by Murder
With a transection (cutting) of the spinal cord, all the body's muscles would immediately become flaccid (limp), and the victim would drop to the floor. He would be unable to speak or breathe because the nerves to the diaphragm, which arise from C3 through C5, would be interrupted. Also, with the loss of enervation to the
body, the blood vessels would rapidly dilate (open up), causing the blood pressure to drop, and shock, unconsciousness, and death would follow.
Would the victim be conscious for a few seconds? Possibly, but he would be as flaccid as a scarecrow, unable to move, speak, breathe, or cry for help. Death would be as immediate as it could be.
What Are the Most Lethal Wounds That Can Be Made with a Knife?
Q: In my story, a right-handed murderer with a very sharp six-inch blade kills a man with one "slice." I know that it's possible for the victim to go into shock and die right away. What I don't know is what the knife has to cut in order to get that result. What would the coroner's report say was the cause of death?
A: I assume from your question that you want the victim to die fairly quickly. There are several possibilities.
A professional assassin can maneuver a blade between the cervical vertebrae (neck bones) and slice the spinal cord in one movement. Usually the attack comes from behind. The assassin slaps a hand over the victim's mouth and thrusts the blade into the back of the neck, slipping it between the bones. The victim goes limp, falls, and dies almost instantly.
From a similar position the killer can draw the blade across the victim's neck, cutting through the carotid arteries and the trachea (Figure 13). Since the carotid arteries supply blood to the brain, the victim dies quickly, and the cutting of the trachea below the vocal cords prevents the victim from crying out. This is what happened to Nicole Brown Simpson.
A thrusting stab wound to the heart is lethal most of the time and fairly quick. The same can be said for the lungs if a major
artery is severed. But people often survive stab wounds to the chest and even the heart, and would, of course, be able to call for help.
A slashing or stabbing wound to the abdomen might work if the aorta or vena cava was sliced. The problem is that both lie along the back of the abdomen, and a six-inch blade might not reach them. It could, though, if the attacker was strong, thrust the knife deeply, and then made a sweeping motion with the blade. Death would take several minutes since it would require the victim to bleed to death.
The cervical spinal cord cut, the throat slashing, or the stab to the heart are the most effective ways and have the highest likelihood of killing the victim.
The coroner or M.E. would be able to determine the cause of
death without difficulty. The cervical cut would be called "transection of the spinal cord at the cervical level." The throat slashing would be termed "transection of the carotid arteries." The stab to the heart would lead to blood filling the pericardium (the sac around the heart), which would compress the heart and interfere with its function. This would be called "death due to pericardial tamponade secondary to a penetrating knife wound." The abdominal stab would result in "death due to exsanguination secondary to a penetrating abdominal knife wound with perforation of the aorta" or vena cava or both.
Gruesome, huh?
What Stractures Must Be Injured to Make a Stab Wound to the Back Lethal?
Q: The scenario is for the sleuth to go into the office and find her boss dying with a letter opener lodged in his back.
Is there an artery in or near the lungs? If a victim is stabbed in the back and this artery is hit, would he then literally drown in his own blood? Would the victim be able to speak and give the sleuth the inevitable cryptic clue? If no artery is hit, would the stab wound in one lung be enough to kill him?
A: Let's review a little anatomy and physiology first. Our lungs are designed for gas exchange. This is simply the loading of oxygen into the blood and the removing of carbon dioxide and other toxins from the blood. To do this, the blood and the air must come into close contact with each another. The lungs allow this to happen by having billions of microscopic air sacs and billions of tiny blood vessels that surround these sacs.
The basic circulation system of the body is divided into the systemic and the pulmonary circuits (Figure 14). The systemic circuit is the left ventricle pumping blood out the aorta and into the various arteries of the body, ultimately reaching every organ and nook and cranny, and then the blood's return via the veins to the right side of the heart. The pulmonary circuit is the right ventricle pumping this blood into the pulmonary arteries, which continually divide into smaller and smaller vessels and spread to all parts of the lungs like a fan. After the blood collects oxygen, it flows through the pulmonary veins into the left side of the heart and the left ventricle.
This points out two facts important to your question: First, the entire volume of blood in the body flows through the pulmonary circuit continuously. This is necessary since the lungs are the only means available to load vital oxygen into the blood. Second, the lungs, like every other organ in the body, receive a portion of the systemic blood flow. This is the oxygenated arterial blood that keeps the lung tissue itself alive. Thus, the organs known as lungs are extremely vascular (loaded with blood vessels—arteries, veins, and capillaries) and bleed profusely when injured (Figure 15).
Now back to your question. A penetrating wound to the lung as occurs in stabbings and gunshots would result in bleeding into the lung and then out the mouth and nose. The blood coming from these orifices would be bright red and frothy since it is mixed with the air flowing in and out of the lungs as the victim struggles for breath. As the lungs fill with blood, the victim would literally drown in his own blood. The injured lung may or may not collapse, which would only add to the victim's struggle to breathe.
The victim would be able to speak as long as he could move air in and out of his lungs, so he would be able to give the sleuth the telltale clue. If the sleuth was savvy, he might roll the victim onto the side of the injury, using gravity as an ally.
For example, if the victim was stabbed in the left lung and lay on his right side, the blood from the injured left lung would follow the dictates of gravity and flow from the left bronchus (the main airway off the trachea to the left lung) into the right bronchus and then into the right lung. Thus, the "good" lung would fill with blood, and the victim would now have both lungs in trouble and would die more quickly. If your sleuth rolled him onto his left side, gravity would tend to keep the blood in the already injured left lung, and the uninjured right lung would not fill with blood and would continue to function normally. This maneuver might
save the victim's life or at least prolong his life so that the needed clue could be obtained.
What Noises Are Made by Victims of Stabbings or Gunshots to the Neck?
Q: My character needs to walk by a room with an open door and be drawn in by a hissing or gurgling noise to find a corpse. Would this type of noise occur if the vic-
tim was shot in the neck? How long might the noises continue after shooting?
A; The short answer is yes.
A gunshot wound (GSW) or any other type of penetrating wound (knife, arrow, ax, machete, and so forth) could produce these sounds if and only if the wound was in the lung itself or one of its airways. The sounds you describe require air moving through a liquid such as blood. Think of a bellows being pumped into a thick liquid, which is exactly what is occurring.
Drowning victims and persons suffering pulmonary edema (literally, lungs filled with water) from heart failure or toxic exposure (such as chlorine or another irritative gas) or certain other processes sound the same way. Again, the sound is that of air bubbling through a liquid regardless of the underlying cause.
A GSW or stab wound to the throat or through the chest into the lung could produce this. Blood would flood the airways (trachea and bronchial tubes), and the movement of air in and out as the victim attempted to breathe would produce a bubbling or gurgling sound. Obv
iously, these sounds would require that the victim still be alive and trying to breathe when the person walked by the room. He might hear the victim's last breaths and then would find a corpse.
The time lapse from wound to death is extremely variable and depends on the nature, location, and depth of the wound plus the age, fitness, and health of the victim, with the former factors being more important than the latter. This gives you free rein to have the victim die in minutes or hours after the injury.
Can Someone Who Has Been Stabbed in the Neck Speak?
Q: Is it possible for someone shot or stabbed in the neck to utter a few intelligible words before expiring?
A: Yes, unless the larynx (voice box) or vocal cords are damaged or the trachea is severed below the larynx or vocal cords. The larynx is the Adam's apple, and the vocal cords stretch across the airway inside the larynx. Sound requires that air move between the cords in sufficient volume and velocity to vibrate them and thus produce sound. If the cords are severely damaged, this may not be possible.
Also, if the trachea is severed below the vocal cords, air exhaled from the lungs exits through the wound, and not enough would reach the cords to produce vibrations and thus sound (Figure 16). People who have had trauma to the larynx or have severe lung disease that requires a permanent tracheotomy (hole cut into the tra-
chea just below the larynx) have to plug the tracheotomy hole in order to speak. Otherwise the air escapes through the hole and never passes through the vocal cords. This is a similar situation to the wound described above.
If the vocal cords and the trachea remain intact, noises and speech would be possible—bubbly, wet, raspy, but still speech.
Where Would an Intoxicated Person Have to Be Shot to Put Him in a Coma for Two Days?
Q: My evil villain is going to shoot someone who is blotto drunk and passed out. Not being a professional killer, he shoots the guy and, thinking he must be dead, leaves the scene.
The questions are these: If he was not found for several hours, could he still be alive and yet remain unconscious for a day or two? If so, in what part of his body would he have to be shot?
A: The scenario you lay out could happen. The two-day period of unconsciousness could not be from the alcohol since it is rapidly metabolized (broken down) by the body, and the victim would wake up after a few hours. If he took in enough alcohol to put him out for two days, he would die in short order from the depressive effects of that much ethanol intake.
Gunshot wounds (GSWs) to most of the body would not lead to a two-day coma. A GSW to the head could. The bullet could enter the skull and damage the brain (which would lead to surgery, a long convalescence, and so forth), or it could simply penetrate the scalp and cause a concussion with or without a fracture of the skull bone (cranium). The concussion could cause a period of unconsciousness, disorientation, confusion, and amnesia, or any combination of these as fits your story.
This type of concussive injury could lead to two days of coma or, more likely, a few hours of coma, and then over the next two days the victim could pass from somnolence (sleepiness and difficulty in arousing) to confusion and disorientation, to periods of wakefulness and progressive lucidity, to being fully awake with intact memory, absolutely no memory of the events, or spotty memory. His amnesia could even be retrograde, which means he would have no memory of events prior to his GSW. This retrograde amnesia could extend back for only a few minutes, a few hours, or, in extreme cases, forever.
I think this type of GSW makes the most sense for your scenario and is entirely plausible. Have the bullet either burrow beneath the scalp—in which case the surgeon could remove it under local anesthesia—or bounce off the skull and exit the scalp entirely. When he is found unconscious, he would be taken to the hospital emergency department, where an ER physician and a surgeon would care for him.
X rays would easily determine if the skull was fractured or not, if the bullet entered the brain cavity or not, or if any bullet fragments were left behind within the scalp after the bullet exited. If the bullet did not enter the brain cavity or fracture the skull, the surgeon would remove the bullet and any bullet fragments, clean and dress the wound, and likely place a surgical drain (a short piece of soft rubber tubing) into the wound to allow drainage of body fluids from the injured area. This lessens the incidence of infection. Closing such "dirty wounds" with sutures would allow collection of these bodily fluids within the wound. These fluids make a good culture medium and would promote the growth of infectious bacteria.
The victim would remain in the hospital for several days and receive intravenous antibiotics. At least twice a day the wound would be examined for signs of infection (redness, swelling, pain, pus formation), cleaned, and a fresh dressing applied. After several days the drain would be removed. The concussion would resolve, and the victim would be essentially normal again.
How Did David Kill Goliath?
Q: I have an interesting question for you. It regards the combat between David and Goliath. Other than the Old Testament, there are no historical accounts of which I am aware. I hope you can help me get the medical details of the combat exactly right. Apparently the rock that David slung did not kill Goliath but only stunned him enough to drop him to the ground, allowing the boy time to separate his head from his neck. The tantalizing single detail is that the rock sunk into his forehead (not his temple). The reference is 1 Samuel 17:48—51. What specifically happened to Goliath from just before the stone landed until just after the neck was severed?
A: Great question.
From the description of the brief combat in 1 Samuel, the rock was embedded in Goliath's forehead, and he "fell upon his face to the Earth." A rock to the head can be merely painful or it can kill. Somewhere in between these results, it can cause a concussion, which like a left hook in boxing can stun the recipient or render him unconscious.
Typically, an object such as a rock would cause "blunt force trauma" and not "penetrating trauma," as with a bullet. A blunt force injury to the head may or may not fracture the skull; may or may not cause unconsciousness; may or may not cause bleeding within the brain; and may or may not kill.
A penetrating head wound, by definition, means that the object breached, or penetrated, the skull. This is a more serious injury since the brain itself is traumatized directly by the object. Such penetrating wounds fracture the skull, but they may or may not
cause unconsciousness; may or may not cause bleeding into the brain; and may or may not kill.
The rule here is that whatever happens, happens. I once saw a man injured in an industrial accident where a metal disk flew out of a grinding machine and struck him in the forehead. He was knocked out, but only briefly. When he reached the hospital, the disk protruded from his forehead as if some miniature flying saucer had attacked him. On further exam I found that the disk's leading edge had penetrated his skull and embedded in his brain. He was awake, alert, and neurologically normal. A neurosurgeon removed the disk and he did well, with no residual problems. Could he have died instantly? Yes. Could he have bled into his brain and required more extensive surgery or died from this complication? Yes. Could he have suffered permanent brain damage? Yes. The point is that none of these happened. Whatever happens, happens.
Now back to David and Goliath. In 1 Samuel 17: 4 it states that Goliath possessed a height of "six cubits and a span." Many experts feel that a cubit was roughly 17 inches, while a span was approximately 9 inches, which means Goliath was over 9 feet tall. If this story is true and not merely a parable, Goliath most likely suffered from both gigantism and acromegaly. These conditions are typically caused by tumors of the pituitary gland, which secrete excess amounts of growth hormone (GH). GH causes lengthening and thickening of bones and muscles. Before puberty and the closing of the epiphyses (growth plates) in the bones, persons so affected grow very tall and have long arms and legs. After the epiphyses close, bones no longer can grow lengthwise, but under the continued influence of excess GH, they grow thick. This
is particularly true of the hands, feet, jaw, and forehead. Acromegalics have thick hands and fingers, square, shovel-like jaws, and thick, protruding foreheads that seem to cantilever over their eyes. Remember Andre the Giant, the professional wrestler? He is a perfect example. Like Andre, Goliath must have developed a GH-producing pituitary tumor at an early age, and grown very tall, and then in his teens and twenties the continued excess of GH made him muscular and thick-boned.
If Goliath did suffer from acromegaly, it is likely that David's stone embedded in the flesh of the giant's forehead but did not penetrate the skull. In other words, a blunt force injury. Goliath was stunned or rendered unconscious by the concussive blow, and death came when David severed his spinal cord with his sword. In France this type of death was served up by the guillotine.
Of course, if David hurled the stone with enough velocity (with or without the aid of a divine hand), the missile could have penetrated the skull, resulting in a penetrating head wound. Death could have come from this or from the later beheading.
The passages that cover the battle are somewhat confusing. Verse 50 says, "David prevailed over the Philistine with a sling and with a stone, and smote the Philistine, and slew him." Verse 51 says, "David ran and stood upon the Philistine, and took his sword, and drew it out of the sheath thereof, and slew him." Did he slay him with the stone or the sword? Did he merely "prevail" over Goliath with the stone and then slay him with the sword?
I would suspect that David knocked Goliath unconscious, or nearly so, with a blunt force injury from the stone, which embedded in the flesh of Goliath's forehead but did not penetrate his skull, and then David finished him with the beheading. But I could be wrong.
POISONS AND DRUGS
Is There a Drug or Poison That Mimics Death but Allows the Victim to Survive?
Q: Is there a drug that truly mimics death to the point that a not-so-careful physician might pronounce death and then leave, after which the victim recovers? If so, how would the drug be administered, how long would the effects last, and is there an antidote?