Beaten to death: why do they die?

The remains of 53 men that had been beaten to death were examined. Six (11.3%) died of either blood aspiration or intracranial hemorrhage; 15 of the cases (28.3%) succumbed to hypovolemic shock, and 32 of the cases (60.4%) died of fat embolism syndrome (FES). Fractures of long bones were found only in four victims. Fatal FES produced by the mechanical disintegration of adipose tissue that migrates into the bloodstream seems to be a common phenomenon in the fatalities examined in this study. No correlation, however, was found between the presence of long bone fractures and the severity of FES, and no bone marrow emboli were detected on histologic examination of target organs. Scattered subcutaneous hematomata were present in all of the victims, although the volume of extravasated blood could not be calculated from the total surface area of the bruises. Contusions limited to the limbs have the potential of masking fatal volumes of extravasated blood that suffuse the musculature mass. Hypovolemic and neurogenic shock, as well as systemic effects of crush injury, should be considered contributing factors to death from FES. These findings contradict the previously published postulate that victims of blunt force trauma succumb primarily to massive hemorrhages.