Oscar Pistorius
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Pathologist says bullet to girlfriend's head was probably fatal, with ammunition designed to mushroom on contact

It was cold, clinical, scientific testimony that finally robbed Oscar Pistorius of his composure.

A pathologist's report from the witness stand of the austere courtroom, detailing the devastating impact of three hollow tipped bullets on the body of his girlfriend Reeva Steenkamp, was punctuated by the gutteral sounds of the sporting celebrity gagging and vomiting repeatedly into a bucket.

While Pistorius has mostly retained his self-possession as a succession of neighbours and an ex-girlfriend gave evidence against him, it was the dry, technical language of professor Gert Saayman that hit him hardest. He was bent double in the dock, hands on his ears as if trying to block out the words, his body in visceral pain and violently sick.

The scene unfolded on the sixth day of the "blockbuster trial" in Pretoria where the testimony was deemed so graphic that judge Thokozile Masipa banned live coverage of it on radio, television, Twitter and blogs.

Saayman was responsible for the post-mortem on Steenkamp, a 29-year-old model, after she was killed on Valentine's day last year in what Pistorius claims was an accident. Based on fragments found in Steenkamp's skull, the forensic pathologist said Pistorius had used an expanding bullet designed to cause maximum tissue damage when he opened fire through a locked toilet door.

Saayman also gave his opinion on how long before she died Steenkamp last ate by the food contents in her stomach. He estimated that it would not have been more than two hours before she died. That appeared to contradict Pistorius's version that suggests the couple had eaten and were in bed by 10pm. Steenkamp was shot after 3am.

The "black talon" or "ranger" ammunition, made by US-based firm Winchester, is designed to "open up, flatten out and mushroom when striking human tissue", Saayman said. "The usual result is it folds out like the petals of flower. They were specifically designed by the manufacturer to have very sharp jagged edges. This projectile was designed to cause maximum damage. It has a black metal jacket.

"If a surgeon were to operate on a patient shot in this nature you have to be careful as you can easily cut yourself on these edges."According to Saayman, Steenkamp suffered bullet wounds in her head, hip and elbow and any could have caused her death because of the extent of the bleeding. She also received injuries from bullet fragments, wood splinters from the door and pieces of her own bone.

A bullet that hit the right side of Steenkamp's head fractured her skull and entered her brain. She would have lost consciousness and "the deceased probably didn't breathe more than a few times after sustaining this wound", Saayman said. "The wound to the head was incapacitating and probably almost instantly fatal."

The bullet wound above Steenkamp's right elbow shattered her upper arm and she would not have been able to use it if she had survived. The hip wound would have affected her balance. "The chances of one surviving such an injury... I would put it off the top of my head at 50-50," the pathologist told the court.

He also described exit wounds caused by the bullets and other abrasions and discolouration of the skin, consistent with the impact of a bullet fired through a wooden object such as a door. Steenkamp was wearing a pair of sports shorts with a Nike logo, a former sponsor of Pistorius and a black undershirt when she was shot, he said.

Saayman stood for his testimony, referring to photographs that were not shown to the gallery and often citing number codes. Yet it drove Pistorius, a double-amputee known as the "blade runner", over the edge. The 27-year-old bowed his head and pressed it against the dock's inner wooden wall, weeping and clasping his hands behind his neck and clutching a white handkerchief. A blue metal bucket was placed in the dock and he threw up several times.

At one stage the trial was adjourned as defence counsel Barry Roux announced his client had been sick. Pistorius's sister, Aimee, joined him in the dock and embraced him for long minutes, but he appeared inconsolable, as if curling into a ball.

Later a reference to a photo showing the "smearing and scattering of tissue including bony elements," made Pistorius rock back and forth and retch.Masipa asked if Roux could do anything to help his client and if Pistorius was able to follow proceedings. Roux replied: "My lady, he's not fine but he's not going to be fine. He's having some difficulty. He's very emotional but it's not going to change."

Roux then approached Pistorius who indicated that the testimony should continue despite his anguish. A court official lifted the dock microphone away from Pistorius but the ongoing sounds of distress were impossible to ignore. Meanwhile, in the public gallery, friends of Steenkamp were also in tears.After court adjourned for the day, Pistorius sat for a few minutes with his hands over his ears and his body heaving and bent forward as his brother held a hand on his back.

Earlier, prosecutor Gerrie Nel, supported by Roux, said Saayman's testimony would have an explicitly graphic nature and should not be shown around the world. Masipa announced a ban on live audio and video broadcasting, and extended the order to live reporting on social media. "Twitter is not allowed. Blogging is not allowed," said Masipa, though subsequent reporting was permitted.

The hearing continues.