FORENSIC MEDICINE:

FORENSIC MEDICINE By: WILFREDO R. BERALDE

Death defined:
Death defined DEATH is defined as the state of complete persistent cessation of respiration, circulation and other vital function of the body. It is the return of the body to a stable equilibrium, chemically and physically. Note: It is hardly possible to determine the exact time of death. SOMATIC DEATH (or Clinical Death) Occurs when a physician declares a person has expired due to complete, persistent and continuous cessation of the vital function of the brain, heart and lungs. But there is still animal life among individual cells as evidenced by presence of excitability of muscles and ciliary movement of individual cells. EARLY SIGNS OF DEATH a. Face and lips become pale b. Muscles become flaccid. Out of condition; not strong or robust; incapable of exertion or endurance c. Sphincters are relaxed d. Lower jaw tends to drop e. Eyelids open and pupils dilate f. Skin loses its elasticity g. Body fluids tend to gravitate to dependent portion h. Body heat gradually assumes the temperature of the surroundings EARLY SIGNS OF DEATH: a.Face and lips become pale b.Muscles become flaccid.Flaccid means out of condition; not strong or robust; incapable of exertion or endurance c.Sphincters are relaxed.Sphincter means a ring of muscle that contracts to close an opening d.Lower jaw tends to drop e.Eyelids open and pupils dilate.Dilate means become wider f.Skin loses its elasticity.Elasticity means the tendency of a body to return to its original shape after it has been stretched or compressed. g.Body fluids tend to gravitate to dependent portion.Gravitate means move due to the pull of gravitation h.Body heat gradually assumes the temperature of the surroundings

MOLECULAR OR CELLULAR DEATH Occurs 3-6 hours after death. There is death to individual cells. APPARENT DEATH (or State of Suspended Animation) This condition is not really death but a mere transient loss of consciousness or temporary cessation of the body. The following condition may produce Apparent Death. Apparent means appearing as such but not necessarily so. Transient means lasting a very short time. Hysteria Uremia Catalepsy Electric Shock Drowning MEDICO-LEGAL IMPORTANCE to prevent premature burial. Hysteria.Hysteria means excessive or uncontrollable fear. Uremia.Uremia means accumulation in the blood of nitrogenous waste products, urea, that are usually excreted in the urine. Catalepsy.Catalepsy means a trancelike state with loss of voluntary motion and failure to react to stimuli.

Legal Importance of Determining Death:

y y y y Civil personality of a natural person is extinguished by death. Property of a person transmitted to his heirs at the time of his death. Criminal Liability of a person is extinguished by death. Civil case for claim, which does not survive is dismissed upon the death of the defendants.

Legal Importance of Determining Death

Signs of Death:
1. Cessation of Heart Action and Circulation. As a general rule, if there is no heart action for a period of five minutes, death is regarded as certain. The auricle is the last to stop, hence called ULTIMEN MARIENS. In judicial hanging, the heart beats for 20-30 minutes after the individual has been executed. In decapitation, the beating is present for an hour after decapitation. (Execution by cutting off the victim's head

Signs of Death Auricle is a small conical pouch projecting from the upper anterior part of each atrium of the heart.

Methods of Detecting Cessation of Heart Action Palpation of pulse Auscultation of heart sound Fluoroscopic examination- Use of electrocardiograph y Palpation of pulsePulsation of the peripheral blood vessels may be made at the region of the wrist or at the neck. The pulsation of the vessels is synchronous with the heart beat. Occasionally the pulsation is very imperceptible and irregular that the examiner experience much difficulty. Auscultation of heart sound.The rhythmic contraction and relaxation of the heart is audible through the stethoscope. heart sound can be audible during life even without the aid of stethoscope by placing the ear at the precordial area. Fluoroscopic examination.Fluoroscopic examination of the chest will reveal the shadow of the heart in its rhythmic contraction and relaxation. The shadow may be enlarged and the excursion made less visible due to pericardial effusion. Use of electrocardiograph.The heart beat is accompanied by the passage of electrical charge through the impulse conducting system of the heart which may be recorded in an electrocardiograph machine. The electrocardiograph will record the heart beat even if it is too weak to be heard by auscultation. This is the best method of determining heart action but quite impractical.

Methods of Examining Peripheral Circulation Magnus test Opening of small artery Icards test Diaphanous test Application of heat on skin 1. Palpation of pulse Magnus test.A ligature (Thread used by surgeons to bind a vessel as to constrict the flow of blood) is applied around the base of a finger with moderate tightness. In a living person there appears a bloodless zone at the site of the application of the ligature and a livid area distal to the ligature. If such ligature is applied to the finger of a dead man, there is no such change in color. The color of the area where the ligature is applied will be the same as that one distal to it. There may be no appreciable change of color if a living person is markedly anemic. 2. Opening of small artery.In the living, the blood escapes in jerk and at a distance. In a dead man, the blood vessel is white and there is no jerking escape of blood but may only ooze towards the nearby skin. When bigger arteries are cut, blood may flow without pressure continuously.

3. Icards test.This consists of the injection of a solution of fluorescein subcutaneously. If circulation is still present, the dye will spread all over the body and the whole skin will have a greenish-yellow discoloration due to fluorescein. In a dead man, the solution will just remain at the site of the injection. This test should be applied only with the use of the daylight as the color is difficult to be appreciated with the use of artificial light. 4. 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. The finger webs may appear yellow in a strong light even if living in cases of anemia or carbon monoxide poisoning. 5. Application of heat on skin.If heated material is applied on the skin of a dead man, it will not produce true blister. There is no sign of congestion, or other vital reactions. But if applied to a living person, blister formation, congestion, and other vital reactions of the injured area will be observed. Palpation of pulse. 6. Palpation of the radial artery with the fingers, one will feel the rhythmic pulsation of the vessel due to the flow of blood. No such pulsation will be observed in a dead man.

2. Cessation of Respiration A person can hold his breath no longer than 3 minutes. In electric shock, respiration may cease for sometime but may be restored by continuous artificial respiration. Conditions in which suspension of respiration is present without death ensuing: Purely voluntary act; example divers, swimmers, etc. Peculiar conditions like Cheyne-Strokes Respiration (apneic interval not longer than 1520 seconds) y Apparent drowning Newly born infants y y Methods of Detecting Cessation of Respiration Observation of the chest movement during inspiration and expiration. Auscultation Use of mirror dimming of mirror if there is respiration due to moist air. Examination with a feather or cotton fibers or glass of water- Winslow test y In feather or cotton fibers: A fine feather or a strip of cotton is placed in front of the lips and nostrils. If there is movement of the feather or cotton not due to external air, respiration is present. The feather or cotton fibers will be blown away during expiration and towards the nose and mouth during inspiration. This is not a reliable test as the slightest movement of outside air or nervousness of the observer will move the feather or cotton fibers.

In glass of water: A glass half full of water is placed at the region of the chest. If the surface of the water is smooth and stable, there is no respiration taking place, but if it waves or water movement is observed, then respiration is taking place. This is not a good test because of the difficulty of preventing movement of the place where the body lies. There is movement of the image formed by reflecting artificial or sun light on the water or mercury contained in a saucer and placed on the chest or abdomen if respiration is not taking place. The reflection is utilized to magnify the movement of the surface of mercury water.

3. Cooling of the Body ( ALGOR MORTIS)

The progression fall of body temperature is due to the cessation of metabolic process, one of the most prominent sign of death, which is rapid during the first 2 hours after death. Fall of temperature of 15oF to 20oF is considered a certain sign of death. Conditions where fall of temperature occur before death are as follows: Cancer, Phthisis,Collapse Involving the lungs with progressive wasting of the body Conditions wherein there is rise of temperature immediately after death usually observed in the first two hours (post-mortem caloricity). Cholera Cerebrospinal fever Liver abscess Rheumatic fever Small fox Strychnine poisoning Yellow fever Conditions wherein there is rise of temperature immediately after death usually observed in the first two hours, post-mortem caloricity. Cholera Cerebrospinal feverMeningitis caused by bacteria and often fatal. Meningitis is Infectious disease characterized by inflammation of the meninges, the tissues that surround the brain or spinal cord, usually caused by a bacterial infection; symptoms include headache and stiff neck and fever and nausea Liver abscess Rheumatic feverA severe disease chiefly of children and characterized by painful inflammation of the joints and frequently damage to the heart valves. Heart valve is a valve to control one-way flow of blood Small fox Strychnine poisoningStrychnine is an alkaloid plant toxin extracted chiefly from nux vomica; formerly used as a stimulant. Nux vomica is a medicine made from the seeds of an Asiatic tree; contains strychnine and brucine; formerly used as a stimulant Yellow feverCaused by a flavivirus transmitted by a mosquito. 4. Insensibility of the Body and Loss of Power to Move After the whole body is insensible. No kind of stimulus is capable of letting the body voluntary movement. Conditions in which the above is present in the living. ApoplexyA sudden loss of consciousness resulting when the rupture or occlusion of a blood vessel leads to oxygen lack in the brain Epilepsy TranceA state of mind in which consciousness is fragile and voluntary action is poor or missing; a state resembling deep sleep have

CatalepsyA trancelike state with loss of voluntary motion and failure to react to stimuli Cerebral concussionInjury to the brain caused by a blow; usually resulting in loss of consciousness Hysteria

5. Changes in the Skin Following Death 1. 2. 3. 4. Pale and waxy looking Loss of elasticity Opacity - the phenomenon of not permitting the passage of electromagnetic radiation Effect of the application of heat 6. Change in and about the Eye y Loss of corneal reflex - Corneal relates to cornea, the transparent dome-shaped anterior portion of the outer covering of the eye; it covers the iris and pupil and is continuous with the sclera. Sclera is the whitish fibrous membrane (albuginea) that with the cornea forms the outer covering and protection of the eyeball y y y Clouding of the cornea Flaccidity of the eyeball- flaccidity Pupil is in the position of rest y Opthalmoscopic findings y Tache noir de la scleratique yellowish to black round triangular spot found in the sclera. 7. Action of the Heat on the Skin Only dry blister is found on dead. In living, blister contains fluid.

CHANGES IN THE BODY FOLLOWING DEATH:

CHANGES IN THE MUSCLES There are three stages after death: CHANGES IN THE BODY FOLLOWING DEATH Stage of Primary Flaccidity: Characteristics are as follows: Occurs 3 6 hours after death; Muscles relaxed, contracts when stimulated, pupils dilated, sphincters relaxed so there is no incontinence or urination and defecation.

Stage of Post-Mortem Rigidity Cadavers rigidity or rigor mortis or death struggle of muscles. Characteristics include: Occurs 6 24 hours and last to 36 hours after death; Whole body becomes rigid (Unchanging and unmoving) due to muscular contraction; Chemically, there is an increase lactic acid and phosphoric content of muscles. The reaction becomes acidic; Healthy muscles delay the onset; Aged, newborn, high temperature, moist air hastens onset.

Stage of Secondary Flaccidity There is the commencement of putrefaction. Muscles become flaccid and soft due to dissolution of muscle protein, which have been previously coagulated during the period of rigor mortis.

CONDITIONS SIMULATING RIGOR MORTIS:

HEAT STIFFENING When the dead body is exposed to temperature above 75oC, muscle proteins coagulates (Change from a liquid to a thickened or solid state) and causes the muscles to be rigid. The body assumes the pugilistic attitude. CONDITIONS SIMULATING RIGOR MORTIS COLD STIFFENING When dead body is frozen, there is stiffening due to solidification of fat. Exposure to warm conditions will make such stiffening disappear. CADAVERIC SPASM Sometimes known as INSTANTANEOUS RIGOR. Instantaneous rigidity of muscles after death due to extreme nervous tension, exhaustion, injury to the nervous system or injury to the chest.

DISTINCTION BETWEEN RIGOR MORTIS & CADAVERIC SPASM:

DISTINCTION BETWEEN RIGOR MORTIS & CADAVERIC SPASM Rigor mortis occurs 6-24 hours after death, whereas Cadaveric spasm appears immediately after death In rigor mortis Muscles involved are: all muscles In cadaveric spasm only Certain group of muscles or asymmetrical are involved The Occurrence of rigor mortis is natural, whereas Cadaveric spasm May or may not appear

Medico-legal importance of rigor more-tis is that it can give approximate time of death, whereas Cadaveric spasm May determine nature of crime.

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CHANGES IN THE BLOOD COAGULATION OF BLOOD This occurs 6-8 hours after death due to the cessation of circulation. Clotting is accelerated by infections and fevers. Clotting is delayed in cases of asphyxia, poisoning by opium, hydrocyanic acid or carbon monoxide poisoning. Asphyxia is a condition in which insufficient or no oxygen and carbon dioxide are exchanged on a ventilatory basis; caused by choking or drowning or electric shock or poison gas. Hydrocyanic acid is a solution of hydrogen cyanide in water; weak solutions are used in fumigating and in the synthesis of organic compounds

Distinctions::
Distinctions: Anti-mortem clot is Firm in consistency, whereas Post-mortem clot occurs Immediately after death In anti-mortem clot, Surface of the blood vessel is smooth and healthy, whereas Post mortem clot is Raw if clot is removed Anti-Mortem Clot is Homogenous in construction, whereas Post Mortem Clot Can be stripped off in layers Anti-Mortem Clot is Uniform in color Post mortem clot has distinct layer

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wilfredor.beralde POST MORTEM LIVIDITY or post mortem suggilation or post mortem hypostasis or liver mortis. This is the accumulation of blood in the most dependent portion of the body giving a dull red or purplish color. Kinds of Post Mortem Lividity: Hypostatic lividity Diffusion lividity Post mortem lividity or post mortem suggilation or post mortem hypostasis or liver mortis. This is the accumulation of blood in the most dependent portion of the body giving a dull red or purplish color.

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TROPICAL:

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TROPICAL

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wilfredor.beralde

SPECIAL MODIFICATION OF PUTREFACTION:

wilfredor.beralde SPECIAL MODIFICATION OF PUTREFACTION MUMMIFICATION. Dehydration of the body resulting in shivering and preservation of the body when buried in hot, arid, place with dry atmosphere and with free access of hot air. Example is death in deserts, like in Egypt. Kinds of Mummification: Natural mummification Artificial mummification By exposure to heat By treatment with formalin, arsenic, etc.

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wilfredor.beralde SAPONIFICATION. Fatty tissues of the body are transformed to soft brownish substances known adipocere.

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wilfredor.beralde DURATION OF DEATH DETERMINATION: Presence of rigor mortis 3-6 hours & may last from 18-36 hours Presence of post mortem rigidity 3-6 hours after death. Onset of decomposition 24 to 48 hours after death Stage of decomposition Entomology of cadaver presence of maggots after more than 24 hours

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wilfredor.beralde Stage of digestion of food in stomach it takes 3-4 hours for the stomach to evacuate its contents after each meal. Presence of live fleas in the clothing in drowning cases Amount of urine in the bladder State of clothing: If the victim is wearing street clothes, the likelihood is that death occurred at daytime; If the victim is wearing nightgown or pajamas, death occurred at nighttime.

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wilfredor.beralde Chemical changes in CSF (15 hours after death) Lactic Acid 15 mg to 200 mg% NPN 15 mg to 40 mg% Amino Acid Concentration 1 to 12% Post mortem clotting and coagulation 6 to 8 hours after death. Presence or absence of soft tissues in the skeletal remains. Conditions of bones