Archive through July 2, 2000

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Archive through July 2, 2000

Casebook Message Boards: General Discussion: Medical / Forensic Discussions: JTR's Hysterectomies: Archive through July 2, 2000

Author: Lindsey Wednesday, 19 January 2000 - 12:28 pm
I wasn't sure where to post this non-hysterectomy related question, but in response to Jon's above remark to Mike that P.C.s didn't wear watches, Don Rumbelow's 'Complete JTR' (pg. 83, last paragraph, re: Eddowes' Inquest) states, "If his (Watkins) times were correct - and Watkins said that he checked his watch immediately after speaking to the watchman..." Would this information be correct/mistaken/outdated? Admittedly, though, with or without a watch, I personally can never be completely sure of the correct time, and I would agree with Jon that the stated times were probably relative. ~Lindsey
Author: Thomas Ind Wednesday, 19 January 2000 - 02:32 pm
ALL I work at Barts and the Royal London but you don't have to steer clear of these hospitals because your surgeon is more interested in JTR during your operation. There is a lot of boredom and waiting aroung in theatre. Between cases you sit and wait sometime for up to an hour for your anaesthetist to wake your patient and put the next one to sleep. That is the time I might think about JTR and in relation to an operation I might have just performed. Not during the procedure. Although I would like to say that I can perform a hysterectomy with such ease that my mind can wonder with thoughts of JTR, I'm afaid it does not and is concentrated on the job in question. Mike Thanks for you ethical thoughts. Perhaps though I might sell it as no one seems to think the experiment would be worthwhile. We agree on almost everything I am glad to see. The one matter is the degree of surgical skill which we disagree. At Eddowes inquest Sequeira & Saunders both thought that the murderer had no designs on any partcular organ and didn't display any particular anatomical skill. Brown thought that it was deliberately sought but did not think that the degree of knowledge and skill displayed would only have been possessed by a medical man. (All this is according to Sugden). Mike has suggested that the uterus was the organ that suggested the most skill. Well I know that I am biased here but I think that it would be the easiest to remove by luck. It is the only 'sticky uppy pointy thing' in the pelvis. I could remove a kidney as well but to find it would take me longer. Furthermore, the more and more I read about the murders the more and more I think that there are factors against surgical knowledge. I think many of the injuries (for example the abdominal excision) are positively against it. I would make a nice clean (and quicker) entry into the abdominal cavity and I'm sure you would too Mike. Penultimately, I think that Bob's statement about preparing foul etc is important. I stated earlier that I didn't think that the skill was important but lack of being squaemish. Perhaps if that was the case Bob then more people in those days would be up to a such a dissection. Finally. We have all talked about a 'Forensic and medical section'. Is anyone inclined or know how to take the lead P.S. I have some interesting information about Eddowes remaining kidney that I will post once someone else on this site has commented via a personal e-mail. PSS I've given up on trying to spell correctly or form any kind of gramatical sense
Author: Jon Wednesday, 19 January 2000 - 06:32 pm
Your quite right Lyn, Rumbelow did make that statement, about Watkins having a watch, Rumbelow said it, but we are not sure if Watkins did. Watkins testimony in the PRO copy of the inquest makes no mention of it, and the coverage contained in The Daily Telegraph also is silent on that detail, so we might wonder where Rumbelow got that from. There may have been the odd beat cop who carried a watch but we are short of any statements to that effect, and PC Harvey refered to the Post Office clock, so its not likely he had one either. George Morris, nightwatchman at Kearley & Tonge might have known exactly what time it was, from a clock in the offices. But unfortunatly most of the stated times throughout the case were all relative, except those given by Doctors & Detectives. (Psst....I think were on the wrong board for this chat :-) ) ~Jon
Author: Christopher-Michael Wednesday, 19 January 2000 - 08:56 pm
Hello, all - I've started a new discussion under the heading of "Medical Roundtable: Forensics, Pathology, &c." in order to cover some of the various discussions we have been having and to give all the medical thoughts a place of their own. "Forensics" and "Pathology" are self-explanatory, and the "&c." is to cover other areas; a discussion of the Lusk Kidney would be nephrology, for example, and thoughts on the ease of locating a uterus possibly under gynaecology (or surgery). See you there, CMD
Author: Thomas Ind Thursday, 20 January 2000 - 01:33 pm
THIS THREAD IS NOW CLOSED Lets go to the round table P.S. My e-mail is up again. Have replied CMD. I think it is my server at work that is the problem but not that at home.
Author: Diana Tuesday, 27 June 2000 - 02:31 pm
I am reading a book by Richard Lourie entitled Hunting the Devil. It is about a Russian serial killer and the eventually successful efforts of the KGB to track him down. The man's name was Andrei Chikatilo. He was a man whose job was to supervise shipments from one factory to another. He had no anatomical background at all. I quote from page 79. "The uterus would be taken with such precision that every surgeon in Rostov Province would become a potential suspect." AC taught himself during the course of his mutilating activities to do this. It did not happen with the first killing or the second, but over time he taught himself. There are many things about this man's career that illuminate facets of JtR, so much so that when I finish the book I think I'll open a new thread on other SK's, not because I want to broaden the main topic of these boards, but only for the purpose of shedding light on JtR. We could have subsections on Ted Bundy, the Black Dahlia, etc. and perhaps some of the parallels would illuminate JTR further. Personally Chikatilo has finally settled the question of anatomical knowledge for me.
Author: Jon Smyth Tuesday, 27 June 2000 - 09:21 pm
Diana Thats a book I have too, its in my 'to read' pile. I tend to buy SK related books for the same reason, but never get around to reading them. I saw the movie about Chikatilo, very good, Donald Sutherland plays the Russian police 'captain'? that persists against all his superiors to hunt him down. From the book are you able to determine about how many victims Chikatilo had before he was able to remove organs 'professionally'?. I know this 'practice makes perfect' theory has been applied to Jack, but in my opinion Jack never had enough victims to practice on. Unless there were bodies discovered with organs missing all over the place that we know nothing about. If Jack had practiced about 4 or 6 times prior to Chapman or Eddowes I would believe it, but as it stands, the 'practice makes perfect' theory for Jack is groundless. Regards, Jon
Author: Diana Tuesday, 27 June 2000 - 09:59 pm
As a teacher I may be able to speak to this problem. The number of exposures to a concept that is neccessary to learn decreases in inverse proportion to the subject's IQ. In other words the smarter you are, the less practice you need in order to learn something. Removal of a uterus is a sensorimotor process as opposed to a language process. It comes closer to riding a bicycle than reading a book. The brain is receiving various inputs during the learning process. The visual imagery of the abdomen and its contents, tactile perceptions of how tough various layers of tissue are to cut through, there may even be some olfactory input. Once when my cat scratched me I thought I detected a faint ripping sound. There may have been auditory inputs. The CNS of the killer instructs the hands to make various motor movements and the sensory inputs inform the brain as to whether that motor activity accomplished the intended objective or if there has to be modification and fine tuning. Then there is the (oh, I can't think of the name for it), but its a sense that allows you to know the position of your own body in space. When the Dr. tells you to close your eyes (to eliminate visual input to the CNS) and touch your nose he is testing that and if you are normal you can do it. Jack would have used that too. I still think that the abdominal cuts in Polly Nichols were the first tentative efforts to get at the uterus and even though he didn't succeed he had a whole week to think about what he had done, what worked, what didn't work, why it didn't work, what to try next time. Motivation also accelerates the learning process and there is no doubt that Jack was certainly highly motivated. When I get back to the Chikatilo book I will try to find out how many practices he had. I have no idea if this is true or not (Help Dr. Ind!) But if the biggest obstacle would be to get through the skin and subcutaneous fat and perhaps a layer or two of muscle and he learned most of that on Nichols, then he might have been ready to take the uterus when he got to Chapman.
Author: Jon Smyth Tuesday, 27 June 2000 - 10:30 pm
Did Chikatilo do any of this in the dark? I can understand what you are refering to, but surely this does not equally apply when you cannot use your sight, your going by touch mainly, as Jack must have. Learn in daylight, apply at night. That sounds resonable. But are we supposed to believe that one dark night Jack experimented, then one week later, after a lot of thought, he managed to impress the Doctors? Thats a bit of a stretch.
Author: Diana Wednesday, 28 June 2000 - 06:03 am
Intelligence is not one amorphous glob. We all have strengths and weaknesses. For instance I am very verbal. That portion of my CNS functions very well and this is not unusual because there are some gender differences in brain function. Overall women tend to do better in that department. Men have other areas in which they excel as opposed to women. That is probably one of the reasons I succeed as a teacher. But don't ask me to do tasks involving visual-motor integration. If you choose me for your team in any sport you will soundly regret it. Incidentally some men are very good verbally and some women are poor verbally. I'm speaking in the broadest terms. Certain people have great ability in understanding and interpreting visual input. Others have the same ability with relationship to tactile input. If God has also gifted them with exceptional motor skills (coordination)then they could learn the things we are talking about very rapidly with little practice and less than optimal input. Superior visual-tactile-motor integration is necessary for people like Dr. Ind who makes his living doing delicate surgery. You could also find these areas of exceptionality in a watch maker, an artist or an auto mechanic. I suspect Jill has exceptional visual-motor skills as well as exceptional language skills and very good visual-language-motor integration. I say this because of the outstanding job she has done in learning and using English, even to the point of being able to interpret post mortem reports and translate them into well-done drawings. I have also noticed her insightful and precise analysis of the Kelly Crime Scene photos. Mr. Radka is probably very good at razor edge analytical thinking. If he wasn't he couldn't interpret all those complex tax laws. There are people who are very good analytically and/or linguistically that have terrible motor skills. I've had two students in the last five years that were at the top of the class in every other respect but their fine motor skills were awful. The point I'm trying to make is that Jack didn't have to be a genius in the overall sense. All he would have needed were above average visual-perceptual skills (CNS is superior in ability to assimilate and use visual input -- creates detailed and utile 3-D mental images in memory and cerebral cortex manipulates them much in the same way as a computer imaging program does), above-average tactile perceptual skills (same as visual-perceptual except input is tactile)very good motor skills (coordination) and good integrative ability (the cerebral cortex takes those well assimilated inputs and is able to send appropriate messages to the lower brain centers which process them exceptionally well into motor output)(motor output = action). I was struck by the fact that Dr. Ind once said something to the effect that it wasn't all that difficult to locate and remove a uterus. At the time my reaction was -- yeah, right. You've had years and years of training. But there's another factor. Dr. Ind would probably not be doing what he is doing if God had not gifted him with superior abilities in the areas we have been talking about. So it seems easy to him. (I'm sure the Dr. has many other abilities too. His language receptive skills would have to be very good to digest all those complex textbooks encountered in medical school).
Author: Jill De Schrijver Wednesday, 28 June 2000 - 08:28 am
Hi Diana, The question about having above average skills, is "how you aquire them?". First of all to be exceptional these skills must be partly innert to the person, in other words you can practice whatever you want, you'll never develop high skill without the 'talent': in my case I know very well from which lineage my visual-motor skills come from - my grandfather was an architect, although only average and my mother always was good in drawing although not trained, my father can hardly put a straight line on paper. This 'taelent' is what you are referring to with JtR in this discussion. But, you can have all the talent you want, if you do not practice anything, you will get as far as the non-talented who had to learn all by practice. Which means that if my father would have tried to learn to draw he would have a result of the same level as my mother now has (I've seen how much two years of sketching classes can result to with people of 18-19 years who almost never drew before except for the usual children drawings and had no talent). Thirdly, you have to be interested enough to learn and practice enough. The combination of innert skills with practice and an interest for the application of the skill results into above-average results, in the eye of an expert on such skills. I'll clarify the last part of my sentence: To me my father draws bad and my mother average. While on the other hand my father will look upon my mother's work as above-average. Why do I make a point of the eye of the beholder? Because Drs. who made the statements about JtR's skill were experts, making declerations in referation to their own skill. About the 3D-mental-manupilation skill. This is a difficult skill to manage, because it has need of many abstrahation skills. It normally starts developing really good for application around the twenties. Dependently of your talent for it and the practice of it previously this development can be rapidly or slow. One of the most difficult classes I had during my studies of Industrial Design were 'spacial geometrics' (mathematical objects in imaginary space). At the same time we learned to imagine our designs, put them on paper and check in our mind if fittings, forms, and what other stuff you got were right, before we started on the 3D model of the design. It took me one year of hard practice to get at an average level. Another year to be above average. After that it became a free-wheeling skill, although I would still be having problems on fittings, since I'm not really a detaillist from nature. It's around the kick off of the free-wheeling year, I applicated this developed skill in drawing. I imagined the image I wanted to paint, searched for pictures of for example a lion and an antilope, and manipulated them in my mind until they were in a position as I wanted them, resulting in a lion striking down an antilope. To be able to do this good, I conclude I certainly have a talent for this 3D-manipulation, but also two full years of math theory, of 2D drawings of just an idea in your head, of manifacturing 10 models, and all the processes in between, and of course several sketches on the subject to get it right. And never had I to do this in the dark, while I was surrounded by police and other people, with once a living being underneath me. If we accept that JtR learned to get at the uterus of Chapman, only by slashing about Nichols' abdomen, under the circumstances he was in, we are searching for a super-intelligent man, especially in relation to the abstrahation, whose interest and innerst skill was enough to overcome practice problems. As I told above, a skill learned fom another application can be applied to others. Nichols is practice in the use of the knife on that certain part of the body. But she's no practice to develop 3D-mental-manipulation, no practice for anatomy. He had to have practised those skills on something else. Greetings, Jill PS. And now stop flirting with my vanity, I would be a sad person indeed if I did not use what nature has given me to every possible application of use it can attribute to :-)
Author: David M. Radka Wednesday, 28 June 2000 - 02:04 pm
Diana, I don't think of myself quite so much as a "razor-edge analytical thinker," although I can hold my own in such activities when I need to. Instead, I see myself as a holistic type of thinker, more attuned to interrelationships, ethics, mystical experience, metaphysics, philosophy and religion than to other kinds of thinking. Bonaventure, Plotinus, Plato, Nietzsche, and so on. I believe my most fundamental influence in learning how to think was my study of music when in childhood--I studied for twelve years under good teachers, and can play several instruments. I agree that Jack probably was able to pick up enough information about how to remove a uterus without being medically trained. I believe his kick was to get that uterus under street conditions, not merely to get a uterus. It was more a matter of motivation, less one of training. David
Author: Diana Wednesday, 28 June 2000 - 06:14 pm
Probably acquisition is at least 50% genes. After that a lot of visual motor stimulation during the preschool years. The brain will actually grow new neurons. This would not have to be a wealthy family with a governess who cheerily announces, "time for your visual motor stimulation practice!" It could be a toddler rooting thru mom's kitchen drawers. We have already discussed the paucity of practice opportunities Jack had. As to motivation his was high. Imagine what he was risking. The problem with statements from Doctors is that they tend to disagree with each other and cancel each other out. Jack did not have to draw a precision picture. What you do, Jill, involves a lot more skill that what he did. It's always easier to destroy than create. Remember intelligence is modular. Jack was good visually and motorically, and tactily. That did not make him a genius. He might have been very poor linguistically, analytically, and in the area of social skills. In fact it was quite possible that he was brain-damaged. It might account for what he did. The damage just did not extend to the areas of the brain that processed visual and tactile input and controlled motor activity. My cat can do acrobatics that I will never do -- that doesn't make him Einstein. Hope nobody minded being analyzed and Mr. Radka, you're right, you are the best person to understand yourself, not me. I based what I said on the fact that my daughter just passed the CPA exam (she didn't get it from me, believe me!) and she refers to herself as analytic.
Author: David M. Radka Thursday, 29 June 2000 - 10:10 am
Now that we're on the subject of hysterectomy-- Was this surgery commonly performed in 1888? Nowadays physicians believe hysterectomy accomplishes certain curative results, and they perform it when it is indicated by the symptoms. Did physicians in 1888 do the same? Or is hysterectomy more modern than the case? A response from one of our resident physicians, please. Thank you. David
Author: Thomas Ind Thursday, 29 June 2000 - 10:41 am
OK , now I'll join in the discussion. However, am off to Spain on Friday for 10 days and have had to promise the wife NO INTERNET. Although I am very flattered by the comments that I have skill and knowledge I would have to admit that I am not that clever and have no great skill. Any mug could do a hysterectomy (or at least in the form that JTR did). Just stick you hand in the pelvis, pull it up and cut it. The difficulty is either achieving a complete hysterectomy (removing the cervix) which JTR failed to do the first time or doing a complete hysterectomy without damaging the bladder which JTR failed to do the second time. There is very little information on the last hysterectomy so I don't know how he did it. To many, surgery sounds complex and skilled. It is very easy though and most surgeons (like me) can't even darn a pair of socks. In terms of the uterus, even I couldn't do a surgical hysterectomy in daylight without light shining in the pelvis. If I had to do a JTR hysterectomy I would place one hand in the pelvis and blindly cut out the uterus. The uterus is the only organ that is obviously palbable in the pelvis so one could contemplate that JTR didn't even know what organ he was removing. I will look for this book called Hunting the Devil but it does seem to support my theory that no medical skill is required to perform a hyusterectomy. In terms of the history of hysterectomy, I have a large book on the history of gynaecology but as I am not going home tonight (staying in the hospital) I will have to look it up tomorrow and will try and post before I leave for the airport. However, few operations at all were done in 1888 by todays standards as antibiotics didn't exist, anaesthetics didn't exist and the whole thing was rather dangerous. (Amazing that all this is less than 100 years old although most of what we did ten years ago sounds pretty wierd to students today).
Author: Thomas Ind Thursday, 29 June 2000 - 11:05 am
Just reading through the posts again. I thought I would a couple of other points. Firstly, we discussed pigs when this thread started. I just returned from Hamburg on Sunday where (yes believe it or not) I operated on a pig. (Please no animal rights activists with letter bombs - this was above board and not vivisection). I couldn't find the uterus until one of the vets demonstrated it to me. Why, it looked and felt nothing like a human uterus. The human uterus is a muscular organ that feels hard and descrete to look at. The pigs uterus looks like a floppy bit of bowel and difficult to differentiate from the intestine. It is soft. The other point is with regards skill. OPne of my scientific interests is what makes a surgeon good or bad. I have done a number of studies looking at conservative movements etc. I also organise basic surgical skills courses for students wishing to enter surgery and I completed one that was held on monday and tuesday. A large number of people attend with no surgical experience at all and they do not lag behind one bit. The so called intellegent part of surgery is the decision making. The surgery itself does not require great skill which is why some of the greatest surgeons could demonstrate little visiospacial ability in other tasks such as ball sports. Diana, i forgot to answer your question. Yes the abdomen is difficult to open surgically, layer by layer without damaging certain blood vessels but JTR appears from Eddowes drawings to have stabbed and sawed with a sharp knife (not the incision i would have made). Finally - Could JTR have done a hysterectomy without any anatomical or surgical skill. I've always been open to suggestions and ideas on this. I am aware that as I do lots I might perceive it to be easier. I am also aware that doctors disagree. There is little in JTR that I can claim to be an expert on. I have listened to the arguments fairly but my opinion is unchanged. On this very small aspect of JTR, I must surely be the most qualified opinion around. I DO NOT BELIEVE THAT ANY SURGICAL OR ANATOMICAL SKILL IS ESSENTIAL TO PERFORM A HYSTERECTOM OF THE STYLE AND IN THE TIME THAT JTR DID. That is my opinion. I am undoubtedly the most qualified to give it and I give it after VERY careful consideration taking into account that my job is such that I may be biased. In fact, as explained earlier, I think there are a number of points regarding the hysterectomies that suggest that no anatomical knowledge or skill is required. BEGG - I have an idea for the ripperologist. In the BMJ a few years ago there was a section where 2 eminent doctors wrote on the same subject but gave 2 completely opposed opinions as to the best management. Perhaps you could have a section in the ripperologist in a similar way.
Author: Thomas Ind Thursday, 29 June 2000 - 12:01 pm
CORRECTION I have just found a book on the shelf at work The first anaesthetic was given in Boston on 16th October 1846 (In the UK on 19th December of the same year) The first abdominal hysterectomy was performed in Boston in 1853
Author: Diana Sunday, 02 July 2000 - 09:20 am
Jon, I went back through the book to try to answer your questions. Chikatilo's first victim was done in a deserted shack on the evening of December 22 (one day after the shortest day of the year) There was, however, electric light. There were three stabs to the abdomen. After that he consistently lured them into the woods. The book is vague about times of day, but if you have ever been in the woods, even at noon, if the foliage is thick enough overhead the light is rather dim. Remember Dr. Ind said he needed a bright light shining right down into the abdomen. Unless he brought a flashlight there would be no source of electricity in the woods. The book does state that #2 was done by starlight. #'s 1-6 involved damage to the external organs of generation and stabs but evisceration is not mentioned until #7. The book is not clear as to when he began taking uteri as it discusses #'s 8-15 as a group and it is in discussing this group that the author makes the statement on page 79 which I quoted above. Perhaps another source of information can be found on Chikatilo which would be more explicit about these details. However, because he used the woods a lot of his victims were not found until there was a lot of decomposition. This makes it more difficult.
Author: Diana Sunday, 02 July 2000 - 09:31 am
I also forgot to add that #5 was a nine year old boy.
Author: Jon Sunday, 02 July 2000 - 01:44 pm
Diana: Thankyou for taking the time..... It appears inconclusive as to how many victims he practiced on. But as you state in your poste, he may have had more than 8 victims (excluding #5) before he was successfull in removing a uterus with some 'skill'. Though we do not know how many he attempted it with. What did he do with the removed organs? (Apparently the 'Jack the Ripper' syndrom is alive and well, in this century) Thanks again Diana Regards, Jon