DEATH

Is the termination/end of life.

A permanent cessation of all vital
functions.
It is an irreversible loss of the
properties of
living matter.
It is an event that takes place at a
precise
time.
Ascertainment of death is a clinical
and not

Kinds of death
1. SOMATIC DEATH (Clinical death) is
a complete and persistent cessation
of respiration, circulation and almost
all brain functions of an organism. It
is usually pronounced by a physician
or other members of the family.

2. MOLECULAR DEATH (Cellular

death) is the cessation of life of
the individual cells of the body
which occurs one at a time after
somatic death.
3. APPARENT DEATH or state of
suspended animation is a state
of temporary cessation of the vital
activities of the body or the vital
processes were depressed to the
minimum compatible to life.

Kinds of death based on

its determination:
1. Brain death
- death occurs when there is deep
irreversible coma
- absence of electrical activity
- complete cessation of all the vital
functions without possibility of
resuscitation

2. Cardio-Respiratory Death
- death occurs when there is a
continuous and persistent cessation
of heart and respiration
- is a condition in which a physician
and the members of the family
pronounced a person dead based on
common sense or intuition

SIGNS OF DEATH
1. CESSATION OF HEART ACTION
AND CIRCULATION
Examination by
1. Palpation of the pulse
2. Auscultation of heart sound
3. Use of electrocardiograph

2. Cessation of respiration
Methods of Detecting Cessation of
Respiration:
a. Movement of chest & abdomen
b. Auscultation
c. Examination with mirror
d. Examination w/ feather or cotton
fibers
e. Examination with glass of water

3. Cooling of the Body

(Algor Mortis)
The progressive fall of the body temperature is
the most prominent sign of death.
Factors Influencing the rate of the cooling of the
Body
a. Conditions that are connected w/ the body:
1) Factors delaying cooling
a) acute pyrexial disease
b) sudden death in good health
c) obesity of person
d) death from asphyxia
e) death of the middle age

2) Factors Accelerating
a) Leanness of the body
b) Extreme age
c) Long-standing or lingering illness
d) Chronic pyrexial disease
associated with wasting

b. Conditions that are connected to

surrounding
1) Factors delaying cooling
a) clothing
b) absence of air
c) small room
d) warm surroundings
2) Factors accelerating cooling
a) unclothed body
b) access of air
c) large room
d) cooling more rapid in water than in air

4. Insensibility of the Body and

Loss of Power to
Move
No kind of stimulus is capable of
letting the body have voluntary
movement.
This condition must be observed in
conjunction with cessation of heart
beat and circulation and cessation of
respiration.

5. Changes of the skin

a. Observed to be pale and waxy-looking
due to the absence of circulation.
b. Loss of elasticity of the skin result to
post-mortem contact flattening
c. Opacity of the skin due to absence of
circulation
d. Effect of the application of heat will not
produce blister or inflammatory reaction

6. Changes in and about the eye

a. Loss of corneal reflex
b. Clouding of the cornea
c. Flaccidity of the eyeball due to lose of
tone of orbital muscle
d. Dilatation of pupil due to iris muscles
loses tone

Changes in the Body Following

Death
1. Changes in the Muscle
The entire muscular tissue passes 3
stages after death:
a. Stage of primary flaccidity or muscular
irritability
-complete relaxation and softening of all
muscle of the body
-muscles are still irritable due to presence
of molecular life after somatic death
-usually lasts about 3 to 6 hours after
death

b. Stage of post mortem rigidity,

cadaveric
rigidity, death stiffening,
death struggle of
muscles or rigor
-occurs 3 to 6 hours after death, totally become stiff after 12
mortis
hours and may last for 24 to 48 hours during cold weather
and 18 to 36 hours during summer
-if rigor mortis sets in early it passes off quickly and vice
versa
-contraction of muscles is due to coagulation of the plasma
protein
-may be utilized to approximate the length of time the body
has been dead
-differ from cadaveric spasm or instantaneous rigor which
occurs at the moment of death due to extreme nervous
tension, only group of muscles are involved and usually not
symmetrical e.g. A weapon held in the hand before death
and can be removed with difficulty; thus important medicolegal point in determination whether it is a case of suicide,
murder, or homicide.
-

c. State of secondary flaccidity or

commencement of
putrefaction

-muscles becomes soft and flaccid and does not

respond to mechanical or electrical stimulus

2. Changes in the blood

a. Coagulation of the blood
-soft of consistency
-surface of blood vessel smooth
and
healthy after the clots are
remove
-clots can be stripped off in layers

b. Post-mortem lividity
This is due to the accumulation of blood in the
most dependent portions of the body.
-color is dull red o pink or purplish
-usually appears 3 to 6 hours after death and fully
developed 12 hours after death
-Importance of cadaveric or post mortem lividity:
-It is one of the sign of death
-It may determine whether the position of the
body has been changed after its appearance
in the body
-It may determine how long the person has been
dead
-It gives an idea as to the time of death

-The color of the lividity may

indicate the cause of death
a. In asphyxia, the lividity is dark
b. In carbon monoxide poisoning, the lividity is
bright pink
hemorrhage, anemia less marked
hydrocyanic acid bright red
phosphorous dark brown
potassium chlorate, potassium bichromate
chocolate or coffee brown
c. If the body is found for considerable time in snow
or ice the lividity is bright red

3. Autolytic or autodigestive
changes after death
After death body enzymes (proteolytic,
glycolytic and lipolitic) ferments
glandular tissues continue to act which
lead to autodigestion of organs.
-facilitated by weak acids and higher
temperature
-delayed by alkaline reaction of the
tissues and low temperature

4. Putrifaction of the body

This is the breaking down of the
complex protiens into simpler
components associated with the
evolution of foul smelling gasses and
accompanied by the change in colour
of the body

Duration of death
In the determination as to how long a
person has been dead the following
points must be given consideration:
1.Presence of rigor mortis, sets in from 2
to 3 hours after death, fully after 12
hours, may last for 18 hours to 36 hours
2.Presence of post mortem lividity, usually
develops 3 to 6 hours after death

Cont...
3. Onset of decomposition, 24 to 48
hours after death
4. Stage of decomposition:
12 hours Rigor mortis complete, hypostasis well-developed
and fixed. Greenish discoloration showing over the
rectum.
24 hours Rigor mortis absent all over. Greenish
discoloration
over whole abdomen and spreading to
chest.
Abdomen distended with gasses.
48 hours Ova of flies seen. Trunk bloated. Face discoloured
and swollen. Blisters present. Moving maggots seen.

Cont...
72 hours
disfigured. Hair
and discolored.
One week

Whole body grossly swollen and

and nails loose. Tissue soft

Soft viscera putrified.

Two weeks
Only more resistant viscera
distinguished. Soft
tissues largely
gone.
One month

Body skeletonized.

5. Entomology of the cadaver

The common flies undergo as egg,
larval, pupal and adult stage.
Usual time for the egg to be
hatched into larva is 24 hours so that
by the presence of maggots in the
cadaver death has occurred more
than 24 hours.

6. Stage of digestion of stomach

It takes normally 3 to 4 hours for
stomach to evacuate its contents after
meals; however this is influenced by
the following factors:
a. Size of last meal
stomach starts to empty w/in 10
minutes after the first food entered, light meal leaves stomach
w/in
1-1/2 to 2 hours after being eaten, medium size
after 3 to 4 hours, and heavy meal after 4 to 6 hours.

b. Kind of meal
liquid move more rapidly than semi-solid
and the
latter more rapidly than solids.

Cont...
c. Personal variation
psychogenic pylorospasm can
prevent
departure of the meal from the stomach for
several hours, while a hypermotile
stomach may
enhance entry of food into
duodenum.
d. Other factors
vegetables needs time for gastric
digestion, less fragmented food needs more time to stay in
the stomach,
absence or insufficiency of gastric
enzymes (e.g. Pepsin) and hydrochloric acid and lesser
amount of liquid consumed with solid food will delay
gastric evacuation.

7. Presence of Live Flea in the clothing

in drowning cases:
Flea can survive 24 hours
submerged in water and can no
longer be revived more than 24
hours.

8. State of clothing
9. Chemical changes in the cerebro-spinal
fluid (15 hours following death)
a. Lactic acid increases from 15 mg to 200 mg per 100 cc
b. Non-protein nitrogen increases from 15 to 40 mg
c. Amino-acid concentration rises from 1 to 12 % following death

10. Post mortem clotting and decoagulation

of blood
- blood clots inside the blood vessels in 6 to 8 hours after
death
-decoagulation of blood occurs at the early stage of
decomposition.

11. Presence of absence of soft tissues

in skeletal remains
Under ordinary condition the soft
tissues of the body may disappear 1
to 2 years after burial.
12. Condition of the bones

Causes of Death
The primary purpose of medicolegal autopsy is the determination of
the cause of death. It must also be
shown that the death is the direct
and proximate consequence of the
criminal or negligent act of someone.

1. Immediate (primary) cause

of death
This applies to cases when
trauma or disease kill quickly
that there is no opportunity for
sequelae or complication
develop.

2. Proximate (secondary) cause

of death
The injury or disease was survived
for a sufficiently prolonged interval
w/c permitted the development of
serious sequelae which actually
caused death. E.g. Stab wound in the
abdomen later caused generalized
peritonitis, the peritonitis is the
proximate cause of death.

The mechanism of death is

the physiologic derangement or
biochemical disturbance
incompatible with life which is
initiated by the cause of death.
E.g. Hemorrhagic shock,
metabolic disturbance,
respiratory depression, toxemic
condition, cardiac arrest,
tamponade, etc.

The manner of death is the

explanation as to how the cause of
death came into being or how the
cause of death arose. It is either
natural or violent.

1. Natural death

It is natural when the fatality is

caused solely by disease.

2. Violent death
Death due to injury of any sort
(gunshot, stab, fracture, traumatic
shock, etc.)
1) accidental death
2) negligent death
3) infanticide death
4) parricide death
5) murder
6) homicidal death

Degree of certainty to the

cause of death
1. When the structural abnormalities established beyond doubt
the identity of the cause of death e.g. Stab wound w/ profuse
hemorrhage, crushing head injury in v.a.
2. When there is degree of probability amounting to almost
certainty the cause of death e.g. Electrical shock, lobar
pneumonia.
3. When the cause of death is established primarily by
historical facts which are confirmed or supported by positive
or negative anatomic or chemical findings e.g. Tetanus,
rabies, drug reaction.
4. When history, laboratory and anatomic findings, taken
individually or in combination is sufficient to determine the
cause of death; but merely speculate as to the cause of
death e.g. Crib death among infants.

Steps in the Intellectual

Process in the
determination of the cause
1. Recognition ofof
the death
structural organic changes
or chemical abnormalities responsible for the
cessation of vital function.
2. Understanding and exposition of the
mechanism by which the anatomic and other
deviations from the normal actually caused
the death, or how the deviation created or
initiated the train of sufficiently potent
functional disturbance which led ultimately
either to cardiac standstill or to respiratory
arrest.

Hanging/Garroting/Poisoning

From: Legal Medicine by Solis

presented by:
Rey J. Millena, MD, MCHM, DPCAM