Medico legal aspect of death

Death is defined as absence of life in a living manner. It is the termination of life

and complete loss of the vital functions of the human body.
In human being, signs of life include the locomotion, respiration, circulation, brain
activity and presence of faculty of senses. The ascertainment of death is a clinical
and not a legal problem.
In medico-legal death, it refers to the death which involve in a crime or medico-legal
cases to prove or disprove that a foul play has been done.

Importance of death determination

1.
2.
3.
4.
5.

Personality of the person is extinguished by death.

Criminal liability is extinguished by death.
Property of a person is transmitted to heirs or nearest kin.
Basis of immediate removal of organs for transplantation.
Civil case for claim is dismissed.

Kinds of death
1. Somatic death
It is a complete, continuous and persistent cessation of respiration,
circulation and almost all brain functions of an organism.
The immediate signs of death in a person are sudden cessation of upward
and downward movements of the chest and process of respiration, sudden
appearance of pale color of the face and lips, the heart beat and the pulse
stops, jaw drops down and flaccidity of the muscles occurs, pupils are dilated
and loss of corneal and light reflexes.
Clinical type of death
A. Sociological death type of death wherein the withdrawal and separation
from the patient by the others producing a sense of isolation and
abandonment.
B. Psychic death the condition of death wherein the patient regresses,
gives up or surrenders accepting death prematurely and refuses to
continue living.
C. Biological death type of death characterized by the absence of cognitive
function of awareness, although artificial support system may maintain
organ functioning.
D. Physiologic death type of death when all vital organs cease to function.
2.

Molecular death or cellular death.

It is the cessation of life of the individual cells in the body which occurs one at
a time after somatic death. Nerve and brain cells die earlier about 5 minutes
after somatic death, while muscle cells live longer until the onset of rigor
mortis which is 2 6 hours.
3. Apparent death or state of suspended animation
It is a state of temporary cessation of vital activities of the body. This
condition is not actually death although classified under the kinds of death
because the person is still alive although it seems that there are no signs of
life. Apparent death may be seen in a disease or condition like hysteria,
drowning and electrocution and sometimes in new-born infants.

Answer to the following questions must be obtained in any case of death which is
the subject of an official investigation.
1. Is the body dead?
2. How long has the body been dead?
3. What is the cause of death?
Signs of death
The most useful signs of death are those which can be detected by external
examination of the body.
1. Loss or power to move and insensibility of the body as determined by visual
inspection
2. Stoppage of respiration.
A person can hold his breath not longer than 3 minutes.
A. Upward and downward movement of the chest and abdomen must be
observed. No movement upon death.
B. Palpation of the respiratory movement.
C. Examination by the aid of stethoscope. Flow air car be heard if there is
respiration.
D. Mirror test. Dimming of the mirror due to the condensation if respiration is
present.
E. Placing a feather of cotton fiber in the nostril and mouth. If there is a
movement then respiration is present.
3. Stoppage of heart action and circulation.
If there is no heart action for period of 5 -10 minutes, death is considered
certain.
Upon death, the heart stops beating in a persistent and continuous which
cannot be revived by the cardiac massage and other resuscitative measures
for a period of 5 minutes.

In case of decapitation and hanging, the heart beat persist for 15 minutes to
1 hour.
Methods of detecting stoppage of heart action and circulation.
A. Heart action
1. Palpation of the heart
2. Auscultation with the aid of stethoscope
3. Electrocardiogram ( ECG )
B. Examination of peripheral circulation
1. Magnus test ligature is tied around the finger, blood zone at the site
of the application and livid area distal to the ligature.
2. Palpation of the radial pulse, carotid pulse and femoral pulse.
3. Icards test - subcutaneous injection of the flourescin dye, the skin will
exibit yellow green discoloration of the living skin.
4. Diaphanous test reddish color of the web of the fingers when the
hand is placed against a sharp light.
4. Loss of body heat resulting to cooling of the body ( ALGOR MORTIS )
When life is extinct and the heat production in the body stops and its
temperature is lowered gradually to that of the surroundings. The lowering of
temperature is one of the earliest sign of death.
5. Changes in the eyes
Upon death, when the eyes are open, the person stares without movement
of the eyes in any direction. Further examination will reveal the following
changes of the eyes.
A. Loss of corneal and light reflexes the cornea will not have a reaction of
winking the eyes, of contraction of the pupil when touch or stimulated by
light.
B. Haziness or clouding of the cornea a white patch may be seen at the
cornea when the eyes are exposed to dry atmosphere after death.
C. Fixation of the pupil the pupil will be fixed and dilated.
6.

Changes in the skin.

A. Change in color upon death, the skin of the face, lips and body becomes
pale and waxy.
B. Loss of elasticity of the skin
C. Absence of reaction to injury application of heat will not produce blister.

Changes of the body after death

The changes that occurred in the body at the time of death or within the next
few minutes or hours are very important to be used in determining that death has
taken place in a person.

Stages of muscular change.

A. Stage of primary flaccidity it is the stage of muscular change upon death
characterized the relaxation of the muscles and the loss of their natural tone
so the jaw of the head drops down. The thorax collapses andt he limbs
become flaccid and the splinter becomes relax. This stage may last 3 4
hours after death.
B. Stage of post mortem rigidity or rigor mortiz the whole body become rigid
due to contraction of muscles. This develops 3 4 hours after death and my
last for 18 to 36 hours.
Condition simulating rigor mortis
1. Heat stiffening a condition characterized by hardening of the muscles
due to coagulation of muscle protein when the dead body is exposed to
intense heat as by burning or immersion to hot liquid.
2. Cold stiffening a condition characterized by hardening of the muscles
due to the solidification of fats, muscles and fluid when the dead body
is exposed to extremely cold temperature.
3. Cadaveric spasm or spontaneous rigidity it is instant stiffening of the
certain group of muscles which occurs immediately at the moment of
death, although its cause is unknown, it is associated with violent
death due to extreme nervous tension, and injury to central nervous
system.
C. Stage of secondary flaccidity a muscular change characterized by the
softness and flaccidity of the muscles in which no longer response to
electrical or mechanical stimuli, due to dissolution of muscle proteins that has
been previously coagulated during the stage of rigor mortis. This stage is the
onset of putrefaction.
Putrefaction
-

is the process of dissolution of tissue by digestive action of its enzymes and

bacteria that results in softening and liquefaction of tissues are usually
accompanied by the liberation of foul smelling gases and change of color of
tissue.
Some authorities defined putrefaction as the breaking down of complex
protein, carbohydrates, vitamins and minerals to simplier components by the
action of its enzymes and bacteria resulting to softening and liquefaction,
liberation of putrid gases and change in color of tissues.

The flies will be attracted to the dead body during putrefaction and sipped the
juicy portion of the tissue.
The egg hatched within 24 hours and form maggots which again feed vigorously
on damage tissue.

Other destructive agents in decompositions are the rodents, lizard, vultures, ants
and dogs. Fishes and aquatic mammals, when dead body is in the water.

Sequence of events in putrefaction of dead body in tropical country.

After 1 2 days ( 24 48 hours)
Rigor mortis is absent, putrefaction changes, muscles are soft and
flaccid. Greenish discoloration over the abdomen. Some veins beneath
the skin seen as interlacing purplish brown network over the shoulder,
chest and abdomen known as marbolization.
3rd day (72 hours )
Abdomen distended with gases, trunk bloated, hair and nails loosened
from its attachment. Blister formation and blebs. Face grossly swollen
and discoloured. Maggots seen.
1 week ( 7 days)
Further bloating of the body and discoloration of the skin. Bursting of
blister and denudation of the skin. Soft tissue continues to putrefy.
2 weeks ( 14 days )
Detachment of the hair and nails from its attachment. Bursting of the
thorax and abdomen. Further dissolution of more resistant viscera.
1 month body completely skeletonized.
The speed in which process of destruction occurs defends on wether
the body is decaying in air, water or underneath the earth. Process
more rapid in the air than 2 media expressed by old formula which
states that 1 week in air is equivalent to 2 weeks in water or 8 weeks
in the soil.
Special forms of putrefaction
1. Mummification
A condition where is removal of body fluid before decomposition set in
that results to shrinking and preservation of the body.

Natural mummification the dead is only buried or exposed to dry, hot

sandy oil with considerable air movements.
Artificial mummification or embalming is a form which preserve the
dead body by the addition of some chemicals like formalin, alcohol,
phenol, mercury and arsenic and covering the skin with plaster of
Paris.
2. Saponification or adipocere formation.
It is a formation of a soft, friable and brownish white greasy substance.
This substance is called adipocere and formed by the post mortem
hydrolysis and dehydrogenation of the body fats. Adipocere is a soapy
or waxy material, rancid in smell, dissolves in alcohol and ether when
burned produces yellow flame.
3. Maceration
It is a condition of the dead body usually the fetus characterized by
softening and discoloration of the tissue as well as formation of blister
in the skin due to the action of circulation autolytic or proteolytic
enzymes in the absence of putrefactive bacteria.
Changes of the blood after death
Change of color
After death, the heart stops beating followed by stoppage of circulation.
The stasis in circulation the blood from capillaries and veins to accumulate
in the most dependent portion of the body due to the pull of gravity
producing discoloration in those areas not subjected to pressure.
Post mortem lividity or livor mortis.
A discoloration of the body after death when the blood tend to pool in the
blood vessels of the most dependent portion of the body which appears
20 30 minutes after death and complete in about 12 hours.
The usual color is dull red or reddish purple with some bluish black
petechiae due to rupture of small engorged capillaries.
Importance of livor mortis
1. One of the signs of death
2. Determines the protein maintains by the body after death
Basis in estimating the time of death
1. General physical changes a warm supple of body with moist, transparent
cornea and moist lips as well the absence of post mortem lividity are a
condition of recent death.
2. Post mortem lividity or livor mortis the onset of post mortem lividity is 20
30 minutes and complete about 12 hours.

3. Post mortem rigidity or rigor mortis onset is 3 4 hours after death and
completed in about 12 hours. May last 24 -36 hours in tropical countries.
4. Onset and state of decomposition in tropical countries, the onset of
decomposition is 1 2 days after death and skeletonized in a months time.
5. Life cycle of flies the egg or ova laid on the dead body will hatch to form
maggots with 24 hours. The maggots will feed vigorously on the damaged
dead bodies, then transform into pupal stage and finally into adult flies within
few days.
6. Change in body temperature upon death, body temperature decreases
gradually until it reaches the temperature of the environment.
7. Changes in the blood the blood remain fluid in the body after death for 6 9
hours.
8. Changes in the stomach it is usually takes 3 4 hours for the stomach to
empty its content after meals.
9. Changes in the hair the rate of growth of hair loss have been estimated
from 0.4mm 0.5mm/day.
10.Changes in the urinary bladder the amount of urine in the bladder may
indicate the time of death when taken into consideration the time when the
person urinates or evacuates his urinary bladder.
11.States of clothing if the dead person is well dressed, it is most likely that
death occurs at day time, but if wearing pajamas or nightgown, it is possible
that the death occurs at night time and probably at home.
12.Presence or absence of fleas in the clothing of the dead person in water if
fleas in the clothing of a drowned person are still alive, then the person has
been in water less than 24 hours. Survival of the fleas is not possible if they
are in water for more than 24 hours.