POST MORTEM CHANGESPOST MORTEM CHANGES

Signs of DeathSigns of Death

AndAnd

Postmortem changes after deathPostmortem changes after death

Immediate ChangesImmediate Changes Early ChangesEarly Changes Late ChangesLate Changes

Immediate changesImmediate changes

• Permanent Cessation of Brain functionPermanent Cessation of Brain function

• Complete Cessation of Circulatory functionComplete Cessation of Circulatory function

• Entire and permanent cessation of Respiratory Entire and permanent cessation of Respiratory

functionfunction

Permanent Cessation of Brain function:Permanent Cessation of Brain function:

• Loss of Sensations; viz,Loss of Sensations; viz,

touch, pain and temperaturetouch, pain and temperature• Loss of reflexesLoss of reflexes• Total loss of E.E.G. RhythemTotal loss of E.E.G. Rhythem• Confirmation of Brain- stem deathConfirmation of Brain- stem death

Brain –stem death:Brain –stem death:

• The patient must be comatose state at least six The patient must be comatose state at least six hours.hours.

• No Abnormal Decorticate or decerebrate No Abnormal Decorticate or decerebrate postures should be presentpostures should be present

• All brain-stem reflexes must be absentAll brain-stem reflexes must be absent ..

• Pupils should be fixedPupils should be fixed• No Corneal reflexNo Corneal reflex• Absent of the oculo-cepralic reflexAbsent of the oculo-cepralic reflex• Absent vestibulo-ocular reflexesAbsent vestibulo-ocular reflexes• No Motor responsesNo Motor responses• No Gag reflexNo Gag reflex• No Respiratory movementsNo Respiratory movements

After disconnection of ventilator.After disconnection of ventilator.

Complete Cessation of Circulatory FunctionComplete Cessation of Circulatory Function

• Magnus’s testMagnus’s test• Finger nail testFinger nail test• Diaphanous testDiaphanous test• Icard’s Fluorescein testIcard’s Fluorescein test• Heat testHeat test• Artery incision testArtery incision test• A flat E.C.G. for a continuous period of five A flat E.C.G. for a continuous period of five

minutesminutes

Entire and permanent cessation of respiratory Entire and permanent cessation of respiratory functionfunction

• Mirror testMirror test• Feather testFeather test• Winslow’s glass water test.Winslow’s glass water test.

Suspended AnimationSuspended Animation

It is a condition in which the vital functions of the body It is a condition in which the vital functions of the body are at such a low level that they cannot be appreciated are at such a low level that they cannot be appreciated by clinical examinationby clinical examination

Apparent deathApparent death

This may last few seconds to minutes. This may last few seconds to minutes. Voluntary- by yogisVoluntary- by yogis

Involuntary – drowning, electrocution, heat stroke, Involuntary – drowning, electrocution, heat stroke, typhoid fever etc. typhoid fever etc.

Early ChangesEarly Changes

• Changes in the eyeChanges in the eye

• Changes in the skinChanges in the skin

• Cooling of the body/Algor mortisCooling of the body/Algor mortis

• Post mortem lividity/HypostasisPost mortem lividity/Hypostasis

• Rigor mortis/Cadaveric rigidityRigor mortis/Cadaveric rigidity

Changes in the eyeChanges in the eye

Corneal Changes;Corneal Changes;• Loss of Clear GlisteningLoss of Clear Glistening• Dry, Cloudy and opaqueDry, Cloudy and opaque• Loss of reflexesLoss of reflexes• Light reflex abolishedLight reflex abolished

• Intra Ocular tension falls, eye balls become flaccid Intra Ocular tension falls, eye balls become flaccid and sink in the orbitand sink in the orbit

• Blood flow in the retina becomes dotted and Blood flow in the retina becomes dotted and segmented looksegmented look..

• Optic disc looks pale.Optic disc looks pale.

• Pupils fully dilated in the early stage and constict Pupils fully dilated in the early stage and constict

later due rigor mortis.later due rigor mortis.

• Brownish discolouration of the sclera due to cellular Brownish discolouration of the sclera due to cellular

debris and dustdebris and dust

Taches NoiresTaches Noires

Changes in the SkinChanges in the Skin

• Loss of its translucencyLoss of its translucency• Pale and Ashy white appearancePale and Ashy white appearance• Loss of ElasticityLoss of Elasticity• Wounds will not gape if it is inflicted after Wounds will not gape if it is inflicted after

deathdeath• Wounds caused during life will retain their Wounds caused during life will retain their

characteristic features.characteristic features.

Cooling of the bodyCooling of the body

• Imbalance between heat production and heat Imbalance between heat production and heat loss.loss.

• Loss of heat of body by means of conduction Loss of heat of body by means of conduction convection and radiation, till it balances with convection and radiation, till it balances with the temperature of surroundings.the temperature of surroundings.

• Rate of cooling is fast during first few hours Rate of cooling is fast during first few hours and later slows.and later slows.

• Temperature is recorded by Chemical Temperature is recorded by Chemical thermometer- Thanotometer 25 cms.thermometer- Thanotometer 25 cms.

• Recording of temperature :Recording of temperature :

Normal temp. – Rectal temp.Normal temp. – Rectal temp.

Rate of temp. fall/hourRate of temp. fall/hour• Variation of body temperatureVariation of body temperature• Conditions in which heat may be retained or Conditions in which heat may be retained or

increased.increased.

- Sun stroke and pontine haemorrhage, Sun stroke and pontine haemorrhage, disturbed heat regulating mechanism.disturbed heat regulating mechanism.

- Tetanus and strychnine poisoning, due to Tetanus and strychnine poisoning, due to increase in heat production in the muscle.increase in heat production in the muscle.

- Acute bacterial or viral infection, lobar Acute bacterial or viral infection, lobar pneumonia, typhoid fever, encephalitis, etc.pneumonia, typhoid fever, encephalitis, etc.

- Intense asphyxial conditions- rise of temp by Intense asphyxial conditions- rise of temp by 2-3 c at death2-3 c at death

“ “ Postmortem Caloricity”Postmortem Caloricity”

The rate of cooling of the body is modified by The rate of cooling of the body is modified by the following conditions;the following conditions;

• AgeAge• Condition of the bodyCondition of the body• Mode of deathMode of death• SurroundingsSurroundings• Environmental temperatureEnvironmental temperature

Postmortem LividityPostmortem Lividity

It means discolouration or staining of the skin It means discolouration or staining of the skin and organs after death due to accumulation of and organs after death due to accumulation of fluid blood in the dependent parts of the body.fluid blood in the dependent parts of the body.

Post mortem staining/Hypostasis/Suggilation/ Post mortem staining/Hypostasis/Suggilation/ Vibices/ Livour mortis.Vibices/ Livour mortis.

1- 3 hr. Starts1- 3 hr. Starts

6-8 hr. Fixes.6-8 hr. Fixes.

• Commencement of LividityCommencement of Lividity

• Development of lividityDevelopment of lividity

• Fixation of lividityFixation of lividity

• Site of distributionSite of distribution

• PatternPattern

• ExtentExtent

• Difference between lividity and bruise.Difference between lividity and bruise.

Medico-Legal Importance Medico-Legal Importance

• It is a reliable sign of deathIt is a reliable sign of death• It gives the information about the position of It gives the information about the position of

the body at the time of deaththe body at the time of death• Time since death can be estimatedTime since death can be estimated• Colour suggest the cause of deathColour suggest the cause of death• Distribution of lividity may give the Distribution of lividity may give the

information about the manner of deathinformation about the manner of death

Changes in the MusclesChanges in the Muscles

• Primary relaxation/ FlaccidityPrimary relaxation/ Flaccidity

• Rigor mortis/Cadaveric rigidityRigor mortis/Cadaveric rigidity

• Secondary relaxationSecondary relaxation

Primary relaxationPrimary relaxation

Starts immediately after death with generalised Starts immediately after death with generalised relaxation of muscle tone:relaxation of muscle tone:

• Drop of lower JawDrop of lower Jaw• Eye balls lose their tensionEye balls lose their tension• Pupils are dilatedPupils are dilated• Joints are flabbyJoints are flabby• Smooth relaxation- incontinence of Urine and Smooth relaxation- incontinence of Urine and

Faeces.Faeces.

Rigor Mortis/ Cadaveric rigidity :Rigor Mortis/ Cadaveric rigidity :

This phenomenon comes immediately after the This phenomenon comes immediately after the muscles have lost the power of contractility muscles have lost the power of contractility and is irreversible changes in the muscles of and is irreversible changes in the muscles of the body, both voluntary and involuntary.the body, both voluntary and involuntary.

MyofibrilsMyofibrilsMyosin and ActinMyosin and ActinAdenosine Triphosphate – A.T.P.Adenosine Triphosphate – A.T.P.

Time of Onset :Time of Onset :

Temperate climates – 3-6 hoursTemperate climates – 3-6 hours

Tropical climates – 1-2 hoursTropical climates – 1-2 hours• Rigor mortis generally occurs when body is Rigor mortis generally occurs when body is

cold.cold.• Not related to nerves actionNot related to nerves action• Develops in paralysed limbs alsoDevelops in paralysed limbs also• First appear in involuntary musclesFirst appear in involuntary muscles• Last to be affected finger and toes muscles.Last to be affected finger and toes muscles.

Duration :Duration :

* Temperate climate – lasts for 2-3 days.* Temperate climate – lasts for 2-3 days.• Tropical climate – 24 – 48 hours in winter Tropical climate – 24 – 48 hours in winter

18 - 36 hours in summer18 - 36 hours in summer• In general – 1-2 hours sets onIn general – 1-2 hours sets on

for , 12 hours developsfor , 12 hours develops

for - 12 hours maintainesfor - 12 hours maintaines

and after 12 hours passes of and after 12 hours passes of

Circumstances modifying the Onset and Circumstances modifying the Onset and Duration of Rigor mortis.Duration of Rigor mortis.

Age- Rigor – Mortis is very rare in premature Age- Rigor – Mortis is very rare in premature

infants.infants.

Rigor –mortis is slow in adolescentRigor –mortis is slow in adolescent

and healthy adultsand healthy adults

Muscular conditon and activity before death.Muscular conditon and activity before death.

Onset is slow and duration is longer in muscular Onset is slow and duration is longer in muscular and healthy body at rest.and healthy body at rest.

Manner of death :Manner of death :

• In wasting disease and great exhaustion- In wasting disease and great exhaustion- cholera, plague, typhoid, T.B. Cancer etc. the cholera, plague, typhoid, T.B. Cancer etc. the onset is early and disappears soon.onset is early and disappears soon.

• In diseases – Pneumonia, asphyxia and In diseases – Pneumonia, asphyxia and nervous conditions- onset is delayed nervous conditions- onset is delayed Atmospheric condtions:Atmospheric condtions:

• In dry and cold air-onset slow and lost for long In dry and cold air-onset slow and lost for long time. Warm and moist air onset is rapid and time. Warm and moist air onset is rapid and duration short. duration short.

Conditions Simulating Rigor-MortisConditions Simulating Rigor-Mortis

• Heat StiffeningHeat Stiffening• Cold StiffeningCold Stiffening• Cadaveric SpasmCadaveric Spasm

Secondary Relaxation :Secondary Relaxation :• Muscles become soft and FlaccidMuscles become soft and Flaccid• Do not respond to a mechnical and electrical Do not respond to a mechnical and electrical

stimulus. stimulus.

Late Signs Of DeathLate Signs Of Death

Decomposition / Putrefaction.Decomposition / Putrefaction.

Adipocere formation / Saponification.Adipocere formation / Saponification.

Mummification.Mummification.

Decomposition / PutrefactionDecomposition / Putrefaction Last stage in the resolution of the body,from the Last stage in the resolution of the body,from the

organic to the inorganic state, is a certain sign of organic to the inorganic state, is a certain sign of death.death.

AUTOLYSISAUTOLYSIS Rise of enzyme levels in the tissue cells after Rise of enzyme levels in the tissue cells after

death.death. Softening & liquefying of the body tissue.Softening & liquefying of the body tissue. Starts 3-4 hrs after death and continues for 2-3 Starts 3-4 hrs after death and continues for 2-3

days.days.

BACTERIAL ACTIONBACTERIAL ACTION Action of bacterial enzymes on tissue Action of bacterial enzymes on tissue

components – carbohydrates/fat/proteins.components – carbohydrates/fat/proteins. Bacterial growth – warmth,moisture are Bacterial growth – warmth,moisture are

conditions favourable.conditions favourable. Clostridium welchii, streptococci, E coli, B Clostridium welchii, streptococci, E coli, B

proteus.proteus.

CHARACTERISTIC FEATURESCHARACTERISTIC FEATURES

COLOUR CHANGESCOLOUR CHANGES Greenish discoloration of skin over caecum Greenish discoloration of skin over caecum

and flanks after death appears 18-24 hrs.and flanks after death appears 18-24 hrs. Greenish to black discoloration- Greenish to black discoloration-

‘Sulphmethahaemoglobin’ formed by H2S ‘Sulphmethahaemoglobin’ formed by H2S due to microorganisms in the large intestine. due to microorganisms in the large intestine.

Appears early in summer & delayed in winter.Appears early in summer & delayed in winter.

Discoloration spreads- front of abdomen, Discoloration spreads- front of abdomen, external genitals, chest, neck, face, arms external genitals, chest, neck, face, arms and legs – spreads whole body in 24-36 hrs.and legs – spreads whole body in 24-36 hrs.

Discoloration of vessel walls due to Discoloration of vessel walls due to pigmentation from decomposed blood over pigmentation from decomposed blood over the shoulder and groin. the shoulder and groin. Arborescent Arborescent pattern- ‘Marbling’pattern- ‘Marbling’

GASES OF PUTRIFACTIONGASES OF PUTRIFACTION Development of gases under the skin and Development of gases under the skin and

hollow viscera 18-36 hrs. 24-48 hrs in solid hollow viscera 18-36 hrs. 24-48 hrs in solid viscera.viscera.

HH22S, ammonia, phosphated hydrogen, COS, ammonia, phosphated hydrogen, CO22 and methane.and methane.

Causes pseudo rigidity, exerts pressure.Causes pseudo rigidity, exerts pressure. More gases accumulation, body floats in More gases accumulation, body floats in

water.water.

PRESSURE EFFECTS OF PUTREFACTIVE PRESSURE EFFECTS OF PUTREFACTIVE GASESGASES

Displaces the diaphragm upwards.Displaces the diaphragm upwards. Discolored fluid and liquefied tissue mixes with Discolored fluid and liquefied tissue mixes with

gases producing froth.gases producing froth. Bloating of the features.Bloating of the features. Shifting of the area of hypostasis.Shifting of the area of hypostasis. Changes in skin, hair and wound.Changes in skin, hair and wound. Extrusion of fluid from the mouth and nose.Extrusion of fluid from the mouth and nose. Emptying of the heart.Emptying of the heart. Changes in appearance of genitals.Changes in appearance of genitals.

APPEARANCE OF MAGGOTSAPPEARANCE OF MAGGOTS Flies lay eggs over the decomposed body- Flies lay eggs over the decomposed body-

nose, mouth, vagina and anus in 18-36 hrs.nose, mouth, vagina and anus in 18-36 hrs. After 24-36 hrs eggs hatch into larvae or After 24-36 hrs eggs hatch into larvae or

maggots, enter the body and destroy the maggots, enter the body and destroy the tissues.tissues.

After 4-5 days develop into pupae.After 4-5 days develop into pupae. After 7-8 days into adult fly.After 7-8 days into adult fly.

OTHER SEQULAEOTHER SEQULAE Fall of teethFall of teeth Separation of skull suturesSeparation of skull sutures Liquefied brain matter oozes out.Liquefied brain matter oozes out. ‘‘Colliquative putrifaction’Colliquative putrifaction’ – this process – this process

takes place between 7-14 days.takes place between 7-14 days.

INTERNALLYINTERNALLY

STOMACHSTOMACH Dark red patches over the wallsDark red patches over the walls Perforation due to autolysisPerforation due to autolysis

LIVERLIVER Softens and flabbySoftens and flabby Becomes spongy Becomes spongy ‘Foamy liver’‘Foamy liver’

Early putrefaction 24-48hrsEarly putrefaction 24-48hrs

Larynx, trachea, brain of infants, stomach, Larynx, trachea, brain of infants, stomach, intestines, spleen, omentum and mesentery, intestines, spleen, omentum and mesentery, liver and adult brain.liver and adult brain.

Late putrefaction 2-3 weeksLate putrefaction 2-3 weeks

Heart, lungs, kidneys, bladder, esophagus, Heart, lungs, kidneys, bladder, esophagus, pancreas, diaphragm, blood vessels, pancreas, diaphragm, blood vessels, prostate, testis and non gravid uterus, prostate, testis and non gravid uterus, ovaries.ovaries.

FACTORS MODIFYING PUTREFACTIONFACTORS MODIFYING PUTREFACTION EXTERNALEXTERNAL

Warmth and clothingWarmth and clothing Putrefaction begins at 10°Putrefaction begins at 10°C and occurs C and occurs

rapidly at 37rapidly at 37°°C.C. Freezing point – bacterial growth Freezing point – bacterial growth

inhibited and putrefaction will not inhibited and putrefaction will not occur.occur.

Clothing hastens putrefaction initially Clothing hastens putrefaction initially and protects against flies and and protects against flies and insects.insects.

MoistureMoisture Help in rapid multiplication of organisms.Help in rapid multiplication of organisms. Bodies recovered from water if left in air, Bodies recovered from water if left in air,

decomposes rapidly.decomposes rapidly.

Air Air 1 week in air = 2 weeks in water = 8 weeks 1 week in air = 2 weeks in water = 8 weeks

buried – ‘Casper dictum’buried – ‘Casper dictum’

Manner of burialManner of burial In air tight coffins, very little change of In air tight coffins, very little change of

body for long periods.body for long periods. Without coffins, putrefaction is very rapid.Without coffins, putrefaction is very rapid. Bodies in deep graves putrefy very slow.Bodies in deep graves putrefy very slow. Bodies buried in lime, decomposition is Bodies buried in lime, decomposition is

retarded.retarded. Bodies in sandy and porous soils are Bodies in sandy and porous soils are

conducive to mummification.conducive to mummification.

INTERNAL FACTORSINTERNAL FACTORS Age and condition of the bodyAge and condition of the body SexSex Mode of deathMode of death

ADIPOCEREADIPOCERE Modification of the process of putrifaction Modification of the process of putrifaction

in the dead body is (checked and is in the dead body is (checked and is replaced) adipocere formation.replaced) adipocere formation.

Hydrolisation of fatty tissue into fatty acids.Hydrolisation of fatty tissue into fatty acids. Bacterial fat splitting enzymes and moisture Bacterial fat splitting enzymes and moisture

are essential – Lecithinase.are essential – Lecithinase. Composed of saturated fatty acids by Composed of saturated fatty acids by

palmitic, stearic, hydroxystearic, olic acidspalmitic, stearic, hydroxystearic, olic acids

Yellowish white, greasy wax with rancid Yellowish white, greasy wax with rancid smell.smell.

It forms at any site where fatty tissue is It forms at any site where fatty tissue is present.present.

Time required, in summer-3 wks, in tropics-Time required, in summer-3 wks, in tropics-5 to 15 days.5 to 15 days.

M.L.I.M.L.I. – to establish the identity – to establish the identity - cause of death- cause of death - time since death- time since death - place of death- place of death

MUMMIFICATIONMUMMIFICATION It is a peculiar desiccation of a dead body It is a peculiar desiccation of a dead body

where by its soft parts shrivel up but retain where by its soft parts shrivel up but retain the natural appearance and the features of the natural appearance and the features of the body. the body.

Rusty brown color, dry, leathery skin Rusty brown color, dry, leathery skin adherent to bones.adherent to bones.

Internal organs get transformed into a thick Internal organs get transformed into a thick brown mass.brown mass.

Mummification occurs in bodies buried in Mummification occurs in bodies buried in shallow graves, in dry sandy soils.shallow graves, in dry sandy soils.

Time – 3 months to 1-2 yrsTime – 3 months to 1-2 yrs M.L.I.M.L.I. – Identification – Identification

- Cause of death- Cause of death

- Time since death- Time since death

- Place of death- Place of death

Time since death/ post mortem Time since death/ post mortem intervalinterval

Important clue for investigation of time.Important clue for investigation of time. It helps apprehend the person likely to be It helps apprehend the person likely to be

involved.involved. Point to be ascertained are;Point to be ascertained are;

-cooling of the body-cooling of the body

-post mortem lividity-post mortem lividity

-rigor mortis-rigor mortis

-decomposition changes-decomposition changes

- Contents of stomach and bowelsContents of stomach and bowels- Contents of urinary bladderContents of urinary bladder- Biochemical changesBiochemical changes- Circumstantial evidenceCircumstantial evidence

THANK YOU !