DEATH AND ITS

MEDICOLEGAL
ASPECTS
DEFINITION
• Permanent disappearance of all evidences of life ay any time after a
live birth has taken place
Classification
• Somatic or systematic death or clinical death
• Molecular or cellular death

SOMATIC OR SYSTEMATIC DEATH

• Complete loss of sensibility and ability to move
• Stoppage of functioning of brain, heart and lungs
Assessment of stoppage of heart and
circulation
• Ceasing- 3-5min
• Magnu’s test
• Diaphanous test
• Finger nail test
• Application of heat
• Artery cut
• ECG
Assessment of stoppage of respiration
• Mirror test
• Feather or cotton test

Assessment of brain death

• Permanent
• Coma depasse
Salient features
• Deep coma
• Cessation of heart and respiration
• Absence of brain stem reflexes
• Pupillary reaction
• Loss of corneal reflex
• Loss of oculocephalic/dolls eye reflex
• Absence of grimacing
• Loss of oculovestibular reflex
• Iso-electrical EEG
SUSPENDED ANIMATION
• Temporary state resembling death
• Last for few seconds to 30 min or more
• CAUSES- Trance, Yoga, Epilepsy, Sunstroke, Electricution, still born
infants, anaesthesia, narcotic poisoning, typhoid fever, hysteria,
hanging, hypothermia etc
MOLECULAR OR CELLULAR DEATH
• Death of tissues and cell
• 3-4 hours
• Features
• Cooling of body
• Changes in the eye, skin, blood and muscles
• Complete stoppage of anaerobic enzymatic process
Mode of death
• Gordons classification- death for medico legal purposes, the stoppage
of vital functions depends upon tissue anoxia
• 3 modes of death
• Asphyxia- occlusion of airways
• Coma/stupor- unarousable unconsciousness
• Syncope or fainting or neurogenic shock
CAUSES OF DEATH
Classification
1. Natural causes
a) Condition incapable with life
• Massive pulmonary thromboembolism
• Spontaneous intracerebral hemorrhage
• The rupture of aortic aneurysm
b) Conditions compatible with life
• Coronary artery disease
• Lobar pneumonia
• Emotional stress, anger, fear, joy- ventricular fibrillation
• Bronchial asthma etc
UNNATURAL CAUSES
• CONDITIONS INCOMPATIBLE WITH LIFE
• Decapitation
• Cutting of a large artery
• Poisoning due to hypnotic or anesthetic overdose etc.

• CONDITIONS COMPATIBLE WITH LIFE

DETERMINATION OF TIME SINCE
DEATH
• EARLY CHANGES
1. Change in eyes
• Eyes
• Eyeballs
• Corneal reflex
• Sclera
• Pupils
• Ophthalmoscopic examination
2. Changes in the skin
• Pale and ashy white (pallor mortis)- 15min
• Changes in wounds or ulcers
• In some concepts changes don’t occur
• Cooling of the body (Algor mortis)
• Normal temperature (37oC) – rectal temperature/rate of fall per hour
• Post mortem caloricity
• 2hours of death
• Post mortem staining (PM lividity/cadaveric lividity/hypostasis/suggilation)
• Vibices
• 1hr- starts, 4-12hours significant
• Primary lividity and fixed lividity
• Petechial haemorrhages
Post mortem staining
Color
Intense bluish-violet and purple
Cherry red or pink
Chocolate or coffee brown
Dark brown or yellow
Bright pink
Black
Bluish green
Causes of death
asphyxia
Carbon monoxide or hydrocyanic acid poisoning
Burns
Exposure to cold (hypothermia)
Poisoning by:
Potassium chlorate
Potassium bichromate
Nitrobenzene
aniline
Poisoning by phosphorous
A refrigerated dead body
Drowning in cold water
Mummified bodies, opiates
Hydrogen sulphide
Medico legal importance of cadaveric lividity
• It is a sign of death
• Assessment of time since death
• Indicates body position after death
• Indicates movement of the body after death
• Color may indicate probable cause of death
Late changes
1. Changes in the muscle
• Fall of the lower jaw
• Eyelids droops downwards
• Limbs become soft and flabby
• Joints become flexible
• Body flattens- contact flatning
• Relaxation of involuntary muscles
2. RIGOR MORTIS (CADAVERIC RIGIDITY/DEATH STIFFENING)
• Fall in the concentration of ATPase
• Fusion of actin and myosin filaments
• All muscle become stiff, hard,opaque and contracted
• First- involuntary
• Heart- within 1 hour (more affected in left chamber)
• Voluntary-
• First in the muscle of eyelids (2hr)
• Muscle back of the neck and lower jaw (3hr)
• Muscle front of the neck, face, chest and upper limb (6hour)
• Abdomen and lower limb (9hr)
• Small muscle of toe and fingers (12hr)