DEATH

Is the termination/end of life.

A permanent cessation of all vital functions.
It is an irreversible loss of the properties of
living matter.
It is an event that takes place at a precise
time.
Ascertainment of death is a clinical and not
a legal problem.
 Kinds of death
1. SOMATIC DEATH (Clinical death) – is a
complete and persistent cessation of
respiration, circulation and almost all brain
functions of an organism. It is usually
pronounced by a physician or other members
of the family.
2. MOLECULAR DEATH (Cellular death) – is
the cessation of life of the individual cells of
the body which occurs one at a time after
somatic death.

3. APPARENT DEATH or “state of suspended

animation” – is a state of temporary
cessation of the vital activities of the body
or the vital processes were depressed to the
minimum compatible to life.
 Kinds of death based on its
determination:
1. Brain death
- death occurs when there is deep irreversible
coma
- absence of electrical activity
- complete cessation of all the vital functions
without possibility of resuscitation
2. Cardio-Respiratory Death
- death occurs when there is a continuous and
persistent cessation of heart and respiration
- is a condition in which a physician and the
members of the family pronounced a person
dead based on common sense or intuition
 SIGNS OF DEATH
1. CESSATION OF HEART ACTION AND
CIRCULATION
Examination by
1. Palpation of the pulse
2. Auscultation of heart sound
3. Use of electrocardiograph
2. Cessation of respiration

• Methods of Detecting Cessation of

Respiration:
a. Movement of chest & abdomen
b. Auscultation
c. Examination with mirror
d. Examination w/ feather or cotton fibers
e. Examination with glass of water
 3. Cooling of the Body (Algor Mortis)
• The progressive fall of the body temperature is the
most prominent sign of death.
 Factors Influencing the rate of the cooling of the Body
a. Conditions that are connected w/ the body:
1) Factors delaying cooling
a) acute pyrexial disease
b) sudden death in good health
c) obesity of person
d) death from asphyxia
e) death of the middle age
2) Factors Accelerating

a) Leanness of the body

b) Extreme age
c) Long-standing or lingering illness
d) Chronic pyrexial disease associated with
wasting
b. Conditions that are connected to surrounding

1) Factors delaying cooling

a) clothing
b) absence of air
c) small room
d) warm surroundings
2) Factors accelerating cooling
a) unclothed body
b) access of air
c) large room
d) cooling more rapid in water than in air
4. Insensibility of the Body and Loss of Power
to Move
• No kind of stimulus is capable of letting the
body have voluntary movement.
• This condition must be observed in
conjunction with cessation of heart beat and
circulation and cessation of respiration.
5. Changes of the skin

a. Observed to be pale and waxy-looking due to the

absence of circulation.
b. Loss of elasticity of the skin result to post-
mortem contact flattening
c. Opacity of the skin due to absence of circulation
d. Effect of the application of heat will not produce
blister or inflammatory reaction
6. Changes in and about the eye

a. Loss of corneal reflex

b. Clouding of the cornea
c. Flaccidity of the eyeball due to lose of tone of
orbital muscle
d. Dilatation of pupil due to iris muscles loses tone
 Changes in the Body Following
Death
1. Changes in the Muscle
The entire muscular tissue passes 3 stages
after death:
a. Stage of primary flaccidity or muscular
irritability
-complete relaxation and softening of all
muscle of the body
-muscles are still irritable due to presence of
molecular life after somatic death
-usually lasts about 3 to 6 hours after death
b. Stage of post mortem rigidity, cadaveric
rigidity, death stiffening, death struggle of
muscles or rigor mortis
-occurs 3 to 6 hours after death, totally become stiff after 12 hours
and may last for 24 to 48 hours during cold weather and 18 to 36
hours during summer
-if rigor mortis sets in early it passes off quickly and vice versa
-contraction of muscles is due to coagulation of the plasma protein
-may be utilized to approximate the length of time the body has
been dead
-differ from cadaveric spasm or instantaneous rigor which occurs at
the moment of death due to extreme nervous tension, only group
of muscles are involved and usually not symmetrical e.g. A weapon
held in the hand before death and can be removed with difficulty;
thus important medico-legal point in determination whether it is a
case of suicide, murder, or homicide.
-
c. State of secondary flaccidity or
commencement of putrefaction
-muscles becomes soft and flaccid and does not respond to
mechanical or electrical stimulus
2. Changes in the blood

a. Coagulation of the blood

-soft of consistency
-surface of blood vessel smooth and
healthy after the clots are remove
-clots can be stripped off in layers
b. Post-mortem lividity

This is due to the accumulation of blood in the most

dependent portions of the body.
-color is dull red o pink or purplish
-usually appears 3 to 6 hours after death and fully
developed 12 hours after death
-Importance of cadaveric or post mortem lividity:
-It is one of the sign of death
-It may determine whether the position of the body
has been changed after its appearance in the body
-It may determine how long the person has been dead
-It gives an idea as to the time of death
-The color of the lividity may indicate the
cause of death
a. In asphyxia, the lividity is dark
b. In carbon monoxide poisoning, the lividity is bright pink
hemorrhage, anemia – less marked
hydrocyanic acid – bright red
phosphorous – dark brown
potassium chlorate, potassium bichromate –chocolate or
coffee brown
c. If the body is found for considerable time in snow or ice the
lividity is bright red
3. Autolytic or autodigestive changes after
death
After death body enzymes (proteolytic, glycolytic
and lipolitic) ferments glandular tissues continue
to act which lead to autodigestion of organs.
-facilitated by weak acids and higher temperature
-delayed by alkaline reaction of the tissues and low
temperature
4. Putrifaction of the body

This is the breaking down of the complex

protiens into simpler components associated
with the evolution of foul smelling gasses and
accompanied by the change in colour of the
body
 Duration of death
• In the determination as to how long a person
has been dead the following points must be
given consideration:

1. Presence of rigor mortis, sets in from 2 to 3

hours after death, fully after 12 hours, may
last for 18 hours to 36 hours
2. Presence of post mortem lividity, usually
develops 3 to 6 hours after death
 Cont...
3. Onset of decomposition, 24 to 48 hours after
death
4. Stage of decomposition:
12 hours Rigor mortis complete, hypostasis well-developed
and fixed. Greenish discoloration showing over the
rectum.
24 hours Rigor mortis absent all over. Greenish discoloration
over whole abdomen and spreading to chest.
Abdomen distended with gasses.
48 hours Ova of flies seen. Trunk bloated. Face discoloured
and swollen. Blisters present. Moving maggots
seen.
 Cont...
72 hours Whole body grossly swollen and disfigured. Hair
and nails loose. Tissue soft and discolored.

One week Soft viscera putrified.

Two weeks Only more resistant viscera distinguished. Soft

tissues largely gone.

One month Body skeletonized.

5. Entomology of the cadaver

The common flies undergo as egg, larval,

pupal and adult stage.
Usual time for the egg to be hatched into
larva is 24 hours so that by the presence of
maggots in the cadaver death has occurred
more than 24 hours.
6. Stage of digestion of stomach

It takes normally 3 to 4 hours for stomach

to evacuate its contents after meals; however
this is influenced by the following factors:
a. Size of last meal stomach starts to empty w/in 10 minutes after the
first food entered, light meal leaves stomach w/in
1-1/2 to 2 hours after being eaten, medium size
after 3 to 4 hours, and heavy meal after 4 to 6
hours.

b. Kind of meal liquid move more rapidly than semi-solid and the
latter more rapidly than solids.
 Cont...
c. Personal variation psychogenic pylorospasm can prevent
departure of the meal from the stomach
for several hours, while a hypermotile
stomach may enhance entry of food into
duodenum.

d. Other factors vegetables needs time for gastric

digestion, less fragmented food needs
more time to stay in the stomach,
absence or insufficiency of gastric
enzymes (e.g. Pepsin) and hydrochloric
acid and lesser amount of liquid
consumed with solid food will delay
gastric evacuation.
7. Presence of Live Flea in the clothing in
drowning cases:
Flea can survive 24 hours submerged in
water and can no longer be revived more than
24 hours.
8. State of clothing

9. Chemical changes in the cerebro-spinal fluid (15

hours following death)
a. Lactic acid increases from 15 mg to 200 mg per 100 cc
b. Non-protein nitrogen increases from 15 to 40 mg
c. Amino-acid concentration rises from 1 to 12 % following death

10. Post mortem clotting and decoagulation of

blood
- blood clots inside the blood vessels in 6 to 8 hours after death
-decoagulation of blood occurs at the early stage of decomposition.
11. Presence of absence of soft tissues in
skeletal remains
Under ordinary condition the soft tissues
of the body may disappear 1 to 2 years after
burial.
12. Condition of the bones
 Causes of Death
The primary purpose of medico-legal
autopsy is the determination of the cause of
death. It must also be shown that the death is
the direct and proximate consequence of the
criminal or negligent act of someone.
1. Immediate (primary) cause of death
This applies to cases when trauma or
disease kill quickly that there is no
opportunity for sequelae or complication
develop.
 2. Proximate (secondary) cause of
death
The injury or disease was survived for a
sufficiently prolonged interval w/c permitted
the development of serious sequelae which
actually caused death. E.g. Stab wound in the
abdomen later caused generalized peritonitis,
the peritonitis is the proximate cause of
death.
 The mechanism of death is the
physiologic derangement or biochemical
disturbance incompatible with life which
is initiated by the cause of death. E.g.
Hemorrhagic shock, metabolic
disturbance, respiratory depression,
toxemic condition, cardiac arrest,
tamponade, etc.
 The manner of death is the explanation as
to how the cause of death came into being or
how the cause of death arose. It is either
natural or violent.
 1. Natural death

It is natural when the fatality is caused

solely by disease.
 2. Violent death
Death due to injury of any sort (gunshot,
stab, fracture, traumatic shock, etc.)
1) accidental death
2) negligent death
3) infanticide death
4) parricide death
5) murder
6) homicidal death
 Degree of certainty to the cause of
death
1. When the structural abnormalities established beyond doubt the identity
of the cause of death e.g. Stab wound w/ profuse hemorrhage, crushing
head injury in v.a.
2. When there is degree of probability amounting to almost certainty the
cause of death e.g. Electrical shock, lobar pneumonia.
3. When the cause of death is established primarily by historical facts which
are confirmed or supported by positive or negative anatomic or chemical
findings e.g. Tetanus, rabies, drug reaction.
4. When history, laboratory and anatomic findings, taken individually or in
combination is sufficient to determine the cause of death; but merely
speculate as to the cause of death e.g. Crib death among infants.
Steps in the Intellectual Process in the
determination of the cause of death
1. Recognition of the structural organic changes or
chemical abnormalities responsible for the
cessation of vital function.
2. Understanding and exposition of the mechanism
by which the anatomic and other deviations
from the normal actually caused the death, or
how the deviation created or initiated the train
of sufficiently potent functional disturbance
which led ultimately either to cardiac standstill
or to respiratory arrest.
Hanging/Garroting/Poisoning
From: Legal Medicine by Solis

presented by:
Rey J. Millena, MD, MCHM, FPCAM