Now, doctor, in talking about stomach contents from this board, item 2 discusses factors affecting stomach emptying. Would you take us through how those factors affect stomach emptying?
A, if it's a liquid, it empties much faster than solids. Liquid empties from the stomach anywhere from 15 minutes to half an hour, but solids can vary anywhere from two to three to four or five hours depending on what type of solid food is eaten. The nature of the food, if it's a fatty food, it takes more time to empty from the stomach than carbohydrate.
And in the scheme of the types of foods and how the stomach empties, is that the type of food which takes longer or shorter relatively speaking to empty from the stomach?
It's a carbohydrate. It would empty earlier than fatty foods, but actually pastas are mixed, depending on the sauce that is used.
The sauce will be a factor, size of food particles. The stomach, usually one of the functions is to reduce the size of the food particles by churning. So if you take larger fragments, they would take a longer time to empty because to empty from the stomach, the food particles must be made into smaller pieces, then go into the intestine.
Doctor, let me interrupt for a moment if I could. Can you explain in general terms how the stomach operates, if you will, so one gets food in and where that food goes once it's in the stomach?
The stomach has several functions. One is the mechanical function, which is the churning of the food, breaking down the food particles into smaller fragments and then passing it on to the intestine for further digestion. The other is absorption, that is absorbing some part of the food content. And this would apply to certain liquids like alcohol can get absorbed in the stomach. Then it also has digestive functions. It produces two substances, both acid and also the enzyme pepsin which is--plays a part in protein digestion.
Protein digestion. And it's also got hormone function, produces a hormone called gastrin, G-A-S-T-R-I-N, which helps the process of digestion. So it's got several functions, and one of the functions is reducing the food particle size so it can go into the intestine where further digestion takes place. Another factor that affects stomach emptying is how well you chew the food. So naturally, if you don't chew the food adequately, the food particles are larger. That's a variable factor here, that those particles will take a longer time to empty from the stomach. If you chewed the food well, then you would have smaller particles in the stomach which would empty faster. Then you have the volume of ingested food. If you take a big meal, it's going to take a longer time to go to--from the stomach rather than if you take a small meal which will empty faster. And of course, factors built into it would be the size of the food particles and the extent of mastication and the type of food that is eaten, whether it's pasta, fatty food or just simpler food material like pasta with tomato sauce, Alfredo or more fatty stuff.
Fettucini Alfredo. Alcohol beverages, that has a factor. If the concentration of the alcohol is more than 30 percent, that will have an inhibitory means delaying the stomach emptying.
Doctor, before you go to the next factor, assuming hypothetically that at dinner at the Mezzaluna restaurant on June 12th, 1994--
And for the record, your Honor, I anticipate there will be evidence concerning this introduced. So I understand that there are no facts in evidence at this stage, but they will be offered.
--that Miss Nicole Brown Simpson's party had alcohol from bottles of alcohol which contained approximately 12 percent alcohol by volume and 12.5 percent alcohol by volume, doctor, assuming that hypothetical, sir, is that the kind of alcoholic beverage that in your opinion would slow down the digestive process?
No. It would be more the hard liquor alcohol that has more higher concentration of alcohol which is reflected by this statement here.
KEY QUOTEAnd, doctor, assuming hypothetically that a person drinks the alcohol on an empty stomach at least initially, would that alcohol be considered as you've indicated under subpart A, the kind of liquid that passes from the stomach within 15 to 30 minutes?
That would be the--that would--what would happen to the alcohol because being a liquid without food, it would be, one, absorbed partially from the stomach and also, it would be rapidly emptied into the intestine within 15 to 30 minutes.
Drugs. There are certain drugs which delay stomach emptying, some drugs which hasten stomach emptying. Drugs which would delay stomach emptying would be some of your narcotic drugs, some drugs which you use for blood pressure, et cetera. Drugs which would hasten stomach emptying, one of the common drugs is valium. It will hasten stomach emptying. Then of course, emotional stress is a factor that should be kept in mind. If somebody is preparing for their testimony the next day, they don't--the stomach will take a longer time to empty when you have fear or emotional stress and/or excitement.
Doctor, before you--I don't know if you intended to add something. I didn't mean to--
Doctor, is this stress that is a factor that slows down stomach emptying stress that must exist at the time of eating and thereafter?
Let me ask you hypothetically. Nicole Brown Simpson eats dinner at the Mezzaluna restaurant on June 12th, 1994 and leaves the restaurant between 8:30 and 9:00 o'clock, and during the course of her eating at the restaurant, she has no sense that her death will ensue sometime later that evening and that it was a casual affair with no observed unusual emotional stress. Would that be a situation which would impact this factor with respect to the stomach emptying time?
From the statements you gave in your question, that would not be considered like what is stated here. This is stress and fear from, as I gave an example, like preparing for an exam or preparing for testifying in court, you know.
Doctor, alternative hypothesis. Assuming that Nicole Brown Simpson and Ronald Goldman were both, without warning, very suddenly and very violently attacked and killed in circumstances which resulted in their bodies being found as they were and with the stomach content being as observed and indicated in Dr. Golden's reports, is that the kind of stress--you would describe that as stress I assume, emotional stress being sustained by the victims during whatever short period of time my hypothetical assumes?
No. That's just as a rapid type of stress where there's acute event--acute event of trauma and death. So that would not play a role. This is more a prolonged process which is preexisting at the time of eating and following the eating which plays a role in the delay of stomach contents emptying. By the same token, if we had somebody who has an injury and--had a head injury and they were lying from the effect of the head injury in the hospital, then that can cause delay in stomach emptying because of the--that being more subacute and chronic even, which can play a role.
KEY QUOTEH, people who are older, the stomach empties slower. Body build again is a factor which is kept in mind. Exercise, moderate exercise. After moderate exercise, it accelerates or hastens stomach emptying. But if you have exhaustion, you can have delay in stomach emptying. Natural diseases. People who have diabetes and certain other medical conditions can have delays in stomach emptying because of the effects of the disease process on the nervous control, of stomach emptying. Extreme environmental temperatures. Extreme cold or heat can have an effect on stomach emptying. Usually they can cause delay. So lots of variability to stomach emptying, from the variable factors I just discussed.
Doctor, in the process of digestion, in looking at item 3, it indicates continuation of the chemical process of digestion; is that correct?
Is there more than one process that takes place in this overall concept of digestion of food?
Yes. I already described a few of them. When the bigger food particles are broken down into smaller particles for absorption into the stomach, there are many enzymatic changes which digest the food, which is the chemical part, which is the hydrochloric acid plus also the pepsin which becomes--which plays a part in a little bit of the digestion of the stomach. So that kind of chemical process of the softening of the food can take place even after death, but the mechanical process won't take place after death.
Because you still have the chemicals which are already in the stomach so the emptying process can take place.
Doctor, if there is--and incidentally, let me ask you, is this opinion of yours as expressed in item 3 one which is consistent with literature that you have reviewed on this subject?
Now, doctor, what would be the effect if one wanted to estimate the time of death based upon stomach contents if in fact after a person dies, the chemical processes of digestion continue?
What will happen is, you'll have a more--let's say the particles are already broken down to a certain extent before that because mechanical functions don't continue after death. You will have a gross, that is external appearance as far as more digested state than was at the time of death if the chemical process had continued.
And what is the impact of that if any on the time period one would conclude is the time period between the meal having been eaten and the time of death if there is in fact this postmortem continued process?
If that process did take place, then it would be overestimation rather than underestimation because you would think the food is digested more really when some of the chemical digestion is taking place after death than when it happens before that. So you always overestimate the time interval rather than underestimate.
Entitled "Gastric stomach contents continued" and it starts with a box "Variability in reported stomach emptying times."
Doctor, as part of your review of literature for your testimony, have you in fact reviewed some of the same materials that you've already described to ascertain if there is variability reported in the literature on how long it takes the stomach to empty its contents?
Yes. There has been a lot of variability in the emptying of the stomach contents and the--some of the references we already discussed. And also, I reviewed some articles wherein there have been studies in living people using radioactive devices to measure food material and variability in the emptying process of the stomach. They've also done ultrasonographic studies on emptying of the stomach, and there seems to be not only variation between different persons for the same food, but also, there seems to be difference in the same person on different times the food is taken. So you have differences in the stomach emptying time.
Doctor, from the literature you reviewed, would it be accurate to describe part of the study as the same person is provided the same meal at two different times, and through whatever technique, like ultrasound or radioactive devices, the time for the stomach to empty is measured and you get two different times for the same individual with the same meal? Is that accurate?
Now, doctor, in general terms, some of the literature that you reviewed besides the text literature, is one of those an article by Louie G. Bolandi, B-O-L-D-N-D-I, and others entitled, "Measurement of gastric emptying time by real time, ultrasonography"?
Yes. That's one of the articles I reviewed. And they studied several people, some normal and some with dyspepsia. And they gave them a pasta meal and they studied whether--how quickly they would empty if all were normal people. The average emptying time was nearly--I am going to give the hours instead of minutes there--four hours plus or minus half an hour. But those who had the preexisting condition of disease process, the emptying time was six hours plus or minus one hour. And that is that study.
Doctor, before you go further if you were going to go away from the Bolandi study, it was a study which used as the test meal pasta?
Such as what has been identified by Dr. Golden in the stomach contents of Nicole Brown Simpson, pieces of pasta?
And just so we can have some information here, the Bolandi study, was that a 1985 study, doctor?
And for the record, your Honor, on that board, I've written "Bolandi-pasta-four hours plus or minus 30 minutes."
Now, doctor, have you in the other materials you've reviewed found that there are different times given as generalizations for the emptying time of the stomach contents?
The Adelson book describes, if it's a light meal, it empties within two to three hours, if medium, three to four hours, and heavy meal, in five to six hours, and then the average emptying time given in some books is three to four hours.
Doctor, I want to invite your attention to page 182 of Adelson's textbook. Is that what you reviewed?
And does that refresh your memory as to the specifics of the Adelson text on stomach emptying times?
The light meal empties within one and a half to two hours, medium meal within three to four hours and the heavy meal is about four to six hours.
Let me write in, "Adelson, one and a half to two hours," abbreviated, "Light meal." Three to four hours, doctor--
And I'll abbreviate "Medium" and otherwise, "Three-four, medium meal." And heavy meal, five to six?
And I'll do the same, except now write "With heavy meal." And, doctor, does Adelson's text provide any definition for what is a heavy meal or a medium meal or a light meal?
And what if any information from there were you provided on stomach emptying times?
Says about three to four hours. And if you see identifiable fragments, it indicates that the meal is taken within two hours of.
Doctor, let me invite your attention to page 30 of the Spitz and fisher book, 3rd edition, and ask if you would read to yourself the last paragraph on the left column of page 30 continuing over and see if that refreshes your memory as to the specifics of Spitz and fisher.
It describes the same light meal, medium meal and heavy meal, but the reference is also for the same as Adelson.
Spitz and fisher cites Adelson's times there, one and a half to two hours and so forth--
Excuse me. So let me write under Adelson, I'll write, "Spitz and fisher" with an "And" sign. Now, doctor, did you also review Dr. Knight's forensic pathology text with respect to stomach emptying time?
And as part of the material--and I'll be very brief, your Honor. As part of the material you read, considered and relied in part upon, is this part of that? "It was assumed that the physiological process of digestion of an average meal lasted some two hours. This is based on the consumption of a test meal of gruel, however, hardly a representative example of a moderate mixed diet. "Moreover, the subjects of the experimental work were healthy and presumably free from sudden stress during the experiment. More elaborate description of digestion times of varying foods have been drawn up, but they have dubious value of--as an example, have great variations over Modi, M-O-D-I, who gives four to six hours for a meat and vegetable meal and six to seven hours for a farinaceous--" is that a cereal, doctor, like material?
"--meal. "Adelson states that the stomach begins to empty within 10 minutes of swallowing, that a light meal takes--leaves the stomach by two hours, a medium meal takes from three to four hours and a larger, heavy meal takes four to six hours." Is that part of what you read, considered and in part relied upon?
One last entry. "Even if one accepts an," quote, "Average," unquote, "Gastric transit time--" is that a funny way of saying emptying of the stomach?
"Even if one accepts an average gastric transit time of an," quote, "Average," unquote, "Meal as being of the order of two to three hours, the assumption that death took place within this time before death can only be valid if the death was quite sudden and unexpected with no stress, no prodromal event," prodromal meaning anticipating event that is coming in advance of the ultimate demise?
And continuing: "What is valid is the nature of the last meal which may be helpful in establishing the time of death. If it was known to the investigators that the deceased person ate a certain type of meal at a certain time, whether it be chicken curry or green beans, the identification of such food in the stomach would be persuasive evidence that he died after taking that food and that it was his final meal before any other substantial food was taken." Again, part of what you read, considered and in part relied upon?
Now, doctor, let me for the record--I'll write in, "And he says two to three hours assuming an average," and I put that in quotes, "Meal"; is that correct?
In this case, given Dr. Golden's description of the stomach contents of Nicole Brown Simpson's stomach pasta and so forth, would the very finding of those identifiable fragments have any significance to you on estimating a time of death based strictly on that finding?
It would help you to give a time frame which would be favored. But as I told you, we do not really know how much Miss Simpson ingested in the restaurant because what we see is what we have remaining in the stomach at the time of death. Of course, the items being seen at the time of death is the identifiable rigatoni, black olives and spinach. So keeping that factor in mind--and also, we do not know how well the food was masticated, if it was well masticated or only partially masticated.
Yes. So that's a factor that we don't know. We still have identifiable fragments. Keeping those variabilities in mind, it would indicate that death took place possibly within two hours of ingestion of the last meal if you know--when the completion time of the meal is known. But again, this is not with absolute certainty you can say that is the time she died. You would favor that given this literature, but I would be unable to say this is the time she died.
Doctor, if you look at the bottom of this particular board, there is a quotation from Dr. Spitz' book, that's the book in front of you. Is that also part of the material you read, considered and in part relied upon in forming these opinions?
Is that consistent with your own experience; that if you are able to identify by naked eye inspection the contents of the stomach, that it indicates or at least favors that the person died within two hours of last eating?
Now, doctor, assuming hypothetically that Nicole Brown Simpson did visit the Mezzaluna restaurant on the 12th of June, 1994, arriving at about ten to 7:00 and that she did leave between approximately 8:30 and 9:00 o'clock and in fact, according to one witness' testimony, about 8:45ish, but was in that period of time, a bill was opened by the server, and one hour and 14 minutes later, the bill was closed, indicating that no further food or beverage was ordered by any of the members of the party, and assume further that Miss Brown Simpson completed her meal, including a rigatoni dish, before actually leaving the restaurant, that is, some period of time passed from the time that she last ate her pasta until the time she set foot out the door, how if at all is that set of hypothetical circumstances useful to you in taking Dr. Golden's findings from the stomach contents and offering, if you can, an opinion regarding range for time of death?
As I told you, there are so many variable factors. We discussed them even in the stomach contents. Based on the fact that the food is identifiable and present, given the literature data, it would suggest that she probably--if the meal is completed by 8:00 or 8:15 you said?
I said hypothetically that the bill was opened between the time of her arrival ten to 7:00 and closed sometime before she left between 8:30 and 9:00, but that the time period between the opening of the bill and the closing of the bill was purported to be an hour and 14 minutes.
So with that information, it would be fair to assume that probably the meal was completed around 8:00 o'clock or 8:30 maximum because the bill was completed by then. Then using these rough perimeters which we discussed and variable factors, it would suggest that she probably died within 10:00 and 10:30. But there's so much variability to this, we only suggest time. I won't say that's the time she died, but it would favor that.
KEY QUOTEAnd that, doctor, is if you wanted to use the stomach contents at all as a means of estimating the range for time of death; is that correct?
Do you wish to use the stomach contents at all as a means of estimating the range for time of death?
It's a factor which can be used. But as I told you, there's so many variabilities. And especially, we don't know how much she ate, how well she masticated it and how much has already passed on to the intestines. Keeping that in mind, I can only say it favors that she died within two hours based on this factor, but it's just an estimate, which is not really pinpointing to time of death.
Doctor, in your review of the Henssge 1995 book describing in detail the techniques available to estimate a range for time of death, is there any reference to the use of the stomach contents of a human being to form that estimated range?
Doctor, if Dr. Golden had saved the stomach contents of Nicole Brown Simpson, in your opinion, would you be any better able to differentiate a time of death of 10:15, from a time of death of 11:00 o'clock than you are with the information that you have and your education, experience and training as a forensic pathologist?
By saving it, you would not have any more information than you had before. As I told you, there's no medical value to save it other than, as I pointed out, that I asked Goldman's stomach contents to be saved for this issue.
KEY QUOTENow, doctor, I want to just briefly conclude by discussing with you Mr. Goldman's stomach contents. Do you recall the testimony that you gave concerning Dr. Golden's report of his stomach contents?
Doctor, is there anything about his stomach contents that is of use to you in identifying a range of death time estimate?
Again, his stomach contents was only, if I recall, 200 cc's, and you could barely identify some spinach fragments. You have the same variable factors you are dealing with, and I will not be able to use that to estimate any range at all.
Doctor, is there any way in your opinion medically that one can use Mr. Goldman's stomach contents and the stomach contents as described by Dr. Golden of Nicole Brown Simpson to correlate the time of death range for the two individuals?
And, doctor, of the part that we went through with Dr. Golden's dictated tape, indicates that contents, approximately 500 ml--and I think you testified earlier 500 ml is equivalent of 500 cc's?
The "L." In terms of how the literature describes the time it takes to have a meal pass through the stomach, is 500 cc's in your opinion a light meal, a medium meal, a heavy meal, an average meal? What is it?
You have to be careful when you make those kind of judgments because of several other factors. You do not know how much liquid was ingested with the food. When Miss Nicole Simpson took the food, you don't know if she took water with it. That's a factor. You also have juices which are secreted by the stomach. As you know, the stomach normally secretes gastric juice which mixes with the food. So that factor is there. You also have sometimes some regurgitation of material from the duodenum also into the stomach in some situations. So may include the digested food material which is remaining, any ingested liquid. So you have all these factors. So I really can't say whether it's a big meal, medium or light. Definitely not a light food, but a lot of material favor being a medium meal, but I want to bring up all these other factors of the liquid which is ingested, gastric juice which is secreted before I make an opinion on this.
Doctor, we started this area of your testimony asking you if you had formed opinions regarding the range for the estimated time of deaths of these two human beings, and you gave testimony. Having reviewed through the subsequent testimony all of these various factors that we have done, are you any better able to narrow the range from your 9:00 to 12:30 or 12:45 range that you gave when we started this testimony?
If you use all the perimeters--but I did mention if you do use the factor of identifiable food fragments with the variable other factors, it would suggest that death took place probably within two hours for Nicole. But again, it's very difficult to be specific because of all the variabilities in all the factors we are evaluating.
And, doctor, if you wanted to give information and subsequent testimony in an effort to see Mr. Simpson convicted on the topic of time of death, could you have used the stomach contents to suggest, if you wished, that the range was closer to 10:15 than 11:00 o'clock?
Doctor, did you ever indicate in any report or was any report generated by Dr. Golden which suggested that the time of death range should be narrowed so that 10:15 was consistent and 11:00 o'clock was not?
All right. Doctor, did Dr. Golden ever provide any report which indicated from his review of the materials, that the time of death was consistent with 10:15 and not consistent with 11:00 o'clock?
Have you provided any kind of report that would indicate the time of death range would include 10:15 and exclude 11:00 o'clock?
And as you sit here today, doctor, have you in your own mind the ability--using all of your knowledge, experience, training and literature, do you have the ability, even if you had been at Bundy at 12:13 in the morning, to have narrowed the range for time of death to exclude 10:15 and to include 11:00 o'clock or vice versa?
It would favor that she died within two hours based on this factor, but it's just an estimate, which is not really pinpointing to time of death.
With that information, it would be fair to assume that probably the meal was completed around 8:00 o'clock or 8:30 maximum because the bill was completed by then. Then using these rough perimeters which we discussed and variable factors, it would suggest that she probably died within 10:00 and 10:30.
No.
By saving it, you would not have any more information than you had before. As I told you, there's no medical value to save it other than, as I pointed out, that I asked Goldman's stomach contents to be saved for this issue.