by Dr. Alan D. Barbour (contributor)
M. Henri Paul died Sunday, 31 August 1997.
Autopsy at Paris morgue:
Blood samples drawn directly from the heart.
Urine, eye fluid and bile sampled.
Urine and vitreous humor samples can be used for alcohol analysis - values slightly higher than for blood at equilibrium; of no use for CO analysis. Vitreous humor not often taken in such a case (fresh body, other fluids readily available), but a good precaution. Can also be used for some other tests. Bile is, in my opinion (others may differ), largely useless for drug analysis.
Stomach was intact, as were other organs. Aorta ruptured.
Ruptured aorta consistent with side impact at greater than forty-odd mph. As I recall, the Mercedes did not hit the column head-on.
No liver damage or signs of alcoholism.
Chronic alcoholism should be manifested in the liver, and detectable by examination of tissue sections. Long before cirrhosis sets in there is fatty liver, and before that comes alcoholic hepatitis (inflammation of the liver).
It is, at least in form, what a conscientious magistrate would do; and the more complicated a conspiracy, the more people who are involved in it, the less the chance that it can be kept secret.
First results announced afternoon of Monday, 1 September 1997
Blood, hair, eye fluid and organ tissues "examined under microscopes, shaken up in test tubes and centrifuges, and combined with chemical reagents..."
Hair analysis? For past drug use? Quite up-to-date--cutting edge, even.
b. Alcohol
Police lab analysis reported 1.87 g/l blood-alcohol; a private lab as a control reported 1.74 g/l.
Identical results, within the limits of experimental uncertainly. The second decimal place should not be reported, because the first decimal place is uncertain by plus or minus one in a good lab.
Alcohol testing is very standardized; these days it would almost surely be done by gas chromatography. The traces of drugs detected would probably have been measured by gas chromatography-mass spectrometry (GC/MS) which can be very good in capable hands or quite the opposite, but said traces of drugs are probably less important than the carbon monoxide.
c. Carbon Monoxide
The principal methods of testing for CO are:
1) A type of automated or semi-automated analyzer intended to measure CO in the blood of living subjects. (Commonly called a "co-oximeter" in the U.S.) Common in hospitals of areas where CO poisonings are frequent. Generally accepted as reliable for freshly and specially collected blood from living subjects; not acceptable for coroners' bloods.
2) Manual spectrophotometric methods where a blood sample is split, the aliquots are treated in two different ways, and spectrophotometric absorbence readings are taken at different wavelengths. The CO level is calculated in a rather intricate manner that involves a small difference between two large numbers. The chemical treatments (some of which are time-sensitive, despite what the textbooks say to the contrary), extensive manipulation and the inherent uncertainties in the measurements combined with the calculation render this method very questionable.
3) Liberation of the CO from the hemoglobin in a closed vessel and its consequent measurement. I know of one lab that measures the liberated CO with an infrared detector. The classical method is to use Conway diffusion cells, which allow one to liberate the CO and then take it up in a solution of palladium chloride, which is thereby decolorized in proportion to the amount of CO in the sample. The CO liberating solution should contain lead acetate to prevent liberation of hydrogen sulfide from putrefied bloods. As long as enough time is allowed for diffusion to take place, this is very reliable (caveat infra).
CAVEAT: Calculation of the carbon monoxide saturation requires measurement of the amount of hemoglobin in the sample tested. The "cyanmethemoglobin" method is the most accurate, and the manual cyanmethemoglobin method works well. However, the cyanmethemoglobin method is often used in automated blood cell counters (e.g., "Coulter" counters), and many people assume it is reliable for measuring hemoglobin in coroners' samples as well as in living subjects. This is not true in the case of blood samples containing significant amounts of carbon monoxide, because they need more time to react than the automated analyzers allow, thus giving falsely low hemoglobin readings and falsely high CO saturations.
CAVEAT #2: Standardization of most carboxyhemoglobin assays is difficult, perhaps unreliable at best. Only the diffusion dish method is readily standardized. Quality control is also not terribly easy. (I used to make my own quality control specimens by bubbling automobile exhaust fumes through a bottle of blood, hoping to escape notice in the parking lot! Since the introduction of low-pollution engines it has been more difficult to make controls by this method--one must search out an old car or use a lawn mower.)
If the CO results were duplicated at two different labs that would seem to vindicate the results UNLESS the two labs used the same analytical method. If they used significantly different methods AND obtained equivalent results, the CO concentration of the blood sample is quite likely correct.
On the other hand, as you say, CO dissipates quickly. If the 20% level is verified, this would mean that his CO level at 10 pm could have been much higher than 20%.
The CO level goes down quickly IF one is given 100% oxygen to breathe rather than air. In competition with air (21% oxygen), CO will win out. After death CO levels will be quite stable.
M. Henri Paul died Sunday, 31 August 1997.
Autopsy at Paris morgue:
Blood samples drawn directly from the heart.
Urine, eye fluid and bile sampled.
Urine and vitreous humor samples can be used for alcohol analysis - values slightly higher than for blood at equilibrium; of no use for CO analysis. Vitreous humor not often taken in such a case (fresh body, other fluids readily available), but a good precaution. Can also be used for some other tests. Bile is, in my opinion (others may differ), largely useless for drug analysis.
Stomach was intact, as were other organs. Aorta ruptured.
Ruptured aorta consistent with side impact at greater than forty-odd mph. As I recall, the Mercedes did not hit the column head-on.
No liver damage or signs of alcoholism.
Chronic alcoholism should be manifested in the liver, and detectable by examination of tissue sections. Long before cirrhosis sets in there is fatty liver, and before that comes alcoholic hepatitis (inflammation of the liver).
Autopsy: Second Batches
4 September 1997 a separate blood sample was drawn, at the request of the family of M. Paul. It is reported that when Stephan saw the first lab. test results and realized their import, he personally attended the taking of a second batch of bodily fluid samples, had the process photographed, and used different labs for tests.It is, at least in form, what a conscientious magistrate would do; and the more complicated a conspiracy, the more people who are involved in it, the less the chance that it can be kept secret.
First test results
a. DrugsFirst results announced afternoon of Monday, 1 September 1997
Blood, hair, eye fluid and organ tissues "examined under microscopes, shaken up in test tubes and centrifuges, and combined with chemical reagents..."
Hair analysis? For past drug use? Quite up-to-date--cutting edge, even.
b. Alcohol
Police lab analysis reported 1.87 g/l blood-alcohol; a private lab as a control reported 1.74 g/l.
Identical results, within the limits of experimental uncertainly. The second decimal place should not be reported, because the first decimal place is uncertain by plus or minus one in a good lab.
Alcohol testing is very standardized; these days it would almost surely be done by gas chromatography. The traces of drugs detected would probably have been measured by gas chromatography-mass spectrometry (GC/MS) which can be very good in capable hands or quite the opposite, but said traces of drugs are probably less important than the carbon monoxide.
c. Carbon Monoxide
The principal methods of testing for CO are:
1) A type of automated or semi-automated analyzer intended to measure CO in the blood of living subjects. (Commonly called a "co-oximeter" in the U.S.) Common in hospitals of areas where CO poisonings are frequent. Generally accepted as reliable for freshly and specially collected blood from living subjects; not acceptable for coroners' bloods.
2) Manual spectrophotometric methods where a blood sample is split, the aliquots are treated in two different ways, and spectrophotometric absorbence readings are taken at different wavelengths. The CO level is calculated in a rather intricate manner that involves a small difference between two large numbers. The chemical treatments (some of which are time-sensitive, despite what the textbooks say to the contrary), extensive manipulation and the inherent uncertainties in the measurements combined with the calculation render this method very questionable.
3) Liberation of the CO from the hemoglobin in a closed vessel and its consequent measurement. I know of one lab that measures the liberated CO with an infrared detector. The classical method is to use Conway diffusion cells, which allow one to liberate the CO and then take it up in a solution of palladium chloride, which is thereby decolorized in proportion to the amount of CO in the sample. The CO liberating solution should contain lead acetate to prevent liberation of hydrogen sulfide from putrefied bloods. As long as enough time is allowed for diffusion to take place, this is very reliable (caveat infra).
CAVEAT: Calculation of the carbon monoxide saturation requires measurement of the amount of hemoglobin in the sample tested. The "cyanmethemoglobin" method is the most accurate, and the manual cyanmethemoglobin method works well. However, the cyanmethemoglobin method is often used in automated blood cell counters (e.g., "Coulter" counters), and many people assume it is reliable for measuring hemoglobin in coroners' samples as well as in living subjects. This is not true in the case of blood samples containing significant amounts of carbon monoxide, because they need more time to react than the automated analyzers allow, thus giving falsely low hemoglobin readings and falsely high CO saturations.
CAVEAT #2: Standardization of most carboxyhemoglobin assays is difficult, perhaps unreliable at best. Only the diffusion dish method is readily standardized. Quality control is also not terribly easy. (I used to make my own quality control specimens by bubbling automobile exhaust fumes through a bottle of blood, hoping to escape notice in the parking lot! Since the introduction of low-pollution engines it has been more difficult to make controls by this method--one must search out an old car or use a lawn mower.)
If the CO results were duplicated at two different labs that would seem to vindicate the results UNLESS the two labs used the same analytical method. If they used significantly different methods AND obtained equivalent results, the CO concentration of the blood sample is quite likely correct.
On the other hand, as you say, CO dissipates quickly. If the 20% level is verified, this would mean that his CO level at 10 pm could have been much higher than 20%.
The CO level goes down quickly IF one is given 100% oxygen to breathe rather than air. In competition with air (21% oxygen), CO will win out. After death CO levels will be quite stable.
