uses the device, or only rarely, then your killer would have to wait a long time, and maybe forever, before the victim had a lethal change in heart rhythm. And since these devices are frequently checked, typically every 1 to 3 months, it would be noted during the check that this portion of the device had been turned off. So that leaves a narrow window for something serendipitously to happen. Most killers want more assurance that their method will work.



A better method is to trick the device into firing an impulse in the hopes that it would start a dangerous arrhythmia. Again this is not assured. In the cardiac catheterization lab, after the device is implanted, it is tested by inducing one of these arrhythmias. But the heart doesn’t always cooperate. Sometimes the rhythm cannot be induced. That would be the same situation with your victim. That is hacking the device and causing it to deliver a shock that was an appropriate might or might not cause the desired effect––a deadly cardiac arrhythmia.

Neither of these methods are assured of working, but of the two, I would go with hacking the device and delivering an inappropriate jolt of electricity. This would have the greatest probability of causing the result your killer wants. If so, death would be immediate.



Can Amyl Nitrite Cause Death And If So Would It Appear To Be Natural?

Q: Under what circumstances can poppers (Amyl nitrite) kill a victim so it looks like natural death? If this is not possible in reality, could you provide a pseudo-medical explanation?

L. Mitana, Slovakia

A: Amyl Nitrite is what we call a vasodilator–meaning it opens up all the blood vessels in the body. Too much can lead to an immediate and profound drop in blood pressure (BP) and this can cause death directly from shock or indirectly by generating a cardiac arrhythmia due to poor blood flow to the coronary arteries. If the victim has coronary artery disease (CAD), this drop in BP can cause a heart attack (myocardial Infarction or MI). So, too much Amyl can definitely be lethal and do so in several ways.

At autopsy the coroner would see nothing unless the victim had CAD. Either way he might write the death off as a cardiac arrhythmia. If he did test for amyl nitrite he might find it or not–it is destroyed very quickly by the body’s enzyme systems but some might remain after death–or not. But he would not test for this unless he had some evidence that Amyl Nitrite might be involved in the death.

This same vasodilatory effect is why Viagra should not be taken with long-acting nitrates. Some people who suffer from CAD are prescribed long-acting nitrates to help relieve angina—chest pain due to poor blood supply to the heart muscle. Like Amyl, these nitrates and Viagra are vasodilators and when taken in combination can cause a dramatic decline in BP and death can follow.



Q and A: Could My Investigator Determine If the Knife Used in a Murder was Made of Obsidian Rather Than Some Other Material?

Q: I am a lawyer in Tacoma, WA with a hobby of writing detective novels, all unpublished but fun for me. My question is would a knife wound from an obsidian knife be identifiable as from an obsidian knife as opposed to a knife made from another material?

John C. Cain, Tacoma, WA

A: Not likely, unless the knife had an unusual shape or curve or both. Wound analysis will only give the width, thickness, and general shape of the blade as well as its minimum length. The depth of the wound would tell the ME what length of the blade entered the victim. The blade could be longer but not shorter–thus the minimum length. If the ME then had the suspected murder weapon he could measure it and say that this blade was or was not consistent with the victim’s wound. That’s as far as he could go. He could completely exclude the knife as the murder weapon if the wound didn’t match but he could not say that this blade, and no other, made the wound. Only that this blade or one similar to it did the deed. The more unique the blade is the better this would narrow the possibilities.

But there are a couple of ways he could make a more conclusive judgement. If the victim’s blood was found on the weapon, say in the groove between the handle and the blade where the killer would overlook it and where even washing the knife might not remove it all, he could then DNA match this to the victim and say that this knife held the victim’s blood and was very likely the murder weapon. Why else would the blood be there?

Even better, if the point of the knife broke off in the victim and this was found at autopsy, then the ME would know the knife was made of obsidian. A comparison of this tip with the suspect weapon could prove very conclusive. If the tip fit the suspect blade in an exact jigsaw fashion this is very conclusive and individualizing evidence. That is, the ME could confidently say that this tip came from this knife to the exclusion of all others. The science behind this is that no two things fracture exactly the same way.


Q and A: What Poison Could Be Placed on an Envelope and Cause a Quick Death?

Q: I have a character who needs to die after licking an envelope. I would prefer a fairly quick demise. What sort of poison could the murderer use? It would need to be something that doesn’t taste too awful or she’ll stop licking it!

A: There are very few poisons that work instantly in small doses, but cyanide would fit your needs and can be acquired fairly easily.

Cyanide is quick and even if someone attempted to save the victim, it is next to impossible because treatment with a Cyanide Antidote Kit or a Cyanokit must begin immediately if any chance of survival is to be realized and people don’t usually carry these kits around. Simple CPR won’t do it. This is because cyanide is a “metabolic poison.” It basically shuts down the ability of cells to use oxygen. The red blood cells cannot carry oxygen to the tissues and the tissue cells of the body can’t use the oxygen anyway. It is as if all the oxygen were removed from the body instantly. This process is immediate and profound and leads to death in 1 to 20 minutes, depending on the dosage and a few other things. Even of CPR were begun immediately, it would be ineffective since the cells couldn’t use the oxygen supplied by this process.

Symptoms would begin very quickly in the delivery method you have chosen since the cyanide would absorb rapidly through the membranes of the mouth. The symptoms are rapid breathing, shortness of breath, dizziness, flushing, nausea, vomiting, and loss of consciousness. Maybe seizure activity. Then death. This could happen in a matter of minutes. Your victim might develop sudden, severe shortness of breath, a flushed face, perhaps clutch at his chest, collapse to the floor, and die, with or without having a seizure in the process. This would look very much like a heart attack. His skin might appear pinkish and if he hit his head or scraped an elbow in his fall and bled, the blood is a noticeably bright cherry red due to a chemical reaction between the cyanide and the hemoglobin molecules in the red blood cells.

Potassium Cyanide (KCN) and Sodium Cyanide (NaCN) are your best bets. They are white powders with a faint bitter almond smell, which most people do not notice. Both dissolve readily in water and saline. One caveat. Your killer must be careful in handling the KCN or NaCN as both readily absorb through the skin and could do in your killer. Rubber gloves or a complete avoidance of direct contact with the powder would be wise.

KCN and NaCN are used commercially in metal recovery such as extracting gold or silver from their ores and in electroplating such metals as gold, silver, copper, and platinum. They could be pilfered from a jewelry or metal plating company or could be purchased from a chemical supply firm.

In your story, the powder could be dissolved in water, applied to the envelope glue, and allowed to dry. When your victim licked the glue, he would develop the above symptoms within a very few minutes and would then collapse and die. This could take as little as two or three minutes.


Black Death Bug Identified–Again

Ring around the rosies,
A pocket full of posies,
Achoo! Achoo!
We all fall down.

This innocent sounding nursery rhyme dates to the Black Death and underscores the effects and forms of this disease. Bubonic Plague caused swollen and necrotic lymph nodes, called buboes, and a circular pinkish rash (the ring of the rosies). Placing flowers  (posies) in your pocket was supposed to ward off the bad air, or evil spirits, or whatever your belief of choice for the cause of the disease. Of course, this didn’t work. When it progressed to Pneumonic Plague, where the victim coughed, sneezed, became short of breath, and coughed up blood, death followed very quickly (all fall down).

The Black Death was a human disaster of catastrophic proportions. Though estimates vary, when it struck Europe between 1348 and 1350, it killed 30-60% of the population and probably reduced the world population from approximately 450 million to 350 million. It disrupted travel and trade, set one village against another, and shook the foundations of medicine and religion. No one knew what caused it and prevention and treatment were mysteries. Nothing worked. No medicine or prayer or ceremony slowed its march or relieved those afflicted. If neither the medical practitioners nor the clergy of the day could help, then of what use were they?

All the populace could do was to burn or bury the dead, often in mass graves. Mourning, prayer, and fear then followed.


The cause of The Plague is the tiny bacterium we call Yersinia Pestis. That was the long held dogma anyway. More recently some have questioned this and have proposed other causes such as the Ebola virus, small pox, typhus, and several other organisms.

But recent studies seem to support dogma. Hendrik Poinar and colleagues at McMaster University in Hamilton, Ontario, recently found a very interesting way to exam the DNA from bones and teeth removed from a plague mass burial pit near London. Their “molecular probe” revealed that the causative agent was our old friend Yersinia Pestis after all.


The Man Who Swallowed the Diamond

So you’re sitting in an airport lounge waiting for your plane, having a drink and biding your time. Then you notice your purse is missing. Fortunately security tracks the creep down and recovers the purse. Money? Check. Cell phone? Check. $16,000 diamond pendant? No check. A search of the guy doesn’t turn it up. Where could it be?


Enter old Dr. Wilhelm Konrad Roentgens invention. You know, the x-ray that he invented almost by accident on a cold November evening in 1895. The thief was subjected to an x-ray examination and “Surprise, surprise, Sargent Carter” there it was.


The ovoid shadows in the above x-ray are the drug-filled balloons.


But diamond thieves aren’t the only ones that swallow stolen items and contraband. Drug traffickers do, too. Not something I would recommend. The mules will take heroin or cocaine, compact it in small balloons or condoms, and swallow a bunch of them, thinking they can sneak across the border and then later collect their booty from their booty. Doesn’t always work out that way. Stomach acids and digestive enzymes simply won’t cooperate. Let one of those little time-bomb balloons leak and you have a dead trafficker on your hands.


This was removed from one mule.


Murder Charges 30 Years Later

David Michael Knick and Robert Duston Strong have been charged with a murder that took place 30 years ago. Sort of. The victim did not die until 2010. So if the victim died 30 years after Knick and Strong’s involvement how could they be charged with murder? It all comes down to the coroner’s determination that the death was a direct result of an act by these gentlemen.

In November, 1980, Orange County Sheriff’s Deputies Ira Essoe and Greg Brown observed three men tampering with a series of cars in a parking lot in Orange, CA. When they approached the men a gun appeared and Deputy Essoe was shot. His injuries resulted in paralysis. The gunmen stole the officers patrol unit and a high-speed chase followed. These are big in Southern California. Seems like one happens every week. This one lasted about an hour and the two men were arrested. That was then.

Deputy Essoe remained paralyzed and suffered many complications from his condition. He also developed diabetes and heart disease and apparently had to have both legs amputated along the way. Last year he develop bed sores, a very common problem in paralyzed individuals, and from these developed an infection that spread to his bloodstream, a condition we call sepsis. He died from this.

Dr. Anthony Juguilon, chief forensic pathologist for the Orange County Coroner, determined that Essoe’s death was a delayed complication of the gunshot that left him paralyzed. This determination is critical. This makes the manner of death homicide and not natural, which would have been the case had Deputy Essoe been injured in a blameless accident, for example. But the fact that he was paralyzed by a gunshot wound that occurred during a criminal act and that his death was directly related to that incident led to the determination that the manner of death was homicide.

Both men will soon be going to trial. The defense will likely argue that the death was natural and was a complication of his other disease processes while the prosecution will of course agree with the coroner’s determination. We’ll see how this one plays out.


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.


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