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  • Elamarna
    replied
    Originally posted by Fisherman View Post
    Payne-James is of the meaning that Lechmere fits very well with the blood evidence. But he is wise enough to recognize that another killer cannot be excluded. Meaning that much as he recognizes that Lechmere fits the blood bill, he does not reccommend convicting the carman categorically.
    What do you mean by "is of the meaning"? Do you mean that he has given you that opinion? That is has he said to you something along the lines of " yes lechmere must have been there or close"?

    And if so what timings as he used/been given for the two witnesses you use Neil and Mizen? Was he told for instance as stated in the documentary that Neil arrived within two minutes of Lechmere leaving the scene? How long after this was he told Mizen arrived?

    Or do you mean that the data Payne-James has given you fits the time scale as you see it. The use of "meaning" is confusing me, could you please clarify?


    Originally posted by Fisherman View Post
    I am of the exact same meaning. Lechmere fits the blood bill, but all we can say is that it would be less likely with another killer, not that it absilutely MUST have been the carman. Taken together with the many anomalies surrounding Lechmere, though, he does become a very compelling candidate, and personally, I have little doubt that he did it.

    The statement that it is less likely is entirely dependent on several issues none of which are established.

    1. The actual degree of blood loss seen by Neil.
    2. The time Neil arrived.
    3. The time Mizen arrived.

    Without these being established the hypothesis itself cannot be tested and as such must fail. That how hypothesis work. And you are left with an unproven theory.

    And again what do you mean by "meaning"? It's a confusing way of expressing oneself.


    Steve

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  • Fisherman
    replied
    Originally posted by David Orsam View Post
    If we want to know what Dr Payne James thought happened to Mary Ann Nichols in respect of "post-mortem bleeding", we can turn to the famous TV documentary.

    First we have the voiceover:

    "Dr Payne James believes that the killer would not necessarily have had blood on his hands. Dr James has worked out that like the other victims Polly Nichols was strangled to death first. Without blood pressure there would have been no arterial spray. Polly Nichols’ killing was surprisingly bloodless."

    At the same time, there is also a list on screen entitled:

    "Forensic Pathology
    Polly Nichols Murder
    "

    Underneath of this heading is shown:

    "Strangulation
    Neck severed to the bone
    Total of twelve injuries
    Less extensive injuries compared to the other victims
    2 minutes to kill
    Dead before knife was used
    No blood spray"


    Then we have Dr Payne James in his own words on the murder of Nichols:

    "I think there is always an assumption that somebody stabbed to death, there is going to be blood everywhere. I think it’s entirely possible that there wouldn’t necessarily be large amounts or indeed any blood necessarily obvious on that person...Although we know the carotid arteries were cut it would seem that that was after death so it may just leak out or dribble out or drain out around the contours of the neck in this case, over a period of minutes".

    I am not a forensic pathologist nor an expert in mathematics or physics but it strikes me as obvious that if you have no arterial spray and no initial gushing of blood then all the blood that would have emerged from the body of Nichols had she not been strangled would remain in her body after strangulation and cut throat. If that same blood was leaking or dribbling or draining (or oozing) out of her body very slowly then it would surely take much, much, longer for the blood to "bleed out" to use an expression much loved of Fisherman (by which he appears to mean no more than "stop bleeding") than would otherwise have been the case, because so much more of it would have remained in the body.

    The obvious question to have asked Dr Payne James therefore would have been this: When you speak of blood leaking or dribbling or draining out of the body, how long could or would this leaking/dribbling/draining have lasted?

    Although Payne James refers to "minutes" in the documentary this is to contrast a situation where there was an immediate gushing or flowing of blood which would have caused the killer’s hands to be bloody.

    What we want him to do is to quantify those minutes.

    But that wasn’t Fisherman’s approach. The simple questioning was not for him.

    His first question to Payne James was this:

    "Just how quickly CAN a person with the kind of damage that Nichols had bleed out, if we have nothing that hinders the bloodflow, and if the victim is flat on level ground? Can a total desanguination take place in very few minutes in such a case?"

    Payne-James' answer was "Yes".

    So this questioning is based on the murder of a woman who has suffered "the kind of damage that Nichols had". Yet Fisherman only mentions two elements of this murder. Firstly, that there was nothing to hinder the bloodflow and secondly that the victim was on flat ground. Nothing is said about strangulation or anything else that is supposed to be unique to Nichols.

    Now, pausing there, one wonders how Dr Biggs, when giving his answer about blood oozing to Trevor Marriott, in the context of the JTR murders generally, can possibly not have had in mind the murder of a woman lying on flat ground with nothing hindering the blood flow. So that when he said that blood oozing after death can certainly continue for 20 minutes, it would be astonishing if this could not be said to apply to the circumstances set out by Fisherman in his question to Payne James.

    But it gets worse, much worse. For look at the final part of the question:

    "Can a total desanguination take place in very few minutes in such a case?"


    Desanguination means a massive loss of blood. So Fisherman was here asking Dr Payne James if, in the case of Nichols, there could be a massive loss of blood in a very few minutes. And Payne James said yes!

    Now hold on a moment! Didn’t Payne James say that with Nichols having been strangled the blood may just leak out or dribble out or drain out around the contours of the neck in this case?

    Yes he did!

    Where is the desanguination, or massive blood loss, in this case? How can there be a massive loss of blood in a few minutes if, as a result of the strangulation, it is doing no more than leaking or dribbling out around the neck?

    So am going to suggest that Fisherman has confused his expert by introducing the concept of desanguination into the equation which has now put into the expert’s mind the idea that there is actually a massive flow of blood out of the neck wound after the throat was cut, a different scenario to the one he offered in the TV documentary, and thus not applying directly to what he believed happened to Nichols.

    And remember that Fisherman didn't do any more than ask him about a person "suffering the kind of damage Nichols had". He did NOT establish that this person had been strangled first. Instead he said that there was desanguination.

    We can skip over the next embarrassing question and answer when the great "post mortem bleeding expert" was asked if he knew of any examples of total desanguination taking place in a few minutes and he said "No".

    So we now come to what is supposed to be the question and answer which condemns Lechmere as the murderer of Mary Ann Nichols and thus identifies Jack the Ripper on the blood evidence. The question was this:

    "Is it possible for such a person to bleed out completely and stop bleeding in three minutes? In five? In seven?"

    The answer was this:

    "I guess blood may continue to flow for up to this amount of time, but the shorter periods are more likely to be more realistic."

    So Fisherman’s question was about "such a person", namely the person who has suffered from "total desanguination". We are not talking about blood leaking or dribbling or draining out of a neck wound. We are talking about someone with a cut throat suffering from massive blood loss.

    Because that is what Mr Clever Fisherman who wanted to show his expert that he knew the meaning of a long medical word like "desanguination" has asked him.

    Of course, the expression "bleed out" is not defined and is rather vague but let’s assume that the expert took it to mean that at the point of "bleeding out" the victim would stop bleeding. And let's ignore that dead people don't really bleed.

    So he says (or rather guesses) that the bleeding would stop most likely after 3 minutes but it could go on for up to 7 minutes.

    That is fine but it is, of course, in the context of a massive blood loss. What Payne James cannot be speaking about is the situation which he believed related to Polly Nichols because he thought she was strangled and that there was no massive blood loss, only a dribbling of the blood.

    So how long can that dribbling or, let me see if I can find another word for that….oh, I know, oozing, last?

    Payne James doesn’t tell us but Dr Biggs does deal with this subject. It can easily last for 20 minutes. That is a general answer for sure but one for which there is no reason to think it could not apply to Polly Nichols and nothing in Payne James’ answers to Fisherman suggests that it could not apply to her.

    Fisherman is sunk. Nothing in the "blood evidence" points specifically to Lechmere. There was sufficient time for another individual to have murdered Polly Nichols before Lechmere turned into Bucks Row. By analysing Fisherman's questions to Payne James, and Payne James' answers carefully, we have saved a man from being framed for murder.
    Yawn. Just yawn.

    "Fisherman is sunk".

    Davids wet dream all over again.

    "We have saved a man from being framed for murder".

    Delusions of grandeur.

    Payne-James is of the meaning that Lechmere fits very well with the blood evidence. But he is wise enough to recognize that another killer cannot be excluded. Meaning that much as he recognizes that Lechmere fits the blood bill, he does not reccommend convicting the carman categorically.

    I am of the exact same meaning. Lechmere fits the blood bill, but all we can say is that it would be less likely with another killer, not that it absilutely MUST have been the carman. Taken together with the many anomalies surrounding Lechmere, though, he does become a very compelling candidate, and personally, I have little doubt that he did it.

    That does not mean that I am "framing a man for murder", nor that Payne-James does so. It means that we are pointing to him as a quite likely candidate, and I entertain a personal belief that the killer has been found.

    David Orsam has been toppled over! Hoorah!! The reign of the nifty naysayer is over! A man who seems to have been the killer of Nichols can finally be reinstated as the main suspect again (for those who so wish)!!! Flags, champagne, fireworks!!!!

    Farcical, David, farcical. But quite rewarding to realize that you always regarded my theory as floating, up until now that you, ehrm, "sunk it". You have forgotten to tell me that, so thanks.
    Last edited by Fisherman; 05-18-2017, 12:44 AM.

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  • Fisherman
    replied
    Originally posted by Sam Flynn View Post
    "I should think by someone who knew something of [anatomy], for whoever did it has attacked all the vital parts" - Lloyd's Weekly 2nd Sept; thereafter summarised in the Daily News and Woodford Times. Judging by the content, all three papers might well have used the same (press agency?) release as the basis for their articles.

    The idea that "all" the vital parts were attacked is, of course, demonstrably untrue, otherwise we might have expected stabs to the heart and lungs, if not a puncture wound through the ear into the brain. This might be a case of journalistic licence, or simple hyperbole on Llewellyn's (vital) part. Whatever it is, it can't be seen as evidence that Nichols' innards were slashed to pieces.
    Nah, it would have been a mere scratch.

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  • Fisherman
    replied
    Originally posted by Sam Flynn View Post
    ...and commits an even more daring and 'orrible murder whilst the Nichols inquest was still ongoing.

    Yes, Gareth, we all know how Gary Ridgway stopped killing the second he was approached by the police. And Sutcliffe, who was approached multiple times, of course also stopped killing on account of that. No serialist would be brazen enough to kill when under possible suspicion! Not Hansen, not Gacy, not a single one of them.

    Why is it that comments like this one are even uttered by people like you, who should be decently well read up on the history of serial killing?

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  • Elamarna
    replied
    Originally posted by Fisherman View Post
    ... which is in keeping with what the Morning Advertiser said:
    "Dr. Llewellyn, who was formerly a house surgeon of the London Hospital, has given his opinion as to the manner in which the murder was committed. He said that the woman was killed by the cuts on the throat - there are two, and the throat is divided back to the vertebrae. He had called the attention of the police to the smallness of the quantity of blood on the spot where he saw the body..."

    So on the spot where he saw the body, there was very little blood. And to check that, the body needed to be removed first. It was not until the body was removed that the spot where the body had lain could be checked.

    Apart from this, I would think it very strange if a medico commented on the amounts of blood on a murder site without having checked first.
    Which of course is just your view that it is strange.

    Steve

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  • Elamarna
    replied
    Originally posted by drstrange169 View Post
    Re Whether Llewellyn was present when the body was removed, I'd say is a 50/50 call.

    The body couldn't be removed without his permission. It is entirely possible, given the ambulance would have taken at least 20 minutes to arrive, that he gave his permission and left before it's arrival.

    On the other hand, his assistant, Dr Secombe's comment can be read as he, at least, might have seen under the body.

    "... her throat was cut, the dreadful abdominal injuries then inflicted, and that the body was then carried, enveloped in her large, heavy cloak, and thrown outside the gateway at Essex Wharf. Mr. Seccombe, Dr. Llewellyn's assistant, is of the same opinions, especially, he says, as there was comparatively little blood where the deceased lay."

    Hi I have no problem with that reading of the events at all. My point was that fisherman said probably for which I see no support.
    Do we have anything to suggest that Seccombe was actually onsite at all , rather than just relaying information he had from others?



    Steve

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  • Fisherman
    replied
    Originally posted by John G View Post
    Is this the same Dr Llewellyn who failed to notice the victim had been mutilated? Maybe he had a major visual impairment!
    You have not learnt a iot of all the information passed on out here, have you?

    Llewellyn was called out, not to perform a full autopsy on the sidewalk, but to determine if the woman was dead. He then directed the body to be taken to the mortuary FOR FURTHER EXAMINATION! What do you think that further examination was about?
    Perhaps it was about getting a full picture? Eh?

    There were numerous people by the body in Bucks Row, some of whom handled the body and lifted it onto the ambulance. None of them noticed the wounds to the abdomen.

    What a pack of incompetent idiots, eh? Or is it just Llewellyn who needs to be painted out as such?

    Do you have any idea why the coroner did not severely reprimand Llewellyn for his lack of professionalism? Why did the coroner not demand that he could see through cloth when required? Any ideas?

    There is one imcompetence only, and it rests firmly with you. For opening your mouth when you could have kept it shut. It is really a very sad business, and it carries with itself the risk that somebody may read you and take what you say as useful and correct information, when it is instead the exact opposite - disinformation.

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  • Fisherman
    replied
    Originally posted by John G View Post
    I would say it's virtually inevitable. Any other approach doesn't make sense.
    Dear me. Dear, dear me. That speaks for itself.

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  • Fisherman
    replied
    Originally posted by David Orsam View Post
    That's a ridiculous sentence. Utterly absurd in fact. She had obviously been recently killed when Lechmere pointed her out to Paul (i.e. PC Neil would have seen her on his previous beat if she had been there much longer than 30 minutes) but nothing in the "blood evidence" adds to that fact or makes it more or less likely that Lechmere was the killer. It certainly does not point out Lechmere as the killer. If Nichols was killed at 3.25 there was ample opportunity for an unknown assailant to have murdered her

    And, once more, a more realistic way of writing the first part of your sentence is that it MAY WELL be that Lechmere was not the killer. The second part needs to be deleted entirely.
    I know who needs to be deleted...

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  • Fisherman
    replied
    David Orsam: If you have to resort to gibberish of this nature then the argument is already lost. In fact, you lost it quite some time ago.

    So you won? Again? Don´t you ever tire of all these triumphs?

    You keep posting as if there is little doubt in the matter that Neil used the word profusely. You could hardly be more wrong. There is no good reason to think that he ever did use the word "profusely" and he certainly did not use it when he was standing in the witness box under oath.

    You keep reading my posts as if you have problems understanding the simplest of things.
    A. I have never expressed - and nor do I think - that there is little dount that Neil used the word profusely.
    B. You have no idea if I would have been wrong if I had been of the meaning that Neil must have used profusely.
    C. We all know that he did not use the word profusely at the inquest, so the point is a total waste of time.

    Can I please ask you not to present your take on what I think and what I don´t think as some sort of truth in the future? Otherwise, I shall have to start spreading misinformation about you too, and that is not what the boards are meant for.

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  • Fisherman
    replied
    Originally posted by David Orsam View Post
    Are you for real? Do I have to explain it all again?

    What I said was that "oozing" is unambiguous and clearly defined, with a single meaning, whereas "running" is ambiguous and vague, with several meanings, because it could mean moving slow, moving fast or something in between or even not moving at all, just as Dr Llewellyn referred to a bruise running along Polly's face.

    That's why I wanted you to answer the question using the non-ambiguous word; a word that PC Neil definitely and without doubt used to describe the blood coming from the neck wound in his witness testimony. It's also the word that Dr Biggs used when he said that oozing can easily go on for 20 minutes after death. So by using the word "oozing" we can get some clarity which we can't do with the word "running".

    But you are clearly determined not to answer the question and I will be drawing my own conclusions from that.
    So you draw you OWN conclusions, David?

    Tell me, how does that tell you apart from the rest of us?

    My conclusion is that the question you asked has been answered to the full, and I therefore conclude that your only aim is and was to try and misinform about me.

    How´s that?

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  • Fisherman
    replied
    Originally posted by Harry D View Post
    Please tell me the irony wasn't lost on anyone else here?

    There's no evidence that Lechmere murdered Nichols, and certainly nothing to tie him to the other murders, so it must have been a phantom!
    A. There is evidence pointing to Lechmere killing Nichols, but there is no proof.
    B. I have never said that there IS proof for it.
    C. The conclusion that it must have been a phantom predisposes that we can say for certain that Lechmere was not the killer.

    So where´s the "irony"?

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  • Fisherman
    replied
    Originally posted by drstrange169 View Post
    Re Whether Llewellyn was present when the body was removed, I'd say is a 50/50 call.

    The body couldn't be removed without his permission. It is entirely possible, given the ambulance would have taken at least 20 minutes to arrive, that he gave his permission and left before it's arrival.

    On the other hand, his assistant, Dr Secombe's comment can be read as he, at least, might have seen under the body.

    "... her throat was cut, the dreadful abdominal injuries then inflicted, and that the body was then carried, enveloped in her large, heavy cloak, and thrown outside the gateway at Essex Wharf. Mr. Seccombe, Dr. Llewellyn's assistant, is of the same opinions, especially, he says, as there was comparatively little blood where the deceased lay."
    ... which is in keeping with what the Morning Advertiser said:
    "Dr. Llewellyn, who was formerly a house surgeon of the London Hospital, has given his opinion as to the manner in which the murder was committed. He said that the woman was killed by the cuts on the throat - there are two, and the throat is divided back to the vertebrae. He had called the attention of the police to the smallness of the quantity of blood on the spot where he saw the body..."

    So on the spot where he saw the body, there was very little blood. And to check that, the body needed to be removed first. It was not until the body was removed that the spot where the body had lain could be checked.

    Apart from this, I would think it very strange if a medico commented on the amounts of blood on a murder site without having checked first.

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  • drstrange169
    replied
    Re Whether Llewellyn was present when the body was removed, I'd say is a 50/50 call.

    The body couldn't be removed without his permission. It is entirely possible, given the ambulance would have taken at least 20 minutes to arrive, that he gave his permission and left before it's arrival.

    On the other hand, his assistant, Dr Secombe's comment can be read as he, at least, might have seen under the body.

    "... her throat was cut, the dreadful abdominal injuries then inflicted, and that the body was then carried, enveloped in her large, heavy cloak, and thrown outside the gateway at Essex Wharf. Mr. Seccombe, Dr. Llewellyn's assistant, is of the same opinions, especially, he says, as there was comparatively little blood where the deceased lay."

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  • David Orsam
    replied
    Originally posted by Abby Normal View Post
    But for the life of me, I just can't see a small, frail, drunk, Nichols, slashed down the middle and apparently without a lot of blood loss to begin with, possible strangled to death- still oozing, bleeding, flowing running blood, whatever for very long. On a chilly night. Seemed she had foot in the grave to begin with and when finally snuffed out would have ceased any kind of activity pretty quickly.
    And wouldn't coagulation set in at some point? Soon???


    But what the hell do I know.

    I would love to see the entire set of circumstances put before an expert and see the response.
    We do have the opinion of Dr Biggs from 2014 about this very point (as posted on the forum at the time by Trevor Marriott) when he said:

    "I think that, though it might seem unlikely for a significant quantity of blood to be flowing out of a body several minutes after death, it would certainly be possible for blood still to be dripping / oozing out of a body 20 mins later. This is likely to be minimal (almost negligible) in nature, as the majority of the blood that was able to come out would have done so much sooner. If a witness discovered a body that was still bleeding relatively profusely then the injuries are likely to have been inflicted more recently than 20 mins previously… but if the 20 min period is critical in ruling out / in certain suspects then I wouldn’t dismiss the possibility of some continued blood loss at this time, as I think it would be possible. (I base this on my own observations of seeing blood leak out of bodies when I have been present at murder scenes some hours after death. This is why I am open to many things being ‘possible’, even though I can’t state categorically what ‘would’ or ‘would not’ have happened in an individual case.)."

    Regarding the specific evidence about the murder of Nichols he made some lengthy comments:

    "As for the extract from the inquest testimony:

    There is actually very little detail of use in this text. Rather than actually naming the anatomical structures injured, there are repeated mentions of ‘tissues’ being severed. This is vague, and does not allow inferences to be drawn with confidence. There is a description of the ‘large vessels’ on both sides of the neck being cut. If this is true then there is certainly scope for profuse haemorrhage from the neck, as well as ongoing leakage of blood from the neck after death. However, I have dealt with cases where ‘vessels in the neck’ have been ‘cut’… where actually only minor vessels and other structures have been cut and, on closer inspection, the truly ‘large’ vessels have been spared.

    Much of the description is vague and potentially ambiguous. … Death might have been caused by blood loss from the wounds… but could also have arisen from a different mechanism (such as a cardiac air embolus or a tension pneumothorax). Some (or all) of the injuries could have been inflicted after death.
    ....

    I’m not trying to be negative or contrary, I’m just trying to be realistic about what I can honestly say based upon what I can trust as genuine. As that remains scanty, there is very little I can say with confidence about these cases. However, as just about anything that can be imagined is probably possible, most things can probably be argued one way or the other!"


    You will of course note the statement of Dr Biggs that "If a witness discovered a body that was still bleeding relatively profusely then the injuries are likely to have been inflicted more recently than 20 mins previously" which might explain why Fisherman has been so keen to insert the newspaper word "profusely" into the evidence.

    Other relevant information provided by Dr Biggs in answer to questions from Trevor were as follows:

    "The short answer [to a question about the gravity being a factor in regard to blood loss] is that ‘a lot’ of blood would be lost from neck wounds such as this… but the exact volume could vary greatly depending on individual circumstances.

    In terms of time, there would be an initial rush of blood, but the victim’s blood pressure would rapidly subside (in a matter of seconds if the blood loss is particularly profuse) so that the rate of flow would become considerably less relatively soon after injury. After the circulation has stopped, it will be down to gravity to continue the blood loss, and clearly this will depend on position / angle and so on. Sometimes a wound will be ‘propped open’ by the position of the body, whereas in other cases the wound may be ‘squeezed shut’ by the weight of the body. Things like vessel spasm and rapid clotting can be surprisingly good at staunching the flow of blood from even very catastrophic injuries. Even if a person is lying such that their injury is gaping open and is ‘down’ in terms of gravitational direction, this does not necessarily mean that blood will continue to flow out until the body is ‘empty’. Things like collapsing vessels and valve effects can prevent this passive flow, and there are lots of ‘corners’ for the blood to go around (it is spread around lots of long thin tubes, not sitting in a large container) before it finds its way out of the injury… so it might end up ‘trapped’ within the body. I have certainly seen cases with multiple large knife wounds and copious blood at the scene, where a significant proportion of the victim’s blood has remained within the vessels to allow me to obtain good samples for toxicological analysis later in the mortuary.

    Getting back to the specific case in question, if the body were lying motionless on the ground with significant open neck wounds then I would imagine that at least a few hundred millilitres (and probably considerably more) could flow out passively, and that this would happen within the initial couple of minutes. If this doesn’t sound like a lot, remember that a little bit of blood can look like an awful lot when it is spilled onto the pavement. For the reasons mentioned above, it would be possible that a lot less blood would be apparent at the scene. It is also possible that a continued slow trickle could go on for many minutes after death if the wound / gravity conditions were right, ending up with even a few litres of blood being present in extreme circumstances.

    In simple terms, nasty neck wounds can bleed a lot (but don’t always). Blood can leak out after death (and for quite some time). You can’t tell anything about time of injury / death by assessing the blood loss at the scene."


    He also said:

    "The position of the neck could potentially influence the rate of flow of blood in that it could either ‘hold open’ or ‘squeeze shut’ various vascular injuries. In practice, if the neck was injured almost to the point of decapitation, then there might be little in the way of a ‘clamping’ effect possible no matter how the neck is angled.

    I think it is certainly possible that ‘bleeding’ could go on for a period of twenty minutes, although I would make a distinction between ‘post mortem leakage of blood from the body’ and actual ‘bleeding’ that occurred during life. The flow of blood is likely to have slowed to a trickle by this time as pressure inside the vessels would have dissipated and the volume of blood remaining available to leak out would have become very little.

    Severe abdominal wounds would ‘contribute’ to the rapidity of bleeding to death, but this effect could range from almost negligible (if the neck wounds were so bad that death would have been very quick, and the abdominal wounds didn’t hit anything major) to very great (if the neck wounds miraculously missed all the major vessels and the abdominal wounds pranged something big).

    As always, I am unable to say very much of definite value as things are so variable that drawing firm conclusions in individual cases based on scanty witness accounts is fraught with unreliability."


    He made one more comment in response to further questions by Trevor Marriott shortly before Christmas 2014:

    "I did an autopsy last week, were the body had been transported a great distance to the mortuary and death had occurred almost 24 hours prior to my examination… and yet the injuries continued to ‘bleed’ relatively profusely for quite some time. So much so that we struggled to get a ‘clean’ photograph as the blood flooded back as quickly as we could wipe it away! This is why I have been so cautious about commenting on ‘maximum’ timings and quantities of blood loss."

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