Eviscerator

Amber Matkowski. British medical student with a special interest in pathology.

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The most intriguing question of all is whether the brain is powerful enough to solve the problem of its own creation.

Eichele, 1992.

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Drowning and Forensics

Most reports will state that drowning almost always occurs as the result of an accident. However, if that were not the case, it would be incredibly difficult to prove - unless there are physical signs of a struggle (cuts, bruising etc.) the death will always be recorded as ‘misadventure’.

It can sometimes be hard for pathologists to know whether or not the body was deceased when it entered the water, because after a body has been submerged for long enough the lungs will begin to fill up with water, as they do in cases of live drowning. One indicator of live drowning is haemorrhaging - blood in the lungs where the force of the water entering the lungs has caused tissue damage (your lungs are pretty delicate).

There is also a chance of the person ‘dry drowning’. This is happens when the larynx goes into spasm when water enters the throat, thus the passage to the lungs is blocked, preventing water from entering or leaving the lungs.

So how can you detect foul play?

The key thing a pathologist wants to ask themselves is 'did this person actually die here?'. To figure this out, they can look for remnants of the local environment e.g. pieces of plant life only found underwater, stones or rocks. A pathologist will also find out whether the deceased died in fresh or salt water; if the unfortunate fellow’s lungs are filled with fresh water but the body is recovered in a salt water environment then you can assume there was foul play.

In addition to all of this, calculating the time of death of a drowned body is very difficult. Unless they died very recently, measuring temperature goes out the window. The usual guidelines of forensic entomology (where different insects swarm the corpse at certain stages of decomposition) are useless as the body will typically remain submerged. Fortunately, there is now new research into how oceanic surroundings feast upon a corpse - often by the way of prawns and other sea creatures.

When a human corpse is on land, the head is typically the first target of the hungry hungry maggots and similar predators. In the water, however, the head is saved for dessert. Interestingly, the head as well as the hands and feet will separate from the body (I have no idea as to why, so if any of you guys know I'd love to hear about it).

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Could you spot someone drowning?

It is a common misconception that drowning is a big, flailing, obvious fuss - but of course you'd be able to spot someone drowning, right?

Outside of Hollywood, in the little bubble I sometimes refer to as 'reality', drowning is often inconspicuous to onlookers. Due to the instinctive drowning response, waving and yelling often becomes impossible. While distress and panic may sometimes take place beforehand (referred to as aquatic distress syndrome), drowning itself is deceptively quick and often silent. Whilst drowning, you are unable to keep your mouth above water long enough to breathe properly and so you can't make a noise. Involuntary actions of the autonomic nervous system override what would be voluntary responses such as waving and instead cause lateral flapping or paddling with the arms to press them down into the water in an attempt to resurface, with little to no leg movement.

To an untrained observer, it may not be obvious that a drowning person is in distress - they may appear to be swimming safely before fully submerging just 20-60 seconds later. 

In emergency situations in which lifeguards or other trained personnel are not present, it is advisable to wait for the victim to stop moving or sink before approaching, rescuing, and attempting to resuscitate. While the instinctive reaction to drowning is taking place, victims latch onto any and all solid objects in attempts for air, which can result in the drowning of a would be rescuer as well as the victim. The event called ‘AVIR Syndrome’ (Aquatic Victim Instead of Rescuer) has killed over 100 would-be rescuers in Australia and over 80 would-be rescuers in New Zealand.

Random fact: 80% of drowning victims are male.

(Check out the source for important facts and figures on drowning)

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This device uses infrared technology to help find veins

How? Well it works in a similar way to pulse oximetry. Haemoglobin in the blood absorbs infrared light. When AccuVein’s device is held above the skin, it can detect the difference in the haemoglobin concentration between the veins and surrounding tissue, projecting a map of the veins on the skin above them. Locating the point of needle placement is suddenly simplified for phlebotomy techniques.

This technique has been used for some time when drawing blood from newborns, but is now becoming more frequently used in adults. Those with particularly difficult venous access (DVA) can include:

The elderly;

Dark-skinned patients, whose veins may not be visible;

Obese patients, whose veins may not be visible or palpable;

Patients having many diagnostic or therapeutic intravenous procedures;

Burn victims;

Agitated or restless patients;

Oncology patients on chemotherapy;

Other patients with chronic diseases;

Drug abusers.

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After observing the unique effects different drugs have on human behaviour, Sarah Schoenfeld explored their qualities further by dropping liquid drug mixtures onto exposed film. This chemical exploration has created a visual presentation of these unique and often mysterious substances. When you view these images, just try to imagine all the various ways these chemicals act inside the body. I like to consider the different colours and textures as representing the alternating emotions and physical changes when under the influence of drugs.

From top to bottom and left to right: ketamine, ecstasy, LSD, MDMA, heroin, speed.

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For the past year I have been volunteering for an organisation called Fastbleep Schools, which is aimed at widening access to medicine. This involves visiting high schools and colleges to teach students medical skills such as anatomy, suturing, taking BP and more, and answer any questions they might have about the application process. Today I was able to do this at my former college (South Cheshire college), where I spent an incredible two years of my life. If it wasn’t for Fastbleep coming to the college when I was a student there, I don’t think I’d have had the confidence to pursue medicine. Fast forward two years: I’m now teaching with them and have recently taken over as their web director/editor. I owe the teachers at that college the world and I continue to find myself being presented with excellent opportunities time and time again at Manchester uni. The last four years of my academic life have been beautiful and I’m very grateful.

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A photo from 1925, tanning babies  at a Chicago orphanage during winter to prevent rickets

What's rickets you might ask? It's a condition causing bones to become soft and weak, which can lead to deformities. It is most commonly caused by a lack of vitamin D, and sunlight is essential for vitamin D production.

You only need about 20 mins a day in the sun for vitamin D production to be adequate, which seems easy right? But for kids, factory workers and those living in the depths of smogged up shady city buildings it can be pretty difficult (not to mention for those addicted to Tumblr - that's right, I'm talking to you).

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In a state of constant alert, the child's ''fight or flight'' stress response goes into overdrive, causing physiological changes to the architecture of the brain.

The results can be catastrophic. As cell growth is impaired and the formation of healthy neural circuits is disrupted, the child struggles to regulate emotions.

Changes in the hippocampus - the part of the brain responsible for memory and emotional control - cause shrinkage, which in turn can trigger learning and behavioural problems, difficulty with impulse control and a heightened sense of rage and self-loathing.

Evidence is also emerging that the effects of toxic stress can last a lifetime, putting the child at increased risk of mental and physical health problems and cognitive impairment in adulthood. The concern is that the trans-generational consequences of family violence, abuse, neglect, economic hardship and parental mental illness and drug and alcohol problems will compound over time.

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Idiopathic cardiomyopathy

This is an example of hypertrophic cardiomyopathy occuring without a known cause. The ventrical walls, and sometimes the walls of the heart's mitral valve, grow thicker. Eventually, ventricular blockage can occur, placing undue stress on the heart muscle as it struggles to pump blood through the narrowed passages of the ventricle.

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Obsidian Scalpels

Obsidian is a volcanic glass, produced when lava cools rapidly. It is extremely hard and brittle, making it a great choice as a cutting tool since the Acheulian age (beginning 1.5 million years previously) dated 700,000 BC.

So why is this important in medicine? When used as a scalpel blade, obsidian is significantly smoother and sharper than steel (as shown above in the electron micrograph) and have been a part of medical practice since the days of Egyptian embalming procedures. The cutting blade of obsidian is 3nm and post-surgical review found that obsidian wounds contained fewer inflammatory cells, less granulation tissue and had smaller scar width compared to incisions made with steel. 

In the US they are only currently being used in surgery with animals as the FDA has not yet approved their use in humans however in Europe this is not the case and obsidian scalpels are being used particularly in facial reconstructive surgeries to avoid disturbing scars that would be produced with a steel blade. Even superior to the obsidian scalpel is the diamond scalpel, but at £77 ($130) the obsidians make an affordable substitute.

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Ventricular Ectopic Beats

The most common type of ventricular ectopic beat is premature; ventricular contraction occurs before the underlying rhythm would normally depolarise the ventricles. 

The impulse of a ventricular ectopic beat is not conducted through the ­ventricles via the rapidly conducting His–Purkinje system. The resultant ­complexes are therefore broad (> 0.12 s) and bizarre in shape, and will not be preceded by a premature P wave. 

They are often idiopathic (without known cause) but when caused by cardiac disease are associated with an increased cardiovascular mortality that will not be reduced by antiarrhythmic drugs.

Often a pattern is seen, with the ectopic beat occurring every other beat, every third or fourth beat, in couplet or triplet patterns and so on. 

The image above shows a ventricular ectopic beat occurring every third beat (V2).

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Wound Man is an illustration which first appeared in European surgical texts in the Middle Ages. 

It laid out schematically the various wounds a person might suffer in battle or in accidents

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I had to share this beautiful medical illustration by Tess Tobolic. Sometimes I regret not pursuing a similar path.

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Tree-barking of the aorta

Before rupture occurs, infamous ‘tree bark’ grooves appear on the inner layer of the aorta.

They are basically stretch marks of the aorta and can be seen in cases of Marfan-style dilatation of the aortic root. The reason you can’t see them in cases of atherosclerosis is because the markings are masked by plaques.

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A classic presentation of syphilitic aneurysm of the aortic arch.