I posted something at FFJ that may be useful for some, so Im going to re-post it here (I know some still do not read there.). Im not in the medical field, and I dont claim any special understanding along that line. In fact, when I read some of the stuff written by professionals, my eyes start to glaze over after a while, and I struggle to try and understand it. So many big words Im not familiar with, that by the time I look them up, Ive usually forgotten why I needed to know what they meant and Ive lost my train of thought. Then trying to put it all together and understand what Im actually reading is just too much.
So what I did is take the portion of the AR detailing the skull and brain injuries and separate it into sections. Then I translated it into plain, simple English (with only a few big words thrown in for reference to what it is addressing.).
My doing this stemmed from a discussion at FFJ about coup vs. contrecoup injuries. It is my contention that there is nothing in Dr. Meyers report that would indicate a contrecoup injury. While it is possible that there was some not mentioned, there is nothing in the AR indicating that there was.
Also, after reading reviews at Amazon of James Kolars book, I see that people are still referring to the little amount of bleeding (1-1/2 Tsp) that Dr. Wecht mentions in his book. But this was only one area of bleeding. There were also two other areas of bleeding within other layers of the brain, as well as the blood that engorged the tissue manifesting itself as bruising.
The following is graphic and (unfortunately at times) brutal-sounding in order to describe the autopsy procedure. So take a deep breath and prepare yourself if you want to understand the brain injuries.
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For reference:
Illustration-1:
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Illustration-2:
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Illustration-3:
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I've copied
the words of the AR in blue first, then my translation in
black and indented. I also added
additional notes and comments [within brackets] and in bold green which may help.
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Skull and Brain: The head:
Upon reflection of the scalp there is found to be an extensive area of scalp hemorrhage along the right temporoparietal area extending from the orbital ridge, posteriorly all the way to the occipital area. This encompasses an area measuring approximately 7x4 inches. After cutting her scalp down to the bone, from ear to ear, across the top of her head, and then pulling the two parts of her scalp down to expose her skull, there is found to be a large area of bleeding from the scalp along the top/right side of her skull which goes from the bone just above her right eye socket, going all the way back to the back part of her skull. This covers an area that measures about 7 long (front to back) by 4 wide (side to side).
This grossly appears to be fresh hemorrhage with no evidence of organization. Without taking into consideration any other evidence, and without benefit of having already examined the blood with a microscope, this looks like recent bleeding without any indication that it has begun the clotting process (coagulation).
[IOW (and this gets pretty complicated here and beyond my complete understanding), there are microscopic things (mostly having to do with the platelets and fibrin in blood) that should be happening within the exposed blood in the area Dr. Meyer is talking about here -- if it had not happened recently. If these microscopic processes had occurred, this blood would appear to be thicker than it is because it had begun coagulating. I have read others opinions that this meant it had to have occurred very close to the TOD (time of death). If true, this would contradict the opinion of Dr. Lucy about TOD, but Ill leave it at that for you decide what it means. If you care to read more about this process, and if you can keep your eyes from glazing over, this, and this are good sources, and then theres always this.
At the upper portion of this area of bleeding is a crack in her skull which includes both a linear crack and a hole which has broken pieces of bone punched out [The word comminuted directly contradicts what Dr. Spitz said about there being a single hinged piece of bone within the hole, and makes me wonder where he was getting his information and doubt everything else in his analysis.] which goes from the right side of the back of her skull, over the top, and forward to just above her right eye socket.
In the posteroparietal area of this fracture is a roughly rectangular shaped displaced fragment of skull measuring one and three-quarters by one-half inch. At the back of her skull (refer to Illustration-1 above) [posteroparietal means the back of the parietal bone], there is a somewhat rectangular hole of broken skull bone which is 1.75 long by 0.5 wide. [I dispute, of course, the rectangular description of the depressed fracture. It could be that at the point in the autopsy that Dr. Meyer was at here, he had not yet removed the thin membrane (the pericranium) covering the skull --only the scalp without this membrane. If this membrane completely covered the hole and it was bruised as it appears to be where we can see only the back portion of it in the only photo we have available, it may have looked to be roughly rectangular at this point in the autopsy. Thats the only way I can imagine that it would have looked to be rectangular instead of oval.]
The hemorrhage and the fracture extend posteriorly just past the midline of the occipital area of the skull. The bleeding and the fracture go back to just past the center of a line drawn down the middle of the occipital bone at the back of her head (refer to Illustration-1).
This fracture measures approximately 8.5 inches in length. The entire length of the fracture is about 8.5, from end to end.
On removal of the skull cap there is found to be a thin film of subdural hemorrhage measuring approximately 7-8 cc over the surface of the right cerebral hemisphere and extending to the base of the cerebral hemisphere. After using a saw to cut off the top portion of her skull, there is a thin layer of bleeding which lies within the space between the outermost meningeal layer (the dura mater -- which adheres to the skull), and the arachnoid, which envelops the brain (refer to Illustration-2). [This is usually what results from tears in the bridging veins that cross through the subdural space. In contrast, epidural hematomas are usually caused by tears in arteries, resulting in a build-up of blood between the dura mater and the skull.] The amount of bleeding here would probably be about 7 to 8 cubic centimeters (7 cc = 1.4 teaspoons; 8 cc = 1.6 teaspoons. So 7 to 8 cc is the equivalent of about 1.5 teaspoons.) if it was collected and placed into a measuring device. This thin layer of blood is spread out over the entire right half of her brain and goes all the way down to the bottom of the right half of her brain.
The 1450 gm brain has a normal overall architecture. The brain weighs 1450 grams (about 3 lbs. and 3oz.) and looks pretty normal in its shape. [IOW, its not larger in any one area than another -- meaning there is not a noticeable amount of swelling in any one area.]
[I should mention here that 1450 gm seems to me rather large for a 6 year old female, but Meyer makes no additional mention of it. For more information on brain weights, see notes below.]
Mild narrowing of the sulci and flattening of the gyri are seen.Even though I (Meyer) just said there was no noticeable uneven swelling, there must be a small amount of swelling because of what is seen in the ridges and grooves of the surface of the brain.
No inflammation is identified. I (Meyer) dont see where this small amount of swelling is coming from.
There is a thin film of subarachnoid hemorrhage overlying the entire right cerebral hemisphere. In addition to the thin layer of subdural bleeding mentioned earlier, there is also another thin layer of blood in the area between the arachnoid and the pia mater (refer to Illustration-2, and Illustration-3) that covers all of the right half of the brain. [This is the type of bleeding that usually occurs during a brain aneurysm.]
On the right cerebral hemisphere underlying the previously mentioned linear skull fracture is an extensive linear area of purple contusion extending from the right frontal area, posteriorly along the lateral aspect of the parietal region and into the occipital area. This area of contusion measures 8 inches in length with a width of up to 1.75 inches. On the right half of the brain underneath the linear fracture is a large area of purple bruising of the outer portion of the brain. This bruising goes from above her eye socket to the back, along the right side of the top of her skull, all the way back to the back of her skull. This bruised area is 8 long by 1.75 wide (It coincides with the length and the location of the linear fracture.)
At the tip of the right temporal lobe is a one-quarter by one-quarter inch similar appearing purple contusion. Only very minimal contusion is present at the tip of the left temporal lobe. This area of contusion measures only one-half inch in maximum dimension.[This is difficult for me to explain with my limited understanding, but the tips of the two temporal lobes are not truly distinguishable as physically identifiable parts of the brain. They are general areas that are theoretically divided regions of a portion of the brain -- so divided because the function of that portion of the brain. The tip is located at the back of the brain. It is probably better to simply see an animation of exactly where it is located here.]
[What Meyer is saying in the above sentences is that there is a very small area of bruising on the back of the brain. This is probably (IMO) because of the initial force from the head blow itself toward the back of her head. Meyer does make note here that the bruising is more dominant on the right tip over the left, but the total area is only one-half inch in maximum size.]
The cerebral vasculature contains no evidence of atherosclerosis.The blood veins and arteries of her brain show no signs of hardening. [Im not sure why Meyer would state this, unless it is just a standard notation made during an autopsy. I dont know of a reason that it could be related to the injuries associated with her head wound.]
Multiple coronal sections of the cerebral hemispheres, brain stem and cerebellum disclose no additional abnormalities. With a carving knife, multiple sections of each of the two upper halves of the brain were cut, as well as sections of the two lower parts of the brain (as is the standard autopsy practice), and nothing else unusual or abnormal was noted.
The areas of previously described contusion are characterized by purple linear streak-like discolorations of the gray matter perpendicular to the surface of the cerebral cortex. These extend approximately 5mm into the cerebral cortex. Once the sections were cut, a cross-section of the bruises noted before on the outer surface of the brain could be seen. These bruises went about 5 millimeters (about 0.2) deep
[essentially, not very deep].
[My question here (and this goes to the issue of the length of time between the head blow, the strangulation, and the actual TOD) is when did the good doctor do the tissue fixation, and how good were his medical practices? I wont spend a great deal of time on it in this post, but this has been nagging at the back of my mind for a long time. Organs are preserved with a solution called formalin. Body tissue (including brain) will continue rotting until it is fixed (fixed in this sense of the word means stabilized). Formalin is a mixture of formaldehyde (which is actually a gas), water (which is what makes the formaldehyde a liquid, as we think of it), and methanol. The liquidized formulation of formaldehyde comes in different percentages of gas to liquid. Different percentages of the gas result in a different calculation of the desired ratio of methanol. There are conflicting opinions as to the different percentages of each that should be used. There are commercial mixtures available, but many pathologists still mix their own. If too much methanol is used, it can contribute to necrosis of the very tissue it is intended to preserve. If the least amount of artificially caused necrosis is present, it will throw off the estimation of TOD making it seem to be longer than it actually is between injury to the organ and actual death. So you can see that the proper fixation of brain tissue is critical to the estimation of the length of time between injury and actual death. Dr. Lucy was not present at the autopsy and has no knowledge of the precision used in the preservation of the brain sections. Her opinion is based on the assumption that it was all done correctly and efficiently. How much faith do you have in the ability of a small town coroner to take this all into consideration? There is also another factor that I dont believe Dr. Lucy considered because her specialty is brain pathology -- but Ill save that for another time.]
[This would only be significant if there were fractures at the base. Much more force is required to cause basilar fractures, and therefore they are relatively rare -- accounting for less than 5% of severe head injuries. Also, basilar fractures have particular, specific signs: blood in the sinuses, a clear fluid called cerebrospinal fluid leaking from the nose or ears, black-eyes (often called raccoon eyes), and other less common symptoms.]
[Notice in this that most of the bleeding is from the breaking of veins and arteries and associated capillaries within the layers of the skull, and that they mostly follow along the linear fracture. This indicates to Dr. otg that the breaking and tearing of them was due to the damage done in the separation of the skull along the linear fracture -- not the moving of the brain within the skull from front to back or vice versa. (Illustration-3 shows the distribution of veins, but not the arteries.) As I stated before, I am not trained in the medical field, so I claim no expertise. If someone who does have the expertise will speak up and explain to me where there is any indication of contrecoup bruising indicated in this AR, I would sincerely welcome the information. As it is, and as I read it, there is none.]
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Additional Notes:
The human
adult skull bone has three layers (or
tables) the outer layer is the hardest. It is thick and tough. The inner table is thinner, denser, and more brittle, and therefore is more likely to shatter or break. It is not terribly unusual that after a blow to the head, the inner table (also called the
vitreous table) will sometimes break off without apparent or severe damage to the outer table. In the center, between these two layers is what is called the
Diploe. But at six years, this diploic layer has not yet developed, and therefore, a childs skull is much thinner than that of an adult.
Weight of the Human Brain:
The average normal mass of an adult male human brain is approximately 1300 to 1400 grams (2.87 to 3.1 pounds).
The average Male's brain weighs 1360 grams (3 pounds)
The average Female's brain weighs 1250 grams (2.8 pounds)
A newborn human brain is about 350 to 400 grams (0.77 to 0.88 pounds).
A humans brain grows quickly in the first years and reaches its full size by around the age of six.
The brain weights of some well known people:
The brain of Albert Einstein weighed a mere 1230 grams (2.71 pounds)
The brain of the German mathematician Carl Friedrich Gauss weighed 1492 grams (3.29 pounds)
The brain of the leading poet of the Russian Revolution Vladimir Vladimirovich Mayakovsky weighed a whopping 1700 grams (3.75 pounds)
Dura mater means literally
tough mother (think of
dura as in
durable -- meaning strong and tough). This layer is what cushions the inside of the skull bone from the other layers that protect the brain.
Pia mater means literally
soft mother, because this layer of the brain is a soft, pliable membrane right next to the delicate tissue of the brain (cortex).
Arachnoid means
spider-like, and is so-named because of the interwoven fibers within the arachnoid layer.
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Translation in its entirety (without the original, and without my additional comments):
The head:
After cutting her scalp down to the bone, from ear to ear, across the top of her head, and then pulling the two parts of her scalp down to expose her skull, there is found to be a large area of bleeding from the scalp along the top/right side of her skull which goes from the bone just above her right eye socket, going all the way back to the back part of her skull. This covers an area that measures about 7 long (front to back) by 4 wide (side to side).
Without taking into consideration any other evidence, and without benefit of having already examined the blood with a microscope, this looks like recent bleeding without any indication that it has begun the clotting process (coagulation).
At the upper portion of this area of bleeding is a crack in her skull which includes both a linear crack and a hole which has broken pieces of bone punched out which goes from the right side of the back of her skull, over the top, and forward to just above her right eye socket.
At the back of her skull, there is a somewhat rectangular hole of broken skull bone which is 1.75 long by 0.5 wide.
The bleeding and the fracture go back to just past the center of a line drawn down the middle of the occipital bone at the back of her head.
The entire length of the fracture is about 8.5, from end to end.
After using a saw to cut off the top portion of her skull, there is a thin layer of bleeding which lies within the space between the outermost meningeal layer (the dura mater -- which adheres to the skull), and the arachnoid, which envelops the brain.
The amount of bleeding here would probably be about 7 to 8 cubic centimeters (7 cc = 1.4 teaspoons; 8 cc = 1.6 teaspoons. So 7 to 8 cc is the equivalent of about 1.5 teaspoons.) if it was collected and placed into a measuring device. This thin layer of blood is spread out over the entire right half of her brain and goes all the way down to the bottom of the right half of her brain.
The brain weighs 1450 grams (about 3 lbs. and 3oz.) and looks pretty normal in its shape.
Even though I (Meyer) just said there was no noticeable
uneven swelling, there must be a small amount of swelling because of what is seen in the ridges and grooves of the surface of the brain.
I (Meyer) dont see where this small amount of swelling is coming from.
In addition to the thin layer of
subdural bleeding mentioned earlier, there is also another thin layer of blood in the area between the arachnoid and the pia mater (refer to Illustration-2, and Illustration-3) that covers all of the right half of the brain.
On the right half of the brain underneath the linear fracture is a large area of purple bruising of the outer portion of the brain. This bruising goes from above her eye socket to the back, along the right side of the top of her skull, all the way back to the back of her skull. This bruised area is 8 long by 1.75 wide (It coincides with the length and the location of the linear fracture.)
There is a very small area of bruising on the back of the brain
The blood veins and arteries of her brain show no signs of hardening.
With a carving knife, multiple sections of each of the two upper halves of the brain were cut, as well as sections of the two lower parts of the brain (as is the standard autopsy practice).
Once the sections were cut, a cross-section of the bruises noted before on the outer surface of the brain could be seen. These bruises went about 5 millimeters (about 0.2) deep.
Examination of the base of the brain discloses no additional fractures.
