THENATOLOGY

SHOMVI,A.M
Introduction
• Definition: Thanatology (Greek thanatos: death) is the scientific study
of death in all its aspects including its cause and phenomena.
• The cessation of life; the cessation of exist; defined by physicians as
the total stoppage of the circulation of blood, and cessation of vital
functions consequent thereon, such as respiration, pulsation, etc
• There is a progression from clinical death to brain death, biological
death and then cellular death.
 Introduction
• Death occurs in two stages
i. Somatic, systemic or clinical.
ii. Molecular or cellular.
• Somaticn Death;Complete and irreversible cessation of function
of brain, and stoppage of the circulation and respiration
• Brain death follows immediately clinical death due to lack of
oxygen. First the cerebral cortex, then cerebellum and then
lower brain centres die; Ultimately the brain stem and the vital
centres die.
Molecular death
• Molecular death ; the death of cells and tissues individually, which
takes place usually one to two hours after the stoppage of the vital
functions. Molecular death occurs piecemeal.
• As long as circulation of oxygenated blood is maintained to the brain
stem, life exists.
• Whether the person is alive or dead can only be tested by withdrawal
of artificial maintenance.
• A person who cannot survive upon withdrawal of artificial
maintenance is dead.
 Molecular death
• When the higher levels of cerebral activity are selectively lost;- a period of
hypoxia, trauma, or toxic insult, the victim will exist in a 'vegetative state'.
• Here the survival of the brainstem ensures that spontaneous breathing will
continue and therefore cardiac function is not compromised.
• The victim can remain in deep coma almost indefinitely(certainly for years ).
• Debilitating complications such as postural skin necrosis, muscle
contractures, and secondary chest infections may well shorten this status of
life
• Vegetative patients are not considered 'dead' by most standards.
Brain death
• Brain death is the complete and irreversible cessation of functioning
of the brain. Brain includes all the central nervous system (CNS)
structures, except the spinal cord.
• Brain death is now accepted as brainstem death.
• Due to inability of autonomous procurement of breath spontaneously
or to regain consciousness
Prerequisites Brain death.
• Brain death is the absence of clinical brain function when the
proximate cause is known and demonstrably irreversible.
i. Clinical or neuroimaging evidence of an acute CNS catastrophe that
is compatible with the clinical diagnosis of brain death.
ii. Exclusion of complicating medical conditions that may confound
clinical assessment.
iii. No drug intoxication or poisoning.
iv. Core temperature > 32°C .
 How to quantify
• The three cardinal findings in brain death are coma, absence of brainstem
reflexes and apnea.
1. Coma or unresponsiveness—No cerebral motor response to pain in all
extremities.
2. Absence of brainstem reflexes
a. Unreactive Pupils
b. Ocular movement
c. Facial sensation and facial motor response
d. Pharyngeal and tracheal reflexes
3. Apnea test: It is based on the fact that loss of brainstem function definitively
results in loss of centrally controlled breathing, with resultant apnea.
Why brain death
1. When to stop artificial life support
2. Organ transplant
• Autograft: Tissue transplanted from one part of the body to another in the same
individual. It is also called autotransplant or homologous transplantation.
• Allograft: Organ or tissue transplanted from one individual to another of the same
species with a different genotype. It is also called allogeneic graft or homograft.
• Isograft: Organs or tissues are transplanted from a donor to a genetically identical
recipient (such as an identical twin).
• Xenograft: Organs or tissue transplanted from one species to another, e.g. grafting
of animal tissue into humans.
• Split transplants: Deceased-donor organ (specifically the liver) may be divided
between two recipients, especially an adult and a child.
 Estimated mantainance of life support
• Beating-heart donor or living cadavers
Cornea can be removed from the dead body within 6 h
skin in 24 h
bone in 48 h
Blood vessels within 72 h for transplantation.
Kidneys within 45 min
Heart within 1 h
Lungs And liver within 15 min
 Cause of death
• Two of the most important functions of the forensic pathologist are the
determination of the cause and manner of death
• Cause of death is any injury or disease producing physiological derangement
which results in the death of the individual
• Example a gunshot wound to the abdomen, a stab wound to the chest, adenocarcinoma of
the lung or coronary atherosclerosis e.t.c
• Mechanism of death is the physiological derangement produced by the cause of
death that results in death
• Example hemorrhage, septicemia, metabolic acidosis, ventricular fibrillation or respiratory
paralysis.
• Mode of death refers to an abnormal physiological state that pertained at the
time of death
• Xavier Bichat;Coma,Syncope,asphyxia
 Manner of
death

Natural unnatural obscured

undetermined Homicide suicide accidental

 Postmortem changes
Immediate changes Early changes Late changes
Loss brainstem function Loss of elasticity of the skin, and Putrefaction
facial pallor

Irreversible loss of Primary relaxation of the muscles Adipocere formation

respiration

Irreversible loss Contact pallor and flattening Mummification

circulation
Changes in the eye
Algor mortis
Livor mortis
Rigor mortis
 Suspended Animation (Apparent Death)
• Definition: Suspended animation is a condition in which vital signs of life (heart
beat and respiration) are not detected by routine clinical methods, as the
functions are interrupted for some time or are reduced to a minimum
• Mechanism: The metabolic rate is greatly reduced so that the requirement of the
individual cell for oxygen is satisfied through the dissolved oxygen in body fluids.
• Types Two types:
i. Voluntary: Seen in practitioners of yoga or in trance.
ii. Involuntary: Seen in hypothermia, poisoning with barbiturates or opiates,
newborns, drowning, electrocution, heatstroke, cholera, postanesthesia,
shock, cerebral concussion or insanity.
 Early changes
• Changes in the skin and facial pallor: Skin becomes pale and ash-white due
to stoppage of circulation and drainage of blood from the capillaries and
the small vessels. The skin loses its elasticity, and the face looks younger
due to loss of creases. The lips appear brownish, dry and hard due to
drying.
• Primary relaxation or flaccidity of the muscles: Muscles loose their tonicity
and become flaccid, but the muscular tissues are still alive, their chemical
reaction is alkaline and responds to electrical stimuli.
• Contact flattening and pallor: The areas which remain in contact with the
ground, become flat and the blood from vessels of these areas is pressed
 Early changes
• Pupils: The pupils are dilated after death, because of the relaxation of muscles
of the iris. Later, they are constricted with the onset of rigor mortis.
• Moreover, the sizes and shapes of the pupils of the two sides may be different
• Opacity of the cornea: There is opacity and haziness of the cornea due to drying
and deposition of dust and debris over it
• If the lids are closed, the cornea remains clear for about 2 hours (h). But the
cornea becomes permanently hazy after about 10–12 h of death.
• Changes in the retina: The blood in retinal vessels appears fragmented or
segmented (cattle trucking or shunting) within seconds to minutes after death,
and persists for about an hour (Kevorkian sign).
• Loss of intraocular tension: Intraocular tension falls rapidly after death. It
becomes zero in 4–8 h from 10–22 mmHg during life. The eyeballs look sunken
in the orbit.
 Algor mortis
• Definition: Algor mortis (Latin algor: coolness, mortis: death) or chill of
death is the cooling of the body that normally takes place after death,
where the body temperature equilibrates with its environmental
temperature.
• The fall of temperature of the cadaver occurs due to cessation of energy
production and inactivity of the heat regulating center after somatic death.
• Algor mortis is usually the first sign of death beyond the obvious, and is
then followed by rigor mortis.
 Factors Affecting Algor Mortis
• Temperature (major factor): Rate of fall of body temperature is directly
proportional to the difference between the temperature of the dead body
and the environmental temperature
• Air movement: Air movement over the surface of the dead body causes a
quick fall of temperature due to increased evaporation of body fluids. A
body kept in a well-ventilated room will cool more rapidly than one in a
closed room
• Cooling is more rapid in a humid rather than in a dry atmosphere, since
moist air is better conductor of heat
 Factors Affecting Algor Mortis
• Media of disposal: Cooling is earliest in water, and late in buried bodies. The
ratio of the rates of fall of temperature in the three media, water:air: soil =
4:2:1. The rate is thus maximum in water, moderate in air and minimum in a
buried body.
• Built of cadaver: Obese bodies cool slowly, and lean bodies rapidly, since fat is a
bad conductor of heat.
• Age : Rate of loss of heat is more in children and the elderly, compared to
adults because the surface area of the body is more in relation to the body
volume.
• Sex:Females retain body heat for a comparatively longer period because of
their subcutaneous fatty tissue.
• Clothing or coverings of the body: A well-covered body retains heat for a longer
period as compared to a naked or thinly clothed body, as clothes are bad
conductors of heat.
Postmortem Staining (Livor Mortis)
• Definition: Postmortem staining or PM staining is bluish or purplish-red
discoloration resulting from gravitational settling of blood in the toneless
capillaries and venules of the dependant parts of the dead body.
• Site: It is present at the undersurface of skin in the superficial layers of the
dermis.
• Cause: After the stoppage of circulation, there is stagnation of blood in the
vessels, and it tends to sink by force of gravity in the capillaries and venules of the
dependent parts of the body.
• In early stages (30 min to 1 h), it consists of discolored patches of 1–2 cm in
diameter on the dependant parts of the body, having the same color as blood
which can be mistaken for bruises.
• Gradually, in 3–4 h, the small patches increase in size and coalesce with each other
to form uniformly stained large areas. It is usually welldeveloped within 4 h,
complete in 5–6 h
• Thumb pressure causes blanching
 Postmortem Staining (Livor Mortis)
• After complete formation of the postmortem staining, if the body is
undisturbed, the staining gets ‘fixed’ in 8–12 h and persists until putrefaction
sets
• At this stage, lividity does not disappear, if finger is firmly pressed against
the skin.
• Distribution of PM Staining Depends on the position of the body.
• In a body lying supine, it appears in the neck, and then spreads over the entire
back with the exception of the areas directly pressed on the ground or the bed,
• This phenomenon is known as contact pallor
 Rigor mortis
• Definition: is that state of the muscles in a dead body become stiff or rigid
with some degree of shortening.
• The phase of primary relaxation of the muscles continues for about an hour
which is followed by stiffening or rigidity. It indicates molecular death of the
concerned muscles.
• Mechanism:
• At rest, actin filaments interdigitate myosin filaments only to a small extent and
the muscle fibers also appear soft and elastic.
• Maintenance of this condition of muscles is due to the presence of ATP
(adenosine-triphosphate) above a certain level.
• On nervous stimulation, hydrolysis of ATP occurs to ADP and phosphate with the
liberation of energy which causes contraction of the muscle fibers and extension
of the actin filaments more inside the myosin filaments.
 Rigor mortis
• After death, there is continuous hydrolysis of the ATP, and as long as glycogen is
available in the muscle, there is resynthesis of ATP
• In this process, once the muscle glycogen is exhausted, no further resynthesis of ATP
is possible and the muscle loses softness, elasticity and extensibility due to
formation of viscid actomyosin complex giving rise to rigor mortis in the muscle
• After the pH of the muscle becomes 5.5, release of autolytic enzymes stored in
lysosomes takes place, the actomyosin complex is broken down and muscles become
soft again.
• This is known as resolution of rigor, That occurs due to onset of decomposition
• Rigor mortis occurs both in the voluntary and involuntary muscles. It occurs
earlier in the involuntary or smooth muscles than in the voluntary or striated
muscles
• Rigor mortis first appears in the heart (involuntary) muscle within an hour after
death. It first appears in the (voluntary)muscles of the eye lids (orbicularis oculi)
 Rigor mortis
Factors Affecting Rigor Mortis
i. Environmental temperature: At high temperature, rigor mortis comes early
and passes off early. In cold temperature, it comes late and stays longer.
ii. Muscular activity: Violent exercise prior to death may hasten the onset as
well as disappearance of rigidity.
iii. Mode of death .
iv. Built: It comes early and passes off early in thinly built subjects with weak
musculature. In well-built subjects with strong musculature, it comes late and
stays longer.
v. Age: Rigor mortis does not develop in a fetus of < 7 months of intrauterine
age. It is moderate in children, emaciated and in elderly people.
Cadaveric Spasm
• Definition: It is a condition in which the muscles of the body which
were in a state of contraction immediately before death, continue to be
so after death without passing through the stage of primary relaxation
• Predisposing conditions: It occurs especially in cases of sudden death,
excitement, fear, severe pain, exhaustion, cerebral hemorrhage,
electrocution, injury to the nervous system, firearm wound of the head
and convulsant poisons, like strychnine.
• Muscles involved: It originates by normal nervous stimulation of the
muscles.
• It is usually limited to a single group of voluntary muscles and frequently
involves the hands.
• Occasionally, the whole body is affected.
 Medico-legal Importance of Rigor Mortis
i. It is a sign of death and indicates molecular death of the muscle involved.
ii. During the early phase after death, it helps in estimating the time since
death. During summer, if rigor mortis has not set in, death might have
occurred within 2 h.
• If rigor mortis has involved the whole body then death might have occurred between
12-24 h back. In winter season, the above timings are roughly doubled.
iii. It indicates the position of the body at the time of death.
iv. Some conditions occur in dead bodies which may imitate/ simulate rigor
mortis:
• Cadaveric spasm or instantaneous rigor
• Heat stiffening
• Cold stiffening
• Gas stiffening or putrefaction
 Medico-legal Importance of cadaveric spasm
• Cadaveric spasm, being an antemortem phenomenon, reflects the last act of the
subject performed before and at the time of his death. The cause and the
manner of death may be judged.
• In case of drowning, the hand may firmly grip sand, mud, gravel or weed which
are present in the pond or lake from where the body was recovered.
• In a case of firearm/stab injury over an approachable vital part of the body, the
pistol/knife may be firmly grasped in the victim's hand which is a strong
presumptive evidence of suicide.
• In homicidal cases, the deceased may grasp some part of clothing, button,
foreign hair of the assailant(s) with whom he had a struggle prior to his death
 Decomposition/Putrefaction
• Definition: It is a process by which complex organic body tissue breaks down
into simpler inorganic compounds or elements due to the action of
saprophytic microorganisms or due to autolysis.
• Autolysis
• Putrefaction
• Microorganisms involved: Clostridium welchii, Staphylococcus, non-
hemolytic Streptococcus, diptheroids, and Proteus are the important ones.
• Gases produced: H2S, phosphoretted hydrogen, ammonia, CO2 , CO,
mercaptans and methane.
 Decomposition changes ('4 Ds')

• Discoloration: Greenish discoloration in the lower abdominal quadrants.

i.e'Marbling' of skin, Postmortem luminescence
• Distension: Various gases produced during decomposition permeate into
skin, soft tissue and organs which manifests as crepitus and distension.
• Degradation: Decomposition causes a loss of anatomic integrity of skin and
other tissues such as localized peeling of skin ('skin slippage'), loosening of
skin of hands and feet ('degloving') and loosening of hair and nails.
• Dissolution: Progressive decomposition leads to liquefaction and
disappearance of tissues and organs and eventual skeletonization
Factors Affecting Putrefaction
External factors Internal factors
• Environmental temperature: • Age
• Moisture • Sex
• Air • Nutrition status(Built)
• Clothing • Cause of death
• Manner of burial • Wholeness of the body
• Time
Depth of grave
Moisture of land
Wrapping and coffin
 Medico-legal Importance of Putrefaction

• It is the surest sign of death.

• From decomposition changes, time since death can be assessed.
• In advanced decomposition, the identity of the deceased may be
impossible.
• In advanced putrefaction, no opinion can be given as to the cause of
death, except in case of poisoning, fractures and firearm injuries.
 Adipocere (Saponification)
• Definition: is formation of an offensive, sweet rancid smelling, soft, whitish
or grayish white, crumbly, waxy and greasy material (similar to soap)
occurring in fatty tissues of a dead body. It is a modification of
decomposition.
• Time required for formation: In hot and moist environment, it may occur
by the end of 1 week (earliest recorded—3 days). In temperate countries, it
starts in 3 weeks and completes in about 3 months.
• Mechanism of formation: The chemical reaction essentially involves
conversion of unsaturated liquid fats (oleic acid) to saturated solid higher
fatty acids, like palmitic, stearic and hydroxystearic acid, mostly palmitic
acid.
• Distribution: It forms at any site where fatty tissue is present. The face,
buttocks, breasts and abdomen are the
 Factors Influencing Adipocere Formation
• Age: Fetuses < 7 months do not show adipocere formation.
• Built: In obese people and mature newborn, it is formed quickly.
• Environmental temperature: Heat accelerates and cold retards adipocere
formation in a body.
• Moisture: Moisture is essential for chemical reactions to occur. It occurs rapidly
in bodies submerged in water than in damp soil.
• Air current: It retards adipocere formation by evaporation of the body fluid and
by reducing the body temperature.
• Running water: Adipocere formation is retarded as the electrolytes are washed
away from the surface of the body which is necessary for the change.
• Bacterial infection: Early activity by anerobes such as Clostridium perfringens
assist in the reaction, as the bacteria produce lecithinase which facilitates
hydrolysis and hydrogenation.
 Medico-legal Importance
• Sign of death: It is the surest sign of death
• Time since death: It gives a rough estimate about the time since death
• Personal identification: When the process involves the face, the features are
well-preserved which help in identification.
• Recognition of injuries: The cause of death may be determined, since injuries
can be recognized.
• Place of disposable of body: Some idea about the place of disposal of the body
can be made, since its formation requires a warm place with high humidity or
presence of moisture or water
 Mummification
• Definition: It is the rapid dehydration/desiccation and shrinking of the
dead body from evaporation of water, with preservation of natural
appearances and features of the body
• The process of normal decomposition of the dead body is prevented, as
the growth of the microorganisms is retarded
• The entire body loses weight, becomes thin, stiff, brittle and odorless. It is
a modification of putrefaction
 Factors Favoring Mummification
• Hot environment: As in the deserts
• Dry atmosphere: Mummification cannot occur in humid conditions
• Free air movement: It helps in rapid evaporation of body fluids.
• Contact of the body with absorbing media: A dead body lying in shallow
grave, in dry sandy soils mummifies early due to absorption of body fluid
rapidly.
• Poisoning: Chronic arsenic or antimony poisoning favors the process of
mummification.
Medico-legal importance: They are same as adipocere
DISCUSSION