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The death of a gran in a maggot-infested bed was "directly contributed to by the neglect of her needs", a court heard.

John Purcell, 71, and Catherine Purcell junior, 35, deny the gross negligence manslaughter of their wife and mum Catherine Purcell senior.

The 68-year-old's body was found at the house she shared with Catherine Purcell jnr in Shacklady Road, Kirkby, on Sunday, July 24, 2016.

Prosecutors allege she died in a "festering mix of urine and faeces", which soaked through and chemically destroyed her mattress and bed.

They say this chemical reaction burned large areas of her skin, which became infected and was fed on by maggots, which turned into flies.

It is alleged the defendants neglected the OAP and failed to seek help, when medical treatment three weeks prior would have saved her life.

Home Office forensic pathologist Dr Christopher Johnson carried out a post-mortem examination of Mrs Purcell's body on July 25.

He said the 4ft 11in gran weighed less than five-and-a-half stone and there were live maggots and pupae cases behind her right knee.

Dr Johnson said her long hair was "unkempt", matted at the rear in one large piece, while her fingernails were "long and ingrained with dirt".

He said Mrs Purcell's left arm and left side of her body was covered in dirt and he could not wash this off completely, which was "unusual".

The doctor described extensive skin ulcers and brown skin staining on her lower back and left buttock, where it was "particularly severe".

He said there was a "deep, infected pressure ulcer" on the left hip, 6.5cm by 6cm, with pus staining at the base, which went down to the bone.

Dr Johnson said he could feel the bone in the wound, such was the ulcer's depth, and the muscle and skin was "dead and disappeared".

He found a cancerous tumour at the back of the tongue, extending to the epiglottis, a flexible flap at the end of the larynx in the throat.

The doctor said this "easily" would have been detected by a specialist if they were looking to see why she had pain or difficulty swallowing.

He said nine of her ribs had fractured, likely after death, which could be done "very easily" with finger pressure, reflecting her "general state".

Dr Johnson found bronchopneumonia plus emphysema - chronic irreversible damage usually caused by smoking - in Mrs Purcell's lungs.

(Image: Julian Hamilton/Daily Mirror)

She also suffered from Korsakoff's syndrome, an alcoholism-related vitamin deficiency disease, resulting in chronic memory problems.

Dr Johnson concluded that the cause of death was primarily bronchopneumonia, with infected skin ulceration and dehydration.

He found secondary factors were neglect of clinical needs, carcinoma of the tongue and Wernicke-Korsakoff syndrome.

The doctor said: "The condition of the skin and dehydrated state has been directly contributed to by the neglect of her needs, which is apparent from the state of the body and the bedroom."

He added that Mrs Purcell's bronchopneumonia was linked to her lying in the same position for an extended period of time on the dirty bed.

Dr Johnson said there was evidence she has been scratching the sores on her left side and there was scarring from where sores had healed.

Mrs Purcell was estranged from Mr Purcell, of Quarry Green, Northwood, but he still visited her daily and sometimes slept over at the house.

The doctor agreed with Nigel Power, QC, defending Mr Purcell, that the emphysema was no surprise, as the pensioner was a heavy smoker.

Mr Power said according to one study, 50% of people with Korsakoff's Syndrome are expected to die within eight years, with the main causes being serious bacterial infection or cancer, which Dr Johnson accepted.

Under questioning by John McDermott, QC, defending Miss Purcell, the doctor said he wasn't in a position to comment on her nutrition, apart from that she had very low body weight and fragile bones, which suggested it was poor.

David McLachlan, QC, prosecuting, asked about Mrs Purcell's skin ulcers, which Dr Johnson said were a result of unrelieved pressure stopping blood flow.

He said she had been lying on the bed for a prolonged period of time, mainly on her left side.

Mr McLachan asked if this could develop over a matter of hours. Dr Johnson replied: "It would take days to get to the state it was at post-mortem."

(Proceeding)