The sciences and even medicine have long been used to justify atrocities. In the early 1800s, the United States of America was a slave nation. Citizens were allowed to purchase and imprison other races and hold them in bondage as property. This is different from indentured servitude, where someone is held in bondage until they pay off a debt. The indentured servant still has some rights and autonomy; the slave has none. The slave may be given permissions and privileges, but these can be revoked at any time at the whim of the “master.”
When slaves dared to want to be free and tried to escape their mistreatment in captivity, the medical profession rushed to the aid of the slave owner to diagnose the recaptured slave with a mental condition called “drapetomania.” The physician who coined this diagnosis was Dr. Samuel A. Cartwright of Mississippi and Louisiana. He served in the Confederate States Army during the Civil War and was an outspoken opponent of the germ theory of disease. Dr. Cartwright was selected by the Medical Association of Louisiana to investigate the diseases and physical peculiarities of the “Negro race,” and his pseudoscientific “diagnosis” was used to justify and absolve the horrific punishments meted out to recaptured slaves.
Now, this was a long time ago, and we would like to think that we have progressed in our thinking today. In many ways, we have. But in some ways, we have not changed at all. Biases formerly explicit became implicit or only expressed in like company, but the bias itself was never properly addressed. That brings us to a recent finding of the American College of Emergency Physicians. This organization recently reversed its position on a condition called “excited delirium.”
Excited delirium came into use in the 1800s to describe a state of emotional and physical agitation related to drug overdose, withdrawal, or poisoning. It could be considered the physical manifestations of what we would call extreme intoxication. There is a state of extreme agitation with physical manifestations like hyperthermia, mania, psychosis, tachycardia, and paranoia that can occur with stimulant toxicosis. Most often seen with cocaine, methamphetamine, amphetamines, and especially phencyclidine, also known as PCP or “Angel dust.” There is little doubt that these substances, when taken at very high doses, can cause these symptoms and lead to death from cardiac arrest. The heart is just overworked and fails.
The problem came when tasers came into use by police departments in the U.S. Tasers fire darts that can be fired at a suspect and often have electrodes that can be held against a suspect. Tasers are a less-lethal way for a policeman to incapacitate a threat without resorting to fully lethal force (guns). This device saves lives when used appropriately, and the appropriate use is when a suspect poses a significant physical risk to the officer, where they could use force but not always deadly force. If a strong, fast suspect is running from an officer, the officer can tackle the fleeing suspect, which is a use of force, or they can tase them. Clearly, they could not shoot them in most cases.
The problem came when the police started to use them inappropriately against anyone who didn’t immediately follow orders or even as a punishment for defying the officers. There are thousands of videos of handcuffed or restrained persons being tased repeatedly and told to “stop resisting.” Their continued movements, involuntary under the extreme voltage of the taser, are taken as evidence that they are still resisting. Tasers have been used against the elderly, children, and even pregnant women.
As tasers came into widespread and frequent use, people started dying after being tased. When this happened, their use was scrutinized under lawsuits to see if the use was justified and if the taser itself had caused the death. There is no reasonable scientific doubt that an electric current running through a human body can cause death. The tasers are designed to be high voltage low ampere discharged so as to cause muscle spasms without permanent tissue damage. The problem is that a high voltage discharge can set off a heart dysrhythmia, leading to ventricular fibrillation or tachycardia that can cause death.
A combination of unnecessary tasing causing death would be very expensive for both the police department and the taser manufacturer. In came the opinions for hire to save the day. Physicians and other science professionals, who routinely ignore the actual “science” part of their duties, will twist themselves into logical knots to defend any action for the right price. In this case, persons not displaying any signs of overdose or toxicosis were described as dying from “excited delirium” and, therefore, not from tens of thousands of volts traveling their hearts. Any substance in their system was used to explain away the death. Low levels of fentanyl and methamphetamine commonly, but also sedating agents like benzodiazepines and alcohol.
And finally, in people with no evidence of substance use at all, juries were told that the person had died from an overexcited state. If overexcited states killed people, we would routinely need a hearse beside every roller coaster and horror movie playing theatre. Then came the ultimate betrayal of medical science. Excusing the thoracic compression-induced asphyxiation deaths of persons in police custody. Experts would ignore scientific fact and deny to juries that these deaths were caused by the police when medical science has known for almost two hundred years that compression of the thorax can cause death.
We know this from the case of William Burke and William Hare. In 19th-century Edinburgh, Scotland, every self-respecting medical school needed cadavers to dissect to educate future doctors. These bodies were usually collected from the hangman’s noose, but business was booming, and there weren’t enough criminals being hanged to keep up. Enter the Williams Burke and Hare. They knew that you couldn’t just dig up someone who died and had been buried because they would be too decomposed, and the sextons were on alert. So they started prowling the dark streets for people out alone, preferably inebriated, but not necessarily. When someone was identified, they would be tackled to the ground, and, while one man pinned their arms, the other would sit or kneel on their chests.
The diaphragm contracts to expand the lungs and pull air in. In normal respiration, the relaxation of this muscle results in exhalation; when we are running, we can use the muscles of our chest wall to forcefully exhale so we can breathe faster. When the chest is compressed, the lungs cannot inflate enough to maintain adequate respiration. The pair killed sixteen people this way before an observant medical instructor noted the bruising on the thorax; the authorities were notified, and an investigation was started. This type of murder left little evidence, and W. Hare was given a sweet deal to flip on W. Burke, who had come up with the plan. Burke was convicted and hanged, and, in a fit of medico-judicial irony, he was dissected in the anatomy theatre. His skeleton was then displayed at Edinburgh Medical School, where it can still be seen today. The method of death he devised was called “Burking,” and when you see several police officers kneeling on someone’s thorax, understand that if continued for more than just a few minutes, that person will die. This is not “excited delirium” it is not anything but what it was called in Edinburgh. Murder. And I, for one, am glad to see this misdiagnostic term retired.
L. Joseph Parker is a distinguished professional with a diverse and accomplished career spanning the fields of science, military service, and medical practice. He currently serves as the chief science officer and operations officer, Advanced Research Concepts LLC, a pioneering company dedicated to propelling humanity into the realms of space exploration. At Advanced Research Concepts LLC, Dr. Parker leads a team of experts committed to developing innovative solutions for the complex challenges of space travel, including space transportation, energy storage, radiation shielding, artificial gravity, and space-related medical issues.