There is much understandable skepticism from a medicolegal viewpoint that death can occur due to blood loss from a single scalp wound. It is hard to believe sometimes that the considerable amount of blood found at the scene of death just could be due to a single scalp wound. But Bratzke and Gilg (1987) have described 3 such cases.

Case Report

A 42 year old chronic alcoholic was found dead by his wife at night in the bathroom sitting on the toilet. The naked body was covered in blood. A large amount of blood was found on the floor of the bathroom, in the bathtub and in the living room. As well, blood soaked towels and handkerchiefs were found.

The only injury found at autopsy was a 5.5 cm (2.1") long linear-tearing crushing wound at the back of the head which was caused by a fall on a wooden bed frame, while he was in an intoxicated state. From the scene it was obvious that he made lengthy attempts to stop the flow of blood, and did not seek medical attention.

His postmortem BAC was 0.307 g/100mL and UAC was 0.389 g/100mL.

Characteristics of Fatal Hemorrhage Cases

I shall not go into detail describing the other 2 cases but the characteristics of the 3 fatal cases of hemorrhage due to a single scalp wound are summarized in the following Table.

The other volatiles (especially methyl alcohol) detected in 2 of the victims are typically biomarkers of alcoholism.

The usual features of these types of cases involve an chronic alcoholic who dies at a high BAC. Chronic alcoholism is known to cause clotting disorders which promote the hemorrhaging. The high BAC is associated with a greater accident risk such as falling or cutting oneself and also impairs the ability of the victim to realize the seriousness of the injury and to seek medical attention.

Conclusions

Fatal hemorrhage cases due to a single scalp wound are rare. (Puschel and Kopcke found only 0.4% of their 1,220 fatal hemorrhage cases were due to a single scalp wound) but they do occur. The typical features of such cases involve a chronic alcoholic with a high BAC at the time of death.

References

Ballard, H.S., "The Hematological Complications of Alcoholism" Alcohol, Health and Research World, 21(1): 42-52, 1997

Bratzke, H., and Gilg, T., "Todliche Verblutung aus Isolierter Kopfschwartenverletzung", Arch. f. Kriminol. 180: 101-106, 1987 (WOA60913)









Wigmore on Alcohol

Read “Wigmore on Alcohol: Courtroom Alcohol Toxicology for the Medicolegal Professional", Chapter 6.09 Homicides and Violent Deaths, Irwin Law Publishing, 559 pp, 2011. availabile from. www.wigmoreonalcohol.com

YouTube Video

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