# Cause of Death

The cause of Madeleine's death is still unknown. Death at all is questioned by the McCann's.

From abduction hypothesis death may or may not have occured. But there is still not one reliable evidence for an abduction.

The vica versa is true for the accidental death theory. There are a bunch of heavy evidence for this theory (see e.g. cadaver odour, cadaver dogs, DNA traces, Cuddle Cat, Smoking Gun, oddities).

## Time of death

From the mechanics of cadaver odour we know, that Maddie died at least 3 hours before 22:00 on 3rd May. This is before 19:00. From witness statements of Kate, Gerry and David Payne we know (see also reconstruction), that death occurred before 18:30. The last independent sign for Madeleine being still alive is given at 17:30 through the creche records.

So death must have occurred between 17:30 and 18:30 on 3rd May 2007, seemingly around 18:00 o'Clock.

## Forensic Evidence in Apartment 5A

Besides the cadaver odour there were several blood freckles found in Apartment 5A on floor, curtains, sofa and walls beneath the living room window. Those freckles obviously were cleaned up shortly after the event, as they were not seen on evening 3rd and after. The were found by forensic technics in August when suspicions about the parents got severe.

Cleaning up fresh blood and body fluids may easily be done with usual household cleaning agents, even shampoo is usable. Also such agents mostly destroy DNA very effectively. But the fact is that always small amounts of the fluids will gor into the materials contaminated. Those small amounts could be found. DNA analysis could also be done, but usual DNA was already destroyed. But at least some mDNA could be extracted. Such mitochondrial DNA (mDNA) is much more stable and contained in some cell particles for energy production and not contained in cell's core. Such mDNA but is delivered only by the mother's line to the childrens and not interfered by fathers DNA thus producing a unique DNA of a child. The mDNA extracted was of Kate McCann's origin. Thus exactly four people could be responsible for the found blood patterns: Kate, Amelie, Sean and of course the victim Madeleine. The widespread blood pattern but can only be explained by a really severe wound. But neither Kate, Amelie or Sean had ever had a severe wound in the Apartment 5A.

So from evidence it is clear that the pattern was produced by victim Madeleine. Now lets see how the pattern looks like: We have a very widespread pattern at the walls, secondly a pattern on the curtains only above the line of the window board and also on the back of the sofa, and also some at the floors.

Obviously the pattern in the whole can only been produced by the following situation:

1. The sofa being apart from the walls
2. The curtains put onto the window board

This is the actual situation at the moment when the blood pattern was produced.

## Checking the three possibilities by forensics

### First: Death by accident

This would be caused obviously by accidental dropping of Madeleine from the sofa or, more severly, from standing on the window board, to the hard floor in free fall.

The sofa has a maximum hight of about 70 cm. Things like this could occure especially when the sofa is close to the wall, as then even if dropped form the window board, the sofa would always hinder a free fall to the ground. The maximum(!) speed available is from simple physically grounds 3.7 m/sec, which more commonly is 13.3 km/h = 8.3 mi/h. Which is just a more strong walking or slowly bicycle speed. Such drops from sofa by the way as every parents know, happen regularly and usually have no injuries to small childrens as a result. This height is indeed much to small for a drop resulting in large wounds, sudden and ultimate and irreversible death.

Much more severe would be climbing the window board, and then dropping in free fall back and hitting the hard floor with the backhead. Which could give a deadly hurt to the neck and/or cerebellum. At here size of approximatly 120 cm here centre of gravity would have been lifted to about 90cm+60cm = 150 cm. Which results in about 5.4 m/sec. And thus 19.5 km/h = 12.2 mi/h a typically velocity of a bicycle.

But now we will have another problem: For the thus needed free fall, the sofa must be apart about a meter from the wall. Now but then, how should she climb the window board? Well may be she used a chair in addition? But indeed this situation is very unlikely, as she had to put the heavy sofa away (how by the little girl?) and take a chair (why, if sofa was much better to do the climb?). And how to do so when the parents were in the apartment, which between 17:30 and 18:30 was the case?

But even if such an unlikely thing happened, what would wounds and blood pattern are likely to occur? Of course a sharp hit to the cerebellum or a broken neck may cause ultimate death. But they are inner wounds with no blood outside (not at that small height). The maximum outer wound would be a wound at the back of the head. But from simple geometrics the blood pattern which occurs then would be very flat, as the head hinders the blood to spread to the needed heigth. Also the question would arise, why then the curtain has no freckles below the window board limit? They must have been laying on the window board, but this would have been very unlikely, if Madeleine climbed the board.

So from forensic evidence we must concede, that there was no accidental drop of Madeleine resulting in ultimate and irreversible death.

### Second: Death by beating

A second possibility were, that Madeleine was beaten to death by one of the parents. For most people this may be seen as „unthinkable“, but indeed more than 90% of small children being killed this is indeed the case. And also seemingly „unthinkable“, in most of such cases the overstressed Mothers are responsible and not so often the Fathers.

From evidence we know that in the family there was a large marital dispute at least since evening the 1st of May (see the Quiz happening). Even seemingly Kate hit Gerry with a slap into his face (see last photo and explanation). From psychology it is also known that women often assign their personal stress to their oldest daughters. Could have Madeleine been killed by a brutal slap into here face from furious overstressed Kate? Well it is thinkable, but also unlikely.

The thing but again is firstly: could such a hit result in ultimate and irreversible death? And secondly again the pattern of the blood spread: The main pattern then should be vertical and not horizontal!

So from forensic evidence we must concede, that there seemingly was also no beating of Madeleine resulting in ultimate and irreversible death.

### Third: Death by false medication

From reconstruction we already could see this possibility is indeed much more likely. But lets see what forensics tell us first:

Obviously the blood pattern was produced by trying to reanimate her by pressuring the heart. And large amounts of blood and body fluids pressed out of her lungs through her mouth.

How can this happen? For this we have to know the very details of an anaphylactic shock. Well, the term „shock“ originally comes from war medicine. As early as around 1743 this incidence was observed and described by Doctors trying to help victims of war. „Shocks“ occur mostly when somebody loses a lot of blood through a large wound, e.g. done by a sword or a bullet. As our system of blood vessels is a closed pressurized system, the open wound and loss of blood will result in a overall loss of blood pressure. Which then results in shutting down the body and the loss of any possibility of further defence. From this nature „invented“ the shock: To sustain blood pressure for at least some short emergency time, the blood vessels open their walls and the blood is pressed into the surrounding tissue of the organs to hold the pressure better than the leaking vessels system. Also thus the venous return of blood to the heart is reduced to a minimum. The organ which is then but very much affected is the lung. The body fluids in the lungs tissue will reduce the size of the bronchial tubes thus much reducing the ability to breath.

Now an allergic reaction of the body is always a overreaction to an external influence, e.g. peanuts or drugs and a lot of other things. In such cases the body interprets such externals misleadingly as an ultimate danger for life and may overreact as if severely wounded. In the extremest case of an anaphylactic shock, the body fluids very fast are pressed into the outer tissues and the heart may fall completely empty. Death then may occur in less than 5 minutes after being exposed to the external influence.

Further readings see e.g.:

→Anaphylaxis: A brisk immune response resulting from the binding of IgE antibodies to high-affinity IgE receptors on mast cells or basophils, with the release of histamine and tryptase and secretion of leukotrienes andprostaglandins; laryngeal oedema may cause death by asphyxia. …

Autopsy findings:

Cutaneous urticaria and angioedema, pharyngeal or laryngeal spasm, upper airway oedema, lower airways obstruction due to bronchospasm and mucus plugging, hyperinflation of lungs, petechial haemorrhage. Anaphylactic Death is quickest with drugs (5 minutes), slower with stings (12 minutes) and slowest with food (30 minutes). …

Management: Adrenaline (with the caveat that too much adrenaline can also kill the patient by causing massive pulmonary oedema).

Fatal anaphylaxis—causative agents

Foods

- Peanuts, as well as pecans and other nuts;
- Prawns and other shellfish;
- Acidic fruits (citrus), strawberries;
- Milk and other dairy products.

Drugs

- Antibiotics—classically penicillin, but increasingly cephalosporins, amoxycillin, ampicillin;
- Anaesthetics—e.g., suxamethonium (succinylcholine), thiopental, acetazolamide, protamine;
- Radiocontrast media—especially ionic media, technitium.

Venoms: Typically cause death by shock, as well as laryngeal oedema and complete upper airway obstruction, usually accompanied by petechial haemorrhage on mucosal and serosal surfaces (a typical finding in asphyxia). …

See also more informations to the fatal „empty heart syndrome“ e.g. at http://advan.physiology.org/content/29/1/15 (19) and some more at http://jp.physoc.org/content/587/21/5015 .

From this we can guess the happenings around 18:00 o'clock in detail:

17:30 Madeleine returns from creche to apartment

17:45 Madeleine is given a medicine. As later evidence (see e.g. vandalized evidence) shows a sedative, oral or by injection.

17:50 while Kate and Gerry are in the bathroom and/or kitchen (as she herself wrote in her diary: Milk and biscuits for the kids. I left them with this and books and games and went to have a quick shower/wash my hair), Maddie suffers a severe anaphylactic shock. Searching for help, she stands up from the table she was sitting at for supper. But she collapses and drops into nearby small niche between the sofa and the wall behind.

17:55 Gerry sees the legs of Maddie pointing from the niche into the room.

He runs to Maddie, and puts the sofa away to get enough space for immediate help. As a heart specialists he recognizes that her heart is not beating anymore. At once he begins with the well trained routine which is rapidly pressurizing the heart 15 times and then giving 2 breaths, then 15/2 again and again. In the procedure of heart pressure the chest is compressed such that the heart is squezed between the ribs and the spinal cord, which but also pressurizes the lungs very much. In her condition this but resulted in pressuring out the large amounts of blood from the lungs tissue while uselessly pressurizing the now empty heart. Even parts of the now irreversible destroyed lungs will be pressured out besides the blood.

18:00 From this, for Gerry the ultimate and irreversible death of Madeleine Beth McCann now is an undeniable fact. Any help, by whom ever, will not render this condition any more.

18:30 Gerry meets David Payne at the tennis court and sends him to Kate in Apartment 5A. (Later David will state he was there for about half an hour, Kate but will state in sharp contradiction just 30 seconds).

(Additional Remark: at →SteelMagnolia we find an interesting remark about BBC news: “An early forensic report is alleged to have mentioned a certain blood spray … commensurate with a certain type of broken larynx … some DNA samples found related to cerebal fluids indicates a broken neck or fracture skull”. Also “Sousa himself told of this very fine mist of spray that was found in the apartment”. This live report was made outside the Police Station at the time Kate McCann was being interviewed, therefore, she must have been presented with the FSS results. This information was released only once that night - BBC 6 o'clock news.“)

## Cause of Death, some more objections

We may now look for more evidence to decide which has happened:

Two questions are very crucial: First, why wasn't there any official call of emergency? No doctors help, no police. And thus secondly, What was the driving motive not to do so?

First: Death by accident

Resulting in ultimate and irreversible death would have been very unlikely. A prove of irreversible death in most cases is even for a trained doctor not that easy. Especially when otherwise healthy and young people are involved, even when death occurs by a non beating heart, the death in most cases is not irreversible but needs urgently professional help.

An emergency call thus would have been done. Especially as there would have been no reason to blame the parents for such an accident. There would have been no motive to not call for immediate help.

Second: Death by beating

Again: Resulting in ultimate and irreversible death would have been very unlikely. A prove of irreversible death in most cases is even for a trained doctor not that easy. Especially when otherwise healthy and young people are involved, even when death occurred by a non beating heart, the death in most cases is not irreversible but needs urgently professional help.

An emergency call thus would have been at least much likely. But (at least one of) the parents would have been blamed for such an accident. But it would have not resulted in both parents losing their licence to work as doctors. This would have been but anyway at least a thinkable motive to not call for immediate help.

Third: Death by false medication

Resulting in ultimate and irreversible death can appear. A prove of irreversible death e.g. by destroyed lungs for a trained doctor is easy. No professional help is needed any more.

An emergency call thus would have been of no practical use. The parents would have been blamed for such an accident.

Depending on the very details, it possibly could have resulted in losing their licence to work as doctors. This would have been a strong motive to not call for immediate help. It also provides a very strong motive to cover up the incidence e.g. as an abduction by an unknown stranger. Losing their licences would have resulted in loosing their new House (which had at the time about 400000 Pounds of mortgage), loosing proper education for the twins while practically falling from middleclass into debt and poverty.

So another question is left: How did Madeleine get her drug? Oral or by injection? Giving a drug, e.g. like calpol or valium oral, will be a risk, but usually not a very large one. Of course it would have been a moral issue to do so for their own comfort instead of a real medical reason, but even doctors have not to expect such a strong allergic reaction. It sometimes happens, but it is very very seldom. So a possible sentence against the parents could have been expected to be somehow moderate if occurred.

Things but are much more serious if a sedativa was given by injection. Every doctor, especially a anaesthetist like Kate McCann knows, that an injection on one side works much better but on the other side also takes much more risks of an allergic reaction and shock. Without a compelling medical reason no one is allowed to do so.

Could it have been this way? Definitely Kate was still furious about Gerry and in large marital dispute and stress. Also we know that Madeleine was seemingly very sensitive to this stress (see 1st may evidence). The only two years old twins were quite easy to handle and may have taken their sedativa oral without any reaction. But the nearly four year old Madeleine had already her own mind. It is very likely that she refused to take any medicine oral and insisted on not taking any pill, not directly and also not dissolved in orange juice (or milk, as she herself wrote in her diary: Milk and biscuits for the kids. I left them with this and books and games and went to have a quick shower/wash my hair). Anaesthetist Kate but was used to take infusions and/or injections in such cases regularly in her practise. In a hospital this is not such a high risk: If allergic shock in very seldom cases occur, it can be handled fast and professional with a lot of available counter medicines (e.g. Adrenalin and others and/or electroshock therapy). In her stress but she may have decided to do such a risky thing now without having possible medical help available.

If now the case happened, it got both Kate and Gerry in the utmost bad circumstances. Not only that they had killed her own daughter, they did it by medical mistreatment. And also this mistreatment had to be blamed to both of them: Firstly, as under no medical stewardship Kate was allowed to give an sedative injection in this circumstances. And also Gerry under no medical stewardship was allow to let Kate do so. And, last but not least, when finding Madeleine suffering a lethal anaphylactic shock pressurizing the lungs was mistreatment too, as it made her death irreversible by destroying her lungs. (Remark: When recognizing the lethal oedema the best treatment would have been calling for immediate help, thus getting Adrenaline and electric shock equipment.) The loss of both licences to practice as a doctor where now definitely at large risk.

The last question now is, who seemingly gave the lethal injection? Kate or Gerry? Indeed the circumstances speak very much that it was Kate. One evidence comes from everybody parents knowledge about childs education in a family. Indeed fathers are mostly very tender with their girls. If parental force is given to a child, mostly mothers do this to the girls. The reason is simply that both are women and understand much better their needs and trouble as well, and thus are not so pity. With boys of course, it is mostly vica versa. But much more evidence is given by the observable behaviour of Kate. At several points of the investigations it is known, that she was →close to confession. Gerry had to do a lot of work to convince her to do not so. If Gerry but gave the lethal injection, in addition with the known fact that he was the origin of the severe marital conflict, certainly she had blamed Gerry for all her sorrow and pain and thus confessed. Only and only if she herself is to blame, the cool Gerry McCann had a chance to convince her to stay silent until today.

## Summary

Accidental Death:

- Blood Pattern: wrong
- Possibility of ultimate and irreversible death: low
- Motive: small, close to zero
- Likeliness: very much unlikely

Death by beating:

- Blood Pattern: wrong
- Possibility of ultimate and irreversible death: low
- Motive: large
- Likeliness: very unlikely

Third (a): Death by false medication (oral sedativa)

- Blood Pattern: correct
- Possibility of ultimate and irreversible death: high
- Motive: very large
- Likeliness: very likely

Third (b): Death by false medication (sedativa by injection)

- Blood Pattern: correct
- Possibility of ultimate and irreversible death: very high
- Motive: ultimate forcing, very large
- Likeliness: very much likely