by Sue Black
Ian and I got on so well with the gravedigger that he invited us to a party in his garden that evening, and of course we were always going to accept. He issued a similar invitation to our US colleagues, who declined politely but firmly. It was their loss.
When we arrived at the gravedigger’s house, our generous host took us out into the garden, where an enormous pot was bubbling over an open fire. The pot, lined with bread, was piled high with chicken and vegetables cooking in the middle so that the bread soaked up all the juices. The scent was divine. Then he broke open a demijohn of homemade demerara-spiced rum and the evening became even more convivial. We knew we would suffer for it the next day, but it was worth it.
As the night wore on, we all sat under the moon around the fire, mellowed by rum and great food, and shot the breeze. I got talking to a charming man who turned out to be the professor of anatomy at the island’s private university. Of course, we had a lot in common and spent a good deal of the rest of the evening in discussion over matters anatomical, educational and anthropological. While exercising the caution demanded by the political sensitivities in talking about the reason for my presence in Grenada (although, as it turned out, I needn’t have bothered, as apparently it was hot gossip all over the island), I commented on how funny, and infuriating, Ian and I were finding the intransigence of our US colleagues in the matter of the elusive report from their previous investigation. Then, beauty of beauties, came words I had never expected to hear.
“I was around at the time and I have a copy of that report. Would you like me to photocopy it for you tomorrow?’
It is astonishing what magic can be woven from the ingredients of a pair of anatomists, a gravedigger’s party and homemade demerara-spiced rum. The child’s ribs were going to be the least of my colleagues’ concerns in the morning.
The next day, at the university, our hangovers in full throb, Ian and I made our way to the professor’s office where the copy of the US report was waiting for us. In fact it contained very little that we didn’t already know, other than a bit more background on the theories suggested at the time of the first, unsuccessful, mission to identify the location of Bishop’s remains, and, of course, the information that Creft had been pregnant, which we were now aware of anyway.
Ian and I returned to the mortuary, where our US colleagues seemed to be very busy packing up, posed our ritual morning question—“Have you managed to find the report yet?”—and received the ritual response: “Sorry, ma’am, not yet. Still looking.” I produced the report from my bag and asked them if perhaps they would like to make a copy of ours, as we would be really happy to assist the USA in completing their records. Well, they were like rats up a drainpipe. The entire team leaped from their chairs, raced out of the room, phones clamped to their ears, chattering nineteen to the dozen. The strange thing is, the Americans never did take me up on the offer of a copy of our report. Maybe they managed to find their own after all.
In the end, there was nothing for anyone to worry about. None of the remains found were those of Bishop, his girlfriend or any of the Cabinet members.
When the Americans invaded Grenada in 1983, they had launched an airstrike on army headquarters, missed their target and instead hit an asylum hospital building nearby. While the child’s ribs were likely to have come from a previous burial in the cemetery, the other bones in the grave, including the ones in the US Marines body bag, were those of several unfortunate patients from the hospital who had simply been in the wrong place at the wrong time. We were able to confirm this from the fragmented nature of the body parts, the mix of sexes and ages and a piece of pyjama waistband still, poignantly, bearing a label with the hospital’s name stitched into it.
It is amazing how much mischief can be had with a set of ribs and a few sheets of paper, especially when people forget to treat each other with the respect we all deserve and when they choose to be divisive rather than collaborative. It was so unnecessary when all any of us was trying to do was to get to the truth.
5
The Throat
Hyoid and Larynx
“The human voice is the organ of the soul”
Henry Wadsworth Longfellow
Poet, 1807–88
If one bone might be said to be the favourite of crime writers, it is the hyoid bone. Because of its susceptibility to fracture, many is the death by strangulation attributed to such an injury in novels.
The hyoid bone sits in the upper region of the neck, below the jaw, in front of the third cervical vertebra. If you place your fingers on either side of your neck in this area and squeeze (not too hard), you may feel resistance on both sides and a rather unpleasant pain in the neck. The bones underneath your fingers are the tips of the greater horns (or wings) of the hyoid bone, which acts as a sort of staging post for the attachment of muscles from the lower surface of the jaw towards the top of the bone, and for the muscles that pass from the lower end of the bone down to the sternum and other structures around the larynx or voicebox below.
In a child, the hyoid is made up of five separate pieces of bone: a piece in the middle (the body), two lesser horns to either side and, below these, the two greater horns. It is roughly C-shaped, with the open part of the C surrounding the windpipe, facing towards the back. The lesser horns will fuse to the body early on in life but the greater horns may not start to do so until the fourth or even fifth decades.
Pressure placed at the sides of the neck between the thumb and fingers of an assailant can break the rather flimsy greater horns, but the truth is that not all strangulations result in a fractured hyoid. It is estimated that around two-thirds do not. Indeed, such fractures are not common in young people and very rare in children. And even if a dead person is found to have a broken hyoid, it doesn’t necessarily mean they have been strangled, as this fracture could have occurred during their life.
Jenny’s sad story is a case in point. She had had a troubled childhood. Both of her parents had died and she had been placed in foster care separately from her brother. She went on to have three children of her own at a young age and, following the break-up of her marriage, her already haphazard life began to descend into chaos. Known to be a heavy drinker and to be involved in substance abuse, she frequently disappeared for weeks at a time, sleeping on friends’ sofas, dossing in abandoned properties or occasionally booking into a hostel if she had a little money. She was thirty-seven years old when she was reported missing by somebody who realized they had not seen her for quite a long time.
Her last-known abode had been an empty house on the outskirts of a northern city. Neighbours of this property frequently complained to the council about vagrants using it as a squat and fly-tippers dumping rubbish there. Nineteen months after Jenny had last been seen, a public health order was placed on the house and a company was contracted to clear it out so that it could be done up and sold. In the back yard, under six feet of rubbish bags and general detritus, they were shocked to encounter human skeletal remains, curled up in the fetal position. Close to the body were an aerosol can and a plastic bag.
The bones were sampled for DNA and they were confirmed as being Jenny’s. It seemed she had died in the back yard of the house and that, as fly-tippers had thrown more and more rubbish over the wall, she had gradually been buried deeper and deeper under the accumulating mass of refuse.
Body recovery was undertaken by a forensic archaeologist to ensure that as much of the remains as possible could be retrieved. The postmortem findings were inconclusive as regards cause of death, although several healed fractures were found in many bones of her body. She had clearly had a life of literal hard knocks but what could not be established was whether death was by misadventure or something more sinister.
The archaeologist had recovered the hyoid bone in four pieces and identified them all—a master class in professionalism. The lesser horns were fused to the body. The right greater horn was separate, and the left one was also detached and in two pieces. The question we had to try to
answer when the police brought the bone to our lab was whether the fracture of the left greater horn had been caused antemortem (before death), perimortem (around death) or postmortem (after death).
A premortem injury would be likely to show some signs of healing, whereas a perimortem or postmortem fracture would not. A perimortem fracture is generally not a clean break because the bone is still wet. Imagine trying to snap a green twig. The broken ends will usually be ragged, with strands of stubborn, straggling wood hanging from them. When you snap a twig that is dead and dry, the break tends to be clean, as do those of bones fractured postmortem, after they have dried out.
Premortem injuries may be the result of violence or trauma that occurred some while before death. Postmortem fractures are generally caused by the treatment of the body after death or during its excavation. One will show healing and the other will not. Perimortem fracturing, however, speaks to us of a possible violent cause of death and may well prompt a homicide investigation. Trying to establish as accurately as possible when the wing of the hyoid had been broken could be the key to understanding something of the nature of Jenny’s death.
With the naked eye, the two separated surfaces of the left greater wing of Jenny’s hyoid looked pretty clean, but under the microscope we were able to see something very different. The bone had been fractured when it was wet, so when she was alive, and the rounded appearance of the strands showed that it had been trying, unsuccessfully, to heal itself. Jenny had lived with her fractured hyoid for quite some time after the event that had caused it, though probably only for months rather than years.
Multiple healed fractures may be an indication of domestic abuse or assault. They might also simply be evidence of a lifestyle of habitual intoxication resulting in regular falls. There was no definitive evidence of assault in Jenny’s background but there were significant hospital records of admission to Accident and Emergency due to falls, especially in bad weather.
Our middle daughter worked for a time in the orthopaedic ward of a city hospital, where she would see many admissions for fractures sustained in falls while under the influence of drink or drugs, frequently when it was raining heavily, or when the first ice of winter settled on the pavements and roads. She recalls how traumatic it was for the nursing staff to try to deal with the complex needs of these patients while simultaneously staying vigilant about health and safety, because you had no idea what infections they might be carrying. Often staff had to treat injured people handcuffed to beds, with police escorts present, because of their violent outbursts as they went through withdrawal. It is a chaotic life not only for those, like Jenny, who are living it, but also for those who are attempting to help them.
However, it is quite difficult to fracture your hyoid in a fall, and so in Jenny’s case, suspicions that she may have previously suffered an assault remained. It was not ultimately possible to determine her cause of death, but whatever had happened, it was unlikely that the broken hyoid had any crucial role to play in it.
The major parts of the voicebox below the hyoid bone are the thyroid and cricoid cartilages, which can begin to turn into bone with advancing age. This ossification can produce an incredibly delicate and strangely beautiful lace pattern of bone formation as we grow older.
The thyroid cartilage, better known as the Adam’s apple—probably a reference to the ancient belief that a piece of the forbidden fruit got stuck in Adam’s gullet—is usually more developed in males as a result of changes to the voicebox during puberty, when the cartilage increases in size and the voice drops. The vocal cords are attached to the back of the thyroid cartilage, and so the more prominent the Adam’s apple, the longer the cord and the deeper the timbre tends to be.
Laryngeal growth is not as pronounced in females, although it can be present in some women with a larger larynx. Generally, though, the prominence of the thyroid cartilage is so strongly associated with masculinity that it can be a cause for concern among those transitioning, especially from male to female. Often scarves, chokers or high-necked clothes are worn to disguise it. It is possible to have the cartilage “shaved” to reduce its size, and some choose that option.
Bone can start to be laid down in the thyroid cartilage as early as the third decade, but the timing is very variable, and there are no obvious sex differences in when ossification of the cartilage begins.
The cricoid cartilage lies below the thyroid cartilage, level with the sixth cervical vertebra. It is shaped like a signet ring, with a broader surface towards the back and the narrower band at the front. Below this is a series of cartilage rings that keep the trachea open so that we can breathe, and these, too, can turn into delicate little bony rings with age.
The hyoid, thyroid and cricoid bones, as well as ossified tracheal rings, are among the assorted funny little bits and bobs that may be presented to the forensic anthropologist by the human skeleton, and which we therefore need to be able to recognize.
The constrictions of this area of the neck can of course be a hazard during our lives should a foreign body enter the airways. I remember one case history I read about while researching for a textbook I was writing. The patient was admitted to A&E at Christmastime in extreme respiratory distress. He thought he had swallowed a turkey bone. During an oesophagoscopy, the foreign body was detected near the thyroid cartilage and extracted.
It turned out to be not a turkey bone but a piece of shell. When asked again to try to list exactly what he had eaten, the patient recalled that the turkey had been stuffed with oysters. So you never know what you might find when you go looking.
PART III
THE LIMBS
Postcranial Appendicular Bones
6
The Pectoral Girdle
“Shoulder blades are where your wings were when you were an angel”
David Almond
Writer
There are two “girdles” in the human body. The word “girdle” is more commonly associated with women’s corsetry, but I gave up using such analogies with my students when references to my mother’s Playtex girdle and Cross-Your-Heart bra drew nothing but blank looks. Evidently I was showing my age.
Our upper bony girdle is the pectoral or shoulder girdle, which connects the bones of the arm (humeri) to the trunk and comprises paired clavicles (the collar bones) at the front and scapulae (shoulder blades) at the back. The lower one, the pelvic girdle, consists of the two hip bones, which form a junction between the sacrum at the back and the femora (thigh bones) of the lower limbs at the sides.
It is interesting that the pectoral girdle should contain both the bone that is the least likely, of all the bones in the body, to fracture—the scapula—and the one most prone to being broken: the clavicle. While all primates possess a collar bone, it is rudimentary in many mammals and absent altogether in the ungulates, which include a variety of animals from horses to pigs, and even the hippopotamus. Cats, for example, have very rudimentary clavicles, which is why they can squeeze through spaces that appear to be much too narrow to accommodate them.
In humans, the clavicle, as well as being a convenient location for muscle attachment, serves as a strut to keep our arms out to the sides of our body. In most quadrupedal animals, the forelimbs, positioned underneath the body, are used solely for locomotion, and as no dual function for the clavicle is required it does not need to be very large. Yet amazingly, the human clavicle isn’t really essential. We can have it taken out as long as the muscles can be stitched to each other. In the past, some jockeys used to have their clavicles surgically removed as a preventative measure. Since it was the bone most often broken in falls from their horses, there was a school of thought that maintained it was better to do without it than to risk the perils of a fracture.
And there is no question that a broken clavicle can be life-threatening. The bone is shaped like an elongated “S’ and a fracture will occur at the weakest point, the major bend in the lateral third. Unfortunately, that lies directly over the subclavian artery and v
ein, which are very large, and makes them susceptible to being ruptured or pierced by sharp shards of broken bone.
Sir Robert Peel, who served twice as Britain’s prime minister between 1834 and 1846 and is regarded as the father of modern policing (hence the antiquated nickname “peeler,” and the more enduring “bobby,” for a police officer), met his end as a result of a fractured collar bone. He had acquired a new horse, a hunter, which had a bit of a reputation as a kicker. Sir Robert and the horse were still getting used to one another when, on his way up Constitution Hill, close to Buckingham Palace, he encountered two ladies of his acquaintance and their groom, who was on a rather skittish horse. Peel’s horse was spooked and threw him off, and then, unfortunately, stumbled and fell on top of him. He suffered several broken ribs and a broken left clavicle, which ruptured the subclavian blood vessels underneath, and he bled to death.
As it took him nearly three days to die, and given the range of additional crush injuries he could have sustained, I suspect that the precise cause of death is more likely to have been due to other complications, but the story of the fractured clavicle has persisted through the years and it is still cited today as being responsible for his demise. The clavicle is the first bone in the human body to start to form and it does so in the fifth week of intrauterine life, possibly before Mum has even realized she is pregnant. It is a very precocious bone, adopting its adult “S” shape very early on, by the end of the second month of pregnancy, and it grows at a very regular rate of about 1 mm a week from that point onwards. By the time the baby is born, it is about 44 mm long and very recognizable, and therefore particularly useful as an indicator of age in fetal and newborn remains.
