Thanatology

Science Dealing with death

Clinical Death
Brain Death
Biological Death
Cellular Death
Brain Death due to lack of oxygen
Cerebral Cortex-Cerebellum-Lower brain
centres-brain stem and vital centres
Legal Issues
Section 46 of IPC deals with death
Death denotes death of a human being unless the
contrary appears from the context.
Registration of Births and Deaths Act Sec.2(b)
defines death as permanent disappearance of
all evidence of life at any time after live birth
has taken place.
DEFINITION OF DEATH
Permanent and Irreversible stoppage of
vital functions of life
Vital Functions
Brain, Heart and Lung
Somatic Death/Biological death
Complete and irreversible cessation of
circulation, respiration and brain
functions (Bishops Tripod of Life)
DEFINITION OF DEATH
Molecular death- death of cells and tissues
individually-depends upon oxygen and
metbolism-Nerve-5 min, muscle-1-2 hours

Definition of Death became in question due to
invention of ventilator, heart lung machine and
organ transplantation.
Circulation of oxygenated blood to brain is
maintained.
Death is tested by withdrawal of life support
If person cannot survive on withdrawal- dead
Cornea-6 Hours
Skin-24 Hours, Bone-48 Hours
HUMAN ORGAN TRANSPLANTATION ACT 1994
Brainstem death means the stage at which all
functions of the brain stem have irreversibly
and permanently ceased and is so certified
under subsection 6 of Section 3
(Section 3 (6), Incharge of Hospital, independent
specialist from the penal,
Neurologist/Neurosurgeon and treating doctor)
MODES Of DEATH
ASHPYXIA- Primarily due to Respiratory
failure
COMA-Primarily death is due to Brain
damage
SYNCOPE- Death due to cessation of Heart



LACK OF OXYGEN TO TISSUES AND FAI LURE
TO ELIMINATE CARBONDIOXIDE

Or

INTERFERENCE IN EXCHANGE OF GASES
AT ANY LEVEL
ASPHYXIA
Stages/Symptoms
Dyspnoea
Convulsion
Exhaustion-Death
CYANOSIS
CONGESTION AND DILATATION OF RIGHT SIDE OF
HEART
FLUIDITY OF BLOOD
PULMONARY OEDEMA
PETECHIAL HAEMORRHAGE
PHARYNGEAL HAEMORRHAGE
BRAIN ANOXIC CHANGES
SPLEEN PALE, WRINKLED, FLABBY, CONGESTED
BLOOD
DECREASED OXYGEN CONCENTRATION
INCREASED CO2 CONCENTRATION
INCREASED LEVEL OF LACTIC ACID

SYSTEMIC FINDINGS
Sensitive neurons
Ammons horn ( Hippocampus)
3
rd
, 4
th
, 5
th
layers of cerebral cortex in sulci
Basal nuclei
Purkinje cells in cerebellum

Cerebral Hypoxia
Cerebral cortex
Basal Ganglia
Brain Stem

DAMAGE

Irreversible damage after 1-2 min. of Anoxia
Autoregulation plays important role
Damage may be Local or Diffuse
Common lesions are:-
Infarction
Haemorrhage
Necrosis


HANGING

STRANGULATION - MANUAL / LIGATURE

SUFFOCATION
SMOTHERING
GAGGING
CHOKING
TRAUMATIC ASPHYXIA

DROWNING or IMMERSION
ASPHYXIA
Types and Causes
Mechanical
Pathological- Bronchitis, lung disease
Toxic- Poisoning gelsemium, CO opium sedatives
Environmental- Enclosed space, high altitude
sewer gas etc
Traumatic-Fat and air embolism
Postural- Alcohol drug or disease, unconscious
patient or stupourous, upper half lower than
reaming
Iatrogenic with anaesthetic drugs
Cycle of asphyxia
Reduction in oxygen tension
Capillary Dilatation
Capillary Stasis
Capillary engorgement
Stasis of blood in organs
Decreased venous return to heart
Decreased blood flow to lung
Deficient oxygenation in lung

COMA
It is a state of unarousable unconsciousness
determined by the absence of any
psychologically understandable response to
external stimuli or internal need
It involves central portion of the brain stem.
It is a clinical symptom and not cause of death
Causes of Coma
Compression of brain-tumour, blood
inflammation or infection
Drugs- Sedatives, cocaine anesthetics, alcohol
Metabolic disorder or infections- Uremia,
eclampsia, diabetes, heat stroke etc.
Others- Thromboembolism, hysteria, epilepsy.
SYNCOPE
Sudden stoppage of action of heart,
May be fatal
Vaso Vagal Attacks-parasympathetic
stimulation
Caused by reflex bradycardia or asystole or
splanchnic vasodilataion
Sudden fall of BP-Cerebral Anaemia-rapid
unconsciousness-recovery
Causes
Anaemia-sudden and excessive bleeding
Asthenia-degeneration of heart muscle, MI
Vagal inhibition
Exhausting Diseases
FORENSIC PATHOLOGY
Post Mortem Examination
Mortuary facilities
Embalming
Preservation of viscera
Histopathology etc.
Exhumation
Magistrate Inquest
Procedure
Post Mortem Examination or Autopsy
Medico-legal
Pathological

Complete Post-mortem
Partial Post-mortem

Post Mortem Examination or Autopsy
OBJECTIVES
Cause of death
Natural or Unnatural death
Manner of death
Time since death
Identity
Born alive or Not (infants)
Trace evidence if any
Tissue/viscera for chemical analysis or other tests

RULES FOR POST-MORTEM EXAMINATION
.
Proper place (Morgue or Mortuary)
Proper Authorization( Cr.PC 174)
Day light
Proper identification
No unauthorized person to be present
Decomposition is no contra Indication
RULES FOR POST-MORTEM EXAMINATION
(Contd)
Post-mortem after sunset
Post-mortem after office hours
Post-mortem out of jurisdiction
Second Post-mortem examination
Second Opinion
Refusal by relations
OBSCURE AUTOPSY
No definite cause of death. The post-mortem findings
are minimal, indefinite or no positive findings at all.
1. NATURAL
Death precipitated by emotions, work stress etc.
Functional failure
Epilepsy
Paroxysmal fibrillation
2. BIOCHEMICAL
Uremia, diabetes, Potassium insufficiency etc.
3. ENDOCRINE DYSFUNCTION
Adrenal, thyroid etc.
CONCEALED TRAUMA
Concussion,
Self reduced neck injury,
Blunt injury to heart,
Reflex Vagal Inhibition
MISCELLANEOUS
Allergy, drug idiosyncrasy etc.
Myocardial infarction,
coronary artery disease etc.
Poisoning
DISEASE & TRAUMA

Neurogenic shock
Concussion of Brain
Diffuse axonal injury
Coronary Atherosclerosis & Heart Attack.
Enlarged liver or spleen.
Pre-existing disease of organs e.g. Brain tumor.
Exacerbation of Pre-existing disease following trauma
e.g. perforation of stomach ulcer.
Onset of disease following trauma e.g.Tumour (Brain
Tumor) or complications of operative procedures.


ARTEFACTS

Definition-Unrelated findings likely to be misinterpreted.
Terminal artefacts (Regurgitation).
Resuscitation artefacts (Fracture if sternum, ribs and
lacerations of liver).
Handling of dead bodies.
Due to post-mortem changes.
Due to destruction by animal and insects.
Positional artefacts (Brain).