I am now sure that there are at least several people who know exactly how Victoria Snelgrove died on the night of October 21, 2004. Surely the treating physicians, radiologists, and the house staff at Brigham and Women’s Hospital; Kathleen O’Toole ( the Boston Police Commissioner); and some Boston reporters; are, or have been made aware of just how the death occurred.
The rest of us remain sealed in the vacuum of our own ignorance.
Why?
I think I know.
If an exploding pepper ball killed Victoria Snelgrove – and let’s assume for a minute that it did – this represents death by an atrocious concatenation of coincidences, and fearfully bad luck.
Bad luck is the layman's term for the statistics of event occurrence. Statistics is a branch of mathematics that the average person shuns, despite its ultimate importance in understanding why many "unexplainable" bad and good things happen to bad and good people. Why don't we more frequently adduce statistical rationales to explain the many occurrences it might elucidate? As T.S. Eliot said "Humankind cannot bear very much reality."
THE MECHANISM
Let me say first that IF Victoria Snelgrove died as a direct result of a pepper ball striking her in the eye, then the likeliest of the unlikely explanations are:
1. As I have explained before, one proposed mechanism of death can be inferred by assuming the transmission of extraordinary pressure directed posteriorly through the globe, through the posterior orbit, then through the optic canal and superior orbital fissure. The implication is that there will therefore be disruption of cranial nerves and cerebral damage leading to demise.
2. As I also proposed before, the pepper ball could have killed Victoria Snelgrove by internal carotid artery/cavernous sinus injury from atypically propagated vectors of force or direct laceration from a sphenoid fracture.
3. A third mechanism I stated in a previous post was neurogenic shock, induced at the level of the brain stem and cranial nerves. There is a term for this type of extremely rare event: the oculocardiac or trigeminocardiac reflex, which has been reported from stabbings in the eye and is an event which leads to heart dysryhthms and asystole.
Here is a reference (Download reflex_reference.doc).
THE CONCATENATION
Bad luck can be defined as being present at the end of a string of unrelated – or limitedly related – coincidences. This is also the definition of good luck.
The astounding revelation when studying such strings of events is that any minor variation in any event would have prevented the outcome. We have all experienced this phenomenon in our lives. We preface these explanations by saying "if only...". A bad occurrence, when it makes its way into our lives, happens in a unique way. This is why it is often so hard to believe, to understand, and, ultimately, to put to rest in our minds and hearts.
What were the elements of this string of incidences the night the Boston Red Sox beat the Yankees in the ALCS game??
1. Petals on a Wet Black Bough: Eighty thousand pairs of eyes and a 20 million to one shot
It is estimated that there were 80,000 people present in Kenmore Square that night. With conservative estimations of geographic space and body orientation, I have calculated the a priori odds of Ms. Snelgrove being struck directly in the orbit, in that crowd, at about 20 million to one. I spared you the details of the calculation but I have uploaded my derivation that you can peruse here: (Download calculating_the_odds.doc0.
2. Framing Fearful Symmetry: No similar projectile has ever been documented to kill anyone even when people are trying to do this
As I previously wrote, in the definitive major study of paintball injuries to the eye, Dr. Daniel Listman, in the Journal Pediatrics, reported that of 149 paintball injuries identified in children, and 200 cases cited total, none had death as an outcome. This study is as close to the situation of Victoria Snelgrove and the pepper ball as can be approached scientifically.
I have also reviewed, extensively, the last 15 years of literature on orbital trauma in peace time and in war situations (here is a document Download orbital_literature.doc with some examples from my search). I have spoken with ophthalmic surgeons and trauma specialists. My literature search included thousands of various projectiles to the eye including high pressure pneumatic glue and paint gun injuries, fish gun injuries, projectile injuries by:
Harpoon
Pencil
BB
Pellet
Bullet
Chopstick
Screwdriver
Pacifier
Pen
Arrow
Knife
Ninja star
Fern
Fencing wire
...and NONE of these were fatal.
The ONLY fatal incidences I could retrieve were from the annals of military medicine and were mostly explosion or shrapnel mechanisms that involved more extensive cranio-facial trauma.
In other words, on TOP of the impossibly long odds that Victoria Snelgrove could get hit directly in the eye by this ball, the odds of this ball then killing her, are unique and incalculably high.
3. Caveat Emptor: Death by a Nonlethal Weapon
The mechanism used by the police was specifically designed and advertised as nonlethal. If we assume that the makers of this item did not purposely misadvertise its use then we have to understand a given: anything can be lethal in the right set of circumstances. Water is lethal if you breathe it in. Wood can be lethal if it falls on you. A sponge can be lethal stuck in your larynx.
I am not excusing mistakes that may have been made by the gun's manufacturers or the police. I am only saying that given that the gun was specifically designed not to be lethal, this adds another level of improbability to the eventual outcome, which is already absurdly remote in its chances.
4. The Ascent of Man : Teleological Reasoning in Orbit and Globe Injuries
I have already discussed the indirect evidence that militates against the mechanism of death proposed for Victoria Snelgrove. What I've said is:
The reason trauma to the globe does not cause death can be derived from standard evolutionary principles. Surely if this mechanism (direct blow to the globe) were fatal, our eyes would have developed behind calcium cages; however, the solution evolution worked out was to create a relatively closed-pressure chamber (the retro orbital space) with thin walls so that any backward-directed force on the globe would “blow out” one of the thin surrounding walls rather than direct the force posteriorly to the central cerebral structures. So by teleological reasoning, the woman shot in the eye with an exploding pepper ball should not have died.
THE CONCLUSIONS
1. The Blame: Sometimes The Fault Lies in the Stars...Victoria Snelgrove's Death was an Accident
Assigning blame is a mathematical computation. A smoking gun can be a 100% indicator of blame. A lightning bolt that strikes a jogger can be classified as 100% accidental. Unfortunately, not all the odds can be as readily grasped or calculated. However, it is important to try and assess relative probabilities when working out relative responsibilities. If we lay away any culpabilities of the crowd, then what is the culpability of the person who launched the pepper ball if we assume that the ball caused the death of Victoria Snelgrove?
When a mechanism designed to be nonlethal hits a spot that there is only one chance in 20 million it can find, resulting in a consequence that is unique in the history of forensic science -- and flys in the face of billions of years of evolutionary design -- that is, by any intelligent and reasonable assessment, an accident.
2. The Silence: Those who speak do not know, those who know do not speak
One of the most disturbing aspects of this entire incident has been the total silence of anyone who knows anything about Victoria Snelgrove's death. Although, as I have stated, the mechanism of her death is improbable and unlikely, there has not been one word about this from the press, or the police or the physicians.
Why the Silence? There are three main reaosns: government regulations; the omnipresence of the liability threat; and, the lassitude of the press.
A. The Government: In 1996 the Congress passed the Health Insurance Portability and Accountability Act (HIPAA), which had, sequestered away in its body a "Wrongful Disclosure" provision which allows for fines up to $50,0000 and a year in jail for "disclosing individually identifiable information to another person." Doctors, hospitals and other health care providers have been put on alert that anything they say about any patient or any case is liable to violate this provision. Therefore, the public cannot know, from these providers, at this time, just how Victoria Snelgrove died.
B. The Liability Lawyers (The Torters): The inevitability, nowadays, of a massive assault by Torters on everyone involved in any case where there are deep pockets has everyone involved here running for cover. And the first thing your own attorney tells you is "keep your trap shut." So the police won't talk. The mayor won't talk. The Commissioner won't talk and the pepper ball manufacturer won't talk. Because they know that anything they say can and will be twisted in a court of perverse law to extort money from them in this continuing abomination that we have allowed these attorneys to foist on our country and our civilization.
C. The Lassitude of the Press
Reporters are people too. They have busy jobs and full schedules, deadlines and pressures. Especially in medical affairs, they are often in over their heads, as I have said before. So, it isn't hard to understand why a reporter might not zero in immediately on the true story of the case. I can understand that. But there are three issues that bother me. 1. The useless, repetitive, frank plagiarism of the news stories, especially on the Internet where a thousand stories are reiterated without further invention (as in all our blogs--many times!). This is especially pernicious when the original stories are cast in the wrong light. Like Victoria Snelgrove's story which has been set in the police brutality mode and continues down that slope wrong-headedly. 2. The temptation to package stories in familiar stereotypes is an infuriating characteristic of slothful reporting. But this foible alone, would not be serious. Unfortunately, this tendency in reporting leads to stereotyping that seriously adversely affects all of us in our every day life and jobs and NO profession has been vitiated as much by this kind of slapdash caricaturing as has the medical field. And I DO blame reporters for this. 3. Unlike the police and the hospital, the reporters are relatively immune from government regulations and torter's attacks. So it becomes their responsibility and duty to rescue us all from the unwary stupor we are immersed in by the "round up the usual suspects and villains" school of reporting. Important details that are omitted and yet make all the difference in the world to our society, our civilization and our freedom are left rotting under rocks unless reporters and journalists -- whose mission it should be to pursue these very aspects of the case -- seek the truth.
WHO KILLED VICTORIA SNELGROVE AND HOW DID SHE DIE?
The public still knows the answer to neither of these two questions. My conclusion is that something is wrong with our system of investigation, reporting, and disclosure.
Maybe that's why blogs evolved?
More to come from CodeBlueBlog.
"The mechanism used by the police was specifically designed and advertised as nonlethal."
Companies with competent lawyers always use the phrase "less lethal". The intent is not to be perfectly safe, but to be safer than beating the rioters with clubs then cramming them into vans. Even a simple sticky bomb will kill if someone takes it in the face.
My pet theories:
(1) She fell on her head and injured her brain that way. That is a popular way for completely disoriented people to die, after all.
(2) The pepper balls are filled with finely-powdered capsaicin and it poisoned her.
Why all the hand wringing anyway? As a homicide, won't the details be released in a coroner's report?
Posted by: Daniel Newby | October 30, 2004 at 07:55 PM
I'm sorry if I made the whole thing too complex. It really isn't targeted for those who don't have the patience or intellect or education to analyze and appreciate the constellations of data, the careful alignment of logical arguments, and the long hours of work and thought.
Better to be a liberal mudslinger, terminally cynical, open to nothing except the facile explanations that fit into their own stereotypical universalities(I'd rather be a Pagan suckled in a creed outworn!). By all means wait for the coroner's report, and drop me a line so I can explain to you what it means.
Posted by: CodeBlueBlogMd | October 31, 2004 at 10:38 AM
If you fire a 'less-lethal' (as it is advertised on the FN Herstal web site) at a crowd, you take the risk of that million-to-one shot hitting home. The questions you are asking are perfectly reasonable, but so are questions about whether the police were trained to use the weapon properly, whether they did use it properly, and whether they should have been using it in the first place.
Posted by: David | November 01, 2004 at 10:14 AM
I do not disagree.
But we cannot ascribe blame -- if it is owed -- until we know how this girl died and why.
If we GET those answers and it is clear that there was negligence by some party, there should then be justice served.
Let us also remember, however, that if one ventures out into the street at ANY time (not to mention in a crowd of eighty thousand during an unplanned and unpredictable celebration), one also is implicitly agreeing to face the increased odds of an untoward event occurring to oneself.
Negligence is negligence; however, we need understand the difference between an accident and malfeasance.
CBB MD
Posted by: CodeBlueBlogMD | November 01, 2004 at 10:31 AM
You are consistently providing some thought-provoking commentary and analysis.
Thanks, your blog is now part of my daily routine.
Posted by: Randy | November 01, 2004 at 02:50 PM
I had to wait a while to see if your message was going to explode or something -- I'm not used to getting compliments, but they are welcome, and they are a driving force. Thank you.
CBB MD
Posted by: CodeBlueBlogMD | November 02, 2004 at 04:40 AM
Interesting analysis.
I'd take issue with your 20 million to one calculation however. The trajectory was not random, the officer who fired pointed his gun at the crowd at about head level, according to eye-witness testimony. That immediately reduces the target area to a much smaller window. It was reported that the officer fired several shots, so unless he was aiming specifically at particular people, the target area was probably no more than about 4 sq. ft.(approx 1 sq. m.)
While the probability of being in that small area was very low, 1 in 80,000 or so. The probablility of being hit in the face by one or more of those shots was much higher.
At 20 yards, which I belive was the reported distance, the projectile would still be travelling at that height. Therefore the "target" area for people at the front of the crowd would be probably top of head to about nipple-level on the chest (depending on the individual's height relative to the shooter's).
As to the lethality or not of the projectile. At that short distance it probably retained most of its initial velocity. According to MedicineNet.com:
While nonpowder guns use compressed air instead of gunpowder to launch projectiles, they are often nearly as powerful as traditional firearms. According to the CPSC, 80 percent of nonpowder guns have muzzle velocities (the speed at which the object leaves the gun) at 350 to 450 feet per second, and 50 percent between 500 and 930 feet per second. A traditional firearm pistol has a muzzle velocity of 750 feet per second to 1,450 per second. Eye penetration can occur at a muzzle velocity of just 130 feet per second.
I don't know the muzzle velocity of the police issue guns, but I'd guess it's probably higher rather than lower. In which case, the projectile that hit Ms Snelgrove was probably travelling fast enough to shatter the back of the orbit and enter the brain, in pretty much the same way as a bullet would have done. I don't have a clue what a large jolt of pepper powder (along with non-sterile ball fragments and shards of bone) would do to the human brain, but I suspect it's not pleasant.
Posted by: Jarrett | November 12, 2004 at 02:36 PM
URL fir the MedicineNet cite:
http://www.medicinenet.com/script/main/art.asp?articlekey=40221
Posted by: Jarret | November 12, 2004 at 02:37 PM
Look...
The odds I calculated were a priori. That means that it doesn't matter where the policeman aimed, the chances of him hitting those few square centimeters on Victoria Snelgrove's globe were 20 million to one.
You can't really take issue with a mathematical certainty. That's like saying you take issue with the square root of 84.
It has absolutely nothing to do with trajectory. Unless he stood up to her face and someone held her down and he fired the shot INTO HER EYE his otherwise striking her there IS AN ACCIDENT.
I don't care what medicine dot net says NO ONE DIES FROM GLOBE INJURIES. Is it possible to get this message across? If globe injuries were fatal, the human race would have died out centuries ago. READ MY POSTS. I explain it as well as can be.
I mean I have described this many times in my posts. There is no friggin' way THAT pepper balloon "penetrated" her brain. And if it did? Can you e mail me back and tell me EXACTLY what the mechanism of DEATH was?
You don't have a CLUE according to your own letter what this projectile might do. And you OBVIOUSLY have not read and digested what I have said about this case...so...what the hell ARE you saying????
Posted by: CodeBlueBlogMD | November 15, 2004 at 10:55 PM
You are completely mad. I like this blog. This is the place where YOU are always right. Hold on to that.
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