DEATH AND POST MORTEM

CHANGES

DR ATWINE RAYMOND

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 Death
 No legal definition.
 Doctor to decide about death certification.

Types of death: -
 Somatic (clinical) death
 Molecular (cellular) death

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 Somatic death-the person irreversibly loses
its sentient personality, being unconscious,
unable to be aware of (or to communicate
with) its environment, and unable to
appreciate any sensory stimuli or to initiate
any voluntary movement.
 Reflex nervous activity may, however,
persist, and circulatory and respiratory
functions continue either spontaneously or
with artificial support so that the tissues and
cells of the body, other than those already
damaged in the central nervous system, are
alive and functioning.
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 Cellular death -the tissues and their
constituent cells are dead – that is, they no
longer function or have metabolic activity,
primarily aerobic respiration.
 Cellular death follows the ischaemia and
anoxia inevitably consequent upon
cardiorespiratory failure, but it is a process
rather than an event.
 Different tissues die at different rates, the
cerebral cortex being vulnerable to only a few
minutes’ anoxia, whereas connective tissues
and even muscle survive for many hours, even
days after the cessation of the circulation.
 Physiological window
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 Medicolegal aspects of brain death
 Several decades ago a number of fatal assaults
were defended in court on the basis that the
original head injuries led to the victims being
placed on life-support machines that were later
disconnected when brainstem death was
diagnosed.
 The defence was that the assailant did not ‘kill’ the
victim, because ‘death’ was caused by the action of
the doctors switching off the machine.
 Judicial decisions have disposed of this defence;
first, that death was diagnosed by the doctors
before discontinuing artificial ventilation and,
second, that the criminal act that initiated the train
of events was not remote enough to avoid
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culpability for the death.
 Physical Signs For Death
Certification
 Absence of radial pulse, apex beat and
respiratory movement.
 Absence of respiratory and heart sounds.
 Loss of reflexes of cornea and pupils (not
reliable sign).
 Pallor of skin and mucous membrane (not
reliable sign).

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 Changes After Death
1. Early Post-Mortem Changes
 Skin changes
 Eye changes
 Post-mortem staining/hypostasis/lividity
 Cadaveric changes in muscle: -
 Primary relaxation
 Rigor mortis
 Secondary relaxation
 Cooling of the body
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2. Late Post-Mortem Changes

 Decomposition (Putrefaction)
 Adipocere (Saponification)
 Mummification

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 Changes in Skin
 Loss of elasticity
 Pale and ash-white colour

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 Changes in the Eyes
 Lossof reflexes (corneal and pupillary)
 Corneal opacity and clouding (2 hours).
 Taches noires sclerotiques (3 hours).

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Post-Mortem Staining (Hypostasis)

 Reddish purple or bluish discoloration of

skin and organs due to accumulation of
blood in toneless capillaries and small
veins in dependent parts due to gravity.

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1. Chronology of Post-mortem Staining

 Mottled patches appear ½ to 1 hour

 Patches gradually increase in size and fuse
in about 3 hours
 Fully developed (6-12 hours) and relatively
fixed (6-8 hours)
 Absent in areas of contact flattening.

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 Factors affecting development of post
mortem lividity

 Heat , sepsis , heart failure may accelerate

fixation of lividity

 Fixationof lividity is delayed by internal

/external hemorrhage and cold

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4. Medico-Legal Importance of Post-
Mortem Staining

 Position of body – change in position

 Time since death ( staining is fixed or
not)
 Its distribution may suggest manner of
death
 Inappropriate lividity patterns or
locations may suggest a body has
been moved after death
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Colour of PM staining may suggest
cause of death
Carbon monoxide poisoning ( Cherry Red).
Cyanide poisoning (Brick Red).
Exposure to cold (Cherry red).
Asphyxia (Deeply bluish, violet or purple).

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 Cooling of the Body (Algor Mortis)

1. Body loses heat until it reaches

temperature of its surroundings.
2. Temperature recorded by inserting a
chemical thermometer (25cm long) into
rectum or under liver for 2-3 minutes.
3. Estimation of time of death from cooling
of the body
4. Body temperature reaches atmospheric
temperature in about 12-18 hours.
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 Estimation of time since death from
cooling of the body
 Moritz’s formula ( 98.6˚ F- rectal temp)
divided by 1.5 hrs= hours since death
 Alternate formula:--

a body cools at 1.5˚F/hour for first 12

hours after death , then 1˚F/hour for next
12-18 hours.

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 Factors Modifying Cooling of Body

 Differencein temperature between body

and surrounding
 Build/Physique of cadaver
 Environmental temperature of body
 Temperature of body at the time of death
and Post-mortem caloricity
 Amount of clothing /bedding

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 Post-mortem Caloricity

 Temperature rise observed for the first two

hours or so in bodies after death from: -
 Excessive bacterial activity
 Regulation of heat production disturbed
before death
 Great increase in heat production in muscles
before death.

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 Cadaveric Changes in Muscles
1. Primary Relaxation/Flaccidity
1. Denotes somatic death: last 2-3 hours
2. Characterized by;
 Relaxation of joints
 Contact flattening
 Muscles respond to external stimuli

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Rigor Mortis: stiffening of the body
1. Stiffening of muscle fibres.
2. Physico-chemical process (ATP
reduction).
3. Involves voluntary and involuntary
muscles.
4. First appears in involuntary muscles –
myocardium (1 hour).

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5. In voluntary muscles – sequence in
proximodistal.
6. Disappears in the same order in which
it appeared.
7. Testing of rigor mortis: Bending of
joints.
8. Breaking of joints.

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Chronology of Rigor Mortis
 Onset after 2-3 hours of death (summer)
 Whole body stiff in about 12 hours
 Persists for another 12 hours
 Disappears in about 18-24 hours (summer)
Effects of Rigor Mortis
 Joints fixed markedly
 Goose skin
 Discharge of semen
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 Conditions affecting rigor mortis
development
 Delayed by  Accelerated by

1. cold 1. activity
2. diminished 2. hyperthermia
musculature 3. certain drugs and
poisons

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Medico-Legal Importance of Rigor Mortis

 Estimation of time of death.

 Position of body at time of death (if body is
already in rigor mortis and is moved from
scene of death, it will remain so).
 Inappropriate rigor may indicate a body was
moved several hours after death.

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Conditions simulating Rigor Mortis

Cadaveric spasm (instantaneous rigor)

Cold stiffening
Heat stiffening

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 Cadaveric Spasm

1. Ante-mortem muscular contraction

continues after death and seen in: -

1. Rapid death (sudden death)

2. Emotional tension at time of death
3. Great muscular activity at time of death

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2. No primary relaxation
3. Only voluntary muscles are involved
4. Can not be produced artificially
5. Cadaveric spasm records last act of life
and may be helpful in indicating manner
of death (accident/suicide/homicide).

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 Cold Stiffening (Freezing)

 Exposure to freezing temperatures,

tissues become frozen and stiff due to
solidification of body fats and fluids.

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 Heat Stiffening (Heat rigidity)

 Coagulation of muscle proteins due to

exposure to temperature above 65°C
 Rigor mortis does not develop
 Body in pugilistic attitude
 Stiffening persist until decomposition sets in.

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 Decomposition
1. Starts at cellular level soon after death, usually
follows rigor mortis.
2. caused by a combination of autolysis and
putrefaction
1. Autolysis ( digestion of cells and tissues due
to intrinsic enzymes and proteins)
2. Putrefaction ( tissue breakdown as a result
of bacterial action )
(In most environments, putrefaction
dominates)

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 Autolysis

1. Enzymes released from tissues cause

auto digestion and disintegration of
organs.
2. Commences after 3-4 hours after
death and continues steadily for about
2-3 days.
3. Prevented by freezing

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Bacterial Action (Putrefaction)

1. Clostridium welchii and other

organisms like staphylococci, B
Proteus, release enzymes, which
cause breakdown of various body
tissues and gas formation.
2. Lecithinase enzyme produced by C.
Welchii dissolves cell membranes.
3. C Welchii forms gas (H2S)
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 Features of Decomposition

1. Colour changes
2. Development of foul smelling gases
3. Pressure effects of gases
4. Softening and liquefaction of tissues
5. Appearance of maggots
6. Skeletonisation

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 Colour Changes
1. Greenish discoloration at the right iliac
fossa due to formation of sulph-
methaemoglobin (18-24 hours in
summer).
2. Discoloration spreads all over the body
(24-28 hours).
3. Greenish brown or purple red vein:
marbling of veins (36-38 hours).
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 Development of Foul Smelling Gases

1. Body emits foul, unpleasant odor due to

gases formation (H2S, CO2methane, etc.)
2. Distension of abdomen – 18 -24 hours
during summer.
3. Rigidity of tissues – 24 – 36 hours during
summer.

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 Pressure Effects of Putrefactive Gases

1. Bloating of features (36-48 hours during

summer).

2. Shifting of post-mortem staining

3. Skin blisters (36-48 hours) and skin

spillage , loose hair/nails (48-72 hours
during summer).
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4. Extrusion of blood stained frothy fluid
from mouth and nostrils

5. Ante-mortem wounds altered.

6. Female genitalia pendulous (36-48

hours).

7. Expulsion of fetus (48-72 hours).

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 Bloody fluid, which is tissue liquefaction
stained by haemolysis, may leak from any
orifice, especially the mouth, nostrils,
rectum and vagina

 Tothe inexperienced, this may suggest

evidence of some lethal haemorrhage

 Pressure inside the chest due to gas

formation in the abdomen may expel air,
so that the fluids of decomposition in the
trachea and bronchi may be blown into a 66

bloody froth from the mouth and nostrils

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 Appearance of Maggots
1. 24 h 4-5 days 4-5 days
Eggs Maggots Pupae Adult flies
2. Ants bite simulate AM abrasion

 NB: Do not attempt to identify

source/type of fly responsible for
maggots. It is the Entomologist’s job!

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 Other squeale: Skeletonisation
1. Larynx and trachea
• 18 – 24 hours during summer
2. Stomach and intestines
• 24 – 36 hours during summer
3. Liver (foamy liver)
• 36 – 48 hours during summer
4. Lungs and brain
• Soft 1 -2 days, liquefies 3 – 4 days
5. Virgin uterus/Prostate resist putrefaction
for a long time. 69
 Decomposition in immersed
bodies
 Water, in fact, slows up putrefaction, mainly because of
the lower ambient temperature, and protection from insect
and small mammal predators.
 Gas formation is the reason for the inevitable flotation of
an unweighted body, though the time of reappearance at
the surface is extremely variable (12-18hrs in summer).
 The usual posture of a freely floating body is face down,
as the head is relatively dense, and does not develop the
early gas formation in the abdomen and thorax
 This lower position favours fluid gravitation and hence
more marked decomposition, so that the face is often
badly putrefied in an immersed body, making visual
recognition difficult or impossible at an early stage.
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Decomposition in buried bodies
 The rate of decay of bodies buried in earth
is much slower than of those in either air or
water. In fact the process of putrefaction
may be arrested to a remarkable degree in
certain conditions, allowing exhumations
several years later to be of considerable
value. In this respect the prospect of an
exhumation should never be dismissed on
the grounds that because of the lapse of
time, it is bound to be worthless.
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 The speed and extent of decay in interred
corpses depends on a number of factors.
If the body is buried soon after death,
before the usual process of decay in air
begins, putrefaction is less and may never
proceed to the liquefying corruption
usually inevitable on the surface A lower
temperature, exclusion of animal and
insect predators, and lack of oxygen are
important factors.

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 Deep burial, as in the usual cemetery interment,
preserves the corpse better than the shallow
grave seen in some concealed homicides. The
deep burial is colder (except in extremely cold
weather), it excludes air better and, unless
waterlogged, is not directly affected by rain.
 The nature of the soil is not directly relevant
except in its drainage and aeration properties.
Heavy clay will exclude air and, if well above the
water table, will exclude percolating surface
water. By contrast, light sandy soil may allow
access of both air and rainwater, but will drain
more effectively
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 Another factor that aids the preservation of
legitimately buried corpses is the coffin.
Though modern coffins are often of
wooden laminate or chipboard, which
rapidly disintegrates when wet, any kind of
coffin helps to exclude water and air for a
time.
 A substantial, sound jointed coffin may last
for years and the modern rarity of a sealed
metal liner can keep a body in an excellent
state of preservation for a long time.
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 Factors Modifying Decomposition Process

Accelerants Decelerants

 Antemortem  Refrigeration
sepsis/infection  Cold environment
 Moisture/ hot  Exposure to cool
environment
surfaces
/hyperthermia
 Air conditioning
 Clothing (heavy) or
bedding
 Hypothermia
 Obesity
 Embalming
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 Advanced ( over 4 to 5 days PM)
 Continued progression of changes described
above
 Hot and dry climate: mummification due to
tissue desiccation
 Cold and wet climates: adipocere formation due
to conversion of free fatty acids into soaps by
the action of Clostridium species
 Skeletonization : occurs over weeks to months

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 Adipocere (Saponification)
1. Due to hydrolysis and hydrogenation of
body fats into substance, Adipocere,
under influence of bacterial enzyme
(lipase).
2. Adipocere (yellowish, white greasy wax-
like).
3. Moisture/warm temperature – essential.
4. Time required 3 weeks to 12 months
(variable).
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 Mummification
1. Dehydration/desiccation of tissues.
2. Body becomes thin, brownish black and
brittle.
3. Hot dry climate and absence of moisture
essential.
4. Process takes about 1 – 2 months.

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 Medico-Legal Importance of
Adipocere/Mummification
1. Ability to preserve the body, which can
aid in personal identification and
recognition of injuries.
2. Cause of death may be ascertained.
3. Time since death may be determined.
4. Place of burial.

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 Animal predation (anthropophagy)
 Refer to tissue destruction occurring after
a death as a result of animals feeding on
the body .

 It
may be due to the activity of pets or
wildlife

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 Maceration
1. Death in -utero results in maceration
(systemic autolysis ) rather than
decomposition due to the sterile intra-
uterine environment..
2. Bacterial putrefaction plays no role in the
process.
3. The changes of maceration are only
seen when a still-born fetus has been
dead for several days before delivery.
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 Post-Mortem Findings in Maceration

1. The body is extremely flaccid with a flattened

head and mobility of the skull.
2. The limbs may be readily separated from the
body.
3. There are large moist skin bullae, which
rupture to disclose a reddish-brown surface
denuded of epidermis.
4. The body has a rancid odour but there is no
gas formation.

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