This document discusses death and its causes according to forensic medicine. It defines death and outlines the different types, including somatic/clinical death which is the complete and irreversible stoppage of circulation, respiration, and brain function. Brain death is described as a process involving cortical, brain stem, and whole brain death. The criteria for determining brain death and the proper diagnosis procedure involving medical experts is explained. Molecular death at the cellular level is discussed as well. Modes of death, manner of death, and mechanisms are outlined. Negative autopsies and obscure autopsies that do not reveal a definite cause are addressed. Sudden unexpected death within 24 hours is also summarized.

1. DEATH & ITS CAUSE
Dr. P. Prasanna
Department of Forensic Medicine

2. • Thanatology
thanatos = “death”
logy = “speaking”
• Definition
“permanent disappreance of all evidences of life at anytime after live
birth has taken place”

3. • Types of Death
1. Somatic (or) Systemic (or) Clinical.
2. Molecular (or) Cellular.
Somatic Death
“It’s complete and irreversible stoppage of circulation, respiration and
brain functions” (BISHOP’S TRIPOD of life)

4. • Moment of Death
“Death is not an event it’s a process”
Clinical Death
Brain Death (lack of Oxygen)
Biological Death
Cellular Death

5. • Brain death & its types
i. Cortical Death
ii. Brain Stem death
iii. Whole Brain Death.
• Various criteria for Determining Brain death:
i. Philadelphia Protocol (1969)
ii. Minnesota Criteria (1971)
iii. Harvard Criteria

6. • Diagnosis of Brain Stem death:
i. Where the patient may be under the effects of drugs, eg: therapeutic drugs
or overdoses.
ii. Where the core temperature of the body is below 35o c.
iii. Where the patient is suffering from severe endocrine or metabolic
disturbances which may lead to severe but reversible coma eg: diabetes.
iv. Suspended animation.

7. • Precondition of Diagnosis:
i. Patient must be deeply comatose
ii. Patient must be maintained on ventilator
iii. Cause of coma must be known.

8. • Who can perform test:
i. Two medical practitioners
ii. Doctors involved should be expert in this field
iii. At least one doctor should be of consultant status.
iv. Each doctor should perform the test twice.
• Test to perform:
i. Pupil v. Motor responses
ii. Cornea vi. Respiratory movements.
iii. Vestibulo – ocular reflex.
iv. Gag reflex.

9. • Molecular death:
“ death of cells and tissues individually”
• Takes place 2 hours after stoppage of vital functions
• Can be confirmed – electrical, thermal or chemical stimuli.
i. Nervous tissue - die rapidly
ii. Vital centers of brain about 5 minutes
iii. Muscles live up to 1-2 hours.

10. • Tissue and Organ Transplantation :
i. Homologous donation
ii. Live donation
iii. Cadaveric donation
iv. Xenograft.

11. 1. Modes of Death:
According to Bichat
i. Coma
ii. Syncope
iii. Asphyxia
2. Manner of Death
3. Mechanism of Death
4. Cause of Death

12. • Negative Autopsy
“when gross and microscopical, toxicological analysis and laboratory
investigations fail to reveal a cause of death, the autopsy is consider to be negative”
• 2-5% of all autopsies are negative.
• Due to:
1. Inadequate history
2. Inadequate external examination
3. Inadequate or improper internal examination
4. Insufficient laboratory examination
5. Lack of toxological analysis
6. Lack of training of doctor

13. • Obscure Autopsy:
“those which do not show a definite cause of death, in which there are
minimal, indefinite or obscure findings or even no positive finding at all”
• Causes are:
i. Natural disease
ii. Biochemical disturbances
iii. Endocrine dysfunction
iv. Concealed trauma
v. Poisoning
vi. Miscellaneous

14. • Sudden death
“death is said to be sudden or unexpected when a person not known to have been
suffering from any dangerous disease, injury or poisoning is found dead or dies within 24
hours after the onset of terminal illness”.
• Causes
1. Disease of Cardiovascular system
2. Disease of Respiratory system
3. Disease of Central nervous system
4. Disease of Alimentary system
5. Disease of Genitourinary system
6. Miscellaneous

15. THANKYOU