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Forensic Medicine
Dr. Suchita Rawat (MSc, MPhil, PhD)
Unit 1: Thanatology
Death: causes and manner of death, signs of death and changes after death. Somatic death, molecular death,
Early changes after death: algor mortis, rigor mortis, pallor mortis, livor mortis, cadaveric spasm, heat
stiffening, cold stiffening, changes in blood; Time since death by body fluid analysis; chemical changes in
cerebrospinal fluid; Changes in vitreous humour; Late changes: putrefaction: external and internal changes.
Adipocere, mummification, skeletonization
Thanatology, Death and its Causes
● STAGES OF DEATH
Antemortem,
Postmortem
and Perimortem
Injuries
*Agonal period
Molecular
Death
Somatic
Death
SUSPENDED ANIMATION (syn apparent death)
Causes
(1) Anesthesia, (2) Barbiturates, (3) Coma (4)
Cholera (5) Concussion, (6) Deep shock (7)
Drowning, (8) Electrocution, (9) Frozen state
(Hypothermia) (10) yoG is [voluntarily
induced, but may be remembered by the
student here as a memory aid], (11) Hanging
(12) Heat stroke, (13) Hypothermia, (14)
Hysteria (15)Illnesses [prolonged],
(16)Infections [Cholera, Typhoid]
(17)Newborn, (19) Opiates.
THE MOMENT OF DEATH
A. Classical
Criteria of
Death
Bichat’s
criteria/Atria
mortis
French physician Marie Bichat (1771 –1802).
[Latin, Gateways of death,
death’s portals of entry]
within 20 seconds
within 20 minutes
3 minutes
3 minutes
Tests to determine the death of
each organ Tests for circulation
• Magnus test (Hugo Magnus in 1872)
• Icard’s test: Vivid yellow (Séverin Icard of France in 1895)
• Diaphanous test: red and translucent vs. yellow and opaque
(transillumination test)
• Finger nail test: red-pale on pressure-red
Tests for respiration
• Winslow’s test: Jacques-Bénigne Winslow (1669-1760)
• Mirror test
• Feather test
Tests for brain function
(1) Blowing a strong stimulant such as hellebore or mustard into the
nose
(2) inserting a sharp instrument under the nail
(3) cauterization or incisions
(4) scalding with hot water or oil
(5) trumpeting or loud noises.
Miscellaneous tests :X-ray fluoroscopy for body movt.
Source: Agrawal, A. (2016).
.
Brain Death 1)Unreceptivity and
unresponsivity
2) No movements or
breathing (at least 1
Hour)
3) No reflexes (pupil,
corneal reflexes, spinal
reflexes i.e. knee jerk
4) Flat
electroencephalogram
5)Repetive test after
24hrs
Harvard criteria of Brain Death (1968)
1)Minnesota criteria of
Brain stem death
(1971) : In 1971,
Mohandas and Chou
(two neurosurgeons
from Minnesota)
2)Indian law on brain
stem death (The
Transplantation of
Human Organs and
Tissues Act, 1994)
Brain Stem Death (Modern Criteria of the
Moment of Death)
https://www.pinterest.com/pin/your-brain-structure-
what-is-the-brain-made-of--962714857820364170/
Minnesota criteria of Brain stem
death (1971)
(1) No spontaneous movement
(2) No spontaneous respiration
when tested for a period of 4
minutes at a time
(3) Absence of 5 major brain stem
reflexes (ref. figure)
(4) EEG not mandatory. All the
above findings must remain
unchanged for at least 12
hours
MODES OF DEATH
GORDON’S CLASSIFICATION OF DEATH
A.Anoxic Anoxia
reduced oxygen in ambient air
i.e. trap/noxious gases h2s, so2, sewer gas/ high altitude
pulmonary blood supply pulmonary gas exchange
reduced
supply of
oxygen
i.e.
mechanical
interface of
air passages
GORDON’S CLASSIFICATION OF DEATH
B. Anaemic
Anoxia
Oxygen carrying capacity of the blood is reduced. i.e. acute massive
hemorrhage , CO poison
GORDON’S CLASSIFICATION OF DEATH
C. Stagnant
Anoxia
Blood is incapable of movement
i.e. heart failure, embolism
GORDON’S CLASSIFICATION OF DEATH
D. Histotoxic Anoxia
1. Cellular histotoxic anoxia ( Oxygen cannot be taken up due to failure of
tissue enzyme system by poisoning, eg CN , PH3 , H2S, overdose of hypnotics and
anesthetics.
2. Pericellular histotoxic anoxia
permeability of cell membrane, eg in
nitrous oxide or halogenated
hydrocarbons [chloroform, cyclopropane,
ether, halothane, trilene].
3. Substrate histotoxic anoxia
failure of efficient cell metabolism,
eg hypoglycemia
4. Metabolite
histotoxic
anoxia
, eg CO2
poisoning,
uremia.
SUDDEN AND UNEXPECTED DEATH
Sudden and unexpected death is death occurring
within 24 hours of the onset of symptoms in an
individual who was not known to be suffering from any
disease, injury or poisoning.
Coronary artery disease
CVS
Acute edema of lungs / Air
embolism
(1) epilepsy (2)
hemorrhage (3)
meningitis, and (4)
tumors.
(1) Acute hemorrhagic (2)
pancreatitis (2) Appendicitis (3)
Cancer of esophagus (4)
Enlarged spleen [rupture]
Signs of Death and Changes Following Death
Immediate
Early
Late
1-30
minus
1hour-
Upto 36
hours
Beyond
36 hours
IMMEDIATE CHANGES
Complete
and
irreversible
cessation of
functions of
brain, heart
and lungs.
Function]
Muscles of
the body
become
flaccid.
(primary
flaccidity)
Corneal and
pupillary
reflexes are
abolished.
EARLY CHANGES
Within few minutes
1) Skin ashy-white,
pale and loses
elasticity
2)Changes in lips:
dry, brownish and
hard due to drying
1. Loss of corneal reflex
2. Opacity of the cornea
3. Pupils
4. Intraocular pressure (14-
3)
4. Retinal vessels
5.Biochemical changes i.e.
Potassium levels
Source: Agrawal, A. (2016).
Source: Agrawal, A. (2016).
EARLY CHANGES (Algor mortis)
Important points
Core temperature (after 2 hours)
Ambient temperature
Method of recording i.e rectal, sub-hepatic temperature
Formula
Factors affecting Algor Mortis
Environmental temp
Build i.e SA/BW
Physique i.e FAT/ lean
Environment i.e. air Ventilation,Humidity i.e.
water submerged, running, sewage
Position
Covering
https://stock.adobe.com/in/search?k=homeostas
ii) Average rate of fall
- (a) during summers
- 0.75°F/h (b) during
winters - 1.5°F/h.
Postmortem caloricity
● The increase in body temperature for the first few hours after death is called
postmortem caloricity.
● The mechanism and conditions of this phenomenon are as follows:
● (i) When the heat regulatory mechanism has been severely disturbed
before death. For example: sun stroke.
● (ii) When there is increased heat production in the muscles of the body before
death due to convulsions. For example: Tetanus, strychnine poisoning and epilepsy.
● (iii) Excessive bacterial activity during life. For example: Septicemic deaths, cholera
and other infections.
Postmortem Lividity (Livor mortis/Postmortem staining/postmortem lividity/postmortem hypostasis)
Development
0.5-2 hours (Appears as bluish purple mottled patches)< 4 h
(Well developed like a sheet but not fixed)< 8 h (Fixation ) <
greater than 8 h Persists till putrefaction sets in.
*Influencing factors (vol of blood/Length
of time blood remains fluid after death/More marked
in conditions where blood does not readily coagulate,
causing more accumulation to occur. Anticoagulants i.e.
Asphyxia/ CO poisoning, Septicemia
Source: Aggrawal, A. (2016).
Source: Aggrawal, A. (2016).
Rigor mortis (cadaveric rigidity, death stiffening)
Source: Aggrawal, A. (2016).
Source: Aggrawal, A. (2016).
Influencing
factors: age fetus/
stillborn/children
and old /infections
gas gangrene, where
putrefaction begins
early] (b) cancer (c)
cholera (d) starvation
(e) tuberculosis (f)
typhoid/
electrocution,lightning/
late in neuromuscular
disease,
CO,hemmorage,
asphyxia/ (1) Onset
slow, duration long –
Cold dry weather (2)
Onset rapid, duration
short – Hot weather.
Cadaveric spasm [syn cataleptic rigidity, instantaneous rigidity, instantaneous
rigor, postmortem spasm, battle-field rigidity]] is a rare condition, in which the muscles that were in
contraction at the moment of death, remain in contraction after death
IV. LATE CHANGES (DECOMPOSITION)
1)Autolysis (enzymatic
degradation)
Inc. in hot/ dec cold
Brain
(liquefaction),Stomach and
GIT, pancreases
Putrefaction (bacterial action)
(i) Color changes (ii)
Production of foul smelling
gases (iii) Liquefaction of
tissues.
*Modifications of Putrefaction
*Casper Dictim
Source: Aggrawal, A. (2016).
Source: Aggrawal, A. (2016).
● • 1st external sign of decomposition is the
Greenish discoloration
(sulfmethemoglobin) in the right iliac
fossa; which becomes evident in 12–24
hours in summer and 1 to 3 days in winter.
• This color change spreads to the entire
abdomen< chest< neck< face <limbs.
• Color gradually changes to dark green
then finally black.
● The putrefaction bacteria spread easily in the
body fluid and colonize in the venous system.
● The superficial veins of the limbs, chest,
abdomen and neck are stained greenish blue
due to hemolysis of red cells and stain the
walls of the vessels.
● This condition is called as “marbling” which
occurs 36 to 48 hours after death in summer
and 2 to 3 days in winter.
● Evolution of foul smelling gases:
• The main gases are ammonia, carbon dioxide, hydrogen sulfide,
phosphorated hydrogen and methane.
• Due to continued accumulation of gases, there is distention of
breast in females, penis and scrotum in males< abdomen (intestines).
● • Eyes bulge out from their sockets; tongue is forced out between
the swollen lips.
● Diaphragm is pushed up compressing the lungs and heart; blood
stained frothy fluid exudes from the mouth and nostrils, which is
called “postmortem purge”.
• Involuntary urination, defecation, seminal ejaculation and delivery
of dead fetus occur at this stage.
• Gas bubbles accumulate in all the tissues; subcutaneous tissues
become emphysematous.
● • Due to the formation of gas blebs,
blisters appear between the epidermis
and dermis all over the body.
• Epidermis becomes loosened (skin
slippage) producing large, fragile sacs of
clear or pink red serous fluid.
Liquefaction of tissues: (Colliquative putrefaction)
● begins from 5 to 10 days.
● The abdomen bursts and contents of abdomen come out of the cavity.
• All encapsulated internal organs are converted into bags of putrid fluid and
subsequently burst open into the thoracoabdominal cavity.
• The rate of putrefaction : enzyme content, water content and blood supply of the
organs: Adrenals and pancreas<stomach and intestines<spleen and liver<lungs
<heart< Kidneys and urinary bladder < Prostrate (males) and (uterus in females)
• “foamy” liver or “honey-combed” liver: accumulation of gases, multiple blisters
appear in the liver
References
● Aggrawal, A. (2016). Forensic Medicine and Toxicology for MBBS. Avichal
Publication Company, 325.
This Photo by Unknown Author is licensed under CC BY-SA

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MSC IV_Forensic medicine - Thanatology.pdf

  • 1. Forensic Medicine Dr. Suchita Rawat (MSc, MPhil, PhD)
  • 2. Unit 1: Thanatology Death: causes and manner of death, signs of death and changes after death. Somatic death, molecular death, Early changes after death: algor mortis, rigor mortis, pallor mortis, livor mortis, cadaveric spasm, heat stiffening, cold stiffening, changes in blood; Time since death by body fluid analysis; chemical changes in cerebrospinal fluid; Changes in vitreous humour; Late changes: putrefaction: external and internal changes. Adipocere, mummification, skeletonization
  • 3. Thanatology, Death and its Causes ● STAGES OF DEATH Antemortem, Postmortem and Perimortem Injuries *Agonal period Molecular Death Somatic Death
  • 4. SUSPENDED ANIMATION (syn apparent death) Causes (1) Anesthesia, (2) Barbiturates, (3) Coma (4) Cholera (5) Concussion, (6) Deep shock (7) Drowning, (8) Electrocution, (9) Frozen state (Hypothermia) (10) yoG is [voluntarily induced, but may be remembered by the student here as a memory aid], (11) Hanging (12) Heat stroke, (13) Hypothermia, (14) Hysteria (15)Illnesses [prolonged], (16)Infections [Cholera, Typhoid] (17)Newborn, (19) Opiates.
  • 5. THE MOMENT OF DEATH A. Classical Criteria of Death Bichat’s criteria/Atria mortis French physician Marie Bichat (1771 –1802). [Latin, Gateways of death, death’s portals of entry] within 20 seconds within 20 minutes 3 minutes 3 minutes
  • 6. Tests to determine the death of each organ Tests for circulation • Magnus test (Hugo Magnus in 1872) • Icard’s test: Vivid yellow (Séverin Icard of France in 1895) • Diaphanous test: red and translucent vs. yellow and opaque (transillumination test) • Finger nail test: red-pale on pressure-red Tests for respiration • Winslow’s test: Jacques-Bénigne Winslow (1669-1760) • Mirror test • Feather test Tests for brain function (1) Blowing a strong stimulant such as hellebore or mustard into the nose (2) inserting a sharp instrument under the nail (3) cauterization or incisions (4) scalding with hot water or oil (5) trumpeting or loud noises. Miscellaneous tests :X-ray fluoroscopy for body movt. Source: Agrawal, A. (2016). .
  • 7. Brain Death 1)Unreceptivity and unresponsivity 2) No movements or breathing (at least 1 Hour) 3) No reflexes (pupil, corneal reflexes, spinal reflexes i.e. knee jerk 4) Flat electroencephalogram 5)Repetive test after 24hrs Harvard criteria of Brain Death (1968) 1)Minnesota criteria of Brain stem death (1971) : In 1971, Mohandas and Chou (two neurosurgeons from Minnesota) 2)Indian law on brain stem death (The Transplantation of Human Organs and Tissues Act, 1994) Brain Stem Death (Modern Criteria of the Moment of Death)
  • 8.
  • 10. Minnesota criteria of Brain stem death (1971) (1) No spontaneous movement (2) No spontaneous respiration when tested for a period of 4 minutes at a time (3) Absence of 5 major brain stem reflexes (ref. figure) (4) EEG not mandatory. All the above findings must remain unchanged for at least 12 hours
  • 11.
  • 13. GORDON’S CLASSIFICATION OF DEATH A.Anoxic Anoxia reduced oxygen in ambient air i.e. trap/noxious gases h2s, so2, sewer gas/ high altitude pulmonary blood supply pulmonary gas exchange reduced supply of oxygen i.e. mechanical interface of air passages
  • 14. GORDON’S CLASSIFICATION OF DEATH B. Anaemic Anoxia Oxygen carrying capacity of the blood is reduced. i.e. acute massive hemorrhage , CO poison
  • 15. GORDON’S CLASSIFICATION OF DEATH C. Stagnant Anoxia Blood is incapable of movement i.e. heart failure, embolism
  • 16. GORDON’S CLASSIFICATION OF DEATH D. Histotoxic Anoxia 1. Cellular histotoxic anoxia ( Oxygen cannot be taken up due to failure of tissue enzyme system by poisoning, eg CN , PH3 , H2S, overdose of hypnotics and anesthetics. 2. Pericellular histotoxic anoxia permeability of cell membrane, eg in nitrous oxide or halogenated hydrocarbons [chloroform, cyclopropane, ether, halothane, trilene]. 3. Substrate histotoxic anoxia failure of efficient cell metabolism, eg hypoglycemia 4. Metabolite histotoxic anoxia , eg CO2 poisoning, uremia.
  • 17. SUDDEN AND UNEXPECTED DEATH Sudden and unexpected death is death occurring within 24 hours of the onset of symptoms in an individual who was not known to be suffering from any disease, injury or poisoning. Coronary artery disease CVS Acute edema of lungs / Air embolism (1) epilepsy (2) hemorrhage (3) meningitis, and (4) tumors. (1) Acute hemorrhagic (2) pancreatitis (2) Appendicitis (3) Cancer of esophagus (4) Enlarged spleen [rupture]
  • 18. Signs of Death and Changes Following Death Immediate Early Late 1-30 minus 1hour- Upto 36 hours Beyond 36 hours
  • 19. IMMEDIATE CHANGES Complete and irreversible cessation of functions of brain, heart and lungs. Function] Muscles of the body become flaccid. (primary flaccidity) Corneal and pupillary reflexes are abolished.
  • 20.
  • 21. EARLY CHANGES Within few minutes 1) Skin ashy-white, pale and loses elasticity 2)Changes in lips: dry, brownish and hard due to drying 1. Loss of corneal reflex 2. Opacity of the cornea 3. Pupils 4. Intraocular pressure (14- 3) 4. Retinal vessels 5.Biochemical changes i.e. Potassium levels Source: Agrawal, A. (2016). Source: Agrawal, A. (2016).
  • 22. EARLY CHANGES (Algor mortis) Important points Core temperature (after 2 hours) Ambient temperature Method of recording i.e rectal, sub-hepatic temperature Formula Factors affecting Algor Mortis Environmental temp Build i.e SA/BW Physique i.e FAT/ lean Environment i.e. air Ventilation,Humidity i.e. water submerged, running, sewage Position Covering https://stock.adobe.com/in/search?k=homeostas ii) Average rate of fall - (a) during summers - 0.75°F/h (b) during winters - 1.5°F/h.
  • 23. Postmortem caloricity ● The increase in body temperature for the first few hours after death is called postmortem caloricity. ● The mechanism and conditions of this phenomenon are as follows: ● (i) When the heat regulatory mechanism has been severely disturbed before death. For example: sun stroke. ● (ii) When there is increased heat production in the muscles of the body before death due to convulsions. For example: Tetanus, strychnine poisoning and epilepsy. ● (iii) Excessive bacterial activity during life. For example: Septicemic deaths, cholera and other infections.
  • 24. Postmortem Lividity (Livor mortis/Postmortem staining/postmortem lividity/postmortem hypostasis) Development 0.5-2 hours (Appears as bluish purple mottled patches)< 4 h (Well developed like a sheet but not fixed)< 8 h (Fixation ) < greater than 8 h Persists till putrefaction sets in. *Influencing factors (vol of blood/Length of time blood remains fluid after death/More marked in conditions where blood does not readily coagulate, causing more accumulation to occur. Anticoagulants i.e. Asphyxia/ CO poisoning, Septicemia Source: Aggrawal, A. (2016). Source: Aggrawal, A. (2016).
  • 25.
  • 26. Rigor mortis (cadaveric rigidity, death stiffening) Source: Aggrawal, A. (2016). Source: Aggrawal, A. (2016). Influencing factors: age fetus/ stillborn/children and old /infections gas gangrene, where putrefaction begins early] (b) cancer (c) cholera (d) starvation (e) tuberculosis (f) typhoid/ electrocution,lightning/ late in neuromuscular disease, CO,hemmorage, asphyxia/ (1) Onset slow, duration long – Cold dry weather (2) Onset rapid, duration short – Hot weather.
  • 27. Cadaveric spasm [syn cataleptic rigidity, instantaneous rigidity, instantaneous rigor, postmortem spasm, battle-field rigidity]] is a rare condition, in which the muscles that were in contraction at the moment of death, remain in contraction after death
  • 28.
  • 29. IV. LATE CHANGES (DECOMPOSITION) 1)Autolysis (enzymatic degradation) Inc. in hot/ dec cold Brain (liquefaction),Stomach and GIT, pancreases Putrefaction (bacterial action) (i) Color changes (ii) Production of foul smelling gases (iii) Liquefaction of tissues. *Modifications of Putrefaction *Casper Dictim Source: Aggrawal, A. (2016). Source: Aggrawal, A. (2016).
  • 30. ● • 1st external sign of decomposition is the Greenish discoloration (sulfmethemoglobin) in the right iliac fossa; which becomes evident in 12–24 hours in summer and 1 to 3 days in winter. • This color change spreads to the entire abdomen< chest< neck< face <limbs. • Color gradually changes to dark green then finally black.
  • 31. ● The putrefaction bacteria spread easily in the body fluid and colonize in the venous system. ● The superficial veins of the limbs, chest, abdomen and neck are stained greenish blue due to hemolysis of red cells and stain the walls of the vessels. ● This condition is called as “marbling” which occurs 36 to 48 hours after death in summer and 2 to 3 days in winter.
  • 32. ● Evolution of foul smelling gases: • The main gases are ammonia, carbon dioxide, hydrogen sulfide, phosphorated hydrogen and methane. • Due to continued accumulation of gases, there is distention of breast in females, penis and scrotum in males< abdomen (intestines). ● • Eyes bulge out from their sockets; tongue is forced out between the swollen lips. ● Diaphragm is pushed up compressing the lungs and heart; blood stained frothy fluid exudes from the mouth and nostrils, which is called “postmortem purge”. • Involuntary urination, defecation, seminal ejaculation and delivery of dead fetus occur at this stage. • Gas bubbles accumulate in all the tissues; subcutaneous tissues become emphysematous.
  • 33. ● • Due to the formation of gas blebs, blisters appear between the epidermis and dermis all over the body. • Epidermis becomes loosened (skin slippage) producing large, fragile sacs of clear or pink red serous fluid.
  • 34. Liquefaction of tissues: (Colliquative putrefaction) ● begins from 5 to 10 days. ● The abdomen bursts and contents of abdomen come out of the cavity. • All encapsulated internal organs are converted into bags of putrid fluid and subsequently burst open into the thoracoabdominal cavity. • The rate of putrefaction : enzyme content, water content and blood supply of the organs: Adrenals and pancreas<stomach and intestines<spleen and liver<lungs <heart< Kidneys and urinary bladder < Prostrate (males) and (uterus in females) • “foamy” liver or “honey-combed” liver: accumulation of gases, multiple blisters appear in the liver
  • 35. References ● Aggrawal, A. (2016). Forensic Medicine and Toxicology for MBBS. Avichal Publication Company, 325.
  • 36. This Photo by Unknown Author is licensed under CC BY-SA