Medico-Legal Aspects of

Death
NOLAN O GENOVA, MD
Medico-Legal Officer
RFU COR
 Death
• Termination of life
• Complete cessation of all the functions
without possibility of resuscitation.
• Irreversible loss of properties of living matter.
 Death

• Cardio-Respiratory
Death
 Brain Death
(Harvard Criteria)
• Unreceptivity and
unresponsibility
• No movements or
breathing
• No reflexes
• Flat EEG
 Philadelphia Protocol
• Lack of responsiveness to internal and
external environment
• Absence of spontaneous breathing
movements for 3 minutes, in the absence of
hypocarbia while breathing room air.
• No muscular movements with generalized
falccidity and no evidence of postural activity
or shivering.
 Philadelphia Protocol
• Reflexes and response:
– Pupils fixed and dilated, non-reactive to strong stimuli.
– Corneal reflexes absent
– Subraorbital or other pressure response absent
– Absence of snouting or sucking response
– No reflex to upper airway stimulation
– No reflex to lower airway stimulation
– No ocular response to ice water stimulation of the inner
ear
– No DTR
– No superficial reflexes
– No plantar respnses.
 Philadelphia Protocol
• Falling arterial pressure without support by
drugs or other means.
• Iso-electric EEG.
 Kinds of Death
• Somatic Death or Clinical Death
– Complete, persistent and continuous cessation of the
vital functions of the brain, heart and lungs which
maintain life and health.
• Molecular or Cellular Death
– Three to six hours later.
• Apparent Death or State of Suspended Animation
– Transient loss of consciousness or temporary
cessation of the vital functions of the body.
 SIGNS OF DEATH
• Cessation of heart
action and circulation.
– “if there is no heart
action for a period of five
minutes, death is
regarded as certain.”
 SIGNS OF DEATH
• Cessation of respiration.
“ a person can hold his
breath for a period not
longer than 3 ½
minutes.”
• Cooling of the body
“Algor mortis.”
• Insensibility of the body
and loss of power to
move.
• Changes in an about the
eye.
• Actions of heat in the
skin.
• Loss of corneal reflex
• Clouding of the cornea
• The pupil is in the
position of rest
• “Tache noir de la
sclerotique”
– Due to the thinning of
the sclera.
 CHANGES IN THE BODY FOLLOWING
DEATH
• Changes in the muscle • Stage of primary
– Muscular system is flaccidity or period
contractile for 3-6 hours muscular irritability.
after death, then rigidity • Stage of post-mortem
sets-in.
rigidity, or cadaveric
rigidity or “rigor
mortis.”
• Stage of secondary
flaccidity or secondary
relaxation
 FACTORS INLUENCING THE TIME OF
ONSET OF RIGOR MORTIS
• Internal Factors
– State of the muscles
– Age
– Integrity of the nerves
• External Factors
– Temperature
– Moisture
 CONDITIONS SIMULATING RIGOR
MORTIS
• Heat Stiffening
– Coagulation of muscle proteins.
• Cold Stiffening
– Solidification of fat
• Cadaveric spasm or Instantenous Rigor
 CHANGES IN THE BLOOD
• Coagulation of the blood
• Livor mortis
– Occurs in most extensive
areas of the most
dependent portions of the
body.
– Involves the superficial
layer of the skin
– Does not appear elevated
from the rest of the skin
– The color is uniform
– No injury of the skin.
 AUTOLOYTIC OR AUTODIGESTIVE
CHANGES
• Autolytic action, seen in
the maceration of the
dead fetus inside the
uterus.
• Due to the proteolytic,
glycolytic and lipolytic
ferments of glandular
tissues
 PUTREFACTION
• Breaking down of the
complex proteins into
simpler components
associated with the
evolution of foul
smelling gasses and
accompanied by the
change of color of the
body.
 TISSUE CHANGES IN PUTREFACTION
• Changes in the color of • Evolution of gases in
the tissue the tissues.
– “marbolization” – Carbon dioxide,
– Prominence of the ammonia, hydrogen,
superficial veins with sulphurated hydrogen,
reddish discoloration phosporetted hydrogen
during the process of and methane gases are
decomposition formed.
 TISSUE CHANGES IN PUTREFACTION
• Liquefaction of the Soft
Tissues
CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES
OCCURING IN TROPICAL REGIONS
CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES
OCCURING IN TROPICAL REGIONS
CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES
WHEN THE BODY HAS BEEN SUBMERGED IN WATER
FACTORS INFLUENCING THE FLOATING OF THE BODY IN
WATER

Age Conditions of the body

Sex
Season of the year
Influence of Bacteria in Decomposition
• EARLY PERIOD
– Aerobic

• LATE PERIOD
– Facultative aerobes and
anaerobes
 Microorganisms
Other bacteria:
•Bacillus coli
•Bacillus
proteusvulgaris
Clostridium welchii •Bacillus mesentericus
- Plays an important and
dominant role in •Bacillus
decomposition aerogenescapsulatus
 Special Modification of Putrefaction
• Mummification
– Dehydration of the
whole body which
results in the shivering
and preservation of the
body.
 Special Modification of putrefaction
• Saponification or
Adipocere formation
– The fatty tissues of the
body are transformed to
soft brownish-white
substance known as
adipocere.
 Special Modification of putrefaction
• Maceration
– Softening of the tissues
when in a fluid medium
in the absence of
putrefactive
microorganism.
 Duration of Death
• Rigor mortis • Presence of post-
– Sets in from 2-3 hours mortem lividity
after death. – Develops 3-6 hours after
– Fully developed in the death
body after 12 hours
– May last from 18 hours
to 36 hours
 Duration of Death
• Onset of Decomposition • Stage of Decomposition
– Tropical countries – The approximate time of
decomposition is early death may be inferred
and the average time is from the degree of
24-48 hours after death decomposition, although
• Entomology of the it must be made with
extreme caution.
Cadaver
– Larva: 24 hours
– Maggots: >24 hours
 Duration of Death
• Stage of Digestion of • Amount of urine in the
Food in the Stomach bladder
• Presence of live fleas in • State of clothing
the clothings in • Chemical changes in the
drowning cases CSF
– Flea can survive for • Post-mortem clotting
approximately 24 hours
submerged in water,
and decoagulation of
blood
 Duration of Death
• Presence or absence of soft tissues in skeletal
remains.
• Condition of the bones
 Stage of Digestion of Food in the
Stomach
• Takes normally 3 to 4 hours for the stomach to
evacuate its contents after a meal.
• The approximate time of death may be deducted
from the amount of food in the stomach in relation
to his last meal.
• The extent of the gastric emptying and the
progression of the last meal in the GI tract can be
useful in estimating the time of death.
Factors influencing the position and condition of
the decedent's last meal
• Size of the last meal
• The stomach usually starts to
empty within 10 minutes after
the first mouthful has entered.
• light meal - 1 1/2 to 2 hrs
• medium sized meal - 3 to 4 hrs
• heavy meal 4 to 6 hrs
Factors influencing the position and condition of
the decedent's last meal
• Kind of meal
• Liquids move more rapdily than
semi solid, and the latter more
rapidly than solids

• Personal Variation
• Psychogenic pylorospasm can
prevent departure of the meal
from a stomach for several hours
 Other factors
• Kinds of food eaten
• Vegetables may require
more time for gastric
digestion.
• The absence or
insufficiency of pepsin
and other digestive
ferments will delay the
food in the stomach.
 Stage of digestion of food in the
stomach
• The head of the meal
ordinarily reaches the
distal ileum and cecum
between 6 and 8 hours
after eating.
 Presence of live fleas in the clothings
in drowning cases
• A flea can survive for approximately 24 hours
submerged in water.
• If the body is found in water, the fleas maybe
found in woolen clothings.
• The fleas recovered must be placed in a watch
glass and observed if it is still living.
• If it moves, then the body has been in water
for less than 24 hours
 Amount of urine in the bladder
• The amount of urine in the urinary bladder
may indicate the time of death when taken
into consideration, he was last seen voiding
his urine
 Chemical changes in the CSF
• Lactic acid increases
from 15mg to 200mg
per 100cc.
• Non-protein nitrogen
increases from 15 to
40mg.
• Amino acid
concentration rises
from 1 to 25% following
death.
 Presence or absenceof soft tissues in
skeletal remains
• The soft tissues of the
body may disappear 1
to 2 yrs time after
burial.
• The disappearance of
the soft tissues varies
and are influenced by
several factors.
 Condition of the bones
• The degree of erosion of
the epiphyseal ends of
long bones,
pulverization of flat
bones and the
diminution of weight
due to the loss of
animal matter may be
the basis of the
approximation.
END