Medical Jurisprudence, Forensic medicine and Toxicology. Vol. 1 by R. A. Witthaus et al.
1. HEMORRHAGE varies in amount with the size of the wound, the
1863 words | Chapter 80
vascularity of the part, and the number and size of the large vessels
involved. In incised or punctured wounds the amount, as a rule, is
quite considerable. If there is a free exit most of the blood runs
off; the rest stays in the wound, where it soon coagulates with the
exceptions mentioned above. But besides partly filling the wound in
the form of a clot, the edges of the wound are deeply stained with
the coloring matter of the blood, and this stain cannot be removed by
washing. This staining involves especially the muscular and cellular
tissues.
Further, a hemorrhage during life is an active and not a passive one;
the blood is forced into the interspaces of the tissues in the vicinity
of the wound, and is found infiltrated in the cellular tissue, the
muscles, the sheaths of the vessels, etc. It is here incorporated,
as it were, with the tissues so that it cannot be washed away. In an
ante-mortem wound the arterial nature of the hemorrhage may show by
the marks of the jets of blood about the wound or on the clothes or
surrounding objects. When a large vessel has been divided and the
exit for the blood is free, this may run off without infiltrating the
tissues or even staining the edges to any considerable extent, and
there may remain but little in the wound. In the case of lacerated and
contused wounds the amount of hemorrhage is less, but rarely fails
entirely, and if the wound is in a vascular part it is liable to cause
death from hemorrhage, though a whole limb may possibly be torn off
without much hemorrhage. In the latter case, however, there are usually
found clots of blood adhering to the edges of the lacerated wound
and the ends of the vessels. In contusions where there is no wound
of the skin the blood is prevented from flowing externally, and its
accumulation and distribution form an ecchymosis. Here again we see the
active power of the hemorrhage which infiltrates between the tissues,
stains them deeply, and appears either as a mere stain or in fine
clots incorporated, as it were, with the tissues or partly occupying a
cavity formed by an extensive displacement of the surrounding parts.
The amount of blood varies under the same conditions as in incised
wounds, and also according to the greater or less disintegration of
the tissues by the blow, allowing a larger or smaller central cavity
to be formed. In “bleeders” the amount of the hemorrhage does not
vary under the normal conditions, but a fatal hemorrhage may occur
from a very insignificant wound. After hemorrhage from a wound made
during life the veins are empty about the wound, especially those
situated centripetally, while normally after death the blood is mostly
aggregated in the veins. They are the source of post-mortem hemorrhage,
but do not empty themselves to any great extent.
The _hemorrhage from a wound made after death_ may be extensive if
the blood remains fluid as in the cases mentioned above, _i.e._,
after death from drowning or asphyxia or after the commencement of
putrefaction. Otherwise the amount of hemorrhage decreases with the
length of time after death, until the blood loses its fluidity and
hemorrhage no longer occurs. In general, it is slight unless a large
vein is opened, for the veins are the source of the hemorrhage. There
is usually scarcely any hemorrhage after the first two to four hours.
This applies also to subcutaneous hemorrhages or ecchymoses. These
post-mortem hemorrhages are passive and not active, consequently there
is less infiltration of blood into the surrounding tissues, which
merely imbibe it, and the stain is less deep and may be washed off the
edges of the wound, in contrast to the stain of ante-mortem wounds.
After putrefaction has set in the hemorrhage may be more abundant,
as the blood is driven to the surface by the formation of gas in the
abdomen and thorax. At the same time, the coloring matter of the blood
transudes through the walls of the veins and is imbibed by and stains
the tissues, so that it may be impossible to distinguish it from a true
ecchymosis. Fortunately these conditions are of small moment, as an
examination is seldom deferred so long.
CADAVERIC ECCHYMOSES show almost invariably while the body is still
warm and the blood more or less liquid, _i.e._, during the first eight
or ten hours after death. They are not due to injury or violence before
or after death, but they may closely resemble ecchymoses produced on
the living body and be mistaken for them. This is the more important as
they are quite constant on the cadaver.
In this connection, it may be said that an ecchymosis due to a blow
before death may not show till after death, as it requires some time
for a deep ecchymosis or even an ecchymosis covered by a thick layer
of skin to show superficially. Thus a man kicked in the abdomen died
thirty-five hours after the injury from peritonitis, due to a rupture
of the bladder. No ecchymosis appeared at the site of the injuries
until after death. It is not uncommon in cases of hanging to observe
an ecchymosis along the course of the cord appearing only after death.
Huize met with a case of this description. Devergie remarked that on
the bodies of those drowned ecchymoses are often hidden for a time on
account of the sodden state of the skin, and they appear only after
the water has evaporated, which may require some days. Furthermore,
it is not necessary to survive long after an injury in order that an
ecchymosis may show post mortem. If the blood is fluid at the time of
the blow and any capillaries or larger blood-vessels are torn, then we
may have an ecchymosis though death be almost instant. Casper thought
that it required some time before death for an ecchymosis to develop,
and that if the person injured by a contusion died soon after the
injury, an ecchymosis would not appear after death. There are many
well-authenticated cases to prove that Casper’s opinion is wrong. Among
the most famous of these is that of the Duchesse de Praslin.[615] She
was attacked and killed by her husband while she was asleep in bed.
The thirty or so wounds showed a mortal conflict, and she could not
have survived more than one-half hour, and yet after death there were
numerous ecchymoses from the contusions.
Another case is also mentioned by Taylor.[616] A young man died
suddenly after a blow from a companion, having been struck in the side
a fortnight before by a heavy box, which knocked him senseless and
nearly killed him. The post mortem revealed an ecchymosis on the side
which on the authority of Casper’s opinion was attributed to the old
injury. The color of the ecchymosis would be sufficient to settle all
such doubts, as the changes of color would have fully developed or the
color even disappeared in part in fourteen days’ time.
An ecchymosis made post mortem does not undergo the color changes
seen in ecchymoses during life, unless the tissues are œdematous in
which the ecchymosis occurs. These changes in color have already been
described, the deep blue changing to violet in eighteen to twenty-four
hours at the earliest. In support of the foregoing and disproving
Casper’s views, Christison found that within two hours after death
severe blows on a dead body are followed by a livid discoloration,
similar to those produced by a blow shortly before death. This livid
discoloration is due to the effusion of a very thin layer of blood
external or superficial to the true skin, sometimes in a stratum of
the true skin or more rarely into the cellular tissue, staining deeply
the partition walls of the fat-cells. Of course, a more or less recent
contusion or ecchymosis on a dead body was not necessarily produced at
the same time as the cause of death. It should be borne in mind in
this connection that ecchymosis is not a necessary result of a blow or
contusion.
According to Devergie, ecchymosis does not appear when a blow inflicted
post mortem is received by skin directly covering a bony surface
beneath, and rarely appears where there is a large amount of fat and no
solid point of resistance beneath the site of the blow.
We have already referred to the fact which Portal long ago remarked,
namely, that the spleen has been ruptured without ecchymosis or
abrasion of the skin. The same absence of ecchymosis has been noticed
in cases where the liver, stomach, intestines, bladder, etc., have been
ruptured as the result of contusing blows.
The following case cited by Taylor[617] illustrates this point. Henke
reported the case of a man who died of peritonitis a few hours after
fighting with another man. There was no mark on the skin or ecchymosis,
though there existed peritonitis from rupture of the small intestine.
The blow was proven by direct evidence, and though some medical
witnesses on account of the absence of external signs thought that no
blow could have been struck, others of more experience admitted that it
could have been the cause of the rupture.
Watson[618] reports a similar case of a girl nine years old who
received a blow from a shoe on the abdomen. This was followed by great
pain, collapse and death in twenty-one hours. No marks of injury were
visible externally, but peritonitis existed from rupture of the ileum.
A similar case is reported by Williamson,[619] where peritonitis
resulted from complete rupture of the ileum without any trace of injury
externally, though the blow was struck by the hoof of a horse.
Another case was brought into Guy’s Hospital[620] who had been run over
by an omnibus. No injury was discoverable, though the wheel had passed
over the chest and abdomen. He died of peritonitis, however, which set
in on the second day, and on post-mortem examination the liver and
small intestines were found ruptured.
Christison thought as the result of his experiments and experience
that the most reliable signs of an ecchymosis made during life, and
distinguishing it from one caused by a blow after death, were as
follows: The skin of the ecchymosed area is generally much darkened and
discolored from blood infiltrated through its entire thickness; the
skin is also much firmer and more elastic from swelling of the part if
the contusion is received some hours before death. But we may have an
effusion beneath and not in the substance of the skin, and the above
signs might possibly be due to an injury inflicted only a few minutes
after death. The above signs may therefore be absent, and when present
are not absolutely indicative of an injury received during life. In
general, the effects of severe contusions inflicted soon after death
may closely resemble those of slight contusions received during life.
There is little danger of contusion if the blow be inflicted on a dead
body after the loss of body heat and the beginning of rigor mortis.
Reading Tips
Use arrow keys to navigate
Press 'N' for next chapter
Press 'P' for previous chapter