DEATH

AND its MEDICOLEGAL

ASPECT

Death :-definition , types ,changes

after death, classification & role in
deciding time since death.
 Definition
• In simpler times, death was defined as the
permanent cessation of cardiac and/or
respiratory function.
• Today, instrumentation can keep a heart beating
and an individual breathing in spite of the fact
that if this machinery were turned off, heart and
respiratory
activity would cease. This has brought about the
concept of brain death.
Clincally death is defined as the irreversible
cessation of life.
 TYPES OF DEATH
For the purpose of understanding about death
and its mechanism , it is divided into two
types :-
 Somatic death.
 Molecular death.
 SOMATIC DEATH
Somatic death is defined as the irreversible
cessation of
 Functioning of brain
 Heart
 Lungs
This results in complete loss of sensibility and
ability to move the body. However , certain body
parts such as muscles can still be made to
respond to electrical, themal or chemical stimuli
suggesting the reality that death has not resulted
completely
 EXPLANATION

In somatic death , life has though ceased in the body as a whole,

it still persists in its component parts , namely the tissues and
cells.
Somatic death is diagnosed by three facts
 Cessation of heart beat :auscultation of the cardiac area for
the presence of heart sounds by a stethoscope continuously
for 5 minutes. A flat ECG may also confirm this.
 Cessation of breathing : by thorough auscultation of chest for
breath sounds.
 Cessation of brain activity : by a flat EEG.
thus somatic death is declared when these three vital organ or
the Tripod of life fail to do their function.
 DIFFERENTIAL DIAGNOSIS
Somatic death resembles to certain conditions
like
 Suspended animation.
 Coma following excessive dose of hypnotics or
sedatives.
 Hypothermia in old age.
 MOLECULAR DEATH
• Somatic death ultimately terminates into
molecular death.
• Molecular death is defined as the ultimate death
of all cellular elements.
 Explanation
After somatic death , various tissues survive till
the oxygen supply to then is adequate. When the
oxygen reserve in the cell gets depleted cellular
death or molecular death sets on.
 Suspended Animation
It is a condition in which the vital functions of the body
are at such a low level that they cannot be
appreciated by clinical examination

Apparent death

This may last few seconds to minutes.

Voluntary- by yogis

Involuntary – drowning, electrocution, heat stroke,

typhoid fever etc.
 Early Changes

• Changes in the eye

• Changes in the skin

• Cooling of the body/Algor mortis

• Post mortem lividity/Hypostasis

• Rigor mortis/Cadaveric rigidity

 Changes in the eye
•
Corneal Changes;
• Loss of Clear Glistening
• Dry, Cloudy and opaque
• Loss of reflexes
• Light reflex abolished
• Intra Ocular tension falls, eye balls become flaccid and sink in
the orbit
• Blood flow in the retina becomes dotted and segmented look .

• Optic disc looks pale.

• Pupils fully dilated in the early stage and constict later due rigor mortis.

• Brownish discolouration of the sclera due to cellular debris and dust.

 Changes in the Skin

• Loss of its translucency

• Pale and Ashy white appearance
• Loss of Elasticity
• Wounds will not gape if it is inflicted after
death
• Wounds caused during life will retain their
characteristic features.
 Cooling of the body
• Imbalance between heat production and heat
loss.

• Loss of heat of body by means of conduction

convection and radiation, till it balances with
the temperature of surroundings.

• Rate of cooling is fast during first few hours

and later slows.
- CONDITIONS IN WHICH BODY TEMP RISES

- Sun stroke and pontine haemorrhage, disturbed

heat regulating mechanism.
- Tetanus and strychnine poisoning, due to
increase in heat production in the muscle.
- Acute bacterial or viral infection, lobar
pneumonia, typhoid fever, encephalitis, etc.
- Intense asphyxial conditions- rise of temp by 2-3
c at death
“ Postmortem Caloricity”
The rate of cooling of the body is modified by
the following conditions;

• Age
• Condition of the body
• Mode of death
• Surroundings
• Environmental temperature
 Postmortem Lividity
It means discolouration or staining of the skin
and organs after death due to accumulation of
fluid blood in the dependent parts of the
body.

Post mortem staining/Hypostasis/Suggilation/

Vibices/ Livour mortis.
1- 3 hr. Starts
6-8 hr. Fixes.
• Commencement of Lividity

• Development of lividity

• Fixation of lividity

• Site of distribution

• Pattern

• Extent

• Difference between lividity and bruise.

 Medico-Legal Importance
• It is a reliable sign of death
• It gives the information about the position of
the body at the time of death
• Time since death can be estimated
• Colour suggest the cause of death
• Distribution of lividity may give the
information about the manner of death
 Changes in the Muscles

• Primary relaxation/ Flaccidity

• Rigor mortis/Cadaveric rigidity

• Secondary relaxation
 Primary relaxation
Starts immediately after death with generalised
relaxation of muscle tone:
• Dropping of lower Jaw
• Eye balls lose their tension
• Pupils are dilated
• Joints are flabby
• Smooth muscle relaxation- incontinence of
bladder.
 Rigor Mortis/ Cadaveric rigidity :
It’s the postmortem stiffness or rigidity of the
muscles after death

mechanism
Mainly due to fusion of Myosin and Actin
Time of Onset :
Temperate climates – 3-6 hours
Tropical climates – 1-2 hours
• Rigor mortis generally occurs when body is
cold.
• Not related to action of nerves
• Develops in paralysed limbs also
• First appear in involuntary muscles
• Last to be affected finger and toes muscles.
Duration :
* Temperate climate – lasts for 2-3 days.
• Tropical climate – 24 – 48 hours in winter
18 - 36 hours in summer
• In general – 1-2 hours sets on
for , 12 hours develops
for - 12 hours maintaines
and after 12 hours passes of
Circumstances modifying the Onset and
Duration of Rigor mortis.
Age- Rigor – Mortis is very rare in premature
infants.
Rigor –mortis is slow in adolescent
and healthy adults
Muscular conditon and activity before death.
Onset is slow and duration is longer in muscular
and healthy body at rest.
 Conditions Simulating Rigor-Mortis
• Heat Stiffening
• Cold Stiffening
• Cadaveric Spasm

Secondary Relaxation :
• Muscles become soft and Flaccid
• Do not respond to a mechnical and electrical
stimulus.
 Late Signs Of Death
• Decomposition / Putrefaction.

• Adipocere formation / Saponification.

• Mummification.
 Decomposition / Putrefaction
• Last stage in the resolution of the body,from the
organic to the inorganic state, is a certain sign of
death.
AUTOLYSIS
• Rise of enzyme levels in the tissue cells after
death.
• Softening & liquefying of the body tissue.
• Starts 3-4 hrs after death and continues for 2-3
days.
BACTERIAL ACTION
• Action of bacterial enzymes on tissue
components – carbohydrates/fat/proteins.
• Bacterial growth – warmth,moisture are
conditions favourable.
• Clostridium welchii, streptococci, E coli, B
proteus.
CHARACTERISTIC FEATURES

COLOUR CHANGES
• Greenish discoloration of skin over caecum
and flanks after death appears 18-24 hrs.
• Greenish to black discoloration-
‘Sulphmethahaemoglobin’ formed by H2S
due to microorganisms in the large
intestine.
• Appears early in summer & delayed in
winter.
• Discoloration spreads- front of abdomen,
external genitals, chest, neck, face, arms
and legs – spreads whole body in 24-36 hrs.
• Discoloration of vessel walls due to
pigmentation from decomposed blood over
the shoulder and groin. Arborescent
pattern- ‘Marbling’
GASES OF PUTRIFACTION
• Development of gases under the skin and
hollow viscera 18-36 hrs. 24-48 hrs in solid
viscera.
• H2S, ammonia, phosphated hydrogen, CO2
and methane.
• Causes pseudo rigidity, exerts pressure.
• More gases accumulation, body floats in
water.
PRESSURE EFFECTS OF PUTREFACTIVE GASES
• Displaces the diaphragm upwards.
• Discolored fluid and liquefied tissue mixes with
gases producing froth.
• Bloating of the features.
• Shifting of the area of hypostasis.
• Changes in skin, hair and wound.
• Extrusion of fluid from the mouth and nose.
• Emptying of the heart.
• Changes in appearance of genitals.
• Early putrefaction 24-48hrs
Larynx, trachea, brain of infants, stomach,
intestines, spleen, omentum and
mesentery, liver and adult brain.
• Late putrefaction 2-3 weeks
Heart, lungs, kidneys, bladder, esophagus,
pancreas, diaphragm, blood vessels,
prostate, testis and non gravid uterus,
ovaries.
 ADIPOCERE
• Modification of the process of putrifaction
in the dead body is (checked and is
replaced) adipocere formation.
• Hydrolisation of fatty tissue into fatty acids.
• Bacterial fat splitting enzymes and moisture
are essential – Lecithinase.
• Yellowish white, greasy wax with rancid
smell.
• It forms at any site where fatty tissue is
present.
• Time required, in summer-3 wks, in tropics-
5 to 15 days.
• M.L.I. –
- cause of death
- time since death
- place of death
 MUMMIFICATION
• It is a peculiar desiccation of a dead body
where by its soft parts shrivel up but retain
the natural appearance and the features of
the body.
• Rusty brown color, dry, leathery skin
adherent to bones.
• Internal organs get transformed into a thick
brown mass.
• Mummification occurs in bodies buried in
shallow graves, in dry sandy soils.
• Time – 3 months to 1-2 yrs
• M.L.I. – Identification
- Cause of death
- Time since death
- Place of death
 Time since death/ post mortem
interval
• Point to be ascertained are;
-cooling of the body
-post mortem lividity
-rigor mortis
-decomposition changes
- Contents of stomach and bowels
- Contents of urinary bladder
- Biochemical changes
- Circumstantial evidence