MedicoLegal Aspect of Death PDF

**OUTLINE** I. **Death** A. Kinds of Death II. **Forensic Pathology** A. Signs of Death B. Changes in the Body Following Death III. **Forensic Taphonomy** A. **Decomposition** B. **Special Modifications on Putrefaction** IV. **Forensic Entomology** V. **Factors affecting Decompositi...

**OUTLINE** I. **Death** A. Kinds of Death II. **Forensic Pathology** A. Signs of Death B. Changes in the Body Following Death III. **Forensic Taphonomy** A. **Decomposition** B. **Special Modifications on Putrefaction** IV. **Forensic Entomology** V. **Factors affecting Decomposition** VI. **Forensic Anthropology** VII. **Duration of Death** +-----------------------+-----------------------+-----------------------+ | **LEGEND** | | | +=======================+=======================+=======================+ | ⭐ | 🖊️ | 📖 | | | | | | Must | Lecture | Book | | | | | | Know | *\[lec\]* | *\[bk\]* | +-----------------------+-----------------------+-----------------------+ DEATH {#death.TransOutline} ===== - It is the termination of life. - The cessation of all the vital functions of the body, without the possibility of resuscitation. - It is an irreversible loss of the properties of living matter. - Death may be: - **Brain Death** - 🖊️ when there is irreversible coma, absence of electrical brain activity, and complete cessation of all vital functions without the possibility of resuscitation. - **Cardio-respiratory Death** - 🖊️ occurs when there is continuous and persistent cessation of heart action and respiration. A. KINDS OF DEATH {#a.-kinds-of-death.TransSubtopic1} ----------------- - **Somatic Death or Clinical Death ** - 🖊️ state of the body in which there is complete, persistent, continuous cessation of all the vital functions of the brain, heart, and lungs which maintain life and health. - **Molecular or Cellular Death ** - 🖊️ It refers to the death of individual cells. Usually occurring 3-6 hours after somatic death.  - **"Apparent Death" or "State of Suspended Animation"** - 🖊️ It is not really death but merely a transient loss of consciousness or temporary cessation of the vital functions of the body on account of disease, external stimulus, or other form of influence.  - 🖊️may arise especially in hysteria, uremia, catalepsy, electric shock, drowning, and stillbirth.* * FORENSIC PATHOLOGY {#forensic-pathology.TransOutline} ================== - Is a specific branch of medicine that applies the principles and knowledge of medicine and related sciences to problems that concern the general public and related to legal issues (Encyclopedia of Forensic and Legal Medicine (2nd Edition), 2016). - 🖊️ also uses a thorough knowledge of the human body to uncover facts about a crime - Pathology focuses on determining the cause of death by examining a corpse. - A post-mortem is performed by a medical examiner, usually under the investigation of criminal law cases and civil law cases in some jurisdictions. Coroners and medical - examiners are also frequently asked to confirm the identity of a corpse (Wikipedia). - Pathology - The study of disease A. SIGNS OF DEATH {#a.-signs-of-death.TransSubtopic1} ----------------- - Cessation of Heart Action and Circulation - Cessation of Respiration - Algor Mortis (Cooling of the Body) - Insensibility of the body and loss of power to move - Changes in the skin - Changes in and about the eye - The action of the heat on the skin - Livor Mortis / Post-mortem Lividity / Hypostasis / Postmortem Suggillation - Rigor Mortis (Cadaveric Rigidity) - Post-mortem Decomposition / Autolytic Changes / Putrefaction CESSATION OF HEART ACTION AND CIRCULATION {#cessation-of-heart-action-and-circulation.TransSub-subtopic2} ----------------------------------------- - There must be an entire and continuous cessation of heart action and flow of blood in the whole vascular system - 🖊️As a general rule, if there's no heart action for a period of 5 minutes, death is regarded as certain. Respiration ceases frequently before the stoppage of the heart contraction and circulation. - The Auricle of the heart is the last to stop contracting after somatic death, hence called ***"ultimen mariens"*** - Examination of the Heart: - Palpation of the pulse - Auscultation of the heart sound at the pre-cordial area - Fluoroscopic Examination - Use of Electrocardiograph (ECG) - **Examination of Circulation: ** - **Magnus Test ** - This is done by a ligature which 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 ligature and a livid area distal to the ligature.  - **Icard's Test ** - An injection of a solution of fluorescein subcutaneously. - The dye will spread all over the body (in a living person) and the whole skin will have a greenish-yellow discoloration due to the fluorescein - **Diaphenous Test** - This is done wherein the fingers are spread wide and finger webs are viewed through a strong light. - Finger webs appear red in the living, but yellow in the dead. - Opening of small artery, palpation of radial pulse, pressure on the fingernails, application of heat on the skin, dropping of melted wax.  CESSATION OF RESPIRATION {#cessation-of-respiration.TransSub-subtopic2} ------------------------ - Cessation of respiration must be continuous and persistent. - A person can hold his breath for a period not longer than **3 ½ minutes.** - **Methods of detecting respiration:** - **Winslow's Test** - There is no movement of the image formed by reflecting artificial light or sunlight on the water or mercury contained in the saucer and placed in the chest or abdomen. - Use of stethoscope - Examination of the mirror, examination with a feather or cotton fibers, examination with a glass of water. COOLING OF THE BODY OR ALGOR MORTIS {#cooling-of-the-body-or-algor-mortis.TransSub-subtopic2} ----------------------------------- - The progressive fall of the body temperature due to the cessation of the metabolic process - It is rapid during **the first two (2) hours.** - A fall of **15 to 20 degrees Fahrenheit** is considered a certain sign of death. - **Post-mortem Caloricity** - Occurs before the body goes into Algor Mortis - Is the rise of temperature of the body after death due to rapid and early putrefactive changes or some internal changes, usually observed in the first two (2) hours after death. #### METHODS OF ESTIMATING HOW LONG A PERSON HAS BEEN DEAD FROM THE COOLING OF THE BODY {#methods-of-estimating-how-long-a-person-has-been-dead-from-the-cooling-of-the-body.TransSub-subtopic3} - **Schourup's Formula** - The chemical method used for the determination of the time of death of any cadaver whose cerebrospinal fluid is examined for the **concentration of lactic acid, non-protein nitrogen, and amino acid** and whose axillary temperature has been taken at the time the cerebrospinal fluid has been removed. A close up of a number Description automatically generated **Figure 1.** Schourup's Formula INSENSIBILITY OF THE BODY OR LOSS OF POWER TO MOVE {#insensibility-of-the-body-or-loss-of-power-to-move.TransSub-subtopic2} -------------------------------------------------- - After death, the whole body is insensible. - No kind of stimulus is capable of letting the body have voluntary movement. CHANGES IN THE SKIN {#changes-in-the-skin.TransSub-subtopic2} ------------------- - Skin is pale and waxy looking **(Pallor mortis)** - Loss of elasticity of the skin - The opacity of the skin - **Post-mortem Contact Flattening** - The body becomes flattened over areas that are in contact with the surface it rests, due to loss of elasticity of skin and post-mortem flaccidity of the muscles. CHANGES IN AND ABOUT THE EYE {#changes-in-and-about-the-eye.TransSub-subtopic2} ---------------------------- - Loss of corneal reflex - Clouding of the cornea - Flaccidity of the eyeball - The pupil is in the position of rest 🖊️ or dilated - **"Tache Noir de la Sclerotique"** - A spot which may be round or oval or maybe triangular with the base towards the cornea - May appear in the sclera a few hours after death (due to thinning of the sclera, making the pigmented choroid visible) - Ophthalmoscopic Findings: - The optic disc is already pale, the retina is also pale, and retinal blood vessels are already segmented with no evidence of blood flow. {#section.TransSub-subtopic2} ACTION OF HEAT ON THE SKIN {#action-of-heat-on-the-skin.TransSub-subtopic2} -------------------------- - No redness  - The dry blister is formed, but no fluid is present.  - Absence of a response of muscle to stimulus. - Loss of animal heat to a point not compatible with life  B. CHANGES IN THE BODY FOLLOWING DEATH {#b.-changes-in-the-body-following-death.TransSubtopic1} -------------------------------------- CHANGES IN THE MUSCLE {#changes-in-the-muscle.TransSub-subtopic2} --------------------- - **Stage of Primary Flaccidity (Post-mortem Muscular Irritability)** - Muscles are relaxed and capable of contracting when stimulated - Pupils are dilated - Sphincters are relaxed - There is incontinence of urination and defecation - Lasts about 3-6 hours after death, in warm countries, the average is 1 hour 51 minutes. - **Stage of Postmortem Rigidity (Cadaveric Rigidity, Death, Stiffening, Death Struggles of Muscles or Rigor Mortis)** - Whole body becomes rigid or stiff due to the contraction of the muscles - **Starts at 3-6 hours, is completed at 12 hours, and may last from 18-48 hours** - It involves both voluntary and involuntary muscles - Reaction is acidic - **Stage of Secondary Flaccidity or Commencement of Putrefaction (Decay of Muscles)** - Muscles become flaccid but no longer capable of responding to mechanical or electrical stimulus - Reaction is alkaline - **Rigor Mortis** - Begins 2-3 hours - Starts from the eyelids, muscles of the jaw, face, arms, legs, and toes - Full rigor in 6-12 hours - Usually disappears after 18-24 hours in warm countries - Lost due to decomposition - **Depletion of ATP** - **Cadaveric spasms** -- instantaneous rigidity of the body immediately after death  **Figure 2.** Rigor Mortis **Table 1.** Livor mortis varies depending on the cause of death ------------------------------------------------------------------ ------------- **Eyelids ** 3-4 Hours **Face and Jaw** 4-5 Hours **Neck and Trunk ** 5-7 Hours **Upper Extremities** 7-9 Hours **Legs** 9-11 Hours **Fingers and Toes** 11-12 Hours #### CONDITIONS STIMULATING RIGOR MORTIS {#conditions-stimulating-rigor-mortis.TransSub-subtopic3} - **Heat Stiffening** - If the dead body is exposed to temperatures above 75ºC it will coagulate the muscle proteins and cause the muscles to be rigid - The body assumes a "**Pugilistic Attitude"** - Commonly observed when the body of a person is placed in boiling fluid or when the body is burned to death. - **Cold Stiffening ** - The cold stiffening is due to the solidification of fat when the body is exposed to freezing temperatures. - **Cadaveric Spasms or Instantaneous Rigor** - This is the instantaneous rigidity of the muscle which occurs at the moment of death due to extreme  nervous tension, exhaustion, and injury to the nervous  system or injury to the chest  - Due to the fact that the last voluntary contraction of  muscle during life does not stop after death but is  continuous with the act of cadaveric rigidity  - Only a group of muscles is involved and they are  usually not symmetrical  - Instantaneous rigor may also be found following ingestion of **cyanide** but usually, it is generalized and symmetrical  - **Strychnine** may produce the same, but rigidity appears sometime after ingestion  - Cyanide and strychnine ingestion may produce the same. CHANGES IN THE BLOOD {#changes-in-the-blood.TransSub-subtopic2} -------------------- - **Coagulation of Blood** - The stasis of the blood due to the cessation of circulation ⇨ Blood may remain fluid inside the blood vessels after death for 6 to 8 hours - **Postmortem Lividity Cadaveric Lividity, or Postmortem Suggillation or Postmortem Hypostasis or Livor Mortis** - Appears 3 to 6 hours - Completely develops at 12 hours - Blood begins to accumulate in the most dependent portions of the body due to the pull of gravity - Also called pooling of the blood - **Livor Mortis** - It is the accumulation of blood in the most dependent portions of the body - Reddish, purplish blue color - Begins in 30 minutes - Intensifies over time - May result in postmortem petechiae - Uniform in distribution and sometimes mistaken for a contusion Close up of a hand Description automatically generated **Figure 3.** Livor Mortis in Caucasians - ⭐ Kinds of Livor Mortis - Hypostatic Lividity - The blood merely gravitates into the most dependent portions of the body but is 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 - 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 changes of position will not change the location of the lividity +-----------------------------------+-----------------------------------+ | **Table 2.** Livor mortis varies | | | depending on the cause of death | | +===================================+===================================+ | Cause of Death | Color | +-----------------------------------+-----------------------------------+ | Hemorrhage | Pale Purple | +-----------------------------------+-----------------------------------+ | Anemia | Pale purple | +-----------------------------------+-----------------------------------+ | Asphyxia | Dark Purple | +-----------------------------------+-----------------------------------+ | **Poisoning by: ** | \- Cherry red  | | | | | 1\. Carbon monoxide  | \- Bright pink  | | | | | 2\. Cyanide  | \- Chocolate brown  | | | | | 3\. Potassium chloride  | \- Red brown  | | | | | 4\. Nitrites  | \- Bluish green  | | | | | 5\. Hydrogen Sulfide  | \- Grayish/Black | | | | | 6\. Opium | | +-----------------------------------+-----------------------------------+ | **Death due to burning/cold ** | Cherry red color | +-----------------------------------+-----------------------------------+ | **Death due to septic abortion | Brown/pale bronze mottling | | (***Clostridium welchii**)*** | | +-----------------------------------+-----------------------------------+ | **Death due to hypothermia ** | Bright pink | +-----------------------------------+-----------------------------------+ GUIDE QUESTIONS {#guide-questions.TransOutline} =============== 1. What is the cause, manner, and mechanism of death? - Cause of Death - The disease/injury that induces the physiologic disruption of the body which produces the fatal termination   - Immediate (Primary) - This applies to cases when trauma or disease **kills quickly** that there is no opportunity for sequelae or complications to develop   - E.g., Gunshot wound of the head, stab wound   - Proximate (Secondary) - The injury or disease survived for a sufficiently prolonged interval which permitted the development of serious sequelae that caused the death   - E.g. gunshot wound of the abdomen. The victim survived but after a few weeks in the hospital he developed pneumonia     - Manner of Death - 🖊️ Explanation of how the cause of death came about  - Natural Death - Natural when the fatality is caused solely by the disease.  - Violent or Unnatural Death - Death due to injury of any sort  - 🖊️ Medico-legal masquerade  - Violent deaths may be accompanied by minimal or no external evidence of injury or natural death where signs of violence may be present.    - Mechanism of Death - The physiological derangement or biochemical disturbance incompatible with life, which is initiated by the cause of death  - 🖊️ For example, hemorrhage or severe dehydration  2. What are the different kinds of manners of death? +-----------------------------------+-----------------------------------+ | **DIFFERENT MANNER OF DEATH** | | +===================================+===================================+ | **Somatic Death or Clinical | state of the body in which there | | Death** | is complete, persistent, | | | continuous cessation of all the | | | vital functions of the brain, | | | heart, and lungs which maintain | | | life and health. | +-----------------------------------+-----------------------------------+ | **Molecular or Cellular Death** | It refers to the death of | | | individual cells. Usually | | | occurring 3-6 hours after somatic | | | death.  | +-----------------------------------+-----------------------------------+ | **Apparent Death or State of | - It is not really death but | | Suspended Animation** | merely a transient loss of | | | consciousness or temporary | | | cessation of the vital | | | functions of the body on | | | account of disease, external | | | stimulus, or other form of | | | influence.  | | | | | | - 🖊️may arise especially in | | | hysteria, uremia, catalepsy, | | | electric shock, drowning, and | | | stillbirth.* * | +-----------------------------------+-----------------------------------+ 3. What are the signs of death? - Cessation of Heart Action and Circulation - Cessation of Respiration - Algor Mortis (Cooling of the Body) - Insensibility of the body and loss of power to move - Changes in the skin - Changes in and about the eye - The action of the heat on the skin - Livor Mortis / Post-mortem Lividity / Hypostasis / Postmortem Suggillation - Rigor Mortis (Cadaveric Rigidity) - Post-mortem Decomposition / Autolytic Changes / Putrefaction REVIEW QUIZ {#review-quiz.TransOutline} =========== 1. Under P.D. 856 Section 95 of the Code of Sanitation, it states that Health officers of the Public Attorneys office and Commission on Human Rights are authorized to conduct autopsies. (True or False)    2. Postmortem examination refers to external examination of a dead body without incision being made, BUT it may include the recovery of blood and other body fluids. (True or False)  3. Ultimen mariens" refers to the stoppage of the auricle of the heart. (True or False)  4. Forensic Pathology and Forensic Medicine are synonymous. (True or False)  5. Algor Mortie is the rise of temperature of the body due to rapid and early putrefactive changes. (True or False)  6. Apparent death refers to the death of individual cells. (True or False)  7. A hospital autopsy educates not only the students and resident but other medical staff as well. (True or False)  8. A medico-legal provides interpretation and correlation of facts and circumstances related to death. (True or False)  9. View and Grant technique is an non-invasive procedure similar to a Verbal autopsy. (True or False)  10. Trauma is one mechanism of death from stab wounds. (True or False)  Answer Key: F,T,T,F,F,F,T,T,T,F  REFERENCES {#references.TransOutline} ========== - **Vladimir V. Villacorte Villasenor (2024) Medicolegal Aspect of Death** - **2025 COM Transcripti** APPENDIX ======== - No appendices