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.
We are so honored to bring you ex-criminal prosecutor and current bestselling author Marcia Clark. She joins us to talk about her latest book, TRIAL BY AMBUSH, her first True Crime novel.
Marcia Clark is the best selling author of nine legal thrillers and one memoir, starting with four bestselling legal thrillers featuring prosecutor Rachel Knight: The Competition, Killer Ambition, Guilt by Degrees, and Guilt by Association. TNT optioned the books for a one-hour drama series and shot the pilot, which starred Julia Stiles as Rachel Knight.
Her most recent series features criminal defense attorney Samantha Brinkman and includes Blood Defense, Moral Defense, Snap Judgment, and Final Judgment. Marcia's latest thriller, released in September 2022, The Fall Girl, was a standalone featuring two leads with alternating chapters. Marcia narrated the audiobook along with TV writing partner, Catherine LePard.
SHOW NOTES:
FORENSIC
SCIENCE TIMELINE
Prehistory: Early cave
artists and pot makers "sign" their works with a paint or impressed finger or
thumbprint.
1000 b.c.: Chinese use
fingerprints to "sign" legal documents.
3rd century BC.:
Erasistratus (c. 304-250 b.c.) and Herophilus (c. 335-280 b.c.) perform the
first autopsies in Alexandria.
2nd century AD.: Galen
(131-200 a.d.), physician to Roman gladiators, dissects both animal and humans
to search for the causes of disease.
c. 1000: Roman attorney
Quintilian shows that a bloody handprint was intended to frame a blind man for
his mother's murder.
1194: King Richard
Plantagenet (1157-1199) officially creates the position of coroner.
1200s: First forensic
autopsies are done at the University of Bologna.
1247: Sung Tz'u publishes
Hsi Yuan Lu (The Washing Away of Wrongs), the first forensic text.
c. 1348-1350: Pope Clement
VI(1291-1352) orders autopsies on victims of the Black Death to hopefully find
a cause for the plague.
Late 1400s: Medical
schools are established in Padua and Bologna.
1500s: Ambroise Paré
(1510-1590) writes extensively on the anatomy of war and homicidal wounds.
1642: University of
Leipzig offers the first courses in forensic medicine.
1683: Antony van
Leeuwenhoek (1632-1723) employs a microscope to first see living bacteria,
which he calls animalcules.
Late 1600s: Giovanni
Morgagni (1682-1771) first correlates autopsy findings to various diseases.
1685: Marcello Malpighi
first recognizes fingerprint patterns and uses the terms loops and whorls.
1775: Paul Revere
recognizes dentures he had made for his friend Dr. Joseph Warren and thus
identifies the doctor's body in a mass grave at Bunker Hill.
1775: Carl Wilhelm Scheele
(1742-1786) develops the first test for arsenic.
1784: In what is perhaps
the first ballistic comparison, John Toms is convicted of murder based on the
match of paper wadding removed from the victim's wound with paper found in
Tom's pocket.
1787: Johann Metzger
develops a method for isolating arsenic.
c. 1800: Franz Joseph Gall
(1758-1828) develops the field of phrenology.
1806: Valentine Rose
recovers arsenic from a human body.
1813: Mathieu Joseph
Bonaventure Orfila (1787-1853) publishes Traité des poisons (Treatise on
Poison), the first toxicology textbook.
1821: Sevillas isolates
arsenic from human stomach contents and urine, giving birth to the field of
forensic toxicology.
1823: Johannes Purkinje
(1787-1869) devises the first crude fingerprint classification system.
1835: Henry Goddard
(1866-1957) matches two bullets to show they came from the same bullet mould.
1836: Alfred Swaine Taylor
(1806-1880) develops first test for arsenic in human tissue.
1836: James Marsh
(1794-1846) develops a sensitive test for arsenic (Marsh test).
1853: Ludwig Teichmann
(1823-1895) develops the hematin test to test blood for the presence of the
characteristic rhomboid crystals.
1858: In Bengal, India,
Sir William Herschel (1833-1917) requires natives sign contracts with a hand
imprint and shows that fingerprints did not change over a fifty-year period.
1862: Izaak van Deen
(1804-1869) develops the guaiac test for blood.
1863: Christian Friedrich
Schönbein (1799-1868) develops the hydrogen peroxide test for blood.
1868: Friedrich Miescher
(1844-1895) discovers DNA.
1875: Wilhelm Konrad
Röntgen (1845-1923) discovers X-rays.
1876: Cesare Lombroso
(1835-1909) publishes The Criminal Man, which states that criminals can be
identified and classified by their physical characteristics.
1877: Medical examiner
system is established in Massachusetts.
1880: Henry Faulds
(1843-1930) shows that powder dusting will expose latent fingerprints.
1882: Alphonse Bertillon
(1853-1914) develops his anthropometric identification system.
1883: Mark Twain
(1835-1910) employs fingerprint identification in his books Life on the
Mississippi and The Tragedy of Pudd'nhead Wilson (1893- 1894).
1887: In Sir Arthur Conan
Doyle's first Sherlock Holmes novel, A Study in Scarlet, Holmes develops a
chemical to determine whether a stain was blood or not-something that had not
yet been done in a real-life investigation.
1889: Alexandre Lacassagne
(1843-1924) shows that marks on bullets could be matched to those within a
rifled gun barrel.
1892: Sir Francis Galton
(1822-1911) publishes his classic textbook Finger Prints.
1892: In Argentina, Juan
Vucetich (1858-1925) devises a usable fingerprint classification system.
1892: In Argentina,
Francisca Rojas becomes the first person charged with a crime on fingerprint
evidence.
1898: Paul Jeserich
(1854-1927) uses a microscope for ballistic comparison.
1899: Sir Edward Richard
Henry (1850-1931) devises a fingerprint classification system that is the basis
for those used in Britain and America today.
1901: Karl Landsteiner
(1868-1943) delineates the ABO blood typing system.
1901: Paul Uhlenhuth
(1870-1957) devises a method to distinguish between human and animal blood.
1901: Sir Edward Richard
Henry becomes head of Scotland Yard and adopts a fingerprint identification
system in place of anthropometry.
1902: Harry Jackson
becomes the first person in England to be convicted by fingerprint evidence.
1910: Edmund Locard
(1877-1966) opens the first forensic laboratory in Lyon, France.
1910: Thomas Jennings
becomes the first U.S. citizen convicted of a crime by use of fingerprints.
1915: Leone Lattes
(1887-1954) develops a method for ABO typing dried bloodstains.
1920: The Sacco and
Vanzetti case brings ballistics to the public's attention. The case highlights
the value of the newly developed comparison microscope.
1923: Los Angeles Police
Chief August Vollmer (1876-1955) establishes the first forensic laboratory.
1929: The ballistic
analyses used to solve the famous St. Valentine's Day Massacre in Chicago lead
to the establishment of the Scientific Crime Detection Laboratory (SCDL), the
first independent crime lab, at Northwestern University.
1932: FBI's forensic
laboratory is established.
1953: James Watson (1928-
), Francis Crick (1916-2004), and Maurice Wilkins (1916-2004) identify DNA's
double-helical structure.
1954: Indiana State Police
Captain R.F. Borkenstein develops the breathalyzer.
1971: William Bass
establishes the Body Farm at the University of Tennessee in Knoxville.
1974: Detection of gunshot
residue by SEM/EDS is developed.
1977: FBI institutes the
Automated Fingerprint Identification System (AFIS).
1984: Sir Alec Jeffreys
(1950- ) develops the DNA "fingerprint" technique.
1987: In England, Colin
Pitchfork becomes the first criminal identified by the use of DNA.
1987: First United States
use of DNA for a conviction in the Florida case of Tommy Lee Andrews.
1990: The Combined DNA
Index System (CODIS) is established.
1992: The polymerase chain
reaction (PCR) technique is introduced.
1994: The DNA analysis of
short tandem repeats (STRs) is introduced.
1996: Mitochondrial DNA is
first admitted into a U.S. court in Tennessee v. Ware.
1998: The National DNA
Index System (NDIS) becomes operational.
SHOW NOTES:
Writers, particularly early in their careers, make mistakes. Often the
same ones over and over. Here are a few pitfalls to avoid.
OVERWRITING:
Too many words
Too cute by far
Strained Metaphors
Purple prose
DIALOG:
Tag alert
Characters all sound the same
Inane conversations
"As you know" chatting
SHOW VS TELL:
DESCRIPTION:
Not too much
Not too little
Just enough-the telling details
SCENES:
In and Out quickly-in medias res
Leave question/tension at end
POV:
Stay in one at a time
Except Omniscient-hard to do
PACING:
Fast but not too fast
Vary pace
BACKSTORY:
How much?
When?
ENTERTAIN:
The one cardinal rule
SHOW NOTES:
It's hard to believe that it's been 50 years. Exactly 50 years.
This show has nothing to do with crime writing or the science of crime. It is rather a step back in world history. And in my personal history. Yes, I was there. Inside the gates of the Cape Canaveral Space Center. July 16, 1969, 9:32 a.m. I remember it like it was yesterday. Please indulge me and join me for this trip down memory lane.
The above picture is more or less the view I had of the launch. The sky was clear, the tension thick, and not a dry eye to be found.
SHOW NOTES:
A scene-by-scene analysis of The Terminator
Each scene is either good (+), Bad (-) or Neutral (0) for Sarah Conner, the protagonist.
Watch the movie and rate each scene. You will see that through the first 2/3s of the film things don't go well for Sarah but she overcomes seemingly insurmountable odds to win in the end.
This is how a good thriller is plotted.
The Terminator (1984)
T = The Terminator
R = Kyle Reese
S = Sarah Conner
SHOW NOTES:
Elements of a Thriller
Open with a Bang or a Chill or a Compelling Question
Establish the 4 Ws Early-------Who, What, When, and Where
Inciting Incident---Sets the protagonist's story in motion
Establish the Story Question-What does the Protagonist want/need?
Rising Tension
Who/What opposes the Protagonist and Why?
What does the antagonist want/need?
Establish a Time or Situation Endpoint
Scenes advance or obstruct the protagonist's attaining goal
Each power scene poses a question and ends with:
Yes------------------------------Weak
No-------------------------------Better
Yes, but------------------------Strong
No, and further more------------Strongest
Convergence of Space and Time-"Life in a Trash Compactor"
Epiphany---Protagonist grasps the solution
Personal Jeopardy---Protagonist must fear for personal safety
Mano a' Mano---Protagonist must confront antagonist "face to face"
Resolution---all major story questions are resolved
From Publishers Weekly:
In Lyle's ingenious third mystery featuring retired major league pitcher Jake Longly (after 2017's A-List), Jake, who runs a restaurant in Gulf Shores, Ala., is again roped into working for his father Ray's PI firm. An attorney has contacted Ray on behalf of Billy Wayne Baker, a convicted serial killer. Though Baker pleaded guilty to strangling seven women, he insists that he killed only five of them, and wants that assertion validated. When Jake meets Baker in prison, the murderer refuses to name the other killer, claiming that doing so would lead to accusations that Jake's inquiries were biased. The investigator's task is made even harder by Baker's not even identifying which of the dead women were killed by someone else . (To his credit, Lyle makes this complicated scenario credible.) Along with his girlfriend, Jake travels to Pine Key, Fla., the scene of three of the strangulations, where the couple pretend to be researching a documentary examining the impact of the killings on the small community. The clever plot twists will surprise even genre veterans. This entry is the best in the series so far.
SHOW NOTES:
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 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 gun shot 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 imbed 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 top 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
recovery fully.
The bullet could simply imbed 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 imbedded 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 imbeds (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.
SHOW NOTES:
For years it was felt that the DNA of identical twins was indeedidentical. 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
From HOWDUNNIT:FORENSICS
Toxicology is a relativelynew science that stands on the shoulders of its predecessors: anatomy,
physiology, chemistry, and medicine. Our knowledge in these sciences had toreach a certain level of sophistication before toxicology could become areality. It slowly evolved over more than two hundred years of testing,starting with tests for arsenic.
Arsenic had been a commonpoison 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).
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
