About the color of the skin outside the livor mortis marks in cases of death from general hypothermia

This study examines the phenomenon of focal skin discoloration observed on corpses that died from general hypothermia, outside the areas of classic livor mortis. The authors note that these discolorations are more common in areas with less intense blood flow and less muscle tissue. The severity and number of these discolorations correlate with the intensity and duration of cold exposure, the condition of the clothing, and the degree of alcohol intoxication. A hypothesis on the mechanism of these spots formation is presented, based on the in vivo freezing of blood in superficial vessels with subsequent thawing and local hemolysis, which is consistent with the modern ideas on the pathogenesis of frostbite. It is emphasized that the development of lethal hypothermia is not necessary for the peripheral tissues freezing, in vivo freezing with subsequent primary and secondary hemolysis is possible. The results of macro- and microscopic studies of frozen and non-frozen corpses indicate that the spots have a heterogeneous origin, which is caused by both in-life exposure to cold and direct cryodestruction of cells. These changes are considered to be a type of frostbite. The authors emphasize the high diagnostic significance of detecting multiple deep frostbites not only in typical locations (fingers, ears, and nose), but also in more proximal areas of the body and torso. In combination with the circumstances of the case and other autopsy data, this allows for a high degree of certainty in diagnosing death from general hypothermia. In conclusion, the authors confirm the diagnostic value of the spots described by Keferstein for identifying death from cold, both on frozen and non-frozen corpses, and offer their own interpretation of the mechanism of their formation.