Legal Medicine

Chapter IV – Medicolegal Aspects of Death

Definition of terms
· Death - the action or fact of dying or being killed; the end of the life of a person or organism,
Termination of Life.

· Ante-mortem - occurring before death

· Post-mortem - occurring after death

· Algor Mortis - term used to describe the normal cooling of a body to the external temperature
after death

· Rigor Mortis - change in the body resulting in the stiffness of the body

· Post mortem caloricity - biochemical and microbial activity in the body.

· Post-mortem lividity - or hypostasis is the settling of blood under the influence of gravity

· Putrefaction - the act or result of decomposition

The importance of the
determination of death
Laws involved in death:

-The civil personality of a natural person is extinguished

- The property of a person is transmitted to his Heirs
- Death of a partner is one of the causes of dissolution of a partnership agreement
- Death of the principal or the agent extinguishes the agency
- Criminal liability is extinguished by death
- Civil claims are extinguished
- Presumption of death
(Art. 391, Civil Code and Sec. 5(x), Rule 131, Rules of Court)

-Presumption of survivorship
(Rule 131, Rules of Court, Art. 43, Civil Code)
Changes in the body following death.

· Hypostasis and Lividity - The blood merely gravitates

into the most dependent portions of the body but still
inside the blood vessels and still fluid in form. Any
change of position of the body leads to the formation
of the lividity in another place.
This occurs during the early stage of its formation.
Changes in the body following death.
Importance of Cadaveric lividity :
- It is one of the signs of death

- it may determine the position of the body during death or if it has been
transferred.

- The color of lividity may indicate the cause of death:

- asphyxia – dark
- carbon monoxide poisoning – bright pink
Changes in the body following death.
Points considered that infers the position of the body at the time of death

- This is also important as the position of the body could indicate whether the

body was in a defensive position or was not prepared for the situation.

·Putrefaction of the body

- Refers to the decomposition of the body.

Changes in the body following death.
· Chronological changes of the body in

Putrefaction

(External | Internal | Temperate | Tropical |

Submerged in water
Changes in the body following death.
· Bacterial influences and destructive agents in

decomposition
Changes in the body following death.
· Mummification - the process of preserving the body

after death by natural or artificial embalming of the

flesh

· Saponification - the process of making soap from

alkali and fat (or oil)

Differences in terms
 
· Brain death | Cardio-Respiratory death
- Brain function vs. Heart and lung function

· Legally dead | Medically dead

- Vital organ function is no more vs. Brain function

· Rigor Mortis
- Rigidity of the muscles

Cadaveric Spasm
- This is the instantaneous rigidity of the muscles which occurs at the moment of death due to extreme
nervous tension, exhaustion and injury to the nervous system or injury to the chest.

Muscular Contraction
- a muscle contraction is isotonic if muscle tension remains the same throughout the contraction. If the
muscle length shortens, the contraction is concentric; if the muscle length lengthens, the contraction is
eccentric.
Differences in terms
· Ante-mortem clot | Post-mortem clot
- before death , after death

· Hypostatic lividity
- The blood merely gravitates into the most dependent
portions of the body but still inside the blood vessels and still fluid in form.
Any change of position of the body leads to the formation of the lividity in
another place. This occurs during the early stage of its formation.

Diffusion lividity
- This appears during the later stage of its formation when the blood has
coagulated inside the blood vessels or has diffused into the tissues of the
body. Any change of position will not change the location of the lividity.
Differences in terms
Contusion (Bruise) | Post-mortem hypostasis
Methods of detection
Methods of detection
Examination of the heart:

(1) Palpation of the Pulse – Neck or Wrist

(2) Auscultation for the Heart Sound at the Precordial Area
(3) Flouroscopic Examination
(4) By the Use of Electrocardiograph
Methods of detection
Examination of the Peripheral Circulation:
(1) Magnus'Test – putting a tie on the tips of the finger to see if it will change color
(2) Opening of Small Artery – pricking of the skin to check if the blood vessel has a
jerking effect or not.
(3) Icard's Test - injection of a solution of fluorescein subcutaneously.
(4) Pressure on the Fingernails
(5) Diaphanous Test - The fingers are spread wide and the finger webs are
viewed through a strong light. In the living, the finger webs
appear red but yellow in the dead.
(6) Application of Heat on the Skin
(7) Palpation of the Radial Pulse
(8) Dropping of Melted Wax
Methods of detection
Examination of the Cessation of Respiration :

(1) Expose the chest and abdomen and observe the movement
during inspiration and expiration
(2) Examine the person with the aid of a stethoscope
(3) Examination with a Mirror – beneath the nose or mouth
(4) Examination with a Feather or Cotton Fibers
(5) Examination with a Glass of Water
(6) Winslow's Test – mercury placed on a saucer and placed on the chest.
Estimating time of death based on temperature
- The rate of cooling of the body is not uniform. It is rapid during the first two hours after
death and as the temperature of
the body gradually approaches the temperature of the surroundings,
the rate becomes slower

· Changes in the muscle after death –

After death, there is complete relaxation of the whole muscular system. The entire muscular
system is contractile for three to six hours after death, and later rigidity sets in. Secondary
relaxation of the muscles will appear just when decomposition has set in.
3 stages:
- primary flaccidity
- Stage of post-mortem rigidity
- Stage of secondary flaccidity or commencement of putrefaction
· Physical characteristics of post-mortem lividity
(1) It occurs in the most extensive areas of the most dependent
portions of the body.
(2) It only involves the superficial layer of the skin.
(3) It does not appear elevated from the rest of the skin.
(4) The Color is uniform but the color may become greenish
at the start of decomposition.
(5) There is no injury of the skin.

· Autolytic or Autodigestive changes after death

- After death, proteolytic, glycolytic and lipolytic ferments of glandular tissues
continue to act which lead to the autodigestion of organs. This action is facilitated
by weak acid and higher temperature.
 Conclusion and recap:
Kinds of death
- Somatic or Clinical death
- Molecular or Cellular death
- Apparent death or a state of suspended animation
* transient loss of consciousness

· Signs of death
- CESSATION OF HEART , CIRCULATION AND RESPIRATION (as discussed previously)

· Factors delaying cooling of the body in death (body & surroundings)

(a) Clothing
(b) Want of access of air to the body.
(c) Small room.
(d) Warm surroundings.

· Factors accelerating cooling of the body in death (body & surroundings)

(a) Unclothed body.
(b) Conditions allowing the access of air.
(c) Large room permitting the dissipation of heat.
(d) Cooling more rapid in water than in air.
Conclusion and recap:
· Stages of Muscle Reaction after death
- primary flaccidity
- Stage of post-mortem rigidity
- Stage of secondary flaccidity or commencement of putrefaction

· Kinds of post-mortem lividity

Hypostatic Lividity:
-The blood merely gravitates into the most dependent portions of the body but still inside the blood vessels and still fluid
in form.
Diffusion lividity:
-This occurs during the early stage of its formation. This appears during the later stage of its formation
when the blood has coagulated inside the blood vessels or has diffused into the tissues of the body.
Conclusion and recap:
· Factors modifying Rate of Putrefaction
a. Internal Factors:
(1) Age
(2) Condition of the Body
(3) Cause of Death
b. External Factors:
(4) Free Air
(5) Earth
(6) Water
(7) Clothing
Conclusion and recap:
Factors influencing changes of the body after burial
- State of the Body Before Death:
Time Elapsed between Death and Burial and Environment of the Body:
Effect of Coffin
 Clothing and Any Other Coverings on the Body when Buried
 Depth at which the Body was Buried
 Condition and Type of Soil
 Inclusion of Something in the Grave which will Hasten Decomposition
 Access of Air to the Body After Burial
 Mass Grave
 Trauma on the Body

· Considerations in the duration of death determination

Conclusion and recap:
Considerations in the duration of death determination:
1. Presence of Rigor Mortis
2. Presence of Post-mortem Lividity
3. Onset of Decomposition
4. Stage of Decomposition
5. Entomology of the Cadaver
6. Stage of Digestion of Food in the Stomach
a. Size of the Last Meal
b. Kind of Meal
c. Personal Variation
d. Other Factors
7. Presence of Live Fleas in the Clothing in Drowning Cases
8. Amount of Urine in the Bladder
9. State of the Clothing
10. Chemical Changes in the Cerebrospinal Fluid (15 Hours Following Death)
11. Post-mortem Clotting and Decoagulation of Blood
12. Presence or Absence of Soft Tissues in Skeletal Remains
13. Condition of the Bones