The person who murdered Stellenbosch student Inge Lotz carried on stabbing her even after she was dead, the Cape high court heard on Tuesday.
Dr Ansie Adendorff, who was district surgeon in Stellenbosch at the time, was giving post mortem evidence in the trial of Lotz's boyfriend Fred van der Vyver, who has pleaded not guilty to the 2005 slaying.
Adendorff was specially flown in by the prosecution from the United Kingdom, where she is now working.
According to her report, handed in as evidence, Lotz was hit or stabbed at least 37 times during the assault.
Adendorff told the court the initial wounds, which repeatedly fractured Lotz's skull, were inflicted with a blunt object. It seemed from wounds on her right hand and a broken metacarpal that she tried to ward off the attack, she said.
But the lack of blood from other wounds, including 17 stab wounds to the neck, indicated that her heart had stopped beating by the time they happened.
Also inflicted after death was a gaping hole in her chest, some 10cm across, which appeared to be made up of multiple stab wounds. It appeared from the clean edges as if the object - which could have been a knife - was inserted and then pulled downwards.
Two ribs were severed in the process, something which she said required considerable force. Five wounds pierced the lungs.
Adendorff also noted that Lotz had a broken nose. "It looks to me like someone who was hit with a fist," she said.
A small puncture wound on the right of Lotz's neck could have been caused by the spike of an earring when her head was forcefully turned to that side, she said.
Lotz had also bled from the ears, and her lungs had filled with blood which flowed down through her air passages from the skull injuries.
In her initial observations in the autopsy report, Adendorff noted that Lotz's skull was "soft as a result of blunt violence".
All the stab wounds to the neck were inflicted from left to right, she said, in a downward direction, and their depth varied from superficial to 5cm.
Referring to the blunt-object wounds to the head, some of which showed a semi-circular edge, she said she had told detectives to look for a hammer as one of the murder weapons.
The prosecution has already handed in as evidence an ornamental hammer with which it claims Van der Vyver committed the killing.
Adendorff backed her testimony with photographs taken of Lotz's wounds during the post mortem.
Judge Deon van Zyl warned the public sitting in the gallery that the images could be disturbing to some and he advised sensitive spectators to leave.
Later in the proceedings he asked the prosecuting team to stop showing the photographs on a screen, and Adendorff continued her testimony referring to a collection of printed photographs instead.
The prosecution has indicated it may consider leading evidence from a psychologist on the nature of the attack.
The case continues on Wednesday.