THANATOLOGY

thanatos- death; logos- science

Assoc. Prof. Beatrice Ioan

MD, PhD, MA
 DEATH
• irreversible loss of the properties of the
living matter (Shapiro)

• cessation of life in a previously viable

organism

• Process- different parts of the human body

die at different moments
 Stages of death
1. Preagony
- precedes agony
- specific psychical symptoms depending on:
* structure and resistance of the organism;
* age
* cause of the terminal condition
* psychical structure, philosophical and religious
convictions

rave images, hypermnesia and incoherent ideation

 Stages of death
2. Agony (vita minima)
- irreversible stage between life and clinical
death
- mixture of vital and thanatologic phenomena

• Decreased activity of cortical neurons

• Bulbar centers are no longer controlled by
cortical and sub-cortical centers- functioning of
the organism is no longer unitary
 Agony
- Progressive disappearance of psychical
functions- psychical chaos
- Diminution of relation functions
- Complete immobility
- “Hypocratic face”
- Progressive disappearance of senses
- Anesthesia
- Diminished vegetative functions
 Agony
Classification
I. According to duration:
• absence of agony- death occurs very rapidly
• short agony (seconds, minutes)
• long agony (hours)
II. According to the psychical condition:
• lucid (conscious) agony- no changes of consciousness;
• unconscious agony;
• alternation of conscious and delirious periods
Importance:
- Validity of the documents signed during agony
- Juridical responsibility
 Agony
Estimation of length
1. Short agony
- disappearance of catecholamine
- report between acidophil and basophile cells in
hypophysis is 1

2. Long agony
- increased level of catecholamine;
- reduced glycogen deposits;
- decreased number of basophile cells in
hypophysis
 Stages of death
3. Clinical death
- Short interval (about 5 minutes)
- Cardiac activity, respiration and cerebral activity are
absent
- The patient can be reanimated
- Circumstances when reanimation can be performed
during a longer time
4. False death
- Very diminished respiration and heart activity
- Cannot be detected by ordinary means
- Loss of consciousness
 Stages of death
5. Biological death (real death)
- irreversible
- characterized by cessation of cellular
metabolism and structural changes of cells
Stages:
a. Somatic (systemic) death
- complete and irreversible cessation of vital functions
- life ceases in the body but still persists in some of its
parts
b. Molecular (cellular) death
- death of the tissues and cells individually
- due to anoxia- different tissues die at different rates
 Brain death
1. Persistent vegetative state (social death)- cortex
destroyed/ brain- stem functions preserved
2. Brain-stem death
3. Whole brain death (brain death)
Criteria (Ad-hoc Harvard Committee):
- deep coma (no depressant drugs, metabolic or
endocrine disorders or hypothermia)
- absence of spontaneous respiration- apnea test
- brain- stem reflexes - absent
- No spontaneous movements
- Plat EEG 24 hours
 Brain death
Tests
1. CT- no brain pulsation+ deviation from the median line
2. Cerebral angiography- evaluation of the cerebral flow
- No cerebral flow more than 30 min
3. Evoked potentials
- No influence due to depressant CNS drugs
4. Echography
- No cerebral echoes
- Doppler- no pulse and blood speed in carotid artery
Observation and tests:
- 12-24 hours in adults
- Children:
7 days-2 months old- 48 hours
2 months-1 year old- 24 hours
 Signs Of Death
I. Immediate signs of death (negative signs of life)
- Cerebral death
- Absence of cardiac activity and circulation
- Absence of respiration

II. Early signs of death

- Postmortem lividity (hypostasis)
- Rigor mortis
- Cooling
- Dehydration
- Autolysis

III. Late signs of death

- Putrefaction (postmortem decomposition)
- Conservatory processes
Postmortem Lividity (hypostasis)

• discoloration of the skin in lowest parts of

the body
• accumulation of blood in the capillaries
and small veins of the skin and organs
• the circulation ceases and the blood is
pulled by gravity in the lowest areas of the
body
• red-bluish/ compression areas
Postmortem Lividity (hypostasis)

Stages:
Hypostasis- 10-12 hours
Stasis- 18-20 hours
Imbibition- after 20-24 hours

Differentiation of the postmortem lividity from bruise

Forensic importance
- Position of the body
- Postmortem interval
- Cause of death
 Rigor mortis (cadaveric rigidity)
rigor-rigidity; mortis- death
• diminution and disappearance of ATP from muscles-
ATP concentration fails to 85 per cent of normal
Factors affecting the timing of rigor mortis
- temperature of the environment
- physical activity before death
- cause of death

Stages- Nisten rule

Installation- 3-6 hours
Generalization- 24 hours
Disappearance- 24-36 hours
 Rigor mortis (cadaveric rigidity)
Particular situations
- Cadaveric spasm (instantaneous rigor,
instantaneous rigidity)
- Heat stiffening
- Cold stiffening (freezing)

Forensic importance
- Position of the body
- Postmortem interval
- Cause of death
 Postmortem cooling
(Algor mortis)
• temperature of the body after death is progressively decreasing
• heat production stops , the body is loosing heat (conduction,
convection, radiation) - equilibrium with the environmental
temperature
Factors affecting postmortem cooling
Environmental temperature
Air moving and humidity
Clothing and coverings
Posture
Surroundings
Dimensions of the body
Hemorrhage
Particular: postmortem caloricity
18 degrees Celsius - 1 degree Celsius per hour
Forensic importance- postmortem interval
 Dehydration
• After death the body looses water due to
ceasing of circulation and metabolism
Aspects
- pergamentation
- finger pads’ skin and lips-wrinkled
- opaque cornea
- soft eyes
 Autolysis
auto- self; lysis- destruction
• enzymes released from the cells soften
and liquefy the tissues of the body
• internal examination
• organs with a high content of enzymes
(e.g. pancreas, stomach)
• prepares the field for putrefaction
• can be prevented by freezing the tissues
 Putrefaction
(postmortem decomposition)
• the last stage in the resolution of the body
from organic to inorganic state- skeleton
Bacterial process
Factors affecting putrefaction
- environmental temperature
- concentration of oxygen
- concentration of water (brain)
- age- new-born/old age
- cause of death
 Putrefaction
(postmortem decomposition)
Aspects
- green spot of putrefaction- 2-3 days
- all the skin - dark green or almost black
- gases of putrefaction- increased volume
- marbling
- birth in the coffin

Particular situations
* Drowning
* New born
 Maggots

• Flies lay their eggs on the corpse- opened

wounds and moist sheltered natural
orifices- 18/36 hours (high temperature)
• maggots or larvae - 24 hours -inside the
body- destroy soft tissues
• pupae - 4-5 days
• adult flies - 3-5 days
Forensic entomology- study the insects
that infest the corpses
 Conservatory processes
Natural processes which, prevent
putrefaction and determine the preservation
of the corpses
I. Mummification
Very rapid dehydration - warm climate + good ventilation
- Bacterial activity stops- high temperature
- 3-12 months after death
Aspect
Skin- dry, shrunken, leathery, brown to dark skin adhering closely to the
bones
Odorless
Preserved features
Reduced body volume
Internal organs - dried mass
 Conservatory processes
II. Saponification (Adipocere)
Fatty tissues are hydrolyzed - saturated fatty acids (stearic, palmitic
acids), calcium soaps
- 3-12 months
Aspect
- yellowish- white greasy wax like substance
- rancid smell
- floats on water
- can be easily cut
- burns - yellow flame
Factors affecting saponification
• Environment- moisture; warm temperature; absence of air
• Lecithinase from Clostridium Welchii
 Conservatory processes
III. Lignification
Environment with great concentration of tanic and
humic acid (swamps, mines, volcanic lava
Aspect
• brownish, hard skin
• soft bones (loosing of calcium);
• good preservation for a long interval
Famous- Man from Tolund/Denmark
 Conservatory processes
IV. Refrigeration
Exposure of the corpse to low temperature
Aspect
• whole body is stiffen;
• perfect preservation for a long period of
time;
• when the body is bring into an warm
environment putrefaction develops rapidly
 Forensic Autopsy
Compulsory in the following situations:
• Violent death
• Sudden death
• When a deficient medical care is
suspected
• Death occurred in the first 24 hours of
hospitalization
• Corpses with unknown identity
 Forensic Autopsy
Rules:
• performed only at the order of the juridical
authority
• after 24 hours from the moment of death
• complete
• performed by forensic pathologists /
sometimes by other physicians