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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

 

Fingerprinting Bullets: A New Forensic Science Technique

Bullets recovered from crime scenes or bodies can tell investigators a great deal: the caliber of the weapon can be determined by measuring and/or weighing the bullet; the marks left on the bullet’s surface by the lands and grooves and twists of the barrel can reveal the manufacturer; and these same striations can be used to match the bullet to a particular suspect weapon. These striations area the most individualizing and therefore the most useful in criminal investigations involving forearms.

But what if the bullet is too damaged for such comparisons? All is not lost. An analysis of the chemical make up of the bullet might reveal not only the manufacturer but also the batch from which it came. This might serve to narrow the location of purchase and ultimately lead to the perpetrator..

Bullet Fingerprints To Help Solve Crimes: http://phys.org/news/2014-07-bullet-fingerprints-crimes.html

 

Murder By Meme: Slender Man and the Wakefield Anti-Vaccine Hoax

Slender Man

We all know that viral illnesses can kill. Ebola would be an example. So would small pox and the 1918 Flu.

But can an internet viral hoax kill? An interesting article titled “Murder By Meme: Slender Man and the Wakefield Anti-Vax Hoax” by Travis Langley, Ph.D. in Psychology Today looks at this issue.

In June, 2009, Eric Knudsen (aka Victor Surge) posted a pair of black & white photos of groups of children in which he had inserted a thin figure in a black suit into the background. This was the birth of the Slender Man hysteria. It led to the attempted murder of a 12-year-old girl by two of her classmates, also 12. Why would they stab their classmate 19 times? Apparently to serve as “proxies” for The Slender Man and to show that he really existed.

Crazy is as crazy does.

And then there’s the 14-year-old who read about Slender Man and decided she needed to burn down her home—-with her mother and brother inside. Fortunately there were no injuries but the house and family car took a hit.

But such internet hoaxes aren’t confined to the world on teen angst. It has also entered the world of legitimate medicine. And has done great harm.

MMR

Ever seen a case of Whooping Cough? Diphtheria? Probably not. I’ve never seen diphtheria and whooping cough (pertussis) only a couple of times way back during my pediatrics rotation as a junior medical student. The reason these and other childhood diseases such a rubella and mumps are now not so common is a robust and widespread immunization program that has done a stellar job in keeping these illnesses at bay.

Enter Dr. Andrew Wakefield. He apparently created an entirely fraudulent research study that suggested that the MMR (Measles, Mumps, and Rubella) vaccine caused Autism. Based on this scam, allegedly funded by an “ambulance-chasing” law firm, many well-meaning and fearful parents refused to vaccinate their children. This led to outbreaks of these uncommon diseases. Here in my own backyard, Orange County, CA, we had an outbreak of pertussis that could be traced for the most part to a single pediatrician who bought into this “bad science.”

The truth? There is not a single piece of legitimate evidence to suggest that MMR is in any way related to autism.

And Slender Man does not exist.

 
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Posted by on October 16, 2014 in Medical History, Medical Issues

 

ORIGINAL SIN Review

OS 200X300

A good review of ORIGINAL SIN by Jon Land in the Providence Journal:

Dr. Doug Lyle puts his medical and forensics training to excellent use in the stellar“Original Sin” (Reputation Books, 238 pages, $19.95) that reads like Robin Cook’s “Coma” on steroids. Lyle treats us to not one, but two terrific heroines in Dr. Lucy Wagner and her friend, as well as ours, ex-cop Samantha Cody. It’s a classic riches-to-rags tale that starts when the famously successful Wagner loses a patient and then nearly everything else. Enter ex-boxer Cody. Never one to shy away from a fight, she encounters more than her share of opponents in trying to get to the bottom of a conspiracy at the hands of those who are about to learn to take a punch. Lyle adroitly balances spot-on medical science and technology with adroit plotting and masterful characters. A mix of Michael Crichton and C. J. Box that adds up to seasoned and savory brain candy.

This and other excellent reviews: http://www.providencejournal.com/features/entertainment/books/20141005-thrillers-novels-that-range-from-old-fashioned-to-cutting-edge-cliffhangers.ece

More Info on ORIGINAL SIN: http://www.dplylemd.com/DPLyleMD/Books-SCody.html

 
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Posted by on October 16, 2014 in Book Review, Writing

 

Book Review: Full Measure by T. Jefferson Parker

Full Measure

FULL MEASURE is now available and is excellent.

T. Jefferson Parker has won three Edgar Awards for a reason—he’s a great writer. With FULL MEASURE, he steps away from more traditional crime fiction and into the mainstream literary genre. The result is this wonderful book. Want to know what a character-driven story feels like? Read FULL MEASURE. Characters that will linger with you for a long time. Highly recommended.

http://www.tjeffersonparker.com

 
3 Comments

Posted by on October 10, 2014 in Book Review, Writing

 

Crime and Science Radio: Inside The Creative Mind: An Interview With Psychotherapist, Screenwriter, and Novelist Dennis Palumbo

Join Jan Burke and DP Lyle on Saturday 10-18-14 at 10 a.m. Pacific as they discuss psychology and storytelling in both novels and on the screen with veteran screenwriter/novelists Dennis Palumbo

DPalumbo

BIO: Formerly a Hollywood screenwriter (My Favorite Year; Welcome Back, Kotter, etc.), Dennis Palumbo is now a licensed psychotherapist and author of Writing From the Inside Out (John Wiley). His work helping writers has been profiled in The New York Times, The Los Angeles Times, GQ and other publications, as well as on CNN, NPR and PBS. He also blogs regularly for The Huffington Post and Psychology Today.

His mystery fiction has appeared in Ellery Queen’s Mystery Magazine, The Strand and elsewhere, and is collected in From Crime to Crime (Tallfellow Press). His acclaimed series of crime novels (Mirror Image, Fever Dream, Night Terrors and the upcoming Phantom Limb) feature psychologist Daniel Rinaldi, a trauma expert who consults with the Pittsburgh Police.  All are from Poisoned Pen Press.

LISTENhttp://www.blogtalkradio.com/suspensemagazine/2014/09/30/crime-and-science-radio-with-special-guest-dennis-palumbo

LINKS:

Website: http://dennispalumbo.com

YOU SEE DEAD PEOPLE? BIG DEAL. JOIN THE CLUB: http://dennispalumbo.com/articles-dennis-palumbo/you-see-dead-people/

Taking The Mystery Out Of Writing Mysteries: http://dennispalumbo.com/take-the-mystery-out-of-writing/

Is Your Psycho Killer Just . . . Psycho?: http://www.huffingtonpost.com/dennis-palumbo/writing-tips-for-mystery-books_b_1450589.html

From Spec Script to the Big Screen—It Can Happen To You!: http://www.huffingtonpost.com/dennis-palumbo/from-spec-script-to-the-b_b_4881332.html

Who (And What) Defines Normal?: http://www.huffingtonpost.com/dennis-palumbo/definition-of-normal_b_1149362.html

Hollywood On The Couch: Going the Distance: http://www.huffingtonpost.com/dennis-palumbo/hollywood-on-the-couch-go_b_779917.html

Through A Glass Darkly: Crime Fiction as a Window on American Culture: http://www.huffingtonpost.com/dennis-palumbo/through-a-glass-darkly-cr_b_494065.html

BOOKS:

NightTerrorsfrontforaupromo copy

http://www.poisonedpenpress.com/night-terrors/

http://www.amazon.com/Night-Terrors-Daniel-Rinaldi-Mystery/dp/1464201315

PhantomLimbcover copy

http://www.poisonedpenpress.com/phantom-limb/

http://www.amazon.com/Phantom-Limb-Daniel-Rinaldi-Mystery/dp/1464202567

 
 
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