FORENSIC MEDICINE

PRESENTED BY- Dr.ROMESHA CHATTERJEE

BDS,MSc forensic science
Parul university
POST-MORTEM CHANGES
Indications of death:
❖ Unconsciousness
❖ Loss of all reflexes
❖ No reaction to painful stimuli
❖ Muscular flaccidity
❖ Cessation of heart beat and respiratory movement
❖ Eye signs:
• Loss of corneal and light reflexes
• Mid-dilated position of the pupils
• Irregular size and shape of the pupils
• Eyelids usually closed incompletely
Postmortem Ocular Changes
• Immediate signs in eyes
• Dilated or fixed pupils
• Absence of corneal and light reflex
• Marked decrease in intra-ocular pressure
• Late signs in eyes
• Cloudiness of cornea
• Increase in potassium levels
Early Postmortem Ocular Changes

• Eyes remain open

• Thin film observed over cornea
within minutes
• Taché noire
• Eyes closed upon death
• Cloudiness within twenty-four hours
• Absence of intraocular fluid
suggests more than 4 days.
Taché Noire
TERMINOLOGIES
• Algor Mortis: Body temperature after Death
• Livor Mortis: Discoloration after Death
• Rigor Mortis: Stiffness after Death
• Decomposition: Putrefaction and Autolysis
 FACTOR AFFECTING TIME OF DEATH

• Livor Mortis
• Rigor Mortis
• Body Temperature
• Stages of Decomposition
• Stomach Contents
• Insect Activity
 ALGOR MORTIS
• Body cools from normal internal temperature to the outside temperature
• Liver or brain temperatures are taken for core temperature
• Body cooling is inaccurate in obtaining time of death.
• FACTORS AFFECTING ALGOR MORTIS:
❑Body weight:
1. Larger bw: slower cooling
2. Smaller bw: faster cooling
❑Edema:
1. Slower cooling rate
❑Surface area of the body:
1. Larger surface area → speeds up cooling rate.
2. Children have an increased surface area which allows for rapid heat loss.
Algor Mortis
• At 70°F – 75°F, the body cools 2.5°F to 2.0°F for first hour, then 1.5°F to 2.0°F for next twelve
hours, then 1.0°F for next 12 hours.
• Time since death = 98.6°F – Rectal Temp (°F)/ 1.5
• The rectum should be checked before insertion of the thermometer (May have been a sexual
assault)
• Patient may not die immediately after assault.
• This may change time of death by several hours.

• Measure inner core temperature

• Liver or brain
 LIVOR MORTIS/DISCOLOURATION
• Purplish-blue discoloration due to the settling of blood by gravitational forces within
dilated, flaccid capillaries of the skin
• It is seen in the dependent areas like:
I. On the back if the body was in a supine position or on the face and front if the
body remained prone
II. The lividity doesn't show where the body is in contact with something. Thus a
body lying on its back will show lividity in the small of its back, its neck etc
III. This a very useful when determining if a body has been moved after death.
• The areas where the blood has settled will turn pink to dark red to dark blue or purple.
• Starts happening immediately and is visible within a couple of hours. At this point skin
is pinkish/bluish and blotchy.
• After five or six hours the blotches have joined up but the skin still goes white when
pressed.
• After ten to twelve hours the blue color remains even when pressed.
• Within the areas of livor, pale areas where the skin was pressed against a hard surface
or object will prevent postmortem sedimentation
SIGNS OF LIVOR MORTIS
❑Depends on the position of the body before death:
1. Supine:
❖shoulders, buttocks
❖heels pressing against surface gives white color (pale).
2. Vertical (hanging):
❖distally in legs & feet.
3. Drowning:
❖chest, upper chest, and upper limbs.
4. Face-down death:
❖as in epilepsy, drunken victims
❖whitening around nose & lips.
❑ May also occur in viscera:
• Heart
• Lungs
• Intestine
Livor Mortis/Hypostasis
❑Postmortem Lividity
• Early stages can “Blanch” the skin
• Can shift position(s) from 1-8 hours
• 8-12 hours congeals in capillary beds
• After 12 -24 hours the lividity is typically “fixed”
• Can continue to move up to 3 days after death
❑Blanching
• Thumb pressure indicates that the lividity is not fully fixed.
Hypostasis vs. Bruises (Ecchymosis)
Hypostasis Bruises
Dependant areas Any where

Well defined edges Ill defined edges

Blood is retained in Blood escapes through
intact capillaries ruptured capillaries
Superficial Deep into skin
Same level on surface Raised
Pale over pressure Red
areas
Incision: blood flows Incision: blood
from the cut vessel coagulates in tissue
(washable)
With a bruise, blood
No swelling May be with swelling will not flow from the cut
 FACTORS AFFECTING POSTMORTEM CHANGES
• Victim’s Age
• Victim’s Pre-morbid Health
• Level of Activity at time of death
• Type of drugs taken prior to death
• Ingestion of drugs prior to death
• Current Environmental conditions
• In advanced stages,
❖Skin level capillaries can cause hemorrhage this causes pinpoint breaks in the skin called
“Tardieu Spots” or petechiae.
❖Can see petechiae on internal organs.
❖These are minute hemorrhages in the soft tissue.
❖Purpura = patches of purplish discoloration due to rupture of small vessels.
Tardieu Spots
Blanching
Blanching
Distribution of Hypostasis/Lividity

If the body remains vertical after death as in hanging cases,

hypostasis will be most marked in the feet and to a lesser
extent the hands.
Can you see hypostasis in the internal organs?
RIGOR MORTIS (Stiffening after Death)
• After death muscles are initially flaccid and can be moved easily
• The flaccidity is followed by increasing stiffness or rigidity of the
muscles
• Joints are frozen
• The rigidity will gradual subside and the body will be flaccid again
after 48hrs
• Chemical changes causes muscle mass to become rigid.
• Rigor usually occurs from head to toe
 MECHANISM OF RIGOR MORTIS
• Metabolic activity after death continues for short time and becomes
anaerobic (lacking oxygen)
• ATP hydrolyzes to ADP
• Calcium ions diffuse from sarcoplasmic reticulum
• Causes chemical lock between actin and myosin proteins.
• As body proteins decompose, chemical locks breakdown and muscles become
flaccid again.
FACTORS AFFECTING RIGOR MORTIS
❑Environmental temperature:
• Cold and wet → onset slow, duration longer
• Hot and dry → onset fast, duration shorter
❑Muscular activity before death:
• Muscles healthy and robust, at rest before death → slow onset, duration longer
• Muscles exhausted/ fatigued → onset rapid, esp in those limbs being used (eg in someone running at time of
death, lower limbs develop RM faster than upper limbs)
• Increase activity (convulsions, electrocution, lightning) ➔ rapid onset & short duration
❑Age:
Extremes of age ➔ rapid onset
❑Health: Pre-morbid health
❑Cause of death:
• Asphyxia, pneumonia, nervous de’s with muscle paralysis & dehydration ➔ slow onset
• Septicemia & poisoning ➔ rapid onset, may even be absent, especially in limbs affected by
septicemia
• Emaciated or died of wasting disease → rapid onset, short duration
Rigor Mortis
• Rigor is accelerated by
• Prior exercise
• Convulsions
• Electrocution
• Hyperpyrexia
• Hot environmental temperatures
• Age (does not form well in children)
• Strychnine poisoning
• Rigor is inhibited by
• Hypothermia
• Cold environment
TIME ESTIMATION OF DEATH
FORENSIC SIGNIFICANCE OF RIGOR MORTIS
• Can tell Time of Death
• Can tell whether the body has been moved or not
• May be able to tell cause of death
CADAVERIC SPASM
• Known as instantaneous rigor, cataleptic rigidity, or instantaneous
rigidity
• Rare form of muscular stiffening that occurs at the moment of
death,it can be mistaken with rigor mortis
• Usually associated with violent deaths happening with intense
emotion,shock
• Occurs in deaths like-
1. Drowning
2. That occur with great excitement of tension
3. Electric shock
4. Burning cases
FORENSIC SIGNIFICANCE OF CADAVERIC SPASM

• Diagnosis of suicide as in case of weapon found in hand

• Drowning Diagnosis
• One to know state of person prior to death
✓Stress
✓Exercise
✓Shock
Rigor Mortis vs. Cadaveric Spasm
Rigor mortis
Onset delayed after death (2-3 hrs)
Duration approx 12-24 hrs
Intensity comparatively moderate
Mechanism of formation: breakdown
of ATP below critical level
All muscles of the body are affected
gradually.
Cadaveric spasm
Onset is instantaneous
Duration is a few hours, until it is
replaced by rigor mortis
Intensity comparatively very strong
Mechanism of formation unknown, but
predisposing factors: Excitement, fear,
fatigue, exhaustion, nervous tension,
contraction of muscles at time of death
Selected muscles, which were in a state
of contraction at the time of death, are
affected.
Postmortem Decomposition
• The disintegration of body tissues after death
• Tissue components leak and release hydrolytic enzymes
• Bacteria and other microorganisms thrive on the organic material of
the body
• Two parallel process of decomposition occur:
• Autolysis: Self-dissolution by body enzymes released from disintegrating cells
• Putrefaction: Decomposition changes produced by the action of bacteria and
microorganisms
Putrefaction
❑The normal final sign of death.
❑Starts immediately after death at the cellular level
❑Becomes visible in 48-72 hrs.
❑Its onset may be sped up or delayed by several
factors mainly:
1. Temperature
• The ambient temperature can speed up or slow down
this process
• A fever prior to death can speed up putrefaction
2. Humidity
• One week in air equals two weeks in water and eight
weeks in soil
• The 1st visible sign of putrefaction is green or greenish red discoloration of the skin of
the anterior abdominal wall
➢Normally starts in the right iliac fossa.
• The Next phase:
➢Gas formation
➢Blisters containing red fluid appear on the skin, mistaken as bleeding
• Humidity, temperature, bacterial activity → body proteins break into
polypeptides & amino acids
• Brain & Epithelial tissues are the 1st to be affected by putrefaction
• Heart, Uterus & Prostate may survive for longer periods.
• Military Plaques: nodules in heart (epi/endocardial)
• Marbling: bacteria colonize venous system ➔ hemolysis ➔ stain.
 The decomposition of a body can be divided into
several stages, even if the duration of each stage may
vary a lot:
➢2 - 3 days: green staining begins on the right side of the abdomen.
• Body begins to swell.
➢3 - 4 days: staining spreads.
• Veins go "marbled" - a brownish black discoloration
➢5-6 days: abdomen swells with gas and skin blisters.
➢2 weeks: abdomen very tight and swollen.
➢3 weeks: tissue softens. Organs and cavities bursting. Nails fall off
➢4 weeks: soft tissues begin to liquefy. Face becoming unrecognizable
➢4 - 6 months: formation of adipocere, if in damp place.
• This is when the fat goes all hard and waxy.
➢A body without a coffin will be decayed within 12 years
 Influences on Putrefaction
• A high environmental humidity will enhance putrefaction.
• The rate of putrefaction is influenced by the bodily habits of the decedent;
obese individuals putrefy more rapidly than those who are lean.
• Putrefaction will be delayed in deaths from exsanguination (bleeding to death)
because blood provides a channel for the spread of putrefactive organisms
within the body.
• Conversely, putrefaction is more rapid in persons dying with widespread
infection, congestive cardiac failure or retention of sodium and salts.
• It tends to be more rapid in children than in adults, but the onset is relatively
slow in unfed new-born infants because of the lack of commensal bacteria.
 Influences on Putrefaction
• Heavy clothing and other
coverings, by retaining body
heat, will speed up putrefaction.
• Rapid putrefactive changes may
be seen in corpses left in a room
which is well heated, or in a bed
with an electric blanket.
• Injuries to the body surface
promote putrefaction by
providing portals of entry for
bacteria and the associated
blood provides an excellent
medium for bacterial growth.
Marbling
Three Stages of Body Breakdown
❑Early Stage: 24-36 hours
• Green-like discoloration, usually in abdomen (R-low) due to denaturation of bacteria in the
colon
• Early decompositional changes are manifested by green discoloration over the
abdomen.
❑Middle Stage: 36-48 hours
• Gaseous bloating, green-purple color in face, neck and shoulders.
❑Late Stage: greater than 72 hours
• Bloating
• Postmortem mucosal purge, tongue swells and protrudes, venous
marbling of subcutaneous vessels
• Skin blebs or blistering
• Explosion of this person can occur
greater than 72 hours
• Skin and hair slippage
• skin of hands or feet can shed with nails intact
• Marked bloating (1-3X)
• Skeletonization (from 4-5 days and up to 1.5 years depending on the climate).
Skin Slippage
Skin Slippage
Hair Slippage
Fingerprinting Using Finger From Deceased
Influences on Putrefaction
• A high environmental humidity will enhance putrefaction.
• The rate of putrefaction is influenced by the bodily habits of the decedent; obese
individuals putrefy more rapidly than those who are lean.
• Putrefaction will be delayed in deaths from exsanguination (bleeding to death)
because blood provides a channel for the spread of putrefactive organisms within
the body.
• Conversely, putrefaction is more rapid in persons dying with widespread infection,
congestive cardiac failure or retention of sodium and salts.
• It tends to be more rapid in children than in adults, but the onset is relatively
slow in unfed new-born infants because of the lack of commensal bacteria.
 Influences on Putrefaction
• Heavy clothing and other
coverings, by retaining body
heat, will speed up putrefaction.
• Rapid putrefactive changes may
be seen in corpses left in a room
which is well heated, or in a bed
with an electric blanket.
• Injuries to the body surface
promote putrefaction by
providing portals of entry for
bacteria and the associated
blood provides an excellent
medium for bacterial growth.
THANK YOU