1

MEDICO-LEGAL ASPECT OF
DEATH
DEATH 2

is defined as the permanent cessation of all

vital bodily functions: the end of life.
DEATH INVESTIGATION and THE LAW
Every death has actual or potential legal
implication
Death investigation procedures are design to
determine the precise factors surrounding death,
which will aid medical sciences and in some cases,
foster the administration of justice.
Fundamentals of death Investigation
3

 Death Investigation is the process that involves the collection

and analysis of data, physical evidence, and circumstances of
the event from which conclusion are derived or hypothesized.
 These data will direct further investigate to establish the
following:
 identification of decedent,
 Approximate interval of time since death
 Cause

 Manner and mechanism of death

Data necessary for medical investigation must observed
4
a consistent process:
1. The actual conduction of investigation
2. Evaluation of data obtained during investigation
3. Reinvestigation
4. Re-evaluation

The cause of death is certified and supported by the

findings of the investigation.
The medical investigation of forensic data include evaluations to determine a
cause and manner of death. Classic questions are asked: 5

WHO is/was the person?

 (confirm the identity beyond any doubt)

WHAT happened?
 ( stabbing, fall, collision)
 vectors and forces caused the death.
WHEN did the person die?
 The best estimate of time of death
 Essential information to help determine the circumstances and manner of
death.
WHERE did it happen? Where did the person die?
 Example, in the street , and in the hospital)
 Represent the location of the body was found.
 WHY did it happen? 6
 Arguments, lost consciousness, defective product
 Refers to the series of sequential circumstances pertaining
to events prior to death, at the time of death, and
immediately afterward.
HOW did it happen?
 Refers to a descriptive account of the circumstances of
WHY in an investigator’s report
Answer to these 6 questions will help establish
the cause of death
 Kinds of death 7
1. SOMATIC DEATH
 The state of the body in w/c there is complete, persistent
and continuous cessation of the vital functions of the brain,
heart and lungs w/c maintain life and health.
 A moment a physician or other members of the family
declare a person has expired and some of the early signs of
death are present.
 It is hardly possible to determine the exact time of death
 Immediately after death the face, lips become pale, the
muscles become flaccid, lower jaw tends to drop, eyelids
remain open, pupils dilate and skin losses its elasticity.
 KINDS OF DEATH

8
2. MOLECULAR OR CELLULAR DEATH
 3 to 6 hours later, there is death of individual cells.
 Presence of excitability of muscles and ciliary movements and
other functions of individual cells

 3. APPARENT DEATH OR STATE OF SUSPENDED

ANIMATION
 This condition is not really death but merely a transient loss of
consciousness or temporary cessation of the vital functions of
the body on account of the disease, external stimulus or other
forms of influence.
 Ex. A newly born child may remain at the state of suspended
animation and may die unless prompt action is taken
 It is important to determine the condition of suspended
animation to prevent premature burial.
 CAUSE OF DEATH
9
 There are two major categories of the cause of a medical
death:
1. Disease 2. Trauma
 The manner of death may be natural or unnatural.
Natural death – if it stems from congenital anomalies or disease
that interferes or disable vital organ functions.
Unnatural death – involves intentional acts such as homicide or
suicide as well as non-intentional traumatic antecedents.
When death result from violence or acts of war, poisoning, fire,
abuse, neglect, or environment toxins they are termed unnatural
 Signs of death
1. Cessation of heart action and circulation 10
2. Cessation of respiration
3. Insensibility of the body and loss of power to move
4. Cooling of the body (algor mortis)
 One of the most prominent signs of death (easily seen)
 After death the metabolic process inside the body ceases.
 No more heat is produced but the body loses slowly its
temperature by evaporation or conduction to the
surrounding atmosphere.
 Cooling of the body is not uniformed. Rapid during the
first 2 hours after death and until it approaches the
temperature of the surrounding.
 FACTORS INFLUENCING THE RATE OF
COOLING OF THE BODY
11
A. Conditions that are connected  B. Conditions that are connected
with the body with the surrounding
 1. Factors delaying cooling:  1. Factors delaying cooling:
 Sudden death in good  Clothing
health  Want of access of air to the
 Obesity of person body
 Death from asphyxia  Small room
 Death of the middle age  Warm surrounding
 2. Factors accelerating cooling:  2. Factors accelerating cooling:
 Leanness of the body  `Unclothed body
 Extreme age  Conditions allowing the access
 Long-standing or lingering illness of air
 Large room
  Cooling more rapid in water
than in air
 Estimating How Long A Person Has Been Dead From The Cooling
Of The Body:
12
 A. When the body temperature is normal at the time of death, the
average rate of fall of the temperature during the first two hours is ½
of the difference of the body temperature and that of the air
 Ex. Body temp is 37 C
surrounding temp. is 31 C
Average rate of fall of temp. for first 2 hours is 37-31 = 6 C (1/2 of 6
degree celcius is 3 )
1st 2 hours = 37- 3 = 34
 During the next 2 hours, the temperature fall is ½ of the previous
rate, and during the succeeding 2 hours, it is one-half of the last
mentioned rate.
34- 1.5 = 32.5 temp. of body during next 2 hours
* (1/2 of 3)
32.5 – 0.75 = 31.75 for the next succeeding 2 hours
 5. Changes in the skin
a. Skin is pale and waxy-looking due to absence of 13
circulation
b. Loss of elasticity of the skin
o Application of pressure after death the skin surface is
flattened.
o The body becomes flattened over areas which are in contact
with the surface it rest.
o This observed at the region of the shoulder blades, buttocks
and calves if the death occurs while lying on his back.
c. Opacity of the skin
o Exposure of the hand of a living person to translucent light
will allow the red color of circulation to be seen underneath
the hands
o The skin of a dead person is opaque due to the absence of
circulation
 cont,. Changes in the skin
 d. Effects of application of heat 14
o Application of melted sealing wax on the breast of a dead
person will not produce blister or inflammatory reaction on the
skin
o In the living, an inflammatory edema will be develop
 6. Changes in and about the eye:
a. Loss of corneal reflex – no reaction to what intensity of light
stimulus
o In living this can also be observes on the following conditions;
 General and local anesthesia
 Apoplexy- unconscious resulting from cerebral hemorrhage or stroke
 Uremia – kidney failure
 Epilepsy
 Narcotic poisoning
 b. Clouding of the cornea –the normal clear and transparent of
cornea is lost 15
o Becomes cloudy
o Opacity of the cornea may be found in certain diseases, like
cholera, and therefore is not a reliable signs of death
o When the eyes remain open, a thin film is observed within
minutes; CORNEAL CLOUDINESS develops within 2 -3
hours
o If the eyes are closed, corneal film is delayed by hours;
Corneal cloudiness may be delayed up to 24 hours or longer
 c. :
o Orbital muscles lose their tone making the intra-orbital tension
rapidly fall.
o The eyeball sinks into the orbital fossa
16
 d.“Tache Noir de la
Sclerotique” 17
o The spot which may be
oval or round and may
appear in the sclera a few
hours after death
o Due to the thinning of the
sclera thereby making the
pigmented choroid visible.
o Absence of Intraocular
Fluid suggests time of death
of AT LEAST 4 DAYS
 7. Action of heat on the skin: 18
o In dead person
 Only a dry blister is produced
 The epidermis is raised on pricking the
blister, no fluid is found
 There is no redness of the surrounding skin
o In living person
 The blister contains abundant serum and
area of vital reaction on the skin around is
present.
Changes in the body following death
19
 I. CHANGES IN THE MUSCLE
 After death, there is a complete relaxation of the whole muscular
system.
 Contractile for 3 to 6 hours after death, and later rigidity set in.
 Secondary relaxation of the muscle will appear just when
decomposition has set in.
 ENTIRE MUSCULAR TISSUE PASSES THREE STAGES
AFTER DEATH
1. Stage of primary flaccidity (post mortem muscular irritability)
2. Stage of post-mortem rigidity (Cadaveric rigidity, or death struggle of
muscles or Rigor Mortis)
3. Stage of secondary flaccidity or secondary relaxation
ENTIRE MUSCULAR TISSUE PASSES THREE STAGES
AFTER DEATH 20
 A. Stage of primary flaccidity (post mortem muscular irritability)
o The muscles are relaxed and capable of contracting when stimulated.
o This stage usually last about 3 to 6 hours after death.
o In warm places, the average duration is only 1 hour and 51 minutes
o The pupils are dilated, the sphincter are relaxed
o There is incontinence of urination and defecation
 B. Stage of post-mortem rigidity (Cadeveric rigidity, or death struggle of
muscles or Rigor Mortis)
o Whole body becomes rigid due to contraction of the muscles.
o Induced by stiffing and shortening of muscles after death due to loss of adenosine
triphosphate (ATP)
o Develops 3 to 6 hours after death and may last from 24 to 36 hours.
o Usually the whole body becomes stiff after 12 hours
o Usually starts at the muscle of the neck, and lower jaw and spread downward to
the chest, arms and lower limbs.
Body Temperature Stiffness of Body Time since
Death

WARM NOT STIFF < 3 HRS.

WARM STIFF BET. 3-8 HRS.

COLD STIFF BET. 8-36 HRS.

COLD NOT STIFF > 36 HRS.

 FACTORS INFLUENCING THE TIME OF ONSET OF
RIGOR MORTIS: 22
1. Internal Factors
(a) State of the muscle
 Rigor mortis appears late and duration is longer in cases where
the muscles have been healthy and at the rest before death
 Rigor mortis quickly develops in cases of:
 Animal having been hunted to death
 Prolonged convulsion and lingering illness
 Death from typhoid fever, cholera and phthisis (PTB)
(b) Age
 Rigor mortis has early onset in the aged and new-born
(c) Integrity of the nerves
 Section of the nerve will delay onset of rigor mortis as shown
in paralyzed muscles.
 2. EXTERNAL FACTORS

23
(a) Temperature
 The development of the rigor mortis is accelerated by
high temperature but a temperature above 75 °C will
produce heat stiffening.
(b) Moisture
 Rigor mortis begin rapidly but the duration is short in
moist air
 C. Stage of Secondary flaccidity or secondary relaxation
( Decay of the muscles.)
o Muscles becomes flaccid
o No longer capable of respond to mechanical or electrical stimulus
o This is due to dissolution of the muscle protein which have been previously been
coagulated during the period of the rigor mortis

II. Changes in the Blood 24
 (a) Coagulation of the blood
 Blood remain fluid inside the blood vessel
after death for 6 to 8 hours.
 (b) Livor Mortis
 Blood begins to accumulate in the most dependent
portion of the body
 The stoppage of the heart action and loss of tone of
blood vessels cause the blood to be under the
influence of gravity

Lividity usually appears 3
to 6 hours after death and
increases until blood
coagulates.
12 hours after death, the post
mortem lividity is already
fully developed. It involve
internal organ
25
 If the body is lying on his back,
the lividity will develop on the
back.
 Areas of the bone prominence
may not show lividity on the
account of pressure
 This process starts in 1-3 hours post
death and begins as mottled patches 26
of color, but over the next 3 to 6
hours it gradually spreads, affecting
larger areas.
 Livor mortis reflects the postmortem
interval (i.e, the time between death
and discovery of the body)
 27
 There are certain situations that
impact livor mortis development
including body position or position
changes and even poisoning
28
III. 29
PUTREFACTION
Putrefaction is the breaking
down of the complex proteins
into simpler components
associated with foul smelling
gasses and accompanied by the
change of color of the body
Putrefaction – action of bacteria
and microorganisms

The presence of
sulfmethemoglobin creates
a greenish discoloration
over the sacrum, flanks,
abdomen, genitalia and
other body parts.
 PUTREFACTION
30
 TISSUE CHANGES IN PUTREFACTION
A. Changes in the color of the tissue
 Hemolysis of the blood within the blood vessel
 Tissue color changed to greenish-yellow, greenish-blue or greenish-
black
 Blood escape into the cavities of the whole body
 Marbolization – this develops on both flanks of the abdomen, root of
neck, and shoulder and which makes the area look like a “marbled”
reticule of branching veins.
 B. Evolution of gases in the tissue 31
 Carbon dioxide, ammonia, hydrogen, sulphurated hydrogen,
phosphorette hydrogen and methane gases are formed.
 Formation of gases causes the distention of the abdomen and bloating
of the whole body.
FACTORS MODIFYING THE RATE OF PUTREFACTION
32
 A. INTERNAL FACTORS
1. AGE
 Healthy adult decompose later than infants
 2. CONDITION OF THE BODY
 Full-grown and highly obese person decompose more rapidly than skinny
ones.
 Bodies of still-born are usually sterile so decomposition is retarded.
 3. CAUSE OF DEATH
 Bodies of person whose death is due to infection decompose rapidly.
 Bodies whose sudden death is not due to microorganism decompose late.
 33
 B. EXTERNAL FACTORS
1. FREE AIR
 Accessibility of free air will hasten decomposition
 Moderate moisture will accelerate decomposition, but excessive amount will prevent
the access of the air to the body thereby delaying decomposition
 The optimum temperature for specific decomposition is 70° F (21°C) to 100°F (37.7
°C)
 Putrefaction prefers more on the absence of light
 2. WATER
 Decomposition in running water is more rapid than in still water.
 3. CLOTHING
 Clothing hasten putrefaction by maintaining body temperature but in the later stage, it
delay decomposition by protecting the body fro m ravages of flies and other insects.
 Tight clothing delay putrefaction due to decrease of blood in the area on account of
pressure.
PURGING – evacuation of
dark body fluids of 34
decomposition through the
nose and mouth as a result of
increased pressures within the
body.
35
36
 37
ADIPOCERE
 Formation of a waxy substance due to the
hydrogenation of body fat. A moist, anaerobic
 Creates a waxy appearance of fatty tissue in face,
extremities, buttocks and female breast.
 Seen in postmortem period, 3 weeks to 1 year, under
condition of high temperature and diminished
airflow.
 Environment is required for the formation of
adipocere.
 Adipocere It is formed by the slow hydrolysis of fats in
decomposing material such as a human cadaver by action of38
anaerobic bacteria.
 The transformation of fats into adipocere occurs best in the
absence of oxygen in cold and humid environment, such as in
wet ground or mud at the bottom of a lake or a sealed cask,
and it can occur with both embalmed and untreated bodies.
PUTREFACTION
ADIPOCERE 39
Duration of death 40

 Entomology of the Cadaver

 Common flies undergo larval, pupal and adult
stages.
 Usual time for the egg to be hatched into larva is
24 hours
 Maggots in the cadever, can conclude that death
has occurred more than 24 hours
41
Duration of death 42
 Stage of Digestion of Food in the Stomach
 It takes 3 to 4 hours for the stomach to evacuate its
content after meal.
 The approximate time of death may be deduced from the
amount of food in the stomach in relation to his last
meal.
 The estimation is dependent upon the amount of food
taken and the degree of tonicity of the stomach
 Factors that influence the decedent’s meal are:

a. Size of last meal

 The following emptying rates are given in the literature (Payne-
James): 43
 1. Light, small volume meal – 1 to 3 hours
 2. Medium-sized meal – 3 to 5 hours
 3. Large/heavy meals – 5 to 8 hours
 Note:
 At 6 hours after NPO (nothing per Orem), stomach is empty
irrespective of food type; 4-hour period ensures that the stomach is
empty
 It has been found that stomach contents which are readily identifiable
by the naked eye were usually ingested within a two-hour period
(Spitz and Fisher)
 b. Kind of meal
 c. personal variation – hypermotile stomach may enhance entry of
food into duodenum
stomach content 44
 Digestion does not stop at death but progresses due to enzymatic activity,
therefore the state of digestion of food is of little value (Payne-James)
 An ideal postmortem protocol of the rate of gastric emptying should
include:
• Nature, amount, size, and condition of stomach contents
• Microscopic examination of the contents if difficult to identify or
partially liquefied
• Examination of the small intestines for undigestible markers
• Toxicological examination of stomach contents
• Evaluation of the prior medical and psychological status and related
medications
 The use of gastric contents as a means of determining time of death
requires caution and careful review of all limiting factors
Duration of death 45
 Presence of Live Fleas in the Clothing in Drowning Cases
 A flea can survive for approximately 24 hours submerged in water.
 Cannot be revived if submerged more than 24 hours
 If the body found in water, fleas may be found in the woolen clothing
 The fleas recovered must be placed in watch glass and observed if it is
still living.
 If it still move, then the body has been in water for a period of less than
24 hours.
Duration of death 46

 State of Clothing
 A circumstantial proof of the time of death is
the apparel of the deceased.
 If the victim is wearing street clothes, there is
more like hood that death took place at
daytime,
 But if in night gown or pajama, it is more
probable that death occurred at night time.
Duration of death 47

 Post-Mortem Clotting and Deco agulation of

Blood
 Blood clots inside the vessels in 6 to 8 hours
after death.
 Presence or Absence of Soft Tissues in Skeletal
Remains
 Under ordinary condition, soft tissue of the
body may disappear 1 to 2 years time after
burial
 Disappearance of the soft tissue varies and
influenced by several factors
MECHANISM OF DEATH
48
 Is defined as the physiologic derangement or biochemical
disturbance incompatible with life, which is initiated by
the cause of death
 Mechanism of death is distinct from the cause, which
initiates the ,mechanism sequence of factors incompatible
with life. For example:
 A stab wound (cause) may lead to blood loss and
collapse of lung, resulting to hemorrhagic shock
(mechanism)
 It may also referred to as the mode of death as often seen
on the death certificate
 Mechanism of death (not cause) include hemorrhagic
(hypovolemic) shock, respiratory depression, paralysis,
sepsis with profound bacterial toxemia and so on.
 CAUSE MECHANISM MANNER
49

Atherosclerotic
coronary Heart failure natural
artery disease
Internal or external Homicide, suicide
Stab wounds blood loss or accident

Hanging asphyxia suicide

strangulation asphyxia homicide

Basic knowledge regarding the scientific 50
investigation of death involves the following:

I. a. Identification of trauma
b. natural disease process
c. self-inflicted wounds versus inflicted by another
d. pharmacology
e. toxicology – poison and their effects
f. entomology- zoology that deals with insects
g. anthropology – (heredity, culture,
environmental and social relation)
Basic knowledge regarding the scientific investigation of
death involves the following: 51

II. a. recognition of wound characteristics related to

injuries resulting from weapon used to inflict death
range from the subtle.
b .innocuous signs of abuse or neglect to catastrophic
fatal injuries or mutilation of bodies before and after death.
III. a. Recovery and documentation of evidence
b. collection and preservation of collected evidence
c. security of evidences are primary responsible of
death scene investigator
IV. Notification of next kin in a personal, timely, 52
compassionate, and sensitive approach.
 At the scene of death, the responding investigator
assesses the circumstances of death, observing for
indicators of violence, poisoning, homicide, suicide
or accident.
 the investigator interview the decedent’s family or
significant others at the scene to determine if the
person has a notable medical history, name of
physician, document any medication or other clues at
the scene that might reveal an associate medical
condition.
 53

Forensic autopsy should precede

embalming procedures, because body
alteration and use of embalming fluids
affect the appearance and characteristics of
body surface, organs, and tissues and the
blood.
 AUTOPSY 54
 is a comprehensive study of a dead body, performed by a
trained physician employing recognized dissection techniques.
it includes removal of tissues for histopathological
examination
 post-mortem examination or obduction
 is a medical procedure that consists of a thorough examination
of a human corpse to determine the cause and manner of a
person's death and to evaluate any disease or injury that may
be present
LEGAL PERSPECTIVE
In the Philippines, the only law
governing the conduct of an
autopsy upon the body of the
deceased lies with PD 856 – The
Code on Sanitation
 Section 91 – Burial Requirements
Paragraph F:
“If the person who issues a death certificate has
reasons to believe or suspect that the cause of
death was due to violence or crime, he shall
notify immediately the local authorities
concerned. In this case the deceased shall not be
buried until a permission is obtained from the
provincial or city fiscal. If these officials are not
available the permission shall be obtained from
any government official authorized by law.”
PERSONS AUTHORIZED TO PERFORM AUTOPSY
57
 PD856 section 95. Autopsy and Dissection of
Remains- the autopsy and dissection of remains are
subject to the following requirements:
 Persons authorized to perform this are:
1. Health officers,
2. Medical officers of law enforcement agencies,
3. Members of the medical staff of accredited
hospitals
CASES WHERE AUTOPSY IS PERFORMED
58
 PD 856 section 95 b – Autopsies shall be performed in the
following cases:
 Whenever required by special laws,
 Upon orders of a competent court, a mayor and a provincial
or city fiscal,
 Upon written request of police authorities,
 Whenever the solicitor general, provincial or city fiscal as
authorized by existing laws, shall deem it necessary to
disinter and take possession of remains for examination to
determine the cause of death,
 Whenever the nearest kin shall request in writing the
authorities concerned to ascertain the cause of death
 59
Autopsies may be performed on patients who die in accredited
hospitals subject to the following requirements:
 1. The Director of the hospital shall notify the next of kin of
the death of the deceased and request permission to perform an
autopsy.
 2. Autopsy can be performed when the permission is granted
or no objection is raised to such autopsy within 48 hours after
death.
 3. In cases where the deceased has no next of kin, the
permission shall be secured from the local health authority.
 4. Burial of remains after autopsy After an autopsy, the
remains shall be interred in accordance with the provisions in
this Chapter
 60
TYPES OF AUTOPSY
a. Clinical or Academic Autopsy

b. Forensic or Medico-Legal Autopsy

CLINICAL AUTOPSY
61
The clinician is mainly concerned with the inside
of the body and with the processes of nature, as
well as thee location/ presence/ absence of natural
disease..
cause of death is known
exam is held to confirm the diagnosis
seeks to learn the extent of a disease
for academic interest
needs consent from the relatives
partial/ hospital based
MEDICO-LEGAL OR FORENSIC AUTOPSY 62
Is mainly concerned with the exterior of body, vectors, forces,
directions, body positions, physical capabilities, cause and
manner of death.
performed on instruction of a legal authority
performed on deaths that are sudden, suspicious, obscure,
litigious, criminal (murder, homicide…) and non-criminal
(accidents, suicide, industrial, medical/surgical…)
may not require consent from relatives
complete/ non-hospital setting
OBJECTIVES OF FORENSIC AUTOPSY
to make positive identification of the body 63
to assess the size and physique and nourishment of the body
to determine the cause/time of death
to determine the mechanism/manner of death
to demonstrate all external and internal abnormalities
to obtain samples for analysis, microbiology and
histopathology
to obtain photos and videos for evidentiary and teaching
purposes
to provide a full written report
to offer an expert opinion or interpretation
IDENTIFICATION OF THE BODY 64

 If the identity of the body is unknown,

every effort must be taken to establish who
the individual was.
 Ifcomplete identification is not possible,
noting the height, weight, age, sex, tattoos,
and scars should contribute to the process
of identification.
 Factors such as dental status, race, religion,
and other characteristics may also assist in
verification of identity.
EXTERNAL EXAMINATION
 This is a detailed head to toe examination of the 65
naked body, documenting stains and soiling, general
and specific individualizing characteristics, post-
mortem changes (temperature, lividity, rigor
mortis,putrefaction).
 The location, extent and type of staining or soiling of
the body are described
 e.g.dual flow pattern of blood from a wound, high
velocity impact blood spatter from gunshot wound,
coffee grounds vomitus and melena (upper
gastrointestinal hemorrhage), antiseptic from
medical intervention
General body characteristics are recorded,
namely:- 66
1. racial group, height, weight, head hair (colour, dyed, length,
style, balding),
2. eyes (colour, pupil size, conjunctival congestion or petechial
haemorrhages, jaundice, prosthesis),
3. nose and ear canals (blood, pus), earlobes (piercing, earlobe
creases),
4. face (hirsute woman, clean shaven, beard, moustache), mouth
(vomit, blood, tablet debris, teeth, dentures),
5. Breasts (normally developed, atrophic, hirsute)
6. genitalia (pubic hair pattern, circumcised, palpable testes),
7. feet(general hygiene, bunions, ingrowing nails).
More specific identifying characteristics are described fully: 67
 tattoos (location, design, colour, names),

 scars (surgical and non-surgical, needle tracks, striae),

 skin lesions (naevi, senile keratoses, other skin diseases),
prosthesis, pacemaker.
Post-mortem changes are documented, namely:-
 body temperature to touch (alternatively state if the body has
been refrigerated),
 rigor mortis (extent and degree),
 hypostatic lividity (distribution, dual pattern, colour, contact
pallor), putrefactive changes.
 68

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