Medical Jurisprudence, Forensic medicine and Toxicology. Vol. 1

by R. A. Witthaus; Tracy C. Becker

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.

2. Coagulation of Blood.—As stated at the beginning of this section, blood from a wound inflicted during life coagulates with the exception of that from those suffering from certain pathological or occasional conditions or in certain locations, already mentioned. This coagulation is not immediate, but is complete in about five minutes. The entire amount of blood lost is thus coagulated and the coagula are firm. These coagula (if the wound is not interfered with) occur in the opening of a wound and on its edges, especially at the mouths of the blood-vessels, which are thus plugged. The blood which infiltrates the interspaces of the tissues is coagulated in the form of these interspaces. The same is true of the blood of an ecchymosis whether there be a hematoma or only an infiltration between the tissues, or both. These clots represent more or less the form of the space occupied by the blood. In the case of the scalp a subcutaneous clot may be mistaken for a depressed fracture of the skull from the fact that the edges of the clot become very hard while the centre is still quite soft. A wound in which a large artery has been divided may present very little clotting in the wound if the opening is free and the blood has mostly escaped in a jet.

In a wound produced soon after death there may be some clotting, but less in amount, firstly, because there is less hemorrhage, and, secondly, because not all the blood clots. These conditions increase with the length of time after death, so that after a time a wound made on a cadaver would show very little if any clotting owing to very slight hemorrhage, and little or no clotting of the blood extravasated. When the body has lost its animal heat and rigor mortis has begun to set in, then there is no more coagulation of the blood and no more hemorrhage, under normal conditions, for the blood has mostly become clotted in the vessels of the body. Consequently, with the exception of wounds inflicted very soon after death, we can distinguish an ante-mortem from a post-mortem wound by the condition in which the blood is clotted. If there is any hemorrhage, the wound being inflicted before the loss of animal heat and the blood remains entirely fluid on the surface or in an ecchymosis, we know that the wound was produced after death and some hours after death unless any of those conditions exist in which the blood does not normally coagulate. If the hemorrhage is slight or quite moderate in amount and venous in character, if the blood is only clotted in part and the clots are rather soft and do not form a plug at the mouth of each artery, and especially if the staining of the walls of the wound can be washed off, then the wound was probably produced post mortem, but not so long after death as in the first case supposed. If the characters of the hemorrhage and the clotting are still more like those normal to a wound inflicted during life, then, as a rule, it is impossible to say from these two features of the wound, hemorrhage and clotting, whether the wound was inflicted during life or a very short time after death.