Death Death: - Defined As Cessation of Life Ie Total Stoppage of Blood Circulation and A

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DEATH

Death: - Defined as cessation of life ie total stoppage of blood circulation and a


cessation of coordinated functions of the organism as a whole. - Permanent
stoppage of cardio pulmonary (f) s or cerebral death (stedmaus) - A human body
with irreversible cessation of total brain (f), according to usual and customary
standards of medical practice, shall be considered dead (Am. Bar Association) Death occurs when the soul leaves the body. Death on neurological grounds first criteria DeathTwo types of death: 2
Somatic death:
The person irreversibly loses its sentient personality
Unable to be aware of (or to communicate with) its environment
Unable to appreciate any sensory stimuli
Unable to initiate any voluntary movement b)
Cellular death:
State in which the tissues and their constituent cells are dead
They no longer (i)/have metabolic activity
It follows ischaemia and anoxia upon cardiorespiratory failure
Is a process, not an event.
Different tissues die at different rates, cerebral cortex muscle connechive
tissues.
DEATH ON NEUROLOGICAL GROUNDS FIRST CRITERIA The first criteria was

put forward in early 1966 at CIBA symposium in London. These criteria were used
to diagnose brain
1. Complete bilateral mydriasis
2. Complete absence of reflexes; natural and to pain
3. Complete absence of spontaneous respiration five minutes after respirator
taken off.
4. Falling BP requiring increasing amounts of vasopressor drug. Flat EEG.
Based on these criteria the first heart transplant was performed in October 1967.
HARVARD CRITERIA OF BRAIN DEATH (1968)
1. Unreceptivity and unresponsivity.
2. No movements (observe for 1 hour).
3. Apnoea (3 minutes off ventilator).
4. No reflexes - fixed dilated pupils - No brainstem reflexes - No spinal reflexes
5. Flat EEG (of great confirmatory value) at 5 uv/mm
6. No change after 24 hours
MINNESOTA CRITERIA OF BRAIN DEATH
1. No spontaneous movement.
2. Apnoea (4 minutes off ventilator).
3. No brainstem reflexes: Dilated fixed pupils, corneal, Ciliospinal, Dolls, eye,
gag, caloric, tonic neck reflex.
4. Status unchanged after 12 hours.
5. Irreparable brain damage.
UNITED KINGDOM CRITERIA OF BRAIN DEATH (1976)
1. Conditions: Deep coma, drugs metabolic and endocrine causes, hypothermia
excluded. Apnoea. Irremediable structural brain damage.
2. Testes: Absent brain stem reflexes, fixed pupils, corneal, caloric test, gag,
apnoea test.
3. Other considerations: Repeat examination depends on injury. EEG not
necessary. Spinal reflexes irrelevant. The Faculties produced another
memorandum in 1979 stressing the point that identification of brain death meant

death irrespective of heart beat. All appropriate diagnostic and therapeutic


procedures done. Drugs, hypothermia and remedial lesions excluded.Criteria:
(Present for 30 minutes, at least 6 hours after onset of coma and apnoea).Coma
with cerebral unresponsivity,Apnoea,Dilated pupils,Absent cephalic
reflexes,Electrocerebral silence.Confirmatory TestAbsence of cerebral blood flow.
PRESIDENTS COMMISSION 1981In July 1981, the Presidents Commission for the
Study of Ethical Problems inMedicine and Biomedical and Behavioural Research
proposed a new definition ofdeath. it was called the Uniform Detemination of
Death Act and was endorsed bythe American Medical Association, American Bar
Association, the NationalConference of Commissioners on Uniform State Laws,
the American Academy of Neurology and the American EEG Society (22).It
stated: An individual who has sustained either,
1. Irreversible cessation of circulatory and respiratory functions or
2. Irreversible cessation of all function of the entire brain including the brain
stem is dead.Absent cerebral function;Deep coma unreceptive and unresponsive.
Absent brain stem function;Pupils, corneal, oculocephalic, vestibular, oropharyngeal reflexes and apnoe.Reversible causes excluded.No change with repeat test.
JAPANESE CRITERIA OF BRAIN DEATH 1985 Prerequisite : Irreparable brain
lesion detected by CT scan.Exclusion : 5
6. Children under 6. Hypothermia. Drug intoxication. Endocrine and metabolic
disorders.Criteria : Deep coma (Glasgow scale 3) Apnoea, confirmed by apnoea
test. Fixed pupils larger than 4 mm. Absent corneal, ciliospinal, oculocephalic,
vestibular, pharyngeal and cough reflexes.Iselectric EEG: Observation : At least 6
hours.
CONFIRMATORY TESTS : BRAIN DEATH1. EEG2. Blood flow study : Conventional
angiongram. Isotope. DSA Doppler3. Evoked potential : Brain stem
Somatosensory4. Imaging CT Scan MRI scan
RECOMMENDATIONS:
1. That the concept and entity of brain death be recognized and accepted;
and that brain death means death.
2. 2 The diagnosis of brain death is a clinical one and no confirmatory test is
necessary. The exception to this is only for children because of the greater
ability of childrens brain to withstand damage.
3. specialists who are experienced in diagnosing brain death are qualified to
certify.
4. 4 Doctors involved in organ transplantation are not allowed to certify brain
death.
Hospitals where brain death are certified shall have a committee that functions
as coordinating body responsible for general policies, to train and accredit staff,
counseling and oversee facilities.
5. To brain death guidelines should be reviewed every 5-10 years to
accommodate new knowledge and contemporary practice.
CHANGES AFTER DEATH forensic importance: in relation to the estimation of
p.m interval : possible interference with the body : indication as to the COD1 )
COOLING OF THE BODY (Penurunan suhu tubuh) reliable up to 24 hrs after
death time of death not time of injury rectal temp. to be taken ASAP when body
is foundvariables to be considered : - initial body T - ambient T - activity prior to
death - death in sleep - infection - asphyxial deaths - pontine haemorrhage - fat
+ air embolism - aspirin poisoning - hypothermiarate of body cooling affected
by:*ventilation (air movement + humidity) *heavy bed clothes + clothings
*infants + elderly (S/A): body dimension *body posture *immersion deaths *gen.
body built (body fat) *infestation with maggots 7

8. -The Newtons Law of Cooling (the rate of cooling is proportional to the


differencein T between the body surface + its surrounding) did not apply to the
human body-Marshall confirmed the double exponential or sigmoid shape of
the rectalcooling curve-the rate is variable depending on above factors-a
chemical thermometer is used to measure rectal T (precaution in possiblesexual
interference)-The use of Henssges nomogram for estimating time since death
using a singlerectal T-The use of Al Alousi cooling curves for estimation of PMI2)
HYPOSTASIS (Lebam mayat) - AKA p.m lividity, staining, suggilation -when
circulation ceases, gravity acts on stagnant blood, pulling to lowestaccesible
areas, rbc initially (gives bluish red colour of hypostasis), then plasma(dependent
oedema contributing to blisters)-initially blotchy, then confluent over dependent
areas-obvious within 1/2 hrs, marked about 6 hrs, fixed within 4-12 hrs-pattern
depends on posture of body after death-most commonly over the back except
over P areas (skin remains white as vasc.channels are compressed over these
areas)-in hanging, hypostasis most marked distally (eg. below waist + elbows)local P can exclude hypostasis + produce distinct pattern eg; irregular
linearmarks by folds of bed linen, pattern of fabric from coarse cloth, tight
belts,brassiere straps, elastic waist bands, socks, skin folds in the neck of the
obese-important in determining position of body after death-of limited value in
estimating time since death-in gen; it becomes more pronounced as PMI
lengthens-elderlies, infants, anaemia + haemorrhage causes slight staining /
none at all-colour may signify underlying problems: depends on state of
oxygenation atdeath, presence of reduced Hb results in darker tint(eg;
congestive, hypoxic deaths)examples : cherry pink in CO poisoning (OxyHb),
drowning (nb; refrigeratedbodies) : brownish red in methHbaemia (cyanide
poisoning) : pale bronze mottling in septic abortions (Cl.perfringens) : rain drops
punctate pigmentation in arsenic poisoning- colour of hypostasis varies even
from different areas of the same body!Timing + permanence of hypostasis: 8
9. If body is moved into a different posture, the primary hypostasis may either:a)
remain fixedb) may move completely to the new dependent zones/c) may be
partly fixed + partly relocated- controversy about its ability to undergo
subsequent gravitational shift whenhypostasis is already establishedHypostasis
in other organs:-hypostasis in the intestines may mislead to mesenteric
infarction / strangulation- hypostasis at the back of lungs-within posterior wall of
LV (early MI)-Prinsloo + Gordon artefact: haem. post. to oesophagus may mislead
to dx ofstrangulationHypostasis VS Bruising:-regular diffuse engorgement of
surface vessels in dependent areas of the bodywith horizontal margin vs
localised/ circumscribed areas in bruising-fresh bruise may be swollen, raised
over surface, a/w abrasions-hypostasis in most superficial layer, bruise is deeper
+ fixed- to incise the suspect area (whether intravascular/ infiltrating tissues
outsidevessels)-problem arise when decomposition sets in3) RIGOR MORTIS
(Kaku mayat)-dt ATP breakdown + accumulation of lactate + PO4 in Ms resulting
in stiffening +M shortening-ATP is converted to ADP, PO4 is used in
phosphorylation reaction, convertingglycogen to lactate (release E)-RM is
initiated when ATP conc. falls to 85% of normal + rigidity of M is at itsmax. when
it declines to 15%-has some use in determing time since death-first apparent in
small muscle groups as smaller joints are more easilyimmobilised-in gen. starting
with the jaw, facial Ms + neck, then wrists, ankles, knees, elbows+ hips-within 6
hrs: RM developing- from 6-12 hours: RM at its peak + remains constant up to18
hours-18-36 hours: RM begins to fadeOnset of RM may be accelerated / retarded
by many factors;a) feverb) physical activity (exercise) shortly before death (as in
assault)c) environmental T, (freezing envir. suspends formation of RM)d)
electrocution (Krompecher + Bergerioux)-infants, cachexic + elderlies may never

develop RMIn an average temperate condition, the following may be used as


arough guide : 9
10. * if the body feels warm + flaccid, its been dead less than 3 hours*if the body
feels warm + stiff, its been dead from 3-8 hours*if the body feels cold + stiff, its
been dead from 8-36 hours*if the body feels cold + flaccid, its been dead for
more than 36 hoursRigor mortis in other organs ;-iris: modifying pupil
constriction/ dilatation p.m-ventricles: simulating LVH-dartos muscles: results in
extrusion of semen from urethral meatus-in erector pili muscles: beard growing
p.m!Heat + cold stiffening:-the pugilistic attitude + opistothonus of a burnt
body (flexors have greater Mmass as compared to extensors)-below -5 C
stifffening occurs in addition to solidification of subcutaneous fat- true RM may
supervene as body is warmed up4)
POST MORTEM DECOMPOSITION
(Perubahan lanjut)- a mixed process ranging from autolysis of indiv. cells by
intern. chemicalbreakdown to tissue autolysis from liberated enzymes, + from
external processesintroduced by bacteria + fungi from intestines + envir.- it
varies from body- body, envir. - envir., even one part of the body to anotherdivided into subclasses: putrefaction, mummification, adipocere
formation,maceration-rate of decomposition depending on variables : climate
(tropical vstemperate regions) : environmental T (moisture) : clothing : COD :
immersion : earth burial 10
11. - estimation of the TOD in a decomposed body is extremely difficult4a)
PUTREFACTION (Pembusukan mayat)-initially there is discoloration of the
abdomen (RIF) where bacteria laden caecumis (36-48 hrs)-marbling (bacterial
colonisation of venous system, haemolysis of blood, stainingof the vessel walls)
on thigh, sides of the abdomen, chest + shoulders- skin slippage + blister
formation (clear, pink, red serous fluid) which leaves,slimy pink epidermis when
burst, tattooes made more visible-Gen. gas formation in abdomen, genitalia,
neck + face (protrusion of eyeballs,tongue etc) making identification difficult/
impossible-purging of bloody fluids from the orifices-may be heavily blood
stained-different rates of decomposition of intern. organs (intestines, pancreas,
spleenvs prostate + uterus)- coronaries with atheromatous change may be
preserved in decomposed bodiesP.m predators and infestation by maggots
(entomology studies)-complex life cycles of the insects may be used to
determine at least the min.time since death by studying the stage of maturationthis is modified by a no. of factors including climatic + geographic-used since
18th century (Megnins Faune des Cadavres)-information to be made to
entomologist include the nature of environment wherebody was found, the
weather especially ambient T of the area during which thebody was discovered,
(as maturation of insects are markedly altered by climaticconditions)-the Diptera
(including bluebottles, greenbottles + common houseflies) arecommon insects
found on relatively fresh bodies-the bluebottle (Calliphora viccinia) is the most
frequent invader of dead flesh +lay eggs only in daylight, they also lay eggs on
the living, esp. in debilitated/wounded victims-the complete cycle lasts about 1824 days from egg to adults-conversely the common housefly (Musca domestica)
prefers to lay eggs onalready decomposed flesh, although it is more attracted to
garbage + manuresthan to cadavers- whole cycle lasts about 14 days (from egg
to adults) emphasizing thatvariations in the ambient T. make considerable
differences in the rate ofmaturation-materials to be collected include maggots,
adults, pupae and empty pupaecases (live and fixed)-expert knowledge + strict
identification of the species is needed before definiteopinions upon min. times
since death are offered.-immersion slows decomposition (lower ambient temp.,
protected from insect +small animal predators) 11

12. -decomposition in interred bodies is delayed due to lower T, protection


frompredators + lacks oxygen.-topography of the burial site vs type of soil-deep
burial preserves corpse better than shallow/ clandestine burial as it iscolder,
excludes air better, + not directly affected by rain-the make of the coffin
preserves the body, hence allowing exhumation severalyears later4b)
ADIPOCERE FORMATION (Adiposer)- p.m conversion of body fat-partial/ irregular/
may be generalised-esp. over the face (cheeks + orbits), breasts, abdominal
walls + buttocks-dt hydrolysis + hydrogenisation of adipose tissue, leading to
formation of waxy,greasy substance (when recent) or brittle chalky material
(months + years)composed of palmitic, oleic, stearic acids together with
glycerol- colours from off-white, to pinkish, grey/ greenish grey dt staining with
productsof decomposition-smell of earthy, cheesy + ammoniacal-favourable
conditions include moisture + warmth-anaerobes such as Cl. perfringens produce
lecithinase, facilitateshydrogenisation + hydrolysis-medicolegal significance ; it
allows the form of the body, facial features(used in identification), even injuries
such as bullet holes to be retained inrecognisable forms-adipocere formation is
grossly visible as early as 3 weeks with 3 months as thetypical period4c)
MUMMIFICATION (Mumifikasi)- like other modes of decomposition, it can be
partial/ generalised + can co-existwith them in different areas of the same bodycan only occur in dry environment, usually, but not exclusively also a warmplace
with moving air current-can occur in freezing conditions, partly due to dryness of
the air which inhibitsbacterial growth-commonly occur in hot, desert zones-there
is desiccation, brittleness of the skin, which is stretched tightly across
bodyprominences such as cheekbones, costal margins + hips-skin is discoloured
(brown), becomes leathery with secondary colonisation bymolds may add
patches of white, green/black (adding to p.m artefact)-skin, underlying tissues +
internal organs becomes hardened, body is preserved 12
13. thus allowing possible identification in concealed homicides, mummified
fetuses /newborns + major injuries to be preserved
5. STOMACH EMPTYING AS A MEASURE OF TIME SINCE DEATH (Kandungan
gaster)-this method is too uncertain to have much validity-the effect of a
physical/mental shock/stress during the digestion process whichcan completely
inhibit digestion, gastric motility + pyloric openingThe following frustrates the
use of gastric emptying as a measure oftime since death;a) digestion may
continue some time after deathb) the physical nature of the meal has profound
effect on emptying time i.e solidvs liquidc) the nature of the food i.e fatty food +
strong alcohol causes delay in gastricemptyingd) systemic shock/stress can
slow / stop gastric motility + digestive juicesecretion as well as holding the
pylorus firmly closed* what is valid is the nature of the last meal which is useful
in establishing theTOD
6. THE USE OF VITREOUS HUMOUR CHEMISTRY IN TIMINGDEATH-most useful
chemical estimation performed on vitreous fluid for PMI interval is K-serum K
rises rapidly after death, impossible to evaluate the status ofpremortem K levelin contrast to serum + csf, vitreous K levels rise linearly following death-external
factors that influence the validity of the test; sampling T analytical
instrumentation body T-the ambient T during PMI is probably the predominant
factor in determining thedegree of slope at which the vitreous K conc. increases
during the p.m interval-The K conc. from either eye differ by a considerable
amount-forcible aspiration from too near the retina, cellular fragments will distort
thevalues because the K reaches the vitreous by leaching out from the retina-K
higher in persons dying of chronic illness with nitrogen retention (due to premortal electrolyte disturbances in patients with metabolic disorders-the rise in
infants is much faster Sturners equation

VIOLENT DEATH FROM DIFFERENT FORMS OF APNCEA (ASPHYXIA).


This includes death from Suffocation, Strangulation, Hanging and Drowning, in all
of which life is destroyed chiefly,if not exclusively,by apncea or asphyxia.
All these modes of violent death possess certain points in common, while, at the
same time, each of them is distinguished by individual peculiarities, which render
a separate consideration desirable.
Their common properties will be first briefly considered. In all cases of apncea, it
will be remembered that death begins in the lungs, and that this is brought about
simply by excluding the air (oxygen) from these organs. This is accomplished by
numerous and diverse means : as by mechanical pressure upon the throat or
thorax, as in throttling; by a ligature around the throat, as in hanging and
strangling; by the flow of water into the windpipe, as in drowning; by foreign
bodies getting into the larynx and trachea, as in choking; by being shut up in a
box (entombed alive), or buried under ruins, or a sand bank, or snow drift ; or by
some disease of the throat, as oedema of the glottis,membranous croup, etc.;"
all of which produce death simply by arresting the function of
respiration.Likewise, there are exhibited certain signs or phenomena, both before
and after death, which indicate death by apncea. These are lividity of the
lips,fingers,and other etixetrs,emiand generally of the whole face, together with
a swollen appearance of the countenance ; convulsive movements of the arms
and legs,at first partly voluntary, but soon becoming spasmodic and involuntary,
as seen in the struggles to breathe ; the veins become turgid ; the pulse,at first
full and rapid, soon becomes feeble ; there is often frothingat the mouth, which
may, at times, be tinged with blood ; there is frequently turgescence of the
genital organs, with involuntary discharge of semen, urine and faeces. Abortive
attempts at respiration are made for awhile, but finally these cease, and the
heart at last ceases to pulsate. Consciousness is lost very early, although in the
earliest stage there is a remarkable activity of the senses ; the
memory is surprisingly acute, so that the events of a ltifmeseem to be crowded
into a moment. But this stage only lasts for a very brief space of time ; such is
the mteonstyi of persons who have been rescued from drowning, or who have
been cut down from hanging, and of those who have experimented upon
themselves by partial strangulation. This kind of death is rapid,not requiring
more than three to five minutes, though there are some apparent exceptions in
the case of drowning. These will be referred to ahefrte-r.
The post-mortem appearances in all these varieties of death by apncea are, in
the main, very similar. These are lividity of the lips,fingersand other parts of the
body, as seen before death ; in drowning, the face is apt to be pale ;sometimes,
likewise, in /tanging. The venous system is egeranlly full of blood. The right side
of the heart, together with the lungs, is usually gorged with dark blood; the
mucous membrane of the bronchial tubes deeply congested.In young persons,
the blood vessels of the lungs will often be found empty, and the lungs
emphysematous, from the violent efforts made to respire. Minute extravasations
of blood (ecchymoses) are found in the mucous and serous

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DEATH & ITS MEDICO-LEGAL IMPORTANCE


INTRODUCTION Definition Types (iii) Changes after death (iv) Time since death
(v) Duties of a doctor

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DEFINITION According to The Registration of Births and Deaths Action, Section


2 (b), I.P.C death is defined as the permanent disappearance of all evidence of
life at any time after live birth has taken place.
TYPES Somatic/ Systemic/ Clinical Cellular/ Molecular
Somatic/ Systemic/ Clinical Death (i) The complete and irreversible stoppage
of the circulation, respiration and brain functions (Bishops tripod of life) (ii)
Heart lung bypass machines, mechanical respirators and other devices have
changed this medically in favour of a new concept called brain death i.e.
irreversible loss of cerebral function.
Cellular/ Molecular Death (i) The death of cells and tissues individually after
the stoppage of vital functions. (ii) Nervous system dies rapidly, Vital centres
of the brain in about 5 minutes and the Muscles in about 1-2 hours depending
on the residual oxygen. (iii) Accompanied by cooling of body, changes in the
eyes, muscles etc.
CHANGES AFTER DEATH Early (Somatic Death) Insensibility and loss of
voluntary power (Loss of EEG Rhythm) Cessation of respiration Cessation of
circulation (Loss of ECG Rhythm) Early (Cellular death) Cooling of body (Algor
mortis) Changes in the eye (iii) Changes in the skin (iv) Post-mortem lividity/
hypostasis (Livor mortis) (v) Changes in the muscles Primary flaccidity of
muscles Rigor mortis/ Cadaveric rigidity (c) Secondary relaxation Late
(Decomposition and decay) Putrefaction Adipocere formation Mummification
COOLING OF BODY (ALGOR MORTIS (i) Cooling occurs at a rate of 2-2.5F per
hour in first hour, 1.5-2F for first 12 hours and then by 1 for next 12-18 hours
(ii) Body cools by: Radiation (transfer of heat to the surrounding air by infrared
rays) Convection (transfer of heat through moving air currents) Conduction
(transfer of heat by direct contact with another object)
SIGNIFICANCE OF ALGOR MORTIS (i) Usually assumed that the body
temperature at the time of death is normal, but in individual cases it may be
subnormal or markedly raised. (ii) Sub-normal temperature: Hypothermia,
Congestive cardiac failure, Massive hemorrhage, and Shock. (iii) Raised
temperature: Heat stroke, Acute bacterial and viral infections, and
Hemorrhage, Tetanus and Strychnine poisoning (iv) Estimation of time since
death
CHANGES IN THE EYE / OCULAR CHANGES (i) Corneal film- Loss of corneal and
light reflexes (ii) Scleral discoloration (Taches noires) (iii) Corneal cloudiness
(iv) Corneal opacity (v) Endophthalmos (Flaccidity of eyeballs) (vi) PupilsInitially dilated, Later constricted (vii) Retinal vessels- Fragmentation or
segmentation of blood columns
CHANGES IN THE SKIN Pallor Loss of elasticity
POST-MORTEM LIVIDITY/ HYPOSTASIS (LIVOR MORTIS) (i) Occurs when the
circulation stops. Gravity acts on the stagnant blood and pulls it to the lowest
part of the body (ii) Visible 30-60 minutes after death (iii) RBCs settle and skin
below turns red (iv) In 6-10 hours, color becomes permanent (v) Advanced
stages- Skin capillaries burst Hemorrhage Petechial hemorrhages/ Tardieu
Spots (Purple spots on skin)
SIGNIFICANCE OF LIVOR MORTIS Reliable sign of death Position of the body at
the time of death and if it has been altered Estimation of time since death
Colour may suggest the cause of death Distribution suggests circumstances at
time of death
CHANGES IN MUSCLES (a) PRIMARY FLACCIDITY: - Relaxation of all the muscles
of the body- Lower jaw falls, eyelids loose tension, joints become flexible. Contact flattening: Body flattens over areas which are in contact with surface
on which it rests - Muscles are relaxed as long as ATP content remains
sufficiently high to permit the splitting of actin-myosin cross bridges
CHANGES IN MUSCLES (b) RIGOR MORTIS/ CADAVERIC RIGIDITY: - The gradual
onset of stiffening of muscles without shortening - Appears 2-4 hours a after
death and is completed by 6-12 hours - First appears in involuntary muscles
and then in voluntary muscles

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MECHANISM OF RIGOR MORTIS C6H12O6 + 6O2 6H2O + 6CO2 + 36 ATP


Muscles need ATP for actin and myosin to interact After death- Body uses ATP,
but stops making it Due to deficiency of ATP, conversion of glycogen into lactic
acid occurs. Excess of lactic acid causes cross-linking of actin and myosin,
resulting in rigor mortis
FACTORS AFFECTING ONSET AND DURATION OF RIGOR MORTIS Age Nature of
death Muscular state Atmospheric conditions
CONDITIONS SIMULATING RIGOR MORTIS Heat Stiffening Cold Stiffening
Cadaveric spasm
SIGNIFICANCE OF RIGOR MORTIS Sign of death Estimation of time since death
Position of body at time of death
PUTREFACTION Decomposition of the body from organic to inorganic state,
resulting in accumulation of putrefactive gases in the tissues, which causes
false rigidity Brought about by 2 processes: (a) Autolysis (b) Bacterial action
SEQUENCE OF PUTREFACTION Colour changes Development of foul smelling
gases Pressure effects of putrefactive gases Appearance of maggots Other
sequelae
ADIPOCERE FORMATION/ SAPONIFICATION Transformation of unsaturated liquid
fats to a yellowish-white, greasy, wax-like substance (saturated solid fats),
with a sweetish rancid odor due to hydrogenation and hydrolysis of fats A
moist, anaerobic environment is required for the formation of adipocere
SIGNIFICANCE OF ADIPOCERE Establishment of identity of a person Cause of
death Estimation of time since death Place of death
MUMMIFICATION (i) Modification of putrefaction characterized by the
dehydration or desiccation of the tissues. (ii) The body shrivels and is
converted into a leathery or parchment-like mass of skin and tendons
surrounding the bone. (iii) Particularly seen in the groins, around the neck, and
the armpits
SIGNIFICANCE OF MUMMIFICATION Establishment of identity of a person Cause
of death Estimation of time since death Place of death
ESTIMATION OF TIME SINCE DEATH
Glaister equation states that the approximate time since death can be
calculated by: 98.4% - Measured rectal temperature 1.5 ALGOR MORTIS
OCULAR CHANGES
LIVOR MORTIS (i) First apparent about 20-30 minutes after death (ii) Fixed after
about 10-12 hours (iii) Repositioning the body, e.g. from the prone to the
supine position, will result in a dual pattern of lividity since the primary
distribution will not fade completely
RIGOR MORTIS
RIGOR MORTIS If the body feels warm and flaccid, the body has been dead less
than 3 hours If the body feels warm and stiff it has been dead 3-8 hours If the
body feels cold and stiff, it has been dead 8-36 hours If the body feels cold and
flaccid it has been dead for more than 36 hours
LATE CHANGES Time required for Saponification and Mummification varies
greatly. Complete by 12 months
DUTIES OF A DOCTOR Doctor must issue death certificate if death is due to
any natural cause, stating the exact cause of death Doctor must not charge
fees for issuing a death certificate Doctor should avoid technical terms. Rather
he/ she should state his opinion briefly and clearly
DUTIES OF A DOCTOR (iv) If death is due to any unnatural cause, the doctor
must not issue a death certificate but report this to the police (v) In order to
avoid issuing a certificate in death from any unnatural cause, the doctor
should thoroughly inspect the body for all signs of death

Four Categories of Death


These four categories of death are:
Natural Causes: Quite simply when the body ceases to function of its own
accord or if there are mitigating medical factors such as terminal illness, heart

disease or the like, which would bring about death - this is generally referred to
as death by natural causes.
Homicide: The taking of one human life by another human being by means of
pre-meditated murder. The term pre-meditated means to have purposely
planned and executed the murder of another human being in cold blood whilst
trying to elude capture by the authorities.
Accidental Death: As the term would suggest the death of an individual by
means other than natural death, murder or suicide. Accidental death can
sometimes be manslaughter - murder but committed out of an involuntary act of
violence towards another. Likewise accidental death can also be categorised as
death by misadventure. This means that the victim has died by accident either
whilst doing something they should not have been doing or by taking risks that
would put them in mortal danger. A lot of extreme sports participants have died
and their deaths have been classified as death by misadventure because of the
extreme nature of their pastimes.
Suicide: The deliberate taking of one's own life due to extreme emotional
distress often brought about by severe depression. Suicide is neither accidental
nor is it classified as death by misadventure simply because the individual has
set about on a course of action that would end with their own inevitable death.
Normally this would occur by means of drug overdose, the cutting of one's wrists
to induce uncontrollable bleeding, or indeed stepping out in front of a moving
vehicle.
Why Categorise Death?
These four reasons for death are often called upon as a means test for a
pathologist when he or she is required to determine how a person died. They will
look at the evidence both physical and trace to try and determine which category
best fits the manner in which the deceased passed away.
Of course if there are visible wounds such as a gunshot wound or a knife wound
then the most likely cause of death would be attributed to Homicide - or Murder.
It could be possible however that accidental death is the most likely explanation
as many people have died from firearms related wounds whilst cleaning or
maintaining them. For the most part the pathologist will concern themselves with
how the victim died and will use this as a means upon which to base their final
findings.
Throughout all of these types of death an autopsy will have to be performed in
order to provide concrete proof that the pathologist - and indeed the police
officers involved with investigating the death - is correct in their assumptions.

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