CHAPTER 4

MEDICO-LEGAL ASPECTS OF DEATH

Death
* is the termination of life/complete cessation of all the vital functions (heart and lungs) w/o
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 det'n, death may be:

1) Brain death
-Harvard report of 1968,chars of'' irreversible coma''
a) unreceptivity / unresponsibility
b) no mov'.ts/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 axn and flow of blood in the whole vascular system
-as a gen rule, (-) heart axn for a period of 5 mins, 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 irreg and feeble
Methods of detecting the cessation of heart action and circulation:
a) Examination of the heart- pulse palpation, auscultation for heart
ECG
b) Examination of peripheral

sound, flouroscopy,

circulation

b) Examination of peripheral circulation

1) Magnus test
application of ligature around
the base of the finger w/ mod. 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 sol'n 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 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

Winslows 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 hours is 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 ( Schourups formula) for the determination of the time of death of any
cadaver whose CSF is examined for the concentrations of Lactic.A., NonProteinNitrogen,
AminoA.
= 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.,
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.

uremia,

7. ACTION OF HEAT ON THE SKIN

>Heat applied while alive produced
blister with serum and redness around
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

the

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
MUSCLES)
> muscle are flaccid, not respond to
stimuli, reaction is alkaline.

( DECAY OF

> 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
a.3 death from- TY, Cholera, Phthisis,

b) Age
* early onset aged and newborn
* delayed good health, good
c) Integrity of nerves

muscular development

illness
typhus

> section of the nerve will delay

onset, paralyzed muscle

(2) External factors

a) Temperature
> Hastened by high temperature
> 75 degrees will produce heat
b) Moisture
> rapidly but with short duration in

stiffening
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
Immediately after death
2.) Muscles involved
Certain group
3.)Occurrence
or may
4.)Medico-legal signif.
Determine

3-6H after death

All muscles
Natural phenomena after death - May
not appear
Approximates time of death nature of crime

RIGOR MORTIS- MUSCLE CONTRACTION

1. Contracted muscle
More or less
transparent

Losses transparency

2. Elasticity
Very elastic
3. Litmus reaction
or sl. alkaline
4. Contraction

Loss elasticity
Acidic
Absolute flaccidity
inherent contraction

Neutral
Possess

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
* Stopp. age 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)
POSTMORTEM HYPOSTASIS
1.Small bruises
Below epidermis in true skin
In the epidermis or
cutis larger ones
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 blood in b.v.

Not elevated,

CONTUSSION (BRUISE)
POSTMORTEM HYPOSTASIS
5. Incision shows blood outside the b.v. = 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

Blood inside the vessels

below

POST-MORTEM LIVIDITY OF ORGANS vs

CONGESTION
1. Postmortem
staining in organs Irregular,
most dependent parts = Uniform,all organs
2. Mucous membrane
in congestion
3. Inflammatory exudate
= Not seen

SIMPLE

Dull,lusterless

= Not
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 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,
* Putrefy late : Highly muscular organs and tissues, Esophagus,
lungs, kidneys,
U.B., uterus, P.G.

*Factors modifying the RATE of putrefaction:

1. INTERNAL FACTORS
a) age :
healthy adults, NB not yet fed,
b) condition of body :
full grown/obese rapid,
Stillborn- late

intestine, liver, spleen

diaphragm, heart,

later than infants

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
d) Clothings early it hastens but delays
* tight clothings - delay

water
in the later stage.

*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 -

6) condition and type of soil

7) inclusion of something in the
8) access of air to the body after
9) mass grave rapid
10) trauma to the body

greater the later

grave which will hasten

burial

decomposition-food

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,
caecum )

greenish-discoloration

24 HOURS ( Rigor mortis absent all over,

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

abdominal distention )

72 H (Whole body grossly swollen, hairs and

loose )
ONE WEEK ( Soft viscera putrefied)
TWO WEEKS ( Soft tissues largely gone)
ONE MONTH (Body skeletonized)

nails

*BEEN SUBMERGED IN WATER

FIRST 4 OR 5 DAYS (Cold water little change,
FROM 5 7 DAYS ( Skin on hands, feet is
1 2 WEEKS (Face swollen and red, skin of
4 WEEKS (Skin wrinkled, nail intact )
6 8 WEEKS (Abdomen distended, skin of

in rigor mortis)
bleached, face faded white )
hands and feet wrinkled )
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
gas
5) water- shallow and stagnant water of
seawater floats sooner than
6) external influence heavy-wearing
*Only teeth, bones and hair remain for
Flat bones disintegrates faster than

putrefaction floats due to

creeks, higher specific gravity

fresh water, higher specific gravity
apparel - slower
an indefinite time.
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 SQ level.

3. Maceration
> softening of the tissues when in
fluid medium in the absence of
micro-org, seen in death in utero .
> reddish or greenish color, skin peeling off and arms flaccid and
frail.

putrefactive

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
with putrefaction

concomitant

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 68 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
3) swelling, detachment or splitting -

PRESUMPTION OF DEATH
Disputable presumption
= not heard in 7 years

burns
injury

Presumption of death
=Absence of 7 years except succession
~ Vessel for 4 years
~ Armed forces 4 years
~ In danger of death 4 years

10 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,
5. under 15, or over 60 y.o. and the other in between - latter

END

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