MEDICO-LEGAL

ASPECT OF DEATH
DEATH
→ is the termination of life.
→ it is the complete cessation of all the vital functions
without possibility of resuscitation.
→ it is an irreversible loss of the properties of living matter.
→ an event that takes place at a precise time.
→ the ascertainment of death is a clinical and not a legal problem
 IMPORTANCE OF DEATH
DETERMINATION
1. The civil personality of a natural person is extinguished by death;
2. The property of a person is transmitted to his heirs at the time of
death;
3. The death of the partner is one of the causes of dissolution of
partnership agreement;
4. The death of either the principal or the agent is a mode of
extinguishment of agency;
5. The criminal liability of a person is extinguished by
death;
6. The civil case for claims which does not survive is
dismissed upon the death of the defendant.
 CRITERION USED IN ITS
DETERMINATION
Based on the Criterion used in its determination, death
may be:
1. Brain Death
• Death occurs when there is deep irreversible coma, absence
of electrical brain activity and complete cessation of all the
vital functions without possibility of resuscitation.
2. Cardio-Respiratory Death
• Death occurs when there is a continuous and persistent
cessation of heart action and respiration
• It is a condition in which the physician and the members
of the family pronounced a person to be dead based on the
common sense or intuition.
3. Brain and Cardio-Respiratory
Death A person will be considered medically and legally dead if
in the opinion of a physician based on ordinary standards of
medical practice, there is:
• Absence of spontaneous respiratory and cardiac function, and
because of the disease or condition which caused, directly or
indirectly, these functions to cease, or because of the passage of
time since these functions ceased, attempts at resuscitation are
considered hopeless;
• Absence of spontaneous brain function and if based on ordinary
standards of medical practice during reasonable attempts to either
maintain or restore spontaneous circulatory or respiratory function
in the absence of aforesaid brain function, it appears that further
attempts at resuscitation or supportive maintenance will not succeed.
KINDS OF DEATH
1. SOMATIC DEATH OR CLINICAL DEATH
• State of the body in which there is complete, persistent and
continuous cessation of the vital functions of the
brain, heart and lungs which maintain life and death;
• hardly impossible to determine the exact time of death ;
• immediately after death,
– the face and lips become pale
– the muscles become flaccid
– the sphincters are relax
– the lower jaw tends to drop
– the eyelids remain open
– pupils dilate
– skin loses its elasticity
– body fluids tend to gravitate to the most dependent portions of the body
– body heat gradually assumes the temperature of the surroundings
2. MOLECULAR OR CELLULAR
DEATH
• After cessation of the vital functions, there is still animal
life among individual cells.
• About 3-6 hours later, there is death of individual
cells known as molecular or cellular death
• Exact occurrence cannot be definitely determined due
to several factors
3. APPARENT DEATH OR STATE OF
SUSPENDED ANIMATION
• This condition is not really death but merely a transient
loss of the vital functions of the body on account of
disease, external stimulus or other forms of influence.
• It may arise especially hysteria, uremia, catalepsy and
electric shock.
SIGNS OF DEATH
1. CESSATION OF HEART ACTION AND
CIRCULATION
a. Examination of the heart
1. Palpation of pulse
2. Auscultation of heart sounds
3. Fluoroscopic examination
b. Examination of Peripheral Circulation
1. Magnus Test
2. Opening of Small Artery
3. Icard’s Test
4. Pressure on the Fingernails
5. Diaphanous Test
6. Application of heat on the skin
7. Palpation of the Radial Pulse
8. Dropping of melted wax
2. CESSATION OF RESPIRATION
• Cessation of respiration in order to be considered as a sign of death must
be continuous and persistent.
• Absence of movement of chest during inspiration and expiration

Test conducted are as follows:

1. Examination with a Feather or Cotton Fibers
2. Examination with a Glass Water
 3. Winslow’s Test
4. Examination with a Mirror

3. COOLING OF THE BODY

– Fall of the body temperature is one of the most prominent signs of death
– The rate of cooling is not uniform, rate is rapid within the first two
hours of death and then decrease
4. INSENSIBILITY OF THE BODY AND LOSS OF POWER TO
MOVE – No kind of stimulus is capable of letting the body have
voluntary movement.

5. CHANGES IN THE SKIN

– Pale and waxy-looking due to absence of circulation
– Loss of elasticity
– Opacity
– No blister form on application of hot molten wax
6. CHANGES IN THE EYE
– Loss of corneal reflex
– Clouding of the cornea
– Flaccidity of the eyeball
– Pupil is in the rest position
– Ophthalmoscopic findings such as pale optic disc and retina, discoloration of the
fundus and segmentation of retinal vessels

7. ‘TACHE NOIR DE LA SCLEROTIQUE’ – spot seen on the sclera after death of the
person
8. ACTION OF HEAT ON THE SKIN
 CHANGES IN THE BODY
FOLLOWING DEATH
STAGE OF PRIMARY FLACCIDITY (Post-
mortem muscular irritability):
– Muscles are relaxed
– Pupils are dilated
– Sphincters are relaxed
– Incontinence of urination and defecation
STAGES OF POST-MORTEM RIGIDITY – Also
known as Cadaveric rigidity or Death struggle of
muscles or Rigor Mortis
– Muscles contract
– Starts 3-6 hours after death
– Lasts 24-36 hours
– Increase in lactic acid and phosphoric content
 STAGES OF SECONDARY FLACCIDITY:
– Also known as commencement of putrefaction (Decay of
the muscles)
– Muscles become flaccid
CONDITIONS SIMULATING RIGOR
MORTIS
1. HEAT STIFFENING
– Exposure of a Body to intense temperature (>65 Degree Celsius)
– Denaturation and Coagulation of muscular proteins
– Muscular shortening (contracted, desiccated, carbonized)

 Seen in burning, high voltage electrocution, falling into hot liquid

 A zone of brownish pink “cooked meat” is seen under contracted muscle
 Changes in posture, especially flexion of limbs
 normal rigor mortis do not occur
2. COLD STIFFENING
– Exposure of a Body to extreme cold (<-5 Degree Celsius)
– Solidification of subcutaneous fat and muscles, freezing of synovial fluid in
joints.
– Rigor Mortis is halted until thawing occurs after which it develops very
rapidly and passes of quickly.
– When joints forcibly flexed, there’s sudden sharp sound.
– Subcutaneous fat hardening may be mistaken for ligature mark, especially in
infants
3. CADAVERIC SPASM
– Also known as Instantaneous rigor, cataleptic rigidity or instantaneous
rigidity
– Rare form of muscular rigidity that occurs at the moment of the death,
persists into the period of Rigor mortis and can be mistaken for RM
– The cause is unknown, but usually alive and well violent deaths happening
with intense emotion, adrenocortical exhaustion
– No other condition simulates Cadaveric Spasm and it cannot be produced
by any method after death
 DISTINCTION BETWEEN
RIGOR MORTIS AND
CADAVERIC SPASM
RIGOR MORTIS
CADAVERIC
SPASM
It is a rare form of rigor
It is a stiffening of body that happens in selected
DEFINITION muscles after 2 – 3 hours muscles which where in a
of death state of contraction at
the moment of death
NATURE OF DEATH Physiochemical Severe nerve stimulation
CIRCUMSTANCES OF No special circumstances Extreme nervous
DEATH stimulation
 After two (2) hours of
STARTING OF APPEAR At the moment of death
death
Few hours till replaced by
DURATION 12 – 24 Hours
rigor mortis
PROCEEEDED BY Primary flaccidity Extreme nervous stress
FOLLOWED BY Secondary flaccidity Rigor mortis
INTENSITY Moderate Strong
Selected types of muscle,
TYPES OF MUSCLES
All types of muscles especially a group of
AFFECTED
voluntary muscles
INDICATED Time of death Mode of death
BODY HEAT Cold Warm
MOLECULAR DEATH Takes place No
 MUSCLUAR CONTRACTION
AND RIGOR MORTIS
The muscles remain in the contracted state until
adenosine triphosphate (ATP) binds to myosin,
releasing the myosin and actin filaments from one
another. Unable to release contraction, all the muscles
of the body remain tense, causing rigor mortis.
 LIVIDITY
– A discolored, bluish appearance caused by a bruise, pooling of blood
due to congestion of blood vessels, strangulation, etc.

There are four (4) Post-mortem sign to tell a great deal about time of
death
1. PALLOR MORTIS – It is when the skin becomes pale because of
lack of blood flow to the skin.
2. ALGOR MORTIS – It is the change in body temperature post
mortem to reach external temperatures.
3. RIGOR MORTIS -
4. LIVOR MORTIS