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After death, the body’s protective functions are absent and its defence barrier is lost. Saprophytil micro-organisms which cannot invade the body during life, physical and chemical agents which are present in the environment, all act on the dead body. Further, some body chemicals and enzymes which are helpful agents during life and take part in different metabolic processes, in the absence of physiological control after death, start acting adversely. All these cause postmortem changes of the dead body.
Some of the changes which occur after death are related to somatic death and some are related to molecular death. Accordingly, some of them are conspicuous immediately, some come early and the rest appear late.
The doctor needs to know enough to recognize the various post-mortem changes in order to avoid confusing them with signs of trauma or unnatural death.
(a) Stoppage of function of nervous system (b) Stoppage of respiration (c) Stoppage of circulation
(a) Facial pallor (b)Loss of elasticity of the skin with decrease in the facial creases (c) Primary relaxation of the muscles
(d) (e) (f) (g) (h)
Contact pallor and contact flattening Changes in the eye Cooling of the body Postmortem staining Rigor mortis or postmortem rigidity
Late changes –
(a) Putrefaction or ordinary decomposition (b) Adepocere change- a modified form of decomposition (c)Mummification- another form of modified decomposition
Stoppage of function of nervous system
With death all functions of the nervous system ceased. The subject has no sense. There loss of both sensory and motor functions. There is loss of relaxes, no response and no tonicity of the muscles. Pupils are widely dilated.
Stoppage of respiration
With somatic death, there is total stoppageof respiration which can be established by the following tests 一 1. Inspection 一 No respiratory movement will be visible ． 2. Palpation 一 Respiratory movement can't be appreciated ． 3. Auscultation 一 No breathing sound can be heard from any part of either lung.
4. Feather test 一 If a downy feather or a few cotton fibres are held in front of nose, then, if respiration is continuing, it will rhythmically move with the inspiration and expiration. If respiration has ceased then, there will be no movement of the feather or the cotton fibres.
5. Mirror test 一 The shining surface (reflecting surface of a mirror) is held in front of the nose and mouth of the person ． If respiration is continuing then, the shining surface of the mirror will partly become hazy due to condensation of the moisture of the expired air on the cold shining surface of the mirror. If respiration has ceased then, there will be no hazy appearance of the surface of the mirror.
Winslow's test 一 A small bowl with water is placed over the chest of the subject with arrangement of some light rays falling on the surface of the water in the bowl. Slightest movement of the chest wall, even due to feeble respiration which cannot be appreciated as such, will disturb the plain of the surface of the water, which can be well marked from the rays of light reflected from the surface of water.
Stoppage of circulation
The following tests may be performed to know, if the circulation has ceased or is continuing 一 1. Radial, brachial, femoral and carotid pulsations will be absent if the circulation has stopped. In case of very feeble circulation, these pulsations are very weak and may not be perceived.
2. Auscultation of heart 一 The whole precordial area and particularly the area over the apex is auscultated, for presence or absence of heart beat which is absent if circulation has ceased. When the circulation is feeble and when there is excessive deposition of fatty tissue over the area, auscultation may miss such heart beats.
3. Diaphanous or transillumination test 一 if, in a dark room the outstretched hand is held against some bright light-rays, then in presence of circulation, the hand will appear pinkish and transluscent. If circulation has ceased then, the hand will appear yellowish and opaque.
4. Magnus test 一 It is a very satisfactory layman's test for circulation. Veins run superficial to the arteries. Ligature is applied on a finger sufficiently tightly to compress the superficial veins but not the deeper arteries. If circulation is continuing then, after a while the part of the finger distal to the ligature will appear swollen and bluish due to venous obstruction and accumulation of the reduced blood in the distal part. If circulation has ceased then there will not be any such change.
5. Icard's test 一 In this test ， 1 ml. of 20% alkaline fluorescein solution is injected either in the dermis or subcutaneously. If circulation has not stopped then, in case of intra-dermal injection, the area of yellowish discolouration spreads locally and in case of subcutaneous injection, the dye travels to the distant parts of the body and yellowish discolouration appears in the conjunctiva.
6. Pressure test 一 In case the circulation is continuing, if pressure is applied on the nail of a finger then, it becomes pale but soon becomes red on release of the pressure. In case of cessation of circulation pressure causes paleness of the nail, which takes much more time to return to its normal colour on release of pressure.
7. Cut test 一 If circulation is continuing then, there is active bleeding from a small superficial cut. But if circulation has ceased then, such a small superficial cut may cause very minor degree oozing of blood but no free active bleeding.
8. Heat test 一 If a small area of the skin is brought in contact with some hot object, say of about 100℃ , then, at the site of contact there will be blister formation surrounded by a red ring. If the period of contact is very short then, there may not be any blister formation but there will be redness over the area of contact. These happen if circulation is continuing. If circulation has stopped then these changes will not be there. Instead, the area of contact will become dry, firm without any redness and blister formation.
9. E.C.G. test 一 By E.C.G. test, very weak functions of the heart muscles and the electrical conductivity there, are detectable. In case of cessation of circulation, the E.C.G. curve is absent with presence only of flat line on the baseline without any elevation and depression.
Early Chances after death
1. Facial pallor- After death, due to stoppage of circulation, blood drains from the capillaries and small vessels to big ones. This is why, generally the face appears pale and bloodless, but in case of agonising death and where there is obstruction of venous return due to compression over the neck or below, as in case of strangulations etc., the face is congested and cyanotic.
2 Loss of elasticity of the skin with ironing of the facial creases – these occur due to loss of tonicity of the skin muscles including those of the face. The face looks younger.
3 Primary relaxation of flaccidity of the muscles After death muscles loose their tonicity and become flaccid. Joints are loose and the chest wall flattens. During this stage of relaxation the muscular tissues are still alive; their chemical reaction is still alkaline and they still respond to electrical stimuli.
4 Contact flattening and pallor –During the stage of primary relaxation of muscles of the body, the areas which remain in contact with the ground, become flat and the blood from vessels of these areas are pressed out.
During the stage of rigor mortis, the areas continue to be flat, as rigor appears in those muscles in their flattened state and the drainage of blood from the vessels of the areas make the areas pale which continue to be so, even after formation of postmortem staining in the surrounding areas. Medicolegal importance-From the contact flattening and pallor, the position of the body in which it stayed for some time after death can be understood.
5. Changes in the eye
(a) With death, the corneal and papillary reflexes are lost. (b) With death, the eyelids usually close due to loss of tone of the muscles of the eyelids. (c) Haziness of the cornea
(d) Shape of the pupils – Ordinarily, they are circular. But ,as after death, there is loss of tone and elasticity of the ciliary muscles, the shape of the pupil can be changed which may persist during the stage of rigor mortis of the muscles.
As the nervous control over the pupils is lost after death, the sizes and shapes of the pupils of the two sides may be different. It has been already mentioned earlier that, the pupils respond to the application of the miotic and mydriatic agents for an hour or two after death.
(e) Loss of ocular tensionOccular tension falls rapidly after death and within about half an hour it becomes zero.
(f) Taches Noire scleroitiques This is a change in the sclera which occurs when the eyes remain open. It is the result of drying and dessication of the exposed conjuctiva and the sclera underneath. Within 2~3 hours, the exposed parts of the eyeballs become yellowish and within 2~3 days, the areas become brown.
In the two sides, 4 such discoloured areas can be noticed, two in each eye. Each discoloured area is triangular in shape with the base on the limbus, the apex at the lateral or medial canthus and the two other sides of the triangle are formed by the margins of the upper and lower eyelids. These are situated on either sides of the cornea of each eye.
RIGOR MORTIS Definition: After death, the dead body become stiff at variable time, this is called rigor mortis. Rigor mortis appears more quickly in young person, body strong, death from asphyxia, electrocution or sudden death.
Temperature dependent: warm-------- more quickly Cold ---------delayed In freezing---may not appear Rigor mortis may be absent or weak in the old, the feeble, and infant.
Sequence of rigor mortis : first in the small muscle group-jaw muscle, finger, eye, mouth gradually developed about 12~24 hrs to the whole body joint stiffening.
Mechanism of rigor mortis;-ATP theory
ATP O 2 acid ) ADP
ADP + energy ( glycogen--lactic
Actin, myogen fuse into gel muscle become stiff
Significance in forensic medicine: 1.to determine the body is died, 2. to distinguish the location and posture to determine if it is moved after death. 3.help to infer the cause of death 4.timing of death:
in an average environment: 1~4hrs in the face 4~6hrs in the legs 6~12hrs strength of rigidity increase in 12 hours, the manual destroyed rigidity can reappeared 12~24 hrs more strong
Follow the decomposition happens, the rigidity gradually disappear, and the second flaccidity become apparent from 24 ~ 48 hours. Warm and flaccid : dead < 3 hours Warm and stiff :dead in 3~8 hours Cold and stiff : dead in 8 ~36 hours Cold and flaccid: dead > 36 hours
Cadaveric spasm or instantaneous rigor it is a condition in a dead body in which the muscles of the body which were in a state of strong contraction immediately before death, continues to be so contracted at the moment of death and after death, without passing through the stage of primary relaxation.
Thus, it is not just stiffening of muscles like rigor mortis. The muscles are in a state of contraction in cadaveric spasm. The spasm involves one or a group of muscles of the body usually, but occasionally the involvement is more extensive and though very very rare, in peculiar circumstances muscles of the whole body may be involved ． The spasmodic contraction of the muscles reflect antemortem state of excitement of mind, fatigue, nervous exhaustion etc.
Medicolegal importances 一 Cadaveric spasm being an antemortern phenomenon in origin, which continues after death, reflects the last act of the subject, performed before and at the time of his death. Thus from the cadaveric spasm, sometimes the cause of death and sometimes the nature of death can be guessed.
In case of a dead body, if the hand is found flexed in a state ot,cadavenc spasm and the grip contains sand, mud, gravel or weea, which are present at the bottom of the pond Or lake from where the body was recovered, then it indicates that at the time of death, the subject was at the bottom of the pond or the tank where he might have tightly gripped the bottom at the time of his death. Hence, with such findings in such a dead body, it can be, safely deduced that, the person must have died when he was at the bottom of the pond or tank or, in other words, his death was due to drowning in that pond or tank.
In a case of death due to stab injury over an approachable vital part of the body, if the weapon used (say a dagger) is found in the tight grip (cadaveric spasm) of the hand and if the position of the weapon in the hand is matching with commission of suicide by using that weapon, then it can be taken that, the person might have committed suicide by using the weapon present in his hand.
Similarly, in the hand of the deceased which is flexed in a state of cadaveric spasm, if we find foreign scalp hair, some fibres of a cloth not used by the deceased or some foreign article like button of a shirt, we can reasonably presume that those articles belong to the assailant or one of the many assailants with whom he had a struggle at the time of his death. Thus, from such a case, not only the homicidal nature of the death is concluded, but also some clue about the assailant is available.
When the circulation ceased, the blood are influenced by gravity and settle in the lowest area to form bluish or pink zone of postmortem hypostasis, which used to be called postmortem lividity.
When the body is contact hard supporting surfaces, the pressure squeezes the vessel bed, so that pale areas are seen at the contact site ( buttock and shoulder ).
The color of lividity is variable from light pink to deep purple Pink -- when stored in refrigerator, in cold water, in snow area Deep purple -- asphyxia, sudden cardiac death Cherry pink - - carbon monoxide poisoning Brick red -- cyanide poisoning Brownish -- metahemoglobinamia
Postmortem staining bruise 1 situation on the dependant parts of the dead body anywhere 2 Tissue level Undersurface of the skin and the skin level externally subcutaneous tissue level externally. 3 surface (a) Not elevated (b) Cuticles not damaged (a) May be slightly elevated (b) Cuticles may be damaged in the form of abrasion 4 Margin Sharp and clearly defined diffused margin 5 Colour Bluish or reddish purple normally. Reddish when fresh which changes in colour with time. 6 Cause due to capille-venous distension with blood due to extravasation of blood from capillaries. 7 Nature of the change Postmortem antemortem 8 Effect of pressure Pressed spot appears pale No change on application of pressure. 9 Cut section Cut surface shows oozing of blood from the smaller vessels which can be cleaned by washing cut surface shows evidence of haemorrhage in the tissue which cannot be washed out ( In dead bodies) 10 Microscopic study Engorgement of capillaries extravasation of blood, cellular infiltration etc. 11 Enzymatic study No change Change in the level of certain enzyme, in the affected area. 12 Medical importance Tells about the time of death and position of the dead body Tells about the nature of injury , weapon use
Significance in forensic medicine 1.to determine the death 2.timing of death
when finger press, it change in to pale: <12 hrs it partly change into pale : 12~~ 24 hrs the color have no change: > 24 hrs
3.to infer the cause of death 4.to determine if the dead body is moved or not 5.to differentiate the antepetechia from postmortem petechia
C. COOLING OF THE DEAD BODY
In life, the body mouth temperature is about 37 ℃ , the deep rectal temperature is about one degree higher than the mouth.
After death, all of the metabolism activity ceased, the produce of body heat stopped, the body surface begins cooling, but the deep organs still keep warm and the body cooling gradually happens, until to the same to surroundings.
The rate of cooling will be vary under the influence of the following factors: the weight of the body ( thin, emaciation, obesity ) children are quickly than the adults. The amount or lack of clothing, Environmental temperature, Wind, humidity, Disease: fever, dehydration, pernicious status
Significance in forensic medicine: timing of death first 5 hour after death, fall 1 ℃ per hour, after 5 hrs postmortem, fall 1/2 ℃ per hour, until to the same temperature to surroundings. according the text book: ambient temperature: 16~~20 ℃ after death: 6hrs: 30~~34 ℃ 10 hrs: 28 ℃ 15 hrs: 24~~26 ℃
Site of the body used to record the inner coretemperature 一 1 .Rectum 一 4' above the anus 2. Subhepatic
Methods of measurement of the inner core temperatureChemical thermometer℃ with graduation ranging from 0 ℃ to 50 ℃ is required. For measurement of the intra-rectal temperature, the bulb of the thermometer is introduced 4' inside the rectum ．
For measurement of the intraabdominal, subhepatic temperature, a small slit like incision is given on the right side of the abdominal wall in front and the bulb of the thermometer is inserted for 4' inside the abdomen through the incised opening.
Hourly temperature is recorded without withdrawing the thermometer, so that, there will not be additional loss of temperature locally and thus there will not be wrong result.
D. POST-MORTEM DECOMPOSITION
Decomposition can be defined as a process by which the complex organic body tissue breaks down to simpler inorganic compounds or elements, due to the action of ferments produced by the saprophytic micro-organisms or due to autolysis. The process leads to discoloration of dead body, evolution of foul smelling gas, swelling of the dead body with gradual and total destruction of the different body parts.
Decomposition is the normal fate of an undisposed dead body. Under certain specific environmental conditions modified decompostition of the dead body occurs, in which cases, instead of early and total destruction of the dead body, the dead body is preserved for a pretty long period,. The ordinary decomposition is also termed putrefaction and the two varieties of modified decomposition are known as adepocere change and mummification
External signs of decomposition ( in summer )
The first external sign of decomposition appears over the right iliac fossa of the abdomen. A greenish discolouration appears there.
Cl. Welchii are most abundant at the iliocaecal zone of the intestinal tract. During life they are not very active and cannot invade through the living tissue. After death, when the tissue barrier is lost, they can invade through the intestinal wall. They break the tissue with the hemoglobin of blood and forms sulphmethemoglobin which discolors the vessels and the surrounding tissue. Diffusion of gas and invasion of the nearby tissue by the organism gradually cause spreading of the discolouration over a wider area of the abdomen.
In India, their first change of greenish discoloration occurs externally over the right iliac fossa of the abdomen of the dead body by about 12 hours after different parts of the body.
Invasion of blood vessels by the organisms and production of H2S gas and formation of sulphmethemoglobin there, causes greenish brown staining of the inner walls of the vessels. This makes the superficial veins prominent and colorful.
This phenomenon in the smaller superficial branches of the vessels and the local tissue gives a marbled appearance of the skin of the area. Marbling of the skin becomes prominent by 36-48 hours after death in summer. Further changes occur as follows:
12-24 Gas accumulates inside the abdominal cavity. The abdomen is tense. Blood-tinged froth comes out through the nose and mouth.
24-48 Gas accumulated in the tissues which appear bloated. Subcutaneous tissue becomes emphysematours. Breasts in females, scrotum and penis in males, are swollen. Tongue is swollen and protruded . On the second day, blisters form due to presence of gas in the vessels. Rupture of blisters occur. Cuticle gets denuded.
48-72- There is prolapse of uterus and anus. Post mortem delivery of fetus from the gravid uterus. Both antemortem and postmortem wounds ooze. Postmortem staining gets displaced from the original stained areas. Eye balls protrude. Face is extremely swollen, discolored and the subject is not identifiable from the face. Hair and nails become loose and may be taken out easily.
3-5 days Abdomen bursts . Swelling of the body passes over due to escape of gas through the damaged body parts . Teeth become loose. Skull sutures separate and decomposed liquefied brain substance comes out, specially in infants
5-10 Colliquative change (liquefaction ) occurs during this period . Soft firm tissue change to thick semisolid black mass. Lately, same thing occurs to cartilages and ligaments.
Skeletonisation of the body
Skeletonisation of the dead body takes varying time depending on various factors. In buried dead bodies, total skeletonisation may take even 1year. When disposed off carelessly on land or water, skeletonisation may occur within a few months.
Factors which influence the process of putrefaction
The factors can be divided into external factors and internal factors.
External factors(not related with the condition of the dead body)
1 Atmospheric or environmental temperatureHigh atmospheric or environmental temperature promotes early decomposition 2 Moisture Presence of moisture promotes decomposition by promoting the growth of the organisms . In absence of moisture, growth of the organisms will not be rapid. If the body dries up quickly, it will prevent putrefaction and will cause mummification of the body.
3 Air (a) Stagnant air promotes decomposition (b) air movement retards the process of decomposition by evaporating the body fluid and cooling the dead body. 4 clothing Summer , slightly reduce the rate of decomposition by preventing invasion of the body by airborne organisms. Winter , help the process of deposition
5 Environment in the water , the process of decomposition is slow.6 6 Invasion of the body by animals and insects (a) In water, fish and other aquatic animals like, crabs , tortoise may injure the dead body helping invasion of the body by bacteria which enhances decomposition
(b) On land, dogs and jackals many partly destroy the dead body and that causes early decomposition. (c) Invasion of the dead body by maggots is an important cause of early decomposition and destruction of the dead body. Maggots are larvae of flies.
1.Putrefaction Mechanism: cell autolysis + bacterial growth Outlook: first on the abdomen wall--greenish hemoglobin decomposed into bilirubin -biliverdin body begins to swell:--bloating , gas formation in the tissue superficial vein become outlined in red or green marbled appearance skin blister happens tongue and eye-ball protrude flies and blue bottle lay eggs on eyes, lips….,soon hatch into maggots body cavity burst, tissue liquefying skeletonlization ( through months~~>years
3 Free air movement – helps rapid evaporation of the body fluid 4 Contact of the body with absorbing mediae.g. a dead body lying on the sand, infant body covered with dry absorbing towel, dries up early for absorption of body fluid rapidity.
Medicolegal importance of mummification
1 It is of the surest signs of death. 2 It also gives a rough idea about the time passed after death,. In estimating the time passed after death, the degree of influence of the factors which favor the change , must be taken into account.
3 Identification of the dead body- Once mummification has occurred in a dead body. Its identification is possible even after a long destroyed and many identification features like , old scars, deformities, tattoo marks, may be detected after a long time. 4 cause of death ,-As the body is not grossly destroyed, injuries can be detected after a long period even though the injuries are limited within the soft tissue and has not involved the bones.
5 The place of disposal of the dead body after death, can be guessed ( dry, hot place with absorbing type of soil etc.)
factors favoring mummification change –
1 Hot atmosphere- as in the deserts of the tropics 。 2 Dry atmosphere –mummification cannot occur in high humid condition of the atmosphere.
4.ADIPOCERE Adipocere is a chemical change of body fat which converts by hydrolysis to a waxy compounds similar to soap. It usually takes place in wet conditions, such as body in the water or buried in wet grounds. Morphology: It is a greenish greasy compounds, which retain the shape of the body, It is often patchy and partial, the rest of the body being decomposed or even partially mummified in dry graves
Medicolegal importance of adepocere change
1. It is another surest sign of death. 2. It also gives rough idea about the time passed after death. 3. As the body and its contour is well preserved, identification of the subject is possible even after a long period.
4. Similarly, as the body is not destroyed , the injuries over the body remains intact and unchanged and these can be recognized even after long period. Thus the cause of death can be ascertained in such cases. 5. Here also, some idea about the place of disposal of the body can be made, which should be a warm place with high humidity or presence of moisture or water
Physical changes useful for estimation of time of death-
1 Death synchronizes with stoppage of circulation, respiration and function of the nervous system.. 2 Other physical changes which are apparent immediately after death, are related with these primary phenomena of death and these are flaccid condition of muscles, loss of elasticity of skin, change of facial appearance and absence of the “look” When , with these changes, a dead body is still warm, not rigid, without any permanent haziness of cornea, the death of the person possibly has occurred within the last 1 hours , if the season is summer and within the l last 2 hours (with some degree loss of surface temperature ), if the season is winter.
3 Cooling of the dead body was once expected to be a countable criterion for estimation of time of death . But the possible physiological and pathological variations of body temperature at death, which greatly depend on the body intrinsic factors like , state of health and physical, metabolic and bacterial activities, and the various extrinsic factors, as also the variation of temperature at different depth or rectum, make it only a less dependable method.
4. Changes in the eye – a good many changes occur in the eye after death. Biochemical estimation of some of the constituents of the vitreous humor has been attempted, without much success. These are: (a) Level of ascorbic acid (b) Level of pyruvic acid (c) Level of potassium
5. Postmortem staining and time of death. 6. rigor mortis 7. putrefaction 8. adepocere change and mummification of the dead body
9. Chemical and biochemical changes in the blood for knowing the time of death10. Study of blood enzymes 11. Biochemical study of C.S.F. constituents 12. Estimation of time of death from the stomach content 13. content of the intestine
14. condition the urinary bladder 15. growth of facial hair in subjects who are habituated to regular shaving 16. changes in the bone marrow. 17. circumstantial evidences 18. Estimation of radioactivity of C14
Qestio s u n
How do you determine time passed after death? What is rigor mortis, how is it formed? all of the hypostasis
There are other beasts or bacterium to destroy the body Mould Ants Rats, Dogs, pigs ,wolves .
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