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Death

  1. 1. DEATH (THENATOLOGY) Forensic medicine and Toxicology. Death is not a moment but a Continuous Process: It is a process rather than an event, except in situationswhere death occur instantaneouslylike bomb blast, crushing of head in Road side accidents. Definition of death: “Complete, permanent and irreversible stoppage of respiration, circulationand brain functions”. Section 2b of the Registration of Births and Deaths Act defines death as “Permanent disappearanceof all evidences of life at any time after live birth has taken place” Defined by Physician as “Total stoppage of circulationand cessation of vitalfunctions, such as respirationand pulsation” Shapiro (1969) defines death as “The irreversible loss of the properties of livingmatter” Calne (1970) states that “ When destruction of the brain has been established,the individual has died no matter what the state of rest of his body, giving four signs for diagnosis: 1. Deep irreversible coma 2. Fixed dilated pupil 3. Absent cranial reflexes 4. No spontaneous respiration 5. Absence of electrical brain activity 6. Cessation of circulation in the retinal vessels Rantoul and Smith (1973):- “ Complete and persistent cessation of respiration and circulation” DEFINITION of death. 1. “Complete and irreversible stoppage of respiration, circulation and brain functions.”
  2. 2. Thus Death was classified into 2 Groups. 1. Body 2. Organs Body may be dead Organs may survive = in the same body The livingbody dependsupon the integrity of three systems, interdependentupon each other, these systems are Respiration, Circulation,Enervation The failure of one of them will cause failure of other two this lead to the death of an individual. 1. There are two phases of death 1. Extinction of the personality OR Somatic Death 2. Progressive disintegrationof the body tissue OR Molecular Death / CellularDeath TWO STAGES i. Somatic Death (Soma-Body) Irreversible loss of integrating and co-coordinating functionsof the organism as a whole is labeledas Somatic Death. It is the complete and persistent loss of coordinatedfunctioning of tripod of life i.e stoppage of Functioning- and failure to return 1. Brain 2. Heart 3. Lung Somatic death is also called Systemic death Clinical death Legal death ii. Molecular Death It is the death of individual organsand/ortissues (which persisted individuallyafter somatic death) In 1967- Single Organ, – Shifted from a dead unit to another living unit. During interval – it was kept alive to avoid moleculardeath. Circulation Enervation Respiration
  3. 3. Till it was shifted to already prepared body – Ready to receive – Heart of Dead Time – Interval between Somatic & Molecular stages ORGAN SURVIVAL TIME Heart 60 mins Liver 15 mins Kidney 45 mins Blood 6 hrs Bone marrow 6 hrs 1. Brain death. Means irreversible loss of brain and brain stem functions simultaneously, 2. It does not include the death of cortical area of brain. Brain death 1. Brain is responsible for all the coordination between the organs. 2. Once brain stem death has established, no matter how healthy an individual, Life will not return to the patient. 3. Even with continuous cardiopulmonary support Complete loss of consciousness/ absence of brainstem function / reflexes Criteria for determining permanent non functioning of the brain. 1. Unreceptivity and unresponsivity 2. No movements and breathing 3. No reflexes 4. Flat EEG (confirmatory test) DIAGNOSIS OF DEATH Brain death is declared – when there is 1. Permanent, fixed bilateraldilatationof pupils. 2. Absent – all nerve reflexes 3. Cessation of respiration (without aids.) 4. Cessation of cardiac activity (COMPLETE FLAT ECG) D/D of Death 1. Suspended animation
  4. 4. 2. Barbiturate poisoning 3. Electrocution 4. Drowning 5. Hypothermia Immediate physical changes 1. Loss of tripod of life 2. Absence of brain function 3. Loss of muscle tone 4. Onset of muscular flaccidity / primary flaccidity 5. Loss of reflexes 6. Dropping of lower jaw 7. Looseness of limbs 8. No response to external stimuli 9. Cooling of body SUDDEN DEATH Definition: WHO defines it as a death which occurs within24 hrs from the onset of first symptom. But this time period is considered too long by some pathologistsand they accept death within one hr, from the onset of symptoms. The death is so sudden and unexpected that suspicion of foul play may arise. 80% of such deathsare natural and 20% are un-natural Natural deaths. Thisoccurs due to some disease, pathological condition,old age and debility. The un-natural may be  Accidental  Criminal– Suicidal,Homicidal.
  5. 5. Caused by the application offorce or by poisoning. (Note: list of naturalcauses in parikh page 3.4 edition8th .) Manner of death 1. Natural 2. Unnatural Natural 1. Cerebral thrombosis and subsequent infarction 2. Cerebral embolism 3. Meningitis 4. Tumor of brain producing pressure 5. Tumor of brain with sudden hemorrhage 6. Metabolicdisorders e.g. uremia 7. Cardiovascularconditione.g. MI 8. Respiratory conditione.g. Asthma, COPD Unnatural 1. Accidentalhead injuries e.g. RTA 2. Homicidalhead injuries e.g. stab, lacerated, incised, firearm 3. Suicidalhead injuries e.g. firearm injury 4. Poisoning e.g. Opium, alcohol MODE OF DEATH Stoppage or failure of vital system. MANNER OF DEATH. It is way, fashion or circumstances of death. - natural– when due to disease - Unnatural – causes other then disease * Accident * Homicide * Suicide * Intoxication
  6. 6. Mode of Death It is stoppage or failure of vital system 1. Coma :- failure of function of brain 2. Syncope :- failure of function of heart 3. Asphyxia :- failure of function of respiratory system 1. Coma:- failure of function of brain and irreversible damage to its vital centers Due to 1. Raised Intracranial Pressure, due to injuries to or diseases of brain e.g meningitis 2. Poisons such as opioidsand alcohol 3. Metabolicdisorders like Uremia Post mortem :- edema and congestion of brain and membranes 1. Syncope :- death due to failure of function of heart due to decrease flow of blood to brain and leading to hypoxia of brain. 2. Due to 1. Heart diseases 2. Diseases of blood 3. Hemorrhage 4. Poisoning due to digitalis,aconite, potassium. Postmortem findings:- Viscera appearpale and capillariesappearcongested 1. Asphyxia :- is death due to failure of respiratorysystem. 2. Due to 1. Lung diseases e.g pneumonia, 2. Paralysis of respiratory centers, 3. Opioidpoisoning 4. Breathing of irrespirable gases
  7. 7. 5. Traumatic asphyxia Postmortem findings:- Cyanosis, petechialhemorrhages, visceral congestion, injury mark on neck. CRITERIA TO DIAGNOSE DEATH HOWARD’s Criteria:It is followed in majority of the countries .The basis of diagnosisis as follows: 1) Non receptive for stimuli & there is no response. 2) No movement for one hr & no breathing. 3) No spontaneousbreathing for 3 min after switching off the artificialmeans. 4) No reflexes. 5) Flat EEG. Suspended Animation (Apparent death)  It is a condition in which the vital functions of the body (heart beat and respiration) are at such a low pitch that they cannot be detected by routine methods of clinical examination. Types : Involuntary Voluntary Drowned person Yogis New born, After anesthesia, Cerebral concussion. Electrocution. Heat stroke. Mesmeric trance Prolong illness. POST MORTEM PHENOMENON OR CHANGES AFTER DEATH Changes after Death 1. Immediate changes 2. Early changes 3. Late changes IMMEDIATE CHANGES
  8. 8. These are the changes which occur simultaneouslywith the onset of clinicaldeaths. These include 1. Insensibility. 2. Loss of reflexes. 3. Flat EEG rhythm. 4. Cessation of Respiration. 5. Cessation of Circulation. EARLY CHANGES 1. Eye Changes. 2. Skin Changes. 3. Primary muscularflaccidity. 4. Contact flattening with pallor. 5. Algor Mortis. 6. Postmortem Lividity/ postmortem staining. 7. Rigor mortis LATE CHANGES 1. Putrefaction 2. Adipocere Formation 3. Mummification 4. Skeletinization Immediate Changes Cessation of Respiration. TEST. 1. AUSCULTATION No respiratory sounds 2. MIRROR TEST  Dimness of Mirror 3. FEATHER TEST  No movement of Feather 4. WINSLOW TEST No movement of water when we put a glass on chest. Cessation of Circulation 1. MAGNUS LIGATURE TEST 2. FINGER NAIL TEST 3. DIAPHENOUS TEST 4. HEAT TEST 5. ARTERY INCISION TEST
  9. 9. 6. Auscultation.No heart soundsfor 5 minutes. 7. Flat ECG for 5 minutes. MAGNUS LIGATURE TEST 1. Tying a ligature tightly at the base of the finger, sufficient to cut off venouschannelsexcluding arteries. 2. Finger remains white if circulationhas stopped otherwise the area beyond ligature graduallybecomes blue and swollen. FINGER NAIL TEST When the pressure is appliedon nailbed it turns pale if circulationis going on and when pressure is withdrawn, it becomes red Diaphanous Test 1. The handis to be held against a strong source of light. 2. During life it is red and translucent. 3. But After death it is opaqueand yellow HEAT TEST 1. During life on the application ofheat to skin, true blister appearsalong with the line of redness. ARTERYINCISION TEST 1. When a small artery is cut there is no jerky flow of bloodafter death. Early Changes Eye Changes 1. AT THE TIME OF DEATH 1. At the time of death eyes seem to stare. 2. Pupilsbecome fixed and dilated. 3. Corneal and light reflex disappeared. 2. WITH IN 10 SECONDS
  10. 10. The bloodin retinal vessels rapidlybecomes dotted first and then break up into segments called“Cattle trucking”. WITH IN FEW MINUTES 3. Drying of cornea can produce haziness, if the eye lids are opened and atmosphere is dry. WITHIN HOURS 4. Tachynoires appear on sclera within 3 hours of death, if eyes remains open. Tachynoires are brown-blackishdiscoloration,due to formation of cellulardebris and dust settling on sclera. 5. Intra ocular Tension becomes 14 g immediately after death from the normal value of 14-25 g and by the end of two hours it becomes zero. 6. Optic disc becomes Hazy in about 6 to 10 hours after death. SKIN CHANGES With the cessation of circulationthe blood drainsfrom the vessels of skin and skin becomes pale and ashy white. Skin loses its elasticity MUSCULAR FLACIDITY/ RELAXATION 1. The muscles relax and lose their natural tone at about the time of death which results in 2. Droppingof lower jaw. 3. Thoraxcollapse. 4. Limbs become loose. 5. Relaxation of facial muscles leadsto ironing of skin crease & sometimes makes a person look younger. The muscular changes also affect the smooth muscles of body as a result 1. Pupils dilated. 2. Sphinters relax resulting in incontinence of urine and feaces.
  11. 11. It persist till the rigor mortis is developed COOLING OF BODY/ Algor Mortis  Algor- Coldness, mortis means Death  Medicolegally:- 1. Algor Mortis is one of the earliest sign of death. 2. It Indicatestime elapsed since Death TAKING THE TEMPERATURE 1. It is measured by inserting a chemical thermometer, known as Thanotometerwhich is 25 cm long, in to the rectum having reading from 00 —5000 C. 2. The alternativesites for putting thermometer are i. Sub hepatic ii. Vagina iii. Nostrils iv. Auditory meatus Rate of Cooling Affected by; 1. Mean atmosphere temperature. 2. Clothingand other covering on body. 3. Air movement and its humidity. 4. State of nutrition and developmentof body. 5. Age. 6. Sex. 7. Coolingin fluid medium e.g water. 8. Temperature of body before death. Estimation of Rate of Cooling 1. General FORMULA Normal body temperature — Rectal temperature 1. Time since death= Average rate of fall of temperature per hour(0.6 o C) According to Simpson 1. The body looses temperature at the rate of 1.5 o C/ hour during the first six hours after death 2. Followed by 0.9o C -1.2 o C/hour in the next six hours when the body is clothed.
  12. 12. The surface of body takes about 12 hours and internalorgans take about 20-24 hours to reach the temperature of the environment Glaister & Rantoul Formula 1. In 1966 calculatedthe time interval after death in hours as 37.2o C – Rectal temp. Time interval after death= Rate of fall of temp / Hour Post Mortem Caloricity Post means After & Mortem means Death, Calor means Heat. After the initialrise of temperature the body begins to cool as usual. This is known as Postmortem Caloricity. Post Mortem CaloricityCauses are: 1. Pontine hemorrhage 2. Tetanus& strychnine poisoning 3. Acute Bacterial or viral infections  Lobar pneumonia  Typhoid fever  Encephalitis  Encephalomyelitis 4. Intense Asphyxial conditions. SUBCUTANEOUS HYPOSTASIS or POSTMORTEM LIVIDITY Or POSTMORTEM STAINING or LIVOR MORTIS or SUGGILATION or VIBICES Hypostasis is the bluish purple discolorationof the skin and organs due to accumulationof bloodin the toneless capillariesand small veins of the dependent parts of the body. Post mortem Lividity is produced because 1. Stoppage of Circulation 2. Stagnationof bloodin bloodvessels. 3. Tendency of the blood to sink by force of gravity.
  13. 13. Time of Hypostasis PML begins as a series of mottled patches on the dependentparts of the body within 1-3 hours These patches increase in size & coalesce in 3-6 hours and Lividity is fully developed & fixed in about 6-8 hours of Hypostasis FIXITY OF HYPOSTASIS 1. Fixation of PMS occurs when the body remains static for 6-8 hours at one place . 2. This is due to the fact that the coagulationin the capillaries takes place in 6-8 hours making the staining permanent. 3. Nevertheless there will be no fixation if the blood remains persistently fluid due to fibrinolysis. 4. Significance:To check whether Lividity has fixed or not apply thumb area pressure. If the area pressed does not blanch it means time since death is more than 8 hours. SHIFTING OF HYPOSTASIS 1. PMS can shift from one part of the body to another due to the movement of the body after death. 2. This is due to the fact that it takes about 6-8 hours for the stain to fix and prior to that period , the staining can keep on shifting as the blood remains fluid . 3. PMS at different areas of the body indicatesthe different positionof the body after death. DISTRIBUTION OF HYPOSTASIS 1. Distributionof PML is patchy to start but with passage of time , it graduallyenlarges to cover all the dependentareas of the body 2. IN SUPINE POSITION back and is deepest in lumber region, Except the areas of contact flatteningi.e. back of shoulders, buttocks, and calves due to pressure on skin is sufficient to prevent the subcutaneousveinsfrom filling with blood).
  14. 14. Any pressure anywhere on the body will prevent the capillariesfrom filling & that is why the pressure areas due to wt of the body, wrist watch, belt & bracelets do not show hypostasis. DISTRIBUTION OF HYPOSTASIS IN FACE DOWNWARDS POSITION Hypostasis is found on front of body. and areas of contact flattening are on cheeks, breast , abdomen and knees and sides of the foot. IN SITTING POSITION Lower half of trunk, back of thighs, legs, below the knees, and forearm. IN HANGING Hypostasis is confined to lower abdomen, hands, thighs, and legs. IN DROWNING Over the front of the Head, Neck, upper part of the chest and abdomen. Cause of Death Colour of Hypostasis Cause of Death Cherry Red Carbon monoxide Bright Red Hydrocyanic acid, Burns Reddish Brown, brown or deep blue Nitrates, Potassium Chlorate Dark brown Phosphate poisoning
  15. 15. Pink Cold & refrigerated bodies Grayish brown COLOR OF HYPOSTASIS Depends on 1. Color of blood 2. Mode of death FACTORS ALTERING DEVELOPMENTOFHYPOSTASIS BEFORE DEATH Hypostasis may appearbefore death in those who die from prolonged illness, in which a terminal circulatory failure permit some ante mortem poolingof bloodat the back of the body. DELAYED HYPOSTASIS In death due to anemia and in deaths due to considerable loss of blood. EXTERNAL PRESSURE Belts, ligature, clothing , e,g brassiere. Septic Abortion MEDICOLEGAL IMPORTANCE 1. It is reliablesign of death. 2. A parameter for time since death. 3. Cause of death from color. 4. Manner of death ---in hanging and drowning distributionof hypostasisfrom parts of body on which it appears. 5. Position of body at time of death and weather the position has been changed or not. 6. To differentiate from ante mortem bruise. 7. To differentiate it from congestion.
  16. 16. CONTACT FLATTENING 1. Those parts of body subjected to pressure become flattened due to loss of muscle tone. 2. Thus when a corpse which hasbeen lying on its back on a flat surface is turned over, the muscles of buttocks, calves, remain flat. 3. Contact palloralso occur internally
  17. 17. RIGOR MORTIS 1. Rigor------A rigidity 2. Mortis-----death/derived from mortic. 3. This is the stiffening of the muscles after death which follows the period of primary flaccidity. 4. Every muscle in the body both voluntaryas well as involuntaryundergoes rigor mortis. CAUSE OR MECHANISM 1. 1. It is due to chemical changes involvingthe proteins of the muscle fibers. 2. 2. As the myofibrils are made up of actin and myosin filamentswhich are protein in nature. 3. 3. During life the separation of actin and myosin filaments and energy needed for contractionare all dependentupon ATP which is in high concentration in resting muscles and is in a balancedstate. 4. 4. After death no more ATP is synthesized and its concentrationfalls within the muscles, both actin and myosin become stiff and get converted into a rigid gel havingno reaction to electrical stimuli. The terminal phase of rigor in which ATP disappearsfrom muscles and the muscles become inelastic.
  18. 18. SEQUENCE OF APPEARANCE 1. All muscles of body both voluntaryas well as involuntary undergo rigor mortis. 2. When it is fully developedin the skeletal muscles the body assumes a BOARD LIKE RIGIDITY. 3. Rigor mortis is said to appearfirst in involuntarymuscles, then in voluntary muscles. 4. Although the progress of rigor is simultaneousin all muscles, they become more apparent and observable in smaller muscles of body. 5. It first appearsin the face, then spread to neck, and upper limb and trunk and last in the lower limb. SEQUENCE OF APPEARANCE 1. 1. Eye lids-------------------------2--4 hours. 2. 2. Face-----------------------------4--5 hours. 3. 3. Neck and trunk----------------5--7 hours. 4. 4. Upper extremities-------------7--9 hours. 5. 5. Legs-----------------------------9--11hours. 6. 6. Finger and toes---------------11--12hours. 7. In our country rigor appearsin 3 hours, is fully developedin 12 hours , persist for an other 12 hours & passes off in another 12 hours, its called RULE of 12. POSITION OF BODY WHEN RIGOR IS FULLY ESTABLISHED 1. The jaw, neck, and extremities become fixed in position with arms bent at elbow and legs at knees and movement at joint are possible only within a very limitedrange. BREAKING OF RIGOR 1. Forcible bending at jointsagainst the force of rigor actually tears the muscles and stiffening of the joints, it will never
  19. 19. return. 2. Rigor of heart produces a firm thickened and contracted left ventricle which containslittle blood. 3. Rigor of seminal vesicles may cause discharge of seminal fluid from penis. Rigor of erector pilaemuscles produce GOOSE SKIN or CUTIS ANSERINA PASSING OFF OF RIGOR 1. It passes off in the same order in which it occurred due to autolysisof muscle proteins, from above downward and takes 12 hours to pass off completely. 2. Those muscles first to developedrigor are first to become flaccid again and the rigor usuallystays longer in lower limbs. FACTORS INFLUENCING RIGOR 1. 1. In fetus the onset is rapid and passes off quickly. 2. 2. In early youth and old age its onset is earlier than in adult life. 3. 3. The onset of rigor is later and durationis longer in strong muscular person. 4. The more feeble and exhausted the muscular condition, the more rapid onset and shorter is the duration As a rule longer it takes to appear, the longer it stays. The rapidity of rigor mortis depends upon glycogen reserves in the muscles. In prolonged febrile illness and chronic diseases and in some convulsive disorders, rigor may appear early and passes off quickly due to depletion of glycogen reserves. Rigor is
  20. 20. frequently absent in septicemic conditions. TEMPERATURE OF SURROUNDING 1. The higher the temperature, the sooner rigor appears after death. CONDITION SIMULATING RIGOR MORTIS 1. 1. Cadavericspasm. 2. 2. Heat stiffening. 3. Cold stiffening. CADAVERIC SPASM/ Instantaneousspasm/ Catalepticrigidity 1. It is the form of muscularstiffening which occurs at the time of death and is not preceded by primaryrelaxation of muscles. 2. It persist until rigor mortis develops. Cause of CADAVERIC SPASM Its exact cause is unknown but it is usuallyseen in 1. Violent deaths in circumstances of intense emotions. 2. Muscular exertion before death Involves groups of muscles (forearm and hands) But in cases of extreme tension whole body is affected.
  21. 21. 1. EXAMPLE 1. Usually occur in war time. 2. Soldiersfound in kneeling posture taking the aim with his rifle. 3. Tea party . Weeds held in the handsof person trying to save himself from drowning. 2. Gun or knife held in hands of person in case of suicide
  22. 22. MEDICOLEGAL IMPORTANCE 1. 1. It records the last act of life. 2. 2. Weeds indicate that the person was alive when he entered in water. 3. 3. Manner of death. It pointstowards suicide when weapon is held in hand. 4. 4. IDENTIFICATIONof assailant In case of homicidewhen some portion of clothing or hair of assailantmay found in handsof deceased.
  23. 23. HEAT STIFFENING 1. Heat as by burning 2. Immersion in hot liquidand 3. Electrocution. CAUSE Coagulationof muscle proteins. APPEARANCE The skin of body becomes severely scorched The muscles are: Pale pink , Stiff but tear easily, Considerableshortening of muscles., PUGILISTIC ATTITUDE/ BOXER`S ATTITUDE: Stiffening and Shortening of muscles give pugilistic attitude to the body. PUGILISTIC ATTITUDE 1. Flexion of elbow, knee and hip joints. 2. Shortening of muscles where it is not present in rigor mortis. COLD STIFFENING/Freezing Stiffening and Freezing of body due to cold environment.
  24. 24. In mortuary at 4 degree will produce a notablesolidity of subcutaneousfat and muscles. On thawing out, the stiffening will disappearsand rigor mortis will developed. Late changes after death PUTREFACTION 1. Putrefaction is defined as that it is the last stage in the resolution of body from organic to inorganic state and is an absolute sign of death. Two processes, 1. Autolysis 2. Bacterial action Autolysis 1. Auto---self. 2. Lysis---destruction. 3. It is the softening and liquefactionof the body tissue. CAUSES 1. Self destruction by enzymes released from cells after death It is prevented by freezing of tissues TIME REQUIRED 1. It commences 3-4 hours after death. 2. Up to 2-3 days and sometimes longer. BACTERIAL ACTION 1. Most of bacteria come from bowels, 2. Chiefly Clostridium Welchii, and other includestreptococci, staph, E Coli, etc. Favorable conditions:
  25. 25. Warmth, moist and air. CASPER`S DICTUM Relates to the rate of putrefaction. The process of putrefaction in air is twice as rapid as in water and eight times as rapid as in the soil. 1 wk of putrefactionin air = 2 wk in water = 8 wk in soil. CHANGES IN PUTREFACTION 1. Colorchanges. 2. Developmentof foul smelling gases. 3. Pressure effect of gases. 4. Appearanceof maggots. 5. Other sequelae 1. COLOR CHANGES 1. The first sign of putrefaction. It is the greenish discolorationof skin. It is first seen on right side over the caecum, gradually spread over the whole abdomen and then the chest MECHANISM: Microorganisms in the bowels produce Hydrogen sulphidewhich acts with Hb and converts it to sulph-met –Hb. TIME Over right iliacfossa in 12 –24 hours (36 hours) whole body 48 hours up to 72 hours. May appearas early as in six hours in summer. Marbling The veinsbecome visible as bluish or greenish lines due to pigments of decomposing blood. Mostly around the shoulders, upper chest, abdomen and groin, This is called MARBELLING OF SKIN. It starts after 24 hours. 2. GASES OF PUTREFACTION Formation of gases start from 12-18 hours. The gases responsible are
  26. 26. Hydrogen sulphide. Ammonia. Methane Carbon dioxide etc. In 12-18 hours in summer gases collect in intestine and distended the abdomen. From 18-36 hours or 48 hours gases collect in tissues and hollow viscera and cause false rigidity and pressure effects. Gases cause a generalized swelling of the body and distention is greater in these areas where the tissues are loose e.g., scrotum and breast Skin Slip The outer layer of skin loosensand can be rubbed off easily with pressure to leave a shiny moist pink base. This is called SKIN SLIP. Skin from Hand or foot may peel off like a glove / stocking in 48-72 hours 3. PRESSURE EFFECT OF GASES 1. Bloatingof features. 2. Shifting of areas of hypostasis. 3. Changes in skin and wound. 4. Extrusion of fluid from mouth 5. Emptying of heart. 6. Changes in the emptying of genitals Bloating of Features it developsin 36-48 hours. Face becomes swollen Eyes bulge from their sockets & tongue becomes swollen Bloating of Features Breasts are enormously swollen. In 48-72 hours the rectum protrudes 2.Shifting of areas of hypostasis
  27. 27. Owing to pressure of gases , PMS may be displaced in any direction. 3. Changes in skin and wound 1. Putrefactive blisters are appearingunder the skin in 36-48 hours. 2. It containsmainlygas and a little reddish colored fluid. 3. Hairs become loose and can be pulledout easily. 4. Extrusion of fluid from the Nose & mouth 1. Due to pressure of gases in the abdomen, the diaphragmis forced upwardscompressing the lungs & heart. 2. Blood stained froth comes from the nose & mouth. Contents of stomach may be forced out / in lung Emptying of heart Heart is commonly found empty. ENTOMOLOGICAL FACTORS IN PUTREFECTION The study of insects that infest dead body in known as Forensic Entomology. It is of Medicolegal importance in 1. estimation of time since death. 2. Maggots also reveals about the drug. 3. Place of death 4. Manner of Death Flies are attracted towards putrefying bodies and lay eggs on the body especially in open wounds, exposed moist, sheltered naturalorifices such as the 1. Nose 2. Mouth 3. Vagina 4. Anus by about 18-36 hours after death They appearas creamy clusters deposited on corps INJURY BY RODENTS 1. Rodents attack the body withinhours after death. 2. They can bare the bone within 12 hours.
  28. 28. FACTORS AFFECTING PUTREFECTION 1. Temperature. 2. Bacterial contents of tissues. 3. Air and moisture. 4. Clothing of body. 5. Presence of body fat. 6. Presence of injuries. 7. Age. 8. Manner of burial. 9. Decomposition in water. Adipocere Formation Adipos= Soft fat, cera means wax Also called as saponification,grave or mortuarywax It is the formation of soft whitish, crumbly or greasy material in the soft tissues of the body after death. It is yellowishwhite, greasy wax like substance with a rancid smell. Its mechanism is not fully known but it is believed that clostridium Welchi initiatesthe processof hydrolysis & hydrogenationof body fats. Unsaturated lequidfats convert to saturated solid fats by bacterial fat splitting enzymes. It hasbeen noticed that superficial fats are initiallyaffected in patches , being first seen in Cheeks , breasts & buttocks. Finally the process spreads to the whole body . Once formed it is relativelypermanent. starts 2-3 weeks to months are required for Adipocere formation CONDITIONS FACILITATING ADIPOCERE FORMATION 1.MOISTURE----It is prerequisite for Adipocere formation.. 2. Warm TEMPERTURE Retarded by cold. 3. lack of air 4.BACTERIA----Facilitated by postmortem invasionof endogenousbacteria.
  29. 29. The putrefaction is inhibited because of increasing acidityand dehydrationof tissues. Medicolegal Information It indicatestime elapsed since death. It establishes the identityof a person It indicatesthe burialplace Mummification Modificationof process of putrefaction. There is dehydrationor desiccationof body tissues & viscera after death. The idealconditionsfor its formation are high atmospheric temperature, devoid of moisture, free circulationof air, Essential features Skin is dry, shrunken, leathery, rusty brown or black adhering to the bones. Soft parts shrivel up but retain the naturalappearances and features. Internal organs becomes dried mass. Factors affecting mummification Free circulationof air High temperature Absence of moisture. Time required 3-12 months are required for mummification Medicolegal Importance 1. It indicatestime elapsed since death 2. It indicatescause of death 3. It establishidentity of the person 4. It indicatesthe burialsite Preservation of Dead Bodies *Naturalpreservation 1. Adipocere formation 2. Mummification * Artificial preservation
  30. 30. 3. Embalming 4. Cold storage or refrigeration Embalming DEFINITON The process of preservation of dead bodies by artificialmummification by injecting certain fluidsin to the dead body is calledembalming. The fluidsusually contains: Formaldehyde, Solutionsof arsenic , lead sulphide, potassium carbonate. The usual site of injections: Femoral arteries , neck arteries, and aorta OBJECTIVES The process is adoptedfor 1. In medical colleges to preserve dead bodies for purpose of dissection. 2. Where dead bodies have to be taken from one country to another for burial. 3. The tissues of body are hardened & stay preserved by embalming. PROCEDURE 1. The methods involveputting a canolainto an artery and injecting the preserving fluid. 2. The presence of fluid prevents the growth of microorganisms and swells the features of the body. The embalmingwill destroy any evidence In case of poisoning; therefore removal of specimen should be completed before embalming Time Since Death Also called as postmortem interval. It is the time between the death & postmortem examination. Methodsof Estimationof Time since Death Two methods 1. Rate Method 2. Concurrence Method Rate Method
  31. 31. Measuring the changes produced by a process which takes place at a known rate which was either initiatedor stopped. Examples include the 1. distributionof rigor mortis 2. Change in body temperature 3. Degree of putrefaction of the body. Concurrence Method Comparing the occurrence of events which took place at known times with the time of occurrence of the event under investigation. For example: 1. A wrist watch stopped by a blow during an assault, or in drowning case. The extent of digestion of the last known meal The pointsto be ascertained are 1. 1. Coolingof body. 2. 2. Postmortem Lividity. 3. 3. Rigor mortis. 4. 4. Decompositionchanges. 5. 5. Content of stomach and bowel. 6. 6. Content of urinary bladder. Biochemicalchanges Cooling of Body 1. Rate of cooling is not uniform but is almost proportionalto the difference in temperature between the body & its surroundings. 2. Average heat loss is roughly 0.5 to 0.7 C. 3. Body attainsenvironmentaltemperature in about 16-20 hours after death. Postmortem Lividity
  32. 32. PML begins as a series of mottled patches on the dependent parts of the body within 1-3 hours. These patches increase in size & coalesce in 3-6 hours. Lividity is fully developed & fixed in about 6-8 hours Rigor Mortis 1. Rigor appears in ------------- 2-3 hours, 2. Fully developed in------------- 12 hours , 3. Persist for an other ----------- 12 hours & 4. Passes off in another ----------- 12 hours. 5. Eye lids------------------------- 3-4 hours. 6. Face----------------------------- 4--5 hours. 7. Neck and trunk---------------- 5--7 hours. 8. Upper extremities------------- 7--9 hours. 9. Legs----------------------------- 9--11hours. 10. Finger and toes--------------- 11--12hours. Decomposition Changes 1. Autolysis 1. It commences 3-4 hours after death 2. Continues steadily for 2-3 days and sometimes longer. 2. Color ChangesGreenish discoloration 1. May appear as early as in six hours in summer. 2. Over right iliac fossa in 12 –24 hours (36 hours) 3. whole body 48 hours up to 72 hours. 3. MARBELLING OF SKIN. 1. It commences after 24 hours , 2. Seen prominently in 36-48 hours in summer 4. Skin from Hand or foot may peel off like a glove / stocking in 48-72 hours in 7 days 5. Postmortem Blister formation within in 36-48 hours 6. The teeth fall out of sockets in 7-10 days 7. The formation of gases - beginning of 2nd week but It may occur in 12-18 hours in summer
  33. 33. Decomposition Changes CHANGES OBSERVED TIME SINCE DEATH 1.Bloating of facial features 36-48 hours. 2.Putrefactive blister formation 36-48 hours 3.Postmortem pulling of skin 48-72 hours of hands and feet. 4.Changes in external 48-72 hours genitalia. 5.Bursting of abdomen 48-72 hours. 3-6 weeks are required for adipocere formation. Mummification which takes 3 to 12 months. Contents Of Stomach & Bowels 1. Milk, tea , coffee leave stomach fairly rapidly (15-20 min). 2. Chappaties stay in the stomach for a long time 3. Mixed diets ( Chappaties, meat , vegetables ) exit the stomach in 4-5 hours. 4. Rice retain their form upto 6 hours & LEAVE The stomach in about 7-8 hours. 5. Vegetable diet containing vegetables, pulses, starchy roots take 6-7 hours to leave the stomach. 6. Conditions like fear, anxiety, shock & coma delaying emptying rate & power of digestion Contents of Urinary Bladder The amount of urine in bladder may give some indication of time since last micturation Contents of Urinary Bladder The amount of urine in bladder may give some indicationof time since last micturation Biochemical Changes
  34. 34. 1. Chemical constituentsof CSF such as lactic acid , Non protein nitrogen & amino acid contents increase in the first 15 hours after death but rise is not uniform 2. Potassium content of the vitreous humor of eye steadily rises after death. Biochemical Changes after Death 1. A. CHANGES IN BLOOD 2. B) CHANGES IN CSF 3. C) CHANGES IN OCCULAR FLUID CHANGES IN BLOOD CHANGES AT THE TIME OF DEATH Agonal acidosisresult of tissue break down: 1. 1. lactic acid 2. 2. Non protein nitrogen ( over 100 mg%) 3. 3.Urea nitrogen (over 75mg%) 4. 4.Amino acid nitrogen( over 12mg%) CHANGES AFTER DEATH; PH at first drops due to 1. 1.Terminal accumulationof CO2 . 2. 2.Glycogenolysis. 3. 3.Glycolysis. 4. 4.Accumulationof phosphoricacid and lactic acid. 5. 5.Splitting of amino acids and fatty acids. Then PH rises due to Production of ammoniafrom enzymatic protein breakdown. There is gradual rise of NPN to 50mg % in first 12 hours. The Free amino acid nitrogen usuallyrises to 10mg% in first 12 hour. SERUM CREATININE Rises to 10 mg % in first 12 hours. SERUM CHLORIDE
  35. 35. Soon after death the concentrationof chloridebecomes equal in plasma and erythrocytes and is equalto concentration in whole blood i.e 74 mmol/ L MAGNESIUM As putrefaction begins serum magnesium level rises and can reach 8 times to normal in 72 hours. POTASSIUM The level rises owing to diffusion from vascular endothelium. PM ACCUMULATION OFENZYMES The enzymes are transaminase , lactic dehydrogenase, phosphatase,amylase. PATTERN OF ENZYME CONCENTRATION First few hours ------ rapid rise. Next 2-3 days ----- show linearrise. Afterwards--------a fall in concentration as proteolysis becomes predominant. PEAK ENZYME ACTIVITY Phosphatase and amylase-------36-48 hours. Transaminase-------------48-60 hours. Lactic dehydrogenase-------4th day( 72-96 hours) BLOOD SUGAR In right side of heart and inferior vena cava : 1. The blood concentrationrises up to 300 mg % in first 12 hours. 2. This is because of breakdown of liver glycogen and the accumulationof dextrose in inferior vena cava and right side of heart. 3. The diffusion does not extend beyond the heart because the lungs provide an effective barrier. IN PERIPHERALBLOOD In 6-8 hours after death free dextrose disappearsfrom peripheralblood. Thisis due to breakdown of dextrose in the body after death. MEDICO LEGAL IMPORTANCE 1. Dextrose level of blood in right side of heart and inferior vena cava is not helpful.
  36. 36. 2. The dextrose level in limbs: If the level raised above 200mg % some hours after death, this is confirmatory evidence of hyperglycemia BLOOD UREA & SERUM CREATININE 1. Blood urea rises in an irregular manner and is due to proteolysis. 2. Serum concentrationwithin first 48 hours is never above 100mg% unlessthere has been an increased urea concentration during life. 3. In case of uremia the serum creatinine usually rises above 6 mg%. MEDICOLEGAL IMPORTANCE 1. The urea concentrationabove 300 mg% and serum creatinine concentrationabove 10 mg % indicaterenal failure with uremia. B) CHANGES IN CSF 1. VOLUME Soon after death volume of CSF is above 150 ml but after 24-48 hours it graduallydisappears. 2. BIOCHEMISTRY Study of chemical changes in CSF is a better indicatorof time since death than the same study in blood. a)POTASSIUM Rises after death in a linearpattern b)INOSITOL Its concentrationin CSF is higher than blood and increase further after death. c)AMINOACID NITROGEN In first 10 hours -- less then 14 mg% In first 24 hours -- non protein nitrogen concentrationunder 80mg %. d) CREATININE VALUE Under 5mg%----------up to 10 hours. Under 10 mg% -------up to 30 hours e)PHOSPHORUS
  37. 37. A concentration greater than 15 mg% ---- death more than 10 hours ago. f ) DEATH FROM RENAL INSUFFICIENCY 3. CSF urea above 120 mg %. 4. CSF creatinine 3.5 mg %. C) CHANGES IN OCCULAR FLUID The fluid within eye ballconsist of 1. 1.Aqueousfluid-------in the anteriorand posterior chambers. 2. 2.Vitreoushumour------in the body of eye ball. Their compositionis similar and the component is easier to use as it is less contaminatedby blood &bacteria than CSF. It is not difficult to withdraw up to 2 ml from each eye ballby gentle suction with 20 bore needle and syringe. a)ASCORBIC ACID It is highest in the body. Fallsslowly in over 20 hours. b)PYRUVIC ACID The concentrationdecreases but range is small. c)NON PROTEIN NITROGEN Rises. d) POTTASIUM Rises. It is helpfulin cases where postmortem interval is more than 24 hours.

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