KENYA METHODIST UNIVERSITY

MEDICAL LABORATORY SERVICES COURSE

FORENSIC MEDICINE UNIT

MAY 2010

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FORENSIC SCIENCE

Introduction

Criminal investigations date back to the period BC and the outcome was mainly
dependent on trials by elders or other persons of authority listening to the accused
and the accuser and making decisions based on the best arguments heard, witness
accounts if any etc. Cases, in which there were no witnesses or any apparent
linkage of persons to the crime, would remain largely unresolved.

Progression to a level in which some corroborative evidence would be looked for

example:

 potential suspects subjected to production of weapons (pangas, sharp

edged articles) and a blood stained one would attract flies
 Torn pieces of clothing or paper found at the scene being may be
matched to those on suspect during a search

Verdicts issued on circumstantial evidence.

Definition of Forensic Science

There are many definitions of forensic science some of which include:

 the application of natural sciences to matters of the law

 resolves legal issues by applying scientific principles to them.
 the application of the methods and techniques of basic sciences to legal
issues.
 the scientific analysis and documentation of evidence suitable for legal
proceedings.
Forensic means ‘pertaining to law’ therefore for purposes of this presentation the
definition adopted will be:

 the ‘application of science to law’

 involves the application of a broad spectrum of disciplines (subdivisions of
forensic science to law).

Since the subject is quite multidisciplinary the definition of the term ‘science’ should
be broadened at least in our minds to cover both social and physical sciences such
that the appropriate definition should be:

‘The application of social and physical sciences to law’

Forensic disciplines

Include but are not limited to

a) Physiological sciences

 Forensic medicine (science of medicine)

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  Forensic pathology (science of causes of and changes produced
by disease)
 Forensic odontology (study of teeth and the uniqueness of
dentition)
 Forensic anthropology (in forensic science it is the application of
anthropology to identification of skeletal remains)
 Forensic entomology (application of the science of insects to
determine time of death)
b) Social sciences
 Forensic psychology
 Forensic psychiatry

Deal with aspects of human behaviour and the legal implications

c) Other specialisations
 Forensic serology (science of body fluids to criminal
investigations)

 Forensic toxicology ( the science of the effect of toxic

substances on the human body)

 Forensic DNA
 Forensic ballistics
 Forensic fingerprint analysis (shoe prints, tyre prints etc)
 Forensic handwriting analysis
 Forensic document examination
 Forensic criminalistics
Criminalistics is the science and profession dealing with
identification, collection, individualisation and interpretation of
physical and trace evidence and the application of natural
sciences to law.
 Forensic auditing

d) Cyber technologies in forensics

• Information forensics
• Computer forensics

Applications of Forensic Science

 criminal or civil investigations by law enforcement agencies or civilians in

disputes in a bid to provide evidence (both factual derived from physical
evidence and from opinions adduced therein) to assist in the administration of
justice and law.

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  Forensic scientists derive their conclusions from and through the gathering,
collection and examination of evidence.

Forensic divisions

The divisions encountered frequently in day to day medicolegal investigations in

laboratories into circumstances leading to criminal investigations would be carried
out in any of the following units:

1. Forensic Medicine (Hospital toxicology and therapeutic drug monitoring)

2. Forensic Pathology ( anthropology, entomology)
3. Forensic Serology
4. Forensic DNA
5. Forensic Toxicology
6. Forensic Criminalistics (An extension of this unit would be the ballistics,
fingerprinting etc units)

Other laboratories have deferent naming systems e.g. Forensic Biology unit to cater
for both serological and DNA cases.

Forensic Serology and DNA Sections

Cases analysed in this unit will focus on identification of biological and other relevant
evidence obtained in the course of criminal or civil investigations in a bid to:

 to establish link or exonerate individuals to crimes

 corroborate or refute witness/suspects stories
 determine the sequence of the events
Cases arise from

 murders
 sexual assaults or
 other violent or non-violent assaults which result in death
 accidents (form natural or man-made incidents)

2. Forensic Toxicology Section

Cases arise from

 sudden death without any previous history of illness

 non-sudden deaths without obvious causes of death (this will cater for
slow acting or lethal but low concentration toxic substances)

Other cases which may be catered for include those

 whose cause may be obvious like drowning or traffic cases but whose
occurrences may be as a result of the administration (self or otherwise) of

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 substances (toxic or otherwise) which may interfere with normal brain
functions.

Definition of Forensic Medicine

Forensic Medicine also referred to as legal medicine or medical jurisprudence

(science or philosophy of law) this has been defined as:-

 The branch of medicine or medical science that uses or applies medical

knowledge for legal purposes

 The branch of medicine that interprets or establishes medical facts in civil or

criminal law cases

All branches of medicine e.g. anatomy, pathology, dentistry, odontology, physiology,

biochemistry, therapeutics, obstetrics, or paediatrics may be called upon to assist in
medico-legal investigations of sickness, disease or death.

Main branches of Forensic Medicine are two

 Clinical forensic medicine (CFM)

 Forensic pathology (FP)
Clinical forensic medicine
Police surgeons, doctors, or other clinicians, deal with medico-legal investigations of
the living on a day to day basis which sometimes ends in a death depending on the
extent of injury. Types cases:

 physical assaults
 sexual assaults
 bestiality
 poisoning

Forensic Pathology

Forensic Pathology contributes a large part of forensic medicine as it deals with both
the dead and the living.

Forensic Pathologists

 death scene investigations arising from

 poisoning
 injury (fatal wounds)
 crushes (smashes from cars, buildings collapse, earthquake etc)
 asphyxia suffocation)
 burns
 freezing
 sadism
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  sexual assault
 other violent incidents like (robberies, thefts, etc)

 the performance of forensic autopsies (forensic autopsies have a different

focus than that of hospital autopsies conducted in cases of natural death),
 review of medical records,
 interpretation of laboratory results and reports,
 certification of sudden and unnatural deaths, and
 court testimony in criminal and civil law proceedings.

During the forensic investigations of the above mentioned type of cases, it must be
noted that the pathologists and police doctors work with other personnel like

 other forensic specialists

 laboratory technologists (chemical, histological and other specialist
laboratories)

All investigations under the umbrella of Forensic Medicine must be done within the
confines of the:-

 legal system (law)

 court system (judiciary)

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Death

Thanatology (the science or study of death) dates back to many centuries ago and
while ancient civilisations accepted death as a matter of course probably based on
signs like cessation of breathing, movement etc, modern medicine with its advances
have created a crisis requiring the re-examination of declaration of the death of a
person.

Questions often encountered on the subject of death include

 whether death is an event or a process and what emerges is that depending

on the incident leading to it, death can actually be both a process and an
event

 whether death is the irreversible loss of function of vital organs in the body
(brain, lungs heart) (the term irreversible may have to be explained)

 whether death is the irreversible loss of function of the whole organism

Arising from this it clearly emerges that

 death may occur as a consequence of several scenarios or incidents

Manner of death

Incidents or events leading to death may be referred to as ‘manner’ of death and

immediately conjures possibilities of more than one option which leads to
‘classification’ of manner death. You may note that manner and cause are two
different things.

 Classification of manner-of death

Death may occur from any of the following incidents

 Suicides which are from self administered injury or exposure as the cause
 Natural causes which may solely be attributed to aging and/or disease
 Disasters (natural or manmade explosions, earthquakes, falling into a
vault of molten metal etc)
 Accidental in which there was no intent by self or other party to kill
 Homicides in which death occurs as a result of action by another
individual ( this may be at mass, genocide or individual level)
 Unestablished/undetermined (not established/not determined) cause is
one in which there are no definite or concrete findings

However, there will always be challenges and exceptions with the above or any other
classifications e.g. administration of a drug of abuse causing a fatal accident or a
stroke while swimming causing drowning. Examples in which death may be
instantaneous include violent explosions in which a body is blown to pieces.

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Definition of Death

In the past, failure of different organs like the heart or the brain would occur rapidly
within minutes of each other and terms like the ‘cessation of heartbeat’ (the famous
cardiac arrest) breathing and circulatory systems were regularly used to define the
cause of death.

However, technological advances in medicine over the past several decades came
with many challenges. The use of artificial respirators and CPR (cardio-pulmonary
resuscitation) and other life-support devices in cases of organ failure like the heart
and lungs extending the ‘state’ of life until they are disconnected defined the
declaration of death. Use of pacemakers for people with cardiac problems has also
seen an extension of life in people who would otherwise have succumbed to death.

Further, innovative procedures like heart transplant being performed threw out the
theory of heart beat as the evidence of presence or absence of life and it became
clear that there needed to be a diagnosis for death that was not based on heartbeat.

Medical personnel are thus confronted by two factors arising from biological and
cellular points of view in certification of death.

 when to certify death

 certification of exact time of death

These led to the examination of the cause death resulting in types of death being
arrived at.

Types of death

Terms like Clinical death in which there is

 no breathing,

 no circulation

 and no brain activity

have been used to characterize clinical death.

However the inadequacy of this definition arises from the fact that some of these
clinical signs begin at the very onset of the symptoms of death.

For example right after a cardiac arrest has caused the heart to stop, for upto four
minutes innovative developments of restarting of critical activities like breathing and
heartbeat can be undertaken using CPR. After a few minutes, death may be
permanent, because the state of the body has gone from clinical death to another
and final state of death.

Traditionally, problems concerning the definition of death belonged to the fields of

legal medicine (inheritance) although ethical and cultural issues also come into play
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with respect to (burial issues, mourning, etc). Pathologists the world over had to
have a unified point from which their certification of cause of death is very clear so
that they may be able to proceed to the next equally important stage of declaring
time of death.

For pathologists and clinicians therefore, the conventionally accepted way of

addressing this dilemma has been to describe two types of death.

a) Cellular death
In cellular death the tissues and their constituent cells die and no longer
function or have metabolic activity (which is primarily aerobic respiration).
Cellular death is a process which follows an event like cardiorespiratory failure
with different tissues dying at different rates. In cases of fragmentation of a
body by a bomb explosion not all the cells will be instantly killed.

The cerebral cortex (brain) is the most vulnerable with a lifespan of about 4
min under anoxia while connective tissue and muscle survive for longer
(hours).

b) Somatic death

This is the process in which a person irreversibly loses their sentient personality
(having the power of sense, perception, sensation, thought and
consciousness) with the loss of consciousness and awareness as well as
inability to respond to any stimulus or initiate any voluntary movement occurring.
Somatic death may be further equated to brain death which is irreversible
unconsciousness with complete loss of brain function, although the heartbeat
may continue. If all other bodily functions do not cease, then the individual will
exist in a vegetative state (coma) for a long period of time.

Brain death (irreversible cessation of all function of the brain) may occur after a
stroke, or an impact that causes the brain to swell and push against the skull and
preventing blood from flowing to the brain. In the absence of oxygenated blood,
brain cells quickly die. Brain death is quite different from reversible coma
(unconsciousness) in which living brain cells remain.

A person can remain permanently unconscious with total or partial brain death. If
injury is to the upper brain (cerebral hemispheres) only, they will lose their
sentient personality, but the living lower brain (brain stem) will continue to control
functions like allowing the heart to pump, the lungs to breathe and the body to
function.
Comas also described as vegetative states have been reported to arise in cases
in which the brain proper is dead but the stem is still active (not dead or injured)
and is able to control or maintain respiration and circulation of blood.

To be legally brain dead, all function of both the upper and lower brain must
cease leading to both heart and respiratory failure.

The concept of brain death developed because ventilators and drugs can
perpetuate cardiopulmonary and other body functions despite complete
cessation of all cerebral activity.

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 The concept that brain death (i.e., total cessation of integrated brain function,
especially that of the brain stem) constitutes a person's death has been accepted
legally and culturally in most of the world.

Clinical death may precede this process in which with the presence of some
nervous, circulatory and respiratory activity may be noted.

Once there is irreversible damage to the brainstem it is acceptable in most

countries some of which have legislated it that somatic death can be certified
without is any dispute legal or otherwise.

An advantage to society of clinical death is that organ harvesting from donors or

people whose family are willing to give authorisation can be done since the cells
and their organs are still alive.

Signs of death

To establish that the somatic or irreversible brain death has occurred in an individual,
it must be ascertained that:

 there is complete loss of consciousness with no response or reaction to

painful stimulus
 there is no evidence of brain function over a period of time
 there should be muscle flaccidity
 presence of drugs which may stimulate signs of death like unconsciousness
etc should be eliminated
 hypothermia (low temperature), hypoglycaemia (low blood sugar) or
hyponatraemia (low blood sodium) should also be ruled out as the cause of
the loss of function
 the person has sustained a brain injury sufficient to account for the irreversible
loss of brain function. Often this is done by CT scan
 there are no reflex functions associated with coughing, gagging, eye
movement, blinking, or dilation of the pupils

Pathophysiology of Death

Pathology may broadly be defined as the study or science of disease and its
diagnosis (causes of, and changes produced in the body by, disease) while
physiology is the branch of medicine that deals with the functions of the different
organs of the body.

Pathophysiology is therefore the study of functional changes in the body which occur
in response to disease or injury.

Signs or indications of death (cont’d)

To establish that the somatic or irreversible brain death has occurred in an individual,
it must be ascertained that:
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  the person makes no attempt to breathe when disconnected from the
respirator for several minutes
 these tests are frequently repeated after a further 24 hours as an assurance
of irreversibility. A flat electroencephalogram, indicating an absence of brain
activity is often used for verification.
 pupil dilation
if the head is so badly damaged that the tests cannot be performed, death can be
determined by total lack of blood flow to the brain. This is done by inserting

Structure of the brain

The brain generally comprises of five main regions but for this presentation will
look at two main regions of interest under

a) Brain incorporating

 cerebrum which comprises of two hemispheres (lobes) is found in the

anterior portion of the cranial cavity brain (fore-brain). It is the largest
part of the human brain and is associated with higher brain function
such receiving and processing information such as thought, action

 cerebellum which is found in the posterior below the cerebrum and is

the region of the brain that plays an important role in motor control,
balance and equilibrium just to name a few

b) Brain stem

It is the lowest part of the brain adjoining and structurally continuous with
the spinal cord. It provides the major route by which the cerebellum and
the rest of the brain send information to, and receives information from,
the spinal cord and peripheral nerves.

A person can remain permanently unconscious with total or partial brain death. If
injury is to the upper brain (cerebral hemispheres) only, they will lose their
sentient personality, but the living lower brain (brain stem) will continue to control
functions like allowing the heart to pump, the lungs to breathe and the body to
function.

Brain death may therefore be characterised as having three possibilities;

 damage to the ‘brain’ i.e. ( the region that deals with consciousness,
motor control and other reflexes, (cerebrum and cerebellum))
 damage of the brainstem
 total brain damage (all of the brain) resulting in death with no possibility of
sustenance of life or resuscitation

A stroke affecting the brain stem is potentially life threatening since it is this
area of the brain (not whole brain death) which is taken to be the significant
indicator of death.

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 The concept that brain death (i.e., total cessation of integrated brain function,
especially that of the brain stem) constitutes a person's death has been accepted
legally and culturally in most of the world.

Clinical death may precede this process in which with the presence of some
nervous, circulatory and respiratory activity may be noted.
An advantage to society of clinical death is that organ harvesting from donors or
people whose family are willing to give authorisation can be done since the cells
and their organs are still alive.

 dyes (angiogram), or radioisotopes into the blood vessels supplying the brain
blood vessels, to ascertain that they do not travel to the brain.

Heart beat as the cause of death

Long standing beliefs that heartbeat was a reliable or dependable indication of death
had to be discarded after the medical miracle of heart transplants showed that
heartbeat could be sustained without a heart.

The Medico-legal Aspects of Brain Death

Cases of complete recoveries from apparent brain deaths have been widely reported
and continue to pose a challenge to the medical field with respect to what can be
considered as the appropriate time to declare a person legally dead and discontinue
life support activities. This is especially more so in cases of disease or other natural
calamities e.g. stokes, heart attacks etc.

In cases of criminal investigations, the points at which the cause of death can be
defined or identified and the time of death determined can of great significance. An
example is given of a blow to the head by a criminal causing brain death (not
brainstem death) and after a period of time a doctor’s intervention, with the
permission of the family to stop life support measures.

Defence of assailants advanced in courts by lawyers that death was caused by the
doctors after the withdrawal of artificial ventilators support systems while holding
water before an agreed state of death was agreed on, ceased to hold water. The
reasons being that the doctors diagnosed death before discontinuation of the
procure and that in any case it was the criminal act which initiated the chain of
events.

The signs or indications of death

When cardiorespiratory failure occurs, brain function ceases soon after (within
seconds) as result of the collapse of cerebral pressure and consequent cortical
ischaemia (a decrease in the blood supply to a bodily organ, tissue, or part caused
by constriction or obstruction of the blood vessel). Within minutes, the loss of brain
function becomes irreversible (may take up to 7 or 10min). Conditions of
hypothermia (from emersion under water or cold environment) reduce oxygen needs
of the tissues increasing the periods of survival.

The signs of death may be classified as

 immediate
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  early

 late

Immediate signs

 cessation of circulation and respiration (heartbeat and respiratory

movements). Electrocardiograph may be unchallenged in confirming cardiac
failure but respiratory failure may be more difficult to confirm in deep comas
(such as those induced barbiturates) and this is done using stethoscopes or
mirrors under the nose to detect moisture.

 unconsciousness, loss of reflexes, lack of reaction to painful stimuli however,

although rarely, post-mortem co-ordinated muscle group activity for upto one
hour possibly from surviving cells in the spinal cord may be noted.

 muscle flaccidity occurs immediately on upper brain failure (cerebrum and

cerebellum). Loss of muscle tone occurs although muscles are capable of
contraction for many hours.

Early signs
a) Body heat loss: This occurs immediately after death
 98.4oF (37ºC) –mouth
 99ºF – rectum
 97ºC - axilla
 Tº taken from rectum or liver

Factors affecting rate of cooling

 Surrounding Tº
 Build of cadaver
 Physique of deceased
 Environment of body
 Absence or presence of clothing
 Rate of cooling = 1-1.5ºF per hour

b) Eye changes

 include corneal clouding

 unreactive pupils which do not respond to light by narrowing

 pupil dilation also referred to as the ‘staring eye’ in which pupils assume
mid-dilated position.

 the iris may respond to chemical stimulation for hours but which will stop
after brainstem death

 what is referred to as ‘trucking’ of blood vessels in the retinal vessels is

another evidence of brain death (brain stem death)arising from the loss of
blood pressure allowing the blood to break up into segments, similar to
trucks in a railway train. This phenomenon occurs all over the body but is
only easily visible in the retina where it is accessible to direct viewing
which may be done using an ophthalmoscope. However, this is not

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 always easily evident as clouding of the cornea may cause interference
(inhibit)

c) Rigor mortis

PM stiffening of both voluntary & involuntary muscles

Onset: 2-4hrs up to 5-7hrs, complete 8-12hrs
Disappeared in 18-36hrs
Order: jaws>facial muscles & neck>wrists & ankles>knees>elbows>hips
Disappears in the same order

Importance of RM

Can be used to est. time of death

 Warm & flaccid = dead < 3hrs
 Warm & stiff = 3-8hrs
 Cold & stiff = 8-36hrs
 Cold & flaccid = >36hrs
d) Hypostasis (PM lividity or pooling)

 Turning blue of a cadaver

 Gravitating blood
 Uses: detect inconsistent patterns
 With decomposition – not detectable
 Can shift in 1st 4-6hrs
 Unchangeable in 6-8hrs
e) Chemical changes in body fluids

Late signs

Hypostasis and rigor mortis occur after somatic death but before cellular death is
complete. As discussed earlier death is a process and not an event and while the
cells of some of some tissues are still alive and even capable of movement (such
as fibroblasts and muscle), others are dying or dead. The process of decomposition
thus begins in some cells while others are still alive and this overlap may continue
for several days in temperate climates.

Decomposition is a mixed process ranging from autolysis of individual cells by

internal chemical breakdown to tissue autolysis from liberated enzymes, and from
external processes introduced by bacteria and fungi from both the intestines and
outer environment. Animal predators, from maggots to mammals can be included in
the range of destruction.

Decomposition may differ from body to body, from different environments and even
from one part of the body to another. A portion of a corpse may show leathery,
mummified preservation whilst the rest is in a state of liquefying putrefaction.
a) Putrefaction & skeletonisation
 Process of decay of the flesh & organs of the body Þgases, salts and liquids
 Action of proteolytic enzymes – anaerobic fungi, bacteria, insect larvae
(maggots)

 Color change: yellow Þblack

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 o Other organs: green (S-cpds)

 Gases: H2S, CO2,NH3,H2,CH4

Order of putrefaction

 Eyeballs
 Brain

 Abdominal viscera

 Lungs

 Kidneys, heart, etc

 Bone (hair does not decompose)

Factors influencing putrefaction

 Atmospheric Tº
 Humidity & air movements

 State of tissues

 Age

 Plane of nutrition

 Causes of death

Under late signs we have the broad categorisation of decomposition which

comprises

 Putrefaction
 Formation of adipocere

 Mummification

 Post-mortem damage by predators

 Forensic entomology (the entomology of the dead)

The Mode versus the Cause of Death

The above terms may cause some confusion which may be of great importance in
relation to the documentary certification of death.

The mode of death refers to an abnormal physiological state that pertained at the
time of death, For example, ‘coma’, congestive cardiac failure, cardiac arrest and
‘pulmonary oedema’.

In most cases, the mode is unhelpful and immaterial in describing and understanding
the cause of death and terms like cardiorespiratory failure or bronchopneumonia
may end up being quite useless.
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In addition to the mode and cause of death there is the ‘manner’ of death which is
not really a medical decision as it refers to circumstantial events (like homicide,
natural cause, suicide, and accidental) and is basically a legal or administrative
categorisation.

One will however find in some countries a provision in the preliminary report of the
pathologist for entry of the manner of death even before a full investigation has been
undertaken.

Post-mortem Changes of Forensic Importance

A number of post-mortem changes of interest to the pathologist will be those of

potential usefulness in relation to

 estimation of post-mortem interval

 possible interference with the body

 indication of the cause of death

1) Hypostasis (post-mortem lividity)

PM hypostasis (also known as ‘lividity’, ‘staining’) occurs when the circulation ceases
as arterial propulsion and venous return then fail to keep blood moving through the
capillary bed and the associated small (afferent and efferent vessels).

Gravity acts on the stagnant blood and pulls it to the lowest accessible areas. The
red cells are most affected sedimenting through the lax network but plasma also
drifts down to a lesser extent causing an eventual post-mortem ‘dependent oedema’
which contributes to the skin blistering that is part of the early post-mortem decay.

Hypostasis is the condition in which blood accumulates in a dependent part as a

result of lack of or feeble circulation. Congestion of the base of the lungs in old
people from this cause and infection is referred to as hypostatic pneumonia.

The erythrocytes in the lower areas of the body may be visible through the skin as
bluish red discoloration.

The pattern will depend on the posture of the body after death. When the body is
lying on its back with the buttocks and calves pressed against the supporting
surface, the vascular channels will be compressed such that hypostasis will be
prevented from forming there, the skin remaining white (Europeans/ Asians/light
skinned)

When the body is moved then redistribution occurs. In the case of hangings where
the body remains vertical after death, hypostasis will be most marked in the feet,
legs and to a lesser extent in the hands.

Colour may vary starting with bluish and turning to pink but this is also not very
definite and in any case cases of the ‘cherry pink coloration of CO poisoning and is
the dark blue-pink colour of cyanide are at variance with this.
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The use of hypostasis to determine time of death is indefinite as its appearance may
is variable (vary from half an hour to many hours after death).

Movement of a body may result in the primary hypostasis

 remaining fixed
 moving completely to the newly dependent zones

 may remain partially fixed and partly relocate.

This would be of great significance in criminal investigations suggesting that the

suspect or somebody else may have returned or come to the scene of crime.
Hypostasis also occurs in other tissues and organs and may cause some
misdiagnosis of cause of death.

2) Rigor Mortis

i) The Process

Unlike hypostasis, the stiffening of the muscles after death has some relevance in
determining the post-mortem interval. However, the timing of this sequence is so
variable that it may just provide very general indications of the time of death.

a) Immediately after death, there is general muscle flaccidity, usually followed by a

period of partial of total rigidity, which in turn passes of as the signs of decomposition
appear. The usual range of times when rigor appears can be summarised as follows.

 The flaccid period immediately after death is variable but commonly extends
to between 3 and 6 hours before stiffening is first detected.
 Rigor is first apparent in the smaller muscle groups not because it begins
there but because the smaller joints such as the jaw are more easily
immobilised. The sequence of the spread of rigor is variable but tends to
affect the jaw>facial muscles>and neck before being obvious in the wrists and
ankles then the knees, elbow and hips.

 The usual method of testing for rigor is by attempting to flex or extend the
joints, though whole muscle mass become hard and can be detected by finger
pressure.

b) Rigor spreads to involve the whole muscle mass within a variable period but in
average conditions may reach a maximum of within 6-12 hours. This state remains
constant until the muscle mass begins to undergo autolysis which releases rigor
gradually before post-mortem changes are externally visible although there may be
discoloration of the lower abdominal wall.

The duration of the full rigor may 18-36 hours until it begins to fade in roughly the
same order. However these are generalities to which there may be exceptions.

ii) The Biochemistry of Rigor Mortis

Studies carried out determined that the essential contractile substances in muscle
contraction were actin and myosin (which are proteins) which form a loose
physicochemical combination called ‘actomysin’ which is shorter than the two
substances combined. Application of energy to the two results in the formation of the
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actomysin and the energy is obtained by the splitting off of a phosphate complex
from adenosine triphosphate (ATP) which then becomes adenosine diphosphate
(ADP). The free phosphate then engages in a phosphorylation reaction that converts
glycogen to lactic acid, high energy being released in the process.

In addition to supplying energy, ATP is responsible for the elasticity and plasticity of
the muscle. The lactic acid leaches back into the bloodstream and is converted into
glycogen. All these reactions are anaerobic and can continue after death albeit in a
distorted form.

In life there is a fairly constant concentration of ATP in the muscular tissues, there
being a dynamic balance between utilisation and resynthesis. At death however, the
ADP to ATP reaction ceases and the triphosphate is progressively diminished. In
normal muscle contractions ATP production would release the actin and myosin
coupling but with its reduction, the permanent state of contraction is maintained
resulting in the stiffening.

The rapid onset of rigor is initiated when the ATP concentration falls to 85% and the
rigidity of the muscle is at maximum when the level declines to 15%. Rigor ceases
with the return of flaccidity due to the breakdown of muscles by digestive enzymes
during the process of decomposition.

iii) Factors affecting the timing of rigor mortis

 temperature will affect the speed of the onset as well as modifying the
duration. The colder the environment the slower the process and vice versa
and in freezing conditions rigor may be suspended indefinitely. Hot weather
conditions speed up the cycle such that rigor may appear in an hour or lee.
 physical activity shortly before death resulting in muscle exertion may hasten
onset rigor

The crude estimates of body conditions may only be used as a rough guide
and not as definitive statement in legal proceedings.

iv) Rigor mortis in other tissues

Rigor mortis occurs in all muscular tissues and organs as well as the skeletal
muscles.

v) Heat and cold stiffening

At extremes of temperatures the body may undergo false rigor. In extreme cold
well below zero, once the intrinsic body heat is lost, the muscles may harden
because the body fluid may freeze solid (-5 degrees C). Part of the apparent
stiffening is also due to solidification of the subcutaneous fat. When the body is
warmed up, true rigor may supervene.

Heat applied to the body also causes stiffness of the muscles as the proteins of the
tissues become denatured and coagulated as in cooking. At autopsy the muscles
may be shrivelled, desiccated and even carbonised on the surface. Beneath this
there is a zone of brownish pink ‘cooked meat’ and under that if the heat has not
penetrated, normal red muscle. Marked shortening occurs causing the well-known
‘pugilistic attitude’ of a burned body. The greater mass of flexor muscles compared
to the extensors, force the limbs into flexion (bending of joints or to an abnormal
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shape) and the spine into opisthotonus (position assumed by the body during one of
the convulsive seizures of tetanus). The muscles of the back arch the body by their
spasmodic contraction). These changes are purely post-mortem and are no
indication of burning during life as similar distortions occur during cremation.

Pathophysiology of Death II

2. Post-mortem Decomposition

a) Putrefaction

The usual process of corruption of a dead body begins at variable times after death
but roughly after 3 days, depending on temperature and storage conditions
(refrigerated bodies can last for days).

Sequence

 discoloration of lower abdominal wall due to the bacterial laden caecum.

Bacteria spread from the bowel into the tissues of the abdominal wall breaking
down haemoglobin and sulphahaemoglobin leading to a distended abdomen
full of gases
 bacteria moves to the dependent areas and moist tissues causing
discoloration
 neck and face swell
 bacteria move through the venous system haemolysing blood, giving rise to
marbling (a branching of reddish then greenish pattern in the skin).
 skin blisters may appear forming from lower surfaces of the trunk and
thighs blister formation is as a result of the upper epidermis becoming
loosened and slips giving to large fragile sacs of fluid ,which soon burst .

After 2- 3 wks

Body fluids comprising of liquefied tissue may leak from any opening

After several weeks

 body will darken

 heavy maggot infestation will have occurred except in winter
 skin will be destroyed with numerous maggot holes (maggots secrete a
photolytic enzyme which speeds up the destruction of tissues)

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  skin slippage causes shedding of the outer layer of the fingers and toes
and although finger and toe nails last longer than the surrounding skin, they
too become loose and eventually fall out.

Internal decomposition proceeds more slowly and at different rates .The lining of the
intestines and pancreas autolyse within hours of death while the uterus and prostate
may still be recognisable in a partially skeletalised body a year later.
The brain soon becomes discoloured being a soft pinkish grey within a week
and liquefying within a month.

 heart is moderately resistant

 in obese people body fat may liquefy into a translucent yellow, fluid that
fills the body cavities between the organs

After several months

 most of the softer tissue will disintegrate leaving uterus, heart and prostate
 some skin under clothing may persist
Eventually the body is reduced to a skeleton although some ligaments and cartilage
may survive for a while within 12-18 months outdoors (temperate environment).

 within 3 years – bare-bore skeleton

 in closed conditions indoors, body may not skeletalise but be converted to a
dried partly putrefied, partly mummified shell.

Decomposition in immersed bodies

The rate of decomposition is slower in cold water due to the lower ambient
temperature and protection from insect and small nocturnal predators.

Decomposition in buried bodies

Rate is much slower than in air or water and depends on:

 if burial is soon after death before decaying in air starts putrefaction will be
less and may never proceed to the liquefying state seen in air decomposition
 low temperature lack of oxygen exclusion of animal and insect restricts
aerobic orgasms
 if body had started decaying this will continue with aerobic bacteria and
any other organism like maggots
Deep burial preserves bodies better than shallow graves.

b) Adipocere formation

An important and relatively common post-mortem change is the formation of

adipocere, a waxy substance derived from the body fat.

 adipocere may be partial and irregular or may be seen in the whole body
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  it is caused by hydrolysis and hydrogenation of adipose tissue (by water in the
body) leading to the formation of a greasy waxy substance
 after months, adipocere becomes brittle and chalky with colour varying for
dead white through to a grey greenish grey
 has a mouldy, earthy, cheesy ammoniacal smell
 Chemistry tests show that adipocere contains palmitic, oleic and stearic fatty
acids together with some glycerol in new adipocere.

Conditions for formation

 air exposure unless conditions favour mummification

 It is a process of moist putrefaction with temperature above 5 o
C
and will be found in bodies:
 immersed in water
 incarcerated in wet vaults and crypts
 in wet graves

Importance of adipocere

 Once formed it may persist for decades or even centuries.

 The usual dissolution of putrefaction is replaced by a permanent firm
cast of the fatty issues and although distorted compared to the
immediate post–mortem shape, it allows the form of the body to be
retained in a recognisable form.
 Adipocere formation may inhibit putrefaction
 Areas which tend to develop adipocere include cheeks, chest,
abdominal wall and buttocks.
 Formation may require from 3-12 months although crystals have been
detected in a body lying in water for only one week.
A body in a coffin or other confinement may be found with different
areas undergoing skeletolisation, mummification and adipocere
formation within their mini-environments.

c) Mummification

The third type of long term change after death is mummification, a drying of
the tissues in place of liquefying putrefaction with the key factor being
evaporation in dry conditions inhibiting bacterial growth. Although it may also
coexist with the other two states, it is the most likely to extend over the whole corpse.

Appearance:

 desiccated, brittle skin stretched tightly across the anatomical prominences

such as the cheekbones, chin and hips

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  brownish colouration which may be infested with mould on some areas giving
it a dark or greenish hue
 skin and underlying tissues are hard (difficult post-mortem)
 condition of internal organs variable (time) may be partly dried or putrefied
 there may be slight adipocere formation
Facial recognition may be possible even with the loss of eyes and full lips.
Mummification occurs over several weeks to months with the internal organs
probably undergoing some degree of putrefactive change.

After complete drying has occurred, the body may remain in that state for many
years. Eventually mould formation and physical deterioration progresses, the dried
tissues becoming split and powdery and gradually disintegrating. The body
eventually skeletolises though tough ligaments tendons and skin may persist for
many years.

Mummification process preserves major physical injuries especially those touching

on bones.

The most widely known forms of mummification are those in hot desert zones like
those seen in Egypt, although the famous mummified Pharaohs underwent
artificial mummification in their crypts.

d) The entomology of the dead and post mortem interval

This is a specialised subject and when the issue of the time since death is
important, such as in a criminal investigation, it is essential that whenever possible
the Pathologist have the assistance of an entomologist with forensic experience.

The rationale of Forensic Entomology is that:

 after death, invasion of an unprotected body by insects and other small

fauna comes in successive waves with different species of arthropods
colonising the corpse at different periods after death.
 In addition, some species e.g. the most common house flies pass through
complex life cycle that can be used to determine at least the minimum
time since death by studying their stage of maturation.
 The basis is that the common housefly does not fly in the dark therefore
eggs are laid only in daylight. This means that a corpse found at night
or in the morning with eggs on it almost certainly died the day before.

The science is inexact and is modified by a number of factors, both climatic and
geographical but in expert hands can yield useful information at a period when
other indicators have ceased to function.

For the bluebottle houseflies, between 30-150 clusters of eggs may be laid by the fly
on moist areas (eyes, eyelids nostrils, month wounds).

Temperature will influence the time span of the larval and papal stages thus flies as
medico-legal indicators must be used in conjunction with the records of
meteorological conditions existing at the time subsequent to the presumed death or
disposal of body.

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The time for laying to hatching is between 8-14 hours depending on the temperature
(they do not hatch below 4o C.

The first maggot stage (first instar) tries to penetrate the tissues or enter any nearby
body cavity such as the mouth or wounds. Their proteolytic enzyme is powerful
enough to aid dissolution of the tissue and facilitate penetration. This first larval
instar persist for another 8-14 hours then the outer skin is shed and the second
larger instar feeds for another 2-3 days.

After the final moult, the third instar spends about six days on the body before
leaving it to migrate some distance to hide in the ground or under some other
cover e.g. a log, carpet etc to pupate. The pupa is a brown leathery capsule in
which the insect metamorphoses into the winged fly after about 12days.

Common housefly prefers to lay its eggs on already decomposed flesh and its eggs
are fewer.

 hatching time 8-12hrs

 first instar persists 36 hour
 second instar persists 1-2 days
 pupation lasts 7days

All this about at about 22o C

Entomologists have constructed tables of variation in larval length, according to

temperature and age. Identification of species is important in provision of option by
experts as different species have different maturation cycle times.

Different type of insects invade the body after the moist putrefaction stage
associated with maggots has passed e.g. beetles may arrive within 3-6 months
after death.

Absence of insect on a body outdoors may indicate that death had occurred
during the winter months when no active colonization was occurring.

Collection of materials for entomological study

Main concern is careful collection of specimens and noting

 temperature of the maggot mass

 ambient temperature
Maggot samples should be stored in a glass jar or container with adult flies if
available and any other insect types also being collected. Soil beneath the body
should be collected including the pupae cases. In immersed bodies, they should be
carefully checked for crustaceans or any other insects including body parasites
like fleas and lice to determine minimum survival time under the existing
circumstances.

Estimation of time since death

This important issue in forensics’ medicine has challenged pathologists for years and
is probably still the most common single topic for forensics research.
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A wide variety of techniques have been advocated through the issue of body
temperature remains the most used as well as being unreliable.

Other methods applicable to the early post-mortem period of the first few days after
death include

 rigor mortis (already discussed )

 electrical excitability of muscle.
 gastric emptying
 eye changes (already discussed )
 vitreous humour chemistry
 blood, pericardial and cerebrospinal fluid chemistry
 cytological change in born marrow
 by cooling

Body temperature: should be through multiple readings with the thermometer

being inserted as high up the rectum as possible.

Liver readings should be discouraged as they introduce an element of

contamination of the crime scene and the body but may however be used in
examined at the scene of crime mortuaries if the bodies have already been
external.

a) Estimation by body cooling

A uniform homogeneous laboratory body will cool after death according to Newton’s
law of cooling which states that the rate of cooling is proportional to the difference in
temperature between the body surface and its surroundings.

However in reality a number of factors will come into play including:-

a) ambient temperature is a major factor in cooling as a body will not cool if the
temperature of the environment is higher than 37 O C and may instead warm
up.

b) air movement and humidity

In still conditions a layer of warm air clings to the skin especially if clothed or
hairy blocking heat loss, however with air movement, fresh cooler air will
result in heat loss. A body in small space will cool more slowly than one
exposed to the open air.

c) medium around the body:

A body immersed in cold water will rapidly lose heat as is seen when fatal
hypothermia occurs within minutes in a cold sea. On the other hand death in a
warm water bath will reduce the rate of cooling and may even elevate the
temperature making estimation of the time of death futile.

b) Stomach emptying as a measure of time since death:

The use of the state of digestion of the gastric contents as an indicator of the time
between the last meal and death although used some time back was eventually
found to be unreliable and uncertain to have much validity.

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It was originally based on the belief that food spent a fairly uniform time in the
stomach before being released into the duodenum, and that the physiological
process of digestion of an average meal lasted some 2-3 hours. However studies
showed that:-

a) Physical nature of a meal affects the emptying time with the more fluid the
contents resulting in faster implying.

b) Nature of food affects emptying time like fatty substances decaying the
opening of the pylorus (lower or right opening of the stomach) while strong
alcohol (spirits) irritate the mucosa and tend to delay opening.

c) The use of vitreous humour chemistry in timing death

The most common chemical estimator performed or the vitreous fluid in the context
of post-mortem interval is that of potassium as it has been found to rise after death.
However its reliability is questionable with variations having been noted of between
1-7 hours to 26 hours.)

Vitreous humour is preferred because after death blood undergoes autolysis with the
breakdown of cell members.

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