Category: Just for Fun

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Warning: This post contains discussion of murder.

A handful of serial killers have gained extreme notoriety in popular culture. You might recognize the names Richard Ramirez, Jeffrey Dahmer, John Wayne Gacy, and Ed Gein. These four infamous men have something else in common too, and it might surprise you. All four reportedly suffered head trauma as children.

Traumatic brain injuries (TBIs) are a leading cause of death and disability in the juvenile population (Williams et al., 2018). In a previous post in this series, we examined the effects of chronic traumatic encephalopathy, which results from repeated head trauma. However, even just one moderate-to-severe head injury can have serious repercussions.

A traumatic brain injury is defined as “an insult to the brain by an external mechanical force” (Williams et al., 2018). Moderate-to-severe TBI cases are characterized by at least one of the following: >30 minutes loss of consciousness, >24 hours altered mental status, >24 hours post-traumatic amnesia, or a score of <13 on the Glasgow Coma Scale (DynaMed). In such cases, internal bleeding and hypoxia can occur. 

When someone suffers a TBI, there is a risk of developing long-term neurocognitive issues including loss of executive function, impulsivity, and aggression (Williams et al., 2018). In turn, this could lead to social issues; for example, people with serious brain injury might have fewer educational and employment opportunities, and might be more likely to abuse drugs (Williams et al., 2018). 

Thus, TBIs could potentially lead to a number of behavioral and social risk factors for violent crime. Studies have borne out this connection; for example, a 2011 meta-analysis found a significantly higher prevalence of TBIs among incarcerated people as compared to the general population (Farrer & Hedges, 2011).

So, do TBIs turn someone into a killer? No, it’s not that simple. First, of course, the overwhelming majority of people who suffer head trauma in their youth do not become serial killers. Moreover, it can be hard to distinguish correlation from causation in these cases because certain factors, such as low socioeconomic status and aggressive and risk-seeking behavior, can predispose one to both TBI and criminal activity (Williams et al., 2018). As well, there are a great number of other biopsychosocial factors associated with serial killers, including experiencing child abuse or having mental illnesses like antisocial personality disorder or psychopathy.

The four serial killers mentioned here were convicted of the murders of 65 people in total. Did traumatic brain injury play a role in this massive loss of life? 

Do you know of another interesting true crime case with medical connections? Email Rachel Brill at rgbrill@gwu.edu.

References

DynaMed. Moderate to Severe Traumatic Brain Injury. EBSCO Information Services. Accessed January 19, 2023. https://www.dynamed.com/condition/moderate-to-severe-traumatic-brain-injury

Farrer TJ, Hedges DW. Prevalence of traumatic brain injury in incarcerated groups compared to the general population: a meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2011 Mar 30;35(2):390-4. doi: 10.1016/j.pnpbp.2011.01.007. Epub 2011 Jan 14. PMID: 21238529. https://pubmed.ncbi.nlm.nih.gov/21238529/ 

Williams WH, Chitsabesan P, Fazel S, McMillan T, Hughes N, Parsonage M, Tonks J. Traumatic brain injury: a potential cause of violent crime? Lancet Psychiatry. 2018 Oct;5(10):836-844. doi: 10.1016/S2215-0366(18)30062-2. Epub 2018 Feb 26. Erratum in: Lancet Psychiatry. 2018 Jul 17;: PMID: 29496587; PMCID: PMC6171742. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6171742/

Warning: This post contains mention of child abuse.

In October 2003, Julie Baumer took her infant nephew Philipp to the hospital. The boy presented with lethargy, irritability, vomiting, and unwillingness to eat. Doctors performed a CT scan and saw that the baby had a skull fracture and subdural and retinal hemorrhaging. The bleeding was so great that his fontanelle (the soft spot where a baby’s skull is forming) was bulging (Bazelon, 2011). Philipp was also dehydrated and septic. Due to the extensive amount of time taken before an emergency operation, Philipp suffered severe brain damage; he survived the ordeal, but lives with cerebral palsy (Bazelon, 2011). For Julie Baumer, the worst was yet to come.

Baumer was charged with first-degree child abuse. Doctors testified that the baby had experienced blunt force trauma and Shaken Baby Syndrome (SBS) at Baumer’s hands. In 2005, she was convicted and sentenced to 10-15 years in prison. 

In 2010, thanks to the Michigan Innocence Clinic, Baumer was granted a new trial. This time, six experts testified that the baby had been suffering from cerebral venous sinus thrombosis (CVST), the effects of which can appear similar to SBS. Vaslow (2021) states that “for infants presenting with subdural hemorrhage, retinal hemorrhage, and neurological decline the ‘consensus’ opinion is that this constellation represents child abuse and that cerebral venous sinus thrombosis … is a false mimic…. [but] this conclusion is false for a subset of infants with no evidence of spinal, external head, or body injury.” 

CVST is known by many names, including cerebral sinovenous thrombosis and cerebral venous thrombosis (CVT). Whatever you call it, this is a stroke characterized by a blood clot in a cerebral blood vessel (DynaMed). Within the pediatric population, newborns account for 30-50% of cases (Ichord, 2017). Although the clinical presentation in children can vary, pediatric patients will typically present with headache, vomiting, and depressed mental status (DynaMed). Other symptoms may include seizures and otalgia (ear pain). 

In newborns, acute systemic illness is the primary risk factor for CVST (Ichord, 2017). In children, the predominant cause of CVST is acute head or neck infections, such as mastoiditis; chronic diseases such as nephrotic syndrome or inflammatory bowel disease are also possible causes. In order to diagnose CVST, neuroimaging must be used, typically an MRI (Vaslow, 2021). 

What about Philipp’s skull fracture? This was a “red herring” in the case which at first seemed like evidence of child abuse, but with further analysis, doctors were able to determine that this was an older injury attributable to Philipp’s difficult birth (Bazelon, 2011). 

Julie Baumer was acquitted of all charges, but some – including the family who ended up adopting Philipp – still believe she is guilty. Although it is not the legal responsibility of a doctor to determine a caretaker’s innocence, medical professionals are required to document injuries objectively and report suspected abuse to authorities (U.S. Department of Justice, 2014). Therefore, research into and awareness of the differences between SBS and CVST is necessary to keep young children safe and healthy and to keep innocent caregivers out of prison.

Do you know of another interesting true crime case with medical connections? Email Rachel Brill at rgbrill@gwu.edu.

References and Further Reading

Bazelon, Emily. Shaken-Baby Syndrome Faces New Questions in Court. The New York Times Magazine. February 2, 2011. https://www.nytimes.com/2011/02/06/magazine/06baby-t.html?pagewanted=all&_r=0

Brown SD. Ethical challenges in child abuse: what is the harm of a misdiagnosis? Pediatr Radiol. 2021 May;51(6):1070-1075. doi: 10.1007/s00247-020-04845-4. https://link-springer-com.proxygw.wrlc.org/article/10.1007/s00247-020-04845-4 

Denzel, Stephanie. Julie Baumer. The National Registry of Exonerations. Updated February 27, 2020. https://www.law.umich.edu/special/exoneration/Pages/casedetail.aspx?caseid=3017

DynaMed. Cerebral Venous Thrombosis (CVT) in Children. https://proxygw.wrlc.org/login?url=https://www.dynamed.com/condition/cerebral-venous-thrombosis-cvt-in-children Accessed May 26, 2022.

Ichord R. Cerebral sinovenous thrombosis. Frontiers in pediatrics. 2017;5:163-163. doi:10.3389/fped.2017.00163 https://www.frontiersin.org/articles/10.3389/fped.2017.00163/full 

U.S. Department of Justice. (2014). Recognizing When a Child’s Injury or Illness Is Caused by Abuse. https://permanent.fdlp.gov/gpo84798/243908.pdf

Vaslow DF. Chronic subdural hemorrhage predisposes to development of cerebral venous thrombosis and associated retinal hemorrhages and subdural rebleeds in infants. Neuroradiol J. 2022 Feb;35(1):53-66. doi: 10.1177/19714009211026904. https://proxygw.wrlc.org/login?url=https://journals.sagepub.com/doi/pdf/10.1177/19714009211026904 

Vinchon M, Noulé N, Karnoub MA. The legal challenges to the diagnosis of shaken baby syndrome or how to counter 12 common fake news. Childs Nerv Syst. 2022 Jan;38(1):133-145. doi: 10.1007/s00381-021-05357-8. https://link.springer.com/content/pdf/10.1007/s00381-021-05357-8.pdf

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Warning: This post contains discussion of murder and eating disorders.

At the turn of the 20th century, there was a doctor who literally starved her patients to death. Dr. Linda Hazzard did not have a medical degree, but she was nevertheless licensed by the state of Washington as a practitioner of alternative medicine. Hazzard called herself a fasting specialist, and her methods were rooted in her belief that all health issues were caused by consuming too much food. She treated her patients by making them fast for long periods of time in order to let the digestive system “rest”. They would consume only small portions of vegetable broth, take enemas, and be subjected to violent so-called “massages”. 

That doesn’t sound like a very pleasant course of treatment, so you might be surprised to learn that Hazzard was very popular in her time. She attracted many patients to her Institute of Natural Therapeutics in Olalla, WA, which opened in 1907. Her most famous patients were the British sisters Claire and Dora Williamson, who came to the institute in February 1911. The sisters had a number of minor ailments and were hopeful that Hazzard’s methods held the cure.

For two months, the sisters consumed no more than two cups of broth a day and endured hours-long enemas. When their friend Margaret Conway received a note from one of the sisters that concerned her, she came to visit them. But she was too late – as soon as Margaret arrived, she was told that Claire had just died. Dr. Hazzard, who had performed Claire’s autopsy herself, explained Claire’s death as the result of drugs administered in her youth which had eventually caused cirrhosis of the liver. Margaret, who had been the sisters’ childhood nurse, thought that explanation seemed unlikely. And then she saw Dora – or what was left of her. At this point the nearly skeletal Dora weighed only about 50 pounds (Lovejoy, 2014). Margaret was now convinced that Claire had starved to death and Dora was next in line.

What leads to starvation? Sadly, of course, there are many people in the world who lack basic access to food, and they might succumb to starvation. There are also a number of reasons that people might make the choice to abstain from eating for long periods of time, such as religious practice or as a political statement, but reports of people dying from voluntary starvation in this way have been limited to extreme cases. In developed countries, death by starvation is most often associated with eating disorders such as anorexia nervosa, a psychiatric illness characterized by extreme calorie restriction and disturbed body image. Although we do not know whether the Williamson sisters suffered from anorexia, an examination of the physical effects of anorexia, starvation, and extreme weight loss in general can give us a sense of what happened to the women. 

As starvation sets in, nutrient scarcity leads to a decrease in basal metabolism, and the resting metabolic rate (RMR) and heart rate both drop (Olson et al., 2020). Without proper nutrition, the body starts breaking down muscles for protein and fat for energy. People with anorexia often have sarcopenia and loss of skeletal muscle mass (Cost et al., 2020). Starvation can also cause hypoglycemia (Cost et al., 2020; Palmer et al., 2021). This can lead to ketoacidosis and liver failure. Extreme weight loss also affects bone development, sometimes leading to irreversible osteoporosis (Epocrates).

Extreme weight loss can cause an abundance of issues with all of the body’s physiological systems, including the cardiac, reproductive, renal, and gastrointestinal systems (Epocrates). Cardiac issues can range from myocardial atrophy to pericardial effusion and even sudden cardiac death (Cost et al., 2020). On the gastrointestinal level, constipation, diarrhea, and functional bowel disorders are common complaints in people with extreme weight loss (Cost et al., 2020).

Back at the institute, Margaret’s horror only increased once she learned that Hazzard had been appointed executor of Claire’s estate and legal guardian of Dora. Along with John Herbert, the sisters’ uncle, Margaret convinced Hazzard to allow Dora to depart from the institute (only after Herbert paid an extortionate amount of money that Hazzard claimed Dora owed in medical bills). Herbert and another man, Lucian Agassiz, then decided to research Hazzard further. They discovered that Hazzard was connected to the deaths of several other wealthy people – more than a dozen – many of whom had signed over their estates to her. They now believed that Hazzard was less a doctor and more a manipulative serial killer. 

Agassiz initiated a court case against Hazzard. In August 1911, Hazzard was charged with the first-degree murder of Claire, although she continued to claim her innocence. In February 1912, Hazzard was convicted of manslaughter. She served two years in prison and had her medical license revoked. However, in 1920, Hazzard was able to return to Olalla to re-establish her institute, now called the School of Health, where she worked until 1935 when the institute burned down. In the late 1930s, Hazzard fell sick and undertook a fast of her own; she died. 

Do you know of another interesting true crime case with medical connections? Email Rachel Brill at rgbrill@gwu.edu.

References and Further Reading:

Cost J, Krantz MJ, & Mehler PS. (2020). Medical complications of anorexia nervosa. Cleveland Clinic Journal of Medicine, 87(6), 361–366. https://doi.org/10.3949/ccjm.87a.19084 https://proxygw.wrlc.org/login?url=https://www.ccjm.org/content/ccjom/87/6/361.full.pdf 

Epocrates. Anorexia nervosa. Accessed May 19, 2022. https://proxygw.wrlc.org/login?url=https://online.epocrates.com/diseases/440/Anorexia-nervosa  

Lovejoy, B. (2014, October 28). The Doctor Who Starved Her Patients to Death. Smithsonian Magazine. https://www.smithsonianmag.com/history/doctor-who-starved-her-patients-death-180953158/

Olsen, G. (2005). Starvation Heights: A True Story of Murder and Malice in the Woods of the Pacific Northwest. Crown.

Olson B, Marks DL, Grossberg AJ. (2020). Diverging metabolic programmes and behaviours during states of starvation, protein malnutrition, and cachexia. J Cachexia Sarcopenia Muscle, 11(6):1429-1446. doi: 10.1002/jcsm.12630. Epub 2020 Sep 28. PMID: 32985801 https://proxygw.wrlc.org/login?url=https://onlinelibrary.wiley.com/doi/10.1002/jcsm.12630  

Palmer BF, Clegg DJ. (2021). Starvation Ketosis and the Kidney. Am J Nephrol., 52(6):467-478. doi: 10.1159/000517305. Epub 2021 Jul 19. PMID: 34350876. https://proxygw.wrlc.org/login?url=https://www.karger.com/Article/FullText/517305  

Washington State Archives. (n.d.) Linda Burfield Hazzard: Healer or Murderess? https://www.digitalarchives.wa.gov/Collections/TitleInfo/2508