THANATOLOGY

Thantos:- Death
Logos = Science
Thanatology. It is the scientific study of
Phenomena and practices relating to
death.

DEATH
&
Medico-Legal Aspects

DEFINITION
1. Me Rental and Smith defined death
Complete and permanent cessation.
2. Mr Shapiro defines death as
Irreversible loss of properties of living matter.

3. Mr Clane has defined that

When destruction of brain has been
established, the individual has died, no
matter whatever is the state of rest of the
body, giving four signs for such a diagnosis.
Deep irreversible coma
(fixed bilateral dilated pupils)
(absent cranial nerve reflexes.)
No spontaneous respiration.
Absence of electrical brain activity.
Cessation of circulation through the
retina.

3.

United State Law dictionary defined death

(in 1951)

The cessation of life, the ceasing to exist

4.

Physicians Definition.

Death is a total stoppage of circulation,

and cessation of all vital functions,
such as respiration and pulsation.

Muller Claims that

5.
Death is not a moment
but
a Continuous Process

CLASSIFICATION OF DEATH
Biologically
Death occurs in bits & pieces
Moment of start of this disintegration,
cannot be ascertained
Declaring------Death - has become more difficult
Since 1967-Dec
(First human heart transplant was successfully carried
out)

Thus Death was classified into 2 Groups.

Body
Separate entities
Organs
Body may be dead
Organs may survive
= in the same body
= in another unit of life

TWO STAGES
I.
Somatic Death (Soma-Body)
Irreversible loss of integrating
and co-coordinating functions
of the organism as a wholeis labeled as Somatic Death.
It is the complete and persistent loss of
coordinated functioning of tripod of life.
i.e stoppage of
Brain
Heart
Functioning and failure to return
Lung

Tripod of life
Life

tion

respi
r

func

ation

CN S

circulation

Modes of death
Coma

Syncope

Tripod of
death

Asphyxia

CNS
function

Circulation

LIF
E

Respiration

Same is also called

Systemic
Clinical
Legal

Death

II.

Molecular Death
It is the death of individual organs and
tissues (which persisted individually
after somatic death)

In 1967- Single Organ, Shifted from a dead

unit to another living unit.
During interval it was kept alive to avoid
molecular death.
Till it was shifted to already prepared
body Ready to receive Heart of Dead

Time Interval between Somatic &

Molecular stages
Heart
Liver
Kidney
Cornea
Blood
Bone Marrow

Survives For
Survives for
Survives for
Survives for
Survives for
Survives for

60 minutes
15 minutes
45minutes
6-24 Hours
6 Hours
6 Hours

DIAGNOSIS OF DEATH
Brain death is declared when there is
1. Permanent fixed bilateral dilatation of
pupils.
2. Absent all nerve reflexes
3. Cessation of of respiration
(without aids.)
4. Cessation of cardiac activity
(COMPLETE FLAT ECG)

D/D of Death
1. Suspended animation
2. Barbiturate poisoning
3. Electrocution
4. Drowning
5. Hypothermia

NATURE OF DEATH
Natural & Un-Natural
Un- Natural:
1. Homicidal
2. Suicidal
3. Accidental

Manner or nature of death

Natural
Unnatural _
Suicidal
Homicidal
- accidental
- manipulative/exhibitionist

Modes of death
Coma

Syncope

Tripod of
death

Asphyxia

1. COMA
Name of coma
Causes of Coma

Fate of coma
Compression of brain
- Inj to Brain
- Inj to meninges
- Disease of brain
Disease of meninges

Concussion,
hemorrhage,inflammation,
abcess,new growth,
thrombosis, embolism.

Epilepsy
Heat Stroke
Hypothermia
Effect of Poison
Metabolic Disorders
- Diabetes
- Hypoglycemia
- Uremia
- Hepatic Failure

POST MORTEM FINDINGS

Compression
Hemorrhages
Inflammation of meninges
Tumor
Foreign body
Vascular Lesions
Minute Hemorrhages (in poisoning)

2. SYNCOPE
Failure of Heart
Reduced blood supply to brain

Causes:
1.
2.
3.

Anemia
Weakness
Sudden Fright Reflex vagal inhibition
- Cardiac
Center paralysis
- Respiratory

Head

4. Direct blow on

Epigastrium
Testis

5. Emotional Stress
6. Sudden Exposure to cold
7. Insertion of instruments in orifices Uterus
- Bladder
- Rectum
- Any body
cavity

8.
9.
10.
11.
12.

Anesthesia
Exhaustion
Heart Diseases
Hemorrhage
Idiopathic

Post Mortem Findings (Non Specific)

Heart
Organs
Capillaries

-------

Usually Empty
Pale
Congested

3. ASPHYXIA
A Condition ----- caused by
Interference with respiration
Lack of oxygen in respired air.
Organs and tissues are deprived of O2
Failure to eliminate CO2

Resulting in :

O2 supply to brain.

Disturbed functioning of nervous tissues.

O2 supply to blood

Rapid unconsciousness
Stoppage of respiration.
Fate After ---- 2 3 minutes ----- Death

TYPES OF ASPHYXIA
Mechanical Asphyxia

Air passages blocked mechanically

Pathological
Asphyxia

Air entry prevented by diseases of

lungs

Toxic Asphyxia

Air entry is prevented by

poisonous substances

Environmental
Asphyxia

Lack of O2 in the Environment

Traumatic Asphyxia

Trauma, Pulmonary embolism

Positional Asphyxia

Forcible flexion of neck on chest

Iatrogenic Asphyxia

Associated with anesthesia

FINDINGS IN ASPHYXIAL DEATH

On the body

:
:
:
:

Congestion
Cyanosis
Edema
Petecheal Hemorrhages

Around the neck

:
:
:

Ligature Mark
Bruising
Defense wounds

Non-Asphyxial

SIGNS OF DEATH
A. Immediate
B. Early
C. Late

A. Immediate Signs:
(Somatic,systemic & clinical death)
a. Insensibility and loss of voluntary power to
move.
b. Cessation of circulation (Flat ECG for 5 minutes)
c. Cessation of respiration.
d. Cessation of brain activity absent reflexes.
(Flat EEG for 5 minutes)

B. EARLY SIGNS (MOLECULAR DEATH)

a.
b.
c.
d.
e.

Cooling of body
Eye changes
Skin changes
Post-mortem lividity
Muscles changes Rigor Mortis

C. LATE SIGNS
Putrefaction (Ultimate fate of all living
creatures.)
Arrest of putrefaction.
(Extra ordinary phenomenon)
- Mummification
- Adipocere formation

A. IMMEDIATE SIGNS
a. Insensibility and loss of voluntary power
to move. (Not a sure sign of death)
It is the foremost sign but also occurs in:
- Prolonged fainting
- Vagal inhibition
- Epilepsy
- Electrocution
- Drowning
- Suspended Animation

b. LOSS OF EEG

No EEG for a continuous period of 5 minutes.

(a+b are sure signs of death)

c. Cessation of circulation

No heart beat for a continuous period of 5 minutes

(with stethoscope - sure sign)
Difficulty in

- Feeble sounds
- Thick Chest
- Emphysema

ECG: A flat ECG for 5 minutes confirms death

Magnuss Test: Tying a thread around the finger

Finger Nail Test: Press and see the pale zone

changes

Diaphanous Test: Finger web test

Heat Test : No true blister with red line

Incision Test: No circulation

Suspended animation
(Apparent Death)
Heart beat & respiratory movements are not
heard ordinarily (as they are at a very low
pitch.)

I. Involuntary S.A may occur in:

Drowning cases
New born
Anesthesia
Concussion
Heat Stroke
Prolonged illness
Electrocution
Deep Shock

All may revive by

resuscitation methods

II. Voluntary S.A

Yogis (Holding of Breath)

Confirmation of Death by:

i.

Rectal Temp - below 75oF

ii.

EEG - FLAT

iii.

ECG - FLAT

iv.

Ophthalmoscope shows segmentation of retinal

blood capillaries.
The blood stream in retinal vessels rapidly becomes
dotted first & then segmented (Cattle trucking)

d. Cessation of Respiration
i.

No abdominal movement (Ant.wall)

ii.

No auscultation sounds with stethoscope for 5

minutes

iii.

Mirror Test

iv.

Feather Test

v.

Glass water Test. (Winslows Test)

B. EARLY SIGNS

a) Cooling of body: (Algor Mortis)

During life: Balance of temperature is
maintained i.e. Heat produced = Heat loss
After death no heat production, so only heat
loss.
The heat loss is gradual.
This remarkable phenomenon was used to
calculate time since death.

Measurement of Heat Loss in Dead Body

Heat is lost till the surrounding temperature is
attained.
Rectal measurement is best.
Sub-hepatic and vaginal measurement may
also be made.
Special clinical thermometer marked from
0- 50oc (graduated in degrees. Thanatometer).

No fall in first few hour

Sudden loss in 5th and 6th hour.

FACTORS INFLUENCING RATE OF

COOLING
1. Atmospheric Temperature
Body Temperature
Atmospheric Temperature

Difference

i.
ii.
iii.
iv.
v.

When difference is more - rate of cooling is rapid

When difference is less - rate of cooling is slower.
Initial few hours (4-5) no loss (called P.M.T plateau)
Gradual fall upto 12 hours.
Falling rate decreases after 12 hrs till attainment of Atmospheric
temperature (20-24 hours)

Temperature

Time since death

2. PRESENCE OF CLOTHING
i.
ii.

Presence of Clothing Cooling rate is

slower.
Absence of clothing Cooling rate is
faster.

3. LOCATION OF BODY
i.

In open area-free air flow rapid cooling.

ii.

Inside the room less or no air slow

cooling.

4. HUMIDITY
Rapid Cooling
Dry Air Less Cooling

5. STATE OF NUTRITION &

DEVELOPMENT
Small Body

Cooling Early

Large Body

Cooling Slower

(Depends upon mass and surface area)

6. FATTY BODY
Cooling slow (as fat is a poor conductor of
heat)
In ladies having more fat slow cooling.

7. MANNER OF DEATH
Heat loss is slower in chronic bacterial diseases.
Heat loss is faster in wasting diseases.

METHODS OF CALCULATION

Hourly calculation.

Newtons Formula.

Un reliable Not applicable

Average fall = 0.5-0.7 C per hour

No fall in temp for few hours

Then Ist two hours fall of temp is roughly half

the difference between body temp and
environment temp.

In next two hours temp fall 1 of above

rate
Next two hours of Ist two hours rate
In tropical country like Pak average loss
is about .5 - .7 C per hour

Required data:

Temperature of the body at the time of death.

Cause of death.

Temperature of environment.

Temperature of seat of body.

- Under average circumstances fall may be
presumed as 0.5- 0.7o C per hour (keeping in mind,
the cooling curve).

Note: Other criterions are more reliable. It should be

least preferred.

RAISED BODY TEMPERATURE

(AT THE TIME OF DEATH)
i.

High grade fever

ii.

Sun stroke

iii.

Pontine Hemorrhage

iv.

Encephalitis

v.

Lobar pneumonia

vi.

Typhoid Fever

vii. Strychnine poisoning

viii. Tetanus
ix.

Many other diseases

POST MORTEM CALORICITY

(GAINING HEAT)
i.

Environmental Temperature is very high.

ii.

Septicemia.

Body Temperature continues to increase till

several hours after death.

BODY IN A FLUID MEDIUM

(LOSS OF TEMPERATURE)
Temperature of fluid: Cold water - cooling rapid
Hot water - cooling slow
Nature of fluid:

Dirty water cooling slow

Fresh water cooling rapid
Sea water

Flow of fluid:

cooling rapid

Running water-cooling rapid

Stagnant water cooling slow

b) EYE CHANGES
i.

Permanent fixed bilateral dilatation of

pupils.

ii.

Cornea becomes hazy & opaque

iii. Corneal & Conjunctival reflexes are lost

iv. Luster of cornea is lost.
v.

Eyes become sunken.

 Taches noires. These are brownish-black

discoloration on the exposed sclera
between the eyelids, due to formation of
cellular debris & dust. They appear on
sclera within 3 hours of death, if eyes
remain open.
Potassium content of vitreous humour
rises steadily.

c) SKIN CHANGES
i.

Skin

becomes

pale(more

dependent parts
ii. Skin elasticity is lost
iii. Skin luster is lost

on

non

POST MORTEM LIVIDITY

It is the staining or discoloration of skin and
organs of a dead body due to accumulation
of blood because of gravitation and arrest of
circulation resulting in distension of tone
less capillaries and veins of dependent
parts.

Also called:
P.M. Hypostasis
Livor Mortis
P.M staining
Cadaveric Lividity
Subcutaneou Hypostasis
Suggilations
Vibices

DEVELOPMENT OF LIVIDITY
After somatic or clinical death: Circulation stops
Blood remains fluid for some hours
O2 in blood (which is carried in loose
combination with Hb) is still being supplied
to the tissue(till molecular death).
No more pumping of blood by heart
O2 is gradually decreased & Hb is reduced
(Blue colour)
Due to gravity blood settles, directly in
dependent areas of skin or viscerae

FACTORS AFFECTING
POSTMORTEM LIVIDITY

Post Mortem Phenomenon

Position of body +
pressure effect on
specific areas

Ante-Mortem state of
body & Mode of death

Reduced Hb

Post Mortem Lividity

Colour of skin

Fluidity of blood

Effect of gravity

Colour of blood

COLOUR OF LIVIDITY
Initially bluish pink.
Later becomes bluish purple (dark blue)
In fair skin colour better appreciated

 In carbon monoxide poisoning

- Bright cherry red colour.

In acute cyanide poisoning

- Bright pink colour.

- later on it fades.

In potassium chlorate poisoning - Chocolate brown colour.

- Due to formation of
methemoglobin.

In death due to cold

- Bright pink colour.

In hemorrhage, anaemia

- Faint colour.

In asphyxia

- Dark purple

Phosphorous
Nitrites
Hydrogen Sulphide
Opium
Burning
Septic Abortion

- Dark brown
- Red Brown
- Bluish green
- Black
- Cherry Red
- Grayish Brown

TIME OF PML & FIXATION

Starts 1-3 hours after death

Completes 3-6 hours after death

Fixed About 6-8 hours after death

Test for Fixation Press with thumb

i. If bleached Not fixed.
ii.If not bleached Fixed.

DISTRIBUTION OF PM LIVIDITY
External (In supine position)
PML is found on: Dorsal aspect of trunk
Posterior aspect of head & neck
Dependent areas of upper and lower
limbs
More Marked on:Lobes of Ear
Tissues under the nails of fingers

EXCLUDING
Back of head
Back of shoulder
Back of Buttocks

(Areas in contact)

Back of heels
Areas under tight clothing

(Contact Flattening)

Internal (In supine position)

Posterior portion of cerebrum & cerebellum
Posterior wall of lungs
Posterior wall of stomach
Dorsal portion of liver & spleen
Lowermost coils of intestine
(Lividity is changed with a change in position of
body) before its fixing

CAUSE OF ABSENCE
Pressure from below, prevents distension
and filling of capillaries and minute veins
of skin. It is called contact flattening.

D/D OF P.M LIVIDITY

a. Cyanosis
b. Bruise
c. Congestion

a. Trait

PM Lividity

Cyanosis

Time of onset

Post-Mortem

Ante-Mortem

Location

On dependent parts

On terminal tips

Appearance

Normal

Abnormal&
Pathological

Volume of blood Enough

Less

Change of
Position

Shifting of lividity

No change

History of
disease

Not required

Positive

Confirmation

Visible as a PostMortem
Phenomenon

Anti-Mortem
Observation/
Evidence

b. Trait

PM Lividity

Bruise

Situation

Epidermal (due to Sub-epidermal.(Due to

engorged vessels) ruptured vessels

Cuticle

Uninjured

Site

Occurs on
Occurs at the site of
extensive areas of injury (may appear any
dependent parts
where)

Appearance

Not elevated

Area is usually swollen

due to accumulation of
blood & edema.

Edges

Clearly Defined

Merge with surrounding

area

May be injured

Colour

Uniform

Variegated in colour

Section

On incision ,blood is
seen in blood vessels,
can be easily washed
away

On incision, extra vasated blood is seen

which is not easily
washed

Effects of
pressure

Not present in areas

under pressure

May be present in
areas under pressure

Blood
Blood elements seen
elements on in blood vessels with
microscopy no evidence of
inflammation

Blood elements seen

out side blood
vessels with evidence
of inflammation

c. Trait

P.M Lividity

Congestion

Distribution Irregular and on

dependent parts

Involves whole
organ

Appearance Normal

Pathological
change is evident.

Mucous
Membrane

Dull & lusterless

Normal

Exudate

No inflammatory
exudate

Exudate seen

Hollow
viscera

Stomach, intestine
when stretched show
alternate stained &
unstained areas

Stomach and
intestine show
uniform distribution

MUSCLE CHANGES
Period of relaxation

(Primary Flaccidity)

Cadaveric rigidity

(Rigor mortis)

Period of relaxation

(Secondary relaxation)

Primary Flaccidity:
Appears immediately after death
Usual duration 2-3 hours
All muscles of body get completely relaxed.
Muscle tone is lost
Can be moved in any direction.

 Due to this lower jaw drops, pupils dilate &

sphincters relax & may result in
incontinence of urine & faeces.
The muscle still react to mechanical
electrical & chemical stimuli.

RIGOR MORTIS
Rigor rigidity
Mortis death
Rigidity after death
It is stiffening of the muscles both voluntary as well as in voluntary
after initial state of primary flaccidity after death

It is a condition characterized by
Stiffening
Shortening
Opacity of muscles
Follows primary relaxation
Is due to chemical changes
Involving the proteins of muscle fibers
Marks the end of cellular or molecular life of muscle fibres
The presence of rigor mortis can be elicited by attempting
to flex the neck and the limbs at joints.

PHYSIOLOGY : (IN LIVING)

Contractile element of muscle consists of
protein filaments.
Myosin
They interdigitate
Actin
> Less in relaxed state.
> More in contracted state.

 Relaxation

of muscles controlled by ATP

Contraction
ATP is stored in high concentration in
muscles
Balanced production of ATP from glycogen
stores.

AFTER DEATH

Glycogen stores
resynthesize ATP,only for
No glycogen
No ATP production

2-3 hrs. After 2-3 hours

No relaxation of muscles
ed interdigitation of
actin &myosin

Break down of ATP into

- lactates
- Phosphates

Actomyosin

ed accumulation of

(stiff gel)

salts in muscles
Stiffening and shortening of muscles
(voluntary + involuntary)
Fixation of joints
Persists till the autolysis of actin & myosin.

TIME PERIOD
Early in Summer
Late in winter
Starts 2-3 hours after death.
In face: eyes, mouth then neck
upper
limb, trunk,
lower limbs Within 12hrs
Stays for 12 hours

passes off

in 12hrs

STARTS
2-3 hours after death
In face, eyes, mouth & neck

SPREADS
Upper limb
Trunk
Lower limbs

with in 12 hours

STAYS

12 hours

PASSES OFF
Next 12 hours

Plateau of variable
temp

Decomposition

36.9oc

Rigor Mortis

(98.4OF)

Temperature of
environment

Lividity

12

18

24 30

36

42

48 54

Hours after death

Chart showing the major changes by which lapse of time after death might be
estimated. The first 4-5 hours often show little fall in temperature.

FACTORS INFLUENCING
RIGOR MORTIS
Factor

Appearance

Passing Off

Late
Early
Early

Late
Early
Late

1. Atmosphere
a.
b.
c.

Dry & cool

Moist & Warm
Cold Water

Factor

Appearance

Passing off

2.

Age

a.

Children

Early

Early

b.

Elderly

Early

Early

c.

Adults

Late

Late

Factor
3.
a.
b.
c.
d.
e.

Manner of Death
Chronic disease
& emaciation
Sudden death
Strychnine
Poisoning
Drowning
Arsenic
poisoning

Appearance

Passing off

Early

Early

Late
Immediate

Late
Early

Early
Late

Late
Late

Factor

Appearance

Passing off

4.

Muscular Condition

a.

Healthy muscles

Late

Late

b.

Exhausted & wasted

Early

Early

muscles

DIFFERENTIAL DIAGNOSIS OF
RIGOR MORTIS
(Simulating Conditions)
1.

Heat Stiffening

2.

Cold Stiffening

3.

Putrefaction stiffening

4.

Cadaveric Spasm

1.

HEAT STIFFENING

i.

When body
temperature.

is

exposed

to

75oC

or

high

ii.

When body is exposed to high voltage current.

High Temperature

High voltage

Coagulation of actin & myosin

Stiffening of muscles

Flexion of all joints of body

Special posture
(pugilistic attitude or boxers attitude)

SPECIAL FEATURES
i.

Burn marks are present

ii.

Stiffening persists till putrefaction

iii. Muscles get lacerated when tried to break

2. COLD STIFFENING
Freezing temp
Solidification of fats and muscular tissues
Rigidity of Muscles

 Rigidity is lost when body is moved to

higher temperature.
Again sets in when moved to freezing
temperature.
Appears quickly : disappears quickly

3. PUTREFACTION STIFFENING
Putrefaction
Formation of gases
Accumulation of gases
False rigidity

Stiff Limbs

4. CADAVERIC SPASM
(Instantaneous Rigor)
A rare type of rigidity of a group of muscles.
May occur instantaneously after death.
Before the actual signs develop.
Does not allow primary relaxation.
Muscles remains stiff till autolysis.
Represents a state of extreme physical
activity or emotional state before death.

Examples:
i.

In drowning, victim may seize a bunch of

weeds in an attempt to save himself (found
clutched tightly in hand)

ii.

A person committing suicide may grip a

pistol in his hand.

iii. A bunch of hair in homicidal scuffle.

Such objects are proof of nature of death

DIFFERENCES
Traits

Rigor Mortis

Cadaveric spasm

1. Time of onset

2 3 hours after
death

Instantaneous

2. Predisposing
factors

Nil

Sudden death, fear,

excitement,
exhaustion,
nervous tension.

3. Muscles
involved

All voluntary &

Involuntary

Usually a single
group of voluntary
muscles

4. Muscle
stiffening

Not marked,
Marked, moderate
moderate force can force cannot break
break it.
it.

Traits

Rigor Mortis

Cadaveric spasm

5. Medicolegal
importance

Helps in
Indicates nature
determination of of death :
time since death suicide,
homicide,
accident.

6. Body Heat

Cold

Warm

7. Molecular
death

Occurs

Does not occur

8. Mechanism

Known

Not known

MEDICOLEGAL IMPORTANCE

RIGOR MORTIS HELPS IN

a. Calculation of time since death.
b.Determination of position of body.

Plateau of variable
temp

Decomposition

36.9oc

Rigor Mortis

(98.4OF)

Temperature of
environment

Lividity

12

18

24 30

36

42

48 54

Hours after death

Chart showing the major changes by which lapse of time after death might be
estimated. The first 4-5 hours often show little fall in temperature.

PUTREFACTION

 Decomposition/dissolution of body
tissues into
Gases
Liquids
Salts
The ultimate fate of body by conversion of
organic to inorganic state.
It is absolute / surest sign of death

Based on
Autolysis (Self destruction)
After death, enzymes are released. They
soften & liquify tissues of the body.
It commences 3-4 hrs after death and
continuous for 2-3 day or longer.
Bacterial Action (Micro-organisms)

MICRO-ORGANISMS
The micro-organisms responsible are
anaerobic & aerobic. They produce variety of
enzymes. They are Clostridium welchi,
Streptococci, Esc coli & B. Proteus which act
on Carbohydrates, Fat and Proteins. C. Welhi
produces lecithinase which hydrolyses the
lecithin present in cell membrane resulting in
haemolysis of blood and initiation of
putrefaction.

MICRO-ORGANISMS
IN LIVING
Present in body in large numbers
Remain under control
JUST AFTER DEATH
Life control fails
Micro-organisms are out of control
Multiply in large numbers
Become virulent
Enter blood vessels
Spread throughout the body

BASIC RULE
Organs (First to putrefy)
Receiving rich blood supply
Near to source of bacteria

PUTREFACTION

Autolysis (self destruction)

Air

Bacterial Action

warmth
moisture
Molecular death

Death of tissue

More bacterial growth

Enzymes production

(Cl - w)
Production of

Lecithinase Enzyme
Effects Tissues
(Dissolution )

Release of enzymes
from tissue cells
Softening
liquefication of
tissue cells

Haemolysis of blood

Hydrolysis of
lecithinase

Gases, Liquid salts

(Putrefaction of body Tissues)

STEPS OF PUTREFACTION
i.

Color changes

ii.

Production of gases

iii. Pressure effects of gases

iv. Appearance of maggots
v.

Other sequelae

COLOR CHANGES
External
a. Greenish discoloration over caecum and the
flanks
(Rt. iliac fossa) 12-24 hrs (earlier in summer)
1st sign.
Indicator of entry of body into advance
putrefaction.
b. Greenish discoloration gradually spreads to
whole abdomen. The whole body is discoloured
within about next 24 hrs.
c. Color gradually changes from greenish to
black.
d. Hb + H2S
Sulf-met Hb

Internal

Under surface of liver (Internal) due to close contact

with fluid and bacterial contents of bowel.

Blood is hemolyzed & Hb is liberated.

Bacteria (Clostridium Welchii) produce H2S with Hb.

Sulf met Hb spreads to the whole body (48 hours).

Greenish discoloration spreads to whole body, both

internal and external.

PROCESS
Blood
Bacteria

Haemolysis
Liberation of Hb

H2S
Hb + H2S gas

Sulph-met Haemoglobin (greenish color)

Diffuses into tissues

MARBLING
The veins converging on the

Root of neck

Over the shoulder

Running into the groins

Become visible as blue or purplish lines

Due to pigments from decomposing blood

passing through the blood vessels

The course of these veins is thus visible as a

bluish network

This condition owing to its mosaic or

arborescent pattern is known as Marbling

Veins are filled with

Gas bubbles
Haemolysing blood

Marbling commences ____ 24 hours

Seen prominently

____36 - 48 hours

PRODUCTION OF GASES
Within 12 13 hrs after death.
Production of foul smelling gases starts:
In hollow viscera
In solid viscera
Below the skin

 In 18 48 hrs
Gases collect in hollow viscera.
They cause false rigidity.
They exert considerable pressure.

Gases: H2S
NH3
Phosphorated hydrogen
CO2
CH4

PRESSURE EFFECTS OF GASES

The gases gradually increase in quantity and due to this, pressure effect on
various tissues occur. The following pressure effects are seen:-

1. Bloating of features
2.

Shifting of areas of PM.L

3.

Changes in skin, hair and wounds

4.

Extrusion of fluid from nose & mouth

5.

Emptying of heart

6.

Changes in appearance of genitals

PRESSURE EFFECTS
a. Bloating of Features. (36 48 hrs)
i.

Face - swollen.

ii. Identification difficult.

iii. Tongue, Lips, nose, eyelids & cheeks are
distended
iv. Face becomes bluish green mass.

v.

Bulging of Lips.

vi.

Tongue is pushed between teeth.

vii.

In females breasts are swollen.

viii.

Rectum also protrude (48 72 hrs)

ix.

Condition of body may be confused with violent

death.

b. SHIFTING OF AREAS OF HYPOSTASIS

Putrefaction

liquification of clottedBlood
Haemolysis of blood

Pressure of duodenal
gas

Post Mortem
staining

Shifting in any direction

c. FLUID AND FROTH FROM MOUTH

Abdominal gases push diaphragm up
Lungs, heart and stomach are also pushed
upwards.
Resulting in extrusion of fluid and froth from
mouth & nose.

d. SKIN SLIP (3 - 4 DAYS)

Outer layer of skin becomes loosened and it
can be rubbed easily with pressure, to leave
a moist, pink base called skin slip.
Skin from hands and feet may peel off in the
form of gloves or stockings.
Can be helpful for getting finger prints.

e. BLISTERS ( 2 3 DAYS)
Blisters are found all over the body.
They can be confused with blisters of
burns.

DIFFERENCES
Trait
Time

True Blister

Putrefaction Blister

Ante-Mortem

2-3 days Post Mortem

Vital reaction Present

Contents

Absent

Full of fluids rich in Mainly gas, very little

albumin

fluid with
no albumin

On rupturing

Fluid escapes but

Gas escapes & blister

blister remains.

is no more visible.

f.
Becomes loosened
Easily pulled out

HAIR

g. CONDITION OF GENITALS
Male: Penis & scrotum become swollen
Female: Genitals appear pendulous
In pregnant ladies fetus may be expelled out.
(in 48 72 hrs)

h. EMPTYING OF HEART
Increased fluidity of blood
Heart may become empty

APPEARANCE OF MAGGOTS

Putrefied material attracts flies.

Flies lay eggs in.
i. Open wounds.
ii. Natural orifices
Nose
Mouth
Vagina
Anus
Flies lay eggs
Larva
Pupa
Adult
Time period varies with type of fly & temp

Knowledge of flies --- Forensic entomology.

Life Cycle
Flies
Eggs
Larvae
Pupae
Adults

FORENSIC ENTOMOLOGY
Study and knowledge of insects and flies,
about their habitat and life cycle.

5. OTHER SEQUELAE
a. Beetles
b. Vultures
c. Dogs
d. Other animals

RESULT IN
i. Liquifaction
ii. Cavities burst
iii. Skeltanization (1-3 month)
iv. Decomposition of bones

Uncoffined 1 year

Coffined

Complete destruction - 25 yrs

3 years

PUTREFACTION OF INTERNAL ORGANS

Starts with External putrefaction
Organs

- Soft
- More blood

Organs

- Hard
- less blood

Putrefy early

Putrefy later

SEQUENCE
i.

Stomach and intestines

ii.

Trachea, Bronchi, lungs, larynx

iii. Liver, Brain, Spinal cord.

iv. Heart, Kidneys, Diaphragm
v.

Prostate, Testis, Uterus, Ovaries

FACTORS INFLUENCING
PUTREFACTION
External Factors:

i. TEMP
a. 70o to 100o F
b. Freezing point
c. 200oF

temp

best temperature
death of bacteria
fluids are dried up

putrefaction
No putrefaction
putrefaction.

(mummification may occur)

ii. AIR
Presence of air
Absence of air

putrefaction
putrefaction

Casper Dictum states that

The rate of putrefaction
The temp. remaining same in each case
Is almost equal for
One week in air
Two weeks in water
Eight weeks when the body is buried
(However it is subject to great variation.)

iii. MOISTURE
Presence

of

moisture

promotes

putrefaction
(More moisture More Bacteria
Multiplication of Bacteria)

iv. CLOTHES

Initially maintain temperature and help

putrefaction.

Later protect body from flies

v. MANNER OF BURIAL
a. In air tight coffin
Body with coffin
b. In deep grave
In shallow grave
c. Body buried in lime

putrefaction delayed
putrefaction early
putrefaction delayed
putrefaction early
putrefaction delayed

d. Body buried in water logged area

putrefaction early.
e. Body buried in sandy area
f.

Body buried in porous land

Mummification

INTERNAL FACTORS
i. AGE
a. Infants, still born, sterile
b. Children

putrefy late

putrefy early than adults

c. Old, less fatty

putrefy late

ii.

CONDITION OF BODY

a. Fatty body

early putrefaction

b. Emaciated body

late putrefaction

c. Mutilated body

early putrefaction

iii. SEX
Very little influence
Female

Fatty

early putrefaction.

Female dying
putrefaction.

after

Female dying
putrefaction.

of

child

birth

septicemia

early
early

iv. MODE OF DEATH

a. Infection
more bacteria
early putrefaction
b. Anemia
less blood
late putrefaction
c. Wasting diseases
Atrophy of muscles
late
putrefaction
d. Poisons may delay putrefaction.
eg. Arsenic, Antimony, Zinc
e. Sudden Death
Good Health slow putrefaction

PUTREFACTION IN WATER

Much slower

Once body is out of water

rate is

higher (16 times)

Also depends on water, cond. of

body & water animals

Fast in still water

----- slow in running water

Fast in dirty water

----- slow in clean water

Fast in deep water

----- slow in shallow water

Fast in naked body

----- slow in clothed body

Fast in body effected ----- slow in body not

by water animals

effected by water

e.g fish, crocodiles,

animals

insects.

APPEARANCE OF COLOR
CHANGES
Putrefaction in water

Putrefaction in air

i.

Face & neck

i. Abdomen

ii.

Thorax

ii. Chest

iii. Shoulder

iii. Face

iv. Arms

iv. Legs

v.

v. Shoulder

Abdomen

vi. Legs

vi. Arms

FLOATATION OF BODY
In summer 24 hrs
In winter 2-3 days

when sufficient gases are produced

Position of body : Abdomen Above (higher due to gases)

Spine Below (Heavy)
No floatation of body:- If sub merged under water with a
weight tied with it, entrapped by weeds

Depends upon
i.

ii.
iii.
iv.

iv.

Age
Adult
Children
Late
Elderly
Late
Built
Strong & Fatty
Weak
Late
Sex
Female
Male
Late
Surrounding
Water
Clear water
Dirty water
Late
Weather
Summer
Early
Winter
Late

Early

Early
Early

Early

MUMMIFICATION
It is also a modification of putrefaction
process, which becomes arrested and body
tissues undergo mummification.
It

is

characterized

by

dehydration

or

desiccation of body tissues and viscerae after

death

The ideal conditions for mummification

are
(1)
High atmospheric temp devoid of
moisture
(2)
Free air circulation round the
body (3) Dry porous sandy soil

Shallow grave

Free air
Evaporation

High temperature

Dry atmosphere
Dry Soil

DEAD BODY

Loss of moisture

Dry & Healthy Skin

Shriveled & Dry Tissues

Porous earth

MUMMIFICATION
(MEDICO-LEGAL IMPORTANCE)
Time period required

3 Months

Artificial Mummification also possible

Mummification may help in:i.

Identity

ii.

Establishing the cause of death

iii. Time since death

iv. Indicates place of recovery

ADIPOCERE (SAPONIFICATION)
It

is

modification

of

process

of

putrefaction, which may become arrested

and fatty tissue of body may get converted
into fatty acids. It has the properties of fat
and wax, so the name
(Adipo

soft fat)

(Cera- Wax)

It results from conversion of unsaturated fats

to saturated fats by bacterial fat splitting
enzymes. The fat is hydrolysed to a wax
compound.
The ideal condition are
(1) Moisture
(2) Warm temperature (moderate)
(3) Diminution of air
Adipocere is a pale, greasy semifluid
material with a rancid smell.

Dead Body
Moisture
Fatty Areas

UN-SATURATED BODY FATS

Bacteria

Lecithinase

Cl-welchii
Release Enzymes

Damp soil
Less Air

Warm Temperature

Firm Fat

SATURATED FATTY ACIDS

Palmitic, stearic,Ca-Soaps

Areas involved:
Abdomen
Cheeks
Breasts
Buttocks
Rarely in infants & obese, whole body is
converted
Time: one limb 3-6 weeks
whole body one year
If body is immersed in fluid - early

MEDICOLEGAL IMPORTANCE
i.

Identification

ii.

Injuries are present cause of death

iii. Indicates time elapsed since death.

iv. Indicates the place water or

moist

ground from which the body has been

recovered

Bio Chemical Changes In Body

Fluid After Death
Blood
C.S.F
Ocular fluid.

Changes In Blood
Concentration of all blood components
Changes after death.
Factor which are responsible for his changes are:
1- Function of organ between Somatic and
molecular death.
2- Post mortem action of bacteria and enzymes.
3- Altered permeability of dying cell membrane.
Also at the time of certain natural deaths certain
changes take place in blood.
Due to altered body function like agonal acidosis
which is associated with marked.

In Lactic Acid
Lactic acid 1 meq/ L.
1 hour P/M 20 meq/L.
12 hour P/M 50 meq/L .
24 hour P/M 75 meq/ L.
Urea nitrogen
@12-30 mg/ dl up to 70 mg/ dl.
Amino Acid Nitrogen
@3-5 mg/dl.
12 hour P/M
10-12 mg/dl.
All as result increase tissue break down.

Ph: of blood and tissue fall (acidic) , due to

terminal accumulation of CO2 and lactic Acid after
death
After about 24 hours due to production of NH3
from enzymatic break down of proteins ,PH starts
rising and reaction again become alkaline.

Plasma Chloride

@95- 105 mg/dl.

Soon after death chlorides in plasma and R.B.C

equalize become 74 m.mol/L and then
concentration drops due to extra cellular
diffusion and become half i.e 37 m.mol /l in 72
hour s.
Mg++: @ 0.07 1.2 m.mol/L.
With the onset of putrification it starts rising and
reach eight times in 72 hours.
K+: @ 3.8 -5 m.mol/L.
Start rising after death owing to diffusion from
vascular endothelium .

Enzymes
Post mortem accumulation of enzymes in serum
like :
Amylases:
@23 85 I.U/L
Lactic Phosphataes : @ 90 250 MILI units /L.
Acidic phosphataes : @ up to 0.7 Units /L.
Alkaline Phosphtates : @ 30- 95 mili units/L.
Transimanase :
@ 5- 35 milil units/L
Rise in first few hour s after death as a result of
increased tissue break down and peak activity
varies for each enzymes .
Amylase & Phosphates :34 -48 hours.
Transaminase: 48-60 hours.
Lactic Dehydrogenase:
4th day.

Sugar and Urea

Blood sugar and Blood Urea also rises after death.
Breakdown of liver glycogen result in accumulation of
dextrose in inferior vena cava and hence in right side of
heart . Blood sugar rise more than 300 mg /dl. Within
first 24 hours.
Diffusion does not extend beyond the heart as lungs
provide an effective barrier. So no reliance can be
placed on blood dextrose levels if blood is collected
from inferior vena cava or right side of the heart .
Examination of peripheral blood might help if raised
more than 200 mg/dl but care should be taken in
interpretation as agonal rise in blood dextrose can be
produced by Hypoxia, CO poisoning and effect of
trauma.

 Blood urea concentration can rise in

agonal period to the level of 150 mg/dl but
usually serum level within first 48 hours is
never above 100 mg/dl unless there is an
increase in urea concentration during
life.serum concentration of urea > 300
mg/dl and creatinine more than 10 mg %
undoubtly indicate renal failure with
uremia.
@creatiae 0.42 -2.42 mg%( in C.S.F)

C.S.F
@Amount in life is 150 ml start disapperaing at 2448 hours after death.
Time of death can be estimated with +8to 8 hour
of actual time .
Sample can be easily obtained by tapping cisterna
magna .In first fifteen hours after death:
Lactic Acid rise from 15 %mg to over 200 mg %
N.P.N :
from 15 mg % to 40 mg %
A.A.N:
from 1 mg % to 12 mg %

Following conclusion can be drawn

A.A.N: less than 14 mg % death less than 12 hour
PM.
N.P.N. less than 80 mg %death less than 24 hours
PM.
Creatine less than 5 mg % death less than 12 hours
PM.:
Phosphorus less than 15 mg/dl death less than 10
hour s PM.
Ocular Fluid:
Vireous and Aqueous fluids are free from
contamination in a dead body

Ocular Fluid:
Vireous and Aqueous fluids are free from contamination
in a dead body and up to 2 ml of fluid can be eaisly
withdrawn from each eye ball with needle and
syringe.
Steady rise in K+ in Viterous after death for over 100
hours . There is a linear relationship between K+
concentration and P/M interval over 100 hours death.
There is a standard error of +4.7 to 4.7 hours and this
did not increase with time.
@3.4 meq/L.
Rate of increase is 0.17 meq/l/hour.
Ascrobic Acid, Pyruvic Acid , N.P.N: Studies are also
helpful in determining time since death but K+ is
more reliable and dependable.

International Form of Medical

Certificate Cause of Death

A: Biodata of deceased
B: Cause of death
I. Disease or condition

Directly leading to death.

Antecedent causes morbid
Condition, if any, giving rise
to the above causes ,starting the
underline condition last.
II. Other significant conditions
Contributing to the death but not
Related to the disease or conditions
cause it.

Approximately interval between

0nset &death.
a)--------------------------------Due to(or as a consequence of)
b)--------------------------------Due to(or as a consequence of)
c)-----------------------------------

---------------------------------------

 This does not mean the mode of dying e.g heart

failure ,cardiopulmonary failure , etc It means
disease, injury or complication which cause
death.
Filling of death certification:
Content s and design of death certificate . There
are two sections. The first headed I asks for:
a. Immediate cause .
b. Morbid conditions if any giving rise to the
immediate cause.
It would be sufficient for instance to write acute
General Peritonitis
Under Ia and perforated Gastric Ulcer under Ib

 Second headed II asks for other significant conditions (if

important ) contributing to death but not related to
immediate cause.
There would be none in the above example but if Ia
Uraemia, I b supportive pyelonephritis, and then we can
place II Carcinoma of prostate or Diabetes Mellitus.
All that is required is that the precise cause of death should
be set out starting from the immediate cause and working
back to the underlying disease responsible .
Terms which merely describe mode of dying like heart
failure or coma should be avoided.
If precise cause of death is not known one should not start
guessing it. Ambiguities like Birth injuries ,C.V.A or
termination of pregnancy should be avoided \rather
qualification must be given to make it clear that they were
natural not accidental or of criminal occurrence .

Under no circumstances should a doctor

sign blank or partially blank death
certificate.
Under Birth and death Registration Act
1874,it is a statutory duty of a doctor
(mandatory) who has been in attendance
of the patient during the last illness to
issue a certificate .no fee should be
charged although there is no regulation.