Criminal Mischief: Episode #27: ABO Blood Typing

Criminal Mischief: Episode #27: ABO Blood Typing

 

LISTEN: https://soundcloud.com/authorsontheair/27-abo-blood-typing

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SHOW NOTES: http://www.dplylemd.com/criminal-mischief-notes/27-abo-blood-typing.html

 

ABO Blood Type System

From FORENSICS FOR DUMMIES

By simply typing the blood at a crime scene, investigators narrow their suspect list and completely exonerate some suspects by using the population distribution information for the four ABO blood types. 

Population Distribution of ABO Blood Types

O: 43%

A: 42%

B: 12%

AB: 3%

Besides determining the ABO type, serologists are able to further individualize blood samples. RBCs contain more proteins, enzymes, and antigens than those used in the ABO classification system. These include antigens with such catchy names as Duffy, Kell, and Kidd and intracellular enzymes such as adenylate kinase, erythrocyte acid phosphatase, and the very useful phosphoglucomutase (PGM).

PGM is an enzyme that appears in many different forms, or isoenzymes, and at least ten of them are fairly common. Regardless of ABO type, a particular individual can have any combination of the isoenzymes of PGM. The ME and the serologist use that fact to further narrow the list of suspects for further DNA analyses and confirmation that they were capable of leaving a particular bloodstain.

For example, say that a stain is Type AB and has PGM 2. The ME knows the AB blood type is found in only 3 percent (see Table 14‐1) of the population, and PGM 2 is found in only 6 percent of people. Because these two factors are inherited independently, the probability of a particular individual being Type AB, PGM 2 is only 0.18 percent or less than 2 per 1,000. 

If the police find blood at the scene that matches the blood of a suspect who has Type AB, PGM 2 blood, the probability that that suspect is not the perpetrator is 2 in 1,000. Although not perfect, those odds still are much better than a coin toss. 

Testing for Paternity 

You inherit your blood type from your parents. For that reason, a serologist can assess paternity in many cases. The crime lab is often involved in paternity testing because paternity may be a critical component in determining child support, custody, and visitation. It also may play an important role in crimes and civil proceedings that involve kidnappings, insurance fraud, and inheritance conflicts. 

Inheriting your blood type 

ABO blood types, or phenotypes, come in only four varieties: A, B, AB, and O. But, for some blood types two genotypes, or gene pairings, are possible. A phenotype is what something looks like (in this case the ABO blood type), while the genotype is the underlying genetic pattern. We receive our ABO genes from our parents, one from Dad and one from Mom. 

The important thing to know in this system is that A and B genes are co-dominant (equally dominant), while the O gene is recessive. So someone who receives an A gene from one parent and an O gene from the other has Type A blood, but not Type O, because the A gene is dominant. 

Determining Possible Genotypes from Phenotypes 

Type A: AA or AO

Type B: BB or BO

Type AB: AB

Type O: OO

People with Type O blood must have an OO genotype. They can have neither an A nor a B gene because having one or the other dominates the O gene and produces either Type A or Type B blood. 

A person with Type A blood can either receive an A gene from each parent and thus have an AA genotype or an A gene from one parent and an O gene from the other for an AO genotype. Remember, A is dominant, so when it is paired with the recessive O gene, the A gene determines blood type. People with the AA and AO genotypes both have Type A blood, but genetically speaking, they’re different. 

Type A parents who have AA genotypes can provide only A genes to their offspring, because all their eggs or sperm have an A gene. But Type A parents who have AO genotypes can provide either an A gene or an O gene to their offspring, because half their eggs or sperm have an A gene, and the other half have an O gene. When both parents are Type A, several possibilities exist for the genotype their offspring will have.

In each of the scenarios presented in Figure 14‐1, the child’s blood type is Type A, except when both parents donate an O gene. In the latter case, the child’s genotype and blood type (phenotype) respectively are OO and Type O. These parents can’t have any offspring who have Type B phenotype or BB, BO, or AB genotypes, because neither parent has a B gene to donate. 

Determining Fatherhood

Blood typing can exclude paternity but cannot absolutely verify it. For example, a man with Type AB blood can’t father a child with Type O blood. So if a child has Type O blood, all men with the Type AB are ruled out as the child’s father. A man with Type A (genotypes AA or AO) blood can be the father, but only if he has an AO genotype. Men who have AA genotypes also are excluded. Men with the AO genotype, however, can’t be ruled out at this point. 

To dig deeper into this complex system grab a copy of either:

FORENSICS FOR DUMMIES: http://www.dplylemd.com/book-details/forensics-for-dummies.html

 

HOWDUNNIT: FORENSICS: http://www.dplylemd.com/book-details/howdunnit-forensics.html

 

Criminal Mischief: Episode #22: Common Medical Errors in Fiction

Criminal Mischief: Episode #22: Common Medical Errors in Fiction

LISTEN: https://soundcloud.com/authorsontheair/criminal-mischief-episode-22-common-medical-errors-in-fiction

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

SHOW NOTES: http://www.dplylemd.com/criminal-mischief-notes/22-comon-medical-errors-in.html

Too often, fiction writers commit medical malpractice in their stories. Unfortunately, these mistakes can sink an otherwise well-written story. The ones I repetitively see include:

Bang, Bang, You’re Dead: Not so fast. No one dies instantly. Well, almost no one. Instant death can occur with heart attacks, strokes, extremely abnormal heart rhythms, cyanide, and a few other “metabolic” poisons. But trauma, such as gunshot wounds (GSWs) and blows to the head, rarely cause sudden death. Yet, how often has a single shot felled a villain? Bang, dead. For that to occur, the bullet would have to severely damage the brain, the heart, or the cervical (neck) portion of the spinal cord. A shot to the chest or abdomen leads to a lot of screaming and moaning, but death comes from bleeding and that takes time. Sometimes, a long time.

Ask any emergency physician or nurse. GSW victims reach the ER with multiple holes in their bodies and survive all the time. This is particularly true if it’s Friday night (we called it the Friday Night Knife and Gun Club), during a full moon (yes, it’s true, a full moon changes everything), or if the victim is drunk. You can’t kill a drunk. That’s a medical fact. They survive everything from car wrecks to gunshots to falling off tall buildings. The family van they hit head-on will have no survivors, but the drunk will walk away with minor scratches, if that.

Sleeping Beauty: I call this the “Hollywood Death.” Calm, peaceful, and not a hair out of place. As if simply asleep. Blood? Almost never. Trauma? None in sight. The deceased is nicely dressed, stretched out on a wrinkle-free bed, make-up perfect, and with a slight flutter of the eyelids if you look closely. Real dead folks are not so attractive. I don’t care what they looked like during life, in death, they are pale, waxy, and gray. Their eyes do not flutter and they do not look relaxed and peaceful. They look dead. And feel cold. It’s amazing how quickly after death the body becomes cold to the touch. It has to do with the loss of blood flow to the skin after the heart stops. No warm blood, no warmth to the touch.

Sleeping Beauty also doesn’t bleed. You know this one. The hero detective arrives at a murder scene a half hour after the deed to see blood oozing from the corpse’s mouth or from the GSW to the chest. Tilt! Dead folks don’t bleed. You see, when you die, your heart stops and the blood no longer circulates. It clots. Stagnant or clotted blood does not move. It does not gush or ooze or gurgle or flow or trickle from the body. 

Trauma? What Trauma?: You’ve seen and read this a million times. The hero socks the bad guy’s henchmen in the jaw. He goes down and is apparently written out of the script since we never hear from him again. It’s always the henchmen, because the antagonist, like most people, requires a few solid blows to go down. Think about a boxing match. Two guys that are trained to inflict damage and even they have trouble knocking each other out. And when they do, the one on his back is up in a couple of minutes, claiming the other guy caught him with a lucky punch. Listen to me: Only James Bond can knock someone out with a single blow. And maybe Jack Reacher or Mike Tyson. A car-salesman-turned-amateur-sleuth cannot.

And what of back eyes? If a character gets whacked in the eye in Chapter 3, he will have a black eye for two weeks, which will likely take you through the end of the book. He will not be “normal” in two days. A black eye is a contusion (bruise) and results from blood leaking into the tissues from tiny blood vessels, which are injured by the blow. It takes the body about two weeks to clear all that out. It will darken over two days, fade over four or five, turn greenish, brownish, and a sickly yellow before it disappears. On a good note, by about day seven, a female character might be able to hide it with make-up.

Similarly, what of the character who falls down the stairs and injures his back? He will not be able to run from or chase the bad guy or make love to his new lover the next day. He will need a few days (or maybe weeks) to heal. And he will limp, whine, and complain in the interim. And if he breaks something, like an arm or leg, he’ll need several weeks to recover.

I Can Run, and Jump, and Fight Like an Olympian: The typical fictional PI (maybe real ones, too) drinks too much, smokes too much, and eats donuts on a regular basis. He is not training for the Olympics. He will not be able to chase the villain for ten blocks. Two on a good day. And hills or stairs will reduce that to a very short distance. Yet chase montages in movies and books often seem to cover marathon distances. And then a fight breaks out. 

Of course, some characters can do all this. Not the PI mentioned above but maybe Dustin Hoffman can. Remember “Babe” Levy (Dustin Hoffman) in Marathon Man? He had to run for his life as Dr. Christian Szell (Sir Laurence Olivier) and his Nazi bad guys chased him endlessly. But early in the film, we learn that he runs around the reservoir in Central Park every day. He constantly tries to increase his distance, improve his time. He could run for his life.

Hopefully, when you run across medical malpractice in your reading you’ll be forgiving and enjoy the story anyway. But maybe not.

 

Criminal Mischief: Episode #18: Gunshot To The Chest

 

Criminal Mischief: Episode #18: Gunshot To The Chest

LISTEN: https://soundcloud.com/authorsontheair/gswtochest

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

SHOW NOTES: http://www.dplylemd.com/criminal-mischief-notes/18-gunshot-to-the-chest.html

Gunshot wounds (GSWs) come in many flavors and those to the chest can be particularly dicey. Yet, a chest GSW can be a minor flesh wound, a major traumatic event with significant damage, or deadly. If you have a character who suffers such an injury, this podcast is for you.

Here are a few interesting questions about chest GSWs:

Could a Person Survive a Gunshot to the Chest in the 1880s?

Q: My scenario is set in 1880. A man in his early 20s is shot in the back by a rifle. He loses a lot of blood and is found a couple of hours later unconscious. Could he survive and if so how long would it take him it recuperate? Also, would it be possible to bring him to consciousness long enough for another man to get him into a buggy. Is any part of this scenario possible?

A: Everything about your scenario works. A gunshot wound (GSW) to the chest can kill in minutes, hours, days, or not at all. The victim would be in pain and may cough and sputter and may even cough up some blood. He could probably walk or crawl and maybe even fight and run if necessary. Painful, but possible. He would likely be consciousness so could even help get himself into the wagon.

If all goes well, he should be better and gingerly up and around in a week or two. He would be fully recovered in 6 to 8 weeks.

After surviving the initial GSW, the greatest risk to his life would a secondary wound infection. Since no antibiotics were available at that time, the death rate was very high—40 to 80 percent—for wound infections. But, if he did not develop an infection, he would heal up completely.

How Is A Gunshot To The Chest Treated?

Q: I have a few questions regarding a gunshot wound that my poor character will be sustaining later on in my story. Supposing it’s a fairly small caliber bullet (typical handgun fare, not buckshot or anything) and it hits near the heart without puncturing anything important, how long might his recovery time be? He’s a strong, kinda-healthy guy in his thirties, although he drinks a fair amount and used to smoke. He’ll be rushed to a high-quality hospital immediately and receive the best care throughout recovery…what’s his outlook? When will he be allowed to go home, if all goes well? How long before he’s healed to normal?  When will it be safe for him to walk around, drive, have sex, etc.?

A: In your story, what happens to your shooting victim depends upon what injuries he received. A gunshot wound (GSW to docs and cops) can be a minor flesh wound or can be immediately deadly or anywhere in between. It all depends on the caliber and speed of the bullet and the exact structures it hits. A shot to the heart may kill instantly or not. The victim could die in a few minutes or survive for days or could recover completely with proper medical care and surgery. It’s highly variable but ask any surgeon or ER doctor and they will tell you that it’s hard to kill someone with a gun. Even with a shot or two to the chest.

A small caliber and slow speed bullet—such as those fired by .22 and .25 caliber weapons—are less likely to kill than are heavier loads and higher velocity bullets such as .38, .357, or .45 caliber bullets, particularly if they are propelled by a magnum load—such as a .357 magnum or a .44 magnum. Also, the type of bullet makes a difference. Jacketed or coated bullets penetrate more while hollow point or soft lead bullets penetrate less but do more wide-spread damage as the bullet deforms on impact.

All that is nice but the bottom line is that whatever happens, happens. That is, a small, slow bullet may kill and a large, fast one may not. Any bullet may simply embed in the chest wall or strike a rib and never enter the chest. Or it could enter the heart and kill quickly. Or it could puncture a lung. The victim here would cough some blood, be very short of breath, and could die from bleeding into the lungs—basically drowning in their own blood. Or the lung could collapse and again cause pain and shortness of breath. But we have two lungs and unless the GSWs are to both lungs and both lungs collapse the person would be able to breathe, speak, even run away, call for help, or fight off the attacker. Whatever happens, happens.

This is good for fiction writers. It means you can craft your scene any way you want and it will work. He could suffer a simple flesh wound and have pain, shortness or breathe, and be very angry. He could have a lung injury and have the above symptoms plus be very short of breathe and cough blood.  If the bleeding was severe or if both lungs were injured he could become very weak, dizzy, and slip into shock. Here his blood pressure would be very low and with the injury to his lungs the oxygen content of his blood would dip to very low levels and he would lose consciousness as you want. This could happen in a very few minutes or an hour later, depending upon the rapidity of blood loss and the degree of injury to the lungs.

Once rescued, the paramedics would probably place an endotracheal (ET) tube into his lungs to help with breathing, start an IV to giver IV fluids, and transport him to the hospital immediately. He would then be seen by a trauma surgeon or chest surgeon and immediately undergo surgery to remove the bullets (if possible) and to repair the damaged lung or whatever else was injured. He could recover quickly without complications and go home in a week, rest there for a couple of weeks, return to part-time work for a few weeks and be full speed by 3 to 4 months. Or he could have one of any number of complications and die. Or be permanently disabled, etc. It all depends upon the nature of Injuries, the treatment, and luck.

What Does a Close-range Gun Shot to the Chest Look Like?

Q: I have a question regarding gunshot wounds. In my latest mystery, a man and a woman, my heroine, struggle for a gun. It goes off, hitting the man in the chest. I want the man to live, but be temporarily incapacitated and need hospital care, so if the chest isn’t the best location, other suggestions are welcome. What would the gunshot wound likely look like before and after the man’s shirt was removed? Would there be a lot of bleeding where my heroine would take his shirt off and stuff it over the wound?

A: A gunshot wound (GSW) to the chest would work well. For it to be quickly fatal, the bullet would have to damage the heart or the aorta or another major blood vessel, such as the main pulmonary (lung) arteries. Under these circumstances, bleeding into the chest, the lungs,  and around the heart would likely be extensive and death could be almost instantaneous or in a very few minutes. He could survive even these injuries, but this would require quick and aggressive treatment, including emergent surgery, and a pile of luck.

If the bullet entered the lung, the victim could die from severe bleeding into the lung and basically drowning in his own blood. Or not. He could survive such an injury and would then require surgery to remove the bullet, control the bleeding within the lung, and repair the lung itself. This would require a couple of hours of surgery, a week in the hospital, and a couple of months to recover fully.

The bullet could simply embed in the chest wall and never enter the chest cavity. It could bounce off the sternum (breast bone) or a rib and deflect out of the chest, into the soft tissues of the chest wall, or downward into the abdomen. Once a bullet strikes bone, it can be deflected in almost any direction. Sometimes full-body X-rays are required to find the bullet. If the bullet simply embedded beneath his skin or against a rib or the sternum, he would require a minor surgical procedure to remove the bullet and debride (clean-up) the wound. He would be hospitalized for only 2 to 3 days and would go home on antibiotics and basic wound care.

Close-range, but not direct muzzle contact, wounds typically have a small central entry wound, a black halo called an abrasion collar, and often an area of charring around the wound. The charring comes from the hot gases that exit the barrel with the bullet. In addition, there is often tattooing, which is a speckled pattern around the entry wound. This is from the soot and unburned powder that follows the bullet out of the muzzle and embeds (tattoos) into the skin. The spread of this pattern depends upon how close the muzzle is to the entry point, If it over about 3 feet, then no tattooing or charring will occur.

In your scenario, the victim’s shirt would likely collect the soot and heat so that it would be charred and “tattooed,” rather than the victim’s skin. So, the shirt would show an entry hole, charring, and blood. Once the victim’s shirt was removed, the entry wound likely be a simple hole without any charring or tattooing, since the shirt would have collected this material and absorbed most of the heat. The wound could bleed a lot, a little, or almost none. It depends upon how many of the blood vessels that course through the skin and muscles are damaged.

Yes, her initial efforts should be the application of pressure over the wound to control bleeding until the paramedics arrive.

For more fun questions check out my Q&A books:

FORENSICS and FICTION: http://www.dplylemd.com/book-details/forensics–fiction.html

MORE FORENSICS and FICTION: http://www.dplylemd.com/book-details/more-forensics-and-fiction.html

MURDER AND MAYHEM: http://www.dplylemd.com/book-details/murder-and-mayhem.html

 

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

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

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 #13: Alice in Wonderland Syndrome

Criminal Mischief: Episode #13: Alice in Wonderland Syndrome

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

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.

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. 

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

 

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

 

 

Criminal Mischief: The Art and Science of Crime Fiction: Episode 11: Civil War “Limb Pit” and the History of Infectious Diseases

Criminal Mischief: The Art and Science of Crime Fiction Podcast:https://soundcloud.com/authorsontheair/limb-pits-and-germ-theory

Past Criminal Mischief Podcasts: http://www.dplylemd.com/criminal-mischief.html

Here in the 21st century we know a great deal about infectious diseases. We can treat bacterial infections with antibiotics, immunize people against numerous diseases, understand how viruses work, and have a huge fund of knowledge about surgical sterility and disease prevention. This was not always the case. In fact, in the history of medicine, all of this is fairly new.

During the 14th century, Europeans didn’t understand infectious diseases so when the Bubonic Plague, also known as the Black Death, struck, they had no understanding of what was going on, how to prevent it, and, more importantly, how to treat it. They were at the mercy of a bacterium that currently is easily treatable. The Black Death killed between a third and a half of the population of Europe and dramatically altered the trajectory of world history.

The transition from ignorance to enlightenment concerning infectious processes was a long process and involved some of the giants of medicine. Names like Ignaz Semmelweis, John Snow, Louis Pasteur, Joseph Lister, and Robert Koch. The observations of these famous scientists were ultimately distilled into Robert Koch’s famous Koch’s Postulates, which proved the Germ Theory of disease. These postulates served as the foundation for our understanding of infectious diseases, and still do today. Simply put they say:

!-If an organism is causing a disease, it must be present in those who suffer from the disease and not in those who are healthy.

2-The suspected organism must be isolated from the diseased individual and grown in culture.

3-The cultured organism must then be given to a healthy individual and reproduce the disease.

4-The organism must then be isolated from this newly diseased individual and identified.

Each of these steps is necessary to show that a particular organism causes a particular disease and is transmissible from one person to another. Basically, this is how infectious diseases work.

Unfortunately, Koch’s Postulates were not put forward until the 1880s, a couple of decades after the Civil War.

During the Civil War, almost any battlefield injury could lead to death, most often from a secondary wound infection. A gunshot to the leg, or arm, or really anywhere could become infected quite easily and this infection could spread through the entire body causing sepsis, which would ultimately lead to death. More soldiers died from infection than from their injuries. Surgeons at that time understood the danger of infections, even though they didn’t know what caused it, and had no clue how to prevent or treat them. This meant that serious limb injuries were treated with amputation. Get rid of the injured limb and hopefully lessen the possibility of a secondary infection. Of course, post-surgical infections were also common and also lead to death.

Not only were sterile techniques and antibiotics unavailable at that time, but also any form of anesthesia was not to be found on most battlefields. Ether was around, having been first demonstrated by William T. G. Morton in 1846, but it’s use and availability wasn’t widespread. This means that a battlefield surgeon’s best skill was speed. Sort of the surgical equivalent of “ripping off the Band-Aid.” Any surgery was agony and the quicker it was done, and the sooner it was over, the better for the victim. And the amputated limbs piled up.

It seems that Virginia’s Manassas National Battlefield Park has yielded what can only be called a “limb pit.” It is a place where surgeons deposited removed limbs. This discovery underlines the state of surgical treatment and its brutal nature during the 1860s.

http://www.newser.com/story/260874/first-civil-war-limb-pit-is-excavated.html

Germ Theory: https://en.wikipedia.org/wiki/Germ_theory_of_disease

Koch’s Postulates: https://en.wikipedia.org/wiki/Koch%27s_postulates

Joseph Lister: https://en.wikipedia.org/wiki/Joseph_Lister

Ignaz Semmelseis: https://en.wikipedia.org/wiki/Ignaz_Semmelweis

John Snow: https://en.wikipedia.org/wiki/John_Snow

Louis Pasteur: https://en.wikipedia.org/wiki/Louis_Pasteur

William T.G. Morton: https://en.wikipedia.org/wiki/William_T._G._Morton

History of General Anesthesia: https://en.wikipedia.org/wiki/History_of_general_anesthesia

 

Criminal Mischief: The Art and Science of Crime Fiction: Episode #10: Rattlesnakes and Murder

Episode #10: Rattlesnakes and Murder Podcast: https://soundcloud.com/authorsontheair/criminal-mischief-episode-10-rattlesnakes-and-murder

Past Criminal Mischief Podcasts: http://www.dplylemd.com/criminal-mischief.html

SHOW NOTES

“Good fences make good neighbors”—Robert Frost, “Mending Wall” 

I suspect Ryan Felton Sauter’s neighbor, Keith Monroe, would agree.

People commit murder for a host of reasons. Things like financial gain, revenge, lust, anger, to cover another crime, and many other motives. It seems that these motives can even include a dispute with the dude who parked his RV next to yours.

All sorts of weapons are used for committing murder. Guns, knives, poisons, explosives, ligatures, drownings, and gentle pushes off buildings or cliffs. Oh, don’t forget rattlesnakes. This seems to be what Mr. Sauter decided to employ. Simply slipping the reptile into his neighbors RV might not work since rattlesnakes make that buzzing noise to warn people away. So, wouldn’t it be best to simply remove the rattle. And I guess the best way for that is to bite it off.

You simply can’t make this stuff up.

But snakebites are not always the result of some criminal activity. In fact, they rarely are. Most snakebites occur accidentally. Hunters and hikers know this all too well. As a kid growing up in Alabama, and stomping around in the woods on a daily basis, I knew snakes well. I knew which ones to avoid and which ones were harmless. A black racer was scary and fast, but harmless. Stumble on a rattlesnake or a copperhead and that’s a different story. And until you’ve seen a water moccasin, or as we call them cottonmouth, you haven’t seen an evil looking serpent. These guys are thick, dark, and prehistoric looking. And very dangerous. Yes, they can bite you in the water. So before you jump into that swimming hole deep in the woods, you better make some noise and shake up the water runoff any cottonmouth might be around.

But other people are bitten while they are handling snakes. I don’t mean just biologist or herpetologist, those that study these creatures, but also those who use them in religious ceremonies. You might think that snake handling is a thing of the past and something that is only found in the South, but that’s not true. There are still several snake handling churches from coast-to-coast. Even though in many locations snake owning and handling is not legal, the laws get shaky when it’s under the guise of religion.

Their justifications come from Mark 16:17-18

“And these signs shall follow them that believe; In my name shall they cast out devils; they shall speak with new tongues; They shall take up serpents; and if they drink any deadly thing, it shall not hurt them; they shall lay hands on the sick, and they shall recover.”

Snake handling in churches is often traced back to 1910 when George Went Hensley began incorporating them into his services at his Church of God with Signs Following. Many others have followed in his footsteps. And many have been bitten such as John Wayne “Punkin” Brown and Jamie Coots, whose son Cody was also bitten while preaching but saved when friends defied the church dictates and got him medical treatment.

For the most part, medical treatment is not offered in the circumstances because it is felt that it’s up to the Lord whether the preacher survives or not. After all, it is religion and the Lord can save you then what’s the point? Not to mention, that many of these groups feel that sipping strychnine is also good for you and will prevent you from dying if you are bitten by a snake. Yeah, that makes good medical sense. Add another poison to the poison authority in your system.

I use much of this in my third Samantha Cody book, Original Sin. One of the bad guys in this story is a snake-handling preacher. During my research for this book, I stumbled across a wonderful book titled Salvation on Sand Mountain. Sand Mountain is maybe 30 or 40 miles from where I grew up so obviously the title intrigued me. Once I got the book and began reading it I discovered it was wonderfully written and then discovered that it was nominated for a National Book Award. It is written by Dennis Covington and is the story of Glenn Summerford, a snake-handling preacher who attempted to kill his wife with a snake.

 

From ORIGINAL SIN:

“I knew you’d come back to us,” John Scully said as Lucy and Sam walked into the church. He and Miriam were standing near the pulpit. 

“Back?” Lucy said. 

“Back to the church.”

“That implies I was ever here.”

“You were,” Miriam said. “From the moment you breathed your first breath.”

“You’re not making sense.”

Scully smiled. “You have always been a part of us. Martha and your parents saw to that.”

Lucy glanced toward Sam. “Am I missing something here?”

“Doesn’t make sense to me either,” Sam said.

“You were baptized into the church when you were only days old.”

“No offense, but I don’t remember that. And no one ever bothered to tell me.”

“But deep inside you know it’s true,” Scully said.

“I don’t think so.”

Felicia walked in, carrying a wooden box. She placed it on a table to Scully’s left. The unmistakable buzzing of snakes rose from the box. Scully raised the lid and casually removed a fat rattlesnake. Its buzzing now adopted an angry tone.

Lucy and Sam each took a step back. 

“I don’t think that’s a good idea,” Sam said.

“Don’t worry. I’m immune to the poison.”

“I’m more worried about me and Lucy,” Sam said.

“He’s been bitten a dozen times,” Miriam said. “His faith protects him.”

“That and a little strychnine,” Scully said.

“Strychnine?” Lucy asked. Her attention never drifted from the snake that now waved its head around as if looking for a suitable target. She felt perspiration gather along her back as her heart rate clicked up a notch. God, she hated snakes.

“A little sip neutralizes the poison,” Miriam said.

“I must have missed that day in med school,” Lucy said.

Miriam offered a maternal smile. “Can’t learn everything from man’s books. Only from the word of the Lord.”

The snake coiled around Scully’s arm, head raised. Lucy felt as if it was watching her. She took another half step back, Actually, she wanted to run out the door, but fought the impulse.

“Why snakes?” Sam asked. “What do they have to do with Jesus?”

Lucy knew Sam was playing cop now. Ty and Bump had told them about Scully’s insane beliefs. And Sam had told her that Gladys Johnston had said the same thing. Sam was merely asking questions she already knew the answer to. Seeing if Scully changed his story in any way. 

Now it was Scully’s turn to offer a paternal smile. It faded and his gaze seemed to glaze over. He spoke.

And he said unto them, Go ye into all the world, and preach the gospel to every creature.

He that believeth and is baptized shall be saved; but he that believeth not shall be damned.

And these signs shall follow them that believe; In my name shall they cast out devils; they shall speak with new tongues;

They shall take up serpents; and if they drink any deadly thing, it shall not hurt them; they shall lay hands on the sick, and they shall recover.

So then after the Lord had spoken unto them, he was received up into heaven, and sat on the right hand of God.

And they went forth, and preached everywhere, the Lord working with them, and confirming the word with signs following. Amen.

The quote Sam had shown her. The one Scully had written on the back of a menu.

“Mark Sixteen,” Felicia said.

“I’m afraid I don’t understand,” Sam said. “This is the scripture that tells you to play with snakes?”

Scully gaze hardened. “It’s not play. But you wouldn’t understand.”

 

LINKS:

https://www.mystatesman.com/news/local/police-caldwell-county-man-uses-rattlesnake-neighbor-dispute/NUFO8d5JNM4ggWDdliKS2I/

Snake Handling In Religion Wikipedia: https://en.wikipedia.org/wiki/Snake_handling_in_religion

Snake Handling Churches: http://www.cerm.info/bible_studies/Apologetics/snake_handlers.htm

Church of God With Signs Following: https://en.wikipedia.org/wiki/Church_of_God_with_Signs_Following

George Went Hensley—the First Snake Handler?: https://en.wikipedia.org/wiki/George_Went_Hensley

Punkin Brown: http://www.hiddenmysteries.org/religion/pentecostal/snakeskill-fool.shtml

Jamie Coots Wikipedia: https://en.wikipedia.org/wiki/Jamie_Coots

Cost Coots: https://www.dailymail.co.uk/news/article-6070685/Snake-preacher-gets-bitten-four-years-father-killed-rattlesnake.html

Salvation on Sand Mountain: https://www.amazon.com/Salvation-Sand-Mountain-Snake-Handling-Redemption/dp/0140254587?_encoding=UTF8&redirect=true

Original Sin: http://www.dplylemd.com/book-details/original-sin.html

 

Cancer Isn’t a Modern Disease

What is cancer? You know the term and odds are great that you know someone personally who has suffered from a member of this constellation of diseases. But what exactly is it?

Cancer is basically a genetic disease in that something changes in the DNA inside certain cells and this, in turn, disrupts their normal functions. These changes might result in uncontrolled growth and this can cause problems simply by the tumor’s size and location. The cancerous tissues might obstruct a bowel or a bile duct, or compress brain cells and increase the pressure inside the cranium, or erode into nearby organs of blood vessels. Others changes within these cells might alter their internal workings so that they no longer function as intended or they might produce chemicals or hormones that alter the function of other cells within the body. Cancer comes in many forms.

What causes cancer? This has been the subject of debate, as well as a tremendous amount of research, for many many years. We have some answers, but there are even more questions. We know that things such as cigarette smoking, exposure to the sun, certain chemicals, and many other things can trigger these genetic changes within cells that can lead to cancers of various types.

Medicine has made tremendous strides in our understanding of cancer and in our methods of early detection, diagnosis, and treatment. There are programs for the early detection of breast and colon cancer and newer treatment protocols have revolutionized the approach to these malignancies. The progress in leukemia and lymphoma treatment, as compared to when I was in medical school, has been nothing short of astounding. 

We often think of cancer as a modern scourge, but cancer is not a new disease. Not by a long shot. It’s been around for many centuries. Evidence for cancers have been found in Egyptian mummies and a recent report from Live Science underscores that.

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