Holiday, murder and landmark milestones.

In this time of lock down I was lucky enough to get away for a few days at the end of August. We went down to the Lake District in England.

To get there you have to pass along this beautiful valley called the Devil’s Beef Tub. The road south from Edinburgh to Moffat runs along side the valley. It twists and turns, passing over bridges and streams that tumble into little waterfalls.

It is at one of these turns and picturesque stone bridges that we can relate it to a mile stone case in forensics and anatomy.

Bella Ruxton, the wife of Buck Ruxton

In 1935 a Lancashire doctor Buck Ruxton took it into his head to murder his wife, Bella, and her maid Mary. Finding himself with two bodies to dispose of he decided to dismember them and dispose of them in the Devil’s Beef Tub. He wrapped them in a local Lancashire newspaper, a fact that would come back to haunt him later, and scattered the 70 pieces of remains into the countryside. Some of them were found by the local police and one of the most famous murder investigations started.

In 1935 forensics was still very much in its infancy. A super team of experts was formed with Glaister, the Glasgow professor of forensics, Smith, the Edinburgh professor of forensics and Brash, the Edinburgh professor of anatomy, leading the way. They very soon reached the conclusion that the bodies had been dismembered by someone who knew what they were doing. Building the grizzly jigsaw soon informed then that they were looking at the remains of two individuals but they still had no idea who, or even what sex the victims were. When they were identified as women the penny dropped that maybe this was related to the two women who had gone missing from Lancashire, reported missing by Buck Ruxton, a man who had the capability to dismember.

The finger tips has been removed from one victim hoping that this would remove the ability to take fingerprints. The other victims hands had decomposed beyond the point of being able to finger print the skin. The newly formed finger print unit in the UK worked with the FBI to take fingerprints from the dermal layers that were left on the hands and managed to produce prints that matched in over 16 positions to those of Mary the maid which they had managed to lift from the house in Lancashire.

This left the puzzle of how to positively identify the other remains. The skull had been recovered but they were struggling to get any identifying features. Then one of the team came up with an idea. At that point it was ground breaking. Now, it is a common feature of masters students projects. Could a picture of the skull be superimposed onto the portrait of Bella. She had a very distinctive jaw line; could it persuade a jury that the remains were her’s?

After much positioning of the skull to match the image above the team were able to produce the picture below

As you can see the ear, the eye socket and the jaw line all match.

It was proof enough for the jury who decided that the remains were those of Bella and her maid Mary.

Buck Ruxton was executed in Strangeways prison in 1936 and the case went down as the first modern murder investigation.

Full details can be found in the book by Tom Wood, Ruxton – the first modern murder but bear in mind it might change your view of that beautiful valley if you travel down that road.

Science and Fiction

Applying science to reading fiction can be likened to golf; it can be a good walk spoiled. Whilst I groaned when the original Bladerunner allowed someone to see something that just wouldn’t have been possible in a mirror, I will quite happily accept a fictional dragon.

I’m reminded of a comment I heard last week – gravity always acts downwards. Somethings in science should not be altered. What you can see in a mirror is governed by the laws of physics – it should always be the same. How a dragon flies is not governed by science. They don’t exist in reality. We don’t have anything with wings and forelimbs because our knowledge of anatomy would not allow it. It can be quite arrogant to say that because we don’t understand it, it can’t exist. It’s certainly not an attitude that is going to take you very far in reading science fiction.

We can use it the other way though.

One of the key ideas with Science Communication is meeting the people where they are. They have an understanding of science fiction – can we use it to engage them in science?

I had my sci fi aha moment when my son was studying higher biology. Well, he was meant to be but he was actually spending most of his time watching the Walking Dead. Over breakfast one morning we started a conversation over which part of the brain would have to be affected to make the zombies lose the ability to speak. It grew from there. An hour later we were still talking about neuroanatomy and what he had studied at school. That summer I appeared at the local Science festival talking about the neuroanatomy of zombies.

Last weekend it went international when I joined the panel at Gen Con to talk about the science of science fiction. Indianapolis science had two panels. One looking at the science behind mythical beasts – is Chewbacca more like a primate or a dog? and the other looking at zombies. I’ve attached the links to the you tube films below. It was great fun joining in with an event like that – even if the time difference meant I had to stay up in to the early hours of the morning!

Science shouldn’t be used to destroy the joy of science fiction but science fiction can be used to enhance science. I’m aware of one medical school that has a session in their anatomy course where students have to design an animal made up of at least three others. It might seem a little strange but just think for a moment. If you are going to combine three animals then you need to understand how all the vital systems within those animals work in order to combine them. If you want to take part in a discussion as to why we don’t have creatures with forelimbs and wings then you need to understand the musculature of forelimbs and wings.

Maybe we can move forward together.

The presence of science in fiction first came to my attention in Tintin. In Destination Moon Tintin goes up into space. In the comic they show the balls that water forms in zero gravity. A great use of science in fiction…it was written in 1950. That is 11 years before the first man went into space. A great example of the fact that the author doesn’t always know what they are writing about and science can’t always be used to explain it.

Links to Gen Con Science of Science fiction panels

Monsters

Zombies

The Pedant, The choke-hold and the Uninitiated.

RIP – Ennio Morricone

As Anatomists, we should be used to things being named in a way that is not helpful or often misleading. The world of eponyms has left us with literally hundreds of structures in the human body that do not provide us with any information other than who first claimed to identify it, the great vein of Galen, the Fallopian tubes and the angle of Louis to name a few.

It should not surprise us to find the same issues in other professions. Let me introduce you to the figure four choke hold in competition grappling.

There is the first issue of what is the difference between choking and strangling. This is as productive and circular as to whether jam or cream goes onto a scone first. I go with the simple, choking is an internal issue – you can choke on a piece of chicken, whereas a chicken has never strangled anyone. This creates the first issue for the pedant. The uninitiated pedant once experiencing a figure four hold might think ‘this opponent doesn’t know what they are doing. There is a large gap at the front of my throat. This isn’t a choke hold.’ and they will continue to think that right up until the moment they pass out, because the choke hold isn’t designed to choke you.

 

There are a lot of important structures in the neck. There is the airway or trachea. This is held open with C shaped pieces of cartilage so that it does not become compressed as the head moves around. We have the oesophagus which connects the mouth to the stomach. This is a stretchy muscular tube that spends most of its time closed anyway. We also have a lot of blood vessels as you can see in the picture. The two most important are the carotid artery and the jugular vein. They run up each side of the neck taking blood to and from the brain. They can just be seen appearing at the top of the sternocleidomastoid muscle running from the back of the head to the front of the chest (from the sternum to the mastoid process – an example of how things should be named).

 

If we had necks like the Sontaran from Dr Who then this wouldn’t be an issue but we have accepted the vulnerability of exposing all of these structures in a long slender neck for the ability to turn our head around and be aware of what is going on around us.

 

The figure 4 hold works by compressing these vessels, restricting blood flow to the brain and causing people to become unconscious. That is where the discussion should have finished but…a little knowledge can be a dangerous thing and we now have two other debates appearing.

Is it the compression of the jugular vein or the carotid artery that causes the unconsciousness?  Veins are quite flat and easy to squash whereas arteries have springy walls and are better at holding their shape.  The jugular vein is more superficial than the artery so it probably gets squashed first. I would be very suspicious of anyone who claims they can compress one and not the other.  The figure 4 hold is a blunt instrument to an end.

Even more ludicrous then is the discussion around the carotid body.  The carotid body is a small structure that sits just above the bifurcation of the carotid artery.  It has a role in controlling blood pressure through out the body.  Theoretically if the carotid artery were compressed below the carotid body then it would perceive a drop in blood pressure and initiate the process to increase the blood pressure.  If the artery were compressed above the carotid body, it would perceive an increase in blood pressure and initiate steps to reduce it. The outcome in terms on consciousness for the opponent would be the same in both circumstances.  The carotid body is about the size of a pea and, due to anatomical variation, not always in exactly the same place in each person. The pressure is being applied with something varying in size between a forearm and a thigh.  I don’t think I need to point out the ridiculousness of claiming any precision in its application.

 

Arm Bars and exercise origins

I was recently asked why arm bar’s are so effective. These questions usually come from people who have not experienced arm bars – one of the most effective submissions moves in grappling. This time however, I thought about the anatomy of it and the effect this might have had on the exercise world.

An arm bar, correctly applied, usually causes a tap out within a few moments. If you can imagine lying on the ground. Your opponents legs are across your chest and neck, effectively pinning you to the ground. Your arm is extended between their leg and your hand held palm up on their chest. This might already be causing you some physical discomfort depending on the flexibility of your shoulder and the size of your opponent. Now they start to push their hips up. The discomfort escalates as your elbow is forced to hyper extend. You are not getting out of it and most people tap out.

Why does it hurt? Just look at the connective tissue around your elbow.

Every ligament and tendon is filled with receptors that you usually use to help locate them in space. They constantly feed back information to your brain that tells it how much stress it is feeling or how quickly it is accelerating. The brain can calculate which direction things are moving in by comparing the messages from different parts of the body. And it does all of this without you even thinking about it.

Have you ever fallen asleep when you shouldn’t have and woken up with your head jerking back? You probably thought you work up and jerked your head up to appear awake. It happens the other way around. When you fall asleep your head will tip forwards as the muscles relax, due to its weight. This causes the muscles and connective tissue at the back of the neck to suddenly be stretched. That sudden stretching sends a message to the brain ‘We are stretching too quickly, slow it down.’ The body slows that down by contracting the muscles that oppose that stretch. This causes the head to jerk back up and that it what wakes you up. Your body took care of its self whilst you were asleep.

As the muscles and connective tissue start to get stretched in the arm bar the brain gets the same messages. ‘We are being too stretched’ Only the arm is trapped, it can’t do anything to reduce that stretch.

Two bones make up the forearm; the radius and the ulna. The ulna has a large hook like prominence that makes up the point of the elbow. When you straighten your arm, this prominence fits into a hollow at the back of the humerus, the bone of the upper arm. If you continue to extend it then the bone can go no further, it is blocked up the humerus. I’m told it is very unusual to break this prominence off of the ulna by using an arm bar – the usual injury is a dislocated elbow. Either way it is painful.

But what does this have to do with the exercise world?

Have you every gone to a legs, bums and tums class. Endless squats but usually also endless bridges. You lie on the ground, feet close to your butt, and push your hips up as high as you can. A great exercise for the glutes but where do you think it came from? The origins of the bridge can be traced back to ancient Greece and wrestling. The easiest way to get off someone who is on top of you is to push up your hips. The best way to get a submission is to apply an arm bar. The best arm bar will be applied with the highest hips. We might use the exercise now to get a shapely bum but that isn’t why it was developed.

Janet has a PGDip in Anatomical sciences and is currently studying for a PhD looking at different groups beliefs about the body. She represented the UK in TKD and learnt grappling as part of her Budokon belt system.

Ethical Entertainment?

By the end of May, two months into lockdown, new forms of entertainment were needed. Into this arena appeared a company who had made their mark on Dragon’s Den two years previously. They were offering a live post mortem!

I had heard of these events before. They usually tour the country offering dinner and dissection for the same price as a Michelin starred meal. The events usually sell out. In the name of research I watched the recordings of post mortem live.

They use a semi synthetic cadaver. The question of what exactly this was appeared on twitter and was not answered. It appears to be a synthetic human shaped shell into which they place pig intestines for the performance. It was covered in plastic for almost all of the performance causing some people to complain about the glare. I expect it was expensive and they wanted to protect it. If you read a long way down on their web site you do find the mention of pig but there was not one mention of it during the 7 hours of broadcast. In fact they seemed to go out of their way to imply that the figure was human. Several people made comments about the human specimen on twitter which were never corrected and several people even thanked the donor.

The presenters, we were told, were anatomists of national acclaim. I’m not sure what that means. One of them was referred to as Dr xxx PhD. This is confusing in the UK. Is that a medic with a doctorate? He introduced himself as a final year medical student (equally confusing in a year when they accelerated the graduation of final year medics to deal with the pandemic) so the Dr and the PhD are actually the same qualification. The company refuses to release the qualifications of its staff, saying it breaches GDPR.

There was nothing wrong with the anatomy. A few mistakes, but who doesn’t make mistakes in a live broadcast. The ease with which the organs were removed from their host was not realistic and on the one occasion when they did cut into the semi synthetic cadaver not only was it not realistic, it was also impossible to see what they were trying to demonstrate. The skeleton beside them would have been a much better illustration of the spinous processes of the vertebrae.

Comments on twitter asked whether they were actually going to use the human specimen at all and suggested a better title for the programme might have been ‘anatomy lessons with animal parts’.

I am not against dissection as a learning tool. I co founded Anatomy Nights. We have a network of qualified anatomists through out the world who perform heart and brain dissections to educate people. In large letters on our web site is the fact that these are of animal origin. The same statement appears on every presentation and every advertising poster. One of our presenters had a plastinated heart and asked if they could take it along to their event to show people. We asked if they wouldn’t. We don’t want any confusion about the origin of the samples.

Why isn’t this a problem for the Post mortem live people? Their show is advertised with a hearse. They offer a promotional item which is a lunch bag emblazoned with ‘Human organ for transplantation.’ A third of each broadcast was taken up with adverts for their other shows, a live operating theatre experience that appears to start with the car crash. They encouraged people to dissect along side them at home. At one point they referred to this as ‘using the organs you have got from the butcher or the ones you ordered from us.’ these ordered organs were described on their web site as ‘REAL’ (their emphasis).

They aren’t breaking any laws. It’s not illegal to dupe the public. It’s clear from twitter that some of the people thought they were going to see a real human body. Is it ethical to pretend to dissect a human? Is it ethical to portray it as such to make more money? Is it ethical to exploit the more basic curiosity in some people who want to see the inside of a real human? The ethical philosopher Kass has an interesting theory called the ‘Yuck’ theory. It’s self explanatory really but essentially if something make you go ‘Yuck’ then it may be ethical dubious.

I wonder what Kass would think of post mortem live?

The Humble Squat (part 1)

The Humble squat – we all used to be able to do it but how many of us can do it now?

If you go and see any exercise professional worth their salt then you won’t be far into the conversation as to how you can get fitter, before they mention the squat.

So, if it is such a fundamental move and we all used to be able to do it – why can’t we now?

You will see some fancy explanations about the relative weight of a toddler’s head versus their femur length but I’m going to suggest to you there are two main reasons why we can’t squat anymore.

1 – someone invented the toilet seat

2 – misguided belief by the exercise profession that your knee shouldn’t go past 90 degrees.

The explanation of point 1 also covers point 2.

What is the problem with the toilet seat? I’m not talking about the flushing water closet that Thomas Crapper introduced to us in the late 19th century. I am talking about the first Greek or Roman who thought about putting a seat above the latrine pit. Up until that point if someone needed to go to the toilet then they had to squat down. At least once every day every adult squatted right down into what we now call the ‘ass to grass’ pose.

Why squatting is better than sitting? Squatting has a lot of benefits. The first thing it does is line up your rectum. The bottom of the digestive tract is supported in the pelvis by a big sling of muscles that help seal it off by putting a big kink into it. When you squat it becomes a lot easier for this kink to be relaxed as you go to the toilet and for the rectum to be completely emptied. You can find a number of devices on the market now that aim to bring your feet up when you use the toilet. They work on the same principle. The increase in colorectal cancer can be related to the drop in use of the squatting pose (so can the increase in the price of ice creams so watch out for cause and effect in medical claims). Squatting also moves your pelvis around. Opinion is divided on whether SI joints can move and what squatting does to them but you can’t deny that squatting moves the pelvis and the lower back around. The number one cause of days off of work (after mental health) is lower back issues. Maybe if we still moved it around by squatting each day it wouldn’t be such an issue. In our groin we also have a number of large lymphnodes. Squatting compresses these lymphnodes. Some would argue that that helps the lymph fluid to circulate, recirculating that fluid around the body – might help immunity (that’s might help, in the same way that feeling good about your self because you squat each day, might help immunity. It’s impossible to perform double blind trials involving humans and movement or touch so hard scientific facts don’t really exist in this realm).

For a long time in our history we squatted to go to the toilet, some people still do. How can it possibly be wrong for our bodies to perform a function they have done for centuries. It damages some people’s knees to go into full flexion because their knees are not used to it. You should never do any exercise that hurts you but a blanket ban on full flexion of the knee joint is as daft as saying don’t flex and twist your spine at the same time. Excellent advice for ballistic movements in high speed aerobic classes but you trying wiping your ass and not doing that movement.

Blanket anything is not good – everything should be considered and, as always, listen to your body.

During the lockdown I have started a program to get me back to full squat. I haven’t been able to do it for years. I’ll let you know how I get on.

Lockdown Activity

It’s hard to come up with activities to keep you busy during lockdown.

I’ve been doing a number of anatomical felts and I’ve been involved in the Cajal Embroidery project.

I’ll post links as they go live and I might add an art page to the web site but to start with I have added the DNA scarf pattern to the article page.

It is not as hard as it looks!

Lockdown and Corona

The world is not as it was.

Rather than adding to the plethora of mis /information out there I thought I would post you to some resources that my real life / twitterverse friends have created.

The first is from Dr Mike Todorovic.

Mike produces excellent videos and is a SciComm guru.  He has a podcast with his college Dr Matt which is worth listening to.  It’s called Dr Matt and Dr Mike.  It’s all about anatomy and physiology.  It’s fantastic.

Dr Mike has produced a short video about the corona virus which was so good the Australian Nurses have made it one of their recommended videos.

You can access his video here

If you are a returning medic called in to help with the pandemic then the University of Edinburgh have released a free course about critical care for covid patients which can be access here

 

If, like me, then you are just waiting it out at home trying to work from a table and chair that were not designed for 9-5 occupation then Gavin Routledge has a helpful video on his web site that explains how you can help yourself to sit more comfortably.

You can access it here – get your towels and masking tape ready

 

Stay Safe Everyone

Atrophy, Isolation and the identification of Batman’s super power

Atrophy is ‘the gradual decline in effectiveness or vigour due to decrease or neglect.’  It is the ‘use or lose it’ component to fitness.

It is why you should take the stairs rather than the lift and why you shouldn’t use the arms on the arm chair to get up.

Your body is clever.  It is not going to put effort into maintaining something that isn’t being used.

In this time of isolation and staying at home it is important for your body (and mind) that you continue to do something with your body otherwise you will lose the ability to do it.

I don’t think this is too much of an issue as so many fitness people are offering on line options and I see so many people out walking around the park (keeping the appropriate distance) that I am sure the message seems to be getting through.

BUT

people are also watching more films.

I am a Batman person – particularly the Dark Knight trilogy.  (spoiler alert for anyone who hasn’t seen it.  And also Why Not?)

In it Batman is beaten up and thrown into a prison.  There he lies on a bed for what we can assume is days and weeks rather than hours.  He is then diagnosed with a broken back.  They fix this by punching the vertebrae back into line – Not the recommended medical procedure – and then they suspend him from a rope until he can walk.

I get a bit confused by the time line in this film but according to the internet (that most reliable source of information) this is for 80 days.

I had a friend who was recently stuck in bed for 6 weeks – that is 42 days.  When she got out of bed she had problems putting one foot in front of the other; her legs were so weak.

After 80 days they cut him down and he still looks as buff as ever.

Is this the back of someone who has suffered atrophy?  Could he ever have  climbed out of a pit in a death defying escape and saved the world if he had suffered atrophy?  No.  Batman’s super power is that his muscles do not atrophy!

 

We do not have Batman’s super powers so do something to keep your body active during this time of restricted movements.  Dance like no one is watching.

Stay Safe

(Ironically the actor’s previous film showed extreme atrophy and they could have filmed out of sequence and it been a bit more realistic – but hey, Its Batman.  Who want’s realistic?)

Learning by Doing

I bake biscuits.  It started off as a bit of down time and then I realised it could actually be a revision tool.

 

The biscuits might look like a simple picture of a spine but as I iced that I revised all the facts I needed to know about the vertebrae.  It is a bit like haptovisual drawing, it’s impossible to tell by looking at the end product what learning process has taken place.

My institute has an innovative learning week, well it used to.  It was cancelled this year – I think it was something to do with the fact that all our teaching should be innovative, not just that one week.

 

 

Last year I had floated the idea of doing a biscuit workshop and not to be deterred by the fact the event no longer existed, we pressed ahead and did it anyway.

Teaming up with out training kitchen (part of accommodation services where they teach the students to fend for themselves) we ran an afternoon workshop aimed towards medical students.

Come along and learn to bake biscuits and we will decorate them with as close to anatomically correct icing as we can.

That afternoon I experienced one of the best educational experiences I have ever seen.

Two fourth year medics turned up.  They were on their orthopaedic rotation.  The simple cutters were not for them.  They went free style with a knife.  After much debate about the structure of the femur and pelvis they produced two dough shapes.  They had gone backwards and forwards in debate to ensure they captured as many features as they could and they named them all, only resorting to an app for help once.

After baking they decided to hold this femur in place by icing on the ligaments of the hip joint.  It’s not very precise but the discussion between the two of them as to where the ligaments should go and what they were called demonstrated that they were recalling information that they had been taught long ago.

The real cherry on the top of this learning experience was when the chef came over and asked them what on earth it was.  They explained.

He then asked them how a hip replacement operation was performed.

Using their biscuit as a prop, they explained the whole operation to him. the final piece in an exchange of knowledge that had started with him showing them how to use a rolling pin (yep 24 years old and no idea how to use a rolling pin).

I hadn’t expected that demonstration of revision and explanation to occur when we came up with the idea but if there was any doubt that these sort of ideas are worth it that experience has convinced me.

You can provide educational experiences anywhere.