MEDICO-LEGAL

ASPECT OF DEATH 2
PCPT VINCENT S BALILLA, MD
MEDICO-LEGAL OFFICER
POST-MORTEM CHANGES AND TIME SINCE DEATH
● The paramount medicolegal issue in any postmortem examination
relates to the determination of time since death (Postmortem
Interval).
● This question arises most commonly in cases of unwitnessed or
unreliably witnessed deaths, but may be of crucial importance
even in cases of reliably witnessed 'simultaneous' deaths.
POST-MORTEM CHANGES AND TIME SINCE DEATH
● the accurate determination of the postmortem interval applies to:
○ civil law -- ascertaining the exact time of death is of practical
necessity in settling family, social, and business matters
○ criminal law -- the accurate determination of the time since
death may either exonerate or inculpate a suspect accused of
a particular homicide
POST-MORTEM CHANGES AND TIME SINCE DEATH
● Such determination is an indispensable component of corpus
delicti (i.e., the body of evidence which proves the commission of
a crime), and may serve as a basis for deciding whether to extend
investigative effort in a particular line or direction.
● Therefore it is extremely important to accurately interpret the
changes that occur after death.
 POST-MORTEM CHANGES: Early vs Late Changes
● Early changes -- which take place between the first 12 to 24 hours.
● Late changes -- include putrefaction and its modifications, namely
adipocere formation and mummification.
● Eventually the changes become visible and these visible changes are important for
two reasons:
○ first, because a doctor needs to know the normal progress of decomposition
so that he does not misinterpret these normal changes for signs of an
unnatural death and,
○ second, because they may be used in estimating how long the individual has
been dead (i.e. the post-mortem interval, or PMI).
 POST-MORTEM CHANGES: Early Changes
● Early changes -- which take place between the first 12 to 24
hours.
● They comprise:
○ Changes in the skin
○ Changes in the eye
○ Algor mortis (Postmortem cooling; Chill of death)
○ Livor mortis (Postmortem lividity; Рostmortem staining;
Hypostasis)
○ Rigor mortis
 POST-MORTEM CHANGES: Early Changes
● Changes in the skin
○ Elasticity is lost soon after death
○ The muscles rapidly become flaccid (primary flaccidity; flaccid means
“soft and hanging loosely or limply”), with complete loss of tone
○ The fall in blood pressure and cessation of circulation of the blood
usually render the skin, conjunctivae and mucous membranes pale.
○ The skin of the face and the lips may remain red or blue in colour in
hypoxic/congestive deaths.
 POST-MORTEM CHANGES: Early Changes
● Changes in the eye
○ In the eye the corneal reflex ceases and the pupils stop reacting to light.
○ The cornea loses its luster (‘shine’) with the passage of time. It becomes
dull, hazy, and finally opaque and wrinkled.
■ If there is a living will for the removal of the cornea for
transplantation, it should be removed preferably within half an hour
after death.
○ Intra ocular tension falls so rapidly that by two hours after death, the
tension is nearly zero and the eyeball appears sunken.
 POST-MORTEM CHANGES: Early Changes
● Algor mortis (Postmortem cooling; Chill of death)
○ After death, heat production is lost and therefore the body starts cooling.
○ The dead body loses its heat by conduction, convection and radiation.
■ radiation (transfer of heat to the surrounding air by infrared rays)
■ convection (transfer of heat through moving air currents)
■ conduction (transfer of heat by direct contact with another object)
○ Measurement of the rate of cooling helps in estimating the time since
death.
ALGOR MORTIS
 POST-MORTEM CHANGES: Early Changes
● Livor mortis (Postmortem lividity; Рostmortem staining;
Hypostasis)
○ is a reddish purple coloration in dependent areas of the body
due to accumulation of blood in the small vessels of the
dependent areas secondary to gravity
○ Livor mortis is usually evident within 30 min to 2 h after death.
○ Livor mortis develops gradually, usually reaching its maximum
coloration at 8–12 h.
LIVOR MORTIS
 LIVOR MORTIS
● Dependent areas resting against a firm surface will appear pale in
contrast to the surrounding livor mortis due to compression of the
vessels in this area, which prevents the accumulation of blood.
● Thus, areas supporting the weight of the body, for example, the shoulder
blades, buttocks, and calves in individuals lying on their backs, show no
livor mortis, but appear as pale or blanched area.
● Tight clothing, for example, a brassiere, corset, or belt, which compresses
soft tissues, collapsing the vessels, also produces pale areas
 LIVOR MORTIS
● The site and distribution of the hypostasis must be considered in
the light of the position of the body after death.
● A body left suspended after hanging will develop deep hypostasis
of the lower legs and arms, with none visible on the torso
● A body that has partially fallen head first out of bed will have the
most prominent hypostatic changes of the head and upper chest.
LIVOR MORTIS
 LIVOR MORTIS
● Of predominant criminalistic significance regarding lividity are the
phenomena of ‘disappearance on pressure and disappearance after turning
the body’.
○ Livor mortis is not very important in determining the time of death. It is
important, however, in determining whether the body has been moved.
● In the early stage, lividity will completely disappear on soft thumb pressure.
● With an increasing postmortem interval, this pressure must increase as well.
● Later, the lividity will disappear only incompletely on blunt pressure and
finally, it will not disappear at all.
LIVOR MORTIS
● If the body is turned in the early
postmortem interval, some or all of the
hypostasis may move down to the most
low-lying areas according to gravity.
● In a comparatively later postmortem
interval, only some of the hypostasis will
slip down to the new low-lying area and
only a faint blanching of the lividity will be
noted in the former low-lying area
 LIVOR MORTIS
Note:
● PM lividity disperses with the onset of putrefaction.
● PM lividity may not develop at all if the body is tossed and turned
continuously as seen in fast flowing waters of rivers or the sea.
● PM lividity cannot be appreciated well in dark coloured subjects.
● PM lividity may not be appreciable even in fair skinned bodies if
they have bled profusely or were severely anaemic.
 POST-MORTEM CHANGES: Early Changes
● Rigor mortis
○ After passing through a phase of primary flaccidity soon after death
during which they are totally relaxed, the muscles over a period of
time, gradually stiffen.
○ This stiffening is known as rigor mortis.
○ Rigor mortis affects all the muscles in the body, both skeletal and
smooth.
○ Rigor mortis usually appears 2–4 h after death, and fully
develops in 6–12 h.
 POST-MORTEM CHANGES: Early Changes
● Rigor mortis
○ After passing through a phase of primary flaccidity soon after
death during which they are totally relaxed, the muscles over a
period of time, gradually stiffen.
○ This stiffening is known as rigor mortis.
○ Rigor mortis affects all the muscles in the body, both skeletal and
smooth.
 RIGOR MORTIS

● It is generally considered that by the first 12 hours after death, rigor affects the whole body.
● It is retained for another 12 hours, and passes off in the next 12 hours with the onset of
putrefaction.
● This Rule of 12, also known as the March of rigor, is only a generalization of the time since death
 RIGOR MORTIS
● Rigor mortis, when it develops, involves all the muscles at the
same time and at the same rate.
● However, it becomes most evident in the smaller muscles. Thus,
rigor mortis is said to appear first in the smaller muscles, such as
the jaw, and then to gradually spread to large muscle groups.
● The classical presentation of rigor mortis in its order of
appearance is jaw, upper extremities, and lower extremities.
 RIGOR MORTIS
● Rigor mortis passes off in the order in which it appeared.
● Rigor mortis is lost due to decomposition.
● In temperate climates, rigor mortis disappears in 36 h, but may be
present up to 6 days.
● In hot climates, a body can be in a moderately advanced to
advanced state of decomposition in 24 h, in which case, there will
be no rigor mortis present.
 CADAVERIC SPASM/RIGIDITY
● Another condition, rarely seen but commonly talked about, is cadaveric spasm or
instantaneous rigor, where instead of primary flaccidity after death, the muscles usually
belonging to small groups go into a sudden state of stiffening.
● The instantaneous appearance of rigor mortis is known as cadaveric spasm.

● This condition though of unknown cause, when seen, is usually associated with violent
deaths coupled with emotional disturbance at the time of death, as in drowning
(where grass or weeds may be clutched in the hands), suicide by shooting (where the
weapon may be tightly grasped in the hand), etc.
CADAVERIC SPASM
 HEAT AND COLD STIFFENING
● Other conditions that result in the body becoming stiff after death:
○ The stiffening of the body in deaths due to burns (heat stiffening) is
due to coagulation of muscle protein
■ Pugilistic attitude/stance/posture -- a ‘defensive’ position fancifully likened to that adopted by
pugilists (boxers), which is typically seen in severely burned bodies, characterised by flexion of
elbows, knees, hip, and neck, and clenching of hand into a fist; it is caused by high-temperatures
in fire, resulting in muscle stiffening and shortening; it occurs even if the person was dead before
the fire
○ exposure to severe cold (cold stiffening), the body becomes stiff due
to freezing of the subcutaneous fat and the water content in the
body, forming icicles.
HEAT AND COLD STIFFENING
 POST-MORTEM CHANGES: Late Changes
● As the post-mortem interval increases, the body undergoes
additional changes that reflect tissue ‘breakdown’, autolysis and
progressive decomposition/ putrefaction.
● DECOMPOSITION involves two processes:
○ 1. Autolysis
○ 2. Putrefaction
 AUTOLYSIS
● Autolysis is the breakdown of cells and organs through an aseptic chemical
process caused by intracellular enzymes
○ This means the process of autolysis is independent of any bacterial action. It is
an aseptic chemical process.
● destruction of tissues and organs by their own enzymes -- self-digestion
● Since it is a chemical process, it is accelerated by heat, slowed by cold, and stopped
by freezing or the inactivation of enzymes by heat
● Organs rich in enzymes will undergo autolysis faster than organs with lesser
amounts of enzyme.
● Soft tissues like the brain, lungs, pancreas, gallbladder, and stomach are affected
earliest.
 PUTREFACTION
● The second form of decomposition, which to most individuals is
synonymous with decomposition, is putrefaction.
● This is due to bacteria and fermentation.
● After death, the bacterial flora of the gastrointestinal tract spread
throughout the body, producing putrefaction.
● This is accelerated in septic individuals because bacteria have
already spread throughout the body prior to death.
 PUTREFACTION
● The onset of putrefaction depends on two main factors:
○ the environment and
○ the body.
● Decomposition results in liquefaction of the soft tissues over a period
of time, the appearance of which, and the rate of progress of which, is a
function of the ambient temperature:
○ the warmer the temperature, the earlier the process starts and the
faster it progresses.
○ In temperate climates the process is usually first visible to the naked
eye at about 3–4 days
TO BE CONTINUED… (PART 3)