The “roughly triangular, parchment-like rust colored abrasion”

Discussion in 'JonBenet Ramsey' started by otg, Dec 22, 2010.

  1. otg

    otg Reports of my death are greatly exagerated... but

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    >>>>> PLEASE, this will be a long post, so if you quote from it in your responses,
    only cut the part you want to address and not the entire post. <<<<<


    Since the autopsy photos were made public, there have been several marks that troubled me. One is the round mark just below JonBenet’s right ear. The two small marks on her back which Smit tried to tie to a stun-gun also interest me, but I can’t account for them either.

    But the one I thought I might be able to start with is the triangular mark on JB’s left side of the neck. As DeeDee249 has pointed out previously, it is very similar to a mark that shows up in some other photos of victims who died as a result of some type of ligature strangulation. This being the case, that this particular type of mark is somewhat common in strangulation victims, I would think that pathologists would have a name for it. But if they do, I haven’t yet found it. But what I have found out is that there Is possibly a simple explanation for it, but it requires a little anatomical knowledge (which I did not have before starting).

    Since I don’t have a medical background, I didn’t understand what all of these marks were, so I didn’t give them a great deal of attention. But I can read and I’m determined to find out what each of these mean. I invite anyone to participate in this discussion, regardless of their slant toward ultimate guilt, because I don’t see it as pointing to “who did it” as much as simply “what caused it”. I especially hope that anyone with a medical background, or access to someone who does, will add to this so we can understand what it means, and whether or not my conclusion is correct.

    Here is what was written in the AR by Dr. Meyer:
    “The area of abrasion and petechial hemorrhage of the skin of the anterior neck includes on the lower left neck, just to the left of the midline, a roughly triangular, parchment-like rust colored abrasion which measures 1.5 inches in length with a maximum width of 0.75 inches. This roughly triangular shaped abrasion is obliquely oriented with the apex superior and lateral.”

    The information that follows is based on about a dozen or so different sources. I made notes as I read and have digested and compiled it (not to mention a lot of copying and pasting) with what I found. (IOW: Don’t think that I use words like this in ordinary conversation.)


    First of all, we all probably think of an abrasion as something caused by a rubbing action which causes some type of visible damage to skin. But if a medical person sees some type of damage and doesn’t know the cause, he might refer to the area as an abrasion because of its definition in dermatology. In other words, he is not addressing its cause, but rather its appearance.

    When we (maybe I should say “I”, as a lay person) think of a cut, a bruise, or an abrasion, we (or, I) think subjectively to the cause of each. When a pathologist uses these terms, he/she is thinking objectively to the appearance until he/she establishes the cause.

    “In dermatology, an abrasion is a wound caused by superficial damage to the skin, no deeper than the epidermis. It is less severe than a laceration, and bleeding, if present, is minimal.”
    http://en.wikipedia.org/wiki/Abrasion_(medical)

    Now we need to understand a few terms that will be used here. It may seem simplistic, but let’s start with an understanding of the words petchiae, purpura, and ecchymoses. All of these are commonly referred to in lay terms as types of bruises (or contusions), and each is more correctly defined by the length of its diameter as either a petechia (< 3 mm), purpura (3 mm to 1 cm), or ecchymosis (1 to 3 cm). While there are different causes of these, including some types of diseases or medical conditions, and they may be present in different areas of the body, they are all manifest as a darker discoloration of the surface of the skin, and they are more pronounced and visible on a lighter-skinned person.

    Since none of the autopsy photos available to us show the area with the scale close enough to see for ourselves, we have to use the only measurements given in the AR as 1.5” by 0.75” (3.8cm by 1.9cm). If you look at the photos showing this area, you see that at what Dr. Meyer refers to as the apex of the triangular area (actually it is more cone shaped because it is rounded at the base), the darkness of the discoloration begins to fade away and is not as pronounced as it is in the center of the rounded area (or the base of the triangle), and it ends at the ligature furrow. Because of its size, let’s look at what an ecchymosis is and what causes it.

    An ecchymosis is a skin discoloration due to hemorrhage (bleeding) under the skin. A small hemorrhagic spot in the skin or a mucous membrane, larger than a petechia, forming a nonelevated, rounded, or irregular purplish patch, caused by the passage of blood (extravasation) from ruptured blood vessels into the interstitial subcutaneous tissue as a result of trauma to the underlying blood vessels.

    An ecchymosis should not to be confused with a hematoma which is a pocket or localized collection of blood usually in liquid form within the tissue. This distinguishes it from an ecchymosis, which is the spread of blood under the skin in a thin layer. Nor should an ecchymosis be confused with internal bleeding which is generally considered to be a spreading of blood within the abdomen or skull, not within muscle tissue.

    Ecchymoses (or bruises) are actually made of little pools of blood, so the blood in one place may flow toward the ground, and the bruise may appear in another location. Bruising present in a different location than the actual site of impact is called ectopic bruising and occurs when the tissue at the site of injury is loose, allowing blood to travel under the skin to another location due to gravity or other forces.

    A bruise forms from seepage of blood in an internal wound. The blood gradually decomposes, changing color from red to blue as hemoglobin loses its oxygen, and then to yellow as the hemoglobin is reabsorbed. Bruises change colors over time in a predictable pattern, so that it is possible to estimate when an injury occurred by the color of the bruise. Initially, a bruise will be reddish, the color of the blood under the skin. After one to two days, the red blood cells begin to break down, and the bruise will darken to a blue or purplish color. This color fades to green at about day six. Around the eighth or ninth day, the skin over the bruised area will have a brown or yellowish appearance, and it will gradually fade back to its normal color.

    After an injury, the color changes that occur are due to the breakdown of hemoglobin from within escaped red blood cells in the extracellular space. More specifically, the striking colors of a bruise are caused by the phagocytosis and sequential degradation of hemoglobin to biliverdin to bilirubin to hemosiderin, with hemoglobin itself producing a red-blue color, biliverdin producing a green color, bilirubin producing a yellow color, and hemosiderin producing a golden-brown color. As these products are cleared from the area, the bruise disappears. Oftentimes the underlying tissue damage has been repaired long before the process is complete.

    (end of aggregate quotes)

    So, with all of this newly found knowledge (for me at least), let’s consider that the area in question is from the subcutaneous pooling of blood (seems like DeeDee may have told us this before) caused by the trauma to the neck. Then the question becomes why or how did it form in this triangular or cone-shaped pattern?

    To answer that, take a look at what the surface of the neck looks like in relation to what is underneath the skin. Here are two illustrations from Gray’s Anatomy on Wikipedia:
    http://en.wikipedia.org/wiki/File:Gray1195.png
    http://en.wikipedia.org/wiki/File:Gray1194.png

    Here is the subsurface musculature:
    http://en.wikipedia.org/wiki/File:Gray385.png

    There are four distinct frontal (anterior) triangular areas that are formed and shown in the shaded areas here:
    http://en.wikipedia.org/wiki/File:C..._for_tringles,_labeled_trianglesanteriorT.svg

    These are better shown in the following illustration (taken from the site http://home.comcast.net/~wnor/lesson5.htm):

    [​IMG]


    Excluding the purple posterior triangle, the four anterior triangles are submental (smen), submandibular or digastric (sm), muscular-visceral (mus), and carotid (car).


    The area we are most interested in is the carotid triangle shown here:

    [​IMG]

    If you place your thumb and fingers around your own neck and apply a little pressure, you can feel the area this is referring to. You’ll notice also by feeling around a bit that this triangular area has no muscles or structures close to the surface, and it represents somewhat of a voided area in this respect.

    I believe that the reddish triangular (or cone-shaped) area shown in the autopsy photos and described in the autopsy report is caused by the rupture of a blood vessel, or a number of small capillaries, in the area of the base of the triangle (or cone). As these capillaries bled outward from the center of the traumatized area along the subcutaneous layer, the blood would be slightly restricted within the carotid triangle, an eventually work its way upward as it begins to trail off toward the apex and end at where the ligature furrow is.



    Additional reading:


    Gray’s Anatomy:
    http://www.bartleby.com/107/

    3a. 3. "The Triangles of the Neck":
    http://www.bartleby.com/107/pages/page562.html

    3b. 2. "The Veins of the Neck":
    http://www.bartleby.com/107/illus558.html

    "Anatomy of the human neck":
    [ame]http://en.wikipedia.org/wiki/Neck[/ame]
    .
     
  2. Steely

    Steely New Member

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    Thanks for all these links, OTG.
    I found this interesting discussion of petechial hemorrhage:
    http://www.nlm.nih.gov/visibleproofs/education/medical/index.html

    What about the "parchment like" nature of this abrasion? I still suspect a curling iron burn because of the description "parchment like" and the conical shape.

    From:
    http://pedsinreview.aappublications.org/cgi/content/extract/25/12/411

    "A third-degree burn is the most serious. It appears pearly white, charred, hard, or parchmentlike. The dead skin (eschar) is white, tan, brown, black, and occasionally red. Superficial vascular thrombosis can be observed; there also can be focal tissue loss with prolonged exposure and a soapy-looking lesion that is found in alkali burns."
     
  3. txsvicki

    txsvicki Active Member

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  4. otg

    otg Reports of my death are greatly exagerated... but

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    I'm not sure if my images showed up in the original post, so I'm posting that section of the post using a different link.

     
  5. my_tee_mouse

    my_tee_mouse Done. Put a Fork in Me.

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    Otg, you certainly did your homework! If only LE had been allowed to approach this case with as much passion and perseverance as you!
     
  6. wonderllama

    wonderllama Registered Snoozer

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    Aren't there plenty of Hollywood movies where someone doing their own research into a case bugs the cop who suddenly sees their work and reexamines the evidence?

    D'oh!
     
  7. DeeDee249

    DeeDee249 New Member

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    Outstanding post, otg.

    I have to rule out any kind of burn, curling iron especially, as the cause of the large triangular mark on her throat. No way would a coroner not see that as a burn, and no way is that part of her throat (or any other) near to where a curling iron would hit it. In view of the fact that OTHER strangulation victims have similar marks on their throats, I cannot believe they have all been burned with a curling iron.
    After death, a bruise will not go through the same kind of color changes, as it will not "heal" after death.
    For myself, I have completely ruled out any type of late-night photo session primping.
    The skin loses elasticity very quickly postmortem, and that may be the reason for the parchment-like appearance.
    I would bet that JB was the only strangulation victim the coroner had even seen. Had he done more research, he'd have seen- just as we have- that the mark appears on other strangulation victims.
     
  8. otg

    otg Reports of my death are greatly exagerated... but

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    MTM (if I may call you that), I think there were people on the BPD who sincerely wanted to see justice done, but as you imply, were thwarted at nearly every turn. We all know why, and by whom.

    (BTW, Mighty Mouse was my hero when I was growing up. I knew every word to his theme song.)
    .
     
  9. Steely

    Steely New Member

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    I'm certainly not an expert on strangulation victims, I admit that. But, from the few photos I have seen, the neck marks are not nearly as uniform a shape as the one on JB. The abrasion on JB looks like a cone. I find the defined lines of that mark coupled with the other marks (some suspect to be stun gun marks) reminiscent of branding type burns. The coroner failed to get tissue samples from the abrasions to send to a pathology lab. I don't have much faith in the coroner's thoroughness and infallibility. Curling iron burns could be anywhere on the body if they weren't accidental.
    Here's one example of a curling iron burn on someone's arm. Note the cone shape.
    http://alexevans.net/page/22/
     
  10. SunnieRN

    SunnieRN Active Member

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    Hi Otg, I am not a coroner and the people I see are patients, still alive, still healing, but there are a few areas I would love to address.



    Otg, I do not in any way shape or form, believe these marks are from a stun gun. I have seen stun gun injuries on prisoners who were at our community hospital in the past. They are uniform in shape. You could place one on top of the other and they would be identical. These marks were all three different.
     
  11. SunnieRN

    SunnieRN Active Member

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    I also could not find a word for the mark which mostly results from strangulation with a soft object. The mark is very distinctive. I wish we had a coroner at our hospital as a coroner would most likely be the person to have a name for this mark.It amazes me, the mark that a softer object leaves, verses a rope or a wire. I would think that exerting the pressure to the neck would create the mark, not the type of object that is used. The act of strangulation is occurring, exerting pressure, so all I can figure out, is that the softer cloth may more easily 'crimp' a portion of the skin. The fact that the mark is always in the same spot would have me tend to turn away from that theory however.
     
  12. SunnieRN

    SunnieRN Active Member

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    You explained perfectly, the types of skin injuries that occur. The differences in them as well as how they differ from bruises, blood blisters or blood pooling. Now that we understand the type of mark on JonBenets neck, we also understand the type of object it was most probably made by.

    The next question is where there sexual choking games occurring in the Ramsey household. If so, between whom. Does it have anything to do with the scarf that was placed in JonBenets coffin? Or am I heading too far ahead at this point?
     
  13. Agatha_C

    Agatha_C New Member

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    Okay, here is another crazy thought. I'm throwing this out there because so many here know so much more than I about autopsies and wounds.

    Is it possible that those burns or marks came from the model train. This idea came to me while setting up our train under the Christmas tree. We have a Lionel train with an "O" gauge track. Our trains power source plugs into the wall, its not run on batteries. While setting it up, my husband was shocked and a small mark was left behind.

    No matter how hard I pleaded, hubby and dog were not down for further experiment (LOL) even when I was willing to be the victim (sissies). I'm not saying that I firmly believe this to be the case, but rather I am speculating on what other then a stun gun could have left those marks.

    Also, I have read that BR was shocked by a deer fence at the FWs on the 25th(?) Does anyone know if thats just another rumor? Could the marks on JB have come from that fence as well? If BR was shocked, why did anyone feel the need to point that out? Any thoughts on this?
     
  14. Agatha_C

    Agatha_C New Member

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    Oh, let me clear this up... By marks I mean those on her back and the burn looking marks on JBs face. I am not throwing a dog in the strangulation hunt (what ever DeeDee says, thats my opinion too...lol....).
     
  15. otg

    otg Reports of my death are greatly exagerated... but

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    I suppose the mark we are talking about could have at least several different explanations, including some type of burn. One of the confusing components of this is whether or not it was inflicted or occurred before or after death, and how the body reacts in either state. But since the same type mark, as has been pointed out, occurs in other strangulation victims, I thought we should look for a medical explanation. Being that my background is not medical, it is perhaps more difficult for me. However, after reading the information I've passed along, I am of the opinion that the cause of the mark (with JB, and as seen in other cases) is (from the quote above) "the passage of blood (extravasation) from ruptured blood vessels into the interstitial subcutaneous tissue as a result of trauma to the underlying blood vessels". IOW, as our resident nurses have called it, "blood pooling". Hopefully, that makes sense.

    And thank you, Steely, for the links. I will read those later when I have more time.
    .
     
  16. belimom

    belimom Our lives begin to end the day we become silent ab

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    I first of all don't think it's a burn because the ME would have called it a burn, IMHO, not an abrasion. I do think it's possible that the whole cord/strangulation could have been set up to cover up the triangle mark. That's a theory that I have read elsewhere - and that the triangle mark may be key in what had happened previously that evening.
     
  17. otg

    otg Reports of my death are greatly exagerated... but

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    Exactly my point, DD.

    Since I (we) haven't yet found a name for this phenomenon, perhaps we can give a name. Let's refer to it as a "CTE" -- Carotid Triangle Ecchymosis. By golly, we may have something. I think I'll drop a note to Turvey.

    Yes! Understanding the different color changes that occur with something of this nature would only be important for estimating the age of an injury. Since this "bruise" occurred just prior to her death, it did not have time to begin the healing process and change colors. It simply reflects the color of the blood that gathered in the area. Do you see in the autopsy photo how it kind of begins to fade as it (IMO anyway) gets further from what I believe is the center from which it emanated? This would be the area Meyers refers to in the AR as the apex of the triangle.

    Again, I agree with you, DD. Actually, Dr. Meyers was younger than I had always thought. I had in my mind the image of a much older man (elderly actually), until I saw a picture of him. He couldn't have seen very many strangulation victims, especially if his experience was limited to Boulder.
    .
     
  18. SunnieRN

    SunnieRN Active Member

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    Well Otg, after having nightmares due to your Grays Anatomy pictures and the horror that was preparing for my instructors anatomy part of my A&P courses, I slept, a couple of hours. I thought about what I typed earlier and I can't get out of my mind why strangulation by one device, differs in looks from another. When we were in A&P, we had several 'corpses' used for our anatomy portion of class work. One of the bodies was a young girl who had been strangled.

    At the time, we all thought that was very morbid and spent more time trying to disassociate from her fate, rather than pay attention to the lessons her body bore. The neck is surprisingly strong. There are vulnerable area, near the spine, the hyoid bone, the thyroid, glands, nerves and the jugular veins, to name just a few. But there is a lot of muscle tissue also. My instructor used to tell us "It takes a lot of muscle to hold up those fat heads of yours."

    So, we asked, how is someone so easily strangled? He looked at us like we had three heads and said, "It's caused by severe hypoxia." Ummm, but why is it so easy to kill someone this way?

    "That's anatomy and physiology," he said, grinning ear to ear. "The complexity of the human body is that in it's strength, are it's most vulnerable weaknesses."

    Brilliant man, he gave me a headache! So, the past several minutes, I researched strangling games, for curiosity sake. To think about this possibility, I had to think about whether there was a possibility, let alone a probability, that JonBenet could have been exposed to these behaviors or games. The R's were a mixed family, with adult children and smaller children. They were active in church, with children of different ages, sports, travel and communities. There is also speculation put forth concerning Patsy and her sisters possible abuse.

    I found this article, which gives background on the 'choking game'. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5706a1.htm

    One excerpt is:

    The earliest choking-game death was identified as occurring in 1995. Three or fewer deaths occurred annually during 1995--2004; however, 22 deaths occurred in 2005, 35 in 2006, and nine in 2007. Seventy-one (86.6%) of the 82 decedents were male, and the age range of decedents was 6--19 years, with a mean age of 13.3 years (standard deviation = 2.1) and a median age of 13 years. Age distribution of the 82 choking-game decedents during 1995--2007 differed from that of the 5,101 youths aged 6--19 years whose deaths were attributed to suicide by hanging/suffocation during 1999--2005§ (Figure).

    Among the 70 deaths for which sufficient detail was reported, 67 (95.7%) occurred while the decedent was alone. Among the 42 deaths for which sufficient detail was reported, 39 (92.9%) parents of decedents said they were not aware of the choking game until the death of their child.

    Choking-game deaths occurred in 31 states; no geographic clustering was evident. Deaths did not vary significantly by season or by day of the week. No information regarding decedent drug use, race/ethnicity, or socioeconomic status was available.


    Interesting and this leads me to further believe why the scarf was placed with JonBenet. There are a lot more articles, I just found the 1995 date interesting in this one.
     
  19. madeleine

    madeleine New Member

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    Was the scarf placed on her neck or just thrown in the coffin next to her?

    Cause maybe this means (on her neck) that they wanted the neck injury covered because this was the injury that meant something and they just didn't wanna see it anymore?

    Another thing,they always claimed they never read the autopsy report and had no idea what injuries JB suffered,etc.Well if the neck injury was ugly enough to be covered with a scarf then I guess they had a pretty good idea re what happened to her?
     
  20. joeskidbeck

    joeskidbeck Rest in Peace

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    Maddy, I read the other day and I believe the account was from DOI, that John wanted the scarf buried with her and that it wasn't around her neck but, more or less, draped around her shoulders like a shawl. That was the impression I got anyway. This would lead one to believe he just wanted the scarf burried with her and was not trying to hide her neck. I will go back and see if I can post a link directly to that passage.
    Becky
     

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