CHANGES AFTER DEATH

Changes after death in Simpson’s Forensic Medicine. 12th ed. (2003). pp 37 -48.
 Objectives
 Main objective: To recognize the valuable
information that can be gleaned from
postmortem changes of a body
 Specific objectives:
 To discuss the different changes the body
undergoes after death and the information that can
be derived from these changes
 To define how the time of death is estimated and
identify the “best” method in the estimation of the
time of death
 To describe the different postmortem artifacts and
their causes
Topics

 Postmortem changes
 Estimation of time of death
 Postmortem artifacts
 Embalming
 Exhumation
Changes After Death

 Early changes
 Rigor mortis
 Cadaveric rigidity
 Post-mortem hypostasis
 Cooling of the body after death
 Estimation of the time of death
Early Changes After Death

 Heart stops, breathing stops → fall in

blood pressure, no supply of oxygen to
the cells of the body → cellular
metabolism ceases
 Loss of neuronal activity
 All nervous activity ceases
 Reflexes are lost
 Breathing stops
Early Changes After Death

 Fall in BP & cessation of circulation of

the blood → pallor of the skin,
conjunctivae, mucous membranes
 skin of the face and the lips may remain
red or blue in hypoxic/congestive deaths
 Hair follicles die at the same time as
the rest of the skin
Early Changes After Death

 Eye
 Corneal reflex ceases
 Pupils do not react to light
 Retinal vessels show the break up or
fragmentation of the columns of blood
(‘trucking’ or ‘shunting’)
 Lost intraocular tension
 Early Changes After Death

 Muscles
 Become flaccid rapidly (primary flaccidity)
with complete loss of tone
 may retain their reactivity & may respond to
touch & other forms of stimulation for some
hours after cardiac arrest
 discharges of the dying motor neurons may
stimulate small groups of muscle cells & lead
to focal twitching which decreases with time
Early Changes After Death

 Loss of muscle tone in the sphincters

→ voiding or urine
 a common finding that no relationship with
deaths from epilepsy or asphyxia can be
established
→ emission of semen (in some deaths)
 presence of semen cannot be used as an
indicator of sexual activity shortly before
death
 Early Changes After Death
 Regurgitation of gastric contents
 very common feature of terminal collapse
 a common complication of resuscitation
 gastric contents are identified in the mouth or
airways in up to 25% of all autopsies
 presence in the airways cannot be used to
indicate that inhalation was the cause of death
unless it is supported by
 eyewitness accounts or
 by the microscopic identification of food debris in the
peripheral airways
Rigor Mortis

 A temperature-dependent
physicochemical change that occurs
within muscle cells as a result of lack
of oxygen → muscles stiffen
Rigor Mortis

 Low muscle glycogen levels or if

muscle are acidic at the time of death
as a result of exercise → rigor mortis
develops fast
 Electrocution → rapid developing rigor
mortis
 may be due to the repeated stimulation of
the muscles
 Rigor Mortis

 Rigor may be extremely hard to detect

in the young, the old or the emaciated
 low muscle bulk
 Rigor develops uniformly throughout
the body
 first detectable in the smaller muscle
groups
 around the eyes and mouth
 jaw and fingers
 Rigor Mortis

 Rigor develops uniformly throughout

the body
 appears to ‘spread’ down the body from
the head to the legs as larger and larger
muscle groups are rendered stiff
Rigor Mortis

 Estimation of time of death – only use

of assessing the presence or absence
of rigor
 A variable process
 can never provide an accurate
assessment of the time of death
 should never be used alone in practice
 Rigor Mortis
 A variable process
 chemical processes that result in the
stiffening of the muscles are affected by
temperature
 the colder the temperature, the slower the
chemical reactions & vice versa
 cold body: onset of rigor will be delayed; the
length of time that its effects on the muscles
can be detected will be prolonged
 body lying in a warm environment: onset of
rigor & its duration will be short
 Rigor Mortis
 Microenvironment around the body affects
rigor
 body lying in front of a fire or in a bath of hot
water → rigor develops fast
 body lying outside in winter → rigor progresses
slowly
 extreme postmortem cooling of the body
 stiffening of the body may be due to the physical
effects of cooling rather that rigor
 when body is moved to a warmer environment →
stiffening due to cold temperature disappears as the
body warms
 true rigor develops as the cellular chemical processes
restart
 Rigor Mortis
 Temperate conditions
 rigor is first detected in the face between 1 & 4
hours after death
 in the limbs between 4 & 6 hours after death
 the strength of the rigor increases for the next 6
- 12 hours
 Rigor remains static once established
 when decomposition of the cellular contents
begins and the muscle cells lose their cohesion
→ secondary flaccidity develops
 becomes apparent 24 -50 hours after death
 Rigor Mortis
 Test for rigor across a joint: gently
apply pressure on a joint using one or
two fingers
 to detect presence and extent of the
stiffness (not to ‘break’ it)
 if rigor is broken by applying too much
force, those muscle groups cannot
reliably be tested again
 Rigor Mortis

 A crude but useful aide-memoire:

 Body feels warm & flaccid – dead < 3 hrs
 Body feels warm & stiff – dead 3 – 8 hrs
 Body feels cold & stiff – dead 8 – 36 hrs
 Body feels cold & flaccid – dead > 36 hrs
 Cadaveric rigidity

 A forensic rarity that is always quoted in

textbooks and in court when rigor is discussed
 Instantaneous rigor, instantaneous rigidity,
cataleptic rigidity
 The stiffness of muscle that is said to have its
onset immediately at death which persists into
the period of rigor mortis
 possible mechanism – neurogenic
 Cadaveric rigidity

 Items gripped firmly in the hand of the deceased

before the onset of normal rigor
 said to be related to individuals who are at high levels
or emotional or physical stress immediately before
death, e.g., battlefield casualties
 reports of individuals recovered from rivers with
weeds or twigs grasped firmly in their hand or the
finger of a suicidal shooting tightly gripping the trigger
 Cadaveric rigidity
 Forensic implications
 weapon firmly grasped in the hand at the moment of
death - presumption of self-infliction of the injuries
 cases of drowning when grass, weeds, or other
materials are clutched by the deceased - proof of life
at the time of entry into the water
 some homicides - hair or clothing of the assailant
may be found in the hands of the deceased

Postmortem changes and time of death. http://www.dundee.ac.uk/forensicmedicine/llb/timedeath.htm#top

 Post-mortem Hypostasis

 Cessation of the circulation & relaxation of the

muscular tone of the vascular bed
→ simple fluid movement of the blood within
the blood vessels
→ occurrence of currents between warmer
and colder areas of the body
 may be of importance in the redistribution of drugs and
chemicals after death
→ filling of the dependent blood vessels
 Post-mortem Hypostasis
 Passive settling of red blood
cells under the influence of
gravity to the blood vessels in
lowest areas of the body:
forensically important
→ pink or bluish color to these lowest
areas
 This color change is called
post-mortem hypostasis (post-
mortem lividity, suggilation)
Post-mortem Hypostasis

 Not always seen in a body

 May be absent in the young, the old
and the clinically anemic or in those
who have died from severe blood loss
 May be masked by dark skin colors, by
jaundice, or by some dermatological
conditions
 Post-mortem Hypostasis
 Most commonly formed on the back,
buttocks, thighs, calves, back of the neck
 Most bodies fall down or lie horizontally when dead
and most are placed in a supine position
 Occurs only where the superficial blood
vessels can be distended by blood
 If the body is lying on a firm surface, the weight of the
body will compress those areas of the skin that are in
contact with the surface & prevent the filling of the blood
vessels
 The compressed areas will remain pale; their pallor will be
more striking because of the surrounding hypostasis
 Most commonly referred to as blanching
Post-mortem Hypostasis

Blanching

Hypostasis
 Post-mortem Hypostasis
 Site and distribution of the hypostasis must
be considered in the light of the position of
the body after death
 Hypostasis of the lower legs and arms is seen in
a body left suspended after hanging; none will
be seen on the torso
 Body that has partially fallen head first out of
bed will have prominent hypostatic changes of
the head and upper chest
 Post-mortem Hypostasis
 Color of hypostasis is variable
 May extend from pink to dark pink to deep purple
and, in some congestive hypoxic states, to blue
 No attempt should be made to form any
conclusions about the cause of death from these
variations of color
 There are a few color changes that may act as
indicators of possible causes of death:
 carbon monoxide poisoning: cherry pink color
 cyanide poisoning: dark red or brick red color
 Infection with Clostridium perfringens: bronze hypostasis
 Post-mortem Hypostasis
 Affected by movement of a body
 RBC continue to move under the influence of
gravity even after the normal post-mortem
coagulation of the blood has occurred, although
severely reduced
 Continued ability of RBC to move is important
 Changes in the position of a body after the initial
development of hypostasis
→ redistribution of the hypostasis
→ two overlapping patterns are revealed on examination of
the body
 Post-mortem Hypostasis

 Time taken for hypostasis to appear is very

variable
 No significant role in determining the time of
death
 Algor Mortis

 Cooling of the body after death

 heat will pass from the warmer body to the
cooler environment and the temperature of
the body will fall
 Most useful single indicator of the time of
death during the first 24 hours post
mortem
Algor Mortis

 Use of body temperature estimations

to assess time of death applies only to
cool and temperate climates
 In tropical regions there may be a
minimal fall in body temperature post
mortem and in some extreme climates,
(e.g. central Australia) the body
temperature may even rise after death
 Algor Mortis
 Assessment is made on the basis of
measurement of the body core temperature
 Requires a direct measurement of the intra-
abdominal temperature.
 In practice either the temperature is measured per
rectum or the intra-hepatic/sub-hepatic
temperature is measured via an abdominal stab.
Oral and axillary temperatures should not be used.
 A chemical thermometer 10-12" long with a range
from 0-50o Celsius is ideal.
Estimation of the Time of Death

 3 pathological features used

 Fall in body temperature - most reliable
 Rigor mortis - unreliable
 Hypostasis - unreliable
 Estimation of the Time of Death:
Body Temperature
 Henssge’s Nomogram
 95% accuracy claim, at
best: 2.8 hours on either
side of the most likely
time of death (a total
spread of over 5.5 hours
 Relies on measurement
of body temperature,
ambient temperature
and body weight
 Applies empirical
corrective factors to
allow for clothing, air
movement and/or water
 Estimation of the Time of Death
 Other methods
 Examination of gastric contents
 May confirm the constituents of the final meal
 Will not determine how long before death the
meal was eaten
 Gastric emptying
 Completely discredited as a means of estimating time
of death
 Great individual variation even in normal conditions
 Digestion of food and gastric emptying may cease if
the individual is under physical or emotional stress
 Estimation of the Time of Death
 Other methods
 Forensic entomologist investigation – can
determine a probable time of death (days to
months)
 Examination of the populations and stages of
development of the various insects that invade a
body
 Generally: 21 – 24 days from egg laying of
sarcophagus flies → instar stage → pupation
 Estimation of the Time of Death
 Other methods
 Large and small animals will arrive to feed
on the body
 The species and the rapidity of their arrival
depend on the time of year and the environment
 Examination of buried bodies or skeletal
remains will need the combined specialist
skills of the forensic pathologist, an
anthropologist, an entomologist
 Estimation of the Time of Death

 “Bracket of probability”
 giving an earliest and latest time between which
the doctor feels that death must have occurred
 width of this time bracket will depend upon the
number and uncertainty of the variable factors
known to the doctor
 is likely to be longer the more remote the death
was from the time of examination of the corpse
– the less precise is the estimate time of death

Postmortem changes and time of death. http://www.dundee.ac.uk/forensicmedicine/llb/timedeath.htm#top

Decomposition

 Early changes maybe confused to be

signs of violence or trauma
 Putrefaction
 The commonest route of decomposition
of a body after death
 Route is followed unless some unusual
conditions apply
Putrefaction
 Results in liquefaction of the soft tissues
over a period of time
 Time of visible onset and the speed with
which this proceeds are functions of ambient
temperature:
 the earlier the process starts, the faster it
progresses
 Generally, within a week or so the body
cavities will burst and the tissue will liquefy
and drain away into the ground
Mummification
 Dessication of a body lying in dry conditions, either
climatic or in the microenvironment
 Mummified tissue: dry, leathery, brown
 Commonly seen in warm or hot environments; also
in cool dry areas
 More likely to occur in the thin individual whose
body will cool and dessicate quickly
 Need not affect the whole body
 some parts may show the normal putrefactive
decomposition, skeletalization or formation of adipocere
 Mummified tissues are affected by degradation and
invasion by rodents, beetles, moths
Adipocere
 A chemical change in body fat which is
hydrolyzed to a waxy compound (like soap)
 Most commonly seen in bodies found in wet
conditions
 seen in some bodies from dry vaults
 Speed with which adipocere can develop is
variable: weeks or months; as early as 3
weeks
 Can be found with areas of mummification
and putrefaction, if the conditions are correct
Adipocere

This beautiful little three year old girl, passed away in 1920;
the photo was taken in about 1951 Palermo, Italy.
 Immersion
 Will slow the process of decomposition
 water temperature usually lower than land
temperature
 Most common position of the body in the early
stage: air-containing chest floating uppermost
and the head and limbs hanging downwards
 Hypostasis on the dependent areas particularly the
head and limbs
 Head and limbs may be damaged by contact with
the bottom if water is shallow
 Immersion
 Loss of epidermis – first change
 Gaseous decomposition
 Bloated body lifted to the
surface by these gases
generally in about 1 week (time
is extremely variable)
 Marine animals can cause
extensive damage
 Adipocere formation can occur if
a body lies under water for many
weeks
Burial

 Buried bodies decay more slowly

 Level of moisture in the surrounding
soil and acidity of the soil will alter the
speed of decomposition
 Skeletalization
 Speed of skeletalization depends on
many factors, including, the climate and
microenvironment around the body
 Occur much more quickly in a body on the
surface of the ground than in a buried body
 In a formally buried body, the soft tissues will be
absent by 2 years
 Tendons, ligaments, hair, nails will be identifiable
for some time after that
Skeletalization
 At about 5 years: the bones will be
bare and disarticulated
 Examination of the bone marrow
space may reveal residual organic
material that can be sometime suitable
for specialist DNA analysis
 Dating bones – need skills of the
anthropologist or archaelogist
Post-mortem Injuries

 Dead bodies
 Not immune to injuries
 Can be exposed to a wide range of
trauma
 Should not be confused with injuries
sustained during life
 Post-mortem Injuries
 Injuries from an initial collapse: lacerations to
the head, scalp
 Damage to the body caused by predation by
land animals and insects
 bite marks – odontologist consult
 Damage to body tissue from water animals can
be made more complicated by added damage
caused by water logging of the skin and the
movement of the body across the bottom or
against the banks
 Post-mortem Injuries
 Leak blood, especially those on the scalp
and in bodies recovered from water
 Confirmation that a wound is post-mortem
in origin may be very difficult
 Injuries inflicted in the last few minutes of life
and those that were caused after death may
appear exactly the same
 Post-mortem Injuries
 Generally:
 Post-mortem injuries do not have a rim of an
early inflammatory response in the wound
edges
 Lack of this response does not exclude an
injury inflicted in the last moments of life
Embalming

 A physically invasive process in which

special devices are implanted, and
chemicals and techniques are used to
give an appearance of restful repose
 Embalming Process
 Body is placed on stainless steel or porcelain
table
 washed with a germicide-insecticide-olfactant.
 insides of the nose and mouth are swabbed with the
solution.
 Rigor mortis (stiffness) is relieved by massage.
 sometimes, tendons and muscles are cut in order to
place the body in a more natural pose if limbs are
distorted by disease, e.g., arthritis.
 Massage cream is worked into the face and
hands to keep the skin soft and pliable.
 Embalming Process
 Facial features are set by putting cotton in the
nose, eye caps below the eyelids, a mouth-
former in the mouth (cotton or gauze in the
throat to absorb purging fluids)

 The mouth is then tied shut with wire or

sutures. (Glue may be used on the eyelids and
lips to keep them closed in an appropriate pose.)

 Facial hair is shaved if necessary.

 Embalming Process
 Arterial embalming
 Inject embalming fluid into an artery while
the blood is drained from a nearby vein or
from the heart.
 two gallons or so of a mixture of
formaldehyde or other chemical and water.
 Chemicals are also injected by syringe
into other areas of the body.
 Embalming Process
 The second part of the
embalming process is called
cavity embalming.
 a trocar (a long, pointed,
metal tube attached to a
suction hose) is inserted close
to the navel
 the stomach, bladder, large
intestines, and lungs are
punctured.
 gas and fluids are withdrawn
before "cavity fluid" (a
stronger mix of formaldehyde)
is injected into the torso.
Embalming Process
 The anus and vagina
 may be packed with cotton or gauze to
prevent seepage if necessary.
 a close-fitting plastic garment may also
be used
 Incisions and holes made in the body
are sewn closed or filled with trocar
"buttons."
 The body is washed again and dried.
Embalming Process
 Nails are manicured
 Any missing facial features are molded
from wax
 Head hair is styled
 Makeup is used on the face and hands
 The body is dressed and placed in the
casket (fingers are glued together if
necessary).
Embalming

“It is better to autopsy a body after it

has been embalmed because its parts
have been preserved.”
PNP Medico-legal Officer
Exhumation
 Province of the skilled and experienced
forensic pathologist
 Legal formalities
 Examination of the body
 seldom as good as the examination of a fresh
body unless the exhumed body is well-
preserved
 Autopsy of the exhumed body
 same with some modification of the basic
technique
 Poisoning as possible cause death
 soil samples, fluid / solid in coffin needed
References
 Changes After Death in Simpson’s Forensic Medicine by
Shepherd R, 12th ed. (2003). p37-48
 Changes After Death. Chapter 7. Lecture Notes in
Forensic Medicine by Derrick Pounder, University of
Dundee, p24-27.
http://www.dundee.ac.uk/forensicmedicine/notes/Lecture
%20Notes%20in%20Forensic%20Medicine%20Derrick
%20Pounder%2048pages.pdf
 Time Since Death. Chapter 8. Lecture Notes in Forensic
Medicine by Derrick Pounder, University of Dundee, p
27-31.
http://www.dundee.ac.uk/forensicmedicine/notes/Lecture
%20Notes%20in%20Forensic%20Medicine%20Derrick
%20Pounder%2048pages.pdf