Author: Diana
Sunday, 02 July 2000 - 08:11 pm |        |
| I wasn't going to get into this because it is so disgusting, but the book indicates that he ate them. It seems there was no real attempt to eviscerate until #7 so I have to think he wasn't practicing on #'s 1-6. He didn't get the idea right away. Three of his female victims in the first (pre-evisceration) group were age 9, 12, 14, and 16. It would (I suppose) be harder to learn from the children because all the anatomical structures would be smaller and possibly configured a little differently. In any case it appears that the abdomens in the pre-evisceration group were not opened (stabs only). Chikatilo had 3 university degrees: Russian Literature, Communications Engineering, and Marxism-Leninism. There is nothing there that would have helped him. |
Author: Diana
Monday, 03 July 2000 - 03:09 pm | |
| In Education we have a term: Task Analysis. It means to take a complex skill and break it down into tiny steps, each step to be learned in succession. For instance, last week I was teaching a retarded child how to brush her teeth. The Task Analysis would have been as follows: 1. Gather up toothpaste and brush 2. Go to the sink. 3. Remove the cap from the toothpaste by twisting. 4. hold the brush so the bristles are pointing up . . . I won't bore you with the rest. If we can get Dr. Ind to do a Task Analysis on hysterectomy when he gets back from Spain then we can intelligently compare Nichols and Chapman and maybe answer rationally: How many steps are there? Which and how many of those steps did he master doing Nichols? Which and how many new steps did he have to master to do Chapman? That might enable us to decide whether there was a reasonable leap in skill from Nichols to Chapman. |
Author: Jill De Schrijver
Monday, 03 July 2000 - 06:09 pm | |
Hi Diana,
Actually that would be a great thing to do, not only on hysterectomy, but also on every task to subdue the victim, I would expand this on every victim, including Martha Tabram.
And as reaction to the previous discussion (sorry, have a deadline still running, so had not really the time to react earlier). Yes, you would be right in that destroying is easier than carefully mending. Besides that, men have the tendency to develop their 3D-mental-manipulation much better than women: tests with children have proven that in general, boys can manipulate difficult geometric forms faster and easier than girls, while girls are better with words. Probably this is a leftover of the hunter-gathering days when women were the center of the family life and taking care of their surroundings (communicating), while men had to envisage the aim of their hunting weapons and be silent so not to scare the deer away.:-)
Greetings,
Jill |
Author: Diana
Sunday, 09 July 2000 - 09:21 am | |
| Maybe we should coin a new word to describe what Jack did so it can be distinguished from what a respectable surgeon like Dr. Ind does. butcherectomy? messerectomy? jysterectomy? jykterectomy? Come to think of it, don't you occasionally find a child who likes to trap small animals and perform exploratory surgery? Nobody would accuse such an individual of having expertise! |
Author: Thomas Ind
Sunday, 09 July 2000 - 01:55 pm | |
Diana
Nice to read that the posts are still going. How to do a hysterectomy? There are som many ways to do a hysterectomy that I cant just post it there are whole books on it. However, as you asked I will give you a very simplified version of how to do an abdominal hysterectomy and just hope that no other gynaecologist is lurking on the site.
P.S. just for the record the uterus is in the pelvis not the abdomen. I probably said abdomen but dont always say what I mean.
PREPARATION
Numerous things such as checking patient, catheterising, scrubbing etc.
INCISION - JTR used a midline incision (well of sorts) so this is what I will describe
1 - Incise the skin
2 - Incise the subcutaneous fat
3 - Procure haemostasis with diathermy
4 - Incise the rectus sheath
5 - Separate the rectus abdominal muscles
6 - Enter the peritoneal cavity
7 - Incise the peritoneal cavity downwards to ensure no damage to the bladder
LAPAROTOMY
1 - Explore the pelvic and abdominal cavities
2 - Place the patient head down
3 - Mobilise the bowel out of the pelvic cavity and keep it up in the abdomen with packs
4 - Insert self-retaining retractor
5 - Direct light into pelvis
(The process of packing the bowel and placing the patient in a head down tilt allows light and access to the pelvis so you can see)
WILL CONTINUE IN NEXT POST |
Author: Thomas Ind
Sunday, 09 July 2000 - 02:00 pm | |
PS for those of you who haven't gathered I have just got back from Spain. Great holiday.
To the hysterectomies again;
HYSTERECTOMY
A - Place 2 clamps over the medial aspect of the round and ovarian ligaments on each die to help retract and mobilise the uterus
B - On each side;
1 - Enter broad ligament through round ligament FIGURE 1
2 - Identify the ureter (also need to identify the external, internal and common iliac vessels to identify this)
3 - Skeletalise a vascular pedicle (either infundibulopelvic or ovarian ligaments depending on whether or not the pvaries are to be removed)
4 - Clamp, cut and ligate (ensuring ureter not involved) FIGURE 2
5 - Incise peritoneum caudally and anteriorly mobilising the bladder FIGURE 3
(The rectum does not require mobilisation unless a radical hysterectomy for cancer is being performed)
5 - Skeletalise the uterine pedicle
5 - Ensure ureter is away
6 - Clamp, cut and ligate FIGURE 4
(If a subtotal hysterectomy is being performed leaving the cervix then the uterine fundus is now cut off from the cervix. The stump is sutured and the hysterectomy is over)
7 - Further mobilise the bladder FIGURE 5
(If the cervix is long take a third pedicle of the paracervical tissue laterally)
8 - Take a pedicle into the vaginal by clamping, cutting and ligating FIGURE 6
9 Remove the uterus FIGURE 6
(IN THE FIGURES THE CLAMPS ARE LEFT AND TIED AT THE END WHICH SOME SURGEONS DO. I TIE EACH ONE AS I GO ALONG)
CLOSURE
Suture the vault of the vagina FIGURE 7
Ensure haemostasis
Remove packs
Reposition the bowel
Close abdomen (wont go into details)
Figure 1
 |
Author: Thomas Ind
Sunday, 09 July 2000 - 02:06 pm | |
OK I'll try again
Figures 1 & 2
  |
Author: Thomas Ind
Sunday, 09 July 2000 - 02:13 pm | |
These images are a bit big and cluttering the screen. I wont send any more unless persuaded to however I will continue and try and send my last image
CLOSURE
Suture the vault of the vagina
Ensure haemostasis
Remove packs
Reposition the bowel
Close abdomen (wont go into details)
HOW I THINK JTR DID IT I AM PRETTY SURE THIS IS THE ONLY WAY HE COULD HAVE DONE IT
1 - Stand on patients right (I alternate the side I stand on between each case as some gynaecologists suffer from neck problems by always leaning in one direction)
2 Make slash/slashes (I will expand on this in the next post but to simplify, the way the knife was held in my opinion examining the drawings of Eddowes is not how a surgeon would hold a knife)
3 Place left hand in the pelvis and feel uterus (only organ that can be easily felt)
4 With one sweep of the knife make a circular movement extracting the uterus not mattering whether the ovaries or cervix are removed or if there is damage to the bladder or other vital organs such as the ureters, iliac vessels and rectum.
A - Broad ligament; B - Round ligament; C - Fallopian tube; D - Ovary; E - Uterosaccral ligaments; F - Cervix (dotted line as inside the vagina); G - Rectum; H - Infundibulopelvic ligament |
Author: Thomas Ind
Sunday, 09 July 2000 - 02:18 pm | |
| To further explain this drawing, the knife enters at the outer arc and cuts through to the inner arc |
Author: Jill De Schrijver
Sunday, 09 July 2000 - 03:42 pm | |
Thank you very much Thomas,
A question - How then would JtR have hold his knife?
And another one - I'm making Task Analyses flowcharts of every victim. May I incorporate your opinion of how JtR took the uterus in the flowchart of Chapman and Eddowes, since I have no professional knowledge?
Still a third one - Could you also try to do the same thing for the missing heart of MJK?
Greetings,
Jill |
Author: Diana
Sunday, 09 July 2000 - 04:16 pm | |
| So he basicly mastered 1 & 2 when he did Nichols and only needed to master 3 & 4 when he did Chapman. A lot of your steps are designed to leave the patient in good condition (i.e. don't cut the ureter) and that wouldn't be a concern for Jack. Thank you so much. I know it involved a lot of work. |
Author: Thomas Ind
Sunday, 09 July 2000 - 05:00 pm | |
Diana
NO
He never mastered 1 & 2
The incision, I believe was a stab and a saw (one movement)
The laparotomy was just a feel around (the uterus is the only hard feeling organ that can easily be grasped.
The uterus was removed in one movement of the knife but to do this I think you would have to hold the blade differently from my photo for the abdominal slash. I think it would be easier to do with it grasped with all the fingers and the palm with the handle at the little finger end and the blade coming out of the end with the thumb and index finger. The primary blade would be pointing away from the thumb and a 'back handed' slash could be made. That is always how I have imagined it but I will have to consider other movements now you and Jill ask. I still think it is possible that he didn't even know it was the uterus he was removing. |
Author: Diana
Sunday, 09 July 2000 - 09:19 pm | |
Under "How I Think JTR Did It" you say: 1. stand on patient's right 2. Make slash/slashes.
Dr.Llewellyn says regarding Nichols: There were no injuries about the body until just about the lower part of the abdomen. Two or three inches from the left side was a wound running in a jagged manner. The wound was a very deep one, and the tissues were cut through. There were several incisions running across the abdomen. There were also three or four similar cuts running downwards, on the right side, all of which had been caused by a knife which had been used violently and downwards.
I'm a slow learner but when I finally get it I get it pretty good. (-: I'm confused. Didn't Dr. Llewellyn describe your #'s 1 and 2? |
Author: Thomas Ind
Monday, 10 July 2000 - 03:58 am | |
No I am the bad listener.
Yes he described 1 & 2 of "How I T JTR Did it". I was mistaken (not reading properly) I thought that you were referring to my major headings of how I would do a hysterectomy as 1 & 2. |
Author: Diana
Monday, 10 July 2000 - 10:34 am | |
| One more question, Dr. I have long wondered why after his long fascination with uteri he failed to take MJK's with him. Two things you said awhile back jogged my thinking. In the one instance you stated that you attempted to spay a sow and the vet had to show you where it was, thus doing major damage to the theory that learning in one species transfers to another. Then you said he may not have even known which organ he was getting. I began to ask myself if there could have been anything about Mary's uterus that would have made it different from the others. I went through this process of reasoning before we heard from Kelly Jones and if her information turns out to be valid then my whole line of thought is wrong. All the other victims were mothers. With Mary we don't know. If Mary had never had a baby would her uterus have been significantly different in size and configuration from the others? So much so that Jack would not have recognized it as being the same thing? Or maybe he had some kind of sick need to take uteri that had nurtured life in the past and was disinterested in uteri that had not? My suspicion is that if one has had a baby the uterus never entirely returns to its prepregnancy size. |
Author: Thomas Ind
Monday, 10 July 2000 - 11:05 am | |
| There are some subtle difference between the uterii in women who have had children and those who have not. However, not even I can notice them all the time. |
Author: Diana
Monday, 10 July 2000 - 04:33 pm | |
Then I think that I would have to put down his taking of the heart rather than the uterus to his evolving inner discovery process whereby he, through performance of various mutilations found out which provided him with the greatest satisfaction. A behaviorist model would refer to positive reinforcement. If such is the case and he escaped to another country, then we would be wise to look for successive victims with thoracic rather than pelvic mutilation. However this might only occur a few times before he moved on to something else. He got Chapman's uterus, and Eddowes uterus. He extracted Kelly's but was bored enough with uteri by that time to leave it behind and take the heart instead. BTW if one is disposed to disparage the self-teaching model, note that Kelly was the first one on which he attempted to take a heart and he got it on the first try. (I know what you're going to say -- He had more time.) I'm going to double check Jill's wound drawings. It seems to me he did cut rather high on Eddowes -- maybe to the breastbone? Maybe he was starting to think about hearts by that time. Nichols had no thoracic wounds, nor
(of course) did Stride and I don't think Chapman did. Of course on Eddowes he was already starting on the face which came to its full development with Kelly. |
Author: Diana
Monday, 10 July 2000 - 04:46 pm | |
| I was right. Before Kelly nobody but Eddowes had cuts going up that high. I wonder if the mutilations of Eddowes liver were the first tentative (and ignorant) efforts to find the heart? He might have thought that if he demolished the liver he could get under and behind it to the heart. A frontal assault would have been difficult because of the breastbone being in the way. |
Author: Simon Owen
Monday, 10 July 2000 - 06:26 pm | |
| Diana , I think you are right ! Well done ! |
Author: NickDanger
Monday, 10 July 2000 - 08:18 pm | |
Hi Diana,
If you are interested in possible motivations for the removal of the uterii in two of the victims, please take a look at Roger Barber's essay on Edward Buchan in the 'Dissertations' section of this website. While Barber does overstate his case a bit, he presents us with an interesting possibility. I'd genuinely like to hear your take on it.
Best regards,
Nick |
Author: Jill De Schrijver
Tuesday, 11 July 2000 - 04:22 am | |
Hi Diana,
I think it is safe to say that the cut made with Eddowes, could have its reason in that JtR was really getting interested in what is inside the body, learning it's anatomy so to say. But I would not think that the liver is an indication of getting at the heart: when people have not much anatomic knowledge then tend to think that the heart is at the left side of the chest, while in fact it lays very central.
I also agree that if he moved onwards on other victims, more thorax mutilation to rib cage and removal of organs like lungs and heart would be perceivable. |
Author: Thomas Ind
Tuesday, 11 July 2000 - 12:21 pm | |
| The liver is on the right side not the left. |
Author: Diana
Tuesday, 11 July 2000 - 12:39 pm | |
| Aargh! do I feel dumb. Unless maybe JtR was dumb too or in the haste of the moment forgot that his right would be her left. Or maybe he just thought the fool thing would have to go if he was going to be able to access the thorax from any angle. I just read Bond's autopsy to see what he did with Mary's liver but I couldn't find anything. Think I'll go and look at that awful picture again. |
Author: Diana
Tuesday, 11 July 2000 - 12:57 pm | |
| I am no anatomist(obviously), but I would think that if he had left Mary's liver where God put it, it would be visible in the area between the arch of her wrist and the edge of her rib cage. That area is filled with tissue(?) of an undetermined nature but a definitely light color. Observations at the meat counter at Kroger lead me to believe that if the liver were in situ we would be looking at something large, and dark-purplish in hue. Of course since the liver is on the right it could (possibly) be hidden by her forearm. Ok, everybody, you may now stop laughing and resume breathing. (-: |
Author: Diana
Tuesday, 11 July 2000 - 01:34 pm | |
| Doubledumb! It was her left arm that would have been obscuring anything and anyway as you have so astutely pointed out the liver is on the right. (Remember, I said I wasn't visuospacial!) Since I am having an attack of the stupids today I am a little reticent to continue, however emboldened by the subnormal functioning of my CNS I press on. I have visited the Victims section of the Casebook. That elusive liver was removed and can be clearly seen laying between her feet. Jill, it looks as though from the photograph her entire abdomen was emptied from the pelvic area to the base of the ribs. I wondered in my bumbling way if maybe your drawing of Kelly needed to be adjusted just the teensiest bit to reflect that. I'm wondering if, in order to reflect the shifting nature of Jack's obsessions a chart could be generated with various organs and body parts as the vertical axis and the victims in temporal sequence as the horizontal. I probably should do the work myself instead of always suggesting it to other people. |
Author: Jill De Schrijver
Tuesday, 11 July 2000 - 04:09 pm | |
| At your request I will see what I can do: I think I drew the hole in the abdomen as much as was referred to in the post-mortem, but I'll recheck it since it would be logic there should be a very large gape for him to reach under the rib cage for the heart. And to do that he certainly would have needed to remove the liver. |
Author: Thomas Ind
Tuesday, 11 July 2000 - 05:02 pm | |
Diana.
I have had my fun at your expense.
Now I must come clean.
I sympathise with your mixing up left with right. I do it all the time. (Don't worry I've never taken out the wrong ovary or operated on the wrong side).
The main bulk of the liver is on the right side. However, the left lobe of the liver crosses the midline and the vena cava (main vein leading to the heart) passes through it. So you are in fact correct that it is quite feasable that the liver is damaged in removing the heart through the abdomen. |
Author: Diana
Tuesday, 11 July 2000 - 09:12 pm | |
| Well!!!! DOCTOR, I never . . . (-: |
