FORENSIC THANATOLOGY ( Medicolegal Aspects of Death )

FORENSIC THANATOLOGY ( Medicolegal Aspects of Death ) 

Thanatology

DEFINITION OF THANATOLOGY

Thanatology is the branch of science which deals with study of death .

DEFINITION OF DEATH 

Death is cessation of life ,

permanent and complete stoppage of functions of the vital organs of the body Bishop's tripod of life - brain , heart & lungs . 

MOMENT OF DEATH 

  • stoppage of respiration 
  • stoppage of circulation , 
  • brain death , 

 brain death was then classified into - 

  1.  Cortical death
  2.  Brain stem death 
  3.  Total brain death 

DIAGNOSIS OF DEATH 

  • Stoppage of respiration
  •  Absence of pulse
  •  Absence of heart beat 
  • Fixed dilated pupils 

STAGES OF DEATH 

As per Shapiro - there are 2 stages of death

  1.  Somatic / clinical / immediate / systemic / tissue death 
  2. Molecular / cellular death 

1 ) Somatic death 

It refers to death of tissue / system / body and is clinical death 

 there is stoppage of functioning of brain , heart and lungs , the oxygen supply is stopped , hence the aerobic processes cease and so the tissue dies 

a ) Muscles still respond to various stimuli - mechanical , electrical & thermal .

 b ) Pupils still respond to meiotics & mydriatics .

 c ) Somatic death is associated with immediate signs of death -

  •  Permanent & complete cessation of function of brain & flat EEG 
  • Permanent & complete cessation of function of heart & flat ECG 
  • Permanent & complete cessation of function of lungs 

2 ) Molecular death

 It occurs after somatic death .

 It refers to death of all individual cells . 

a ) Muscles do not respond to stimuli .

 b ) Pupils do not respond to stimuli or drugs . 

c ) Molecular death is associated with early and late signs of death -

 Early signs

  •  Changes in eyes
  •  Changes in skin 
  • Cooling of body 
  • PM lividity 
  • Changes in muscles 

Late signs 

  • Decomposition / Adipocere formation / Mummification 

d ) Molecular death occurs at varying intervals after somatic death 

  • Nervous tissue - after 5 minutes 
  • Liver after - 15 minutes 
  • Heart after - 45 minutes 
  • Kidney after - 1 hour 
  • Muscles after - 3 hours 
  • Cornea after - 6 hours 
  • Blood after - 6 hours 

MODES OF DEATH 

A ) As per Gordon 

There are 4 modes of death - 

1 ) Anoxic anoxia 

Reduced oxygen availability so reduced oxygenation of blood . In mechanical obstructions , high altitude & irrespirable gases .

 2 ) Anaemic anoxia 

Reduced oxygen carrying capacity of blood . In haemmorrhages , respiratory poisons including carbon monoxide . 

3 ) Stagnant anoxia

 Defective circulation Heart failure , shock , embolism 

4 ) Histotoxic anoxia 

Defective utilisation of oxygen by tissue In cyanide poisoning , pulmonary fibrosis , lung collapse 

B ) As per Bichat ( Presently accepted classification ) There are 3 modes of death -

1) Coma ( failure of function of brain ) 

2 ) Syncope ( failure of function of heart )

3) Asphyxia ( failure of function of lungs ) 

1 ) COMA 

Definition 

Coma is defined as mode of death , where death results from failure of function of brain . 

Causes

 1 ) Raised intracranial tension 

2 ) Any gross injury to brain . 

3 ) Poisons - opium, alcohol , insecticides , anaesthetics and dhatura 

4 ) Metabolic disorders - hypoxia , diabetic coma 

5 ) Pathological disorders thrombosis , embolism , infarction , hypothermia , heat stroke , 

PM appearance 

1 ) Cause of coma is found 

2 ) Left chambers of heart are full 

2 ) SYNCOPE 

Definition

Syncope is defined as the mode of death , where death results from failure of function of heart .  

Causes 

1 ) Anaemia - reduced oxygen carrying capacity of blood 

2 ) Asthenia - weakness of muscles of heart myocardial infarction 

3 ) Neurogenic shock -  ( Primary shock / vasovagal shock / vagal inhibition / reflex cardiac arrest ) . Due to stimulation of vagus nerve 

Causes of neurogenic shock 

  • Sudden fear 
  • Sudden joy 
  • Emotional disturbances 
  •  Severe pain 

3) ASPHYXIA 

Definition 

Asphyxia is defined as the mode of death, in which death is due to failure of function of lungs.

 Hypoxia is a condition in which the supply of oxygen to the blood and tissues is reduced 

Causes 

Mechanical obstruction to airways 

AJ External 

a) Compression of neck - hanging, strangulation, throttling 

b) Compression of nose & mouth - smothering 

c) Compression of chest - crush asphyxia/traumatic asphyxia 

B] Internal - drowning, gagging, choking 

Hypoxia 

a) High altitude 

b) Irespirable gases - CO, Co2, SO2, H2S, NH3

Pulmonary embolism 

Collapse of lungs 

SUDDEN DEATH 

Definition 

Sudden death is defined as the death , which is either not preceded by any manifestatio or the death occurs within 24 hours of manifestations .

 Types - Sudden death may be -

 1 ) Natural 

due to old age or natural diseases . 

2 ) Unnatural

 technically unnatural deaths are not included in sudden deaths 

Unnatural deaths may be suicidal , homicidal or accidental . 

Causes of sudden natural death

 1 ) CVS causes ( Incidence 45-50 % ) 

Myocardial infarction , coronary artery disease , thrombosis , embolism , hypertension 

2 ) Respiratory causes ( Incidence 15-30 % ) 

Haemoptysis , tuberculosis , carcinoma , asthma , COPD 

( 3 ) CNS causes ( Incidence 10-20 % ) 

Thrombosis , embolism , infarction , raised intracranial tension , 

4 ) Abdominal Causes ( Incidence 10-15 % ) 

Bleeding from viscera ,hepatic failure , cirrhosis of liver , pancreatitis , peritonitis , 


SIGNS OF DEATH

 Signs of death are classified as - 

1 ) Immediate signs 

Permanent & complete cessation of function of brain & flat EEG . 

Permanent & complete cessation of function of heart & flat ECG . 

Permanent & complete cessation of function of lungs . 

2) Early signs (Appear after 3-24 hours) 

  •  Changes in eyes 
  • Changes in skin
  •  Cooling of body - Algor mortis 
  • PM lividity - Livor mortis 
  • Changes in muscle - Rigor mortis 

3 ) Late signs ( manifest after 24 hours )

  •  Decomposition ( putrefaction ) / Adipocere formation (saponification)/ Mummification 

EARLY SIGNS OF DEATH 

 changes appearing in the dead body after 3-24 hours of death . 

The early and late signs of death are also referred to as signs of molecular death 

CHANGES IN EYES 

  1.  Reflexes - There is abolition of pupillary & corneal reflexes . 
  2. Lustre - The eye loses its lustre 
  3. Cornea - Cornea becomes dry , hard , hazy 
  4. Pupils - Pupils dilate after death ( normal size is about 5 mm ) 
  5. Sclera - If eye remains open after death , dust deposits on sclera , leading to brown pigmentation - known as Traches noires


CHANGES IN SKIN

  •  Colour changes - After death the skin becomes greyish white in colour . 
  • Loss of translucency After death the skin loses its translucency and becomes opaque
  • Loss of elasticity After death there is loss of elasticity of skin 
  • Lips - become dry , hard & brown in colour due to drying . 


COOLING OF THE DEAD BODY ( ALGOR MORTIS)

Definition 

After death , the dead body behaves like an inert substance and therefore , if atmospheric temperature is low , body loses its heat by conduction , convection , radiation & evaporation , 

fall in body temperature by more than 10 deg °C is a sure sign of death . 

Measurement of temperature in dead body 

Time required for cooling

 Body starts cooling after 1-2 hrs of death and attains the atmospheric temperature in 12-13 hrs , while internal body parts take 18-24 hrs to cool .

Thus the curve of cooling is a sigmoid curve - inverted ' S ' shaped curve 

Factors influencing cooling of dead body 

  1. Age - Body of small children & elderly cools faster ( less muscle mass ) . 
  2. General condition of body - A thin & lean body cools faster . 
  3. Sex - Usually body of male cools faster . 
  4. Clothes - A clothed body or body lying in bed cools slowly .
  5.  Atmospheric temperature - Rate of cooling is directly proportional to the temperature difference between body & atmosphere . 

6. Type of death

1 ) In sudden death , cooling is slow . 

II ) In death due to chronic diseases - cooling is faster .

 III ) In some conditions , instead of cooling , body may gain heat for sometime - phenomenon is known as Post mortem caloricity . 

Rate of cooling in water : air : buried : 4 : 2 : 1 

POST MORTEM CALORICITY 

Definition 

In some situations , for initial 2-3 hours , the dead body may gain heat , however later body cools as routine . 

Reasons for PM caloricity 

1 ) Metabolic processes ( anaerobic ) or chemical processes continue after death , and liberate heat - known as exothermic processes . 

Bacterial or viral activity continuing after death - leading to heat production . 

Heat regulating mechanism severely affected - sun stroke 

Examples 

  1. Heat stroke 
  2. Death due to lightening or electric current . 
  3. Deaths due to heat or flame - burns . 

POST MORTEM LIVIDITY ( LIVOR MORTIS )

Definition 

Dead body behaves like an inert substance , therefore there is gravitational flow of blood to the dependent parts of body , causing stagnation of blood in the toneless , dilated capillaries 

Site of PM Lividity 

 If body is not disturbed PM lividity occurs on dependent parts of the body , 

1 ) In a supine body - PM lividity is seen on posterior aspects of body .

 2 ) In hanging PM staining is seen on all around the distal half of upper & lower limbs ( gloves & stocking lividity ) . 

3 ) In drowning - head being the heaviest part , 

Time required for PM staining 

PM lividity starts appearing after about 1 hour of death , as small discoloured patches . 

During 3 - 6 hours , these patches enlarge , coalsce with each other to finally form large areas of staining .

 After 6 hours , PM lividity becomes fixed 

Colour of PM Lividity 

  • Initially lividity is ( bluish pink , but after sometime it becomes bluish purple 
  • In carbon monoxide poisoning - Bright cherry red
  •  Burns & cold - Bright red 
  • Cyanide poisoning - Pink 

Medicolegal importance of PM lividity 

  1. Is a sign of death 
  2. Helps us know time since death 
  3. Helps us know position or posture of dead body 
  4.  If body is shifted in first 6 hours , it can be known 

CHANGES IN MUSCLES AFTER DEATH (Rigor mortis)

Changes in muscles after death are - Usually a sequence of - 

a ) Primary relaxation / flaccidity 

b ) Rigor mortis / cadaveric rigidity 

c ) Secondary relaxation 

PRIMARY RELAXATION 

Immediately after death , muscles are relaxed , so -

  1.  Eye ball sinks into orbit 
  2. Pupils change their shape on pressure 
  3. All muscles relaxed 
  4. Lower jaw droops 
  5. All joints relaxed & movements of joints are possible 

B ] RIGOR MORTIS 

( Cadaveric rigidity , death stiffening ) 

Definition 

Rigor mortis is defined as contraction , stiffening , shortening and opacity of muscles after death . This change occurs after molecular death . 

Effects of rigor 

1 ) Whole body becomes fixed & rigid 

2 ) All joints become fixed 

3 ) Hair may stand out 

 Factors influencing rigor mortis

  •  Age 
  • Sex 
  • Condition of muscles 
  • Atmospheric temperature 

Medicolegal aspects of rigor mortis 

  1.  Is a sign of death
  2.  Time since death can be known 
  3.  It can be known , if dead body was shifted 

Differential diagnosis of rigor 

Rigor mortis can be confused with 

1 ) Cold stiffening

2 ) Heat stiffening 

3 ) Putrefactive ( gas ) stiffening 

4 ) Cadaveric spasm 

LATE SIGNS OF DEATH 

if refers to changes which manifest in the dead body , after more than 24 hours . Depending upon the environment of the body , the change may be decomposition ( putrefaction ) or adipocere formation or mummification . 

DECOMPOSITION / PUTREFACTION 

Definition

 The phenomenon due to - 

1 ) Action of enzymes released by bacteria and 

2 ) Autolysis .

Causing softening and liquefaction of dead body due to conversion of complex organic matter into simple inorganic elements , is known as decomposition 

Mechanism 

1 ) Bacterial enzymes - Aerobic & anaerobic bacteria ( present in large intestine ) like Chlostridium welchii , Streptococcus , Staphylococcus 

2 ) Autolysis - ( Auto = self , lysis = break down ) The enzymes of the body , break down the dead body by proteolysis , glycolysis and lipolysis . 

3 ) To a little extent , fungi & insects also help in decomposition . 

Necessary conditions 

The conditions which are essential for bacterial growth warmth , moisture & air are also essential for decomposition.

Signs / Effects of decomposition 

  1. Colour changes - greenish discolouration 
  2. Formation of foul smelling gases 
  3. Pressure effects of gases 
  4. Appearance of maggots 

FACTORS INFLUENCING DECOMPOSITION 

A ) External factors 

  1. Warmth
  2.  Air
  3.  Moisture 
  4.  Clothes 
  5.  Surface injuries 
  6.  Manner of burial

 B Internal factors 

  1. Age 
  2. Sex 
  3. Condition of body 
  4. Internal injuries 
  5. Cause of death 

Rate of decomposition ( Casper's dictum ) - 
Air : water : removed from water : Buried ::
 1 : 1/2 : 2 : 1/8 

MEDICOLEGAL ASPECTS OF DECOMPOSITION 

1 ) It is surest sign of death 

2 ) Time since death can be known 

3 ) Advanced decomposition 1 ) Obliterates identity II ) Obliterates cause of death 


MUMMIFICATION 

Definition 

Mummification is defined as dessication or drying up of the dead body .

 It is also a modification of decomposition .

 Mechanism 

Mummification occurs because of evaporation of body fluids .

 Essential requirements 

1 ) Absence of moisture

 2 ) Excess of air 

3 ) Warmth 

The ideal atmosphere for mummification is present in deserts , especially in summer and also in bodies buried in shallow grave in sandy soil . 

Characteristics 

1. Body becomes thin , shrivelled , dried and dark brown or black . 

2. Skin & muscles become thin , dark , leathery and adherent to bones . 

3. All internal viscera blend with each other . 

4. Body emits smell like rotten cheese . 

5. Facial features and injuries are well preserved , therefore 

a ) Identification of dead body is possible . 

b ) Cause of death in case of death due to injuries can be established 

Time required 

Time required for mummification , varies between 3 months - 2 years .

 If properly preserved , a mummified body can remain for years 

Medicolegal importance of mummification 

  1.  It is a sure sign of death . 
  2.  Identity of the dead can be known . 
  3.  Cause of death , in case of death due to injuries can be known . 
  4.  Time since death , can be known . 
  5.  Surroundings of the dead body can be established 

TIME SINCE DEATH ( PM interval - PMI ) 

Interval between death & PM

During post - mortem examination , it is essential to establish time since death , so as to know the approximate time of death . 

 Time since death , may not be the time of crime , because the individual may have survived for sometime after the crime 

1 ) Cooling of body 

After death , body loses heat by conduction , convection , radiation and evaporation and tries to attain the atmospheric temperature . 

The external surface of body cools in 12-15 hours & internal viscera cool in 18-24 hours , considering the average rate of cooling in India to be 0.5-0.7 ° C . 

2 ) PM Lividity 

Due to stagnation of blood in toneless dilated capillaries of dependent parts of body , body stains bluish purple . 

PM lividity starts appearing after 1 hour , becomes established during 3-6 hours , and gets fixed after 6 hours . 

3 ) Rigor mortis

 Due to non availability of ATP , because of depletion of glycogen stores , actin & myosin filaments fuse with each other to form actomyosin gel , resulting in shortening , stiffening , rigidity and opacity of muscles . 

Rigor mortis starts appearing 2-3 hours after death , becomes established in 12 hours after death , remains for next 12 hours , and then slowly passes off in the next 12 hours . 

4 ) Decomposition

 In presence of moisture , air & warmth , the body and bacterial enzymes act on the bacteria resulting in conversion of complex organic matter into simple inorganic elements ... to cause softening and liquefaction of the dead body .

 This change starts in body after 2-3 hours becomes manifest between 12-24 hours , is fully established in 2-3 days after death 

5 ) Adipocere formation

 In a body lying in water , in the absence of air , there results PM hydrolysis & hydrogenation of body fats to form fatty acids , which combine with calcium and ammonium ions to form insoluble soaps , in 3-35 days . 

6 ) Mummification

 In the absence of moisture and excess of warm air , body mummifies in - 3-24 months , due to dehydration .

 7 ) Changes in bones 

Soft tissue is lost after 1-3 months

 Bone marrow is moist upto 3 months

 Bone marrow dries After 6 months

 Bones decompose in few many years 












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