LECTURE NOTES

on
CHANGES AFTER DEATH
 CHANGES AFTER DEATH

• Somatic or molecular changes which occur

after death

• Changes may be immediate, early or late

 IMMEDIATE CHANGES

•1. Cessation of respiration - no repiratory

movement, no breath sounds by auscultation

•2. Cessation of Circulation - no pulse, no heart

sounds on auscultation

•3. Cessation of the function of the nervous

system - loss of reflexes, dilated pupils, loss of
muscle tone
 EARLY CHANGES

1. Changes in the eye : Tache Noir

2. Algor mortis
3. Hypostasis / Livor mortis
4. Rigor mortis
 1. Tache Noir
• Haziness of the cornea or cloudy cornea due to
drying
• Tache noire de la sclerotique is dark, brown,
stripe across the eyes when eyelids are not closed
after death, due to drying
 2. Algor Mortis
• Cooling of the body, occurs due to cessation of heat
production. If the surface area to body ration is
large, than cooling is faster i.e. infants, elderly.

• Cooling is influenced by atmospheric temperature,

medium surrounding body, body built, clothing,
air movement and dry weather
 Algor Mortis : Rate of cooling

•Except where the environmental (ambient)

temperature remains at or even above 37°C, the
human body will cool after death.
•Newton’s Law of Cooling, states that the rate of
cooling is proportional to the difference in
temperature between the body surface and its
surroundings.
•However, a human body does not obey Newton’s
Law.
Algor Mortis : Rate of cooling

KNIGHT’S FORENSIC PATHOLOGY, 4TH EDITION

 Algor Mortis : Factors Affecting

•Initial Body temperature

•The body dimension
•Posture
•Clothing and coverings
•Ambient temperature
•Air movement and humidity
•Medium around the body
•Haemorrhage

KNIGHT’S FORENSIC PATHOLOGY, 4 TH EDITION

 3. Hypostasis
• Also known as livor mortis.
• DEF: The red-purple colouring of the skin surface
which appears on dependent body parts after
circulation has ceased.
• MOA: It occurs when the circulation ceases, as arterial
propulsion and venous return fail to keep blood moving
through the capillary bed and the small vessels.
• Gravity then acts upon the now stagnant blood and
pulls it down to the lowest accessible areas.
(sedimentation)
• The arrival of erythrocytes in the lower areas is visible
through the skin as a bluish red discolouration.
Blotchy post-mortem hypostasis, forming in the early hours after death.
The patchy disposition has no significance and this usually sinks down
and becomes confluent in the most dependent areas within a few more
hours.
Knight’s Forensic Pathology 4th edition
The pattern of hypostasis depends on the posture of the
body after death.

Post-mortem hypostasis in the normal distribution. The

pale areas are the result of pressure against a hard
supporting surface.
Knight’s Forensic Pathology 4th edition
Post-mortem hypostasis in a death from hanging.

The discolouration of the skin is in the legs and hands,

due to the vertical posture after death.
Post-mortem hypostasis in a death from hanging.

Extensive confluent skin haemorrhages may occur

within the dependent hypostasis. They worsen as the
post-mortem interval lengthens and must not be taken
to indicate so-called ‘asphyxia’.
 Hypostasis

The colour (the hue) of hypostasis may indicate

certain types of poisons:
• Cherry pink in Carbon Monoxide
poisoning.
• Dark brown in phosphorus poisoning
• Greenish blue in hydrogen sulphide
• Red in cyanide HCN (Hydrogen Cyanide)
 Hypostasis:
The Timing of Hypostasis (In Malaysia)

Patologi Forensik, 2001

 Hypostasis : Caveat
May not be seen in
cases with
massive
haemorrhage,
infants and
elderly.

The distribution of
hypostasis on the
body may change
when the position
of body changes.
Cherry pink hued hypostasis Carbon Monoxide poisoning
Hypostasis Vs Bruise

• Must be
differentiated from
bruise :

Bruise -
subepidermal
bleeding

Hypostasis – no
bleeding
 4. Rigor Mortis

•Stiffening of the muscles that develops when

the body’s energy source i.e. ATP is depleted
or breakdown of ATP. Muscles require ATP for
relaxation, thus, once depleted, actin and
myosin remain complexed or locked resulting
in muscle stiffening

•Develops in the smaller muscle groups first

like the jaw, eyelids and hands
 CUTIS ANSERINA

Contraction of the
erector pili
muscles
- “goosebumps”
 Rigor Mortis : PMI

• Immediately after death there is general

muscular flaccidity, usually followed by a
period of partial or total rigidity, which in
turn passes off as the signs of
decomposition appear.
• The timing of this sequence of events is so
variable, however, that it is a poor indicator
of the time since death.

Knight’s Forensic Pathology 4th edition

 Rigor Mortis : PMI

Less than 1-3 Hours: primary flaccidity

1-3 H to 9-12Hour: Partially established
Patologi Forensik, 2001
 Rigor Mortis : Factors
1. Temperature
The colder the environment the slower the process
and vice versa. Conversely, hot weather or tropical
conditions can speed up the whole cycle so that
rigor appears within an hour or even less.
2. Physical activity shortly before death.
Muscular exertion affects the interaction of these
substances (glycogen and ATP) in the muscle and
hastens the onset of rigor.
3. Age and body built of the deceased
Fetus, baby, very old person, slim person: Faster
formation of rigor due to less muscle in the body.
 RIGOR MORTIS & ALGOR MORTIS
AND THE ESTIMATION OF POST MORTEM
INTERVAL i.e Time of Death
•Warm + Flaccid > 3 hrs

•Warm + Stiff 3-8hrs

•Cold + stiff 8-36hrs

•Cold + Flaccid < 36hrs

 Rigor Mortis and Posture
• Rarely, rigor can assist in showing that a body has
been moved between death and discovery.
• If an arm or leg is found projecting into free space
without support, in a posture that obviously could
not have been maintained during primary post-
mortem flaccidity, then it must have been rolled
over or otherwise moved. In these cases, a simple
restorative movement (after the scene has been
fully examined) can usually indicate the original
attitude quite simply.

Knight’s Forensic Pathology 4th edition

Rigor Mortis and Posture
 Rigor Mortis : Cadaveric Spasm
• It is a rare form of virtually instantaneous rigor
that develops at the time of death with no period of
post-mortem flaccidity.
• It seems confined to those deaths that occur in the
midst of intense physical and/or emotional activity.
• The phenomenon usually affects only one group of
muscles, such as the flexors of one arm, rather
than the whole body.
Rigor Mortis : Cadaveric Spasm
 Rigor Mortis Vs Heat Stiffening
• Heat applied to the body also causes stiffness of
the muscles, as the proteins of the tissues become
denatured and coagulated.
• The degree and depth of change depends on the
intensity of the heat and the time for which it was
applied.
• Marked shortening occurs, causing the well-known
‘pugilistic attitude’ of a burned body.
• This is because of the greater mass of flexor
muscles compared with extensors, which forces the
limbs into flexion and the spine into opisthotonus.
Knight’s Forensic Pathology 4th edition
 Rigor Mortis Vs Heat Stiffening

Heat flexures of the limbs, part way towards the ‘pugilistic attitude’ formed
when the arms are raised higher. The elbows, knees and wrists are strongly
flexed because muscle contraction is stronger in the flexor groups.
 LATE CHANGES

• 1. Decomposition or putrefaction
• 2. Adepocere formation
• 3. Mummification
• 4. Skeletonization
 DECOMPOSITION

Decomposition is tissue breakdown :

•Due to autolysis of tissues from chemical

breakdown and liberation of enzymes as well as
saprophytic microorganisms

•Exacerbated by external process i.e animal

predators and bacterial actions
 DECOMPOSITION

• Foul smelling
• Maggot infestation
• Marbling
• Skin discolouration
and slippage of
skin
• Loss of tissue
DECOMPOSITION

• Skin disclouration
usually greenish,
starts in the lower
abdomen, due to
bacterial infestation
in the large
intestines
DECOMPOSITION: SKIN BLISTERS
• Skin blisters may appear,
at first on the lower
surfaces of trunk and
thighs where hypostatic
oedema has loaded the
tissues with fluid.
• The upper epidermis
becomes loosened, the
so-called ‘skin-slippage’
giving rise to large,
fragile sacs of clear, pink
or red serous fluid.
 DECOMPOSITION: MARBLING

• Delineation of the
venous tributaries as
a result from the
reaction of hydrogen
sulphide produced by
bacteria with
haemoglobin from
lysis of erythrocytes
 DECOMPOSITION : BLOATING
• Gas formation will now become marked, with
increased tension in the abdomen. The scrotum and
penis may swell up to remarkable size and the neck
and face will become grotesquely bloated, making
visual identification difficult or impossible. The
pressure may cause the eye globes and tongue to
protrude.
DECOMPOSITION : MAGGOTS
 MAGGOTS

• A dead body attracts houseflies and other

insects which lay eggs that turn into
maggots :

Eggs – Larva – Maggots – Pupa – Flies

1 day 3 days 5 days
 DECOMPOSITION : FACTORS
AFFECTING THE RATE

•Ambient temperature that the body was found.

•Clothing of the deceased.
•Medium of the body that was found.
•Aeriation and sunlight
•Body built of the deceased
•Medical illness of the deceased
 SKELETONIZATION
• A corpse outdoors in a temperate climate is likely to be
converted to a skeleton carrying tendon tags within 12–18
months, and to a ‘bare- bone’ skeleton within 3 years;
Knight’s Forensic Pathology 4 th edition

• In Malaysia,

Patologi Forensik, 2001

 ADIPOCERE

• Hydrolysis of adipose tissue forming

greasy waxy substance i.e fatty acids

• Requires moisture

• Retains facial feature

• Formed btwn 1-3 months after death

 MUMMIFICATION

•Drying of tissues with moving air current

•Requires dry and warm environment

•Inhibits bacterial growth

•Preserves facial features

Postmortem Artefacts
Postmortem Artefacts
Postmortem Artefacts
 Postmortem Artefacts
General features:
• There is no bleeding
• certainly no active haemorrhage into the wound
margins.
• Naturally, there is no oedema or reddening of the
edges
• Crenation of the edges is a useful guide where
small rodents or other animals are involved, though
large carnivores can make totally irregular tears in
the tissue.
• Some animals, such as dogs and foxes, may leave
punctured wounds adjacent to the damaged edge
where sharp teeth have penetrated.
• On bones, the incisor teeth of rodents and larger
carnivores can leave parallel gouges.
 QUIZ

• 1. What is the difference between algor mortis

and livor mortis?

• 2. If at autopsy the body is cold and stiff, what is

the estimated post mortem interval?

• What is marbling due to?