Medicolegal aspects of death

This slide contains a detailed description of medicolegal aspects of death.

1. “Medicolegal aspects of death” Presented by Pallavi Kumari SHUATS, Prayagraj M.Sc.Forensic science (Sem- IInd)

2. CONTENTS Introduction. Classification of death. Phases of death. Manners of death. Modes of death. Criteria to diagnose death. Sudden death. Death trance. Tests for death. Postmortem phenomenon.

3. INTRODUCTION “Forensic Thanatology” , where Thanatos means death and Logos means science, is a branch of science that investigates the mechanisms and forensic aspects related to death, like body changes that accompany death and the post-mortem period. Forensic thanatology is known as scientific study of death. Generally, it is conducted upon direction of Police or Court for the determination of cause and manner of death and with a view to assist the investigation process. Definitions of ‘DEATH’ “Permanent disappearance of all evidences of life at any time after live birth has taken place”. (According to Section 2b of the Registration of Births and Deaths act). Total stoppage of circulation and cessation of vital functions, such as respiration and pulsations. (According to Physicians).

4. Shapiro (1969) defined Death as “The irreversible loss of the properties of living matter”. Calne (1970) states that “when destruction of the brain has been established, the individual has died no matter what the state of rest of his body, giving five signs for diagnosis: Deep irreversible coma. Fixed dilated pupil. Absent cranial reflexes. No spontaneous respiration. Absence of electrical brain activity. Rantoul and Smith (1973) defined death as “Complete and persistent cessation of respiration and circulation”.

5. CLASSIFICATION OF DEATH BODY DEATH ORGAN DEATH --- Body may be dead but organs may survive. --- The living body depends upon the integrity of three systems, interdependent upon each other, these systems are Respiration, Circulation, Enervation. “The failure of one of them will cause failure of other two this lead to the death of an individual”.

6. PHASES OF DEATH --- It is the complete and persistent loss of coordinated functioning of tripod of life i.e Brain, Heart, and Lung. ✓ Somatic death is also called Systemic death/ Clinical death/ Legal death. --- It is the death of individual organs and tissues ( which persisted individually after somatic death). ✓ It follows 2-3 hrs after somatic death. * Also called as cellular death. 1. SOMATIC DEATH 2. MOLECULAR DEATH

7. MANNERS OF DEATh It is the way, fashion or circumstances of Death. NATURAL UNNATURAL 1. 2. --- Due to disease. ✓ E.g. Myocardial infraction, uremia, asthma, meningitis, etc. --- Causes other than disease. ✓ E.g. Accidental Head injuries, Homicidal head injuries (incised, firearm, stab, etc), Suicidal Head injury (e.g. firearm injury), Poisoning (e.g. Opium,etc).

8. MODES OF DEATH As per Xavier Bichat, a French physician, irrespective of what the remote cause of death may be, there are three modes of death. --- Failure of nervous system. --- Failure of circulatory system. --- Failure of respiratory system . 1. COMA 2. SYNCOPE 3. ASPHYXIA

9. CRITERIA TO DIAGNOSE DEATH “HOWARD’s Criteria” It is followed in majority of the countries. The basis of diagnosis is as follows: Non receptive for stimuli & there is no response No movement for one hour & no breathing. No spontaneous breathing for 3 min after switching off the artificial means. No reflexes. Flat EEG.

10. SUDDEN DEATH Sudden Death are unexpected,occur from unnatural causes such as violence or poison as well as from natural causes. Death may suddenly occur due to excitement,mental tension or strenuous physical work. Causes of sudden death are- Cardiovascular diseases (40-50%). Respiratory diseases (15-23%). Central nervous system diseases (10-18%). Gastrointestinal diseases (6-8%). Genito- urinary system diseases (3-5%). Miscellaneous like rupture of bladder, acute renal failure, bleeding disorder, etc. (5-10%).

11. DEATH TRANCE It is the condition in which all signs of life or vitality are seemed to be absent although the individual still remains alive. The person appears to be dead because of very feeble or minimum function of his body systems. The function of circulatory, respiratory or nervous system may not be perceived by conventional method though the person is still alive. The function of these system may return after sometime by proper resuscitaion. Such a death like state is known as suspended animation. Actually the circulation do not completely stop but is maintained in minimum This type of conditions are found in Yogis, person suffering from histeria, cholera, sun stroke, drowning, hanging, tetanus, etc. This stage may last for a few seconds to 30 minutes or more.

12. TESTS FOR DEATH For stoppage of function of Nervous system Look for movement- No movement Look for response-No response to stimulus Look for jerk-No jerks Look for reflex- No reflex Confirmation by EEG For Stoppage of respiration Feather test- Feather/cotton- Nose- Movement Mirror test –Mirror-Nose/Mouth –Hazy Winslow’s test –Water bowl-Chest-Light reflection

13. For stoppage of circulation Detection of pulse & BP: abent Absence of heart sound. ECG Tracing shows no evidence. Through magnum test, the tight part at the base of finger will not swell beyond the Ligature and becomes blue. If circulation is stopped, application of heat or flame will not form a true vesicles. I card test—hypodermic injection of fluoresces doesn’t produce any discoloration of skin. If a small artery is cut, there will be no spurting of blood. On the application and withdrawal of pressure to the finger nails, it does not assume alternatively a white or pink colour as in life.

14. POSTMORTEM PHENOMENon (Changes after death) IMMEDIATE CHANGES EARLY CHANGES LATE CHANGES

15. IMMEDIATE CHANGES Insensibility and loss of both sensory and motor function. Loss of reflexes, no response and no tonicity of the muscles. Pupils are dilated. Complete stoppage of respiration. Complete stoppage of heart beat. Stoppage of function of nervous system.

16. EARLY CHANGES Changes in the eye Changes in the skin Algor mortis Hypostasis Changes in the muscles

17. LATE CHANGES 1. PUTREFACTION 2. Adipocere 3. Mummification 4. Skeletonization

18. 1. EYE CHANGES At the time of death: Eyes seem to stare, pupils become fixed and dilated, Corneal and light reflex disappeared. Within 10 seconds: The blood in retinal vessels rapidly becomes dotted first and then break up into segments called “Cattle trucking”. Within few minutes : Drying of cornea can produce haziness, if the eye lids are opened and atmosphere is dry. Within 3 hours: Tache Noire appear on sclera within 3 hours of death, of eyes remains open. Tache Noire are brown blackish discoloration, due to formation of cellular debris and dust settling on sclera. Within 6-10 hours: Optic disks become hazy.

19. 2. Skin changes Loss of its translucency. Pale and Ashy white appearance. Loss of Elasticity. Wounds will not gape if it is inflicted after death. Wounds caused during life will retain their characteristic features. Lips becomes dry,hard and Brown in color due to drying .

20. 3. Algor mortis After death, the body commences to loose its temperature due to the stoppage of the process of oxidation which maintains the heat of the body and gradually attains the temperature of its surrounding. The body starts cooling after 1-2 hrs after death and attains atmospheric temperature in 12-15 hrs while internal body parts take 18-24 hrs to cool. Rate of cooling is affected by Mean atmosphere temperature, Clothing and other covering on body, Air movement and its humidity, State of nutrition and development of body, Age, Sex, Cooling In fluid medium e.g water, Temperature of body before death .

21. 4. Livor Mortis (Postmortem staining/ Hypostasis/ Suggilation/ Vibices) Due to gravitational force the blood flow to the dependent parts of the body, causing stagnation of blood in the toneless, dilated capillaries resulting in bluish purple staining. Areas exposed to pressure will not show lividity, as the blood vessels are mechanically compressed preventing blood flow. Begins to develop 1 – 3 hours after death and fully developed by 10 to 12 hours. Initially, livor is due to blood settling within vessels, and thus can shift with movement of the body and will blanch with pressure. Later, blood will hemolyze and diffuse out of the vascular space; at this point, livor is fixed; it will not shift with movement of the body and is nonblanchable As livor progresses, some bodies show dark purple Tardieu spots in dependent areas, due to ruptured capillaries

22. 5. Muscle Changes Primary relaxation/ Flaccidity Rigor Mortis Decomposition

23. A. Primary Relaxation/Flaccidity Flaccid period starts immediately after death.
All the muscles begin to relax.
Lower jaw begins to fall. Limbs are perfectly mobile.
Eyelids loose tension. Extremities are soft and flabby.
Joints are flexible
Extends 3-6 hours after death before stiffening Occurs.
Muscle irritability and response to electrical or mechanical stimuli still persist .

24. B. Rigor mortis This phenomenon comes immediately after the muscles have lost the power of contractility ( means the body has become stiff) and is irreversible changes in the muscles of the body, both voluntary and involuntary.
Time of onset - Temperate climates : 3-6 hours , Tropical climates : 1-2 hours. Duration- Temperate climates : lasts for 2-3 days , Tropical climates : 24- 48 hours in winter and 18- 36 hours in summer . With the lapse of about 24 hours , muscles again becomes soft and the body enters into 3 rd stage of Cadaveric rigidity I.e. Beginning of Decomposition stage. Factors affecting rigor mortis- Age, Nature of death, Molecular state, Atmospheric conditions, Hot stiffening, Cold Stiffening.

25. C. Decomposition After Rigor Mortis, the body again becomes soft and Flaccid but doesn’t respond to external stimulus. The difference between first and third stage of the Cadaveric rigidity stage in muscle are as in first stage respond to external stimuli whereas in third stage no such response so that muscles pass through distinct stage. Rigor Mortis starts first in the small muscles of eyelids by approximately 1-2hrs of death and then progresses in the muscles of the lower jaw, neck, muscles of trunk, upper extremities and lower extremities. Lastly the muscles of the fingers and toes are affected.
The disappearance of rigor mortis is the same as its order of appearance .

26. CADAVERIC SPASMS (Instantaneous Rigor mortis/ Cataleptic rigidity) This is the stage when the muscles of the body directly pass into a stage of contraction after death without passing the normal early phase of relaxation. It is generally limited to a single group of muscles rather than involving whole body. This instant rigor is seen at the time of death. The body was in a state of great muscle exertion or mental excitement. Excess neuronal discharge at that time is believed to be the reason to instant .

27. 6. Putrefaction Putrefaction is defined as the last stage in the resolution of body from organic to Inorganic state and is an absolute sign of death . A. Autolysis B. Bacterial action

28. AUTOLYSIS ‘Auto’– Self and ‘Lysis’ – Destruction.
It is the softening and liquefaction of the body tissue. Causes- Self destruction by enzymes released from cells after death. It is prevented by freezing of tissues. B. BACTERIAL ACTION Most bacteria come from bowels Chiefly Clostridium Welchii, and other include Streptococci, Staphylococcus, E. Coli, etc. Favourable conditions- Warmth, moist and air .

29. Time required for putrefaction In 1-2 hours Greenish patch on right iliac fosa is seen; In another 2-4 hours cornea become white and opaque; In 12-13 hours Greenish coloration spreads all over the body; Formation of gases starts from 12-18 hours ; The superficial veins become prominent resembling marble like appearance; In 72 hours rectum and uterus protrude; The hair become loose; In 3-5 days sutures of skull open up and, the teeth became loose and may fall. Changes in putrefaction Color changes; Development of foul smelling gases; Pressure effect of gases; Appearance of maggots. Medicolegal importance of putrefaction Estimation of time since death; Place of death; Manner of death; Maggots also reveal about the drugs. Factors affecting putrefaction Temperature, bacterial content of tissues, air and moisture, Clothing of the body, presence of body fat, Presence of injuries, age, manner of burial.

30. 7. Adipocere ‘Adipose’ means Soft fat, ‘cera’ means wax. Also called as saponification, grave or mortuary wax. It is the formation of soft whitish, crumbly or greasy material in the soft tissues the body after death. It is yellowish white, greasy wax like substance with a rancid smell. Its mechanism is not fully known but it is believed that Clostridium Welchii initiates the process of hydrolysis & hydrogenation of body fats. Unsaturated liquid fats convert to saturated solid fats by bacterial fat splitting enzymes. It has been noticed that superficial fats are initially affected in patches, being first seen in Cheeks, breasts & buttocks. Finally the process spreads to the whole body. Once formed it is relatively permanent. Starts 2-3 weeks to months are required for Adipocere formation .

31. Conditions affecting Adipocere formation 1.MOISTURE---It is prerequisite for Adipocere formation..
2. Warm TEMPERATURE Retarded by cold.
3. Lack of air.
4.BACTERIA---Facilitated by postmortem invasion of endogenous bacteria. Medicolegal Information It indicates time elapsed since death.
It establishes the identity of a person. It indicates the burial place .

32. 8. Mummification Modification of process of putrefaction.
There is dehydration or desiccation of body tissues & viscera after death.
The ideal conditions for its formation are- high atmospheric temperature, devoid of moisture, free circulation of air, Essential features - Skin is dry, shrunken, leathery, rusty brown or black adhering to the bones.
Soft parts shrivel up but retain the natural appearances and features.
Internal organs becomes dried mass. Time required - 3-12 months are required for mummification Medicolegal Importance - It indicates time elapsed since death, It indicates cause of death, It establish identity of the person, It indicates the burial site.

33. 9. SKELETONIZATION Skeletonization refers to the final stage of decomposition, during which the last vestiges of the soft tissues of a corpse or carcass have decayed or dried to the point that the skeleton is exposed. The speed of skeletalization will depend on many factors, including the climate and the microenvironment around the body. It will occur much more quickly in a body on the surface of the ground than in one that is buried. Generally, in a formally buried body, the soft tissues will be absent by 2 years. Tendons, ligaments, hair and nails will be identifiable for some time after that.
At about 5 years , the bones will be bare and disarticulated, although fragments of articular cartilage may be identified for many years and for several years the bones will feel slightly greasy and, if they are cut with a saw, a wisp of smoke and a smell of burning organic material may be present .