Tiny metallic objects, opaque to x-ray, were spread bilaterally across her chest. A shotgun blast? The metallic objects resembled birdshot, but there was too many of them. There was also no external trauma - no lacerations and no blood. She had not been shot, yet there they were, a collection of tiny metallic rounds. Whatever they were, and however they got there, these objects were making her terribly ill.
She had come to the hospital complaining of a persistent cough, chest pain, shortness of breath, and fatigue. Looking at her chest x-ray, a radiologist knew what was causing her respiratory symptoms - those metallic objects in her lungs. What were they? How did they get there? The radiologist was baffled. The patient was hospitalized, but released on the say-so of another doctor. The only care instruction she was given was bed rest. Two months later, she was back in the hospital and she was worse.
In addition to her previous symptoms, which had advanced, there were new ailments to be treated. Abdominal pain, weight loss, ulcers in her mouth, and bleeding gums. No x-rays were taken during this second visit, which would see her hospitalized for 10 days. She was released by the same doctor as last time. Three months later, that very same doctor found her dead in bed. That doctor was her husband.
Her husband was not a suspect upon her death. Chiefly because no one thought a crime had been committed. Her long illness, worsening month-by-month, was well documented - along with the attempts to treat whatever it was that ailed her. Her decline, while perhaps bit mysterious, was not considered suspicious. The death was ruled "natural", no autopsy was performed, and she was buried the day after she died.
She would not stay buried. Infidelity would cast her death in a new and unnatural light. Her doctor husband - the one that had discharged his sick wife (twice) and found her dead - was caught having an affair with a nurse in his hospital. Their affair had been going on for several months and its discovery provoked her family to request an forensic autopsy*. While the affair brought suspicion, an autopsy would provide answers. Two months after her death, she was exhumed and examined.
An internal exam cleared-up the mystery of those metallic objects observed in her chest x-ray. Those metallic objects were mercury globules.
Seven months after her first hospital visit and two months after her death, her lungs were full of mercury globules. These globules weren't just in her lungs, they were also in her pulmonary arteries. High mercury concentrations were found in her liver, heart, and kidneys. Her x-ray and presenting systems are nearly textbook for mercury poisoning (mercurialism) of a very particular exposure type. She had been injected with mercury. An injection site wound was found during her autopsy beneath the crease of her left elbow.
Intravenous elemental mercury poisoning is extremely rare. This mode of poisoning is also not a reliable murder weapon.
… no lethal consequences from intravenous injected metal are to be expected…
Elemental mercury, when injected, as opposed to inhaled, caused few of the effects typical of mercurialism (because only a part of mercury is transported into the central nervous system; most of it is deposited in internal organs, lungs, kidneys, aortic valve, as well as at the site of injection), e.g. mercurial tremors and leg pains; however pleuritic chest pain was frequent, whereas renal and central nervous system symptoms were less common. (Lech & Goszcz, 2008, p21)
Mercury made her ill, but something else hastened her demise. Toxicology results showed she had been exposed to cyanide, which is a far more lethal poison than mercury upon injection. Cyanide causes histotoxic hypoxia - cells are unable to use available oxygen and death results. She was injected with an extraordinarily high dose of cyanide - 1 gram of sodium cyanide dissolved in normal saline. A 100 miligrams of sodium cyanide delivered in the same fashion would have been more than than enough to bring about her quick death. Cyanide, however, wasn't the only injection she received the day of her death. Shortly before the cyanide, an injection of meperidine (trade name Demerol®) was also administrated.
Meperidine is a narcotic analgesic used to treat moderate-to-severe pain. As with the cyanide to follow, meperidine was mixed with a glucose solution prior to injection. With the first two injections - mercury and mepheridine - she was told it was just glucose. She was told it would make her feel better. She'd a headache a week before her first trip to the hospital. Her doctor husband told her an injection of glucose would help her headache. He injected her with 40 milliliters of a glucose solution and 3 milliliters of mercury. Within a week she was so sick she had to be taken to the hospital, but death did not ensue. She got worse, and there was the second trip to the hospital, but she didn't die. He got tired of waiting. Five months after poisoning her with mercury, he "treated" her again with glucose - merperidine. This drove her to a state of semi-consciousness. It was then that he injected her with cyanide.
He appears to have obtained the mercury, meperidine, and cyanide at the hospital he worked as a physician. The same hospital he took his ailing wife to. The same hospital the nurse he was having an affair with worked. Several days before her death, he visited the hospital laboratory and obtained 20 grams of sodium cyanide for ‘‘chemical analysis for his study’’ (Yan et. al., 2012). Upon being confronted with his wife's autopsy results and evidence of his affair, he confessed all - the timeline, poison dosages, his duplicity.
His lies and his position seem to have provided a sufficient smokescreen for her protracted murder. Why hadn't the radiologist diagnosed mercury poisoning? Her doctor husband twice checked her out of the hospital... why didn't that raise an alarm? Bells didn't ring over his procurement of 20 grams of sodium cyanide using, quite frankly, a thin story - why? Did the hospital not notice the missing mercury and bottle of meperidine? If his affair hadn't been discovered, he might have gotten away with murder.
*Her head was not examined at the request of her family (Yan et. al., 2012)
- Lech, T.; Goszcz, H. Chronic, long-term presence of mercury due to a single injection of elemental mercury in human, Int J Biochem Biotechnol, 2012, 1, 19-23.
- Vallant, B.; Deutsch, J.; Muntean, M.; Goessler, W. Intravenous injection of metallic mercury: case report and course of mercury during chelation therapy with DMPS, Clin Tox, 2008, 46, 566–569
- Yan,P,; Huang, G.; Daoquan, L.; Li, L. Homicide Due to Intravenous Metallic Mercury Injection Followed by Sodium Cyanide Injection, Am J Forensic Med Pathol, 2012, 33, 273-275
Casebook image from IGAS
Mercury image from Keuka College