CHAPTER 4

MEDICO-LEGAL ASPECTS
OF DEATH
Death

* is the termination of life/complete

cessation of all the vital functions
(heart and lungs) without
possibility of resuscitation.
Kinds of death:
1. Somatic or Clinical death – persistence of
vital functions
2 Molecular or Cellular death – 3 to six
hours after cessation of life, death of
indiv. cells
3. Apparent death or ''State of suspended
animation''
transient loss of consciousness/temporary
cessation of the vital fxns of the body, as
in hysteria,uremia, electric shock,catalepsy
Importance of Death
determination:
1.The civil personality of a natural person is
extinguished by death.

2. The property of a person is transmitted

to his heirs at the time of death.

3. The death of a partner is one of the

causes of dissolution of partnership
agreement.
4. The death of either the principal or agent
is a mode of extinguishment of agency.

5. The criminal liability is extinguish by

death.

6. The civil case for claims which does not

survive is dismissed upon death of the
defendant.
 
Based on the criterion used in its
determination, death may be:
1) Brain death
-Harvard report of 1968,chars of'' irreversible coma''
a) unreceptivity / unresponsiveness
b) no movements/breathing
c) no reflexes
d) flat ECG-great confirmatory value
e) falling arterial pressure w/o support by
drugs/other means
BRAIN DEAD
 2)CR death-(CARDIO-
RESPIRATORY) –
>MD pronouncement based on
intuition/ordinary standards of med
practice.
> death occurs when there is a
continuous & persistent cessation of
heart action & respiration.
CARDIORESPIRATORY DEATH
Signs of death:
1. Cessation of heart action and
circulation.
-entire and continuous cessation of heart action
and flow of blood in the whole vascular system
-as a gen rule, (-) heart action for a period of 5
minutes, death is regarded as certain.
-in judicial hanging, heart continues to beat for
25mins or half an hour after he has been
executed although its beating is irregular and
feeble.
Methods of detecting the cessation of
heart action and circulation:

a) Examination of the heart- pulse

palpation, auscultation for heart sound,
flouroscopy, ECG

b) Examination of peripheral circulation

b) Examination of peripheral
circulation
1) Magnus test –
application of ligature around the base
of the finger with moderate lightness
bloodless area at site of application
dead man – no change in color

2) Icards test – injection of flourescein

subcutaneously
- greenish yellow discoloration in the
whole skin dead man solution will
remain at the site of injection.
3) Diaphanous test – fingers are
spread wide & the finger webs
are viewed through a strong
light
 * if person is dead,the color is

yellow
 * if alive, the color is red
4) Pressure on fingernails

5) Application of heat on the skin – blister

6) Palpation of Radial pulse

7) Dropping of melted wax

2. Cessation of respiration –breath holding not
more than 3 ½ minutes

Methods of detecting cessation of respiration:

a) Observance of movement of chest and
abdomen
b) With the aid of stet.
c) Examination with a mirror
d) Examination with a feather or cotton fibers
e) Examination with a glass of water
 Winslow’s test
no movement in the image formed
by reflecting artificial light on the
water in a saucer and placed.
3. Cooling of the body ( ALGOR
MORTIS)
- After death the metabolic process inside the
body ceases.
- The progressive fall of the body temp. is one
of the most prominent signs.
- First two hours after death the cooling is
rapid.
- Fall of temp. of 15 to 20 degrees Fahrenheit is
considered as a certain sign of death.
*POSTMORTEM CALORICITY –
is the rise of temp. of the body after
death due to rapid and early
putrefactive changes. Usually in the
first 2 hours.

>seen in cholera, liver abscess,

tetanus, RF, Strychnine poisoning,
Peritonitis
 
A. Conditions connected with the
body:
 Factors delaying the rate of cooling of the
body:
1) Acute pyrexial disease
2) Sudden death in good health
3) Obesity of person
4) Death from asphyxia
5) Death of the middle age
Factors accelerating cooling:
1) Leanness of the body
2) Extreme age
3) Long-standing illness
4) Chronic pyrexial disease with
wasting
B. Conditions that are connected
with the surroundings

 Factors delaying cooling:

1) Clothings
2) Want of access of air to the body
3) Small room
4) Warm surroundings
Factors accelerating cooling:
1) Unclothed body
2) Conditions allowing the access of
air
3) Large room permitting the
dissipation of heat
4) Cooling more rapid in water than in
air
*Methods of estimating how long a person
has been dead from the cooling of the
body:
1. If body temp. is normal at the time of
death:
= the average rate of fall of the temp. during the
first 2 ½ hours is ½ of the
difference of the body temperature and that of
the air.
=as a gen rule, the body attains the temp. of the
surrounding air from 12 to 15 hours after death in
tropical countries.
 
2. Chemical Method ( Schourup’s
formula) for the determination of the time of
death of any cadaver whose CSF is examined for
the concentrations of Lactic.Acid.,
NonProteinNitrogen, AminoAcid.
= L.A> 15 mg to 200 mg/100cc rapid in
1st 5 hours.
= NPN inc. from 15 to 40 mg/100 cc in
1st 15 hours
= A.A. inc. from 1 mg to 12 mg% 1st 15
hours.
4. INSENSIBILITY OF THE
BODY AND LOSS OF POWER
TO MOVE
may be seen in the living with-
apoplexy, epilepsy , trance,
catalepsy, hysteria ,cerebral
concussion.
5. CHANGES IN THE SKIN –
opacity on transillumination,
flattening, loss of elasticity of skin,
pale, waxy looking, no blister
formation on application of heat.
6. CHANGES IN AND ABOUT THE
EYE
a) Loss of corneal reflex –may be seen
In live pts: Gen./local anesthesia.,
uremia, narcotic poisoning
b) Clouding of cornea
c) Flaccidity of the eyeball
d) Pupil in the position of rest.
e)'' TACHE NOIR DE LA
SCLEROTIQUE'' – spot found in the
sclera after death.
7. ACTION OF HEAT ON THE SKIN
>Heat applied while alive – produced
blister with serum and redness around
the area.
>Following combinations of signs show
death has occurred:
a) Loss of animal heat to a point not
compatible with life
b) Absence of response of muscle to
stimulus
c) Onset of rigor mortis.
CHANGES IN THE BODY FOLLOWING DEATH

1. CHANGES IN THE MUSCLE – complete relaxation of

the whole muscular system.
*Three Stages After Death:
a) Stage of primary flaccidity (POSTMORTEM
IRRITABILITY)
= muscle relax, may contract, dilated pupil,
sphincters are relaxed, incontinence of urination and
defecation
= presence of molecular life
= warm place: 1 hour and 51 minutes
= chemical reaction of muscle is alkaline
b) Stage of postmortem rigidity
(CADAVERIC RIGIDITY/ DEATH STRUGGLE
OF MUSCLES OR RIGOR MORTIS)
= whole body is rigid due to contraction of
the muscles
= starts at muscle of neck, lower jaw
= Reaction is acidic due to inc. of lactic acid
= develops 3 to 6 hours after death in
temperate, earlier in warm
= last from 2 to 3 days in temperate, warm:
24-48H cold weather 18-36H summer
c) Stage of Secondary flaccidity
or Commencement of
putrefaction ( DECAY
OF MUSCLES)
> muscle are flaccid, not respond to
stimuli, reaction is alkaline.

> due to dissolution of muscle proteins.

*FACTORS INFLUENCING THE TIME OF
ONSET OF RIGOR MORTIS
(1) Internal Factors
a) State of the muscles
> healthy – appears late
> Onset is hastened in:
a.1 hunted animal
a.2 prolonged convulsion/lingering
illness
a.3 death from- TY, Cholera, Phthisis,
typhus
b) Age
* early onset – aged and newborn
* delayed – good health, good
muscular development

 c) Integrity of nerves

> section of the nerve will delay
onset, paralyzed muscle
 
(2) External factors
a) Temperature
> Hastened by high temperature
> 75 degrees will produce heat
stiffening
b) Moisture
> rapidly but with short duration in
moist air
Conditions simulating RIGOR MORTIS:
1. Heat stiffening > 75 degrees
coagulates muscle proteins resulting
to rigidity.
* “Pugilistic attitude” flexed upper
and lower limb, hands clenched, flexor
stronger than extensors, burned to
death
2. Cold stiffening
= due to solidification of fats when
exposed to cold temp.
3. Cadaveric spasm or
Instantaneous Rigor
> instantaneous rigidity due to
extreme nervous tension,
exhaustion, injury to the nervous
system.
> findings of weapon in hand,
weeds-alive before disposal.
RIGOR MORTIS CADAVERIC SPASM
1.) Time of appearance
3-6H after death
Immediately after death
2.) Muscles involved
All muscles
Certain group
3.)Occurrence
Natural phenomena after death - May or
may not appear
4.)Medico-legal signif.
Approximates time of death -
Determine nature of crime
 
 RIGOR MORTIS- MUSCLE CONTRACTION
1. Contracted muscle
Losses transparency More
or less transparent
2. Elasticity
Loss elasticity Very elastic
3. Litmus reaction
Acidic Neutral or sl.
alkaline
4. Contraction
Absolute flaccidity Possess
inherent contraction
 
2. CHANGES IN THE BLOOD
a) Coagulation of blood

* blood may remain fluid inside the

blood vessels 6-8H after death.
 
ANTEMORTEM CLOT
POSTMORTEM CLOT
1. Consistency
Firm Soft
2. Surface of blood vessels
Raw after clots are removed
Smooth, health after
3. Clots
Homogenous in construction so it:
cannot be stripped into layers can be
stripped off in layers
 
b) Postmortem Lividity or Cadaveric
Lividity , or Postmortem Suggilation or
Post-mortem Hypostasis or Livor Mortis
* Stoppage of heart action and loss of tone of
blood vessel accumulates in dependent areas
except in bony areas.
* capillaries coalesce > purplish in color called
''Postmortem lividity''
= Hasten by death due to cholera, uremia,
Typhus fever
= appears 3 – 6 H after death and fully
developed 12 H after death.
*Physical characteristics of
Postmortem Cadaveric Lividity
1) Occurs in the most dependent
areas
2) Involves the superficial layer of the
skin
3) Does not appear elevated from the
rest of the skin
4) Color is uniform
5) No injury of the skin
*Kinds of Postmortem Cadaveric
Lividity

1) Hypostatic lividity

2) Diffusion lividity
 
*Importance of Cadaveric
lividity:
1) One of the signs of death.

2)Determines the position of the

body has been changed after its
appearance in the body.
3) Color of lividity may indicate the
cause of death
example:
* asphyxia – lividity is dark
* CO poisoning – pink
* Hemorrhage – less marked
* Hydrocyanic acid – bright red
* Phosphorus – dark brown
* Potassium chlorate – coffee brown
 4)Determines how long the person
has been dead.

5) Gives us an idea as to the time

of death.
 
*Points to be considered which
may infer the position of the
body at the time of death:
1) Posture of the body when found.

2) Post-mortem hypostasis or lividity

3) Cadaveric spasm
 
 
 CONTUSSION (BRUISE) vs.
POSTMORTEM HYPOSTASIS
 1.Small bruises
Below epidermis in true skin In the epidermis or
cutis larger ones
below this
 2. Cuticle
Abraded by the same violence - Unabraded that
produce the bruise.
 3. Bruise
Appears at the seat or surrounding -Always dependent
may or may not be dependent
 
4.Elevated, inflammatory condition - Not elevated,
blood in b.v.
 
CONTUSSION (BRUISE) vs.
POSTMORTEM HYPOSTASIS
 
5. Incision shows blood outside the b.v. -
Blood inside the vessels
= most certain test of difference
 
6. Color variegated Uniform color
 
*Internal hypostasis in Visceral
organs::
Organs affected are:
1) Lungs

2) Loops of intestine

3) Brain
POST-MORTEM LIVIDITY OF ORGANS vs
SIMPLE CONGESTION
1. Postmortem
staining in organs Irregular,
most dependent parts = Uniform,all organs
 
2. Mucous membrane
Dull, lusterless
= Not in congestion
3. Inflammatory exudate
Not
seen = Not seen
*Other changes in the blood
1). Hydrogen ion concentration – acid
pH CO2, L.A., After 24H alkaline
ammonia.
2). Breakdown of liver glycogen leads
to accumulation of dextrose in the
IVC and the right side of the heart.
3). Rise in NPN and Free A.A.
4. Chemical:
* Chloride in the plasma/RBC
decrease due to extravascular
diffusion, in 72 H only ½ of its
content.
* Mg – increases due to diffusion
from without.
* K – increases due to diffusion
from the vascular endothelium.
3. AUTOLYTIC OR
AUTODIGESTIVE CHANGES
AFTER DEATH
After death, proteolytic, glycolytic
and lipolytic ferments of the
glandular tissues continue to act
which lead to the autodigestion of
organs.
4. PUTREFACTION OF THE BODY
Is the breaking down of complex
proteins into simpler
components associated with the
evolution of foul smelling gasses
and accompanied by the change
of color of the body.
 
*Tissue changes in putrefaction:
 1. Changes in the color of the
tissue
* Hemolysis of blood within blood
vessels > Hgb diffuses through the walls
of BV imparting a Reddish-brown color
* In the tissues > Hgb undergo chemical
change imparting Greenish-yellow 1st
seen at R Iliac fossa then spreads over
whole abd'l wall
• MARBOLIZATION –
• prominence of the superficial veins
with reddish discoloration which
develops on both flanks of the
abdomen, neck, and shoulder .
* look like “marbled” reticule of
branching vein ( esp. observed
among fair complexion )
2. Evolution of gases in the tissues
* CO2, ammonia, H2, Sulfurated hydrogen,
methane = offensive odor

* Effects of pressure of gases of putrefaction:

a) displacement of the blood – bleeding in
open wounds
b) bloating of the body
c) fluid coming out from nostrils, mouth
d) extrusion of the fetus in a gravid uterus
e) floating of the body
 
 
3. Liquefaction of the soft tissues
* Putrefy rapidly : Eyeball, lining
of trachea, larynx , brain, stomach,
intestine, liver, spleen
* Putrefy late : Highly muscular
organs and tissues, Esophagus,
diaphragm, heart, lungs, kidneys,
U.B., uterus, P.G.
*Factors modifying the RATE of
putrefaction:
1. INTERNAL FACTORS
a) age :
healthy adults, NB not yet fed,
later than infants
b) condition of body :
full grown/obese – rapid,
Stillborn- late
c) cause of death : infection - rapid
 
2. EXTERNAL FACTORS
a) Free air
a.1 air : free air hasten decomposition

a.2 moderate moisture - accelerates

a.3 loaded with septic bacteria – early

aerobes, later anaerobic

* Clostridium welchii= decomposition

b) Earth
b.1 dry absorbent soil - retards
b.2 moist fertile soil - accelerates

c) Running water- more rapid than still

water
d) Clothings – early it hastens but delays
in the later stage.
* tight clothings - delay
 
Factors influencing the changes in the body
*

after burial:
1) state of the body before death – thin slower,
mummify
2) time elapsed between death and burial and
environment of the body
3) effect of coffin – later

4) clothings and other coverings on the body when

buried – pressure, insects

5) depth at which the body was buried - greater the

later

 
6) condition and type of soil
7) inclusion of something in the
grave which will hasten
decomposition-food
8) access of air to the body after
burial
9) mass grave – rapid
10) trauma to the body –
11) violent death - slow
*CHRONOLOGICAL SEQUENCE OF
PUTREFACTIVE CHANGES OCCURING IN
TEMPERATE REGIONS
 1-3 DAYS AFTER DEATH (greenish discoloration
over iliac fossa, soft eyeballs )
3-5 DAYS ( frothy blood from mouth, nostrils)

8-10 DAYS (abdominal distention, nails firm )

14-20 DAYS( blisters all over the body, maggots)

2-5 MONTHS (skull exposed, orbits empty)

*IN TROPICAL REGION
 
12 HOURS ( Rigor mortis all over, hypostasis, greenish-
discoloration caecum )

24 HOURS ( Rigor mortis absent all over, abdominal

distention )
48 H ( Ova of flies, trunk bloated,face discolored)

72 H (Whole body grossly swollen, hairs and nails

loose )
ONE WEEK ( Soft viscera putrefied)
TWO WEEKS ( Soft tissues largely gone)
ONE MONTH (Body skeletonized)
 
*BEEN SUBMERGED IN WATER

FIRST 4 OR 5 DAYS (Cold water little change,

in rigor mortis)
FROM 5 – 7 DAYS ( Skin on hands, feet is
bleached, face faded white )
1 – 2 WEEKS (Face swollen and red, skin of
hands and feet wrinkled )
4 WEEKS (Skin wrinkled, nail intact )
6 – 8 WEEKS (Abdomen distended, skin of
hands/ feet come off with nails)
*Factors influencing the floating of the
body in water:
1) age – fully developed, well nourished -
rapid
2) sex – females floats sooner
3) conditions of the body – obese float
quicker
4) season of the year – moist hot air –
putrefaction – floats due to gas
5) water- shallow and stagnant water of
creeks, higher specific gravity
seawater floats sooner than fresh
water, higher specific gravity
6) external influence – heavy-wearing
apparel - slower
*Only teeth, bones and hair remain for
an indefinite time.
Flat bones disintegrates faster than
round bones.
*SPECIAL MODIFICATION OF
PUTREFACTION
1. Mummification
*is the dehydration of the whole
body which results in the shivering
and preservation of the body.

* usually occurs when buries in a hot,

dry with free access of hot air.
 
 2) Saponification or Adipocere
formation

* a condition where the fatty tissues

of the body are transformed to soft
brownish-white substance known
as ADIPOCERE at subqutaneous
level.
 
 3. Maceration
> softening of the tissues when in
fluid medium in the absence of
putrefactive micro-organism,
seen in death in utero .
> reddish or greenish color, skin
peeling off and arms flaccid and
frail.
 
HOW LONG A PERSON HAS BEEN DEAD?
DURATION OF
DEATH
1. Presence of rigor mortis: 2-3 hours after death
12 H fully developed
18-36 H disappears
concomitant with putrefaction

2. Presence of Post-mortem lividity

3-6 H after death appears as small petechia-like
red spots
3. Onset of decomposition
24-48 H after manifested watery.
foul smelling froth, mouth, nostrils
4. Stage of decomposition
5. Entomology of the cadaver – 24 H
before eggs are hatched, maggots
 
6. Stage of digestion - 3-4 H gastric
empty 6-8 distal ileum, cecum

7. Presence of live flies in the clothing

in the drowning victim – less than
24H
 8. State of clothings - pajama =
night
9. Changes in CSF

10. Blood clots inside the b.v. in 6–8 H

after death.

11. Soft tissues of the body may

disappear 1 to 2 years after burial.
 
Postmortem conditions simulating
disease, poisoning or injury:
1) post mortem hypostasis –
contusion, inflammation , poisoning
2) blisters of the cuticle – scald and
burns
3) swelling, detachment or splitting -
injury
PRESUMPTION OF DEATH
Disputable presumption
= not heard in 7 years
 
Presumption of death
=Absence of 7 years except succession
10 years
~ Vessel for 4 years
~ Armed forces 4 years
~ In danger of death 4 years
PRESUMPTION OF SURVIVORSHIP
1. under 15 y.o. – older survives
2. above 60 y.o.- younger
3. under 15, above 60 - former
4. over 15 and under 60 y.o. – male,
older
5. under 15, or over 60 y.o. and the
other in between - latter
 
END