wanted: scientific references on corpse color

[Hannover]

This thread is In conjunction with:
'wanted: testimonies on corpse color'
viewtopic.php?f=2&t=7355

We already have an excellent thread which gives us some scientific references on corpse color when exposed to cyanide & CO poisoning (1). There are some excellent references in that thread. However, I feel it's important to acquire an even greater number of them. There is an end product in all this and I want to leave little room for spin doctoring by The Believers.

So, in this thread I would like to collect only scientific references on corpse color after exposure to CO & cyanide poisoning. Please be as thorough as possible in giving your citations.

(1) 'The most important Photograph / corpse color' - viewtopic.php?f=2&t=7320

- Hannover

[friedrichjansson]

I have many of these. It will take me a while to copy them all here. I'll start with passages dealing with carbon monoxide, since there seem to be fewer difficulties there, although many passages will refer to cyanide as well because the two are frequently discussed together. After I've completed the material on carbon monoxide I'll turn to cyanide.

The books I cite can be found at http://libgen.info/ - this should assist people in verifying citations.

1) Alan Gunn, Essential Forensic Biology, 2009
p. 20
Section heading: "Indications of Poisoning"
Sometimes the cause of death may result in striking changes to normal skin coloration. For example, deaths from carbon monoxide poisoning often result in a cherry red / pink coloration to the skin, lips and internal body organs (Fig. 1.6) although if the body is not discovered until several hours after death the coloration may not be immediately apparent owing to the settling of the blood to the dependent regions.

pp. 21-22
When carbon monoxide binds with haemoglobin in the blood or myoglobin in the muscles it forms carboxyhaemoglobin and carboxymyoglobin respectively and they are responsible for the pink coloration. There are cases in which carbon monoxide poisoning does not result in the formation of a cherry pink coloration (Carson & Esslinger, 2001) and it can be difficult to spot when the victim is dark skinned – though it may be apparent in the lighter regions such as the palms of the hands or inside the lips or the tongue.


2) Wiley encyclopedia of forensic science / editors in chief, Allan Jamieson, Andre Moenssens, 2009

p. 703, article "Death: Time of"
In carbon monoxide intoxication and cyanide intoxication, the color of hypostasis is cherry pink

p. 704

p. 2505, article "Toxicology: Forensic Applications of"
Skin color and lividity can suggest poisoning, for example, in carbon monoxide and cyanide poisoning the lividity is typically reddish.

p. 233, article "Asphyxia"
Carboxyhemoglobin imparts a bright cherry red color to blood and tissues at autopsy. Similarly, cyanide can cause pink–red discoloration of post-mortem hypostasis.


3) Forensic science / Andrew R.W. Jackson and Julie M. Jackson. -- 3rd ed. 2011

p. 217
The post-mortem examination of individuals who have died as a result of gas poisoning might reveal the likely identity of the gas responsible. For example, the unusual cherry-pink appearance of any post-mortem lividity indicates carbon monoxide poisoning while a deeper red coloration of this feature is sometimes observed in cases of cyanide poisoning

p. 380
One final point worth making is that in certain types of poisoning, the colouring of post-mortem lividity is markedly different from the dark pink or dark purple-blue colour normally observed. For example, a cherry-pink coloration is indicative of carbon monoxide poisoning

4) Charles Catanese, Color Atlas of Forensic Medicine and Pathology, 2009

p. 112
You can also evaluate livor for its color. For example, people who die as a result of carbon monoxide or cyanide poisoning will have a bright “cherry red” color to their livor mortis. People who die in a cold environment might also have a similar red color to their livor.

5) Handbook of Autopsy Practice, Fourth Edition, 2009. Edited by Brenda L. Waters.

p. 425, section "Poisoning, Carbon Monoxide"
Pink discoloration of skin and organs usually indicates the presence of more than 30% carboxyhemoglobin (but rule out cyanide poisoning* and exposure to cold*).
p. 425

6) Carbon Monoxide Poisoning, edited by David G. Penney, 2008

p. 289
Symptoms seen in people with higher level CO exposure include severe headache, dizziness, nausea, vomiting, mental confusion, visual disturbances, reddening of the skin (not always), compartment syndrome, loss of muscle tissue, fatigue, hypotension, and coma. Severe exposure can of course be fatal.

p. 298 [a case study of three CO victims, all of whom survived]
All three people were diagnosed by physicians at the hospitals as having CO-poisoning. Their symptoms at the emergency room (ER) included severe headache, dizziness, nausea, vomiting, reddening of the skin, compartment syndrome, loss of muscle tissue, fatigue, hypotension, and coma. These are consistent with what would be expected from CO exposures.


7) D.J. Gee, Notes on Forensic Medicine, 1979
pp. 241-2

More to follow later.

[friedrichjansson]

Vincent DeMaio, Dominick DeMaio. Forensic Pathology, 2nd ed. 2001

p. 22
Livor mortis usually, but not invariably, has a cherry-red to pinkish color in deaths due to carbon monoxide. This is due to carboxyhemoglobin. Identical coloration may be caused by exposure of a body to cold temperatures, and in deaths due to cyanide.

p. 376
[in the context of deaths caused by fires] At autopsy, it is usually relatively easy to determine whether the individual died of carbon monoxide intoxication. The livor mortis, the muscles, and internal organs, as well as the blood, will have a cherry-red coloration. In spite of this coloration, a carbon monoxide determination on the blood is mandatory. The cherry-red coloration can be produced by other factors (e.g., cyanide). A cherry-red coloration to livor mortis is very common in bodies exposed to cold for long periods of time. In addition, an individual could have a fatal carbon monoxide level, yet a prominent cherry-red color be absent.

p. 395
Autopsy findings in CO deaths are fairly characteristic. In Caucasians, the first impression one gets on viewing the body is that the person looks very healthy. The pink complexion is caused by coloration of the tissue by carboxyhemoglobin, which has a characteristic cherry-red or bright-pink appearance that can be seen in the tissue. Cherry-red livor mortis suggests the diagnosis even before autopsying the individual. It must be realized, however, that this color can be simulated by prolonged exposure of the body to a cold environment (either at the scene of death or in a morgue “cooler”) or cyanide poisoning.

Remark: this passage could be seen as troubling for the revisionist argument on this topic, with the statement that the dead at first appear healthy - I also noted this in the pdf with images I previously posted. As I've stated before, the fact that the gassed people are supposed to have been naked makes our argument much stronger.

9) Howard C. Adelman. Forensic Medicine, 2007

p. 16
In cases of exposure to cold, carbon monoxide or cyanide poisoning, the lividity appears to be bright red.


10) Jay Dix, Color Atlas of Forensic Pathology, 2000

p. 99 of document - but pages are unnumbered
Cyanide causes livor mortis to be red as in carbon monoxide poisoning.


11) Time of death, decomposition and identification: an atlas / by Jay Dix and Michael Graham. 2000

p. 12
In certain causes of death, livor mortis may take on a different color. Carbon monoxide poisoning, cyanide poisoning and hypothermia are often associated with livor mortis that appears bright red or pink.


12) Guide to forensic pathology / Jay Dix, Roben Calaluce, 1999

p. 45 of document - pages are unnumbered, but appears to be p. 34 of book
Variations in color during livor mortis depend on the cause of death. Carbon monoxide or cyanide poisoning, hypothermia, and refrigeration cause bright, cherry red livor mortis.

13) Atlas of Forensic Pathology / Joseph A. Prahlow and Roger W. Byard, 2012

p. 635
One of the hallmarks of a body that has been exposed to lethal levels of CO is bright cherry pink discoloration of the skin and soft tissues such as muscles.


14) Forensic Pathology for Police, Death Investigators, Attorneys, and Forensic Scientists / Joseph Prahlow, 2010

p. 165
Carbon monoxide, cyanide, certain other toxins, and extreme cold can cause bright red discoloration of the lividity.

p. 421
The most impressive autopsy finding in cases of carbon monoxide poisoning is the bright red (sometimes called “cherry red”) discoloration of tissues (Disc Image 15.41). This bright red color is typically evident in the lividity, as well as internally, involving the organs and tissues (Disc Image 15.42). It should be noted that CO is not the only source of bright red lividity and tissue discoloration: such a finding can occur with cyanide, very cold temperatures, and certain other substances.

Note: I don't have disc with the images cited, but they may correspond to the images in the book "Atlas of Forensic Pathology" also by Prahlow. Those images are included in the pdf file I posted previously.


More to follow.

[friedrichjansson]

Not sure why an 8 followed by a right parenthesis produced a smiley face in the above post...

15) Autopsy pathology : a manual and atlas / Walter E. Finkbeiner, Philip C. Ursell, Richard L. Davis ; contributor, Andrew J. Connolly—2nd ed. 2009

p. 278 (right hand column)

16) Clinical Forensic Medicine 3rd edition / Edited by W.D.S. McLay, 2009

p. 207
The onset of hypostasis is too variable to be of any great use in estimating time of death, and it may be difficult to see if the person has a lot of fat or has lost a lot of blood. Take note of its colour, which may be cherry red due to carboxyhaemoglobin in carbon monoxide poisoning, pink due to undissociated oxyhaemoglobin in hypothermia, a deep red due to blood remaining fully oxygenated in cyanide poisoning and grey-brown in methaemoglobinaemia.

Note: this quote is from Chapter 18: Investigation of Death, so despite the word "clinical" in the title of the book, this passage is about the deceased.

17) Principles of Biochemical Toxicology Third Edition / John Timbrell, 2000

p. 312 / p. 597 of electronic document
When the level reaches 20–30% the victim may have a headache, raised pulse rate, a dulling of the senses and a sense of weariness. At levels of 30–40% the symptoms will be the same but more pronounced, the blood pressure will be low and exertion may lead to faintness. At 40–60% carboxyhaemoglobin there will be weakness and incoordination, mental confusion and a failure of memory. At concentrations of 60% carboxyhaemoglobin and above, the victim will be unconscious and will suffer convulsions. There are many other clinical features: nausea, vomiting, pink skin, mental confusion, agitation, hearing loss, hyperpyrexia, hyperventilation, decrease in light sensitivity, arrhythmias, renal failure and acidosis.

18) Knight, Bernard. Lawyer’s Guide to Forensic Medicine – 2nd edn. 1998

p. 139
The colour of the hypostasis is of more forensic use than its totally unpredictable timing. A cherry red hue is diagnostic of carbon monoxide poisoning. A darker red is suggestive of cyanide and brownish colours may be due to methaemoglobin or sulphaemoglobin, usually due to industrial exposure. In death from hypothermia (qv) the skin may be bright pink or brownish pink, due to unreduced oxy-haemoglobin in the tissues. This may even be seen as a post-mortem phenomenon in bodies from cold water and also after refrigeration.

19) Poisoning & Drug Overdose, Fifth Edition / edited by Kent R. Olson, 2006

p. 70 of document but pagination not preserved in electronic copy
Flushed red skin may be caused by carbon monoxide poisoning, boric acid toxicity, chemical burns from corrosives or hydrocarbons, or anticholinergic agents. [the context is clinical - we are dealing with the living]

p. 271 of document
There are no specific reliable clinical findings [for carbon monoxide poisoning]; cherry-red skin coloration or bright red venous blood is highly suggestive but not frequently noted.

Remark: the description "not frequently noted" applies to the world of ALL clinical cases of CO poisoning, including chronic low level poisoning. The conclusion that ante-mortem redness would be rare among people being gassed with CO is not justified - they will have carboxyhemoglobin levels much higher than the typical clinical case. The same book states that "carbon monoxide poisoning accounts for approximately 40,000 emergency department visits every year in the United States" but CDC data records only 525 unintentional deaths and 1988 suicides by CO in 1996 (see also http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5650a1.htm ) Thus most clinical cases are not in life threatening danger - and redness grows with severity of CO poisoning.

20) The Forensic aspects of poisons / Richard A. Stripp, 2007

p. 31
The most significant postmortem change in CO poisoning is a cherry red color of the blood, which manifests itself as a reddish coloration of the skin.


21) The Complete Idiot's Guide to Forensics 2nd edition / Alan Axelrod and Guy Antinozzi, 2007.

p. 129
The medical examiner will also note the color of the lividity. Cherry red or vivid pink lividity indicates carbon monoxide poisoning, and other poisons also impart a telltale color to the lividity.

[friedrichjansson]

22) Concise Textbook of Forensic Medicine and Toxicology 3rd ed. / RK Sharma, 2011

p. 46
Sometimes, the colour of post-mortem staining may point toward cause of death. In asphyxial deaths, the post-mortem staining is bluish violet or deep purple while it is cherry red in poisoning due to carbon monoxide or hydrocyanic acid.

p. 233
The post-mortem should be done very carefully in cases of poisoning. There may be stains of poison on the body or on clothes. Some parts of vomitus may also be seen on clothes or on body. The colour of skin may also point toward the kind of poison. Cherry red appearance in cases of carbon monoxide poisoning may be seen.

p. 320
The lips and fingernails [of a CO decadent] show a bright red colour. Irregular patches of bright red colour are seen scattered over anterior surface. The post-mortem staining shows the same bright red colour. The blood in the vessels is seen to be bright red and fluid. The internal organs also appear bright red due to the colour of the blood. The mucous membranes also appear bright red.

23) Simpson’s Forensic Medicine 13th Edition / Jason Payne-James et al, 2011

p. 45
The colour of hypostasis is variable and may extend from pink to dark pink to deep purple and, in some congestive hypoxic states, to blue. In general, no attempt should be made to form any conclusions about the cause of death from these variations of
colour, but there are, however, a few colour changes that may act as indicators of possible causes of death: the cherry pink colour of carbon monoxide poisoning, the dark red or brick red colour associated with cyanide poisoning and infection by Clostridium perfringens, which is said to result in bronze hypostasis.

p. 212
Poisoning by CO is described as a ‘disease with a thousand faces’ because of its many different clinical presentations. Classic acute CO intoxication is said to cause the triad of cherry-red lips, cyanosis and retinal haemorrhages, but this type is rare.

Note: the remark in reference 19 applies here as well.

24) Simpson’s Forensic Medicine 12th Edition / Richard Shepherd, 2003

p. 182
The external signs of CO poisoning, apart from the symptoms, are a pink coloration of the skin, usually described as ‘cherry-pink’. The nail beds and lips may also show this characteristic colour, but this may not be obvious in the living until high saturations are reached. In the hypostatic areas of the dead body, the pink coloration is usually obvious, but exceptions may be found in the old or anaemic, in whom reduction in haemoglobin content reduces the intensity of the coloration.

Note: the sections on CO poisoning and cyanide poisoning were removed from the 13th edition.

25) Death scene investigation : a field guide / Scott A. Wagner, 2009

p. 22
Carbon monoxide poisoning will cause the livor to be bright red. Cold, freezing, refrigeration, and cyanide poisoning c auses red-to-salmon-pink lividity (Figure 3.3).

p. 96
In CO poisoning, the livor, tissue, and blood appear cherry red. Poisoning due to hydrogen cyanide and cold temperatures causes a pink lividity.

p. 167
Drugs and chemicals, however, seldom leave characteristic or identifying visual findings at the autopsy. Even those substances that do leave visual findings [e.g., cyanide (pink livor) and carbon monoxide (red livor)] must be confirmed and quantified.

26) Forensic science : an encyclopedia of history, methods, and techniques / William J.Tilstone, Kathleen A. Savage, and Leigh A. Clark, 2006

p. 99
Carbon monoxide poisoning is associated with a cherry-red coloration of the skin and muscles.

p. 114
[section discussing the formation of hypostasis] To begin with there are small scattered patches, but these merge with time.The color starts as pink but changes to dark pink and then to blue as oxygen is removed. Carbon monoxide or cyanide poisoning each produce a bright cherry pink.


27) Encyclopedia of Forensic Sciences / edited by Jay Siegel, Geoffrey Knupfer, Pekka Saukko, 2000

p. 1158, article "Autopsy"
A pink lividity, rather than the usual purple-red, raises the possibility of death from carbon monoxide poisoning, cyanide or hypothermia.

pp. 309-310, article "Asphyctic Deaths"
Carbon monoxide combines with hemoglobin to produce the pink pigment, carboxyhemoglobin, which can readily be identified at postmortem. The classic `cherry pink' discoloration of the skin and tissues is usually evident when the carboxyhemoglobin saturation of the blood exceeds about 30%. Under most conditions following death, deoxygenation of hemoglobin occurs but in carbon monoxide poisoning the carboxyhemoglobin bond is stable and the body will retain its characteristic pinkish so-called
flesh tone and discoloration for many hours after death even until decomposition commences.

p. 1164, article "Postmortem Changes"
In a naked body exposed to air, transcutaneous oxygenation may impart a pinker hue. This is also well seen in bodies exposed to cold, be it hypothermia or deliberate refrigeration. The marked `pinking' may lead to a mistaken diagnosis of death by carbon monoxide or cyanide poisoning.

p. 1166, article "Postmortem Changes"
It is said that poisoning by arsenic or cyanide delays the onset of putrefaction. Certainly the only case of homicidal arsenic poisoning seen by this author was remarkably well preserved upon exhumation several weeks after death and the initial autopsy.

Note: this passage damages any attempt to salvage the witnesses who claimed they saw greenish skin on those killed by HCN by asserting that they simply saw corpses that had begun to putrefy.


28) Encyclopedia of Forensic and Legal Medicine / Editor in chief Jason Payne-James, 2005

p. 459 (page 1515 of document - pagination is preserved, but the multiple volumes have independent page numbers), article "Postmortem Changes: Overview" I quote extensively because it's a good summary of the issues. Emphasis in original.

Color of Livor Mortis
In the early phase of their formation, livores have a reddish color, due to the prevailing number of erythrocytes carrying oxygenated hemoglobin. With an increase in the length of the postmortem interval, livores become darker, and when fully developed, the
normal color of livor mortis is bluish-violaceous to purple. This is a result of oxygen dissociation from both the postmortem hemoglobin of erythrocytes and continuous oxygen consumption from cells that initially survive the cessation of cardiovascular function (e.g., skeletal muscle cells survive cessation of the cardiovascular system for 2–8 h). The resulting product is deoxyhemoglobin, which is bluish-violaceous to purple in color.

Light reddish/pink livores Light reddish or pink livores are frequently seen in carbon monoxide poisoning, fatal hypothermia, cyanide poisoning, or in bodies deposited postmortem in cold ambient temperatures.
A light reddish or pink, sometimes described as ‘‘cherry-red,’’ coloration of livores is classically seen in carbon monoxide poisoning as a result of carboxyhemoglobin formation (Figure . The assumption that a bluish-violaceous color of the matrix of the nails, when found together with a light reddish color of livores, refutes carbon monoxide poisoning as being responsible for the reddish coloration of livores must be vehemently contradicted. Tsokos and coworkers have seen cases of fatal carbon monoxide poisoning where the matrix of the nails showed a bluish-violaceous color despite carbon monoxide hemoglobin concentrations of 50% and more. In such doubtful cases, laboratory testing of heart blood samples should be carried out immediately to avoid exposing other individuals to danger at the scene of death.

Light reddish or pink livores are also frequently seen in fatal hypothermia cases since cold ambient temperature inhibits dissociation of oxygen from the hemoglobin. Oxygenated hemoglobin has a lighter red color than deoxyhemoglobin. Under cold ambient temperatures (roughly below 15  C), reoxygenation of hemoglobin slowly occurs postmortem, and this is the explanation for the light red color of livores seen in bodies after storage in a cooling apparatus postmortem (Figure 9).

In cyanide poisoning, the cyanide inhibits dissociation of oxygen from the hemoglobin by blocking cytochromoxidase activity, leading to a light reddish or pink coloration of livor mortis.

Encyclopedia of forensic and legal medicine CO - 2.png (147.84 KiB) Viewed 22391 times

encyclopedia of forensic and legal medicine - cold.png (181.13 KiB) Viewed 22391 times

p. 485 / page 1541 of document, article "Postmortem Changes: Postmortem Interval"
The medicolegal importance of lividity lies in its color, as an indicator of the cause of death, and in its distribution, as an indicator of body position. The purple color of lividity reflects the presence of deoxyhemoglobin in the increasingly oxygen-depleted
postmortem blood. Death from hypothermia or cyanide poisoning imparts the pink hue of oxyhemoglobin, carbon monoxide poisoning the cherry-red of carboxyhemoglobin, and poisoning from sodium chlorate, nitrates, and aniline derivatives impart the gray to brown color of methemoglobin.


p. 302, article "Carbon Monoxide Poisoning"
Clinical Findings
A vast range of symptoms of CO exposure have been described, hence the description of CO poisoning as a ‘‘disease with a thousand faces.’’ Classically, acute CO intoxication is said to cause the triad of cherry-red lips, cyanosis, and retinal hemorrhages, but this type of presentation is rare. In many cases a more insidious presentation develops, with the only indicator a general malaise or suspicion of a viral-type illness. The group of illnesses broadly described as chronic fatigue syndromes may have features that are attributable at least in part to CO exposure.

p. 316, article "Carbon Monoxide Poisoning," subsection "Incidence and Findings at Postmortem"
‘‘Cherry-Red’’ Livor Mortis and Tissues
The most distinctive and oft-observed finding is neither specific nor uniform. The typical bright-red or ‘‘cherry-red’’ livor mortis (Figure 1) may also be seen in numerous other situations. Another electron transport toxin, CN, also produces a similar color but is
distinguished by an odor of bitter almonds, detectable by a subset of the population. The red color associated with CN exposure is due to the continued presence of oxyHb after death. In addition, with deaths due to environmental hypoxia and submersion
(especially in cold water), the presence of a moist or damp postmortem environment, early decomposition, and/or fluoroacetate exposure, the livor may appear pink.

[...]

The typical description of a decedent with CO poisoning is that he/she ‘‘looks healthy.’’ That is, the body retains a normal in vivo hue due to the continued presence of unutilized oxyHb. As livor may be subtle or unapparent early and/or in darkly pigmented bodies, other easily visualized vascular tissues can be assessed. The typical bright-red color is most readily appreciated in the mucosa of the mouth (Figure 13) and the conjunctiva. Fingernails are an excellent site to assess, as the nail beds are usually prominently cyanotic after death. With sufficient COHb, the nail beds appear pink. With a CO of less than 30% and in living patients, the classic ‘‘cherry-red’’ color is absent or barely perceptible, even in lightly pigmented individuals. In clinical cases the bright-red color may be dismissed as mild sunburn or flushing.

Note: the assertion about nail beds is qualified by the passage quoted from the same book above.

[friedrichjansson]

29) Forensic Pathology: Principles and Practice / David Dolinak, Evan W. Matshes, Emma O. Lew, 2005

p. 247
The cherry-red coloration is evident in the skin (Image 10.24). The man figured in Image 10.25 died from carbon monoxide toxicity and is not burnt but covered with black soot down to the waist.

10.24.png (217.91 KiB) Viewed 22383 times

10.25.png (221.41 KiB) Viewed 22383 times

p. 250
one might infrequently notice [in cases of hypothermia] that the coloration of the dependent lividity has changed to a bright pink or red, similar to that found in carbon monoxide toxicity or cyanide poisoning.


30) Atlas der Rechtsmedizin / P._Dickens, S._Leadbeatter, S._Pollak, P._Saukko, 2003

p. 33
Farbe der Totenflecke. Nach Aufzehrung des Sauerstoffes sind die Totenflecke blaulivide verfärbt (. Tabelle 2.14). Hellrote Totenflecke findet man bei einer Kohlenmonoxidvergiftung, sie werden auch bei Zyanidintoxikationen beschrieben. Bei Kohlenmonoxidvergiftung ist die Ursache die Bildung von Carboxyhämoglobin (CO-Hb); Kohlenmonoxid hat eine wesentlich höhere Affinität zum Hämoglobin als Sauerstoff.
Ab CO-Hb-Werten von mehr als 30% findet sich die typische kirschrote Farbe der Totenflecke, die bei sachgemäßer Untersuchung zwanglos zu erkennen ist. Unter 20% CO-Hb findet sich keine auffällige Verfärbung, was insofern unbedenklich ist, da diese Werte nicht oder selten letal sind.
Retrospektive Untersuchungen ergaben, dass nur in 61% der Fälle mit eindeutig kirschroten Totenflecken vom Leichenschauer die Todesursache CO-Intoxikation erkannt wurde. Je älter der Verstorbene, desto häufiger wurde die CO-Intoxikation verkannt, bei Übersiebzigjährigen in mehr als 50% der Fälle.

p. 362

31) Knight's Forensic Pathology, 3rd edition / Pekka Saukko, Bernard Knight, 2004

p. 12, section "The Autopsy: External Examination"
The general skin colour is noted, especially hypostasis (discussed at length in Chapter 2). Congestion or cyanosis of the face, hands, and feet is sought. Localized discoloration, especially unilateral in a limb, suggests arterial embolism or incipient gangrene. Pink or brownish pink patches over the large joints may indicate hypothermia (Chapter 17). Other abnormal colours include the brownish hue of methaemoglobinaemia in some poisonings, the bronze speckling of clostridial septicaemia and the dark red of cyanide that somewhat resembles the cherrypink coloration of carboxyhaemoglobin. Naturally racial pigmentation will modify the ease with which abnormal skin coloration can be seen.

p. 321
The pathology of carbon monoxide is dealt with in another section of this book, but it may be repeated here that the autopsy -signs are primarily that of a cherry-pink coloration of the skin, blood and tissues. Where smoke staining or extensive charring has occurred, there may be little skin to examine, though there is usually some in a protected position under the body. The blood and tissues usually have the characteristic colour but, when the person is anaemic or exsanguinated, this may be hard to detect. A high saturation with monoxide is usually unmistakable at autopsy, though sometimes certain types of artificial light in the autopsy room, such as some fluorescent tubes, make the cherry-pink colour difficult to confirm.

p. 562, section "The Autopsy in Carbon Monoxide Poisoning"
many a case has first been recognized by the mortuary technician who commented on the colour of the skin or tissues. A number of fatal monoxide poisonings have already been certified as 'natural causes' by uncritical clinicians (especially in general practice) when in fact carbon monoxide poisoning, either suicidal or accidental, was the true reason for the death. Failure to examine the body fully is the usual cause, as the pink coloration may only be noticeable in the areas of postural hypostasis not normally visible in a body in bed, though the sides and back of the neck are reasonably accessible even to cursory examination. The author (BK) recollects at least one suicide where the relatives placed the body back in bed and had it certified as 'coronary thrombosis' by an unsuspecting family doctor.
At autopsy the most striking appearance of the body is the colour of the skin, especially in areas of post-mortem hypostasis. The classical 'cherry-pink' colour of carboxyhaemoglobin is usually evident if the saturation of the blood exceeds about 30 per cent. Below this, familiarity and good lighting are needed and below 20 per cent, no coloration is visible. As these low concentrations are rarely fatal, however, little is lost. Sometimes, darker cyanosis tends to mask the skin colour, but the margins of the hypostasis and the internal tints are usually apparent.
When the victim is anaemic, the colour may be faint or even absent because insufficient haemoglobin is present to display the colour. In racially pigmented victims the colour may obviously be masked, though may still be seen on the inner aspect of the lips, the nail-beds, tongue, and palms and soles of the hands and feet. It is also seen inside the eyelids, but rarely in the sclera.


32) Color Atlas of Human Poisoning and Envenoming / James H. Diaz, 2006

p. 405

[friedrichjansson]

Now we turn to the question of at what percent carboxyhemoglobin saturation red skin appears. This was already discussed in references 5, 27, 28 (in the caption to figure 1), 30, 31, and 32. Another reference is the study on CO deaths which Thomas Kues has cited, which found no case with higher than 31% carboxyhemoglobin that did not display the characteristic color.

33) Color Atlas of Forensic Medicine and Pathology / edited by Charles Catanese, 2009

p. 354
Carbon monoxide levels of 15–30% are associated with dizziness, nausea, and headache. Cherry-red lividity first becomes apparent at levels of 30–35%.


34) Vincent DeMaio, Dominick DeMaio. Forensic Pathology, 2nd ed. 2001

p. 395
One of the authors autopsied an individual with a carboxyhemoglobin level of 45% in whom the characteristic coloration was not present. He at first ascribed the cause of death to heart disease. The individual had such a “healthy complexion.” However, the
author’s suspicions were aroused enough to order a carbon monoxide determination. Death had been caused by CO, produced by a defective heating unit in the residence.

Note: obviously this is abnormal, and is being mentioned by the authors specifically for that reason.






NOW WE TURN to the question of what the carboxyhemoglobin levels are in the kind of deaths we are dealing with - deaths caused by exhaust.


35) Forensic Pathology for Police, Death Investigators, Attorneys, and Forensic Scientists / Joseph Prahlow, 2010

p. 422
In exhaust deaths, the CO levels are usually well over 50%, frequently within the 70s.


36) Vincent DeMaio, Dominick DeMaio. Forensic Pathology, 2nd ed. 2001

p. 377
in the authors’ experience, in individuals whose deaths are caused by inhalation of automobile exhaust, the average carbon monoxide level is 79%, with 82% of cases having levels of 70% or greater.


37) Knight's Forensic Pathology, 3rd edition / Pekka Saukko, Bernard Knight, 2004

p. 322
Many fatalities [caused by CO in fires] will display 50-60 per cent saturation, though levels in general are less than in pure carbon monoxide poisoning, such as car exhaust suicides or industrial exposure, where concentrations of up to 80 per cent may occur.

[Friedrich Paul Berg]

Many thanks again to Friedrich Jannson who has just posted many excellent references which were totally unknown to me. The more we have the better. The hoaxers will NOT give up easily.

The issue should prove decisive--because it is clear and simple and persuasive ultimately.


Friedrich Paul Berg
Learn everything at http://www.nazigassings.com
Nazi Gassings Never Happened! Niemand wurde vergast!

[friedrichjansson]

Now turning to cyanide. I won't repeat the references given above which mentioned cyanide along with carbon monoxide.

38) Alan Gunn, Essential Forensic Biology, 2009

p. 22
Cyanide poisoning also results in the skin developing cherry red coloration although it is said to be somewhat darker than that caused by carbon monoxide.
[...]
Cyanide poisoning can also cause cyanosis – a bluish tinge to the skin, fingernails and mucous membranes – although the term is derived from the blue–green colour cyan rather than the chemical cyanide. Cyanosis may be localized or more widespread and be found on its own or in conjunction with the cherry red skin coloration. It is caused by a reduction in the level of oxygen in the blood and therefore darker deoxygenated blood imparts colour to the tissues, blood vessels, and capillaries rather than the normal bright red oxygenated blood. Cyanosis is therefore a common symptom of a whole range of conditions that interfere with the supply of oxygenated blood to the tissues including carbon monoxide poisoning, a heart attack and asphyxia from hanging.

39) Forensic Science: Fundamentals and Investigations / Anthony J. Bertino 2012

p. 258
Cyanide overdose can be fatal six to eight minutes after ingestion. Rapidly causes weakness, confusion, coma, and pink skin from high blood oxygen saturation. Produces an almond-like odor.

40) Handbook of Autopsy Practice, Fourth Edition, 2009. Edited by Brenda L. Waters.

p. 427
Bright red skin color is not always present.

41) Handbook of forensic toxicology for medical examiners / D.K. Molina, 2010

p. 78
[cyanide is] Associated with bright red lividity and musculature at autopsy


42) Vincent DeMaio, Dominick DeMaio. Forensic Pathology, 2nd ed. 2001

p. 271
At the autopsy of an individual who ingests a cyanide salt, the mouth and stomach give off the distinct smell of bitter almonds. Unfortunately, the ability to smell cyanide is governed by a genetic trait and a significant percentage of the population cannot smell it. The gastric mucosa and blood will have a bright red color. Livor mortis is often bright pink. This coloration is caused by cyanide’s inhibition of the cytochrome oxidase system, which prevents utilization of circulating oxyhemoglobin. It is oxyhemoglobin that gives the bright pink color to the blood, not cyanohemoglobin, which is not formed in any significant quantity in life.


43) Encyclopedia of Toxicology / Editor-in-Chief Philip Wexler, 2005

p. 699, article "Cyanide"
Following the inhalation of toxic amounts of cyanide, symptoms usually appear within a few seconds, whereas it may take a few minutes for symptoms to appear following oral ingestion or skin contamination by the salts. The symptoms include a flushed skin, tachypnea, and tachycardia. Stupor, coma, and seizure immediately precede respiratory arrest and cardiovascular collapse. Death shortly occurs. If large amounts have been absorbed, collapse is usually instantaneous-the patient falling unconscious and dying almost immediately. With smaller doses, weakness, giddiness, headache, nausea, vomiting, and palpitation usually occur. With the rise of the blood cyanide level, ataxia develops and is followed by lactic acidosis, convulsive seizures, coma, and death. At higher cyanide doses, cardiac irregularities are often noted, but heart activity always outlasts the respiration.


44) Forensic Pathology for Police, Death Investigators, Attorneys, and Forensic Scientists / Joseph Prahlow, 2010

p. 423
A general autopsy feature that is sometimes noted in cyanide cases is a bright red discoloration of tissues (similar to that which occurs in CO cases).


45) Poisoning and toxicology handbook / editors Jerrold B. Leikin and Frank P. Paloucek. -- 4th ed. 2008

p. 781, section "Cyanide"
Signs and Symptoms of Overdose Agitation, apnea, bitter almond
breath, coma, cyanosis, dizziness, flushing, headache, hyperventilation,
hypothermia, hypotension, metabolic acidosis, mydriasis, myoglobinuria,
nausea, nystagmus, pruritus, pulmonary edema, ototoxicity, seizures,
skin irritation, tachycardia followed by bradycardia, tachypnea, tinnitus,
vomiting


46) Knight's Forensic Pathology, 3rd edition / Pekka Saukko, Bernard Knight, 2004

p. 57
The colour of hypostasis
The usual hue is a bluish red, but variation is wide. This depends partly on the state of oxygenation at death, those dying in a congested, hypoxic state having a darker tint as a result of reduced haemoglobin in the skin vessels.
[...]
Other changes in the colour of hypostasis are more usful. The best known is the 'cherry-pink' of carboxyhaemoglobin, which is a unique colour and is often the first indication to the pathologist of carbon monoxide poisoning. Cyanide poisoning is said to have its own characteristic dark blue-pink hue, but it is really an index of the congested, cyanotic, mode of death and, if the pathologist was not already aware of the potential cause from the history - and perhaps the odour of cyanide - it is doubtful whether hypostasis would be a primary indication of the nature of the death.

p. 586, section "Autopsy findings in cyanide poisoning"
Externally there can be wide variations in the appearance. Traditionally, the hypostasis is said to be brick-red, due to excess oxyhaemoglobin (because the tissues are prevented from using oxygen) and to the presence of cyanmethaemoglobin. Many descriptions refer to a dark pink or even bright red skin, especially in the dependent areas, which can be confused with carboxyhaemoglobin. The few cases seen by the authors have shown a marked dark cyanotic hypostasis, perhaps caused by lack of oxygenation of the red cells by paralysis of the respiratory muscles. There may be no other external signs apart from the colour of the skin and possibly black vomit around the lips.
[...]
The oesophagus may be damaged, especially the mucosa of the lower third, though some of this may be a post-mortem change from regurgitation of the stomach contents through the relaxed cardiac sphincter after death. The other organs show no specific changes and the diagnosis is made by history smell and the reddish colour of the internal tissues, and often skin.

Remark: this book is the least supportive of the revisionist argument of all I have surveyed. The statement that "cyanide poisoning is said to have its own characteristic dark blue-pink hue" is quite odd, because no other source says that at all. Reference 31 above - from the very same book - says that "the dark red of cyanide that somewhat resembles the cherrypink coloration of carboxyhaemoglobin," and Knight's book "Lawyer's Guide to Forensic Medicine" (2nd edition 1998, reference 18 above) describes hypostasis for cyanide cases as "a darker red" - darker, that is, than the color of CO cases. I don't have the previous editions of this book (1991 and 1996) but would be interested to see what they say on this matter.


47) Concise Textbook of Forensic Medicine and Toxicology 3rd ed. / RK Sharma, 2011

p. 315, section "CYANIDE (HYDROGEN CYANIDE, HCN)"
Post-mortem Appearance
The characteristic feature is that the skin presents a livid or violet colour. Post-mortem staining appears as bright red or pink due to cyanomethaemoglobin and also due to the fact that tissues could not take up oxygen from blood leaving bright red colour in veins. The features of asphyxial death are seen. Rigor mortis sets in early and lasts longer. The smell of hydrocyanic acid may be appreciated on opening the body. The blood is bright red in appearance and is fluid. Stomach may show congestion and haemorrhages due to the local action. Mouth and lips may show corrosion.


48) Principles of Biochemical Toxicology Third Edition / John Timbrell, 2000

p. 314 of book / 602 of document, section "Cyanide"
The symptoms of poisoning include headache, salivation nausea, anxiety, confusion, vertigo, convulsions, paralysis, unconsciousness coma, cardiac arrhythmias, hypotension and respiratory failure. Both venous blood and arterial blood remain oxygenated, and hence the victim may appear pink.


49) Simpson’s Forensic Medicine 12th Edition / Richard Shepherd, 2003

p. 183
The blood remains pink, due to failure of uptake of O2 by the tissues. The skin, especially after death, may be a brick-red colour, particularly in the dependent hypostasis. This may be confused with CO poisoning, though cyanide usually gives a darker, sometimes purplish hue, whereas CO has a pinker colour.


50) Introduction to Military Toxicology: a crush course. 2001. Pharmacology Department, University of Bristol. [is "crush course" an anglicism for "crash course" or is this a typo?]

p. 44 of document
Light HCN poisoning is manifested by feeling the smell of bitter almonds (but see the comment above), metallic taste and bitterness in the mouth, “scratching” in the throat and nose, dizziness, fatigue, weakness.
Medium stage HCN poisoning adds noise in the ears, pulsation of temporal arteries, nausea & vomiting, gasping for air, speech difficulties, bradicardia, pain in the chest, muscle weakness. Mucose membranes and face often turn pink. As severe poisoning develops, hyperpnea follows, skin is pink, pulse is slow and tense, consciousness is dimmed, affected are excited, anxious, afraid of dying, experience angina-like chest pain, stagger, pupils are dilated. Then the consciousness is lost and intense tonic-clonic seizures develop. During the seizures skin is bright pink, pupils dilated, exophthalmia, corneal reflex is absent, pulse is slow, blood pressure is normal or slightly elevated, breathing is arrhythmic and infrequent, urination and defecation often take place. Seizures may last from several minutes to several hours and are followed by paralysis, coma and cardiac arrest.

Lightning form of cyanide poisoning leads to hyperpnea in 15 seconds, loss of consciousness and fall in 30 seconds, apnea and seizures in 3-5 min, coma and cardiac arrest in 5-8 min. Oral cyanide poisoning is similar to the inhalational, but develops slower, in 15 – 30 min.

51) Medical Aspects of Chemical Warfare / Editor in Chief Martha K. Lenhar(2008), chapter 11
http://www.scribd.com/doc/51917108/Medi ... rfare-2008

p. 383
Common themes in case presentations (acute, severe) include rapid onset of coma; mydriasis with variable pupil reactivity; burnt/bitter/pungent almond scent; tachycardia; metabolic acidosis, often extreme; cyanosis of mucous membranes and/or flushed skin; absence of cyanosis despite respiratory failure;

Note: this refers to the clinical case.


52) Handbook of Toxicology of Chemical Warfare Agents / Ramesh C. Gupta, 2009

p. 261

table 19.4.png (55.99 KiB) Viewed 22365 times

53) Chemical warfare agents : toxicology and treatment / editors, Timothy
C. Marrs, Robert L. Maynard, Frederick R. Sidell. – 2nd ed. 2007

p. 517

chemical warfare agents toxicology and treatment.png (36.98 KiB) Viewed 22365 times

54) Color Atlas of Human Poisoning and Envenoming / James H. Diaz, 2006

p. 407

55) D.J. Gee, Notes on Forensic Medicine, 1979

p. 239

[friedrichjansson]

Continuing with references on cyanide. Finishing with the textbook literature, turning to articles. There are several I'd like to look at but can't due to access restrictions, so if anyone has institutional access to scientific and medical journals, please let me know.

56) Medical Management of Chemical Casualties Handbook
http://www.fas.org/nuke/guide/usa/doctr ... yanide.htm

Physical Findings: Physical findings are few and non-specific. The two that are said to be characteristic are in fact not always observed. The first is severe respiratory distress in an acyanotic individual. When seen, "cherry-red" skin suggests either circulating carboxyhemoglobin from carbon monoxide poisoning or a high venous oxygen content from failure of extraction of oxygen by tissues poisoned by cyanide or hydrogen sulfide. However, cyanide victims may have normal appearing skin and may even be cyanotic, although cyanosis is not classically associated with cyanide poisoning.


57) An uncommon case of a suicide with inhalation of hydrogen cyanide
http://www.sciencedirect.com/science/ar ... 3810002665

Has a picture of a cyanide fatality - the first I've seen.

cyanide.png (120.86 KiB) Viewed 22365 times

58) A case study of sorts: the suicide of Michael Marin

http://usatoday30.usatoday.com/news/nat ... 56153806/1
http://www.dailymail.co.uk/news/article ... arson.html

Someone in the video on the first link says his face looked quite red, although he seems to have been fairly reddish even before ingesting the cyanide.


59) Suicide by Cyanide: 17 Deaths

Suicide_by_Cyanide__17_Deaths.pdf

(275.29 KiB) Downloaded 335 times

A study of suicidal ingestions of cyanide in New York City. Seven of the cases are whites. Of them four were classified as purple, one pink purple, one pink (a putrefied case), and one cherry-pink.

This study makes the strongest case against the revisionist argument I have seen, and will inevitably join Knight's Forensic Pathology as the foundation of antirevisionist polemics on this subject. Antirevisionists will emphasize the purplish, cyanotic appearance of some cyanide deaths, and attempt to use this to rehabilitate as many witness accounts as they can.


60) Attempted Suicide by Cyanide: a report of two cases

califmed00023-0029.pdf

(675.74 KiB) Downloaded 333 times

two clinical cases; flushing was remarked upon in one; odor was remarked upon in both

[friedrichjansson]

Continuing with cyanide. I've been looking at the old (public domain) literature. It often gives more details on physical appearance and other naive questions than does the modern literature.

61) Rudolf Kobert, Lehrbuch der Intoxicationen, volume 2, 1906

States that 30% of cases in Germany and Austria are bright red; he thinks the number is higher in Russia. Gives references to a man Strecker who observed 10 cases all of whom were bright red, and a study by M. Richter which found that 32% of cases in Vienna were bright red.

62) R.A. Witthaus, Medical Jurisprudence, volume 4, 1911
States that when death occurs quickly the livor will be light red; when death is delayed the blood is dark and we are looking at darker, cyanotic hypostasis.

This is a very important point. Since the deaths at Auschwitz are supposed to have occurred quickly, a higher than normal percentage of the corpses gassed at Auschwitz should have been red. But the reference is quite old. It is correct? I emailed an couple of experts; one replied and told me that in his opinion, cyanosis in cases of cyanide poisoning is caused by deoxyhemoglobin, and that this is entirely consistent with the statement that people who die rapidly from cyanide will be more red and people who die more slowly will tend to be more cyanotic/purple. He stated that he "can readily believe" that those who die rapidly are more red and those who die slowly are darker, but that he has no hard data to back that up.


63) Rudolf Kobert, Practical Toxicology, 1897

64) Collected studies on the pathology of war gas poisoning: from the Department of Pathology and Bacteriology, Medical Science Section, Chemical Warfare Service, under the direction of M.C. Winternitz, 1920, p. 117

[friedrichjansson]

65) Lethal cyanide inhalation with post-mortem trans-cutaneous cyanide diffusion
http://www.sciencedirect.com/science/ar ... 2303000786

Another image of a cyanide victim. He died sitting in a cyanide solution, which accounts for the coloration around the buttocks and on parts of the legs.

sitting in cyanide.jpg (26.29 KiB) Viewed 22085 times

66) Alexander Blyth, Poisons: Their Effects and Detection, 1906, p. 214

[Friedrich Paul Berg]

The following account is from the "Death Penalty Information Center:"

17. April 6, 1992. Arizona. Donald Eugene Harding. Asphyxiation. Death was not pronounced until 10 1/2 minutes after the cyanide tablets were dropped.[23] During the execution, Harding thrashed and struggled violently against the restraining straps. A television journalist who witnessed the execution, Cameron Harper, said that Harding's spasms and jerks lasted 6 minutes and 37 seconds. "Obviously, this man was suffering. This was a violent death ... an ugly event. We put animals to death more humanely."[24] Another witness, newspaper reporter Carla McClain, said, "Harding's death was extremely violent. He was in great pain. I heard him gasp and moan. I saw his body turn from red to purple."[25] One reporter who witnessed the execution suffered from insomnia and assorted illnesses for several weeks; two others were "walking vegetables" for several days.[26]

See also: http://www.capitalpunishmentuk.org/gascham.html There we have the following text near the very end under "comments:" "The inmate is expected to contribute to his (or her) own death by actively inhaling the lethal fumes and typically takes several minutes to lapse into unconsciousness, generally showing signs of great suffering during this period." That Jews in Nazi camps would assist in their own executions seems highly unlikely--and is not even suggested in the holocaut literature. The dispersal of the gas to remote parts of any gas chamber w-i-t-h-o-u-t any kind of circulation fans (Kreislaufprinzip) makes any conceivable execution of a thousand or so prisoners a far lengthier pocess.

As an indirectly related sidenote to the above, I just came across the following about the last known official execution by burning in the US in 1830:
http://www.executedtoday.com/2011/05/01/1830-the-slave-jerry-the-last-american-execution-by-burning/
Let us not forget the US had no problem incinerating countless women and children and babies during WW2 and the Korean War


Friedrich Paul Berg
Learn everything at http://www.nazigassings.com
Nazi Gassings Never Happened! Niemand wurde vergast!

[Friedrich Paul Berg]

What follows is the largest image I can include here (for technical reasons) of some of the fingertips from a photo from the Wikepdia essay about cyanosis that is linked on this forum. Readers can enlarge the image many times more with "Conrol +" and/or other commands.Some of the cyanotic areas are enlarged without any tampering with the color:


The enlarged view is clearly NOT blue at all--but a warm-grey instead. That warm grey color puts it on the red end of the color spectrum and about as far from blue as possible.

The very same procedure can be used with any image to remove the psychological effect of surrounding colors on the viewer's perceptions. Just crop out the non-cyanotic areas. It will confirm again and again for objects photographed in normal light that any perceived "blueness" is not really there at all--but is merely a psychological effect caused by contrast with surrounding normal skin colors. Readers miay enlarge the images even more to confirm the phenomenon for themselves.

Friedrich Paul Berg
Learn everything at: http://www.nazigassings.com
Nazi Gassings Never Happened! Niemand wurde vergast!

[friedrichjansson]

67) B.M. Singh et al. "The metabolic effects of fatal cyanide poisoning"

Postgrad Med J-1989-Singh-923-5.pdf

(329.54 KiB) Downloaded 303 times

Case report

A previously well 24 year old man was admitted as an emergency. The patient had been working alone in the bottom of a silver plating tank removing several inches of residue of silver cyanide sludge without protective clothing or respirator or supervision and was found unconscious in the sludge by his workmakes. An immediate antidote of amyl nitrite was not administered. The air in the tank was subsequently found to contain 200 parts per million of hydrogen cyanide.

On arrival in casualty his hair and clothes were matted with a black compound. He had chemical burns on exposed skin which had the characteristic brick red colour of cyanide poisoning. There was a strong odour of bitter almonds. He was apnoeic and his pulse was 120 beats per minute, faintly palpable but with no recordable blood pressure...

This case report is notable because is concerns redness in a still living patient, whereas certain anti-revisionists like to argue that red coloration would not be visible until x time after death.