CHANGES AFTER DEATH

Cause and Means of Death

There is a difference between cause and means with regards to death. Cause is the medical reason e.g.
traumatic brain injury. Means is the mechanism or physical reason e.g. gunshot wound to the forehead.
There can be multiple of causes of death, but there are only five classifications:

1. Natural
2. Accidental
3. Suicide
4. Homicide
5. Undetermined

After death, a sequence of changes naturally occurs in the human body. Although these changes
proceed in a relatively orderly fashion, a variety of external factors and intrinsic characteristics may
accelerate or retard decomposition. Understanding common postmortem changes and the variables that
affect them allows the forensic pathologist or scientist to more accurately estimate the postmortem
interval (PMI) and to provide a time frame during which death occurred. Further, an awareness of
common postmortem artifacts limits the risk of mis-diagnosis at the time of autopsy. Mortis is the
anatomical term for changes in a body after the moment of death. Medically, that’s when the central
nervous system gets unplugged and oxygenated blood is no longer delivered to the tissues, which
naturally start recycling. The five types of mortis are:

1. Rigor: stiffening of muscles

2. Livor: settling of blood
3. Algor: change in temperature
4. Palor: change in color
5. Decomp: breakdown in tissue

All these mortis conditions are integral to a decomposing process. Death is a part of life and
decomposition is a part of death. Just as life is not always predictable, neither is estimating the post-
mortem interval (PMI) between when death anatomically occurred and when first examination of the
body begins.

Rigor Mortis is the gradual postmortem development of muscular rigidity. It’s caused by the body’s
energy source, adenosine triphosphate (ATP), being depleted. Actin and myosin filaments become
irreversibly bound as the molecular fuel (glycogen and adenosine triphosphate) is consumed and the
cellular environment become increasingly acidotic. With no energy left to keep the muscles flexible,
they naturally go to a rigid state until another enzyme begins the breakdown of tissue and relaxation
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returns. Immediately upon death, the body enters a brief period of primary flaccidity where it’s dead
limp. Depending on many factors, temperature and body mass being the big ones, the muscle stiffening
begins in 1- 2 hours, first setting into the eyelids, jaw, and neck. The body, especially the extremities
and neck, will be fixed in the position present as rigour develops. It proceeds to the limb joints and
extremities after 4-8 hours and fixes in the organs in about 12 hours. Rigor releases in a reverse
sequence and can be absent in as little as 12 hours or can stay for days, again depending on factors.
Factors that accelerate rigour mortis include; temperature, exercise, infection, and higher

environmental temperature.

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Freezing temperatures may result in a false rigour mortis due to actual freezing of muscles. Other
factors that can greatly affect rigor mortis include age, illness, activity before death, and physical
conditions surrounding the body. Rigor mortis is useful as an aid in determination of death (rather than
time of death) and is helpful as an adjunct in determining whether a body may have been moved after
remaining in another position for an extended period of time after death.

Livor Mortis (Hypostasis) is the postmortem settling of blood, particularly erythrocytes, to the
dependent parts of the body in accordance with gravity. The process begins upon cessation of the
circulation of blood.

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It’s evident by purplish-red blotching where blood is free to pool and blanched white where pressure
points restrict it. Lividity, as it’s also known, sets in between 30 minutes to 1 hour after death and
‘fixes’ in about 8-12 hours. ‘Fixing’ is the entire settling where blood has coagulated and no longer
runs free.

Algor Mortis is the change in body temperature. A cadaver will always achieve ambient temperature,
regardless of time. A normal, living human’s core temperature is 36 Celsius (98.6 Fahrenheit) but the
scene temperature could be anywhere above or below. In a cold environment, the body will drop to
equilibrate. In a hot environment, it will rise. Here’s where so many peripheral factors come into play;
body size, layered clothing, air movement etc. A rule of thumb is that a body’s temperature will
change about 1 degree Celsius per hour.

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Pallor Mortis is the change of color. Live humans are pretty much a reddish tinge due to oxygenated
blood flowing (different tones for different races). Immediately upon death, a bluing phase occurs,
following by a grey, then a white, and it can be a rainbow of colors as decomposition takes over.

Decomp, or decomposition, is not really a true class of mortis, rather it’s the culmination of the four
mortis processes which leads to a breakdown of the body tissues and a return to nature. Decomposition
is a complex and unpredictable thing. There are two processes that metamorphous into one:
1. Putrefaction: action of bacteria on body tissues
2. Autolysis: body breakdown by endogenous substances
In most deaths these two work in tandem, starting with a breakdown in internal organs which produces
gas. This causes bloating and skin discoloring, as well as the foul odor from purging or ‘gassing-off’.
As the muscle tissues change, the skin begins to dislodge, the joints become loose enough to
disarticulate, fats become liquefied, and bones become exposed. Advanced decomp can become
skeletonized, mummified, or consumed.

Time of Death

Time of death is categorized in three ways:

1. Physiological time of death: The point at which the deceased's body including vital organs
ceased to function.
2. Estimated time of death: A best guess based on available information.
3. Legal time of death: The time at which the body was discovered or physically pronounced dead
by another individual. This is the time that is shown by law on a death certificate.

Post-mortem Interval (PMI)

A post-mortem interval is the time that has elapsed between the time a person dies and the time the
body is examined. It is the estimated number of hours, days, weeks, or months between the discovery
of a cadaver and the time of death. The determination of time of death is of crucial importance for
forensic investigators, especially when they are gathering evidence that can support or deny the stated
actions of suspects in a crime. Both the time of death and the postmortem interval cannot be
determined with 100% accuracy, particularly when a body is found in advanced state of decomposition
or is recovered from fire, water, or ice. Therefore, time of death and PMI are given as estimates, and
can vary from hours to days or from months to years, depending on each particular case. Evidence for
estimating time of death includes physical evidence present in the corpse (postmortem changes,
presence of insects, etc.), environmental evidence such as location where the body was found (indoors,

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outdoors, buried, burned, in water, etc.), and other evidence found at the crime scene (a stopped wrist
watch due to a blow or impact, an answering machine record, a 911 call, phone calls received or made
around the time of the assault, etc.), and finally, the historical evidence (habits and daily routine of the
victim, relationships, existence of enemies, etc.). The knowledge of the internal sequential changes a
dead body undergoes in relation to the variations on the rate of their occurrence due to ambient
temperature, humidity, and the presence of insects or other predators are all considered when
estimating the time of death.

The classical method of estimating time of death is the rate method, which measures postmortem (after
death) stages and the types of transformation a body undergoes such as cooling rates (algor mortis),
stiffening (rigor mortis), initiation and duration, postmortem lividity (discoloration stains), degree of
putrefaction, adipocere (body fat saponification), and maceration (tissue softening due to the presence
of liquid). Not all these stages take place in a single cadaver. Adipocere, for instance, is not common in
most male adult corpses. It occurs most often in women or obese adult individuals and children,
requiring enough humidity or the presence of water to take place. The process of maceration occurs at
known rates in fetuses that died in the womb. Stomach contents can reveal the stage of digestion of the
last meal at the time of death. The time of onset and rates of each postmortem transformative event are
also subjected to variations originated by existing chronic diseases, types of medication, and individual
metabolic characteristics. These variables are known as endogenous factors. For example, if the
deceased individual was taking antibiotics at the time of death, the internal process of bacterial-
mediated putrefaction may be delayed beyond the normal observed rates, thus masking the real PMI.

Summary of Changes after Death

Table 1: Time Since Death Estimated by Assessing the Condition of Body

Table 2: Sequential Changes after Death

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Table 3: Effect of Temperature in the Development of Rigor Mortis.

INJURIES

Injury, also known as physical trauma, is damage to the body caused by external force. This may be
caused by accidents, falls, hits, weapons, and other causes. Major trauma is injury that has the potential
to cause prolonged disability or death. The World Health Organization (WHO) developed the
International Classification of External Causes of Injury (ICECI). Under this system, injuries are
classified into:

1. mechanism of injury

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 2. objects/substances producing injury

3. place of occurrence

4. activity when injured

5. the role of human intent

However, the United States Bureau of Labor Statistics developed the Occupational Injury and Illness
Classification System (OIICS). Under this system injuries are classified by

1. nature

2. part of body affected

3. source and secondary source

4. Event or exposure

Definitions
Trauma or injury is defined in two different ways, legally and mediolegally or clinically.

Legally perspective
Injury is defined as “any harm whatsoever in nature caused illegally to the body, mind, reputation, or
property’

Clinically perspective
Injury is defined as breach or dissolution of the natural continuity of any of the tissues of a living body
by actual physical violence

Legal classification
Depending on the legal aspects, trauma includes two types and they are:

1. Simple

2. 2. Grievous

Medicolegal classification
Depending on the causative factor, medicolegally trauma includes five types and they are:

1. Mechanical

2. Thermal

3. Chemical

4. Electrical

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 5. Radiation.

Mechanical Injury
All injuries sustained due to physical violence to the body constitute mechanical injury. Usually there
are two mechanisms involved and they are: impact of a moving object and impact of a virtually non-
moving object on actively moving victim.

Classification of mechanical injury

Mechanical injury is further sub-classified into blunt force trauma, sharp force trauma and firearm
injuries.

Blunt force trauma- It is injury produced by weapons or objects with blunt edges or surfaces.
Basically they are:

1. Abrasion

2. Contusion

3. Laceration

Sharp force trauma: It is injuries produced by weapons or objects with sharp cutting edge or edges.
Basically they are:

1. Incised wound

2. Stab

3. Chop

Firearm Injuries- These are injuries produced by firearms. They are further classified into:

a. Injuries by rifled firearms (gunshot injuries)

b. Injuries produced by smooth bored firearms (shotgun injuries)

Abrasion
An abrasion is defined as a superficial injury, inducing displacement of only epidermis in the skin by
friction. Examples are fall on a rough surface, blow with blunt weapon, hurt by fingernails, thorns,
teeth bite etc. various types of abrasions encountered routinely are scratches, grazes, brush burns, rope
burns, impact abrasion.

Contusion

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A contusion is also knows as bruise, haematoma, a haemorrhage into the skin, or into the tissues under
the skin or both, as a result of rupture of small blood vessels, especially capillaries by a blunt impact.
The injuries can be produced by blunt force with fist, stone, stick, bar, whip, cane, shoe, etc. bruises
are classified into three types: superficial, deep and patterned.

Laceration
Also called tears, or ruptures. It is a disruption of the continuity of tissues, produced by stretching or
crushing types of blunt forces. Causes includes tearing up of tissues by blunt force, e.g. splitting of the
skin by the overstretching on fractured bones underneath, crushing of skin between two hard objects,
etc. Basically lacerations are of three types: split, stretch and avulsions.

Incised Wound
An incised wound is a clean cut through tissues by an object with sharp cutting edge. Lesion produced
could be simple or dangerous. Incised wound is simple when it is superficial and bleeds minimum and
heals completely in 15 days. The scar will be permanent. It is dangerous or fatal when deep and
involves the viscera or major blood vessels.

Stab Wounds (Punctured Wound)

Stab wounds are wounds produced by sharp pointed objects penetrating the skin and underlying
structures. Causative weapons are knife, dagger, nail, screwdriver, needle, spear, arrows, sword, etc.
lesion produced is usually dangerous or fatal due to bleeding which may be external or internal, mild
or severe and injury to vital organs.

Chop Wounds (Chop lacerations)

Chop wounds are injury produced by a blow with the sharp cutting edge of a fairly heavy weapon like
an axe, hatchet, saber etc. Lesion produced is always dangerous and fatal due to bleeding and usually
involving deeper viscera.

POISONS
Another name for poison is toxic chemical. Poison, in biochemistry, a substance, natural or synthetic
that causes damage to living tissues and has an injurious or fatal effect on the body, whether it is
ingested, inhaled, or absorbed or injected through the skin. Although poisons have been the subject of
practical lore since ancient times, their systematic study is often considered to have begun during the
16th century, when the German-Swiss physician and alchemist Paracelsus first stressed the chemical

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nature of poisons. It was Paracelsus who introduced the concept of dose and studied the actions of
poisons through experimentation. It was not until the 19th century, however, that the Spaniard
Matthieu Orfila the attending physician to Louis XVIII correlated the chemistry of a toxin with the
biological effects it produces in a poisoned individual. Both concepts continue to be fundamental to an
understanding of modern toxicology.

US Department of Transport divides poisons in two classes:

Class A: highly toxic chemicals which even in very small quantities as gas or vapor in air are
dangerous to life (such as cyanogen, hydrocyanic acid, nitrogen peroxide, and phosgene)

Class B: chemicals other than those included in Class-A and comparatively less toxic but considered
dangerous.

Poisoning involves four basic elements:

1. the poison,
2. the poisoned organism
3. the injury to the cells
4. the symptoms and signs or death.

These four elements represent the cause, subject, effect, and consequence of poisoning. To initiate the
poisoning, the organism is exposed to the toxic chemical. When a toxic level of the chemical is
accumulated in the cells of the target tissue or organ, the resultant injury to the cells disrupts their
normal structure or function. Symptoms and toxic signs then develop, and, if the toxicity is severe
enough, death may result.

Nature of a toxic substance

A poison is a substance capable of producing adverse effects on an individual under appropriate
conditions. The term “substance” is almost always synonymous with “chemical” and includes drugs,
vitamins, pesticides, pollutants, and proteins. Even radiation is a toxic substance. Though not usually
considered to be a “chemical,” most radiations are generated from radioisotopes, which are chemicals.
The term “adverse effects” above refers to the injury, such as structural damage to tissues.
“Appropriate conditions” refers to the dosage of the substance that is sufficient to cause these adverse
effects. The dose concept is important because according to it even a substance as innocuous as water
is poisonous if too much is ingested. Whether a drug acts as a therapy or as a poison depends on the
dose.

Classification of a poison

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Poisons are of such diverse natures that they are classified by origin, physical form, chemical nature,
chemical activity, target site, or use.

Classification based on origin

Poisons are of microbial, plant, animal, or synthetic origin. Microbial poisons are produced by
microscopic organisms such as bacteria and fungi. Botulinus toxin, for example, is produced by the
bacterium Clostridium botulinum and is capable of inducing weakness and paralysis when present in
under processed, non-acidic canned foods or in other foods containing the spores. An example of a
plant toxin is the belladonna alkaloid hyoscyamine, which is found in belladonna (Atropa belladonna)
and jimsonweed (Datura stramonium).

Animal poisons are usually transferred through the bites and stings of venomous terrestrial or marine
animals, the former group including poisonous snakes, scorpions, spiders, and ants, and the latter
group including sea snakes, stingrays, and jellyfish. Synthetic toxins are responsible for most
poisonings. “Synthetic” refers to chemicals manufactured by chemists, such as drugs and pesticides, as
well as chemicals purified from natural sources, such as metals from ores and solvents from petroleum.
Synthetic toxins include pesticides, household cleaners, cosmetics, pharmaceuticals, and hydrocarbons.

Blue ringed octopus: The venomous blue ringed octopus (genus Hapalochlaena) is small but deadly,
displaying bright blue rings as a warning when alarmed or threatened.

Classification based on physical form

The physical form of a chemical solid, liquid, gas, vapour, or aerosol influences the exposure and
absorbability. Because solids are generally not well absorbed into the blood, they must be dissolved in
the aqueous liquid lining the intestinal tract if ingested or the respiratory tract if inhaled. Solids
dissolve at different rates in fluids, however. For example, compared with lead sulphate granules,
granules of lead are practically nontoxic when ingested, because elemental lead is essentially insoluble
in water, while lead sulphate is slightly soluble and absorbable. Even different-sized granules of the
same chemical can vary in their relative toxicities because of the differences in dissolution rates. For

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example, arsenic trioxide is more toxic in the form of smaller granules than is the same mass of larger
granules because the smaller granules dissolve faster.

A poison in a liquid form can be absorbed by ingestion or by inhalation or through the skin. Poisons
that are gases at room temperature (e.g., carbon monoxide) are absorbed mainly by inhalation, as are
vapours, which are the gas phase of substances that are liquids at room temperature and atmospheric
pressure (e.g., benzene). Because organic liquids are more volatile than inorganic liquids, inhalation of
organic vapours is more common. Although vapours are generally absorbed in the lungs, some vapours
that are highly soluble in lipids (e.g., furfural) are also absorbed through the skin.

Aerosols are solid or liquid particles small enough to remain suspended in air for a few minutes. Fibres
and dust are solid aerosols. Aerosol exposures occur when aerosols are deposited on the skin or
inhaled. Aerosol toxicity is usually higher in the lungs than on the skin. An example of a toxic fibre is
asbestos, which can cause a rare form of lung cancer (mesothelioma)

Many liquid poisons can exist as liquid aerosols, although highly volatile liquids, such as benzene,
seldom exist as aerosols. A moderately volatile liquid poison can exist as both an aerosol and as a
vapour. Airborne liquid chemicals of low volatility exist only as aerosols.

Classification based on chemical nature

Poisons can be classified according to whether the chemical is metallic versus nonmetallic, organic
versus inorganic, or acidic versus alkaline. Metallic poisons are often eliminated from the body slowly
and accumulate to a greater extent than nonmetallic poisons and thus are more likely to cause toxicity
during chronic exposure. Organic chemicals are more soluble in lipids and therefore can usually pass
through the lipid-rich cell membranes more readily than can inorganic chemicals. As a result, organic
chemicals are generally absorbed more extensively than inorganic chemicals. Classification based on
acidity is useful because, while both acids and alkalis are corrosive to the eyes, skin, and intestinal
tract, alkalis generally penetrate the tissue more deeply than acids and tend to cause more severe tissue
damage.

Classification based on chemical activity

Electrophilic (electron-loving) chemicals attack the nucleophilic (nucleus-loving) sites of the cells’
macromolecules, such as deoxyribonucleic acid (DNA), producing mutations, cancers, and
malformations. Poisons also may be grouped according to their ability to mimic the structure of certain
important molecules in the cell. They substitute for the cells’ molecules in chemical reactions,
disrupting important cellular functions. Methotrexate for example, disrupts the synthesis of DNA and
ribonucleic acid (RNA).

Other classifications

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Unlike the classifications described above, there is usually no predictive value in classification by
target sites or by uses. Such classifications are done, however, to systematically categorize the
numerous known poisons. Target sites include the nervous system the cardiovascular system, the
reproductive system, the immune system and the lungs, liver, and kidneys. Poisons are classified by
such uses as pesticides, household products, pharmaceuticals, organic solvents, drugs of abuse, or
industrial chemicals.

Transportation
In order for a poison to produce toxicity, a sufficient quantity of that chemical must be absorbed into
the body. Because the chemical must pass through a number of cell membranes before it can enter the
blood, the ability of the chemical to cross these lipid-rich membranes determines whether it will be
absorbed, and that ability depends on the chemical’s lipid solubility. The cell membrane the most
external layer of all animal cells, is composed of two layers of lipid molecules (the lipid bilayer). The
lipid molecules each have a hydrophilic (water-loving, or polar) end and a hydrophobic (water-hating,
or nonpolar) end. Because they are surrounded by an aqueous environment lipid molecules of the cell
membrane arrange themselves so as to expose their hydrophilic ends and protect their hydrophobic
ends. Suspended randomly among the lipid molecules are proteins, some of which extend from the
exterior surface of the cell membrane to the interior surface. A chemical tends to dissolve more readily
in a solvent of similar polarity. Nonpolar chemicals are considered lipophilic (lipid-loving), and polar
chemicals are hydrophilic (water-loving). Lipid-soluble, nonpolar molecules pass readily through the
membrane because they dissolve in the hydrophobic, nonpolar portion of the lipid bilayer. Although
permeable to water (a polar molecule), the nonpolar lipid bilayer of cell membranes is impermeable to
many other polar molecules, such as charged ions or those that contain many polar side chains. Polar
molecules pass through lipid membranes via specific transport systems.

The four types of chemical transport systems through cell membranes are:

1. diffusion
2. facilitated diffusion
3. active transport
4. pinocytosis.

Lipophilic, nonpolar chemicals dissolve in the lipid bilayer. Simultaneously, some of the molecules are
leaving the lipid bilayer. The net result is that chemicals cross the membrane until the concentrations
of chemical molecules on both sides of the membrane are equal and there is no net flow of molecules
across the cell membrane (diffusion). Therefore, chemicals diffuse across the membrane only when a
concentration gradient exists across the cell membrane. Diffusion is considered to be passive transport
because no external energy is used. Polar molecules, such as water and small water-soluble molecules
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(e.g., urea, chloride ions, sodium ions, and potassium ions), can diffuse across membranes through the
water-filled channels created by membrane proteins. Large polar water-soluble chemicals, such as
sugars, however, do not diffuse through the membrane. Certain relatively large water-soluble
molecules cross the cell membrane using carriers. Carriers are membrane proteins that complement the
structural features of the molecules transported. They bind to the chemicals in order to move them
across the cell membrane. Energy is consumed because the transport proceeds against the
concentration gradient.

Active transport systems move chemicals essential to cellular functions through the membrane into the
cell. Such essential chemicals include calcium ions, amino acids, carbohydrates, and vitamins. Because
the structures of poisons usually are not similar to those of chemicals essential to cells, few poisons are
absorbed by active transport. Active transport, however, is important in the elimination of organic
acids, bases, and foreign compounds by the kidneys and liver.

Molecules of similar structure compete with one another in binding with the carrier molecule. Thus,
the transport of one chemical can be inhibited by another chemical of similar structure, a phenomenon
called competitive inhibition. The chemical being transported also competes with itself for a carrier
molecule, so that only a limited amount of the chemical can be transported by the carrier protein
during a specific time.

Transport systems that use carrier molecules but which do not require energy to proceed are called
facilitated diffusion. A chemical first binds to the carrier protein in the cell membrane and then
diffuses through the membrane. Because no energy is used, facilitated transport into the cell cannot
proceed if the concentration of that chemical is greater inside the cell membrane than outside. The
involvement of carriers means that the process is also subject to competitive inhibition and saturation.

Large molecules, such as proteins and solid particles, are often transported by pinocytosis. The cell
membrane engulfs a particle or protein molecule outside the cell, and brings it into the cell. Although
inefficient, pinocytosis operates in the slow absorption of proteins and particles in the intestine and
respiratory tract.

Conditions of exposure

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Figure 1: Routes of absorption, distribution, and excretion of toxicants in the human body.

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