THANATOLOGY

Thantos:- Death Logos = Science

Thanatology. It is the scientific study of
Phenomena and practices relating to
death.
 DEATH
&
Medico-Legal Aspects
 DEFINITION

1. Me Rental and Smith defined death

“Complete and permanent cessation”.

2. Mr Shapiro defines death as

“Irreversible loss of properties of living matter”.
3. Mr Clane has defined that
When destruction of brain has been
established, the individual has died, no
matter – whatever is the state of rest of the
body, giving four signs for such a diagnosis.
– Deep irreversible coma –
(fixed bilateral dilated pupils)
(absent cranial nerve reflexes.)
– No spontaneous respiration.
– Absence of electrical brain activity.
– Cessation of circulation through the
retina.
3. United State Law dictionary defined death
(in 1951)

“The cessation of life, the ceasing to exist”

4. Physician’s Definition.

“Death is a total stoppage of circulation,

and cessation of all vital functions,
such as respiration and pulsation.”
Muller Claims that
5. Death is not a moment
but
a Continuous Process
 CLASSIFICATION OF DEATH
Biologically

Death occurs in bits & pieces

Moment of start of this disintegration,
cannot be ascertained
Declaring------Death - has become more difficult –
Since 1967-Dec
(First human heart transplant was successfully carried
out)
Thus Death was classified into 2 Groups.
• Body
Separate entities
• Organs

Body may be dead

Organs may survive
= in the same body
= in another unit of life
TWO STAGES
I. Somatic Death (Soma-Body)
Irreversible loss of integrating
and co-coordinating functions
of the organism as a whole-
is labeled as Somatic Death.
It is the complete and persistent loss of
coordinated functioning of tripod of life.
i.e stoppage of
Brain
Heart Functioning and failure to return
Lung
 Tripod of life

Life

CN S
ation

func
r
respi

tion
circulation
 Modes of death

Coma

Tripod of
death
Syncope Asphyxia
 CNS
function

LIF
Circulation E Respiration
Same is also called

Systemic

Clinical Death

Legal
II. Molecular Death

It is the death of individual organs and

tissues (which persisted individually
after somatic death)
In 1967- Single Organ, – Shifted from a dead
unit to another living unit.
During interval – it was kept alive to avoid
molecular death.
Till it was shifted to already prepared
body – Ready to receive – Heart of Dead
 Time – Interval between Somatic &
Molecular stages

Heart Survives For 60 minutes

Liver Survives for 15 minutes
Kidney Survives for 45minutes
Cornea Survives for 6-24 Hours
Blood Survives for 6 Hours
Bone Marrow Survives for 6 Hours
 DIAGNOSIS OF DEATH

Brain death is declared – when there is

1. Permanent – fixed bilateral dilatation of
pupils.
2. Absent – all nerve reflexes
3. Cessation of of respiration
(without aids.)
4. Cessation of cardiac activity
(COMPLETE FLAT ECG)
D/D of Death
1. Suspended animation
2. Barbiturate poisoning
3. Electrocution
4. Drowning
5. Hypothermia
 NATURE OF DEATH
Natural & Un-Natural

Un- Natural:
1. Homicidal
2. Suicidal
3. Accidental
Manner or nature of death
Natural –
Unnatural _
Suicidal
Homicidal
- accidental
- manipulative/exhibitionist
 Modes of death

Coma

Tripod of
death
Syncope Asphyxia
 1. COMA
Name of coma

Causes of Coma
Fate of coma

Compression of brain
Concussion,
- Inj to Brain
hemorrhage,inflammation,
- Inj to meninges
abcess,new growth,
- Disease of brain
Disease of meninges thrombosis, embolism.
Epilepsy
Heat Stroke
Hypothermia
Effect of Poison
Metabolic Disorders
- Diabetes
- Hypoglycemia
- Uremia
- Hepatic Failure
 POST MORTEM FINDINGS
• Compression
• Hemorrhages
• Inflammation of meninges
• Tumor
• Foreign body
• Vascular Lesions
• Minute Hemorrhages (in poisoning)
 2. SYNCOPE
Failure of Heart
Reduced blood supply to brain
Causes:
1. Anemia
2. Weakness
3. Sudden Fright – Reflex vagal inhibition
- Cardiac
Center paralysis
- Respiratory
 Head

4. Direct blow on Epigastrium

Testis
5. Emotional Stress
6. Sudden Exposure to cold
7. Insertion of instruments in orifices – Uterus
- Bladder
- Rectum
- Any body
cavity
8. Anesthesia
9. Exhaustion
10. Heart Diseases
11. Hemorrhage
12. Idiopathic
Post Mortem Findings (Non Specific)
• Heart --- Usually Empty
• Organs --- Pale
• Capillaries --- Congested
 3. ASPHYXIA

A Condition ----- caused by

• Interference with respiration

• Lack of oxygen in respired air.

• Organs and tissues are deprived of O2

• Failure to eliminate CO2

Resulting in :
• O2 supply to brain.
• Disturbed functioning of nervous tissues.
• O2 supply to blood
• Rapid unconsciousness
• Stoppage of respiration.
Fate After ---- 2 – 3 minutes ----- Death
 TYPES OF ASPHYXIA
Mechanical Asphyxia Air passages blocked mechanically

Pathological Air entry prevented by diseases of

Asphyxia lungs

Toxic Asphyxia Air entry is prevented by

poisonous substances

Environmental Lack of O2 in the Environment

Asphyxia

Traumatic Asphyxia Trauma, Pulmonary embolism

Positional Asphyxia Forcible flexion of neck on chest
Iatrogenic Asphyxia Associated with anesthesia
 FINDINGS IN ASPHYXIAL DEATH

• On the body : Congestion

: Cyanosis
: Edema
: Petecheal Hemorrhages

• Around the neck : Ligature Mark

: Bruising
• Non-Asphyxial : Defense wounds
 SIGNS OF DEATH

A. Immediate
B. Early
C. Late
 A. Immediate Signs:
(Somatic,systemic & clinical death)

a. Insensibility and loss of voluntary power to

move.
b. Cessation of circulation (Flat ECG for 5 minutes)
c. Cessation of respiration.
d. Cessation of brain activity – absent reflexes.
(Flat EEG for 5 minutes)
 B. EARLY SIGNS (MOLECULAR DEATH)

a. Cooling of body
b. Eye changes
c. Skin changes
d. Post-mortem lividity
e. Muscles changes – Rigor Mortis
 C. LATE SIGNS

Putrefaction (Ultimate fate of all living

creatures.)

• Arrest of putrefaction.

(Extra ordinary phenomenon)

- Mummification
- Adipocere formation
 A. IMMEDIATE SIGNS

a. Insensibility and loss of voluntary power

to move. (Not a sure sign of death)
It is the foremost sign but also occurs in:
- Prolonged fainting
- Vagal inhibition
- Epilepsy
- Electrocution
- Drowning
- Suspended Animation
 b. LOSS OF EEG

No EEG for a continuous period of 5 minutes.

(a+b are sure signs of death)
 c. Cessation of circulation
• No heart beat for a continuous period of 5 minutes
(with stethoscope - sure sign)

Difficulty in - Feeble sounds

- Thick Chest

- Emphysema
• ECG: A flat ECG for 5 minutes confirms death

• Magnus’s Test: Tying a thread around the finger

• Finger Nail Test: Press and see the pale zone
changes
• Diaphanous Test: Finger web test
• Heat Test : No true blister with red line
• Incision Test: No circulation
• Suspended animation
(Apparent Death)
Heart beat & respiratory movements are not
heard ordinarily (as they are at a very low
pitch.)
 I. Involuntary S.A may occur in:
• Drowning cases
• New born
• Anesthesia
• Concussion
All may revive by
• Heat Stroke resuscitation methods
• Prolonged illness
• Electrocution
• Deep Shock
 II. Voluntary S.A

• Yogis (Holding of Breath)

Confirmation of Death by:
i. Rectal Temp - below 75oF
ii. EEG - FLAT
iii. ECG - FLAT
iv. Ophthalmoscope shows segmentation of retinal
blood capillaries.
The blood stream in retinal vessels rapidly becomes
dotted first & then segmented (Cattle trucking)
 d. Cessation of Respiration
i. No abdominal movement (Ant.wall)
ii. No auscultation sounds with stethoscope for 5
minutes
iii. Mirror Test
iv. Feather Test
v. Glass water Test. (Winslow’s Test)
 B. EARLY SIGNS

a) Cooling of body: (Algor Mortis)

During life: Balance of temperature is
maintained i.e. Heat produced = Heat loss
After death no heat production, so only heat
loss.
The heat loss is gradual.
This remarkable phenomenon was used to
calculate time since death.
Measurement of Heat Loss in Dead Body

• Heat is lost till the surrounding temperature is

attained.
• Rectal measurement is best.
• Sub-hepatic and vaginal measurement may
also be made.
• Special clinical thermometer marked from
0- 50oc (graduated in degrees. Thanatometer).
No fall in first few hour
Sudden loss in 5 and 6 hour.
th th
 FACTORS INFLUENCING RATE OF
COOLING

1. Atmospheric Temperature
Body Temperature
Difference
Atmospheric Temperature
i. When difference is more - rate of cooling is rapid
ii. When difference is less - rate of cooling is slower.
iii. Initial few hours (4-5) no loss (called P.M.T plateau)
iv. Gradual fall upto 12 hours.
v. Falling rate decreases after 12 hrs till attainment of Atmospheric
temperature (20-24 hours)

Temperature

Time since death

 2. PRESENCE OF CLOTHING

i. Presence of Clothing – Cooling rate is

slower.
ii. Absence of clothing – Cooling rate is
faster.
 3. LOCATION OF BODY

i. In open area-free air flow – rapid cooling.

ii. Inside the room – less or no air – slow
cooling.
 4. HUMIDITY
• Rapid Cooling
• Dry Air – Less Cooling
 5. STATE OF NUTRITION &
DEVELOPMENT

• Small Body : Cooling Early

• Large Body : Cooling Slower
(Depends upon mass and surface area)
 6. FATTY BODY

• Cooling slow (as fat is a poor conductor of

heat)

• In ladies – having more fat – slow cooling.

 7. MANNER OF DEATH

Heat loss is slower in chronic bacterial diseases.

Heat loss is faster in wasting diseases.

 METHODS OF CALCULATION
• Hourly calculation.

• Newton’s Formula.
Un – reliable Not applicable
• Average fall = 0.5-0.7 C per hour

No fall in temp for few hours

Then Ist two hours – fall of temp is roughly half

the difference between body temp and
environment temp.
In next two hours – temp fall 1 ½ of above
rate

Next two hours – ¼ of Ist two hours rate

In tropical country like Pak average loss

is about .5 - .7 C per hour
Required data:
• Temperature of the body at the time of death.
• Cause of death.
• Temperature of environment.
• Temperature of seat of body.
- Under average circumstances fall may be
presumed as 0.5- 0.7o C per hour (keeping in mind,
the cooling curve).
Note: Other criterions are more reliable. It should be
least preferred.
 RAISED BODY TEMPERATURE
(AT THE TIME OF DEATH)
i. High grade fever
ii. Sun stroke
iii. Pontine Hemorrhage
iv. Encephalitis
v. Lobar pneumonia
vi. Typhoid Fever
vii. Strychnine poisoning
viii. Tetanus
ix. Many other diseases
 POST – MORTEM CALORICITY
(GAINING HEAT)

i. Environmental Temperature is very high.

ii. Septicemia.
• Body Temperature continues to increase
till several hours after death.
 BODY IN A FLUID MEDIUM
(LOSS OF TEMPERATURE)

• Temperature of fluid: Cold water - cooling rapid

Hot water - cooling slow
• Nature of fluid: Dirty water – cooling slow
Fresh water – cooling rapid
Sea water – cooling rapid
• Flow of fluid: Running water-cooling rapid
Stagnant water –cooling slow
 b) EYE CHANGES

i. Permanent fixed bilateral dilatation of

pupils.
ii. Cornea becomes hazy & opaque
iii. Corneal & Conjunctival reflexes are lost
iv. Luster of cornea is lost.
v. Eyes become sunken.
• Taches noires. These are brownish-black
discoloration on the exposed sclera
between the eyelids, due to formation of
cellular debris & dust. They appear on
sclera within 3 hours of death, if eyes
remain open.
Potassium content of vitreous humour
rises steadily.
 c) SKIN CHANGES

i. Skin becomes pale(more on non

dependent parts
ii. Skin elasticity is lost
iii. Skin luster is lost
 POST – MORTEM LIVIDITY

It is the staining or discoloration of skin and

organs of a dead body due to accumulation
of blood because of gravitation and arrest of
circulation resulting in distension of tone
less capillaries and veins of dependent
parts.
Also called:
P.M. Hypostasis
Livor Mortis
P.M staining
Cadaveric Lividity
Subcutaneou Hypostasis
Suggilations
Vibices
 DEVELOPMENT OF LIVIDITY
After somatic or clinical death:-
• Circulation stops
• Blood remains fluid for some hours
• O2 in blood (which is carried in loose
combination with Hb) is still being supplied
to the tissue(till molecular death).
• No more pumping of blood by heart
• O2 is gradually decreased & Hb is reduced
(Blue colour)
• Due to gravity blood settles, directly in
dependent areas of skin or viscerae
 FACTORS AFFECTING
POSTMORTEM LIVIDITY

Fluidity of blood
Post Mortem Phenomenon Reduced Hb

Position of body +
pressure effect on Post Mortem Lividity Effect of gravity
specific areas

Ante-Mortem state of Colour of blood

Colour of skin
body & Mode of death
 COLOUR OF LIVIDITY
• Initially bluish pink.
• Later becomes bluish purple (dark blue)
• In fair skin – colour better appreciated
• In carbon monoxide poisoning - Bright cherry red colour.
• In acute cyanide poisoning - Bright pink colour.
- later on it fades.
• In potassium chlorate poisoning - Chocolate brown colour.
- Due to formation of
methemoglobin.
• In death due to cold - Bright pink colour.
• In hemorrhage, anaemia - Faint colour.
• In asphyxia - Dark purple
• Phosphorous - Dark brown
• Nitrites - Red Brown
• Hydrogen Sulphide - Bluish green
• Opium - Black
• Burning - Cherry Red
• Septic Abortion - Grayish Brown
 TIME OF PML & FIXATION

• Starts – 1-3 hours after death

• Completes – 3-6 hours after death
• Fixed – About 6-8 hours after death
• Test for Fixation – Press with thumb
i. If bleached – Not fixed.
ii. If not bleached – Fixed.
 DISTRIBUTION OF PM LIVIDITY
• External (In supine position)
• PML is found on:-
• Dorsal aspect of trunk
• Posterior aspect of head & neck
• Dependent areas of upper and lower
limbs
• More Marked on:-
Lobes of Ear
Tissues under the nails of fingers
 EXCLUDING

• Back of head

• Back of shoulder

• Back of Buttocks (Areas in contact)

• Back of heels

• Areas under tight clothing (Contact Flattening)

 Internal (In supine position)

• Posterior portion of cerebrum & cerebellum

• Posterior wall of lungs
• Posterior wall of stomach
• Dorsal portion of liver & spleen
• Lowermost coils of intestine
(Lividity is changed with a change in position of
body) before its fixing
 CAUSE OF ABSENCE

• Pressure from below, prevents distension

and filling of capillaries and minute veins
of skin. It is called contact flattening.
 D/D OF P.M LIVIDITY

a. Cyanosis
b. Bruise
c. Congestion
a. Trait PM Lividity Cyanosis
Time of onset Post-Mortem Ante-Mortem
Location On dependent parts On terminal tips
Appearance Normal Abnormal&
Pathological
Volume of blood Enough Less
Change of Shifting of lividity No change
Position
History of Not required Positive
disease
Confirmation Visible as a Post- Anti-Mortem
Mortem Observation/
Phenomenon Evidence
b. Trait PM Lividity Bruise
Situation Epidermal (due to Sub-epidermal.(Due to
engorged vessels) ruptured vessels
Cuticle Uninjured May be injured
Site Occurs on Occurs at the site of
extensive areas of injury (may appear any
dependent parts where)
Appearance Not elevated Area is usually swollen
due to accumulation of
blood & edema.
Edges Clearly Defined Merge with surrounding
area
Colour Uniform Variegated in colour
Section On incision ,blood is On incision, extra -
seen in blood vessels, vasated blood is seen
can be easily washed which is not easily
away washed
Effects of Not present in areas May be present in
pressure under pressure areas under pressure
Blood Blood elements seen Blood elements seen
elements on in blood vessels with out side blood
microscopy no evidence of vessels with evidence
inflammation of inflammation
c. Trait P.M Lividity Congestion

Distribution Irregular and on Involves whole

dependent parts organ
Appearance Normal Pathological
change is evident.
Mucous Dull & lusterless Normal
Membrane
Exudate No inflammatory Exudate seen
exudate
Hollow Stomach, intestine Stomach and
viscera when stretched show intestine show
alternate stained & uniform distribution
unstained areas
 MUSCLE CHANGES

• Period of relaxation (Primary Flaccidity)

• Cadaveric rigidity (Rigor mortis)
• Period of relaxation (Secondary relaxation)
Primary Flaccidity:
• Appears immediately after death
• Usual duration 2-3 hours
• All muscles of body get completely relaxed.
• Muscle tone is lost
• Can be moved in any direction.
• Due to this lower jaw drops, pupils dilate &
sphincters relax & may result in
incontinence of urine & faeces.
• The muscle still react to mechanical
electrical & chemical stimuli.
 RIGOR MORTIS

Rigor – rigidity
Mortis – death
Rigidity after death
It is stiffening of the muscles both voluntary as well as in voluntary
after initial state of primary flaccidity after death
It is a condition characterized by
• Stiffening
• Shortening
• Opacity of muscles
• Follows primary relaxation
• Is due to chemical changes
• Involving the proteins of muscle fibers
• Marks the end of cellular or molecular life of muscle fibres
• The presence of rigor mortis can be elicited by attempting
to flex the neck and the limbs at joints.
 PHYSIOLOGY : (IN LIVING)

• Contractile element of muscle consists of

protein filaments.
– Myosin
They interdigitate
– Actin

> Less in relaxed state.

> More in contracted state.
• Relaxation
of muscles controlled by ATP
• Contraction
• ATP is stored in high concentration in
muscles
• Balanced production of ATP from glycogen
stores.
AFTER DEATH
Glycogen stores resynthesize ATP,only for 2-3 hrs. After 2-3 hour
No glycogen No ATP production

No relaxation of muscles

ed interdigitation of Break down of ATP into

actin &myosin - lactates
- Phosphates

Actomyosin ed accumulation of
(stiff gel) salts in muscles

• Stiffening and shortening of muscles

(voluntary + involuntary)
• Fixation of joints
• Persists till the autolysis of actin & myosin.
 TIME PERIOD

• Early in Summer
• Late in winter
• Starts 2-3 hours after death.
• In face: eyes, mouth then neck upper
limb, trunk, lower limbs Within 12hrs
• Stays for 12 hours passes off in 12hrs
 STARTS

• 2-3 hours after death

• In face, eyes, mouth & neck

 SPREADS

• Upper limb
• Trunk with in 12 hours
• Lower limbs
STAYS

12 hours
PASSES OFF

Next 12 hours
 Plateau of variable Decomposition
temp
36.9oc
(98.4OF) Rigor Mortis
Temperature of
environment
Lividity

0 6 12 18 24 30 36 42 48 54

Hours after death

Chart showing the major changes by which lapse of time after death might be
estimated. The first 4-5 hours often show little fall in temperature.
 FACTORS INFLUENCING
RIGOR MORTIS
Factor Appearance Passing Off

1. Atmosphere
a. Dry & cool Late Late
b. Moist & Warm Early Early
c. Cold Water Early Late
Factor Appearance Passing off
2. Age
a. Children Early Early
b. Elderly Early Early
c. Adults Late Late
 Factor Appearance Passing off

3. Manner of Death
a. Chronic disease Early Early
& emaciation
b. Sudden death Late Late
c. Strychnine Immediate Early
Poisoning
d. Drowning Early Late
e. Arsenic Late Late
poisoning
 Factor Appearance Passing off

4. Muscular Condition

a. Healthy muscles Late Late

b. Exhausted & wasted Early Early

muscles
 DIFFERENTIAL DIAGNOSIS OF
RIGOR MORTIS
(Simulating Conditions)

1. Heat Stiffening

2. Cold Stiffening

3. Putrefaction stiffening

4. Cadaveric Spasm
 1. HEAT STIFFENING

i. When body is exposed to 75oC or high

temperature.
ii. When body is exposed to high voltage current.
High Temperature High voltage

Coagulation of actin & myosin

Stiffening of muscles

Flexion of all joints of body

Special posture
(pugilistic attitude or boxer’s attitude)
 SPECIAL FEATURES

i. Burn marks are present

ii. Stiffening persists till putrefaction

iii. Muscles get lacerated when tried to break

2. COLD STIFFENING

Freezing temp

Solidification of fats and muscular tissues

Rigidity of Muscles
• Rigidity is lost when body is moved to
higher temperature.
• Again sets in when moved to freezing
temperature.
• Appears quickly : disappears quickly
3. PUTREFACTION STIFFENING

Putrefaction

Formation of gases

Accumulation of gases

False rigidity

Stiff Limbs
 4. CADAVERIC SPASM
(Instantaneous Rigor)

• A rare type of rigidity of a group of muscles.

• May occur instantaneously after death.
• Before the actual signs develop.
• Does not allow primary relaxation.
• Muscles remains stiff till autolysis.
• Represents a state of extreme physical
activity or emotional state before death.
Examples:
i. In drowning, victim may seize a bunch of
weeds in an attempt to save himself (found
clutched tightly in hand)
ii. A person committing suicide may grip a
pistol in his hand.
iii. A bunch of hair in homicidal scuffle.

Such objects are proof of nature of death

 DIFFERENCES
Traits Rigor Mortis Cadaveric spasm
1. Time of onset 2 – 3 hours after Instantaneous
death
2. Predisposing Nil Sudden death,
factors fear, excitement,
exhaustion,
nervous tension.
3. Muscles All voluntary & Usually a single
involved Involuntary group of voluntary
muscles
4. Muscle Not marked, Marked, moderate
stiffening moderate force can force cannot break
break it. it.
Traits Rigor Mortis Cadaveric spasm
5. Medicolegal Helps in Indicates nature
importance determination of of death :
time since death suicide,
homicide,
accident.
6. Body Heat Cold Warm

7. Molecular Occurs Does not occur

death
8. Mechanism Known Not known
MEDICOLEGAL IMPORTANCE
 RIGOR MORTIS HELPS IN

a. Calculation of time since death.

b.Determination of position of body.

 Plateau of variable Decomposition
temp
36.9oc
(98.4OF) Rigor Mortis
Temperature of
environment
Lividity

0 6 12 18 24 30 36 42 48 54

Hours after death

Chart showing the major changes by which lapse of time after death might be
estimated. The first 4-5 hours often show little fall in temperature.
PUTREFACTION
• Decomposition/dissolution of body
tissues into
– Gases
– Liquids
– Salts
• The ultimate fate of body by conversion of
organic to inorganic state.
It is absolute / surest sign of death
Based on
Autolysis (Self destruction)

After death, enzymes are released. They

soften & liquify tissues of the body.
It commences 3-4 hrs after death and
continuous for 2-3 day or longer.

Bacterial Action (Micro-organisms)

 MICRO-ORGANISMS
The micro-organisms responsible are
anaerobic & aerobic. They produce variety of
enzymes. They are Clostridium welchi,
Streptococci, Esc coli & B. Proteus which act
on Carbohydrates, Fat and Proteins. C. Welhi
produces lecithinase which hydrolyses the
lecithin present in cell membrane resulting in
haemolysis of blood and initiation of
putrefaction.
 MICRO-ORGANISMS
IN LIVING
• Present in body in large numbers
• Remain under control
JUST AFTER – DEATH
• Life control fails
• Micro-organisms are out of control
• Multiply in large numbers
• Become virulent
• Enter blood vessels
• Spread throughout the body
 BASIC RULE

Organs (First to putrefy)

• Receiving rich blood supply

• Near to source of bacteria

PUTREFACTION
Autolysis (self – destruction) Bacterial Action
Air
warmth
moisture
Molecular death More bacterial growth Enzymes production

Death of tissue (Cl - w)

Production of

Lecithinase Enzyme
Effects Tissues
Release of enzymes (Dissolution )
from tissue cells

Haemolysis of blood Hydrolysis of

Softening
liquefication of
lecithinase
tissue cells
Gases, Liquid salts
(Putrefaction of body Tissues)
 STEPS OF PUTREFACTION
i. Color changes
ii. Production of gases
iii. Pressure effects of gases
iv. Appearance of maggots
v. Other sequelae
 COLOR CHANGES
External
a. Greenish discoloration over caecum and the flanks
(Rt. iliac fossa) 12-24 hrs (earlier in summer)
• 1st sign.
• Indicator of entry of body into advance
putrefaction.
b. Greenish discoloration gradually spreads to whole abdomen.
The whole body is discoloured within about next 24 hrs.
c. Color gradually changes from greenish to black.
d. Hb + H2S Sulf-met Hb
Internal
• Under surface of liver (Internal) due to close contact
with fluid and bacterial contents of bowel.

• Blood is hemolyzed & Hb is liberated.

• Bacteria (Clostridium Welchii) produce H2S with Hb.

• Sulf – met Hb spreads to the whole body (48 hours).

• Greenish discoloration spreads to whole body, both

internal and external.
 PROCESS

Blood Haemolysis
Liberation of Hb
Bacteria H2S
Hb + H2S gas

Sulph-met Haemoglobin (greenish color)

Diffuses into tissues

 MARBLING
The veins converging on the
• Root of neck
• Over the shoulder
• Running into the groins
• Become visible as blue or purplish lines
• Due to pigments from decomposing blood
passing through the blood vessels
• The course of these veins is thus visible as a
bluish network

• This condition owing to its mosaic or

arborescent pattern is known as Marbling
• Veins are filled with

– Gas bubbles

– Haemolysing blood

• Marbling commences ____ 24 hours

• Seen prominently ____36 - 48 hours

 PRODUCTION OF GASES

• Within 12 – 13 hrs after death.

• Production of foul smelling gases starts:

– In hollow viscera

– In solid viscera

– Below the skin

• In 18 – 48 hrs
• Gases collect in hollow viscera.

• They cause false rigidity.

• They exert considerable pressure.

Gases:-
• H2S
• NH3
• Phosphorated hydrogen
• CO2
• CH4
 PRESSURE EFFECTS OF GASES
The gases gradually increase in quantity and due to this, pressure effect on
various tissues occur. The following pressure effects are seen:-

1. Bloating of features
2. Shifting of areas of PM.L
3. Changes in skin, hair and wounds
4. Extrusion of fluid from nose & mouth
5. Emptying of heart
6. Changes in appearance of genitals
PRESSURE EFFECTS

a. Bloating of Features. (36 – 48 hrs)

i. Face - swollen.
ii. Identification – difficult.
iii. Tongue, Lips, nose, eyelids & cheeks are
distended
iv. Face becomes bluish green mass.
v. Bulging of Lips.

vi. Tongue is pushed between teeth.

vii. In females breasts are swollen.

viii. Rectum also protrude (48 – 72 hrs)

ix. Condition of body may be confused with violent

death.
 b. SHIFTING OF AREAS OF HYPOSTASIS

Putrefaction liquification of clottedBlood

Haemolysis of blood

Pressure of duodenal
gas Post Mortem
staining

Shifting in any direction

c. FLUID AND FROTH FROM MOUTH

• Abdominal gases push diaphragm up

• Lungs, heart and stomach are also pushed

upwards.
• Resulting in extrusion of fluid and froth from
mouth & nose.
 d. SKIN SLIP (3 - 4 DAYS)

• Outer layer of skin becomes loosened and it

can be rubbed easily with pressure, to leave
a moist, pink base called “skin slip”.
• Skin from hands and feet may peel off in the
form of gloves or stockings.
• Can be helpful for getting finger prints.
 e. BLISTERS ( 2 – 3 DAYS)

• Blisters are found all over the body.

• They can be confused with blisters of
burns.
 DIFFERENCES
Trait True Blister Putrefaction Blister
Time Ante-Mortem 2-3 days Post Mortem
Vital reaction Present Absent

Contents Full of fluids rich in Mainly gas, very little

albumin fluid with
no albumin
On rupturing Fluid escapes but Gas escapes & blister
blister remains. is no more visible.
 f. HAIR
• Becomes loosened
• Easily pulled out
g. CONDITION OF GENITALS
• Male: Penis & scrotum become swollen
• Female: Genitals appear pendulous
• In pregnant ladies fetus may be expelled out.
(in 48 – 72 hrs)
 h. EMPTYING OF HEART
• Increased fluidity of blood
• Heart may become empty
 APPEARANCE OF MAGGOTS
• Putrefied material attracts flies.
• Flies lay eggs in.
i. Open wounds.
ii. Natural orifices
• Nose
• Mouth
• Vagina
• Anus
Flies lay eggs Larva Pupa Adult
Time period varies with type of fly & temp
• Knowledge of flies --- Forensic entomology.
Life Cycle
Flies

Eggs

Larvae

Pupae

Adults
 FORENSIC ENTOMOLOGY

• Study and knowledge of insects and flies,

about their habitat and life cycle.

 5. OTHER SEQUELAE

a. Beetles

b. Vultures

c. Dogs

d. Other animals
 RESULT IN
i. Liquifaction
ii. Cavities burst
iii. Skeltanization (1-3 month)
iv. Decomposition of bones
• Uncoffined – 1 year
• Coffined – 3 years
• Complete destruction - 25 yrs
PUTREFACTION OF INTERNAL ORGANS

Starts with External putrefaction

Organs - Soft
Putrefy early
- More blood

Organs - Hard Putrefy later

- less blood
 SEQUENCE

i. Stomach and intestines

ii. Trachea, Bronchi, lungs, larynx
iii. Liver, Brain, Spinal cord.
iv. Heart, Kidneys, Diaphragm
v. Prostate, Testis, Uterus, Ovaries
 FACTORS INFLUENCING
PUTREFACTION
External Factors:

i. TEMP
a. 70o to 100o F best temperature putrefaction
b. Freezing point death of bacteria No putrefaction
c. 200oF temp fluids are dried up putrefaction.
(mummification may occur)
ii. AIR
Presence of air putrefaction
Absence of air putrefaction
 Casper Dictum states that
• The rate of putrefaction
• The temp. remaining same in each case
• Is almost equal for
One week in air
Two weeks in water
Eight weeks when the body is buried
(However it is subject to great variation.)
iii. MOISTURE
• Presence of moisture promotes
putrefaction
(More moisture  More Bacteria 
Multiplication of Bacteria)
iv. CLOTHES
• Initially maintain temperature and help
putrefaction.
• Later protect body from flies
 v. MANNER OF BURIAL

a. In air tight coffin putrefaction delayed

Body with coffin putrefaction early
b. In deep grave putrefaction delayed
In shallow grave putrefaction early
c. Body buried in lime putrefaction delayed
d. Body buried in water logged area 

putrefaction early.

e. Body buried in sandy area

Mummification
f. Body buried in porous land
 INTERNAL FACTORS

i. AGE
a. Infants, still born, sterile putrefy late
b. Children putrefy early than adults
c. Old, less fatty putrefy late
ii. CONDITION OF BODY

a. Fatty body early putrefaction

b. Emaciated body late putrefaction
c. Mutilated body early putrefaction
iii. SEX

• Very little influence

• Female Fatty early putrefaction.
• Female dying after child birth early
putrefaction.
• Female dying of septicemia early
putrefaction.
iv. MODE OF DEATH

a. Infection more bacteria early putrefaction

b. Anemia less blood late putrefaction
c. Wasting diseases Atrophy of muscles late
putrefaction
d. Poisons may delay putrefaction.
eg. Arsenic, Antimony, Zinc
e. Sudden Death Good Health slow putrefaction
PUTREFACTION IN WATER

• Much slower
• Once body is out of water rate is
higher (16 times)
• Also depends on water, cond. of
body & water animals
• Fast in still water ----- slow in running water

• Fast in dirty water ----- slow in clean water

• Fast in deep water ----- slow in shallow water

• Fast in naked body ----- slow in clothed body

• Fast in body effected ----- slow in body not

by water animals effected by water

e.g fish, crocodiles, animals

insects.
 APPEARANCE OF COLOR
CHANGES
Putrefaction in water Putrefaction in air
i. Face & neck i. Abdomen
ii. Thorax ii. Chest
iii. Shoulder iii. Face
iv. Arms iv. Legs
v. Abdomen v. Shoulder
vi. Legs vi. Arms
 FLOATATION OF BODY

In summer 24 hrs when sufficient gases are produced

In winter 2-3 days

Position of body : Abdomen – Above (higher due to gases)

Spine – Below (Heavy)

No floatation of body:- If sub merged under water with a

weight tied with it, entrapped by weeds
Depends upon
i. Age Adult Early
Children Late
Elderly Late
ii. Built Strong & Fatty Early
Weak Late
iii. Sex Female Early
Male Late
iv. Surrounding
Water
Clear water Early
Dirty water Late
iv. Weather
Summer Early
Winter Late
 MUMMIFICATION

• It is also a modification of putrefaction

process, which becomes arrested and body

tissues undergo mummification.

• It is characterized by dehydration or

desiccation of body tissues and viscerae after

death
The ideal conditions for mummification
are
(1) High atmospheric temp devoid of
moisture
(2) Free air circulation round the
body (3) Dry porous sandy soil
Shallow grave Free air High temperature
Evaporation

Dry atmosphere

Dry Soil Loss of moisture

DEAD BODY

Shriveled & Dry Tissues Dry & Healthy Skin

Porous earth
 MUMMIFICATION
(MEDICO-LEGAL IMPORTANCE)
Time period required 3 Months
Artificial Mummification also possible
Mummification may help in:-
i. Identity
ii. Establishing the cause of death
iii. Time since death
iv. Indicates place of recovery
 ADIPOCERE (SAPONIFICATION)

It is a modification of process of putrefaction,

which may become arrested and fatty tissue
of body may get converted into fatty acids. It
has the properties of fat and wax, so the name

(Adipo - soft fat) (Cera- Wax)

It results from conversion of unsaturated fats
to saturated fats by bacterial fat splitting
enzymes. The fat is hydrolysed to a wax
compound.
The ideal condition are
(1) Moisture
(2) Warm temperature (moderate)
(3) Diminution of air
Adipocere is a pale, greasy semifluid
material with a rancid smell.
 Dead Body Damp soil
Moisture
Fatty Areas Less Air

UN-SATURATED BODY FATS Warm Temperature

Bacteria Lecithinase Firm Fat

Cl-welchii SATURATED FATTY ACIDS

Release Enzymes
Palmitic, stearic,Ca-Soaps
Areas involved:
• Abdomen
• Cheeks
• Breasts
• Buttocks
• Rarely in infants & obese, whole body is
converted
Time: one limb – 3-6 weeks
whole body – one year
If body is immersed in fluid - early
MEDICOLEGAL IMPORTANCE
i. Identification
ii. Injuries are present – cause of death
iii. Indicates time elapsed since death.
iv. Indicates the place – water or moist
ground from which the body has been
recovered
Bio Chemical Changes In Body
Fluid After Death
• Blood
• C.S.F
• Ocular fluid.
 Changes In Blood
• Concentration of all blood components
Changes after death.
Factor which are responsible for his changes are:
1- Function of organ between Somatic and
molecular death.
2- Post –mortem action of bacteria and enzymes.
3- Altered permeability of dying cell membrane.
Also at the time of certain natural deaths certain
changes take place in blood.
Due to altered body function like agonal acidosis
which is associated with marked.
 In Lactic Acid
Lactic acid 1 meq/ L.
• 1 hour P/M 20 meq/L.
• 12 hour P/M 50 meq/L .
• 24 hour P/M 75 meq/ L.
Urea nitrogen
• @12-30 mg/ dl up to 70 mg/ dl.
Amino Acid Nitrogen
@3-5 mg/dl.
12 hour P/M 10-12 mg/dl.
All as result increase tissue break down.
Ph: of blood and tissue fall (acidic) , due to
terminal accumulation of CO2 and lactic Acid after
death
After about 24 hours due to production of NH3
from enzymatic break down of proteins ,PH starts
rising and reaction again become alkaline.
 Plasma Chloride @95- 105 mg/dl.

• Soon after death chlorides in plasma and R.B.C

equalize become 74 m.mol/L and then
concentration drops due to extra cellular
diffusion and become half i.e 37 m.mol /l in 72
hour s.
Mg++: @ 0.07 – 1.2 m.mol/L.
• With the onset of putrification it starts rising and
reach eight times in 72 hours.
K+: @ 3.8 -5 m.mol/L.
Start rising after death owing to diffusion from
vascular endothelium .
 Enzymes
Post –mortem accumulation of enzymes in serum
like :
• Amylases: @23 – 85 I.U/L
• Lactic Phosphataes : @ 90 – 250 MILI units /L.
• Acidic phosphataes : @ up to 0.7 Units /L.
• Alkaline Phosphtates : @ 30- 95 mili units/L.
• Transimanase : @ 5- 35 milil units/L
Rise in first few hour s after death as a result of
increased tissue break down and peak activity
varies for each enzymes .
Amylase & Phosphates :34 -48 hours.
Transaminase: 48-60 hours.
Lactic Dehydrogenase: 4th day.
 Sugar and Urea
• Blood sugar and Blood Urea also rises after death.
• Breakdown of liver glycogen result in accumulation of
dextrose in inferior vena cava and hence in right side of
heart . Blood sugar rise more than 300 mg /dl. Within
first 24 hours.
Diffusion does not extend beyond the heart as lungs
provide an effective barrier. So no reliance can be
placed on blood dextrose levels if blood is collected
from inferior vena cava or right side of the heart .
• Examination of peripheral blood might help if raised
more than 200 mg/dl but care should be taken in
interpretation as agonal rise in blood dextrose can be
produced by Hypoxia, CO poisoning and effect of
trauma.
• Blood urea concentration can rise in
agonal period to the level of 150 mg/dl but
usually serum level within first 48 hours is
never above 100 mg/dl unless there is an
increase in urea concentration during
life.serum concentration of urea > 300
mg/dl and creatinine more than 10 mg %
undoubtly indicate renal failure with
uremia.
• @creatiae 0.42 -2.42 mg%( in C.S.F)
 C.S.F
• @Amount in life is 150 ml start disapperaing at 24-
48 hours after death.
• Time of death can be estimated with +8to – 8 hour
of actual time .
• Sample can be easily obtained by tapping cisterna
magna .In first fifteen hours after death:
Lactic Acid rise from 15 %mg to over 200 mg %
N.P.N : from 15 mg % to 40 mg %
A.A.N: from 1 mg % to 12 mg %
Following conclusion can be drawn
• A.A.N: less than 14 mg % death less than 12 hour
PM.
• N.P.N. less than 80 mg %death less than 24 hours
PM.
• Creatine less than 5 mg % death less than 12 hours
PM.:
• Phosphorus less than 15 mg/dl death less than 10
hour s PM.
Ocular Fluid:
• Vireous and Aqueous fluids are free from
contamination in a dead body
 Ocular Fluid:
Vireous and Aqueous fluids are free from contamination
in a dead body and up to 2 ml of fluid can be eaisly
withdrawn from each eye ball with needle and
syringe.
Steady rise in K+ in Viterous after death for over 100
hours . There is a linear relationship between K+
concentration and P/M interval over 100 hours death.
There is a standard error of +4.7 to – 4.7 hours and this
did not increase with time.
• @3.4 meq/L.
• Rate of increase is 0.17 meq/l/hour.
Ascrobic Acid, Pyruvic Acid , N.P.N: Studies are also
helpful in determining time since death but K+ is more
reliable and dependable.
 International Form of Medical
Certificate Cause of Death
A: Biodata of deceased
B: Cause of death
I. Disease or condition Approximately interval between
Directly leading to death. 0nset &death.
Antecedent causes morbid a)---------------------------------
Condition, if any, giving rise Due to(or as a consequence of)
to the above causes ,starting the b)---------------------------------
underline condition last. Due to(or as a consequence of)
II. Other significant conditions c)-----------------------------------
Contributing to the death but not
Related to the disease or conditions
cause it. ---------------------------------------
• This does not mean the mode of dying e.g heart
failure ,cardiopulmonary failure , etc It means
disease, injury or complication which cause
death.
• Filling of death certification:
Content s and design of death certificate . There
are two sections. The first headed “I” asks for:
a. Immediate cause .
b. Morbid conditions if any giving rise to the
immediate cause.
It would be sufficient for instance to write acute
General Peritonitis
Under “Ia” and perforated Gastric Ulcer under “Ib”
• Second headed “II” asks for other significant conditions (if
important ) contributing to death but not related to
immediate cause.
• There would be none in the above example but if “Ia”
Uraemia, “ I b” supportive pyelonephritis, and then we can
place “II” Carcinoma of prostate or Diabetes Mellitus.
• All that is required is that the precise cause of death should
be set out starting from the immediate cause and working
back to the underlying disease responsible .
• Terms which merely describe mode of dying like heart
failure or coma should be avoided.
• If precise cause of death is not known one should not start
guessing it. Ambiguities like “Birth injuries” ,”C.V.A” or
termination of pregnancy should be avoided \rather
qualification must be given to make it clear that they were
natural not accidental or of criminal occurrence .
Under no circumstances should a doctor
sign blank or partially blank death
certificate.
Under Birth and death Registration Act
1874,it is a statutory duty of a doctor
(mandatory) who has been in attendance
of the patient during the last illness to
issue a certificate .no fee should be
charged although there is no regulation.