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CAUSES OF DEATH

Introduction

Primary purpose of ML autopsy: determination of the cause of death


It must further be shown that the death is the direct & proximate consequences of
the criminal or negligent act of someone
If death developed independent of an unlawful act, then the person who
committed the unlawful act cannot be held responsible for the death

Cause of Death

Injury, disease or the combination of both injury and disease responsible for
initiating the trend or physiological disturbance, brief or prolonged, which produce
the fatal termination
o Immediate
o Proximate

Immediate (Primary) Cause of Death


-

Applies to cases when trauma or disease kill quickly that there is no opportunity for
sequelae or complications to develop

Ex: extensive brain laceration as a result VA

Proximate (Secondary) Cause of Death


-

Injury or disease was survived for a sufficiently prolonged interval which permitted
the development of serious sequelae which actually causes the death

Ex: Peritonitis in SW abdomen

Mechanism of Death
-

Physiologic derangement or biochemical disturbance incompatible with life which


is initiated by the cause of death
Hemorrhagic shock, metabolic disturbance, respiratory depression, toxemic
condition, cardiac arrest, tamponade

Cardio-respiratory arrest
-

Terminal mechanism of most causes of death & can never stand independently as
a reasonable explanation for the fatality
Cause of such arrest must be stated (hge, skull fx, sepsis, trauma on the chest)

Manner of Death

Explanation on how the cause of death came into being or how the cause of death
arose.
Natural
o Caused solely by disease
Violent/Unnatural
o Due to injury of any sort (Gunshot, stab, fracture,
traumatic shock
Suicidal, accidental, homicidal

Medico-legal Masquerade
-

Violent deaths may be accompanied by minimal or no external evidence of injury


or natural death where signs of violence may be present

NATURAL DEATH
-

caused by natural disease condition in the body


Develop spontaneously / consequence of physical injury inflicted prior to its
development

If a natural disease developed without the intervention of the felonious acts of another
person, no one can be held responsible for the death.
Complete autopsy to determine exactly the cause of death; exclude possibility of
violent cause

Sudden Death
-

Termination of life
Comes quickly, unexpected

Natural Cause:
Heart disease/cerebral apoplexy most common
Violent Cause:
Poisoning, asphyxia, severe trauma most common

If signs of violence are associated with the natural cause of death, the physician must be
able to answer the following questions:
1. Did the person die of a natural cause and were the Physical Injuries Inflicted After
Death?
Violence applied on a dead person person inflicting the physical injuries cannot be
guilty of murder, homicide or parricide
Considered impossible crime

Person must have no knowledge that the victim is dead at time of infliction
Penalized depending upon the degree of criminality and social danger of offender

2. Was the Victim Suffering from a Natural Disease and the Violence Only Accelerated
the Death?
Offender inflicting the violence responsible for the death of the victim
Immaterial whether the offender has no intention of killing the victim

3. Did the Victim Die of a Natural Cause Independent of the Violence Inflicted?
Accused will not be responsible for the death but merely for the physical injuries he had
inflicted
To make the offender liable for the death of the victim:
Proved that the death is the natural consequence of the physical injuries inflicted
Physical injuries is the proximate cause of the death
Proximate cause natural and continuous sequence, unbroken by an efficient
intervening cause
Produces injury/death
Without which the result would not have occurred
Deaths due to NATURAL CAUSES:
I. affection of the CNS:
A. Cerebral Apoplexy
Cerebral Hemorrhage
Cerebral Embolism
Cerebral Thrombosis
B. Abscess of the brain
C. Meningitis of the fulminant type
A. Cerebral Apoplexy
Sudden loss of consciousness followed by paralysis or death due to hemorrhage from
thrombosis or embolism in the cerebral vessels
1. Cerebral Hemorrhage
Brought about by the breaking or rupture of the blood vessels inside the cranial cavity
2. Cerebral Embolism
Blocking of the cerebral blood vessels by bolus or matters in the circulartion

3. Cerebral Thrombosis
Occlusion of the lumen of the cerebral vessels by the gradual thickening of its wall
thereby preventing the flow of blood peripheral to it

B. Abscess in the Brain


Circumscribed accumulation of infective materials in certain areas of the brain
May produce coma or death when it ruptures/when it produces acute edema of the brain

C. Meningitis of the Fulminant type


Inflammation of the covering membranes of the brain due to infection or some other
causes
Deaths due to NATURAL CAUSES:
II. Affection of the Circulatory System:
Occlusion of the coronary vessels
Fatty or myocardial degeneration of the heart
Rupture of the anuerysm of the aorta
Valvular heart diseases
Rupture of the heart

A. Occlusion of the Coronary Vessels


Occlusion nay be due to embolism, thrombosis or stenosis of the coronary openings
Most common cause of sudden death due to natural cause

B. Fatty or Myocardial Degeneration of the Heart


Heart muscles may gradually degenerate & replaced bt fatty/fibrous tissue
Extra strain put on the heart may produce sudden heart failure
Rupture of the aneurysm of the aorta
D. Valvular Heart Disease
Valves of the heart may be diseased either to become insufficient or stenotic & may
produce sudden death

E. Rupture of the Heart

Found in severe cardiac dilatation with fibrosis of the myocardium

Deaths due to NATURAL CAUSES:


III. Affections of the Respiratory System
Acute edema of the larynx
Tumor of the larynx
Diphtheria
Edema of the lungs
Pulmonary embolism
Lobar pneumonia
Pulmonary hemorrhage

A. Acute edema of the larynx


Develop from acute infection or from swallowing irritant substance
B. Tumor of the larynx
C. Diphtheria
an upper respiratory tract illness caused by Corynebacterium diphtheriae, a gram
positive bacterium
D. Edema of the lungs
E. Pulmonary Embolism
a blockage of the main artery of the lung or one of its branches by a substance that has
travelled from elsewhere in the body through the bloodstream (embolism)
F. Lobar pneumonia
form of pneumonia that affects a large and continuous area of the lobe of a lung
G. Pulmonary Hemorrhage
Severe coughing or slight exertion may rupture a normal or diseased pulmonary vessel
causing severe hemorrhage

Deaths due to NATURAL CAUSES:


IV. Affection of the Gastro-Intestinal Tract:
Ruptured peptic ulcer
Acute intestinal obstruction

V. Affection of the Genito-Urinary Tract:


A. Acute strangulated hernia
B. Ruptured tubal pregnancy
C. Ovarian Cyst with twisted pedicle
Deaths due to NATURAL CAUSES:
VI. Affection of the Glands:
Status thymico lymphaticus
- Condition assoc with the enlargement of the thymus & hyperplasia of the
lymphoid tissues in general
B. Acute hemorrhagic pancreatitis
- acute inflammation of the pancreas accompanied with hemorrhages & in
some cases suppuration & gangrene

Deaths due to NATURAL CAUSES:


VII. Sudden death in young children:
A. Bronchitis
B. congestion of lungs
C. acute broncho-pneumonia
D. acute gastro-enteritis
E. Convulsion
F. spasm of the larynx
VIOLENT DEATH
Due to injuries inflicted in the body by some forms of outside force
Due to the natural and direct consequence of injuries inflicted
Physical injury proximate cause of death
Classification of Trauma/Injuries:
Physical Injury trauma sustained thru the use of physical force
Thermal Injury caused by heat/cold
Electric Injury - due to electrical energy
Atmospheric Injury due to change of atmospheric pressure
Chemical Injury caused by chemicals

Radiation Injury brought about by radiation


Infection caused by microbic invasion
Penal Classification of Violent Deaths:
1. Accidental death
due to misadventure/accident
Happens outside of the sway of our will
Lies beyond the bounds of human forseeable consequences
In pure accidental death exempted from criminal liability
Exempting Circumstances
Person is performing a lawful act
He performed with due care
He causes an injury to another by mere accident
He is without fault & with no intention of causing it.
Penal Classification of Violent Deaths:
2. Negligent Death
Due to reckless imprudence, lack of skill, lack of foresight
If death occurred due to recklessness if someone, he may be charge for homicide
through reckless imprudence

3. Suicidal Death
Destruction of ones self
Person who gives assistance, punishable
4. Parricidal Death
Killing one/s relative
Father, mother, child (legitimate or not)
any descendants, ascendants, spouse (legitimate)
Reclusion perpetua / death
5. Infanticidal Death
Killing of a child less than 3 days old
By mother for purpose of concealing her dishonor prision correcional
By maternal grandparents prision mayor

6. Murder
Punished by reclusion temporal in its maximum period to death

Killing of another with any of the ff circumstances:


Treachery, taking advantage of superior strength, aid of armed men, weaken the
defense, insure of afford impunity
Price, reward, promise
Inundation, fire, poison, explosion, shipwreck, stranding of a vessel, derailment,
assault upon a street car or locomotive
Evident premeditation
Cruelty, inhumanly augmenting the suffering victim, outraging or scoffing at
person or corpse
7. Homicidal Death
Offender killed victim without any justification
Intention on part of offender to kill the victim and such presumption can be
inferred from the death of the victim
Killing does not fall under murder, parricide, infanticide
Death under Special Circumstances:
Death Caused in a Tumultuous Affray

Requisites of the Crime:


Person was killed in a confused or tumultuous affray
Actual killer is not known
Person/s who inflicted the serious physical injuries/violence are known

Person/s inflicted serious physical injuries prision mayor


Cannot be determined who inflicted serious physical injuries prision
correcional

Death under Special Circumstances:


2. Death or Physical Injuries inflicted under Exceptional Circumstances:

Requisites of the Crime:


Surprise of the spouse:
Must be valid marriage
Guilty spouse was caught by surprise in the act of committing sexual
intercourse with another person
Killing/injury was inflicted to either
Or both at the very act or immediately thereafter

2. Death or Physical Injuries inflicted under Exceptional Circumstances:

Requisites of the Crime:


Surprise of a daughter
Daughter is below 18 years of age
Daughter is living with the parents
Parents caught her by surprise committing sexual intercourse with the
seducer
Killing was done at the very act of sexual intercourse/immediately
thereafter
Kill/inflict serious physical injuries penalty of destierro
Inflict physical injuries of any kind exempt from punishment

A. Death from SYNCOPE


Sudden and fatal cessation of action of the heart within circulation included
Causes of death from syncope:
Coronary disease, embolism or thrombosis
Rupture of heart through softened infarct
Myocardial degeneration
Valvular diseases
Rupture of the aortic and other aneurysm
Systemic embolism occurring in bacterial endocarditis
Congenital heart diseases of the newborn

Reflex inhibition of the heart or of the cardiac center as in shock, emotion, or blow
over the area of some sensory nerve
Arterial hypertension with sclerosis
Deficiency of blood as in profused hemorrhage, especially sudden
Exhaustive diseases
Extensive injury to the body from mechanical causes
Symptoms of syncope:
Person fall and remain motionless
Face is pale
Pulse at wrist disappears or is filiform
Respiration ceases
Person breaks out in cold sweat
Dimness of vision
Pulse rapid and filiform
Vomiting and involuntary movement of limbs
State of delirium
Death may be preceded by convulsion

B. Death from ASPHYXIA


Supply of oxygen to the blood or to the tissues or both has been reduced below normal
working level
Causes of death in asphyxia

Diseases of respiratory system (pneumonia, acute bronchitis, bronchitis of infancy,


rupture of the blood vessels in pulmonary TB with cavitation
Impaction of foreign bodies in the larynx
Compression of the larynx

Pressure on the respiratory tract due to tumor, or intracranial hemorrhage


Strangulation, suffocation, hanging, drowning, inhalation of irritant gases
Refraction of the atmosphere
Causes operating nervous system

Paralysis or fixation of respiratory muscles


Causes operating from the lung or pulmonary circulation: pleurisy with effusion,
emphysema, pulmonary embolism, pulmonary thrombosis
Symptoms of asphyxia:
A. Stage in increasing dyspnea:
to 1 minute:
Increased rate and depth of respiration leading to dyspnea
Exaggerated movement of inspiratory muscles soon replaced by
exaggerated expiration
Rise of blood pressure, consequently the heart beat becomes quicker and
forcible
Person becomes bluish and consciousness is lost
Pupils are contracted
B. Stage of Expiratory Convulsion
1 minute
marked expiratory effort
Convulsive movements of limbs accompanied by expiratory effort
Blood pressure gradually falls owing to failure of the heart due to lack of
oxygen
C. Stage of Exhaustion
3 minutes
Lies still except for occassional deep inspiration
Blood pressure falls
Pupils dilated
Post mortem findings
A. external findings
Lividity of the lips, fingers, toe nails
Livid markings on the skin
Marked post mortem lividity
B. internal findings
1. lungs
Engorged with dark blood
On section, dark color frothy exudation

Punctiform hemorrhages of pleura (Tardieu spots)


Reddish discoloration of trachea and bronchial mucous membrane
B. internal findings
2. Heart
Subpericardial petecheal hemorrhages
Right ventricle of the heart dilated and engorged
Left side of the heart and arterial system empty
abdominal viscera congested
Brain congested and may show punctiform hemorrhages
Blood dark in color
Rigor mortis has slow onset

C. Death from COMA


State of unconsciousness with insensibility of the pupil and conjunctivae and inability to
swallow, resulting from the arrest of the functions of the brain
Causes of coma:
1. gross lesions of the brain: depressed fracture, apoplexy, embolous, abscess,
tumor
2. poisons: uremia, cholemia, acetomia, ingested morphine, ingested alcohol
Symptoms of coma:
Person unconscious
Breathing is stertorous
Pulse is full but intermittent
Cold clammy perspiration
Imperfect perception of sensory impression
Delirium
Relaxation of all sphincter muscles
Accumulation of mucous in the respiratory passages
Post mortem findings: same as asphyxia with congestion of brain and spinal cord
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