Thanatology

-Study of Death in all aspects

"Death" One Word Used in Several Ways
Death as a state of existence or nonexistence,
Death as an event:
Death as a condition:
Death may be
MORAL DEATH, mawt ma’nawi
SPIRITUAL DEATH, mawt ruhani
BIOLOGICAL DEATH
Physical or Chemical Death:
• Biological death can be at several levels: the
cell, the tissue, the organ, or the organism.
Cellular Death:
Organ Death:
Clinical Death (Somatic, or
Systemic):
 All aspects of Death

Natural
Manner
Unnatural

Modes Death Place

Suicide
Homicide
Time Accident
Coma Syncope Asphyxia

Causes Postmortem
changes
• Vegetative stage
• Concussion
• Coma
• Suspended animation
• Brain stem death
 To declare the death

•Be very cautious.

•Satisfy that,
- Respiration & Circulation, have stopped
and cannot be started again.
•Avoid premature declaration.
•Otherwise, is disastrous for the
professional life of the doctor.
•On which basis, the event of death will be
decided?

•What is the Definition/s of death?

 Definitions of death
• Legal definition –
Law has not tried to define death.
By death, Black’s law dictionary means
“cessation of life or ceasing to exist”.
• Age-long Physicians’ conception of death :
“Total stoppage of circulation with
consequent cessation of animal and vital
function”.
• With the advent of science, Sustaining
life by artificial maintenance of
circulation inherits certain legal
implications.
• Medico Legal definition of death
(Comprehensive definition)
• Death is permanent and irreversible cessation
of functions of the three interlinked vital
systems of the body (tripod of life),
-Nervous systems,
-Circulatory systems
-Respiratory systems.
• If any of these three systems fails then, other two
also will fail (as they are functionally ‘interlinked’).
• But this def. no way helps to take the decision on
-withdrawal /continuation of the artificial aids,
- However, in consultation with another doctor and
after more than two trial of that withdrawal of the
artificial aids for short periods did not revive the
normal functioning of the aided i.e. failed system/s
Waiting for ten minutes after withdrawal of artificial
aids is must to declare
 Importance of exact time / moment of death
• for cremation & ritual purposes: death certification
• from a different therapeutic point of view i.e. from
tissue transplantation point of view:
moment of death
• But this proposition of transplanting tissue from a
dead body is not possible in case of most of the body
organs, due to death of the tissue within a short
period of cessation of circulation and respiration.
• Cessation of the functions of nervous,
circulatory and respiratory systems, are also
known as-
Somatic deaths or clinical or systemic deaths.
• Due to somatic death further lack of oxygen
supply different organs, Individual cells of
different tissues or organs die. This death of
the individual cells is known as
Cellular or molecular death.
• As a general rule, organs which receive or
need more blood supply during life, die
early in absence of circulation.

• This gap between the somatic and the

molecular deaths has helped the ‘process
of’ organ transplantation from dead bodies.
• Highly vascular organs -Heart, liver, kidney, etc,
cannot be left till circulation and respiration
stop, as lack of oxygenated blood-supply will
soon make them unsuitable for the purpose of
transplantation.
• So, have to be removed before stoppage of
circulation i.e., before occurrence of the
“somatic death”.
• Brain, cannot be used for transplantation
because brain cells die within a few minutes of
stoppage of circulation or respiration, even
though their stoppage may be taken as to have
occurred permanently before brain death.
• But If it becomes certain that, brain has
stopped functioning permanently and
irreversibly, then by maintaining circulation
and respiration, transplantable organs can be
suitably removed from such a donor.
• This gave rise to the necessity of
understanding the conception of “brain
death”.
 Brain Death
• death of the brain cells occurs earliest after
the stoppage of the circulation.
• In some cases brain death initiates the process
of the somatic death.
• more weightage to death of the base of brain
where the vital centers are located,
-than the death of the cerebral cortex,
the vegetative existence will not continue for
long after the death of the brain tissue at the
cortical level
• Thus for applied purposes, brain death has
been classified into three types —
• I) Cortical death
• ii) Brain-stem death
• in) Both cortical and brain stemdeath.
 BRAIN-STEM DEATH diagnosis
absence of following brain-stem reflexes —
1. Absence of cornea! Reflex
2. Dilated and fixed pupils, not reacting to light
3. Absence of vestibulo-occular reflex
4. Absence of cranial motor nerve responses to
painful stimuli
5. Absence of cough reflex
6. Test withdrawal of respiratory aid (ventilator)
should cause stoppage of respiration.
Precautions to avoid misdiagnosis -
1. Some of the clinical signs of brain stem
death may be there in hypothermia. Hence,
before testing for the above features,, the
temperature of such subjects should be
raised to 35°C.
2. The diagnosis of brain stem death should be
reached by a team of doctors,
Team of doctors consisting of :
a) a Neurologist, b) Anaesthesiologist and
c) an experienced doctor of the intensive care
unit of the hospital.
3. The patient should be examined by the
above team of doctors at least twice, with a
reasonable gap of period in between.
4. None of the doctors who participate in the
diagnosis of brain-death should have any
interest, in the transplantation of an organ,
removed from the subject
Persistent Vegetative State (PVS):
PVS is a state of higher brain death with lack of intellectual, emotional,
memory, and other functions associated with a functioning cerebral cortex.
Diagnosis
– Flat EEG of the cerebrum.
– Loss of orientation about self, place and time
– Movements of purposeless and are not coordinated.
– No sensory or language functions, produce meaningless
sounds
– Retained automatic cranial & spinal reflex on stimulation.
– Because of intact brain stem and hypothalamic function,
they retain autonomic functions of swallowing, coughing,
gagging, sucking, and gastro-intestinal movements.
– They can swallow food and drink on their own or assisted by
means of nasogastric tubes.
– Patients can survive in the vegetative state for up to 30
years.
‘Locked in Syndrome’ OR’ Coma Vigilante’:
• Cerebral cortex is intact as indicated by EEG
measurements.
• The patient is aware of himself and his
surroundings. He however has lost the ability to
make any voluntary movements.
• The only movement that is usually preserved is in
movement of the eyes up and down.
• They can develop some communication using eye
movements.
• Suspended Animation / Apparent death
• This is a death like state in which vital functions of the
body are at such a low pitch that they can not be
determined by ordinary methods of clinical
examination but they can only be detected by artificial
means.
• Voluntarily- Yoga Practitioners
• Involuntarily due to
(i) Severe shock following accident
(ii) Electrical shock
(iii) Poisoning— barbiturate
(iv) Drowning
(v) Epilepsy
(vi) Sunstroke
(vii) Cholera and
(viii) Hysteria
• Hypothermia
• Newborn infants
• Vagal inhibitory reflexes: narcotic poisoning,
hanging, catalepsy, hysteria, sunstroke,
concussion

•28
• Suspended animation lasts for seconds to hours and by
ordinary clinical methods, distinction is not possible.

• Extreme cold can be used to precipitate the slowing of

an individual's functions; use of this process has led to
the developing science of cryonics.
• Cryonics is another method of life preservation but it
cryopreserves organisms using liquid nitrogen that will
preserve the organism until reanimation.
• Laina Beasley was kept in suspended animation
as a two-celled embryo for 13 years Laina's birth
on February 4, 2005 for a 45-year-old mother
• Suspended animation in humans can be very
useful; the doctors can put the patients with
serious injuries into a “stop” to avoid
deterioration of their tissues, while they fix their
injuries.
• Placing human organs or tissues in such a state
would have an enormous impact on
transplantation since organs such as the heart or
lungs can survive outside the body for only up to
six hours
• Human hibernation
 Medico-Legal Importance of Death
Diagnosis
• Detect cause of death
• Know time of death
• Social reasons presumption of death
/survivorship
• Organ donation
• Apparent death
• Statistical reasons
• Heritage reasons
 Medico legal considerations
1. Presumption of death: “ the person has not
been heard of for 7 years by those who would
naturally have heard of him had he been alive”

2. Presumption of survivorship ( sec 107 and 108

0f IEA)
“ if it is shown that a person was alive within 30
yrs and there is nothing to suggest the
probability of his death it is presumed that he is
alive”
•32
3. Declaration of death:
Legal definition
Legal time of death
• A patient may be legally dead because of
lack of brain function but still have a
heartbeat when on a mechanical ventilator.
• There is no point in ventilating a dead
patient, but stopping the ventilator before
the legal criteria for death have been met
may involve the physician in both civil and
criminal proceedings.
•33
• The legal time of death may be a long time
after the death actually occurred.
• Many accident victims are obviously dead at
the scene of the accident but are pronounced
dead officially on arrival at a hospital because
no physician was at the scene.

•34
4. Organ donation:
– Donor for organ transplantation including marrow.
– For storage and preservation of organs for transplant.
– Factory to produce hormones and antibodies.
5. For experimentation
– In basic medicine to help determine physiologic
functions in human in place of animal
experimentation.
– In clinical medicine
• To serve as disease models
• for use in technological development
• for use in preliminary test of new drugs
6. They may get potential benefit from tissue (Foetal brain
tissue) transplantation.
•35
6. Removal of the life supporting system: Aruna
Shaunbag case
• Passive euthanasia has been legalised by
Supreme court in india on 7 march 2011, with
a careful monitoring by high courts.

•36
 All aspects of Death

Unnatural
Manner
Natural

Modes Death Place

Suicide
Homicide
Time Accident

Causes Postmortem
changes
 Coma CNS causes

CNS

Death

Asphyxia R.S C.V.S

Syncope
 CNS causes
1. Cerebral compression resulting from head
injury :- Intra-cranial haemorrhages, cerebral
oedema, depressed./ comminuted fracture skull.
2. Cerebral injuries
3. Infective states :-encephalitis, meningitis, abscess
4. New growth/tumors
CNS causes
5. Metabolic disorders like diabetes, uremia.
6. Lack of circulation in brain :-as in case of
embolism or occlusion of carotid and vertebral
arteries.
7. Drugs/ poisons:-opium, barbiturates, alcohol,
anaesthetizing agents, CO,CO2
8. Heatstroke, epilepsy
 Coma

CNS

S s
CV use
Death ca

Asphyxia R.S C.V.S

Syncope
 CVS causes

1. Pathology of the heart :-myocardium, pericardium

in valves, conduction system, heart circulation
2. Vagal inhibition of the heart
3. Anaemia:- sudden loss of excessive -1/3rd or more
of the total volume of the body blood due to injury
CVS causes
or some disease
4. Anoxia - In severe hypoxia, healthy heart may fail
to function /may stop functioning before the failure
of the respiratory centre /stoppage of respiration
5. Cardiac poisons –
6. Over-exercise or exhaustion may cause syncope.
 Coma

CNS
.S s
R se
u
ca
Death
R.S C.V.S
Asphyxia Syncope
 Respiratory
causes Asphyxia
I Mechanical Causes
• Construction around or pressure over the neck : -
hanging, strangulation
• Closure of the external respiratory orifices : -
smothering
• Occlusion of respiratory passage from inside: -
chocking, gagging, drowning
• Restriction of the respiratory movement caused
due to compression over the chest, : - traumatic
asphyxia and overlying.
II Toxic
• Respiratory center depressant— Opium, barbiturate, CO2,
H2S chloroform, bromides etc.
• Respiratory tract irritants:- volatile /vapors poisons -chlorine
gas, SO2, HNO3, HC1, ammonia gas etc.
• Affecting the pick-up, carriage, and diffusion of oxygen at
the tissue level:- phosgene, CO. cyanides.
• Lack of oxygen in the inhaled air:
• Poisons causing paralysis of the respiratory muscles:-Muscle
relaxants, curare, cobra snake venom.
III. Traumatic:
• Injury to both lungs
• Pulmonary embolism -fat, air, thrambo, emboli of traumatic
origin
STAGES OF DEATH:
(a) Somatic, Systemic, Medical or Clinical
(b) Cellular or Molecular(leading to Organ Death).
(a)Somatic, Systemic, Medical, or Clinical: The term
death as commonly employed means somatic
death.
It is due to complete and irreversible cessation of
the vital functions of the brain, heart and lungs.
• In somatic death, though life ceases in the
body as whole,
it persists in its component parts
viz,
the tissues and cells, which respond to chemical,
thermal or electrical stimuli.
• It signifies loss of life in the component parts
of the body, and it is accompanied by cooling,
and changes in the eye, skin, muscles etc.
(b) Cellular or Molecular:

Molecular death is generally complete within

three to four hours of somatic death.
(Testing the response of skeletal
muscles to electrical stimuli easily establishes
if molecular death has set in or not).

If the skeletal muscles respond to electrical

stimuli then there is no molecular death.
 POST MORTEM CHANGES

1. Immediate Changes
(a) Stoppage of function of nervous system
(b) Stoppage of respiration
(c) Stoppage of circulation.
2. Early changes —
(a) Facial pallor
(b) Loss of elasticity of the skin with decrease in
the facial creases
(c) Primary relaxation of the muscles
(d) Contact pallor and contact flattening
(e) Changes in the eye
(f) Cooling of the body
(g) Postmortem staining (lividity)
(h) Rigor mortis
3. Late changes— Decomposition
(a) Putrefaction or ordinary decomposition
(b) Adepocere change — a modified decomposition
(c) Mummification —modified decomposition.
(d) Skeletonisation
• Diagnosis of Immediate Changes
 Nervous system
Relaxed muscles
Absence of reflexes
 Respiration
Inspection:
Palpation :
Auscultation :
Feather test :
Mirror test:
Winslow’s test: water in bowl on chest
 Circulation:
Palpation —Pulsation
Auscultation —Heart beat
Diaphanous/Transillumination test : pink &
Transparent
Magnus test: occlusion
Icard’s test: 1ml of 20% alkaline fluorescein solu. Inj. in
dermis/S.C
Pressure on nail
Cut – Active bleeding
Heat-Blister with red line
 Post Mortem Changes - in the Eye
• Loss of corneal and light reflexes is immediate.

• The iris may respond to chemical changes for hours after

death.
• Pupils become fixed in a mid dilated position.

• The eye globe tension decreases because it is dependant on

arterial blood pressure to maintain rigidity
• Examination of the fundi for Segmentation/Tracking of retinal
blood columns "boxcars“ Kevorkian sign ( only present in
30%). -by ophthalmoscopic examination
 Post Mortem Changes - in the Eye

In cases where the eyes remain open, ‘tache noire

sclerotique’ will appear on the sclera of the eye.
Post Mortem Changes - in the Skin

– Pale and waxy looking

– Loss of elasticity
– Action of the Heat on the Skin – Only dry blister is found on dead. In living, blister contains fluid.
 Body Cooling/ Algor Mortis
 the most useful indicator of time of death during the first 24 hours post-
mortem.
 after death all metabolic activity ceases rapidly (muscles, liver) &
circulation stops  heat production ceases soon after death
 The body surface begins cooling immediately after death, followed by
delay in deep organs cooling, until a heat gradient is set up between the
core of the body and the surface.
 Delay  “temperature plateau”
 Plateau = variable: from minutes to 2-3 hours.
 In practice the temperature is either measured per rectum or intra-
hepatic via an abdominal stab.
 The rate of body cooling:
 1C/hr in summer
 1.5C/hr in winter.
 
 Factors affecting Rate of Cooling
  Surface area of the body:
 larger surface area  speeds up cooling rate.
 Children: increase surface area gives rapid heat loss.
 Body weight:
 Larger b. w: slower cooling
 Smaller b.w: faster cooling
 Edema:
 slower cooling rate.
 Clothing, posture and emaciation.
 Environmental Temperature :
 Higher humidity: rapid cooling rate
 Rapid air velocity: rapid cooling rate
 Water:
 rapid cooling rate:
 More rapid in flowing water than still water
 If there is a fulminating infection, e.g. septicaemia, the body temperature may
continue to rise for some hours after death.
 Algor Mortis
• The assessment is made on the basis of measurement of
the body core temperature which, post mortem,
requires a direct measurement of the intra-abdominal
temperature.
– In practice either the temperature is measured per
rectum or the intra-hepatic/sub-hepatic temperature
is measured via an abdominal stab.
– Oral and axillary temperatures should not be used.
– An ordinary clinical thermometer is useless because
its range is too small and the thermometer is too
short.
– A chemical thermometer 10-12" long with a range
from 00 -500 Celsius is ideal.
• Alternatively a thermo-couple probe may be used and this
has the advantage of a digital readout or a printed record.
 Algor Mort cont…...
• Whether the temperature is measured via an abdominal stab or
per rectum is a matter of professional judgment in each case.
• If there is easy access to the rectum without the need to seriously
disturb the position of the body and if there is no reason to
suspect sexual assault, then the temperature can be measured
per rectum.
– It may be necessary to make small slits in the clothing to gain access to the
rectum, if the body is clothed and the garments cannot be pushed to one
side.
– The chemical thermometer must be inserted about 3-4" into the rectum
and read in situ.
• The alternative is to make an abdominal stab wound after
displacing or slitting any overlying clothing.
– The stab may be over the lower ribs and the thermometer inserted within
the substance of the liver or alternatively a subcostal stab will allow
insertion of the thermometer onto the undersurface of the liver.
 Algor Mort cont…...

• The body temperature should be recorded as early as

conveniently possible.
• The environmental temperature should also be
recorded and a note made of the environmental
conditions at the time the body was first discovered
and any subsequent variation in these conditions.
• If a method of sequential measurement of body
temperature is use then the thermometer should be
left in situ during this time period.
– This method is much easier to undertake when
using a thermo-couple with an attached print-out
device.
 Algor Mort cont…...

• The normal oral temperature fluctuates between 35.9oC

(96.7oF) and 37.2oC (99oF).
• The rectal temperature is from 0.3-0.4oC (0.5o-0.75oF)
higher.
• Since heat production ceases soon after death but loss
of heat continues, the body cools.
• During life the human body loses heat by radiation, convection,
and evaporation.
• Heat loss by conduction is not an important factor
during life, but after death it may be considerable if the
body is lying on a cold surface.
 Algor Mort cont…...

• The fall in body temperature after death

mainly depends upon a loss of heat through
radiation and convection, but evaporation
may be a significant factor if the body or
clothing is wet. The cooling of a body is a
predominantly physical process which,
therefore, is predominantly determined by
physical rules.
 Algor Mort cont…...

• It is usually assumed that the body

temperature at the time of death is normal,
but in individual cases it may be subnormal or
markedly raised.
• As well as in deaths from hypothermia, the
body temperature at death may be sub-normal
in cases of congestive cardiac failure, massive
hemorrhage, and shock.
• The body temperature may be raised at the
time of death in heat stroke, some infections,
and hemorrhage.
 Important Unknowns
• Two important unknowns in assessing time of death
from body temperature are
– the actual body temperature at the time of death;
and
– the actual length of the post mortem temperature
plateau.
• For this reason assessment of time of death from
body temperature clearly cannot be accurate, (even
approximately), in the first four to five hours after
death when these two unknown factors have a
dominant influence.
• Similarly, body temperature cannot be a useful guide
to time of death when the cadaveric temperature
approaches that of the environment
Rigidity of body
(rigor mortis) Decomposition
of body

Lividity of body
(livor mortis)

Cooling of body
(algor mortis)
 Decomposition
Rigidity of body of body
370 C (rigor mortis)

Lividity of body
(livor mortis)

Cooling of body
(algor mortis)
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54
Time since death (in hours)
 Hypostasis/Livor Mortis /suggilation
cadveric lividity/

vibices
 Hypostasis/Livor Mortis
(lividity or suggilation)

 after death occurs, circulation of blood ceases &

subsequent movement of blood is by gravity
 blood accumulates in the capillaries in the dependent parts
of the body  purple or reddish purple discoloration of
the adjacent skin
 in pressure areas such as the shoulder blades, buttock &
calves discoloration will be pale.
 starts immediately after death.
 apparent after 2 hrs and fixed after 8 hrs.
 may not appear at all especially in infants, old people and
anemic people.
 Hypostasis (cont’d)
 early hrs after death it appears in the form of blotchy
post-mortem hypostasis which usually sinks down and
becomes confluent on the most dependant area
 once hypostasis is established, there is controversy
about its ability to undergo subsequent gravitational
shift if the body is moved into a different posture.
 Primary hypostasis may either:
 Remain fixed
 Move completely to the newly dependant zone
 Be partly fixed and partly relocated
 Sites of Hypostasis
 Depends on the position of the body before death:
 Supine:
 shoulders, buttocks
 heels pressing against surface give white color (pale).
 Vertical (hanging):
 distally in legs & feet.
 Drowning:
 chest, upper chest, and upper limbs.
 Face-down death:
 as in epilepsy, drunken victims
 whitening around nose & lips.
 Hypostasis may also occur in viscera:
 Heart: mistaken for MI
 Lungs: mistaken for pneumonia
 Intestine: mistaken for hemorrhagic infarction
Distribution of Hypostasis

•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.
 Color of Hypostasis

 The color of hypostasis is variable and depends on the

state of oxygenation at death.
 Usual color is blue-pink
 It’s a crude indicator of the mode of death:
 Cherry-pink: CO poisoning
 Dark blue-pink: cyanide poisoning
 Brown: methahemoglobinemia
 Bronze: septic abortion caused by Clostridium perfringes.
 Pallor: anemia, hemorrhage (or normal in extremes of age)
 Timing and Permanence of Hypostasis
• Hypostasis appears at variable times after
death
– May appear half hr to many hrs after death
• In the early hrs after death it appears in the
form of blotchy post-mortem hypostasis
which usually sinks down and become
confluent on the most dependant area.
 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 will
No swelling May be with swelling
not flow from the cut
 Medico-legal Importance of
Hypostasis

– Sure sign of death

– Cause of death
– Time estimation
– Position before/ after death
– Indicate if the body was moved or not after death
 Body Cooling/ Algor Mortis
 the most useful indicator of time of death during the first 24 hours
post-mortem.
 after death all metabolic activity ceases rapidly (muscles, liver) &
circulation stops  heat production ceases soon after death
 The body surface begins cooling immediately after death, followed
by delay in deep organs cooling, until a heat gradient is set up
between the core of the body and the surface.
 Delay  “temperature plateau”
 Plateau = variable: from minutes to 2-3 hours.

 In practice the temperature is either measured per rectum or intra-

hepatic via an abdominal stab.

 The rate of body cooling:

 1C/hr in summer
 1.5C/hr in winter.
 
 Factors affecting Rate of Cooling
 Surface area of the body:
 larger surface area  speeds up cooling rate.
 Children: increase surface area gives rapid heat loss.
 Body weight:
 Larger bw: slower cooling
 Smaller bw: faster cooling
 Edema:
 slower cooling rate.
 Clothing, posture and emaciation.
 Environmental Temperature :
 Higher humidity: rapid cooling rate
 Rapid air velocity: rapid cooling rate
 Water:
 rapid cooling rate:
 More rapid in flowing water than still water
 If there is a fulminating infection, e.g. septicaemia, the body temperature may
continue to rise for some hours after death.
Post mortem regidity-Rigor Mortis
 Rigor Mortis
• It is that state of the muscles of dead body
when they become stiff or rigid with some
degree of shortening.

• One of the recognizable signs of death that is

caused by a chemical change in the muscles
after death, causing the limbs of the corpse
/dead to become stiff and difficult to move or
manipulate.
• Death cessation of respiration depletion of
oxygen used in the making of ATP
 ATP no longer provided to operate the
SERCA pumps in the membrane of the
sarcoplasmic reticulum, which pump calcium
ions into the terminal cisternae Calcium ions
diffuse from the terminal cisternae and
extracellular fluid to the sarcomere  Ca binds
with troponin  crossbridging between
myosin and actin proteins.
• Unlike normal muscle contractions, the body is unable to
complete the cycle and release the coupling between the
myosin and actin, creating a continuous state of muscular
contraction, until the breakdown of muscle tissue by digestive
enzymes during decomposition.

• RM initiated when the ATP concentration falls to 85% of

normal
 Rigor Mortis (cont’d)
Sequence:
1. Primary muscular flaccidity
2. Generalized muscular stiffness
3. Secondary muscular flaccidity

• RM starts to develop about 2-3 hrs

after death
• Usually it’s first detected in smaller
muscle groups (of face) such as
those around the eyes, mouth, jaw
(however in fingers occurs late).
• Occurs in descending order
• It resolves in the same order in
which it develops.
• It concludes around 36-48 hrs after
death
 Factors affecting timing of RM
• 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:
• Cause of death:
– asphyxia, pneumonia, nervous de’s with muscle
paralysis & dehydration  slow onset
– septicemia & poisoning  rapid onset, may even
be absent, esp in limbs affected by septicimia
– emaciated or died of wasting disease  rapid
onset, short duration
 
 RM: time estimation

Warm Flaccid Death < 3 hrs

Warm Stiff 3-8 hrs

Cold Stiff 8-36 hrs

Cold Flaccid Death > 36 hrs

 Rigor Mortis (cont’d)
• RM in Iris:
• Antemortem constriction or dilation modified
• May affect the eyes unequal, making the pupils unequal
• RM in the Heart:
• Contracted, stiff LV may be mistaken for LV hypertrophy
• RM in Dartos muscle of scrotum:
• Rigor in Dartos constricts testes and epididymis expulsion of
semen
• Contraction of seminal vesicles and prostate
– Postmortem expulsion of semen
• RM in Erector Pilli muscles attached to hair follicles:
• Goose bumps, hair stands up
Rigor Mortis
Cadaveric Spasm
 Rigor Mortis vs. Cadaveric Spasm
Rigor mortis Cadaveric spasm
Onset delayed after death Onset is instantaneous
(2-3 hrs) Duration is a few hours, until it is
Duration approx 12-24 hrs replaced by rigor mortis
Intensity comparatively Intensity comparatively very strong
moderate
Mechanism of formation: Mechanism of formation unknown, but
breakdown of ATP below predisposing factors: Excitement, fear,
critical level fatigue, exhaustion, nervous tension,
contraction of M’s at time of death
All muscles of the body are Selected muscles, which were in a state
affected gradually. of contraction at the time of death, are
affected.
 •Cadaveric spasm in a drowning
victim: had grass from the river bank
firmly clutched in the hand

•Victim of suicide: The

cadaveric spasm has
maintained the position of his
arms after the shotgun has
been removed
 Conditions Mistaken as RM
• Heat stiffness:
– Exposure of a body to intense heat (burning, high
voltage electrocution, etc) coagulation of
muscular proteins  muscular shortening
• Cold stiffness:
– Exposure of the body to extreme cold (<-5⁰C)
solidification of subcutaneous fat and muscles,
freezing of synovial fluid in joints
– Rigor mortis halted until thawing occurs, after
which it develops very rapidly
 Medicolegal Importance of RM

• Time estimation
• Cause of death
• Know position
• Sure sign of death
Post-Mortem Decomposition
 Post-Mortem
Decomposition / Putrefaction

1. Putrefaction
2. Arrested and modified putrefaction
1. Mummification
2. Adipocrere
3. Skeletanization
 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:
temperature
humidity.
 Two phenomena for putrefaction:
Autolysis: occurs by digestive enzymes released from the
cells after death.
Bacterial action: most of them come from the bowel and
Clostridium welchii predominates (same bacteria that
causes gas gangrene)
1. The 1st visible sign of putrefaction is green or
greenish red discoloration of the skin of the
anterior abdominal wall
a) normally starts in the right iliac fossa.
2. The next phase:
a) gas formation
b) blisters containing red fluid appear on the skin,
mistaken as bleeding
3. Humidity, temperature, bacterial activity 
body proteins break into polypeptides &
amino acids
1. Brain & epithelial tissues are the 1st to be affected
by putrefaction
2. Heart, uterus & prostate may survive for longer
periods.

3. Military plaques: nodules in heart

(epi/endocardial)
4. Marbling: bacteria colonize venous system 
hemolysis  stain.
Marbling
 Influences on Putrefaction
• A high environmental humidity -enhance putrefaction.
• The rate of putrefaction is influenced by the bodily habits of the
decedent;
obese putrefy more rapidly than lean.
• Putrefaction delayed in deaths from ex-sanguination
(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.
• More rapid in children than in adults, relatively slow in
unfed new-born infants (lack of commensal bacteria).
 Influences on Putrefaction
• Heavy clothing and other coverings, by
retaining body heat, will speed up
putrefaction.
• Rapid putrefactive changes may been
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.