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Category Archives: Trauma

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

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?

wagon_train-2

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 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 may have seen similar injuries in the past and may 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 live and then be very shocked 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. They train may 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.

 

Greed Can Be Dangerous: A 2800-year-old Case Solved?

Gold Bowl

 

How did a valuable gold bowl and three skeletons end up at the bottom of a refuse shaft in the ancient Iranian citadel of Hasanlu? It just might have been a building collapse that did in the unlucky thieves. Interesting historical forensics.

New Scientist: http://www.newscientist.com/article/dn26129-iron-age-csi-finds-gold-thieves-died-in-the-act.html?full=true&print=true#.VAS4ekuaGzA

Ancient Origins: http://www.ancient-origins.net/news-general/dark-tale-behind-golden-bowl-hasanlu-002054

 

Remains of the citadel of Hasanlu

Remains of the citadel of Hasanlu

 

DP Lyle on Investigation Discovery’s Deadly Affairs

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Set your DVRs for the ID Channel show Deadly Affairs Saturday night 8-23-14 at 9 p.m. EDT. I was asked to discuss this horrible crime that took place in Irvine, CA, a very few miles from my home. A chilling crime story.

Watch the promo trailer at the link below—-after an annoying commercial of course.

Details:

Program: Deadly Affairs

Episode Title: Swan Song

Air Date: August 23, 2014

Air Time: 9pm EDT/8pm CDT

Channel: Investigation Discovery (ID) 

Link to ID Show Schedule: http://www.investigationdiscovery.com/tv-shows/deadly-affairs/tv-schedule.htm

 
 

Crime and Science Radio: Dealing With the Dead: A Life in the Morgue: In Conversation with Dr. Cyril Wecht

Join DP Lyle and Jan Burke as they welcome Dr. Cyril Wecht, internationally renowned forensics pathologist Dr. Cyril Wecht as we discuss his life in criminal justice and the numerous famous cases he has been involved with over his stellar career.

BIO: Dr. Cyril Wecht holds degrees in both medicine and law, receiving his MD degree from the University of Pittsburgh and his law degree from the University of Maryland. He holds professorships at the University of Pittsburgh and Duquesne University School of Law. He has published nearly 600 scientific articles, is on the editorial board of more that 20 medical-legal and forensic scientific publications, and had published several books on forensic science. His list of famous cases is a who’s who in medical-legal investigation.

 

CYRIL-WECHT

LISTEN: http://www.blogtalkradio.com/suspensemagazine/2014/03/07/crime-and-science-radio-with-special-guest-cyril-wecht-md

LINKS:

Dr. Wecht’s Website: http://www.cyrilwecht.com

Dr. Wecht’s books and videos: http://www.cyrilwecht.com/books.php

50 Years Later, Wecht Continues To Poke Holes in Report on JFK Assassination: http://triblive.com/news/allegheny/5017529-74/wecht-commission-specter#axzz2tuBTchS1

Dr. Cyril Wecht Believes Killers of JFK, RFK, MLK Had Help: http://www.vindy.com/news/2013/may/01/renowned-pathologist-makes-a-case-for-co/

Dr. Cyril Wecht Lectures on the JFK Assassination: https://www.youtube.com/watch?v=-muQL-QPKeM

Dr. Cyril Wecht on JFK Assassination: Let’s Uncover the Truth: https://www.youtube.com/watch?v=YtUL-BpZAu8

Crime Library: JonBenet: From Impressions To Book by Dr. Katherine Ramsland: http://www.crimelibrary.com/criminal_mind/forensics/cyril_wecht/6.html

Dr. Cyril Wecht Discusses Forensic Challenges of Cold Cases: http://www.wtae.com/news/local/allegheny/Dr-Cyril-Wecht-discusses-forensic-challenges-of-cold-cases/19648550

Dr. Cyril Wecht: The Benefits of Forensic Credentialing: http://www.pbs.org/wgbh/pages/frontline/criminal-justice/real-csi/dr-cyril-wecht-the-benefits-of-forensic-credentialing/

Cyril H. Wecht: What I Know: http://www.pittsburghquarterly.com/index.php/What-Do-I-Know/what-do-i-know-with-cyril-h-wecht.html

Dr. Cyril H. Wecht: Pittsburgh’s Polymath: http://www.popularpittsburgh.com/pittsburgh-info/pittsburgh-history/famous-pittsburghers/dr-cyril-wecht.aspx

 

Final-Exams

 

 

 

 

 

Joseph Rivera: The New Andrew Luster?

Joseph Rivera

Joseph Rivera

 

In a case that seems to echo that of Andrew Luster, Joseph Rivera has been arrested and charged with multiple sexual assaults involving the use of sedative drugs. Exactly like Andrew. Andrew’s drug of choice was GHB and that might also be what Rivera used. No details yet, but it wouldn’t be surprising if that’s the answer.

 

Andrew Luster

Andrew Luster

 

GHB is one of the so-called Date Rape Drugs. Their treachery lies in that, unlike true intoxicants such as alcohol and the various narcotic and sedative drugs out there, the victim appears more or less normal. Maybe a little giddy but certainly not sloppy drunk. But the victim becomes very complaint and suggestable and has no memory of what happens while under the drug’s influence. Scary stuff.

 
 

Q and A: Can a Blow to the Head Render My Character Blind?

Q: My male character hits his head on a wall, rendering him blind. How long would he be blinded for, once the swelling that caused it goes down? Any long term effects, such as headaches and that?

Michelle Cunin, Alliance, Ohio

A: Blunt trauma to the head if it is severe enough to cause a cerebral contusion (brain bruise), where by definition there is some degree of bleeding into and swelling of the brain tissues as a result of the trauma, can easily cause a malfunction in that area of the brain. If it is the area of the brain that controls vision, your victim could easily have blindness. We call this cortical blindness since it arises from the cortex of the brain and not from the eye or from the optic nerve. In other words the loss of the ability to see comes from the brain itself. The visual cortex, the part of the brain that controls seeing, is in the very back of the brain in what we call the occipital lobe. In order for your victim to be completely blind both halves of the brain would have to be damaged otherwise he would only lose vision to his right side or his left side but not both. But this could easily happen with a blow to the back of the head or can occur after a fall where the back of the head strikes a wall, the floor, stairs, or almost anything else.

 

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If the injury were severe enough to significantly damage the optical cortex then his blindness could be permanent but in most cases once the bleeding inside the brain stops and the swelling resolves, vision will return. This could take a few hours or many weeks so you have a broad range to consider when constructing your story. Any of these are possible.

The victim’s blindness might be complete or only partial in that he might be able to see shadows and shapes or one half of his visual field might be clearer than the other. This later situation would indicate that one side of the brain was damaged more severely than the other. If it were the left occipital lobe that was more severely damaged then the right half of his visual field would be the most affected. If he were struck in the left back side of the head, for example, he could lose vision of the entire right side of his visual field. It would appear as if a line had been drawn down the center of his visual field and everything to the right of the line would be black while to the left all would be normal. But since you want him completely blind it would require injuries to both occipital lobes.

Whether his vision returns or not, he could suffer from long-term headaches, dizziness, poor balance, and a few other symptoms but he could also return to complete normalcy. These symptoms could last a few days, months, or forever. All is possible.

 

 

 
25 Comments

Posted by on July 1, 2013 in Medical Issues, Q&A, Trauma

 

Are Bite Marks Junk Science?

The forensic examination of bite marks left on victims, both alive and deceased, is being brought into question. If someone has an unusual tooth pattern and leaves bite marks on a victim, it seems logical that a match between the tooth pattern and the bite mark pattern would indicate that this person was the one who did the biting. And that just might be the case.

Bundy

 

The poster boy for serial killers, Ted Bundy, had an unusual dental pattern and was convicted in part on bite mark evidence. No doubt old Ted was guilty but was the bite mark evidence used against him reliable?

 

Bundy's Teeth

Bundy’s Teeth

 

It comes down to exactly how accurate these comparisons are?

28santos.600

 

It mostly depends on the “quality and clarity” of the bite mark and the skill, experience, and attention to detail of the observer. The key being that it varies from case to case and from examiner to examiner. Forensic science doesn’t like such unpredictable variability. In general, such variability means that either the technique is not useful or accurate, or the protocols for making the comparison are inexact. Time will tell, but a couple of upcoming court rulings could derail the entire process. We shall see.

AZ Daily Star

The Daily

 

 
 
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