32. =Hypostasis.= After death the blood passes into the veins and
very soon through gravity collects in the greatly distended veins
of the lowest portions of the body, except where these are pressed
upon by the weight of the body. Such a settling of the blood begins
usually within 1-2 hours after death, but may take place even
before death (hypostatic congestion) in cases of long-standing
recumbent position, cardiac lesions with failure of compensation,
wasting diseases, acute infections, death from suffocation, etc.
Postmortem lividity should be described as to its extent, location
and color. In anæmia the color is pale purplish red, in congestion
dark purple, in cyanosis the color may be dark bluish red and the
fingers, toes, ears, etc., retain the cyanotic appearance for some
hours after death; in potassium-chlorate poisoning the color is
chocolate, in hydrogen-sulphide poisoning grayish green, in poisoning
with hydrocyanic acid or carbon monoxide it is rose or cherry red.
Fresh hypostatic patches can be made pale by pressure and when cut
they will bleed freely. Hemorrhages cannot be pressed out nor will
hemorrhagic areas bleed as freely as hypostatic patches. In all
medicolegal cases care should be taken to differentiate bruises and
ecchymoses from hypostatic patches, as in the popular mind the latter
are often regarded as evidences of trauma or violence. The location
of the hypostasis is of importance in showing the position of the
body after death; if the anterior portion of the body is hypostatic
the cadaver must have been lying upon its face for some time after
death; suspension of the body for some time after death by hanging
causes a hypostasis of the lower extremities. Of the internal organs
the brain, lungs, stomach and coils of intestine chiefly show
hypostasis. Antemortem hypostasis of the lungs is distinguished from
postmortem by its deeper color, firmer consistence, more marked
œdema and microscopic signs of beginning inflammation (hypostatic
pneumonia). Cadaveric lividity reaches its maximum in 24-48 hours,
and after this time diffusion gradually occurs. In connection with
the examination of hypostatic areas the condition of the superficial
vessels as to size, distention, etc., should always be noted.
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