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 (Bishop’s 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 supportIf person cannot survive on withdrawal- deadCornea-6 HoursSkin-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

CYANOSISCONGESTION AND DILATATION OF RIGHT SIDE OF HEARTFLUIDITY OF BLOODPULMONARY OEDEMAPETECHIAL HAEMORRHAGEPHARYNGEAL HAEMORRHAGEBRAIN – ANOXIC CHANGESSPLEEN – PALE, WRINKLED, FLABBY, CONGESTEDBLOOD

DECREASED OXYGEN CONCENTRATIONINCREASED CO2 CONCENTRATIONINCREASED LEVEL OF LACTIC ACID

SYSTEMIC FINDINGS

Sensitive neurons Ammon’s horn ( Hippocampus) 3rd, 4th, 5th 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:-

InfarctionHaemorrhageNecrosis

• HANGING

• STRANGULATION - MANUAL / LIGATURE

• SUFFOCATIONSMOTHERINGGAGGING CHOKINGTRAUMATIC 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

h Post Mortem Examination

h Mortuary facilities

h Embalming

h Preservation of viscera

h Histopathology etc.

Exhumation

• Magistrate Inquest• Procedure

Post Mortem Examination or Autopsy

hMedico-legal hPathological

hComplete Post-mortemh Partial Post-mortem

Post Mortem Examination or Autopsy

OBJECTIVESh Cause of deathh Natural or Unnatural deathh Manner of deathh Time since deathh Identityh Born alive or Not (infants)h Trace evidence if anyh Tissue/viscera for chemical analysis or other tests

RULES FOR POST-MORTEM EXAMINATION .

h Proper place (Morgue or Mortuary) h Proper Authorization( Cr.PC 174)h Day lighth Proper identificationh No unauthorized person to be presenth Decomposition is no contra Indication

RULES FOR POST-MORTEM EXAMINATION (Contd…)

hPost-mortem after sunset hPost-mortem after office hours hPost-mortem out of jurisdictionhSecond Post-mortem examinationhSecond OpinionhRefusal by relations

OBSCURE AUTOPSY

“No definite cause of death. The post-mortem findings are minimal, indefinite or no positive findings at all”.1. NATURAL h Death precipitated by emotions, work stress etc.h Functional failure h Epilepsy h Paroxysmal fibrillation 2. BIOCHEMICAL hUremia, diabetes, Potassium insufficiency etc.3. ENDOCRINE DYSFUNCTION hAdrenal, thyroid etc.

CONCEALED TRAUMAhConcussion, hSelf reduced neck injury,hBlunt injury to heart,hReflex Vagal Inhibition

MISCELLANEOUS hAllergy, drug idiosyncrasy etc.hMyocardial infarction, hcoronary artery disease etc.hPoisoning

DISEASE & TRAUMA

h Neurogenic shockh Concussion of Brainh Diffuse axonal injuryh Coronary Atherosclerosis & Heart Attack.h Enlarged liver or spleen.h Pre-existing disease of organs e.g. Brain tumor.h Exacerbation of Pre-existing disease following trauma

e.g. perforation of stomach ulcer.h Onset of disease following trauma e.g.Tumour (Brain

Tumor) or complications of operative procedures.

ARTEFACTS

Definition-“Unrelated findings likely to be misinterpreted”.h Terminal artefacts (Regurgitation).h Resuscitation artefacts (Fracture if sternum, ribs and

lacerations of liver).h Handling of dead bodies.h Due to post-mortem changes.h Due to destruction by animal and insects.h Positional artefacts (Brain).