Medical Question: Life Threatening Condition 1830’s

This medical question for a current work in progress came to me via Facebook. Remember, I am always looking for those pesky medical questions to answer to make sure your medical stuff has the ring of truth… even if it is fiction.

Question: Is there a life-threatening condition that twins could have that could be fixed with minor surgery in the 1830’s?

http://www.sciencephoto.com/media/155709/enlarge

Answer: This question sets up a very difficult scenario for the author to work through. First conundrum is the “life-threatening”, ” minor surgery” and “1830’s”. First of all, most life-threatening conditions require a fairly extensive surgery to fix. One life-threatening option that might easily be fixed would be to have a severed artery that could be tied off. But, this doesn’t fit with the twin scenario. Next problem is that surgery wasn’t all that advanced in this time period. No OR’s… etc.

Secondly, a condition that affects the twins. First thought that came to my mind was a congenital heart defect present in identical twins that would require surgery. But again, limited by the chosen era. Not a good solution.

Then, I thought of the post I did on milk sickness http://www.jordynredwood.com/2011/06/anna-bigsby-milk-sickness.html. A good idea for this time era would actually be a medical condition that the local doctor could figure out and treat. Something along the lines of a toxic plant poison passed through the mother’s milk or a metabolic disorder that could be managed by diet. It would take a very crafty doctor to figure out and would be a plausible option given the constraints of that time period. Here’s an extensive list: http://emedicine.medscape.com/pediatrics_genetics.

Any other thoughts for this writer?

Medical Question: 1950’s Coroner

April asks: For a grad assignment, I have to come up with murder mystery plot line.  I have the general plot line down, but I’m wondering how efficient an autopsy in the 1950s would be?
I need the victim to be poisoned, most likely by a relatively common plant–probably a daffodil, yew, or Wild Cherries (those are my top three choices at the moment).  However, I have no idea how much or what kind of poisons would have been detectable by a small-town, 1950’s coroner.
Jordyn says:  First thing, is a medical examiner and coroner are very different. A medical examiner is a trained physician (the one who does the autopsy) and the coroner is an elected official to decide how an investigation should proceed. For instance, if the coroner feels the cause of death does not involve a crime, there may not even be an autopsy.


Yew Plant

The second thing you need to determine is when tests for toxicology/poisons came about: “Screening tests, such as radio immunoassay, enzyme immunoassay and thin-layer chromatography are often very sensitive, but not very specific. Because they are very sensitive, they will very likely detect the chemical/poison if it is, indeed, present in the sample. Unfortunately, because they lack specificity, they are given to false-positives – mistaking a substance with a similar chemical make-up for the suspected poison. Unless the results of these screening tests are confirmed with a reliable testing methodology, such as gas-chromatography/mass-spectrometry, the results of these screening tests do not satisfy the evidentiary standards for admissibility.”

When I did a little searching, some of these tests were not developed until the 1950’s and 1960’s. So, for them to be widely used would take some years. If you want to be very specific in your ms, you need to research when each of these tests were developed for forensic use. For example, google “development of forensic radio immnoassay”. That will give you a timeline for when they may have been able to detect your chosen poisons on autopsy. I did link you to some forensic timelines below— there are a few of these tests mentioned.
I think the easiest route for you would be this: This small town has a coroner who doesn’t suspect anything criminal is going on. This is still very common today because a coroner may have absolutely little or no medical training and probably no forensic training. Then, maybe based on the victim’s symptoms before death, the very smart local doctor begins to think someone is poisoning these people. This sets up conflict which is always a must. I would research the symptoms people have when they ingest the items you have listed. Then, maybe this local doctor can push the coroner into having a fancy, big-town ME do an autopsy.
3. http://jimfisher.edinboro.edu/forensics/fire/tox.html: forensic toxicology (poisonings)
Hope this helps and gives you some direction.

  

Principles of Poisoning: Part 1/3

Nothing will get a writer’s mind whirling like dreaming up the perfect poison to kill off a character. Is there a perfect, undetectable poison? Maybe, probably… but you’d be amazed at what might be available in your own bathroom cabinet.

If you’re going to use drug poisoning as a way to sicken or kill a character, there are a couple of things you’re going to need to research in order to figure out how much to give them, how long it will take the medication to take effect and what the patient’s signs and symptoms will be.

Consider these guidelines:

Guideline #1: What is a toxic dose of the drug/plant/poison? After all, you don’t want to hype up this scene where a character is poisoned and you’ve given them a normal dose of the drug. That would be very anti-climatic. One way to do this is to look for the LD50 which stands for median lethal dose. In very basic terms, it’s the dose of the drug that will kill 50 out of 100 people. Now, it may take less of the drug to kill some and some people may live through that dose as well, but it will be a good place to start from. You can also get a good gauge on this from looking at drug information sheets under the overdose or toxicology sections.

To read more on LD50:
1. http://en.wikipedia.org/wiki/Median_lethal_dose
2. http://www.rsc.org/pdf/ehsc/ld50.pdf

Guideline #2: When does the drug peak and what is its half life? These are time issues. Peak concentration is the maximum concentration of drug in the circulation. Generally, when the patient will feel the full effect of the medication. This is important to know because drug peak concentrations range wildly from a few seconds to days. Half-life is how long it takes 1/2 the drug to be eliminated from the blood. This is roughly how long the effect of the medication will last.

To read more:
1. http://www.beltina.org/health-dictionary/peak-level-drug-concentration-blood.html
2. http://www.wisegeek.com/what-does-a-drugs-half-life-mean.htm

Guideline #3: How is the drug metabolized in the body? This is important because whatever organ breaks down the drug will be overwhelmed by the amount of the drug and begin to shut down. In addition to this, it’s important to know what that organ does specifically. Acetaminophen is metabolized by the liver. Hence, its toxic effects and what ultimately kills the patient is the failure of this organ.

1. http://www.medicinenet.com/tylenol_liver_damage/page3.htm
2. http://www.medicinenet.com/script/main/art.asp?articlekey=191

Have you written a scene using a drug/plant/poison to injure or kill a character?