Dr.

Mohammed Madadin
University of dammam

Death &Post-Mortem
Dr_msm83@hotmail.com

Changes
 ‫بســـم الله الرحمـــن الرحيـــم‬
In The Name of Allah, most gracious ,most
merciful

- Death Lecture contents

-Hypostasis

-Rigor mortis

-cooling

-Decompositio

n
-Mummificatio

n
-Adipocere

-G. Emptying

& P.M
chemistry
 DEATH
Definition of Death :

- 0ld def. ( 1960s) : cessation of circulation and respiration

- Death
e.g ‘’ black law dictionary 1968 ‘’ : cessation of life , the ceasing to exist defined by
-Hypostasis physician as total stoppage of circulation and cessation of vital function such as
respiration .
-Rigor mortis Old def. has challenged by advanced resuscitation tech. and equipment
-

1- Somatic : irreversible damage to CNS

-cooling

- unconscious
-Decompositio

n - No Cardio-Pulmonary
functions
-Mummificatio

n -No voluntary Movement

-Adipocere -No response to stimuli
-G. Emptying -No reflexes
& P.M - EEG : flat
chemistry Criteria for Dx : these criteria must be
 Brain death is suitable or golden time for
organ transplantation
- Death As brain death interval increase the
-Hypostasis possibility of rejection increase
-Rigor mortis

-cooling

-Decompositio

n 2-cellular : - Dead of tissue and their

-Mummificatio
constituent cells
-No functions , Metabolic activity
n
-Adipocere
Different tissues die at different rate
-G. Emptying Neurons ( 5 min.)
& P.M Heart ( 30 min. )
chemistry Muscles ( 4 hours )
Differential Diagnosis of flat EEG ( silence or isoelectric
EEG)
• Brain dead
• PVS
• Barbiturate overdose
• Brain injury
• Hypothermia
• Encephalitis

Brain death & persistent vegetative state( PVS)

- Both conditions clinically irreversibly comatose
- However Dx of brain death is based on brainstem death determination
- PVS : permanent and total destruction of frontal lobe function
while the vegetative functions such as respiration , sleep-wake cycle occur
but no response to external stimuli
Different Tissue Die at
different rate

Death is
process
Rather than
An event
 Diagnosis of Death

Irreversible loss of brain functions due to anoxia will

•

achieved within minutes ( 3-4 minutes ) may be longer

e.g : hypothermia Reduced oxygen need of the tissues .

-Unconsciousness
-loss of all reflexes
-No reaction to painful stimuli
-Muscular flaccidity

-Cardiac&Resp. cessation: auscultation , ECG

-Eye signs :loss of corneal reflex –} insenstive cornea , loss of

reflectivity
Loss light reflex--} fixed unreactive pupil , mid-dilated postition
may be different between Rt&Lt , (no Dx sig.) ,
lost their circular shape as result of uneven relaxation
Eye lid incomplete closure because falccid muscles
corneal cloudiness
Tache noire in sclera due to incomp.closure of eye lid – dust acc.
FIGURE 1

Tache noire
2 yellow triangle in sclera on
each side of cornea within
few hours become brown .

‘’ These are brown areas

of scleral drying caused
dust deposit due to failure
of the lids to close after
death ‘’

IOP : will decrease to half

once death occur , then 1/8
after 30 min. , nil after 2 hours
 Cause Mode Manner

Cause of Death : Disease or injury that produce physiological changes resulting in

death

Mode = Mechanism:The physiological changes due to the cause that result

in death

Manner of Death : how the cause come out

Natural , accident , suicide , Homicide ,undetermined , unclassified
 Hypostasis

Hypostasis , Lividity , Livor Mortis

- Death Old names ( lucidity , staining , cogitation)
-Hypostasis

-Rigor mortis
-Discoloration of the dead body due to
-cooling accumulation of blood in small vessels
-Decompositio
( settling of the blood) in the dependent
n areas due to gravity .
-Mummificatio

n Distribution depends on the posture of the

-

-Adipocere
body after death
-G. Emptying

& P.M It covers the dependent areas except in

-

chemistry pressure areas ( shoulder , buttock , calf )

 FIGURE 2 (hypostatsis)

Photos show
distribution of the
hypostasis over
dependent areas.

Pale color over pressure

area
•Time of hypostasis
•Medico legal Importance

Timing of hypostasis is variable

•

infant
and may not, old people
appear , anemic
as in : or extensive blood loss
•Average time to

Appear : 30 min
Blenchable : less than 6 H
Fixed : 8 – 12 Hour
Medico legal importance
•

:
- Confirm sign of death
- Estimation time of
death
- posture of death
 Colors of Hypostasis :

-Bluish red discoloration but the variation is wide

-It depend on the state of oxygenation at death ( darker in
congested or hypoxic state) , but not specific indicator of
mode of death .
- May differ from site to site in the same body , specially
Hypotherm
with prolong intervalCynid
ia e
Sulfaemogl
obin
e.g
Methaemoglobinaemia Co hydrogen
e.g Na chlorate posoninig sulfide
inorganic nitrate carboxyH
B
 To differentiate
It is Important
between
Ant-mortem bleeding & hypostasis

-As blood settles in skin , it does in other organ

-Intestine : loop of jejunum , ileum markedly discolored ,

discontinuous
Mistaken to mesentric infarction , strangulation
-Lung : diff. color , posterior surface More dark , more

cong. And edema .

-Myocardium : dark patch in post.wall of Lt V , mistaken fro

early infarct
-Hmg behind oesoghagus at level of larynx : confused with
Hypostasis & Bruising

Differences Between Hypostasis and

Bruising
Hypostasis Bruising
•Intravascular •Extravascular
•Dependent areas •Anywhere
•Affected by •Not affected
pressure •May be raised
•Not raised(if it is , swelled
washable) , in s.f •Can associated
layer of dermis with abrasion
•Edge: ill-defined •Deep layer
•Regular margin •Edge :well-defined
•+ve blenchable •Irregular margin
early
 Rigor Mortis

Primary flaccidity
•

- Death immediately after death ,2-3 hr ,all body

-Hypostasis
muscle .
-Rigor mortis
Secondary flaccidity
•

-cooling after rigor mortis ,it appear first in head

-Decompositio
and go
Rigor down.:
mortis
n
-Mummificatio
•Stiffness of the muscles after death due to
n depletion of ATP which lead to muscle
contraction.
-Adipocere

-G. Emptying •It start after primary flaccidity and start to pass
& P.M off as sign of decomposition appear .
chemistry
 FIGURE 3 (Rigidity)

•MedicoLegal
Importance of
rigidity

- Confirm sign of
death
-Post-mortem

interval Rt photo show the knee is still rigid after

moving because rigor mortis still in fixed.

-Post-mortem shift
LT photo show absence of lividity where the
in position hand was contact
Time of Rigidity

Time of rigor mortis :

•variable and depend on the some factors
•Average appear within 2 hour

•Complete in 6-12 h

•Duration to end 18-36 h

• may not be recognizable in infant , cachectic , old people

Factor affect rigor mortis :

1- temperature: colder temperature the slower the process (delay to appear ,
more sustained) and vice versa.
2- Age: very rapid in infants and old age
3- Activity prior to death :if activity increase before death it will be faster
(violence+ epilepsy )
-Rigor set in more quickly in death from electocution and passes off more

rapidly
-Drugs : e.g strychnine toxicity
Rigidity in other tissues

Rigor mortis also affect involuntary muscles

•iris muscle, so unequal pupils

heart , it make ventricle to contact, can be mistaken

•

by hypertrophy

•dartos muscle of scrotum compress testes &

epididymis with contraction of muscular fibers in
seminal vesicles and prostate may lead to post
mortem extrusion of semen

Rigor in erector pili muscles (arrectores pilorum)

•

attached to hair follicles can cause pimpling ;cutis

Biochemistry of Rigidity
myofibril (structures that carry
•

out contraction)

Sarcomere ( group of
•

myofibril)

The myofibril consist of thin

•

filaments (consisting of actin)

and thick filaments (consisting
of myosin).
A-actin B-Myosin c-
•They form combination called Actomyosin
actomyosin (physically shorter
Biochemistry of Rigidity
•Myosin bind to the actin, forming a cross bridge.
•The ATP binds to the myosin head---causing it to break the

cross bridge and detaching it from the binding site.

•The ATP is then hydrolysed to form ADP + P, and this

changes the angle of the myosin head. The ADP + P is then

released, causing the myosin head to return to its original
angle ,this then pulls the actin closer to the centre of the
sarcomere, causing an overall shortening.
•The myosin then picks up another ATP molecule and the

cycle repeats .

ATP depletion unbreak cross bridge

Biochemistry of Rigidity

After death:
ADP to ATP ceases ,triphosphate diminished
L.A accumulate
Depletion of glycogen
Actin and myosin rigidity linked ( unbroken
bridge )
Rigor mortis initated when ATP conc. Drop to 85%
and become maximun when atp drop to 15%
CADAVERIC SPASM

Rare form of instantaneous rigor develop at time of

•

death with no primary flaccidity.

•It affects only one group of muscle

•It is initiated by motor nerve action

•Associated with deaths with physical or emotional

activity

It has importance in :
•

1-in case of suicides the weapon may be found in

hand
2-during drowning some weeds, grass may be
found grasped in hand or during fall from height so
FIGURE 4 (Cadaveric spasm)

This victim
was
recovered
within short
time from fall
in river ,
showing
grass firmly
clutched in
the hand
Cold & Heat Stiffness

Cold stiffening:

It happen in extreme cold ,-5C, due to body fluid freeze &

solidification of subcutaneous fat.

Heat stiffening:

•Due to tissue proteins become denaturated and

coagulated
•Marked shortening occur (pugilistic attitude)

due to greater mass of flexor muscle compared with

extensor
• its post mortem change and does not indicate burning

during life
 Body cooling

- Death
•After death body temperture will
decrease
-Hypostasis
•Estimation post-mortem interval by
-Rigor mortis
body cooling not accurate because:
-cooling
-We don’t know if body temp. was
-Decompositio normal before
n death
-Mummificatio
- is
• 2 the cooling to
thermometry process will follow
estimation post-
n uniform pattern?
mortem interval
-Adipocere
1- 1 C \ H
-G. Emptying
2- 37 – Rectal Temp +3
& P.M
chemistry
Factors affecting cooling

1- initial body temperature: “It differ from person to

person,exercise , time , place”

2- Body dimensions: surface area ,mass of the body ,

conduction prop.

3- posture: “amount of skin on supporting surface , nature of

surface , air mov.”

4- Clothing and covering:”depend on clothes ,wet clothes

accelerate cooling”.

5- Ambient temperature:” If its higher than body temp., it will

warm it up, and if its
so cold it will accelerated fast”
 Decomposition

•Disintegration of body
tissue after death
- Death Decomposi •Start once death
-Hypostasis
tion occur
-Rigor mortis
•Differ from body to

-cooling body , environment ,

-Decompositio even in same body
•Time scale variable
n
-Mummificatio according
n circumstances&
climate
-Adipocere
Breakdown Breakdo
-G. Emptying
autoly of tissue by putrefacti wn by
& P.M sis internal on bacteria
chemistry enzymes
Putrefaction

Time is variable
-

start at time of death

appear in 3 days in average temp (indoor
18C)

- Affected by many factors such as :

1- Environment: hot temperature

increase rate , cold decrease it, slow in
water and slower in buried bodies

2- Age: faster in infants

 Sequence of putrefactive changes

Internal GI bacteria
Direct
spread
Abdominal wall Tissue Discoloration
breakdow
nHb-----Sulphaemoglobin
spread
Other Tissue
Signs of external
putrefaction
Skin Skin Gas
Discolor.moist
tissue Marbling distension
F\N red,swellow 1 week blisters slippage formation
Purging ofProtrude Hair\nail Maggot
Bloody fluid
Urine\faces
Tounge,eye deattachedinfestation
• Internal putrefaction slower than the external
•Pancreas(1st) , lining of intestine , adrenal medulla first to

•autolys
Prostatewithin hours still for long time
and uterus
•Brain : discolor after 1 week , liquefying after 1 Month

Mening.Hmg , heamatoma , some tumors will

persist
non – hmg lesions in brain vanish early .
•Heart : atheroma and thrombus persist for many months

miliary plaques : nodules 1 mm or less seen in putr.

heart
Skeleton carrying tendon in outdoor climate 12-18
Months
Bare-bone skeleton 18 months -3 years
 - Decomposition in immersed bodies

Slower rate than in air because

1- lower ambient Temp .
2- protect from insect and predators

- Decomposition in buried bodies

- much slower than air and water

- lower temp. , no animals and insect , lack of O2 inhibit aerobic org.
- others : nature of soil , coffin type ,
• 1 week in air = 2 weeks in water = 8 weeks
in soil
 Mummification

• is a modification of putrefaction
- Death
-Hypostasis
characterized by the
drying of the tissues
-Rigor mortis

• Occur in dry environment , can occur in

-cooling

-Decompositio
freezing
conditions
n •Essential req. is Dry env. With prefrably

-Mummificatio
moving air current , low humidity
n •Desert zones , closed rooms , cupboards

-Adipocere

-G. Emptying
•The forensic importance of mummification
& P.M :
chemistry
Skin color : brown usually , leathary
Internal organ : may be partly dried , partly putrefied ,
adipocere
Conjunctiva of eye , scrotum , bent knee and elbow
Stiff tissue for histlogical EX. : soaking in 15% solution of
glycerine for several days
 Adipocere

Adipo=fat , cire =wax

•

- Death •formation of waxy substance derived from

-Hypostasis
body fat
Due to hydrolysis and hydrogenation of
-Rigor mortis
adipose tissue.
-cooling • it is partial and irregular process ,

-Decompositio
sometimes can affect the whole body ,
n buried bodies .
-Mummificatio
•The color vary from white through pinkish
n to gray or greenish
-Adipocere The substance itself off-white but colored
-G. Emptying
red from blood or greenish from
& P.M decomposition
chemistry •
 •Factors of adipocere
•Medico legal Importance

Factors lead to adipocere :

•Moisture : high humidity and high temperature

• In body immersed in water, wet graves

•warm environment,

•the water content of a body may be sufficient

•Hydrolysis by endogenous lipase & bacterial enzyme

principally clostridium perfringens anerobe which

release (lecithinase)
The medico-legal importance of adipocere :

•preserve the body form help in personal

identification
•recognition of injuries

•Preserve organs
FIGURE 8 (ADIPOCERE)

Rt photo
show visually
identified
body because
of adipocere
formation

Lt photo show
tattoo which
still preserved
Post-mortem damage by predators (anthropophagy)

•The type varies depend on area & if the body out or indoor.
•The most active tissue remover are maggots (larval stage of

bluebottles(calliphora) and flies

(musca)

•Insect lay egg in fresh corps on wounds and moist

areas(eyelid , lips , gentalia) , and anywhere in putretfied
corpse
•Foxes , dogs , cats , rats , ant

•In water : water rate and fishes

Putrefaction make disarticulation easy

•
 Gastric emptying
If the time of last meal was known
•

The time of death could be estimated

•Average digestion take 2-3 hours
- Death
•Meal reach cecum 6-8 H
-Hypostasis

-Rigor mortis Factors affecting gastric emptying

•

-cooling - type and amount of meal

-Decompositio . Fatty meals : delay opening of pylorus
n . Alcohol : delay emptying
- Stress : can completely inhibit digestion
-Mummificatio
close pylorus , decrease G.motility and secretions
n
increase intestinal motility
-Adipocere
Drugs and medical conditions
-

-G. Emptying atropin , narcotic decrease emptying , while diazepam and laxitave accelerate
-

& P.M DM , P.U : decrease emtyoing

-

chemistry Age : slower in old people

-
Vitrous Humour

-Remaining controversial procedure

- the most common chemical in V.H for P.M interval is

the Potassium
-There is marked and progressive rise in K after death

- many factors can affect this

. Pt with die with chronic dis. With metabolic

disturbances
. Sampling method
.effect of temp. changes post-mortem
.different analytical techniques used
- The commonest calculation used