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-(CARDIORESPIRATORY)
>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 heartpulse 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 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

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., 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.

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.

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
* 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
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)
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

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 Reddishbrown color
* In the tissues > Hgb undergo
chemical change imparting
Greenish-yellow 1st seen at R Iliac
fossa then spreads over whole abd'l

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.

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

*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)

*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 brownishwhite substance known as
ADIPOCERE at SQ level.

3. Maceration
> softening of the tissues when
in
fluid medium in the
absence of putrefactive microorg, 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
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 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