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Category Archives: Trauma

Would Lincoln Have Survived With Modern Medical Treatment?

Lincoln 1863

Lincoln’s assassination took place 150 years ago this evening. He died the next day, April 15, 1865. Since he lived overnight, could modern medicine techniques have saved him? Here is a question that appeared in my second Q&A book—FORENSICS AND FICTION

Would Abraham Lincoln Have Survived His Injuries Today?

Q: This is a pure curiosity question. Do you think that Lincoln could have been saved if they had today’s medical knowledge, techniques and equipment in 1864?

Martha Kuhn, Mt. Gilead, Ohio

A: Most likely, yes. He was shot in the back of his head, and the bullet apparently entered his brain. He lived for many hours so the shot was not immediately fatal. A surgeon probed the wound but feared removing the bullet, since it might cause bleeding. He probably should have, but we’ll never know.

Similar wounds today are treated by a trip to the OR, removal of the bullet, controlling bleeding, and preventing any subsequent infection. He would have had at least a 50 percent chance of survival. And since he survived several hours anyway his survival with modern techniques would likely have been much higher.

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Posted by on April 14, 2015 in Medical History, Medical Issues, Trauma

 

Q and A: Can DNA Be Used To Identify Multiple Assailants In a Three Decade Old Rape?

Q: Was it possible in 1969 (or even today for that matter) to determine if a woman found dead in sub-zero temperatures was raped by more than one assailant. If so, how could this be accomplished? Could a pathologist conclude that the woman was raped, as opposed to consensual intercourse, even if there is an absence of physical evidence such as bruising? What language would the pathologist employ when writing his conclusions?  Could evidence from 1969 be preserved (how would it be preserved?) and used today to identified suspects through DNA testing?

D3

A: DNA for testing comes from the genetic material found in the nuclei of the body’s cells. Essentially every cell in the body contains a nucleus. The notable exception is the Red Blood Cells (RBCs), which do not contain nuclei. But, White Blood Cells (WBCs) do. DNA testing of blood tests the DNA found in the nuclei of the WBCs.

Adequate DNA samples for testing have been gleaned from semen stains, bite marks, sweat, sputum, hair, and saliva. Even from the saliva left behind by licking a stamp or sealing an envelope. In the case of saliva from stamps or bites, the DNA tested comes from the cells that line the mouth (called buccal cells), which are constantly shed into the saliva. Hair does not contain cells and thus no DNA, but hair follicles do. A single hair follicle may yield enough DNA for testing.

As you can see, very small samples might be enough.

DNA is a fairly hardy molecule and survives time, freezing, drying, mixing with other materials, and many other adverse circumstances. It does not survive heating, however. Heat denatures, or destroys, the DNA strands. It is important to note that DNA testing does not require intact cells, merely intact DNA. This means that clotted blood, dried semen, and tissue fragments found under victims’ fingernails might yield enough DNA for conclusive testing.

The sub-zero temperatures in your scenario would serve to protect the DNA and would thus help the coroner by preserving better samples for his evaluation.

Yes, he would be able to determine that there had been two assailants, since each would have his own distinctive DNA pattern. The finding of two different DNA patterns in the semen sample obtained from the victim would prove this and when the suspects were apprehended, each could be matched to his own contribution to that sample. Mixing the semen would not alter this finding in any way since each DNA strand would be unchanged. It’s not like mixing blue paint with yellow paint to make green paint but rather like mixing a bunch of tiny blue beads with tiny yellow beads. From a distance, they might appear as though they had melted together to form a green mixture, but on close examination, each tiny bead would be seen to have remained intact and separate. DNA strands don’t “melt” into one another.

DNA can last for years, decades, even centuries. It has been found in Egyptian mummies, exhumed bodies, and samples stored from very old crimes. Recently, DNA evidence linked Gary Leon Ridgway to the famous string of prostitute murders know as the Green River Murders in Washington State. The DNA evidence connected him to murders that occurred in the early 1980s. This was possible because the DNA was handled and stored properly. Typically, the sample is dried and placed in a non-reactive container such as a glass vial.

The problem of determining if a rape occurred is a question for the jury. Rape is not a medical term, but rather a legal term. The coroner could determine if penetration occurred and if semen was present. If he found trauma to the vagina or to other body parts that might suggest the victim was struck or restrained, he might conclude that in his opinion the intercourse was not consensual. Still, it would require a judge or a jury to determine whether a rape occurred or not.

Published in Suspense Magazine December, 2014

 

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

Q: My story takes place in a wagon train in the late 1800’s. My character is dragged by a horse while crossing a river. He hits rocks and is bounced off the back wheel of a wagon. Of course the horse’s hooves do damage as well. Three days later he dies from massive bleeding from his internal injuries. This three day delay followed by the sudden loss of blood is important to the story’s timing, but is it realistic?

wagon_train-2

A: The answer to your question is yes.

This type of accident could, as you can imagine, result in all types of injuries. Broken bones, skull fractures, neck fractures, cracked ribs, punctured lungs, and intra-abdominal injuries (injuries inside the abdominal cavity). This last type of injury might serve you well.

A ruptured spleen or lacerated liver or fractured kidney would bleed into the abdominal cavity. Death could be quick or take days if the bleed was slow. There would be great pain, especially with movement or breathing, and the abdomen would swell. Also a bluish, bruise like discoloration could appear around the umbilicus (belly button) and along the flanks. This usually takes 24 to 48 hours or more to appear. This occurs as the blood seeps between the “fascial planes.” The fascia are the tough white tissues that separate muscles from one another. The blood seeps along these divisions and reaches the deeper layers of the skin causing the discoloration. But, these injuries wouldn’t lead to external bleeding since the blood has no exit from the abdominal cavity.

However, if the injury was to the bowel, then external bleeding could occur. For blood to pass from the bowel, the bleeding would have to be within the bowel itself and not just in the abdomen somewhere. If the bowel were ruptured or torn so that bleeding occurred within the bowel, the blood would flow out rectally. But, blood in the bowel acts like a laxative so the bleeding would likely occur almost immediately and continue off and on until death, which in this situation would be minutes to hours to a day, two at the most. It would be less realistic for the bleeding to wait three days before appearing in this case. With one exception.

The bowel could bruised and not ruptured or torn, and a hematoma (blood mass or clot) could form in the bowel wall. As the hematoma expanded it could compromise the blood supply to that section of the bowel. Over a day or two the bowel segment might die. We call this an “ischemic bowel.” Ischemia is a term that means interruption of blood flow to an organ. If the bowel segment dies, bleeding would follow. This could allow a 3 day delay in the appearance of blood.

In your scenario, the injuries would likely be multiple and so abdominal swelling, the discolorations I described, great pain, fevers, chills, even delirium toward the end, and finally bleeding could all occur. Not a pleasant way to die, but I would imagine this happened not infrequently in frontier days.

The victim would be placed in the bed of one of the wagons and comforted as best they could. He might be sponged with water to ease his fevers, offered water or soup, which he would likely vomit, and prayers would be said. They could have tincture of opium (a liquid) available and give him some. This would lessen the pain since it is a narcotic and would also slow the motility (movement) of the bowel and thus lessen the pain and maybe the bleeding.

Of course, during the time period of your story, your characters wouldn’t know any of the internal workings of the injury as I have described. They would only know that he was severely injured and in danger of dying. Some members of the wagon train may have seen similar injuries in the past and may know just how serious the victim’s condition is, but they wouldn’t understand the physiology behind it. They might even believe that after he survived the first two days that he was going live and then be very shocked when he eventually bleed to death. Or they might understand that the bouncing of the wagon over the rough terrain was not only painful but also dangerous for someone in his condition. They train may be halted for the three days he lived or several wagons might stay behind to tend to him while the rest of the column moved on.

 

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

Gold Bowl

 

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

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

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

 

Remains of the citadel of Hasanlu

Remains of the citadel of Hasanlu

 

DP Lyle on Investigation Discovery’s Deadly Affairs

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

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

Details:

Program: Deadly Affairs

Episode Title: Swan Song

Air Date: August 23, 2014

Air Time: 9pm EDT/8pm CDT

Channel: Investigation Discovery (ID) 

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

 
 

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

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

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

 

CYRIL-WECHT

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

LINKS:

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

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

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

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

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

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

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

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

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

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

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

 

Final-Exams

 

 

 

 

 

Joseph Rivera: The New Andrew Luster?

Joseph Rivera

Joseph Rivera

 

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

 

Andrew Luster

Andrew Luster

 

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

 
 
 
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