Discussion in 'Justice for JonBenet Discussion - Public Forum' started by otg, Dec 19, 2012.
Indeed. Thank you.
Absolutely, the white mark is almost always a postmortem occurrence. It is something investigators look for which, once it happens, cannot be undone even by removing whatever it is that caused it. But there are instances where it can occur because of accompanying circumstances. The answer is not simple, so bear with me if I go off on tangents while trying to get to where I’m going.
I actually agree with you in saying that it most likely occurred after death, although I didn’t word it to where it sounded like it because I wanted to allow for the outside possibility of it happening perimortem. If you notice, the first sentence I wrote about it is a fragment, because I didn’t finish my thought about it before I posted it. I do think the ligature remained in place until after death, but that certainly doesn’t mean that it wasn’t put there before death. So even though I don’t think it’s how it happened, I’ll explain the circumstance I was allowing for that could possibly make the statement that it absolutely had to happen after death wrong. Just like other things that I don’t think happened, if I can’t exclude their possibility, I allow for their exception.
From Estimation of Time of Death by Patricia J. McFeeley, M.D.:
“Livor begins at or very soon after death since it is a function of blood flow and, therefore, cardiac activity. However, stasis can occur to some extent in shock and some degree of lividity can be present even while a person is technically alive.”
“(Livor Mortis) May occur antemortem (before death) in slow deaths”Knowing exactly why blanching occurs will probably explain how this can occur:
Blood flows away from the heart in arteries, which branch and narrow into the arterioles, and then branch further still into the capillaries. Capillaries are the smallest of a body's blood vessels and are parts of the microcirculation. Capillaries are where the transition occurs between supply and return of blood. These microvessels, measuring 5 to 10 microns (a micron is one-thousandth of a millimeter, or 0.001 mm) in diameter, connect arterioles and venules, and enable the exchange of water, oxygen, carbon dioxide, and other nutrients and waste chemical substances between blood and surrounding tissues. After the tissue has been perfused (Perfusion is the process of delivery of blood to a capillary bed in biological tissue.), capillaries join and widen to become venules and then widen more to become veins, which return blood to the heart.
Individual capillaries do not function on their own. The capillary bed that they form is an interweaving network of capillaries that supply blood. The more metabolically active the cells, the more capillaries they will require to supply nutrients and carry away waste products. It is these capillary beds that give the color to the surface of our skin (along with whatever our natural skin pigmentation is).
When you press on the skin of a living person, you force the blood out of the capillaries and the skin turns white. When skin is blanched, it takes on a whitish appearance as blood flow to the region is prevented. If circulation is normal, the capillary blood comes back almost instantly when the pressure is removed, and skin color returns. But if the blood return is sluggish, the skin stays white for several seconds and can indicate poor blood circulation. This test is called “diascopy”. EMT’s and healthcare professionals use this test (or do the test with a small piece of glass) as a clinical assessment of a person’s condition, and to determine whether a rash or lesion is vascular in nature (meaning that it is inflammatory), or non-vascular (nevus -- such as a birthmark) in nature, or hemorrhagic (such as the petechial or purpura rash associated with meningococcal disease).
Blanching of the skin is usually a localized reaction and may be a sign that the skin tissue is not receiving its usual blood supply (poor circulation) due to swelling, cold, or even other problems causing insufficient blood flow through the vessels. Some of these other factors that may influence skin blanching are drug concentration, duration of application, vascular occlusion, posture of the individual, and location (surrounding temperature). You would think that low blood pressure would also be a factor (and it can be). But in some instances, the heart will actually beat faster to try and make up for a lower blood pressure resulting in increased circulation. (The heartrate is one of the functions controlled by the vagus nerve, which has been pointed out as a possible factor in reactions to strangulation and could have been an invoked response in JonBenet’s death.)
In a healthy, normal, living person, the temporary blanching is quickly dissipated by the reperfusion of blood into the capillaries of the skin. But under other circumstances, this reperfusion can be delayed for a length of time dependent on other factors. If it is delayed for a sufficient length of time, and if normal blood circulation doesn’t return, it may remain blanched until fixation has occurred. This fixation begins when the heart is no longer pumping blood to resupply the evacuated vessels and is the beginning of a process called “hypostasis” (the settling of blood in the lower part of an organ or the body as a result of decreased blood flow). All postmortem changes begin at the molecular level, sequentially progress to microscopic, and then finally to gross morphology (visible appearance of the body).
After death, livor mortis is the purple-red coloration that appears on dependent (lower) portions of the body, except in areas exposed to pressure after the heart ceases to beat. It results from the settling of blood under the force of gravity (hypostasis). The lividity that is often referred to is not in regard to tissue or organs that are in the upper portion of the deceased, but rather in the lower portions in which the blood settles due to gravity. In earlier stages (before fixation), the purple-red skin in the lower portions where livor mortis has become apparent can be depressed causing the deep color to turn white, but will slowly return to its original deep color after removing the pressure. In middle stages (after fixation has begun to take hold), it will remain white because of the sluggishness of the congealing blood. In the last stage (after complete fixation), pressing on the livid skin will not turn it white at all. This is how livor mortis is used to approximate TOD. (But again, livor mortis refers to the deeply colored/stained area where the blood has settled in the lower portions of the body.)
I think if there was a second wrapping of the cord around her neck at the time of autopsy, Meyer would have made note of it. I also think if it was still wrapped around her neck for the same amount of time as the ligature that Meyer did describe, it would have caused a furrow similar to the one apparent in the photos.
There are cases I know where this has happened. The ligature which caused the strangulation presses against another part of the neck causing a white mark in the adjacent skin. But in each and every one of those cases, it was because the material used as a ligature was large enough in diameter to be elevated above the level of the skin on either side of the furrow, allowing it to press against the corresponding skin. With JonBenet though, the cord was small enough in diameter that it was completely embedded below the surface of the neck and therefore unable to cause pressure on an adjacent area of flesh.
Also, had her neck been bent down enough to press a ligature into the area below the furrow until her body was brought up from the basement, it would have remained in that contorted position due to rigor.
The very reason you state as to why the furrowed area is not evidence of suspension is the reason the white line is. The white line (in strangulation, referred to as an “argent line”) is the evidence of suspension. It goes from the lower area at the front of the neck, upwards toward the back, and then it disappears toward the back forming the missing “V” which is typical in hanging deaths. The apex of this “V” pattern would be in the back of the neck at about the same location as the furrow. The furrow was formed after the cord slipped upwards over the laryngeal prominence (causing the petechial hemorrhaging in the underlying area) and then stopped just below the chin. When the suspension was ended, the cord settled into a circumferential position where it remained until post mortem swelling caused the furrow to form.
BTW, the knot is usually located posteriorly (in one study, ~53% of the time). So common is this position, it is referred to as a “typical” suspension, and any other knot location (lateral or anterior) is referred to as an “atypical” suspension.
All this is why, I believe, Henry Lee said after seeing the evidence that this was a tragic accident. The head blow was deliberate (IMO), regardless of whether or not the intent was there to cause that much damage. But she may have lived (not likely -- but possibly) with immediate medical care. But the strangulation caused her death, and I think Lee recognized that it happened as a result of accidental circumstances -- not intentional tightening of the cord around her neck -- not to “put her out of her misery” (as some have suggested) -- and not to “finish her off” because she was already dying.
No one has to agree with me that this is what happened. Even though it is my opinion, I recognize that there is evidence which could point to other things, and the evidence of suspension does not negate all other evidence. But just because you may disagree with my conclusion doesn’t mean that you can say with any legitimacy that “there is NOTHING that indicates she was hung or suspended in any way.”
The evidence is there. If you fail to recognize it, or even acknowledge it, nothing I say or point out will matter to you. If everyone chooses to disagree with my conclusion, I understand, I’m used to it. If it doesn’t fit with your theory, you can disregard it. But the evidence is there.
So, otg. If you believe she was struck intentionally, why do you believe she was suspended following? I'm not disputing, just trying to understand.
Amazing post otg. Also incredible intelligent posts by all of you here; especially when it comes to explaining the medical history of what you all thought happened to little JonbenÃ©t Ramsey.
As for me, I don't have all this incredible medical knowledge you and all the others have otg, but I still think this was a tragic accident with no one home but the four Ramseys.
I should have added I believe Patsy and John spent hours covering the accident up. No need to go through it
all. Everyone here knows the full story.
I canâ€™t get away from thinking the head blow was deliberate. Iâ€™ve tried imagining any other possibility that might have caused it, and I canâ€™t make enough sense out of any other scenario that, to me, accounts for it and all of the other injuries. So if I accept it as deliberate, and then try to account for the rest of the injuries, this is what I come up with. To me, I can see the cord being used to â€œplayfullyâ€ restrain her where she wouldnâ€™t be free to simply walk away. If it was tied loosely around her neck and then secured to another object, it would be presented to her under the pretense of tying up a pet or pretending she had been captured (as a child, I remember playing games we called â€œcops and robbersâ€ and â€œcowboys and Indiansâ€). While this may sound silly to anyone reading this, remember we are talking about children. Tying a cord around a childâ€™s neck is not something that would be done by anyone capable of thinking about just how dangerous it is. It set up a precariously dangerous situation which, unfortunately, played out with the worst imaginable outcome. For whatever the reason -- anger, rage, panic, fear of discovery -- at some point the head blow is struck causing immediate unconsciousness. The weight of her body collapsing would cause the cord to tighten around her neck. At that point, she has two things working to cause death (either one of which could alone be enough to cause it). But it is this combination of insults that complicates the amount of bleeding and swelling in the brain and her bodyâ€™s reaction to the ligature strangulation beyond what would otherwise be expected. If this is indeed what might have happened, the strangulation would have happened immediately after the head blow in the amount of time it would take for her body to collapse and cause the cord to tighten around her neck. I believe it stayed in its original position (where the white line is) until she was dead, and that it then moved up to the position higher on her neck where the furrow formed (even though I apparently confused everyone when I had earlier allowed for the possibility that she was still technically alive when it moved). And before anyone points out that the petechiae on her neck is something that happens only while a person is still alive, I will just mention that that is not always the case. If you read my last post and understand how the capillaries work, you can probably see why there are exceptions. But if further explanation is needed, just let me know and Iâ€™ll explain.
I wonâ€™t try to convince anyone that this is what happened. It is what I think happened though. It accounts for all the injuries from her neck up. It doesnâ€™t require thinking the very worst of either parent. It doesnâ€™t point to some unknown ring of pedophiles or child porn subculture, or some sort of religious or satanic ritual. Itâ€™s not nearly as appealing to those who want to look at this as some deep conspiracy within the FBI, or a group of people trying â€œto send JR a messageâ€. It doesnâ€™t mean the person who caused it was a monster or even someone who would be compelled to act out in the same way at some time later on in his life. It is not that complicated when you look only at what could not be hidden or altered before the police arrived -- that being the state of her body and what it tells us.
Many autopsy rooms have a Latin phrase written on the entrance: â€œMortui viventes docentâ€ -- The dead teach the living. JonBenetâ€™s body tells the story of what happened to it. Itâ€™s up to us to listen.
And really, Elle, that bolded statement says it all. Does anyone have to know anything more than that to know that JR and PR are ultimately responsible?
I will be the first one to shake your hand otg if you truly solve this case.
You sure put your heart and soul into it!
It's not far-fetched at all to believe children could tie one another up...even
tying a string, rope, etc., around a neck, etc.
According to your theory, why did the parents cover up? How, and why, did the vaginal injury occur? Do you think sexual experimentation was taking place with the tie up?
Then if you agree with that point, you can see how it was set up for the disastrous consequences that weren't foreseen by the person who tied her up. Right?
Yes, I believe the pretense for restraint was play, but the ulterior motive was sexual experimentation. I think this sexual exploration began over a prior period of time which escalated up to the night she died. The "chronic" vaginal injuries are evidence of what led up to it, and the "acute" injuries are from what occurred immediately before the head blow. I don't believe there were any vaginal injuries that were inflicted as a means of "covering up" past injuries. In fact, I don't think the parents would necessarily even be aware of any possible prior injuries, even though one or both may have been aware of possible past "involvement". I think when the parents became aware of it, she was already dead, and that they saw the evidence of the molestation that had just happened. I'm not sure if they were even aware of the head blow until they were told the results of the autopsy. It could have been that they were only told that the two were playing and that she slipped and it tightened the cord accidentally. Of course with the obvious evidence of sexual involvement, the person who caused it would have to admit to it even though it might not have been volunteered initially. It is because of the sexual aspect and the resulting death, that I believe the parents decided to cover up what really happened -- and how it happened -- and especially the evidence of the sexual molestation (that they were aware of).
Certainly, young children, often-times, fail to see the potential danger lurking in their actions.
Interesting. I'll have to give this scenario some thought. Thanks.
I have no medical experience. I donâ€™t claim any special knowledge beyond what I have learned by reading other sources. In fact, I often point out that I do not have any expertise in much of anything, and I again will remind you of this. But I have found a lot of information available which I gladly share with anyone interested in researching on their own. If I state something other than personal opinion or interpretation, I will provide links if asked.
Since I have stated a lot of stuff that is from other sources, I offer the following links for anyone interested in learning more. Keep in mind the following:
The physiological responses are the same in a suspension (hanging) as they are in a strangulation where the ligature is pulled by hand. The only difference is whether the ligature is pulled by another person or by the weight (full or partial) of the body against a stationary object -- but the bodyâ€™s response and the resulting injuries are the same. Typically (but not always), the angle of the pull will be close to horizontal when the cord is pulled from behind by a person, and it will be angled obliquely upwards in a suspended strangulation.
Most suspended strangulations are suicidal. Much less are accidental, and very few are homicidal. This only addresses intent, since obviously the result is the same, so reading about any is still useful in learning about the injuries that are consistent with any of the causes.
Some of the articles are from foreign sources, so common ligature sources may be different from what would be expected in the U.S. (e.g., A â€œchunniâ€ is a common article of clothing for women in South Asia and is therefore often used in both suicides and homicides in that area of the world.)
Here are a few links to get started (in no particular order). I wonâ€™t offer any more unless requested (this is probably more than most here will care to read, but these sources have a great deal of information which pertains to the injuries inflicted on JonBenet):
But the autopsy report states that the head blow and the strangulation by the cord did NOT happen at the same time or even shortly separated, and the bleed in her brain shows that there was a time between the 2. If she had been strangled by the cord right after the head blow, her brain would not have had time to bleed out into her skull to the extent that it did.
You’ll have to point me to where in the AR is says anything about the timing between the two. I only read that she died from “asphyxia by strangulation associated with craniocerebral trauma”. That in itself doesn’t speak to the timing between the two.
As for the amount of bleeding in her skull, I would appreciate a chart that tells us how much bleeding should be expected under the exact same circumstances to know whether it was too much or too little -- but there isn’t one. There are so many conflicting factors as to what should be expected that even the so-called experts can’t agree. Dr. Wecht believes that because of the “small amount” of blood, she must have been already dead or near-dead (from strangulation) when the head blow was struck. On the opposite side of the debate, Dr. Rorke-Adams believes that because of the amount of edema and necrosis of brain tissue, she was hit over the head a full 45-minutes to 2-hours before she was strangled (I strongly disagree with her on this and will at some time go into more detail about why.). Dr. Kerry Brega (chief neurologist at Denver Health Medical Center at the time) said it is not uncommon for people with skull fractures to not have any bleeding in the brain at all.
Why such a wide difference in opinion?
Perhaps each expert considers one or two factors and fails to take into consideration something else, because of how complicated the circulatory system is (even more so in the system that supplies the brain with blood and oxygen). I wrote a pretty detailed explanation of some of the factors in a post at WS if anyone cares to read it. But I think everyone here has read and learned enough already that they could probably make an argument either way. IMO, it is enough simply to say that because of the combination of the strangulation and the head trauma, it could be expected to find either more or less blood in the brain than there actually was. So the amount of blood that was described by Meyer in itself is not enough to determine the order of the two, or even more the amount of time between them.
I disagree with Wecht on this one. Had she been dead when bashed, there would be NO flattening and swelling of the sulci and gyri in the brain. You must be alive for ANY swelling to occur.
I disagree with Dr. Wecht on this one too, DD. The swelling that occurs in the brain is mostly due to fluids that build up almost immediately after trauma. As the outer “folds” of the brain expand due to the swelling, they press against the skull cap (calvarium) and become flattened, narrowing the spaces between them.
Here is a good illustration showing several different signs of swelling in a brain (because of copyrights, I should mention it was taken from Knight’s Forensic Pathology by Pekka J. Saukko and Bernard Knight):
Here is the accompanying text about edema from the same book (Notice the exceptions mentioned referring to children):
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So in children (and I’ve read this from other sources as well), cerebral edema is more likely, more pronounced, and more quickly occurring than in an adult. Also, edema in the brain can be caused from (or worsened by) hypoxia (ischemic hypoxia can be caused by strangulation).
Injuries to the skull and brain are divided into two types: primary and secondary. Primary injuries are the direct result of the physical cause. Secondary injuries are the body’s response to the primary injuries. Brain swelling is a secondary injury.
Four types of cerebral edema (referring to response mechanism) are generally accepted (Vasogenic, Cytotoxic, Osmotic, and Interstitial), and some sources include a separate fifth type (Hydrostatic) which is considered a sub-type of vasogenic edema by others. JonBenet’s cerebral edema was (IMO) primarily cytotoxic as well as vasogenic, which is not particularly important because it is only different on a cellular level and Dr. Meyer doesn’t mention it in the AR.
Cerebral edema is classified into three categories of extent (or patterns): local, diffuse half-brain, and diffuse whole-brain. Unfortunately, Dr. Meyer didn’t go into detail about the extent of the swelling. He only mentions one of the signs of it describing it as “mild”, and he tells us the weight of the brain (which indicates that there was swelling):
“The 1450 gm brain has a normal overall architecture. Mild narrowing of the sulci and flattening of the gyri are seen. No inflammation is identified.”Here is a scale showing average brain weights and brain-to-body weight ratios with JonBenet’s age/gender marked by a green line showing where it should fall (JBR’s ratio is 1.45 kg/20.4 kg X 100 = 7.1):
According to Kolar, the extent of cerebral swelling was one of the factors Dr. Lucy used in forming her opinion as to the length of time between the head blow and the strangulation. But as we know, the additional factor of strangulation can have an influence on how the brain reacts to the head blow (which is why the coroner worded the COD as he did, IMO).
Exactly how much swelling should be expected is really indeterminable due to all the complicating factors, so I don't think it can accurately be used to estimate the amount of time between the two insults. It can be used though to determine the order of the two.
The head blow happened before the strangulation.
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