WEEK 2

                                              Cause, Manner and Mechanism of Death

Most lay people confuse the cause of death with the manner of death. The cause of
death is the sequence of events that lead to the cessation of life while the manner of death is
the way in which those events came about. It is possible for a forensic pathologist to know the
cause of death but remain undecided about the manner. Did the person fall or was he pushed?
Did the husband shoot his wife intentionally or did she commit suicide? The cause of death is
more scientific  and medical, while the manner of death is more legal and cultural; Houck, M. M.
(ed.), (2017). Forensic pathology. Elsevier.
Cause, Manner and Mechanism of Death
A forensic pathologist must determine how and why a person died by performing a
thorough autopsy and studying the results of a good scene investigation. Both are essential in
determining the correct cause, manner, and mechanism of death. 
The cause of death is the injury or disease which begins a sequence of events that
ultimately leads to death. The cause of death may either be proximate or immediate, the initial
and last events prior to death, respectively. For example, a beam falls on the back of a man
working at a construction site leaving him paralyzed. As a result of paralysis he losses bladder
control and become susceptible to urinary infections. Years after the incident he develops a
severe kidney infection (pyelonephritis), becomes hospitalized and ultimately dies. In this case
the proximate cause of death is the injury which left him paralyzed. The immediate cause is
pyelonephritis. The length of time between the proximate and immediate cause does not
change the ultimate cause of  death as long as the sequence of events between the two is
continuous. The time frame maybe minutes, days, or years.
The mechanism of death is the biochemical or physiologic abnormality resulting in death.
Examples of mechanisms of death are: shock, ventricular fibrillation and cardiorespiratory
arrest. The mechanism of death is not the cause of death and should not appear alone on a
death certificate. For example, someone who suffers a gunshot wound to the head, pulpification
of the brain, and the resultant cerebral edema (the mechanism of death) are not included on a
certificate; the correct cause of death is a gunshot wound to the head.
Examples of Cause and Mechanism of Death
Proximate Immediate Cause Mechanism
Cause
Stab Wound Pneumonia Septicemia (infection)
Gunshot Wound Loss of Blood Shock

The manner of death is the circumstance surrounding a death. Traditionally classified as one of
the following: homicide, suicide, accident, natural or undetermined. For example, if a man dies
from sepsis as a result of a paralyzing injury, the manner of death is accident.
For a pathologist to determine the cause, manner, and mechanism of death, a complete
investigation must be performed. An autopsy alone is not sufficient. The circumstances of a
death scene and a detailed history of the decedent are necessary. 
Criminalistic Aspects
When an individual dies without having presented any previous symptoms (sudden death), the
medical examiner can determine neither the manner (natural/unnatural) nor the cause of death.
These cases are categorized as “manner of death undetermined” and can only classified by
performing an autopsy and further examinations.
The circumstances under which death occurred, the situation at the scene, or the findings on
the body may even be suggestive of the involvement of another person such as:
 If an individual dies during an argument or in close temporal connection with an accident, a
traumatic cause seems possible
 Agonal falls or seizures sometimes cause suspicious injuries
 Anticoagulant therapy or diseases associated with hemorrhagic diathesis may lead to
multiple hematomas resembling blunt-force injuries from abuse.
 Massive external bleeding especially if associated with extensive blood traces at the scene
is always suspicious.

In natural deaths, the following sources of bleeding are of major importance: bite marks of the
tongue due to convulsions, esophageal varices, gastroduodenal ulcers, erosion of the
pulmonary vessels in the presence of tuberculosis or bronchial carcinoma.

Manner of death: 
1. Natural
2. Accident
3. Suicide
4. Homicide
5. Undetermined

Natural death occurs as a result of aging, illness, or disease

Accidental death occurs when an injury causes death, but it is unintentional
Suicide results from an injury occurring from a deliberate, self-inflicted act committed to harm or
cause death to oneself.
A homicide occurs when death is caused by another person.
Undetermined is used as a classification when the information pointing toward one manner of
death is no more compelling than any others.
A pending death is one that is waiting on more evidence analysis before the examiner can make a
determination.

Deaths due to Natural Causes:

1. Affection of the central nervous system:
a. Cerebral apoplexy which is the sudden loss of consciousness followed by paralysis
or death due to hemorrhage from thrombosis or embolism in the cerebral vessels
A1. Cerebral hemorrhage – this is brought about by a break or rupture in the blood
vessels inside the cranial cavity.
 A2. Cerebral embolism – there is a blocking of the cerebral blood vessels by a bolus
or matters in the circulation.
A3. Cerebral thrombosis – there is occlusion of the lumen of the cerebral vessels by
the gradual thickening of its wall preventing the flow of blood peripheral to it.
b. Abscess of the brain – a circumscribed accumulation of infective materials in certain
areas of the brain. It may produce coma or death when it ruptures or when it
produces acute edema of the brain.
c. Fulminant meningitis – there is inflammation of the covering membranes of the brain due
to infection or some other causes.

2. Affection of the Circulatory System: 

a. Occlusion of the Coronary Vessels: 

The occlusion may be due to embolism, thrombosis or stenosis of the coronary

openings. This is the most common cause of sudden death due to natural cause
b. Fatty or Myocardial Degeneration  of the Heart:

The heart muscles may gradually degenerate and replaced by fatty or fibrous tissues
such that extra strain put on the  heart may produce sudden heart failure.
c. Rupture of the Aneurysm  of the Aorta
d. Valvular Heart Diseases – the valves of the heart may be diseased either to become
insufficient or stenotic and may produce sudden death.
e. Rupture of the Heart – this is found in severe cardiac diatation with fibrosis of the
myocardium.

3. Respiratory System
a. Acute edema of the larynx which may develop from an infection or from swallowing
irritant substance.
b. Tumor of the larynx
c. Diphtheria
d. Edema of the. Lungs
e. Pulmonary Embolism
f. Lobar pneumonia
g. Pulmonary hemorrhage

Severe coughing or slight exertion may rupture a normal or diseased pulmonary

vessel causing severe hemorrhage.

4. Affection of the Gastro-intestinal Tract

a. Ruptured peptic ulcer.
b. Acute intestinal obstruction.
5. Genito-Urinary tract:
a. Acute strangulated hernia
b. Ruptured tubal pregnancy
c. Ovarian cyst with twisted pedicle
6. Affection of the Glands:
a. Status thymico-lymphaticus , a condition associated with the enlargement of the thymus
and hyperplasia of the lymphoid tissues in general.
b. Acute Hemorrhagic Pancreatitis – an acute inflammation of the pancreas accompanied
with hemorrhages and in some cases suppuration and gangrene.
7. Death in Children
a. Bronchitis
b. Congestion of the lungs
c. Acute bronchopneumonia
d. Acute gastro-enteritis
e. Convulsions
f. Spasm of the larynx