Unit 3 Medico-legal Aspect of Death

Importance
1. Civil personality is extinguished by death
2. Property is transmitted to heirs
3. Dissolution of partnership agreement
4. Extinguishment of agency
5. Criminal liability is extinguished by death
6. Case that does not survive is dismissed
Death is the termination of life. Complete cessation of vital functions
BICHAT`S TRIAD-Death is a failure of the body as integrated system associated with
irreversible loss of
A. Circulation
B. Respiration
C. Innervation

1. Brain death- deep irreversible coma

Harvard Report of 1968---“Irreversible coma”
1. Unreceptivity and unresponsibility
2. No movement or breathing
3. No reflexes-pupillary reflex, blinking reflex,swallowing yawning, plantar reflex
4. Flat electroencephalogram (EEG)
 repeated after 24 hours with no change--------DEAD

Philadelphia Protocol
1. Lack of responsiveness to internal or external stimuli
2. Absence of spontaneous breathing for 3 minutes
3. No muscular movements
4. No reflexes and response eg. Corneal reflex,sucking reflex,etc
5. Falling arterial pressure
6. flat EEG
 at least 2 hours certified by 2 physicians-----DEAD

Kinds of Death
1. Somatic or Clinical death
- complete persistent cessation of vital function
- heart, lungs, brain
- lips becomes pale, flaccid, sphincters relaxed
2. Molecular/Cellular Death
- life in individual cells
- 3-6 hours after Somatic death
3. Apparent death/ State of Suspended Animation
- Transient loss of consciousness
- Temporary cessation of vital functions
Signs of Death
1. Cessation of Heart Action
 certain if there is no heart action for 5 minutes
Methods of Detecting Heart Action
1. Palpation of the pulse
2. Auscultation of Heart sounds
3. Fluoroscopic Examination
4. Electrocardiograph (ECG)
Methods of detecting Circulation (Most are impractical)
1. Magnus Test
- ligature applied around the base of the finger with moderate tightness
- living-bloodless zone on the site of application and livid zone distal to it
- dead-no change in color
2. Opening of Small Artery
- Living—jerking of blood
- Dead- no jerking, blood vessel is white
3. Icard`s test
 Injection of fluorescein subcutaneously
 If circulation is still present, the dye will spread all over the body with a
greenish-yellow discoloration
 If dead, dye remains in the site of injection
4. Pressure on the fingernails
 If alive, zone of paleness on the site of application which becomes livid on
release
 If dead, no change
5. Diaphanous test
 Finger webs appear red when viewed in strong light in living, anemia and
CO2 poisoning
 Appears yellow in the dead
6. Application of heat on the skin
 Living-produce blister, signs of inflammation
 Dead-no blister
7. Palpation of the Radial pulse
8. Dropping of melted wax
 Living-inflammatory edema
 Dead-none

2. Cessation of Respiration
 No person can hold breath for a period not longer than 3 ½ minutes
1) Expose the abdomen and observe movement of inspiration and expiration
2) Examination with a mirror
 Dimming of the mirror-living
 No dimming-dead
3) Examination with a feather or Cotton fibers-place on nostrils
 Movement-living
 No movement-dead
  Not reliable, affected by outside air and nervousness of the observer
4) Use stethoscope
5) Examination with a glass of water
 Put a glass of water on the chest
 Living-surface shows water movement
 Dead- water is smooth and stable
 Not reliable
6) Winslow test-mercury/water is placed in a saucer and placed on the chest or the
abdomen of the subject, check image by reflecting on light
 No movement of image—dead
 With movement-living
3. Cooling of the Body (Algor Mortis)
- Fall of temperature of 15-20 degrees Fahrenheit (-5 to -6 degrees celcius)---------
certain sign of death
- Rate of cooling is not uniform
- Rapid during the first 2 hours of death
- A fall in temperature may occur before death in the following conditions
o Cancer
o Phthisis
o Collapse

Post mortem Caloricity-rise in the temperature of the body after death due to rapid and
early putrefactive changes or some internal changes
 Occurs first 2 hours after death
 Occurs in the following:
1. Cholera
2. Yellow fever
3. Liver abscess
4. Peritonitis
5. Cerebrospinal fever
6. Rheumatic fever
7. Tetanus
8. Smallpox
9. Strychnine poisoning
Factors delaying Cooling Factors Accelerating Cooling
Acute pyrexial diseases Diseases that are not related to
Sudden death in good health fever
Obesity Long standing disease
Death from Asphyxia Leanness
Death of middle age
thick clothing Extremes of ages
Small room Thin clothing/naked
Warm surroundings Large room
Cool surroundings
Estimating Time of Death the Cooling of the body
a. based on the surrounding Air temperature
- Body temperature is normal at the time of death
- Fall of temperature for the first 2 hours
=1/2 difference of body and air temperature
- Next 2 hours=1/2 of previous rate
- Next 2 hours=1/2 of the previous rate
- General rule-body attains the temperature of the surrounding air from 12-15
hours after death in tropical countries
b. (Normal Temperature) 98.4 degrees Fahrenheit- Rectal temperature
1.5
=approximate number of hours after death
**Formula is only applicable when the rectal temperature has not yet
assumed the temperature of the environment, otherwise it is constant
c. Chemical method (Schourup`s formula)
 CSF examined for concentration of lactic acid and amino acid
4. Insensibility of the body and loss of power to move
- no amount is capable of making the body have voluntary movement
Maybe present although living in:
 Apoplexy
 Epilepsy
 Trance
 Catalepsy
 Cerebral concussion
 Hysteria

5. Changes in the Skin

a) Pale and waxy looking-absence of circulation
b) Loss of Elasticity of the Skin
**Post mortem Contact Flattening-seen on shoulder blades, buttocks and
calves
c) Opacity of the skin
 Exposure to light-red color of circulation seen underneath the
skin in living
 Opaque in dead due to absence of circulation
6. Changes in and about the Eyes
 Loss of corneal reflex
 Clouding of the cornea
 Flaccidity of the eyeball-sinks into the orbital fossa
7. Pupils in the position of rest
 May occur in the living with the following diseases- Uremia, Tabes dorsalis
8. Changes in the Muscle
Stages:
I. Stage of Primary Flaccidity (post-mortem muscular irritability)
 Muscles are relaxed and capable of contracting when stimulated
 Pupils are dilated, sphincters are relaxed
 Extremities flexed, lower jaw falls, eyeball looses its tension
 Electrical stimuli-irritability
 Lasts 3-6 hours
 Amount of muscle proteins same as in living
II. Stage of Post-mortem Rigidity /Rigor Mortis
 3-6 hours after death up to 24-36 hours
 Starts at the muscles of the neck and the lower jaw and spreads
downward to the chest, arms and lower limbs
 Whole body stiffens at 12 hours after death
 Increase in lactic acid and phosphorus in the muscles
 Early onset on elderly and newborns, delayed if in good health
 Accelerated by high temperature
 Rigor mortis commences rapidly but the duration is short in moist
air
Conditions Simulating Rigor Mortis
1. Heat Stiffening- assumes a “pugilistic attitude” with lower and upper
extremities and the hands clenched because the flexors are stronger than
extensors
 Coagulation of proteins
2. Cold Stiffening- frozen body, exposure to warm condition will make the
stiffening disappear
 Solidification of fats
3. Cadaveric spasm/ Instantaneous Rigor
 Occurs at the moment of death due to extreme nervous tension,
exhaustion and injury to the nervous system or injury to the chest
 A weapon will be held in the hand before death and can only be
removed with difficulty
III. Stage of Secondary Flaccidity
a. Flaccid, alkaline, no longer capable of responding to mechanical
stimuli
b. Does not respond to mechanical or electrical stimulus
c. Dissolution of muscle proteins

Rigor Mortis Cadaveric Spasm

Time of Appearance 3-6 hours after death Immediately after Death
Muscles involved All the muscles of the body Group of muscles,
asymmetrical
Occurrence Natural phenomenon May or may not appear
Medico-legal significance Approximate time of death Useful in the determination
of the nature of the crime
 9. Changes in the Blood
a. Coagulation of the blood
 Cessation--- clotting
 Clotting is accelerated by infectious fever and delayed by asphyxia, poisoning
by opium, hydrocyanic acid or CO poisoning
 Blood remain fluid after death for 6-8 hours

Ante-mortem Clot Post-mortem clot

Firm in consistency
Surface of the blood vessel raw after the
clot is removed
Clot homogenous in construction, it
cannot be stripped into layers
Clot with uniform color
Soft in consistency
Surface of the blood vessel is smooth
and healthy after the clots are removed
Clots are stripped off in layers
Clot with distinct layer

b. Post mortem Lividity/ Cadaveric Lividity or Livor Mortis

 Blood begins to accumulate on the dependent portions
 Dull or purplish in color
 Back if lying or the feet if death due to hanging
 Only involves the superficial layer of the skin
 There is no injury to the skin

Kinds of Post-mortem Lividity

1. Hypostatic-blood merely gravitates to the dependent portion
 change in the position of the body leads to the formation of lividity
in another place
2. Diffusion Lividity
 later stage when blood diffused to the tissues of the body
 any change in the position will not change the location of lividity
Importance of Cadaveric Lividity
1. One of the signs of death
2. Determines if the position of the body has been changed
3. Color of the lividity may indicate the cause of death
Asphyxia- lividity is dark
CO poisoning- bright pink
Hydrocyanic acid-bright red
Hemorrhage, anemia-less marked
Phosphorus- dark brown
Potassium chlorate, Potassium bichromate-chocolate or coffee brown
4. It determines how long the person has been dead

10. Autolytic changes after death

Autolysis- enzymes breaks down tissues
e.g dead fetus after sometime-maceration
11. Putrefaction- breaking down of the complex proteins into simplier components
associated with foul smelling gasses and accompanied by change in the color of the
body
a. Change in the color-hemolysis of blood ---hemoglobin is liberated---greenish yellow,
greenish blue---greenish black
MARBOLIZATION-prominence of superficial veins with reddish discoloration
during the process of decomposition, “marbled” appearance on the abdomen,
root of the neck and the shoulders
b. Evolution of gas- CO2, Hydrogen, NH3, methane
---due to the distention of the abdomen and bloating of the body
Due to the pressure of the gas:
1. Displacement of blood-post-mortem bleeding on open wounds
2. Bloating of the body-eyes protruding, tongue comes out
3. Fluid comes out from the nostrils and mouth----frothy
4. Extrusion of fetus from a gravid uterus
5. Floating of the body- specific gravity becomes less
c. Liquefaction of Soft Tissues

Factors Modifying the Rate of Putrefaction

1. Age- Healthy adults decompose later than infants
2. Conditions of the body-obese decompose rapidly than skinny ones
3. Cause of death- due to infection-decomposes rapidly
sudden death-decompose late
4. Air-accessibility to air hastens decomposition
5. Water- decomposition in running water is more rapid than still water
Chronological Sequences of Putrefactive Changes Occurring in Tropical Regions
12 hours Rigor mortis is present all over,
hypostasis well developed
greenish discoloration
24 hours Rigor mortis is absent
Greenish discoloration all over the Abdomen
Abdomen distended with gases
48 hours Ova of flies are seen
Trunk bloated
Face discolored and swollen, blister present
Maggots seen
72 hours Whole body is swollen and disfigured
Hair and nails loose
Tissue soft and discolored
1 week Soft viscera putrefied
2 weeks Only more resistant viscera distinguishable
Soft tissues largely gone
1 month Body skeletonized.
Pathological Classification of the Causes of Death
1. Death from Syncope-sudden cessation of the action of the heart and circulation
ex. Coronary Disease
2. Death from Asphyxia-condition in which the supply of Oxygen to the blood has
been reduced below working levels ex. hanging
3. Death from Coma-state of unconsciousness with insensibility of the pupils and
inability to swallow resulting from the arrest of the functions of the brain ex. Brain
lesions

Medico-legal Classification of the Cause of Death

Cause of death- the injury, disease or the combination of both injury and disease
responsible for initiating the trend or physiological disturbance, brief or prolonged which
produced death
Immediate (Primary) Cause of death- cases when trauma or disease kill quickly that
there is no opportunity for sequelae to develop
Proximate (Secondary) Cause of Death-The injury was survived for a sufficient
period which permitted the development of a sequelae

Mechanism of death- physiologic derangement or biological disturbance incompatible

with life which is initiated by the cause of death
Ex. hemorrhagic shock, Respiratory depression
Manner of death-explanation on how the cause of death came into being

Medico-legal Classification of the Causes of Death

A. Natural death- without outside force
B. Violent death- with outside death
a. Accidental death
b. Negligent death
c. Parricidal death
d. Infanticidal death
e. Murder
f. Homicidal Death

1. Accidental Death
Elements of the Provision
1) A person is performing a lawful act
2) He performed it with due care
3) He caused injury to another by mere accident
4) He is without fault and no intention of causing it
2. Negligent death-due to reckless imprudence, lack of skill or foresight
3. Parricidal death
Requisites of the Crime
1) A person was killed
 2) The person killed was the father, mother or child, whether legitimate or
illegitimate in relation with the offender, or other legitimate ascendance, or
descendants or spouse of the offender
4. Infanticidal death
Requisites of the Crime
1) A person was killed
2) The person killed was a child less than 3 days old
5. Murder
Requisites of the Crime
1) The offender killed the victim
2) Killing is attended by any of the qualifying circumstances
3) There was an intent to kill the victim
4) The killing is not Parricide or infanticide

Qualifying Circumstances for Murder

a. With treachery, taking advantage of superior strength, with the aid of armed men,
or employing means to weaken the defense
b. In consideration of a price, reward, promise
c. By means of inundation, fire, poison, explosion, shipwreck, stranding of a vessel
or any other means involving waste and ruin
d. With evident premeditation
e. With cruelty, by deliberately inhumanly augmenting the suffering of the victim, or
outraging or scoffing at his person or corpse

6. Homicide
Requisites for the Crime
1) The victim of the criminal assault was killed
2) The offender killed the victim without any justification
3) There is an intention on the part of the offender to kill the victim
4) That the killing does not fall under the definition of crime of parricide, murder
or infanticide

Pathological Classification of the Causes of Death

A. Death from Syncope-sudden cessation of the action of the heart and circulation ex.
Coronary Disease
B. Death from Asphyxia-condition in which the supply of Oxygen to the blood has been
reduced below working levels ex. hanging
C. Death from Coma-state of unconsciousness with insensibility of the pupils and
inability to swallow resulting from the arrest of the functions of the brain ex. Brain
lesions
I. Asphyxia- general term applied to all forms of violent death which results primarily
from the interference with the process of respiration

Types of Asphyxial Death:

1) Anoxic death-failure of the arterial blood to be normally saturated with Oxygen
a. Breathing in atmosphere without or with insufficient Oxygen
b. Obstruction of the air passage
c. Paralysis of the respiratory center due to poisoning, injury or anesthesia
d. Shutting of blood from the right side of the heart to the left side
2) Anemic Anoxic Death-due to a decreased capacity of the blood to carry Oxygen
e.g. Hemorrhage, low hemoglobin
3) Stagnant Anoxic Death-due to failure in circulation e.g. Heart failure

Classification of Asphyxia
1. Hanging- form of violent death brought about by the suspension of the body by
ligature which encircles the neck and the constricting force is the weight of the
body
Lynching-form of homicidal hanging found in Southern United States. Negroes are
executed without due process of law.

2. Asphyxia by Ligature
 Compression by means of a ligature which is tightened by a force other than
the weight of the body.
Hanging Strangulation by Ligature
Hyoid bone is frequently injured Hyoid bone is frequently spared
Direction of the ligature mark is Ligature mark is usually horizontal and
inverted V shaped with the apex at the the knot is on the same horizontal
site of the knot plane
Usually at the level of hyoid bone Ligature is usually below the larynx
Ligature groove is deepest opposite Ligature groove is uniform in the depth
the site of the knot in its whole course
Vertebral Injury is frequently observed Vertebral Injury is not observed

3. Asphyxia by Suffocation/Throttling
 a form of asphyxial death whereby the constricting force applied to the neck is
the hand

Post-mortem findings
1) Cyanosis of the face
2) Findings in the neck
a. contusions with the form and shape of the fingers
b. interstitial hemorrhages in the neck muscles
c. fracture of the laryngeal cartilage
3) Heart on the right side is distended with blood
4) over distention of the lungs
4. Asphyxia by Suffocation
Exclusion of air from the lungs by closure of air openings
Smothering-closure of the external respiratory orifice by hand or other means
Overlaying-children
Gagging-application of handkerchief, linen or other clothing materials to
prevent air to have access to the mouth or nostrils
Plastic Bag suffocation
Choking-impaction of foreign body in the respiratory tract
- Vommitus
- False teeth
- Café coronary-a restaurant patron apparently has sudden heart attack in
the middle of his dinner and dies without much untoward symptoms. On
autopsy, a large mass of food is lodged on the throat. High alcohol levels
may anesthetize Gag reflex

Special forms of Strangulation

a. Garroting- a ligature, metal collar or a bowstring is placed around the neck
and tightened at the back. A judicial execution in the 19th century in Spain
and Turkey
b. Mugging (Strangle-hold) - a form of strangulation with the assailant
standing at the back and the forearm is applied in front of the neck.
- Used by wrestlers
c. Compression of the neck with a stick

5. Asphyxia by submersion or drowning

- Submersion for 1 ½ minutes is considered fatal, if ordinary method for
respiration is made, a person may survive even after 4 minutes of
submersion
- The average time required for death in drowning is 3-5 minutes
Gettler`s Test- a quantitative determination of the chloride content of the blood in
the right and left ventricles of the heart. The demonstration of at least 25mg
proves that death occurs in fresh or salt water and drowning is the cause of
death

Findings Conclusive that Person died of drowning

a) presence of foreign materials in the hands
b) Increase in volume(Emphysema aquosum) and edema of the lungs (edema
aquosum)
c) presence of water and fluid in the stomach
d) presence of foam, froth on the air passage
e) presence of water in the middle ear
 Within 24 hours, on account of the decomposition, the body floats
 Flexed extremities because flexor muscles predominates
 Head is the most dependent and the blood accumulates-“tete de negri”
 6. Compression Asphyxia (Traumatic Crush Asphyxia)-exchange of air is prevented
by immobility of the chest or crush injury

7. Burking- form of traumatic asphyxial death when murderer kneel on the chest or
sit on the victim with his hands close the nostrils and the mouth of the victim
 invented by Burke and Hare for the purpose of murdering people to be sold to
Medical Schools for dissection

8. Asphyxia by Breathing Irrespirable Gases

a) Carbon Monoxide (CO/ Silent Killer/ Carbonic oxide gas)
 main action is Oxygen deprivation
 burning of wood, oil, coal, kerosene or gasoline engines in
car
Qualitative test for CO in the blood
Kunkel`s test
Potassium ferricyanide
Gas Chromatogaphy
b) Carbon dioxide (CO2/ Carbonic Acid Gas)
- Colorless, heavy gas found in drainage pipes, deep wells and sewage
tanks
- 2% stimulates increase in depths of breathing
- 10% ataxia, fall in BP, diminished respiration
- 60% immediate loss of consciousness
c) Hydrogen Sulfide
- Sewer, septic tank, deep wells
- Colorless, transparent gas, sweetish taste, rotten egg odor
d) Hydrogen Cyanide
- Addition of acid potassium or sodium salt
- Peaches, bamboo shoots, oils, beans
e) Sulfur Dioxide
- Colorless gas, pungent odor
- Produces irritation of the respiratory passage, thus causing sneezing,
coughing, spasm of the glottis and suffocation
6. War Gases
- Tear gas/ lacrimator
- Vesicant/ Blistering gas
- Nerve gas

Special Deaths

A. Judicial death
Methods of Judicial Death
- Lethal injection
- Electrocution- > 1,500 volts is applied on a person sited on a chair
- Death by Hanging
 - Death by Musketry-firing squad
- Death by gas chamber- CO
- Beheading
- Crucifixion
- Beating
- Destruction by wild beast
- Stoning
- Flaying-skinning alive
B. Euthanasia/Mercy killing-deliberate and painless acceleration of death of a person
suffering from incurable or distressing disease

Types of Euthanasia
1. Active Euthanasia-intentional or deliberate application of the means to shorten
the life of a person
2. Passive Euthanasia-absence of application of the means to accelerate death but
the natural course of the disease is allowed to have its way to extinguish the life
of the person
a. Orthothanasia-when an incurably ill person is allowed to die a natural
death without the application of any operation or treatment procedure
b. Dysthanasia-when there is an attempt to extend the life span of a person
by the use of extraordinary treatments without which the patient would
have died earlier
** Dysthanasia does not comply with the definition of euthanasia

C. Suicide/Self destruction
Evidence that Will Infer Death is Suicidal
1. History of depression, unresolved problem or mental disease
2. Previous attempt of self destruction
3. If committed by infliction of physical injuries, the wounds are located in areas
accessible to the hand, vital parts of the body and usually solitary
4. The effects of the act of self-destruction maybe found in the body of the victim
a. Hand may be blood-stained if suicide was done by inflicting wound
b. Wounding hand may be positive to paraffin test in gunshot. The wound of
entrance may show manifestations of a contact or near shot
c. Empty bottle or container of poison maybe present at the suicide scene
d. Absence of signs of struggle or
e. Cadaveric spasm present in the wounding hand holding the weapon
5. Presence of a suicide note
6. Suicide scene not susceptible to public view; and
7. Evidences that will rule out homicide, murder, parricide

D. Death from Starvation/Inanition

 - Deprival of a regular and constant supply of food and water which is necessary to
normal health of a person
- Causes
o Suicidal ex. Hunger strike
o Homicidal
o Accidental-due to scarcity
- Length of survival
o Without food loses 1/24th of its weight daily
o Loss of 40% of weight results to death
o Without food or water person cannot survive more than 10 days
o With water, without food can survive for 50-60 days
- Factors that influence the length of Survival
a. Age- children suffer earlier from the effects of starvation than old aged
people
b. Condition of the body-healthy people with more fat deposit can resist more
deprival of food
c. Sex-women can withstand starvation longer because they have relatively
more adipose tissues than men
d. Environment-exposure to higher temperature will accelerate death
Post-mortem findings
a. External findings
- Body is greatly emaciated and emitting a peculiar offensive odor
- The eyes are dry, red and open with eyeballs sunken
- Skin is dry, shriveled and sometimes there are secondary skin infection
- Bed sores are present
b. Internal findings
- Muscles are pale and wasted
- Reduction in size and weight of all organs, except the brain
- Lungs edematous with hypostatic congestion
- The intestines are thin empty
- Superficial ulceration of the colons noted
Determination of the cause of the starvation
- Suicidal, homicidal, accidental

Medico-legal Investigation of Death

Stages:
1) Crime scene Investigation
Persons to compose the search team
 - Physician with training on medico-legal investigation
- Photographer
- Assistant-note-taker, evidence collector

Methods of conducting a search

a. Strip Method- area is blocked out in the form of a rectangle. The searchers
proceeds slowly at the same pace along the path to the base and then
parallel to the side
b. Double Strip or Grid method-searchers will traverse first parallel to the base
and then parallel to the side
c. Spiral Method-searchers follow each other in the path in the spiral manner
beginning from the center toward the outside or vice versa
d. Wheel method-searchers will gather at the center and proceed outwards
along radii or spokes
e. Zone method-whole area is subdivided into subdivisions or quadrants and
search is made in individual quadrants

2) Autopsies

Autopsy-comprehensive study of a dead body

 internal examination of the dead body
 done by:
a. Health officers
b. Medical officers by law enforcement agencies
c. Members of the medical staff of accredited hospitals
Post mortem examination- refers to the study of a dead body without incision
although blood and tissue samples may be collected
Methods Disposal of a dead body
A. Embalming- injection of 6-8 quarts of antiseptic solutions of formalin, perchloride
of mercury or arsenic
B. Burial or Inhumation
C. Disposing of the body at sea
D. Cremation-pulverization of the body to ashes by the application of heat

Assignment 3
1. Briefly describe the following signs of death and how they are used to
indicate time of death 5 pts each
a. Rigor Mortis
b. Algor mortis
2. Differentiate Diffusion from Hypostatic lividity. (5 pts)
3. What can a fly (Langaw) tell us as to the time of death? (5 pts)

Due date February 27, 2021

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Assignment 4 on Coupon bond.
Draw the different methods of conducting a search. 20 pts
Due date: March 6, 2021
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