Stages of death can be classified into immediate, early, and late changes. Immediate changes include irreversible cessation of brain function, respiration, and circulation. Early changes involve loss of skin elasticity and pallor, muscle relaxation, and eye changes. Late changes include algor mortis (body cooling), livor mortis (postmortem lividity), rigor mortis (muscle stiffening), and eventual decomposition through autolysis and putrefaction. Understanding these postmortem changes can help estimate time of death and determine cause.

1. STAGES OF
DEATH
SUBJECT: FORENSIC MEDICINE

2. INTRODUCTION
– Definition: Thanatology (Greek thanatos: death) is the scientific study of death
in all its aspects including its cause and phenomena. It also includes bodily
changes that accompany death (postmortem changes) and their medico-legal
significance.
– The changes which occur after death are helpful in estimation of the
approximate time of death and to differentiate death from suspended
animation. It can be classified into:
– Immediate changes
– Early changes
– Late changes

3. CHANGES AFTER DEATH
IMMEDIATE CHANGES EARLY CHANGES LATE CHANGES
Irreversible cessation of: Loss of elasticity of the skin, & facial pallor Decomposition
Function of brain Primary relaxation of the muscles Modifications of
Putrefaction
Circulation Contact pallor and flattening
Respiration Changes in the eye
Algor mortis
Livor mortis
Rigor mortis

4. IMMEDIATE CHANGES
(SOMATIC DEATH)
• Somatic death is the permanent, irreversible death of an organism as a whole.
• Traditionally the concept was that it occurs when there is irreversible cessation of
heart, lungs and brain [Bichat’s criteria].

5. IMMEDIATE CHANGES
(SOMATIC DEATH)
– Irreversible cessation of the function of brain including brainstem:
 Stoppage of functions of the nervous system
 Insensibility and loss of both sensory and motor functions
 Loss of reflexes, no response and no tonicity of the muscles.
 Pupils are widely dilated.
 This condition is sometimes seen in:
• Prolonged fainting attack
• Vagal inhibitory phenomenon
• Epilepsy, mesmeric trance, catalepsy, narcosis, electrocution.

6. IMMEDIATE CHANGES
(SOMATIC DEATH)
– Irreversible cessation of respiration:
 Complete stoppage of respiration for > 4 min
 Stoppage of respiration can be established by the following tests:
i. Inspection: No visible respiratory movement.
ii. Palpation: No respiratory movement can be felt.
iii. Auscultation: Breath sounds cannot be heard from any part of the lungs.
 Feather test, mirror test and Winslow's test are no longer utilized.
 Respiration may stop briefly without death as in:
• Voluntary breath holding
• Drowning
• Cheyne-Stokes respiration
• Newborns.

7. IMMEDIATE CHANGES
(SOMATIC DEATH)
– Irreversible cessation of circulation:
 Stoppage of heart beat for > 3–5 min
 Tests performed to test circulation:
i. Radial, brachial, femoral and carotid pulsations will be absent, if the circulation has stopped.
ii. Auscultation of heart: Absence of the heart beat over the whole precordial area and
particularly over the area of the apex.
iii. ECG: In case of cessation of circulation, the ECG curve is absent and the tracing shows a flat
line without any elevation or depression.
iv. Other tests: Various tests, like diaphanous, magnus, I-card, pressure, cut and heat tests are
now obsolete.

8. TEST TO DETECT STOPPAGE
– BRAIN FUNCTION (Tests for “sensibility”)
 Blowing a strong stimulant such as hellebore or mustard into the nose
 Inserting a sharp instrument under the nail
 Cauterization or incisions
 Scalding with hot water or oil
 Trumpeting or loud noises
– TESTS FOR RESPIRATON
 Winslow’s test
 Mirror test
 Feather test
 Other (Submerging the body in water to detect bubbles produced by respiration)

9. TEST TO DETECT STOPPAGE
– TESTS FOR CIRCULATION:
 Magnus test (ligature test)
 Icard’s test
 Diaphanous test (transillumination test)
 Finger nail test
 Other tests
o Cutting a small artery
o Heat test

10. SUSPENDED ANIMATION
(APPARENT DEATH)
– Definition: Suspended animation is a condition in which vital signs of life (heart
beat and respiration) are not detected by routine clinical methods, as the
functions are interrupted for some time or are reduced to a minimum.
– Mechanism: The metabolic rate is greatly reduced so that the requirement of
the individual cell for oxygen is satisfied through the dissolved oxygen in body
fluids.
– Types:
Two types:
i. Voluntary: Seen in practitioners of yoga or in trance.
ii. Involuntary: Seen in hypothermia, poisoning with barbiturates or opiates, newborns,
drowning, electrocution, heatstroke, cholera, postanesthesia, shock, cerebral
concussion or insanity.

11. EARLY CHANGES
(MOLECULAR DEATH)
– Changes in the skin and facial pallor
– Primary relaxation or flaccidity of the muscles
– Contact flattening and pallor
– Changes in the eye
 Loss of corneal and pupillary reflexes
 Pupils
 Opacity of the cornea
 Tache noire
 Loss of intraocular tension
 Changes in the retina
 Vitreous potassium and hypoxanthine

12. ALGOR MORTIS
(COOLING OF BODY)
– Definition: Algor mortis (Latin algor: coolness, mortis: death) or chill of death is the
cooling of the body that normally takes place after death, where the body temperature
equilibrates with its environmental temperature.
– Salient features:
 Transfer - During life heat is constantly transferred from one body part to other by
conduction as well as convection [through flow of blood]. After death this occurs only
through conduction, as blood flow stops.
 Heat production - There is some production of heat during initial period after
somatic death due to two mechanisms:
(i) ATP molecules breaking down [up to 2 h only]
(ii) Anaerobic glycolysis [much longer]. Because of this, rectal temp falls little or not
at all during first 2 hours.

13. ALGOR MORTIS
(COOLING OF BODY)
 Cooling – occurs from the surface of the body to the surroundings. It occurs due to temp difference
between the body and surroundings [air, water etc]. If the temperature of surroundings is higher,
the body temp may actually rise.
 Core temp:
(i) Core temperature is the temp of the viscera. It is slightly lesser as compared to surface temp of
the body.
(ii) Core temp is a better guide to TSD than surface temp.
 Ambient temperature – Human body rarely reaches the ambient atmospheric temperature unless
the latter is at or near freezing point. This is because of the heat released due to enzymatic and
bacterial actions on the body.
 Site to take temp from: (i) Rectal - Best method.

14. ALGOR MORTIS
(COOLING OF BODY)
 Method of recording temp:
(i) By touching
(ii) Lab thermometer
(iii) Thermocouple
 Things to be recorded:
(i) Temp of body
(ii) Temp of environment
(iii) Time of recording
 Number of recordings - at least 5 at half hour intervals, so rate of fall may be obtained.

15. ALGOR MORTIS
(COOLING OF BODY)
 Calculation of TSD (in hours):
Normal Rectal Temperature – Measured Rectal Temperature
Rate of fall of temperature / hour
(i) Rectal temperature is higher in case of struggle or exercise prior to death.
(ii) Low temperature is seen in congestive cardiac failure, hemorrhage, collapse and secondary
shock.
TSD= 98.6ᵒF – Rectal Temp(ᵒF)/1.5

16. ALGOR MORTIS
(COOLING OF BODY)
– Factors affecting Algor Mortis
 Environmental temperature (major factor)
 Air movement
 Humidity
 Media of disposal
 Built of cadaver
 Age and sex
 Clothing or coverings of the body
 Position and posture of the body
 Mode of death

17. ALGOR MORTIS
(COOLING OF BODY)
– Medico-legal Importance of Algor Mortis:
i. It is a sign of death.
ii. It helps in the estimation of the time of death.
iii. Rapid cooling of a dead body delays the processes of rigor mortis and
decomposition. If the heat is preserved for a longer period, then both the processes
start early.

18. LIVOR MORTIS
(POSTMORTEM LIVIDITY)
– Postmortem lividity (syn: cadaveric lividity, darkening of death, hypostasis, livor mortis (L.
Livor, blueness; mortis, death), livores, postmortem hypostasis, postmortem lividity,
Postmortem staining, subcutaneous hypostasis, suggillation) is the:
(i) Bluish-purple or purplish-red discoloration
(ii) Which appears after death,
(iii) On the most dependent parts of the skin
(iv) Due to collection of blood in the capillaries and small veins (rete mucosum) of the
most superficial layers of the dermis
(v) Due to gravity.

19. LIVOR MORTIS
(POSTMORTEM LIVIDITY)
– Salient features:
(1) Cause:
(i) Stoppage of circulation
(ii) tendency of blood to sink by gravity to the most dependent parts; its collection in toneless BV and
capillaries
(iii) Backward flow – of venous blood to the capillaries from the venular end [adds to the blueness of
pm staining]
(2) Color:
(i) Hue – Bluish purple, but may vary in different parts of the body
(ii) Intensity – depends upon the amount of reduced Hb in the blood. Large amounts of reduced Hb
produce deep purplish coloration
(iii) Portions drained of blood – become correspondingly pale
(iv) may depend on cause of death.

20. LIVOR MORTIS
(POSTMORTEM LIVIDITY)
Etiology Color of Liver Mechanism
Normal Red-Blue-Purple Venous Blood
Carbon Monoxide Pink, cherry-red Carboxyhemoglobin
Cyanide Pink, cherry-red Excessive oxygenated blood
because of inhibition of
cytochrome oxidase
Refrigeration/hypothermia Pink, cherry-red Oxygen retention in
cutaneous blood by cold air
Hydrogen sulfate Green Sulfhemoglobin
Sodium chlorate Brown Methemoglobin

21. LIVOR MORTIS
(POSTMORTEM LIVIDITY)
(3) Place:
(i) In general – well marked in lobes of ears and in tissues underneath fingernails
(ii) back of chest and abdomen in supine position. Most common
(iii) front of chest and abdomen in prone position;
(iv) lower legs and hands in hanging
(v) Face in drowning [in drowning, face is the most dependent part]. On the contrary, antigravity regions
of the body are drained of blood and become pale.
(4) Visibility:
(i) More clearly seen in
(a) fair skinned people
(b) young having good nutrition and normal hemogram
(ii) Less clearly appreciated in
(a) dark colored people
(b) old, anemic persons

22. LIVOR MORTIS
(POSTMORTEM LIVIDITY)
(5) PM staining and congestion:
(i) True congestion
(ii) Hypostatic congestion – may occur even a few hours before death in persons dying slowly with
circulatory failure, eg asphyxia, CCF, cholera, coma [deep], poisonings.
– Medico-legal Importance of PM Staining
i. It is a sign of death.
ii. The time since death can be roughly estimated from the formation, extension and fixation of the
postmortem staining.
iii. It indicates the posture of the body at the time of death
iv. It may indicate the moving of the body to another position sometime after death.
v. Cause of death may be judged from the distribution and color of postmortem staining.
CONGESTION
PM STAINING

23. L
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Differentiation: PM staining and bruise
S.No. Feature PM staining Bruise
1. Situation On the dependant parts Anywhere
2. Tissue level Undersurface of the skin Subcutaneous tissue level
3. Surface Not elevated May be slightly elevated
4. Margin Sharp and clearly defined Diffuse
5. Color Bluish or purplish red Reddish when fresh, change in color occurs
with time
6. Cause Capillo-venous distension with blood Extravasation of blood from capillaries
7. Nature of change Postmortem Antemortem
8. Effect of pressure Pressed spot appears pale No change
9. Cut section Oozing of blood from the vessels which
can
Hemorrhage in the tissue which
be cleaned by washing cannot be washed
10. Microscopically Engorgement of capillaries infiltration Extravasation of blood, cellular infiltration
11. Enzymatic study No change Change in the level of certain enzymes
12. Medico-legal importance Time of death and position of the body Nature of injury and weapon used may
may be known be known

24. PM STAINING AND BRUISE
PM STAINING BRUISES

25. BLANCHING:- It is the area where the livor mortis is absent: the involved body surface appears pale to
white, in contrast with the surrounding red/purple skin. This contact blanching may capture
the shape and pattern of objects that were in contact with the dependent parts of the body
surface during livor mortis formation.
TARDIEU SPOT:- Purple to black spots on the skin that can develop along with lividity, from the rupture
of capillaries.
BLANCHING TARDIEU SPOTS

26. RIGOR MORTIS
(STIFFNESS AFTER DEATH)
– Definition: Rigor mortis (Latin, stiffness of death) is that state of the muscles in a dead body when
they become stiff or rigid with some degree of shortening.
– Rigor can be seen within 30 min. to 1 hour after death.
– Covers the entire body after 8-12 hours.
– Complete Rigor will remain for about 8-12 hrs.
– Rigor begins to dissipate over the next 12 hrs.
– This is dependent on environmental temperatures
– Fully flaccid body by 36 hours.
– Mechanisms Leading to Rigor:
 Metabolic activity after death continues for short time and becomes anaerobic (lacking oxygen)
 ATP hydrolyzes to ADP
 Calcium ions diffuse from sarcoplasmic reticulum

27.  Causes chemical lock between actin and myosin proteins,
 As body proteins decompose, chemical locks breakdown and muscles become flaccid again.
– Cadaveric Spasm
Cadaveric spasm Cadaveric spasm [syn cataleptic rigidity, instantaneous rigidity, instantaneous rigor,
postmortem spasm] is a rare condition, in which the muscles that were in contraction at the
moment of death, remain in contraction after death without passing through the stage of primary
relaxation
– Factors Affecting Rigor Mortis
 Muscular Activity
 Environmental Temperature
 Cause of death and condition of the body
 Built
 Age

28. LATE CHANGES
A. DECOMPOSITION
 Autolysis
 Putrefaction
B. CONDITIONS AFFECTING THE RATE OF PUTREFACTION
 External
 Internal
C. CASPER’S DICTUM
D. ML ASPECTS OF PUTREFACTION
E. MODIFICATIONS OF PUTREFACTION
 Adipocere
 Mummification

29. A. DECOMPOSITION
– Autolysis is the breakdown of cells and organs through an aseptic chemical
process caused by intracellular enzymes.
– Putrefaction is due to fermentation by bacteria. After death, the bacterial flora
of the GIT spread throughout the body, producing putrefaction.
 External phenomena
 Color changes
 Development of foul smelling compounds
 Other changes
 Appearance of maggots

30. (a) Larynx and trachea
(b) Brain of infants
(c) Stomach, intestines
(d) Spleen
(e) Omentum and Mesentery
(f) Liver
(g) Adult Brain
(h) Heart
(i) Lungs
(j) Kidneys
(k) Adrenals
(l) bladder
(m) Esophagus
(n) Pancreas
(o) Diaphragm
(p) Blood vessels
(q) Gall bladder
(r) Skin, muscle, tendons
(s) Prostate, virgin uterus
(t) bones.
 Internal phenomena
 Order of putrefaction
– General rule - The softer the organ, the more blood it contains and the nearer to sources of
bacteria it is, the faster it putrefies
– In general, organs show putrefactive changes in the following order –
 Skeletonization (last stage)

31. B. CONDITIONS AFFECTING
THE RATE OF PUTREFACTION
 External
 Air
 Clothing
 Manner of burial
 Moisture
 Temperature
 Internal
 Age
 Sex
 Condition of the body

32.  Cause of death
 Putrefaction is rapid in deaths due to:
(i) Anasarca [generalized]
(ii) Asphyxia
(iii) Inflammatory conditions
(iv) Peritonitis
(v) Epticemia
 Putrefaction is delayed in deaths due to:
(i) Anemia
(ii) Debility
(iii) Wasting diseases
(iv) Poisons which either have preservative action on tissues or a destructive [or inhibitory]
action on bacteria or both.
 Mutilation

33. C. CASPER’S DICTUM
– Casper’s dictum [syn Casper’s law, Casper Regel, Casper’s Rule] states that the time taken
for same amount of putrefaction to occur when the body is in air, water and buried in
earth is in the ratio of 1:2:8. Putrefaction occurs fastest in air and slowest in earth.
AIR WATER EARTH

34. D. ML ASPECTS OF
PUTREFACTION
– Time of death
– Cause of death
– Infanticides
– Poisons
– Raygat’s Test

35. E. MODIFICATIONS OF
PUTREFACTION
– Adipocere
Adipocere (Latin adipo fat, cera wax) is a modification of putrefaction in which a friable,
crumbly, water insoluble grayish-white to brown wax-like material is produced in the
dead body by the breakdown and conversion of body fats to fatty acids (FA), mainly oleic,
palmitic, and stearic acids.
– Mummification
Mummification is a modification of putrefaction in which the skin becomes brittle,
contracted, dried, firm, leathery tough, parchment like, shrunken and wrinkled, turning
yellow-brown to black in color. [from Latin mumia, bitumen; because of the blackened
skin, bitumen was once thought to be used by Egyptians to produce mummies].

36. The decomposition of a body can be divided into
several stages, even if the duration of each stage
may vary a lot:
– 2 - 3 days: green staining begins on the right side of the abdomen.
• Body begins to swell.
– 3 - 4 days: staining spreads.
• Veins go "marbled" - a brownish black discoloration
– 5-6 days: abdomen swells with gas.
• Skin blisters
– 2 weeks: abdomen very tight and swollen.
– 3 weeks: tissue softens. Organs and cavities bursting. Nails fall off
– 4 weeks: soft tissues begin to liquefy. Face becoming unrecognizable
– 4 - 6 months: formation of adipocere, if in damp place.
• This is when the fat goes all hard and waxy.
– A body without a coffin will be decayed within 12 years.

37. Green discoloration over the
abdomen
Marbling

38. Gaseous bloating, green-purple color in face,
neck and shoulders

39. Skin And Hair Slippage
SKIN SLIPPAGE HAIR SLIPPAGE