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Author Archives: D.P. Lyle, MD

About D.P. Lyle, MD

Author, Lecturer, Story Consultant

Criminal Mischief: The Art and Science of Crime Fiction: Episode #17: DNA and Twins

DNA Replication

 

LISTEN: https://soundcloud.com/authorsontheair/criminal-mischief-episode-17-dna-and-identical-twins

PAST SHOWS: http://www.dplylemd.com/criminal-mischief.html

SHOW NOTES:

For years it was felt that the DNA of identical twins was indeed identical. Since they come from a single fertilized egg, this would seem intuitive. But, nature likes to throw curve balls—and the occasional slider. After that first division of the fertilized, and after the two daughter cells go their way toward producing identical humans, things change. And therein lies the genetic differences between two “identical” twins.

LINKS:

One Twin Committed the Crime—but Which One?: https://www.nytimes.com/2019/03/01/science/twins-dna-crime-paternity.html

The Claim: Identical Twins Have Identical DNA: https://www.nytimes.com/2008/03/11/health/11real.html

The Genetic Relationship Between Identical Twins: https://www.verywellfamily.com/identical-twins-and-dna-2447117

Identical Twins’ Genes Are Not Identical: https://www.scientificamerican.com/article/identical-twins-genes-are-not-identical/

Rare Australian Twins Are “Semi-Identical,: Sharing 89 Percent of Their DNA: https://www.inverse.com/article/53633-semi-identical-twins-share-78-percent-of-dna

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Criminal Mischief: Episode #16: Arsenic: An Historical and Modern Poison

Arsenic

Criminal Mischief: Episode #16: Arsenic: An Historical and Modern Poison

LISTEN: https://soundcloud.com/authorsontheair/criminal-mischief-episode-15-arsenic-an-historical-and-modern-poison

SHOW NOTES: http://www.dplylemd.com/criminal-mischief-notes/16-arsenic-an-historical.html

PAST SHOWS: http://www.dplylemd.com/criminal-mischief.html

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From HOWDUNNIT:FORENSICS

Toxicology is a relatively new science that stands on the shoulders of its predecessors: anatomy, physiology, chemistry, and medicine. Our knowledge in these sciences had to reach a certain level of sophistication before toxicology could become a reality. It slowly evolved over more than two hundred years of testing, starting with tests for arsenic. 

Arsenic had been a common poison for centuries, but there was no way to prove that arsenic was the culprit in a suspicious death. Scientist had to isolate and then identify arsenic trioxide—the most common toxic form of arsenic— in the human body before arsenic poisoning became a provable cause of death. The steps that led to a reliable test for arsenic are indicative of how many toxicological procedures developed. 

1775: Swedish chemist Carl Wilhelm Scheele (1742–1786) showed that chlorine water would convert arsenic into arsenic acid. He then added metallic zinc and heated the mixture to release arsine gas. When this gas contacted a cold vessel, arsenic would collect on the vessel’s surface. 

1787: Johann Metzger (1739–1805) showed that if arsenic were heated with charcoal, a shiny, black “arsenic mirror” would form on the charcoal’s surface. 

1806: Valentine Rose discovered that arsenic could be uncovered in the human body. If the stomach contents of victims of arsenic poisoning are treated with potassium carbonate, calcium oxide, and nitric acid, arsenic trioxide results. This could then be tested and confirmed by Metzger’s test. 

1813: French chemist Mathieu Joseph Bonaventure Orfila (1787–1853) developed a method for isolating arsenic from dog tissues. He also published the first toxicological text, Traité des poisons (Treatise on Poison), which helped establish toxicology as a true science. 

1821: Sevillas used similar techniques to find arsenic in the stomach and urine of individuals who had been poisoned. This is marked as the beginning of the field of forensic toxicology. 

1836: Dr. Alfred Swaine Taylor (1806–1880) developed the first test for arsenic in human tissue. He taught chemistry at Grey’s Medical School in England and is credited with establishing the field of forensic toxicology as a medical specialty. 

1836: James Marsh (1794–1846) developed an easier and more sensitive version of Metzger’s original test, in which the “arsenic mirror” was collected on a plate of glass or porcelain. The Marsh test became the standard, and its principles were the basis of the more modern method known as the Reinsch test, which we will look at later in this chapter. 

As you can see, each step in developing a useful testing procedure for arsenic stands on what discoveries came before. That’s the way science works. Step by step, investigators use what others have discovered to discover even more. 

Acute vs. Chronic Poisoning 

At times the toxicologist is asked to determine whether a poisoning is acute or chronic. A good example is arsenic, which can kill if given in a single large dose or if given in repeated smaller doses over weeks or months. In either case, the blood level could be high. But the determination of whether the poisoning was acute or chronic may be extremely important. If acute, the suspect list may be long. If chronic, the suspect list would include only those who had long-term contact with the victim, such as a family member, a caretaker, or a family cook. 

So, how does the toxicologist make this determination? 

In acute arsenic poisoning, the ME would expect to find high levels of arsenic in the stomach and the blood, as well as evidence of corrosion and bleeding in the stomach and intestines, as these are commonly seen in acute arsenic ingestion. If he found little or no arsenic in the stomach and no evidence of acute injury in the gastrointestinal (GI) tract, but high arsenic levels in the blood and tissues, he might suspect that the poisoning was chronic in nature. Here, an analysis of the victim’s hair can be invaluable. 

Hair analysis for arsenic (and several other toxins) can reveal exposure to arsenic and also give a timeline of the exposure. The reason this is possible is that arsenic is deposited in the cells of the hair follicles in proportion to the blood level of the arsenic at the time the cell was produced. 

In hair growth, the cells of the hair’s follicle undergo change, lose their nuclei, and are incorporated into the growing hair shaft. New follicular cells are produced to replace them and this cycle continues throughout life. Follicular cells produced while the blood levels of arsenic are high contain the poison, and as they are incorporated into the hair shaft the arsenic is, too. On the other hand, any follicular cells that appeared while the arsenic levels were low contain little or no arsenic. 

In general, hair grows about a half inch per month. This means that the toxicologist can cut the hair into short segments, measure the arsenic level in each, and reveal a timeline for arsenic exposure in the victim. 

Let’s suppose that a wife, who prepares all the family meals, slowly poisoned her husband with arsenic. She began by adding small amounts of the poison to his food in February and continued until his death in July. In May he was hospitalized with gastrointestinal complaints such as nausea, vomiting, and weight loss (all symptoms of arsenic poisoning). No diagnosis was made, but since he was doing better after ten days in the hospital, he was sent home. Such a circumstance is not unusual since these types of gastrointestinal symptoms are common and arsenic poisoning is rare. Physicians rarely think of it and test for it. After returning home, the unfortunate husband once again fell ill and finally died. 

As part of the autopsy procedure, the toxicologist might test the victim’s hair for toxins, and if he did, he would find the arsenic. He could then section and test the hair to determine the arsenic level essentially month by month. If the victim’s hair was three inches long, the half inch closest to the scalp would represent July, the next half inch June, the next May, and so on until the last half inch would reflect his exposure to arsenic in February, the month his poisoning began. Arsenic levels are expressed in parts per million (ppm).

An analysis might reveal a pattern like that seen in Figure 11-1. 

IMAGE in HOWDUNNIT: FORENSICS

 The toxicologist would look at this timeline of exposure and likely determine that the exposure occurred in the victim’s home. The police would then have a few questions for the wife and would likely obtain a search warrant to look for arsenic within the home. 

LINKS: 

Arsenic Poisoning (2007): CA Poison Control: https://calpoison.org/news/arsenic-poisoning-2007

Arsenic Poisoning Cases Wikipedia: https://en.wikipedia.org/wiki/Arsenic_poisoning_cases

Arsenic” a Murderous History: https://www.dartmouth.edu/~toxmetal/arsenic/history.html

Facts About Arsenic: LiveScience: https://www.livescience.com/29522-arsenic.html

Poison: Who Killed Napolean?: https://www.amnh.org/explore/news-blogs/on-exhibit-posts/poison-what-killed-napoleon

Victorian Poisoners: https://www.historic-uk.com/HistoryUK/HistoryofEngland/Victorian-Poisoners/

12 Female Poisoners Who Killed With Arsenic: http://mentalfloss.com/article/72351/12-female-poisoners-who-killed-arsenic

 

 

Criminal Mischief: Episode 15: Introducing Characters

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Criminal Mischief: The Art and Science of Crime Fiction: Episode #15: Introducing Characters

LISTEN: https://soundcloud.com/authorsontheair/criminal-mischief-episode-15-introducing-characters

PAST SHOWS: http://www.dplylemd.com/criminal-mischief.html

You never get a second chance to make a first impression. The same is true for your fictional characters. So, make them vivid and memorial. How do you do this? There are many ways. Let’s explore a few of them.

SHOW NOTES:

Riding the Rap–Elmore Leonard

Ocala Police picked up Dale Crowe Junior for weaving, two o’clock in the morning, crossing the center line and having a busted tail light. Then while Dale was blowing a point-one-nine they put his name and date of birth into the national crime computer and learned he was a fugitive felon, wanted on a three-year-old charge of Unlawful Flight to Avoid Incarceration. A few days later Raylan Givens, with the Marshals Service, came up from Palm Beach County to take Dale back and the Ocala Police wondered about Raylan.

How come he was a federal officer and Dale Crowe Junior was wanted on a state charge. He told them he was with FAST, the Fugitive Apprehension Strike Team, assigned to the Sheriff’s Office in West Palm. And that was pretty much all this Marshall said. They wandered too, since he was alone, how you’d be able to drive and keep an eye on his prisoner. Dale Crowe Junior had been convicted of a third-degree five-year felony, Battery of a Police Officer, and was looking at additional time on the fugitive warrant. Dale Junior might feel he had nothing to lose on this trip so. He was a rangy kid with the build of a college athlete, bigger than this marshal in his blue suit and cowboy boots — the marshal calm though, not appearing to be the least apprehensive. He said the West Palm strike team were shorthanded at the moment, the reason he was alone, but believed he would manage.

The Long Goodbye–Raymond Chandler

When I got home I mixed a stiff one and stood by the open window in the living room and sipped it and listened to the groundswell of traffic on Laurel Canyon Boulevard and looked at the glare of the big angry city hanging over the shoulder of the hills through which the boulevard had been cut. Far off the banshee wail of police or fire sirens rose and fell, never for very long completely silent. Twenty four hours a day somebody is running, somebody else is trying to catch him. Out there in the night of a thousand crimes, people were dying, being maimed, cut by flying glass, crushed against steering wheels or under heavy tires. People were being beaten, robbed, strangled, raped, and murdered. People were hungry, sick; bored, desperate with loneliness or remorse or fear, angry, cruel, feverish, shaken by sobs. A city no worse than others, a city rich and vigorous and full of pride, a city lost and beaten and full of emptiness. It all depends on where you sit and what your own private score is. I didn’t have one. I didn’t care. I finished the drink and went to bed.

Trouble Is My Business—Raymond Chandler

(Marlowe meets Harriett Huntress—Chapter 3)

She wore a street dress of pale green wool and a small cockeyed hat that hung on her left ear like a butterfly. Her eyes were wide set and there was thinking room between them. Their color was lapis-lazuli blue and the color of her hair was dusky red, like a fire under control but still dangerous. She was too tall to be cute. She wore plenty of make-up in the right places and the cigarette she was poking at me had a built-on mouthpiece about three inches long. She didn’t look hard, but she looked as if she had heard all the answers and remembered the ones she thought she might be able to use some time.

The Neon Rain—James Lee Burke

My partner was Cletus Purcel. Our desks faced each other in a small room in the old converted fire station on Basin Street. Before the building was a fire station it had been a cotton warehouse, and before the Civil War slaves had been kept in the basement and led up the stairs into a dirt ring that served both as an auction arena and a cockfighting pit. 

Cletus’s face looked like it was made from boiled pigskin, except there were stitch scars across the bridge of his nose and through one eyebrow, where he’d been bashed by a pipe when he was a kid in the Irish Channel. He was a big man, with sandy hair and intelligent green eyes, and he fought to keep his weight down, unsuccessfully, by pumping iron four nights a week in his garage. 

“Do you know a character named Wesley Potts?” I asked. 

“Christ, yes. I went to school with him and his brothers. What a family. It was like having bread mold as your next-door neighbor.” 

“Johnny Massina said this guy’s talking about pulling my plug.” 

“Sounds like bullshit to me. Potts is a gutless lowlife. He runs a dirty movie house on Bourbon. I’ll introduce you to him this afternoon. You’ll really enjoy this guy.”

California Girl-T. Jefferson Parker

Here And Now

I drove past the old SunBlesst packinghouse today. Nothing left of it. Not one stick. Now there’s a bedroom store, pet Emporium and a supermarket. Big and new. Moms and dads and kids everywhere. Pretty people, especially the moms. Young, with time to dream, wake up, and dream again.

I still have a piece of the flooring I tore off the SunBlesst packinghouse back in sixty-eight. When I was young. When I thought that what had happened there should never happen anywhere. When I thought it was up to me to put things right.

I’m made of that place – – the old wood and the rusted conveyors and the pigeons in the eaves and the sunlight slanting through the cracks. Of Janelle Vonn. Of everything that went down, there in October, 1968. Even made of the wind that blew that month, dry and hot off the desert, huffing across Orange County to the sea.

I have a piece of the picket fence from the grassy knoll at Dealey Plaza, too. And a piece of rock that came not far from where Mercury 1 lifted off. And one of Charlie Manson’s guitar picks.

But those are different stories.

Queenpin—Megan Abbott

 I want the legs.

That was the first thing that came into my head. The legs were the legs of a 20-year-old Vegas showgirl, a hundred feet long and with just enough curve and give and promise. Sure, there was no hiding the slightly worn hands or the beginning tugs of skin framing the bones in her face. But the legs, they lasted, I tell you. They endured. Two decades her junior, my skinny matchsticks were no competition.

In the casinos, she could pass for thirty. The low lighting, her glossy auburn hair, legs swinging, tapping the bottom rim of the tall bettor stools. At the track, though, she looked her age. Even swathed in oversized sunglasses, a wide-brimmed hat, bright gloves, she couldn’t outflank the merciless sunshine, the glare off the grandstand. Not that it mattered. She was legend.

I was never sure what she saw in me. You looked like you knew a thing or two, she told me later. But you are ready to learn a lot more.

Miami Purity—Vicki Hendricks

Hank was drunk and he slugged me – – it wasn’t the first time – – and I picked up the radio and caught him across the forehead with it. It was one of those big boom boxes with the cassette player and recorder, but I never figured it would kill him. We were sitting in front of the fan, listing to country music and sipping Jack Daniels – – calling each other “toots” like we both enjoyed – – and all of a sudden the whole world changed. My old man was dead. I didn’t feel like I had anything to do with it. I didn’t make that choice.

I spent a few days in jail till the law decided I wasn’t to blame. It was Hank’s long record got me out. He was known to the cops. Afterwards I went on drinking and missing that son of a bitch like hell. There were several months I don’t know what I was doin. He had a terrible mean streak, but we were good together – – specially when we got our clothes off.

At some point I woke up from a blackout and was in the hospital. I had vague memories of some asshole buying me drinks, and him on top of me in a musty smelling car. There were flashes of fist and the sound of it against my jaw, but I wasn’t sure whose fist it was – – I could’ve been mixing up another time. The nurse told me I looked like I’d been kicked, beat up so bad I was lucky to be alive. I don’t know why I believed her – – about being lucky – – but after they patched me up and dried me out for a while I was ready to give it a go. Really try to make myself a life, for the very first time. It was a big mistake.

To Kill A Mockingbird—Harper Lee

When he was nearly thirteen, my brother Jem got his arm badly broken at the elbow. When it healed, and Jem’s fears of never being able to play football were assuaged, he was seldom self-conscious about the injury. His left arm was somewhat shorter than his right; when he stood or walked, the back of his hand was at right angles to his body, his thumb parallel to his thigh. He could’ve cared less, so long as he could pass and punt.

When enough years have gone by to enable us to look back on them, we sometimes discuss the events leading to his accident. I maintain that the Ewells started it all, but Jem, who was four years my senior, said it started long before that. He said it began in the summer Dill came to us, when Dill first gave us the idea of making Boo Radley come out.

I said if he wanted to take a broad view of the thing, it really began with Andrew Jackson. If Gen. Jackson hadn’t run the Creeks up the creek, Simon Finch would never have paddled up the Alabama, and where would we be if he hadn’t? We were far too old to settle an argument with the fist-fight, so we consulted Atticus. Our father said we were both right.

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Original Sin—DP Lyle

Lucy Wagner knew exactly when she would hold the heart in her hands, its hard muscle churning against her palm, its moist heat warming her fingers. Knew when its rhythmic twisting would stagger and fall silent as the drugs brought it to a standstill. Frozen in time.

She just didn’t know it would be this heart or under these circumstances.

John Doe changed everything. John Doe couldn’t wait. John Doe bumped her 7:30 elective coronary bypass until later. Probably much later.

Thirty-five minutes earlier, Doe had been found down, face down, on the ER entry ramp at the Remington Medical Center. Purple, breath coming in shallow gasps, pulse barely palpable, and spiraling toward death. Circling the drain in medical slang. The heroic efforts of ER Director Dr. Jeffrey Dukes and his staff, pumping Doe full of fluids and blood, restoring just enough blood pressure to feed Doe’s weak but tenacious spark of life, somehow stabilized him long enough to reach Lucy’s operating table in OR Suite 3.

Now, the scalpel she held in her rock-steady hand hovered near the old man’s flesh. Tinted reddish brown by the hasty pre-op Betadine scrub, the parchment-thin skin and its underlying age-wilted muscles were all that separated the blade from the torn aorta and the massive pool of blood she knew waited within Doe’s abdominal cavity. A cardiovascular surgeon’s worst nightmare. The elderly man had little chance of getting through this alive but absolutely none if Lucy didn’t jump right in. As one of her fellowship mentors at Vanderbilt had been fond of saying, “They’re are times to contemplate and times to slash and grunge.” 

This was slash and grunge time. 

Prayer wouldn’t hurt.

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Deep Six—DP Lyle

It was precisely 12:12 a.m. when the window shattered. A crack-crunch, an eardrum concussing pop, and a spray of glass shards. It didn’t explode by itself, mind you, but rather courtesy of a cavity-backed, perimeter-weighted two-hundred-dollar five iron. A Callaway. I recognized it because it was mine. Or at least it had been.

I knew the exact time because the flying glass yanked me from sleep, my forward-slumped head aligned squarely with the dashboard clock. Took a couple of seconds to gain any sort of perspective on what had happened. 

Of course, sleep wasn’t part of the job. Watching the house two doors down and across the street was. In my defense, nothing had moved in the house, or even along the street that snaked through the high-dollar neighborhood, for at least a couple of hours. But sitting in the dark, behind the wheel of my car, boredom did what boredom does. Knocking back the better portion of the bottle of Knob Creek hadn’t helped either. Stakeouts were mind numbing and a little more numbing of the mind couldn’t be all bad. Right?

“Jake, what the hell are you doing?” the reason for the glass explosion screeched through the jagged hole. 

This wasn’t just any window. It was vintage, the reason it shattered rather than simply spider-webbing. The original passenger window of my otherwise spotless 1965 Mustang. Burgundy with black pony interior, now littered with glass shards. Going to be a bitch to find a replacement.

Speaking of bitches, I recognized the grating voice even before I looked up into the face of my ex. Tammy’s the name; crazy’s the game. I’d lost four good years listening to it. Mostly whining and complaining, sometimes, like now, in a full-on rage. She had a knack for anger. Seemed to need it to get through the day. 

She gripped the five iron with both hands, knuckles paled, cocked up above her shoulder, ready to smash something else. If history offered any lesson it was that she might graduate from the side window to the windshield and so on until she got to me. Tammy didn’t have brakes. Or a reverse gear.

Cute according to everyone, except maybe me, she was a beach-blond with bright blue eyes, a magic smile, and a perfect nose. Some plastic surgeons were gifted. Expensive, but gifted. I knew. I’d paid for the nose.

But cute Tammy had a short fuse. She could go from zero to C4 in a nanosecond.

Like now.

“Funny, I was just fixing to ask you the same thing?” I said.

Still shaking the cobwebs loose and trying to get oriented to person, place, and situation, I managed to get the characters involved sorted out pretty quickly. Staring at a cocked five iron in the hands of your ex-wife will do that. The place came along in short order. Peppermill Road. A loop off Perdido Beach Boulevard that arched through The Point, a megabuck enclave nestled into another expensive enclave known as Perdidio Beach. Very high up the financial food chain, The Point was a row of seven-figure, stilted homes that hung off Peppermill like charms on a bracelet, each facing the Gulf over a wide sugary beach. 

Okay. Two down, one to go.

Person, check. Place, check. It was the situation I struggled with.

“Why are you parked in front of my house?” she asked, chin jutted forward, eyes flashing that anger I knew so well.

Well, there was that.

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Run To Ground–D. P. Lyle

“I can still smell him.” Martha Foster inhaled deeply and closed her eyes.

Tim stood just inside the doorway and looked down at his wife. She sat on the edge of their son’s bed, eyes moist, chin trembling, as were the fingers that clutched the navy-blue Tommy Hilfiger sweatshirt to her chest. It had been Steven’s favorite. He had slept in it every night the first month, until Martha finally pried it away long enough to run it through the wash.

Behind her, a dozen photos of Steven lay scattered across the blue comforter. A proud Steven in his first baseball uniform. A seven-year-old Steven, grinning, upper left front tooth missing, soft freckles over his nose, buzz-cut hair, a blue swimming ribbon dangling around his neck. A playful Steven, sitting next to Martha at the backyard picnic table, face screwed into a goofy expression, smoke from the Weber BBQ rising behind them. Tim remembered the day he snapped the picture. Labor Day weekend. Just six months before that day. He squeezed back his own tears and swallowed hard.

Martha shifted her weight and twisted toward the photos. She laid the sweatshirt aside and reached out, lightly touching an image of Steven’s face. The trembling of her delicate fingers increased. She said nothing for a moment and then, “I’m taking these.”

Tim walked to where she sat and pulled her to him, her cheek nestling against his chest, her tears soaking through his tee shirt. He kissed the top of her head. 

“He’s gone,” Martha said. “Everything’s gone. Or will be.”

 
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Posted by on March 21, 2019 in Criminal Mischief Show, Writing

 

Criminal Mischief: Episode #14: Rules of Writing

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Criminal Mischief: Episode #14: Rules of Writing

LISTEN: https://soundcloud.com/authorsontheair/criminal-mischief-episode-14-rules-of-writing

PAST SHOWS: http://www.dplylemd.com/criminal-mischief.html

SHOW NOTES:

Somerset Maugham

There are three rules for novel writing. Unfortunately, no one knows what they are.

Terry Brooks Rules

Read, Read, Read

Outline, Outline, Outline

Write, Write, Write

Repeat

Dave Barry:

Don’t Be Boring

Elmore Leonard’s 10 Rules of Writing

1-Never open a book with weather

2-Avoid prologues

3-Never use a verb other than “said” to carry dialogue

4-Never use an adverb to modify the verb “said”

5-Keep your exclamation points under control. You are allowed no more than two or three per 100,000 words of prose

6-Never use the words “suddenly” or “all hell broke loose

7-Use regional dialect, patois, sparingly

8-Avoid detailed descriptions of characters

9-Don’t go into great detail describing places and things

10-Try to leave out the part that readers tend to skip

From BLACK CHERRY BLUES by James Lee Burke

Her hair is curly and gold on the pillow, her skin white in the heat lightning that trembles beyond the pecan trees outside the bedroom window. The night is hot and breathless, the clouds painted like horsetails against the sky; a peal of thunder rumbles on the Gulf like an apple rolling around in the bottom a wooden barrel, and the first raindrops ping against the window fan. She sleeps on her side, and the sheet molds her thigh, the curve of her hip, her breast. In the flicker of the heat lightning the sun freckles on her bare shoulder look like brown flaws in sculpted marble.

LINKS:

Elmore Leonard: “What a Guy,” says Jackie Collins

https://www.theguardian.com/books/2013/aug/21/elmore-leonard-what-a-guy-jackie-collins

Writers On Writing: Easy on the Adverbs, Exclamation Points, and Especially Hooptedoodle by Elmore Leonard

https://www.nytimes.com/2001/07/16/arts/writers-writing-easy-adverbs-exclamation-points-especially-hooptedoodle.html

Jack Kerouac’s 30 Tips:

http://writing.upenn.edu/~afilreis/88/kerouac-technique.html

6 Writing Tips From John Steinbeck:

https://www.theatlantic.com/entertainment/archive/2012/03/6-writing-tips-from-john-steinbeck/254351/

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SUNSHINE STATE, Jake Longly #3
Coming May 21, 2019

 

 
 

Criminal Mischief: Episode #13: Alice in Wonderland Syndrome

Criminal Mischief: Episode #13: Alice in Wonderland Syndrome

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LISTEN: https://soundcloud.com/authorsontheair/criminal-mischief-episode-13-alice-in-wonderland-syndrome

SHOW NOTES: http://www.dplylemd.com/criminal-mischief-notes/13-alice-in-wonderland.html

PAST SHOWS: http://www.dplylemd.com/criminal-mischief.html

One pill makes you larger, and one pill makes you small

And the ones that mother gives you, don’t do anything at all

Go ask Alice, when she’s ten feet tall

White Rabbit, The Jefferson Airplane

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And then there was this excellent question from my friend and wonderful writer Frankie Bailey that was published in SUSPENSE MAGAZINE as part of my recurring Forensic Files column:

What Drugs Might Cause Side Effects in My Character With Alice in Wonderland Syndrome?

Q: I have a question about Alice in Wonderland Syndrome (AIWS) My character is in his mid-30s. From what I’ve gathered from reading about this syndrome, it is fairly common with children and with migraine sufferers and it is controllable. However, I want my character to have side-effects. In other words, even though the AIWS and his migraines are under control, he is increasingly erratic. Insomnia, impotence, and irritability would all be a bonus. Could he be dosing himself with some type of herb that he doesn’t realize would have these side-effects when combined with the medication prescribed for AIWS. Or is there a medication for AIWS that might cause these kind of side-effects but be subtle enough in the beginning that the person becomes mentally unstable before he realizes something is wrong?

FY Bailey

A: Alice in Wonderland Syndrome is also known as Todd’s Syndrome. It is a neurologic condition that leads to disorientation and visual and size perception disturbances (micropsia and macropsia). This means that their perception of size and distance is distorted. Much like Alice after she descended into the rabbit hole and consumed the food and drink she was offered.

AIWS is associated with migraines, tumors, and some psychoactive drugs. It is treated in a similar fashion to standard migraines with various combinations of anticonvulsants, antidepressants, beta blockers, and calcium channel blockers. Both anticonvulsants (Dilantin, the benzodiazepines such as Valium and Xanax, and others) and antidepressants (the SSRIs like Lexpro and Prozac, the MAOIs like Marplan and Nardil,, and the tricyclic antidepressants like Elavil and Tofranil, and others) have significant psychological side effects. Side effects such as insomnia, irritability, impotence, confusion, disorientation, delusions, hallucinations, and bizarre behaviors of all types–some aggressive and others depressive. Beta blockers can cause fatigue, sleepiness, and impotence. The calcium channel blockers in general have fewer side effects at least on a psychiatric level.

As for herbs almost anything that would cause psychiatric affects could have detrimental outcomes in your character. Cannabis, mushrooms, LSD, ecstasy, and other hallucinogens could easily make his symptoms worse and his behavior unpredictable.

Your sufferer could easily be placed on one of the anticonvulsants, one of the antidepressants, or a combination of two of these drugs and develop almost any of the above side effects, in any degree, and in any combination that you want. This should give you a great deal to work with.

What is Alice in Wonderland (AIWS) Syndrome?

A neuropsychiatric syndrome—also know as Todd’s Syndrome after Dr. John Todd, the physician who first described it in 1955—in which perceptions are distorted and visual hallucinations can occur. Often objects take an odd size and spatial characteristics—-just as Alice experienced. They can appear unusually small (micropsia), large (macropsia, close (pelopsia, or far (teleopsia).

It can be caused by many things including hallucinogenic drugs, seizures, migraines, strokes, brain injuries, fevers, infections, psychiatric medications, and tumors.

Migraines are often preceded by auras—visual, auditory, olfactory.

Lewis Carroll was known to suffer from migraines. His own diary revealed he had visited William Bowman, an ophthalmologist, about the visual manifestations he regularly had when his migraines flared. So it just might be that he himself experienced AIWS and took his experiences to create Alice.

AIWS Wikipedia: https://en.wikipedia.org/wiki/Alice_in_Wonderland_syndrome

AIWS Healthline: https://www.healthline.com/health/alice-in-wonderland-syndrome#outlook

AIWS NIH Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909520/

AIWS and Tumor: https://www.livescience.com/64520-alice-in-wonderland-brain-tumor.html

AIWS and Visual Migraines: https://www.webmd.com/migraines-headaches/alice-wonderland-syndrome#1

 

What’s the Deal with Typhus?

Ever heard of Typhus? Probably in history class, or something similar. It reared its head many times during the Middle Ages and helped take down Napolean’s Grand Army in 1812. Many believe that as much as one-third of his army succumbed to the disease. It pops up here and there from time to time. Like now. Seems LA has a Typhus problem and it’s centered around City Hall.

Typhus is what we call a Rickettsial disease since it is caused by a bacterium known as Rickettsia typhi—-at least the form that comes from fleas is. A Rickettsial disease you’ve likely heard of is Rocky Mountain Spotted Fever (RMSF). There are several types of Typhus, each caused by a different bacterium and spread by a different vector. Scrub Typhus is carried by mites, Endemic Typhus by lice, and the one that’s affecting LA is Murine Typhus, which is carried to humans by fleas from infected rats.

Flea

When an infected vector bites a human, the bacterium enters the body and spreads. A week or two later the victim will develop fever, chills, and headaches. Sometimes GI symptoms such as nausea, vomiting, and abdominal pain occur. Not unlike a bad flu. Then, a few days later, the rash appears. 

Typhus-murine

If untreated, the disease can cause severe damage to the kidneys, liver, lungs, heart, brain, and can lead to death. But once diagnosed, the treatment is rather easy. The antibiotic doxycycline, sometimes ciprofloxacin, kills the rickettsial bacterium quickly and efficiently.

Right now, LA is treating the infected and trying to figure the best way to clear the rodents and fleas from City Hall. It’ll be a big job.

Typhus Wikipedia: https://en.wikipedia.org/wiki/Typhus

Typhus in LA: http://www.newser.com/story/271086/city-hall-faces-medieval-illness.html

Napolean and Typhus: https://qcurtius.com/2017/07/16/the-victory-of-general-typhus-napoleons-catastrophic-invasion-of-russia/

Typhus WebMD: https://www.webmd.com/a-to-z-guides/what-is-typhus#1

Murine Typhus CDC: https://www.cdc.gov/typhus/murine/index.html

 
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Posted by on February 11, 2019 in Medical History, Medical Issues

 

Criminal Mischief: The Art and Science of Crime Fiction: Episode #12: Fentanyl—A Most Dangerous Game

Criminal Mischief: The Art and Science of Crime Fiction Podcast: https://soundcloud.com/authorsontheair/fentanyl-a-most-dangerous-game

PAST SHOWS: http://www.dplylemd.com/criminal-mischief.html

SHOW NOTES: 

Fentanyl is a synthetic opioid that is as much as 300 times more powerful than morphine sulfate. It can be injected, ingested, inhaled, and will even penetrate the skin.

It is used in medical situations frequently for pain management, sedation, and for twilight-anesthesia for things such as colonoscopies. 

Fentanyl is the number one cause of drug ODs.

Americans have a slightly higher than 1% chance of ultimately dying of an opioid overdose. That’s better than one in 100 people. In fact, 60 people die every day from opioid ODs. That translates to over 22,000 per year. In fact, US life expectancy dropped slightly between 2016 and 2017 due to opioid overdoses.

Thirteen people suffered a mass OD at a party in Chico, Ca in January 2019.

It is often added to other drugs such as heroin to “boost” the heroine effect. Unfortunately, Fentanyl is much more powerful than heroin and when the two are mixed it becomes a deadly combination. It’s also often added to meth and cocaine.


How powerful is fentanyl? A single tablespoon of it could kill as many as 500 people; 120 pounds as many as 25 million people. A recent bust, the largest in US history, recovered over 250 pounds of Fentanyl secreted in a truck crossing the US-Mexico border-—enough to kill 50 million people. 

When cops arrest people who possess or are transporting fentanyl they must take precautions not to touch or inhale the product as it could prove fatal. The opioid crises is the reason many cops carry Narcan (Naloxone) with them as either an injection or a nasal spray. It reverses the effects of narcotics very quickly. 

The “Dark Web” is a source for many things that can’t be purchased or the open market. Weapons, hitmen, and drugs. But even many of these dealers won’t deal Fentanyl.

Could fentanyl be used as a weapon of terror? Absolutely. A fentanyl aerosol sprayed into a room of people could easily kill everyone present in a matter of minutes. It is a powerful narcotic that acts very quickly and depresses respiration so that people die from asphyxia.

In 2002 a group of around 50 Chechen terrorists who took 850 people hostage in a Moscow theater. Many of the attackers were strapped with explosive vests. The standoff lasted 4 days until the Russians pumped Fentanyl-maybe carfentanil or remifentanil—through the vents and took everyone down. All the terrorists were killed but unfortunately, over 200 of the hostages died before medical help could reach them. 

Carfentanil—-Been around since 1974 but just now entering the world of drug abuse. Used in darts as a large animal tranquilizer. AN analog of fentanyl but is 100X stronger.

The famous Kristin Rossum “American Beauty” case involved fentanyl.

Kristen Rossum

 

Fentanyl Deaths Top Car Accidents: https://www.breitbart.com/politics/2019/01/15/accidental-opioid-deaths-top-car-accident-deaths-for-the-first-time/

Mass OD in Chico, CA: https://www.ems1.com/overdose/articles/393267048-Calif-mass-overdose-highlights-severe-new-phase-of-opioid-epidemic/

Narcan: https://en.wikipedia.org/wiki/Naloxone

Even many “Dark Web” Dealers won’t sell Fentanyl: http://www.newser.com/story/268019/even-dark-web-dealers-refuse-to-sell-this-drug.html

Fentanyl As Terror Weapon: https://www.breitbart.com/asia/2019/01/03/report-experts-insist-opioid-fentanyl-could-be-used-as-tool-of-terror/

Fentanyl as WMD: https://www.bloombergquint.com/business/killer-opioid-fentanyl-could-be-a-weapon-of-mass-destruction#gs.UwnsSzO8

Carfentanil Wikipedia: https://en.wikipedia.org/wiki/Carfentanil

Kristin Rossum Wikipedia: https://en.wikipedia.org/wiki/Kristin_Rossum

 

 
 
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