| Death from stabbing and incising
| |
| | severed a coronary artery, the victim not
|
| ("cutting" or "slashing") wounds is
| |
| | only remained conscious, but was also
|
| mainly brought about through five
| |
| | able to walk home.15 Much later, in 1936,
|
| mechanisms: massive hemorrhage
| |
| | a paper was presented to the American
|
| (exsanguination), air in the bloodstream
| |
| | Association of Thoracic Surgery in which
|
| (air embolism), suffocation (asphyxia),
| |
| | thirteen cases of stab wounds to the
|
| air in the chest cavity (pneumothorax),
| |
| | heart were cited. Of these, four victims
|
| and infection. Of these, exsanguination
| |
| | were said to have collapsed immediately.
|
| is the most common, with hemorrhaging
| |
| | Four others, although incapacitated,
|
| confined principally to the body cavity
| |
| | remained conscious and alert for from
|
| because stabbing wounds tend to close
| |
| | thirty minutes to several hours. The
|
| after the weapon is withdrawn.4 The
| |
| | remaining five victims, thirty-eight per
|
| amount of blood loss necessary to disable
| |
| | cent of the total, remained active: one
|
| totally an individual varies widely and
| |
| | walking approximately twenty-three meters
|
| may range from as little as one-half to
| |
| | and another running three blocks. Yet
|
| as much as three liters.5 To reach a
| |
| | another victim remained active for
|
| vital area it is first necessary to pass
| |
| | approximately ten minutes after having
|
| the blade through the body's external
| |
| | been stabbed in the heart with an ice
|
| covering and whatever else lies between,
| |
| | pick, and two managed to walk to a
|
| and with regard to techniques in
| |
| | medical facility for help.16 In another
|
| swordsmanship, an important consideration
| |
| | instance a report cites an impressive
|
| is the degree of force required to pass
| |
| | case of a man stabbed in the left
|
| through intervening structures in order
| |
| | ventricle. Despite a wound 1.3
|
| to reach vital structures with a
| |
| | centimeters in length, the victim was
|
| sword-thrust or cut. In France, in 1892,
| |
| | able to continue routine activity for
|
| this issue was raised during a trial
| |
| | some time and lived a total of four days
|
| conducted as a consequence of a duel
| |
| | before expiring.17 In 1961, a survey
|
| fought between the Marquis de Mores and a
| |
| | conducted by Spitz, Petty and Russell
|
| Captain Meyer.6 The question arose on
| |
| | included seven victims stabbed in various
|
| account of an accusation that the weapons
| |
| | regions of the heart. While none of these
|
| used in the duel were "too heavy."7 While
| |
| | people expired immediately, some were
|
| two physicians, Drs. Faure and Paquelin,
| |
| | quickly incapacitated. Five were not,
|
| testified that it did not require great
| |
| | however, and one victim, despite a 2
|
| strength to inflict a wound similar to
| |
| | centimeter slit-like "laceration" located
|
| that which took Captain Meyer's life,
| |
| | in the left ventricle, managed to walk a
|
| there was some difference of opinion
| |
| | full city block. After arming himself
|
| expressed by a number of fencing masters
| |
| | with a broken beer bottle, the victim
|
| called to testify on the matter of
| |
| | finally collapsed while in the act of
|
| acceptable weights of weapons, and the
| |
| | attempting to re-engage the individual
|
| force required to employ them in the
| |
| | who stabbed him.18 The amount of time
|
| delivery of a fatal thrust.
| |
| | elapsing between a stab wound to the
|
| Even today, prosecutors trying homicide
| |
| | heart and total incapacitation of the
|
| cases involving death by stabbing will
| |
| | victim is dependent upon the nature of
|
| sometimes attempt to convince juries that
| |
| | the wound and which structures of the
|
| a deeply penetrating stab wound serves as
| |
| | heart are compromised.
|
| an indicator of murderous intent by
| |
| | In the light of the cases cited in the
|
| virtue of the great force required to
| |
| | preceding paragraphs, one may expect that
|
| inflict such wounds. It is generally
| |
| | a penetrating wound to the left
|
| accepted today among experts of forensic
| |
| | ventricle, such as that which would be
|
| medicine, however, that the force
| |
| | inflicted by a smallsword, may not
|
| requisite to inflict even a deeply
| |
| | necessarily bring a combat to a sudden
|
| penetrating stab wound is minimal.8 This
| |
| | conclusion. Blood in this chamber of the
|
| opinion would seem to be supported by the
| |
| | heart, at the end of ventricular
|
| experience of a stage actor who
| |
| | contraction (end-systole), may reach
|
| inadvertently stabbed a colleague to
| |
| | pressures as high as one hundred twenty
|
| death during a stage performance of
| |
| | millimeters of mercury or more,19
|
| Shakespeare's play, Romeo and Juliet. The
| |
| | especially during combat, and one might
|
| unlucky young man delivered a thrust at
| |
| | reasonably expect blood under such
|
| the very moment his vision was
| |
| | pressure to escape readily through a
|
| inadvertently obscured by a member of the
| |
| | breach in the ventricular wall. The walls
|
| cast. Although he claimed to have felt no
| |
| | of this chamber are comprised almost
|
| resistance, a post mortem examination
| |
| | entirely of muscle tissue, however, and
|
| revealed that he had penetrated the chest
| |
| | are exceptionally thick. As a
|
| of the victim to a depth of eighteen
| |
| | consequence, the left ventricular wall
|
| centimeters.9 Except for bone or
| |
| | has the potential to seal itself
|
| cartilage which has become ossified, it
| |
| | partially through the contraction of the
|
| is the skin that offers the greatest
| |
| | muscle tissue immediately surrounding the
|
| resistance to the point of a blade. In
| |
| | site of the wound. While the end-systolic
|
| fact, once the skin is penetrated, a
| |
| | pressure in the right ventricle normally
|
| blade may pass, even through costal
| |
| | amounts to only eighteen percent that of
|
| cartilage, with disquieting ease.10
| |
| | the left, wounds to the right ventricle
|
| Generally, of the factors governing the
| |
| | are far more likely to be quickly fatal
|
| ease of entry, the two most important are
| |
| | because the thickness of this ventricular
|
| the sharpness of the tip of the blade and
| |
| | wall is only a third that of the left
|
| the velocity with which it contacts the
| |
| | ventricle and is, consequently, less able
|
| skin. While the mass of the weapon is a
| |
| | to close a wound.20 With respect to
|
| factor in penetration, the velocity of
| |
| | penetrating (stabbing) wounds to the
|
| the blade at the moment of contact is of
| |
| | heart the location, depth of penetration,
|
| greater importance, since the force at
| |
| | blade width, and the presence or absence
|
| impact is directly proportional to the
| |
| | of cutting edges are important factors
|
| square of the velocity of the thrust.11
| |
| | influencing a wounded duelist's ability
|
| Unlike injuries inflicted with pointed
| |
| | to continue a combat.
|
| weapons, the depth of cutting wounds,
| |
| | Large cuts that transect the heart may be
|
| produced by the edges of weapons like the
| |
| | expected to result in swift
|
| sabre or rapier, is governed by a
| |
| | incapacitation due to rapid
|
| somewhat different set of dynamics which
| |
| | exsanguination,21 and immediate loss of
|
| include the radial velocity of the blade
| |
| | pressure, but stab wounds, similar to
|
| at impact, its mass, the proficiency with
| |
| | those that might be inflicted by a thrust
|
| which the blade is drawn across the body
| |
| | with a sword with a narrow, pointed blade
|
| upon contact, and the distance over which
| |
| | may leave a mortally wounded victim
|
| the force of the cut is distributed. The
| |
| | capable of surprisingly athletic
|
| greatest depth of penetration in many of
| |
| | endeavors. Knight cites a case of one
|
| these wounds is found at the site where,
| |
| | individual who, stabbed "through" the
|
| with maximum force, the blade first makes
| |
| | heart, was still able to run over 400
|
| contact. As the edge is pushed or drawn,
| |
| | meters before he collapsed. Yet two more
|
| the force of the cut dissipates and the
| |
| | striking cases are also reported of
|
| blade tends to rise out of the wound as
| |
| | victims who survived wounds to the heart,
|
| it traverses the body.12 In the case of
| |
| | one of which is described as, "a
|
| cutting wounds directed to the chest, the
| |
| | through-and-through stab wound of the
|
| total force required to reach the
| |
| | left ventricle that transfixed the heart
|
| interior of the chest is greater than
| |
| | from front to back."22 Wounds to the
|
| that for a point thrust, not only because
| |
| | Major Thoracic Blood Vessels The vital
|
| the force of the stroke is distributed
| |
| | area located in the center of the chest
|
| across the length of the cut, but also
| |
| | is not occupied by the heart alone. The
|
| because of the likelihood that the blade
| |
| | large thoracic blood vessels converge
|
| will encounter greater resistance
| |
| | with the heart in such a way as to
|
| afforded by the underlying ribs and the
| |
| | present an area nearly equal in size to
|
| breastbone (sternum).13 Wounds to the
| |
| | that presented by the heart.
|
| Heart Because exsanguination is the
| |
| | Consequently, a sword-thrust that
|
| leading and most frequent cause of death
| |
| | penetrates the chest but fails to find
|
| in stabbing and incising wounds, it is
| |
| | the heart may nevertheless pierce or
|
| not unreasonable to direct our attention
| |
| | incise one or more of these large
|
| initially to wounds to the cardiovascular
| |
| | vessels.
|
| system and further, to consider the
| |
| | Normally, blood pressure in the major
|
| evidence provided by the medical records
| |
| | arteries located in the chest (thorax)
|
| and coroners reports of the current era.
| |
| | averages approximately one hundred
|
| Let us first begin with a brief review of
| |
| | millimeters of mercury, with a maximum
|
| human anatomy. In an adult, the heart is
| |
| | pressure of some one hundred twenty
|
| approximately twelve centimeters long,
| |
| | millimeters at end-systole. Subdivisions
|
| eight to nine centimeters wide at its
| |
| | of the aorta greater than three
|
| widest point, and some six centimeters
| |
| | millimeters in diameter offer little
|
| thick. It is encased in a membranous
| |
| | vascular resistance. Consequently, the
|
| sack, the pericardium, and rests on the
| |
| | average blood pressure in these vessels
|
| upper surface of the diaphragm, between
| |
| | is nearly the same.23 Since the thoracic
|
| the lower portions of the lungs and
| |
| | arteries confine blood under considerable
|
| behind the sternum. The organ is divided
| |
| | pressure, and because the walls of these
|
| into four chambers: the left and right
| |
| | vessels are relatively thin, compared to
|
| atria and the left and right ventricles.
| |
| | the walls of the ventricles, punctures or
|
| It is comprised almost entirely of
| |
| | cuts in these vessels may allow blood to
|
| muscle, and serves a vital function as a
| |
| | escape quite rapidly, depending on the
|
| pumping mechanism to distribute blood
| |
| | size of the opening. The major thoracic
|
| throughout the body. It is unattached to
| |
| | arteries then, are more vulnerable to
|
| the adjacent organs, but is held in place
| |
| | stabbing wounds than are the ventricles
|
| in the chest cavity, suspended by the
| |
| | of the heart.24 While a good deal smaller
|
| pericardium and by continuity with the
| |
| | in diameter, a puncture or severing of
|
| major blood vessels. The muscular walls
| |
| | the coronary arteries, because they
|
| of the heart are supplied with blood by
| |
| | supply blood to the walls of the heart's
|
| the the right and the left coronary
| |
| | ventricles, may also result in rapid
|
| arteries, each of which bifurcates into a
| |
| | incapacitation of a duelist. Forensic
|
| series of subdivisions.14 Because the
| |
| | pathologists Dominick and Vincent Di Maio
|
| heart is a vital organ, it is generally
| |
| | point out that especially vulnerable is
|
| thought that a serious injury to the
| |
| | the left anterior descending coronary
|
| heart will result in instant death.
| |
| | artery which supplies the anterior wall
|
| Consequently, it is not unreasonable to
| |
| | of the left ventricle. Stabbing wounds
|
| suppose that the duelist expected a
| |
| | which transect this small vessel may be
|
| thrust to his adversary's heart to
| |
| | expected to result in sudden death.25
|
| disable him immediately. While swordplay
| |
| | Nevertheless, cases have been reported in
|
| done in earnest is now a thing of the
| |
| | which stabbing victims, whose thoracic
|
| past, a wealth of information regarding
| |
| | arteries were penetrated, remained
|
| stab wounds to the heart has been
| |
| | physically active for a surprisingly long
|
| accumulated in recent times by the
| |
| | period of time. An example may be found
|
| practitioners of modern forensic
| |
| | in the case of a twenty-three year old
|
| medicine. Many of these wounds have been
| |
| | man who was stabbed in the chest with a
|
| inflicted with instruments very much like
| |
| | kitchen knife.26 At autopsy a wound tract
|
| the blades of rapiers, sabres, and
| |
| | was disclosed that penetrated both the
|
| smallswords and the means by which such
| |
| | aorta and the left ventricle. Blood
|
| wounds have been treated, combined with
| |
| | issuing from these wounds into the chest
|
| assessments of the injuries through the
| |
| | cavity amounted to a volume of two
|
| sophisticated discipline of forensic
| |
| | liters. Despite the serious nature of his
|
| medicine, reveal some surprising truths
| |
| | wounds, the victim nevertheless managed
|
| with which many duelists most certainly
| |
| | to walk more than 100 meters before
|
| had to deal.
| |
| | collapsing and remained alive until
|
| While a stab wound to the heart is a
| |
| | shortly after he had been taken to the
|
| grave matter, numerous instances of
| |
| | hospital. Another example is that of a
|
| penetrating wounds to this organ have
| |
| | twenty-five year old man whose subclavian
|
| been documented in which victims have
| |
| | artery and vein were severed by a thrust
|
| demonstrated a surprising ability to
| |
| | delivered by a kitchen knife. Losing a
|
| remain physically active. In 1896 a case
| |
| | total of three liters of blood, he was
|
| was reported in which a twenty-four year
| |
| | able to run a distance of four city
|
| old man was stabbed in the heart. Despite
| |
| | blocks before finally collapsing.
|
| a wound to the left ventricle which
| |
| |
|
