POST MORTEM CHANGES

1. IMMEDIATE
- Of somatic death
2. EARLY
- Of molecular death
3. LATE
- Of decomposition
IMMEDAITE SIGNS:

1. Insensibility and loss of

movements – with voluntary
power.

2. Cessation of respiration

3. Cessation of circulation
 EARLY SIGNS OF DEATH:

1. Pallor and loss of elasticity of skin

2. Changes in the eyes
3. Primary flaccidity of muscles
4. Cooling of body
5. Post mortem lividity
6. Rigor mortis
LATE SIGNS:

1. Decomposition

2. Adipocere formation

3. Mummification
 CHANGES IN THE EYES

1. loss of corneal reflex

2. opacity of cornea
3. flaccidity of eye balls
4. Changes in retinal vessels
5. Pupils
6. Chemical changes in vitreous
humour
CHANGES IN THE EYES:
1. OPACITY OF THE CORNEA-
- Due to drying in open eyelids.
- In closed eyes occurs in 2 hours.
-May occur even before death in cholera &
wasting diseases.
- “ Tache Noirs”- At each side of iris , on
sclera, triangular in shape, yellowish brown in
colour occurs in few hours due to deposition of
film of cell debris and mucus, if the eyelids are
left open after death.
2. CORNEAL REFLEX 3.FLACCIDITY OF
EYEBALLS
- A sign of
death , but not -- Due to fall in intra
ocular tension within
a reliable one as minutes of death the
even before eyeballs go flaccid.
death , in all - IOT can be measures
cases of deep with TONOMETER.
insensibility it - Normal value 15-25
mg - Soon after death-
may be absent
12 mg
-Half hour- 3 mg
- 2 hours – 0 ( zero )
 4. CHANGES IN PUPILS:
-Normal size is 2-5 mm, < 2 mm – constricted, > 5
mm dilated
-Soon after death, due to relaxation of muscles of iris
pupils dilate and with onset of rigor mortis they come
back to same position due to constriction- NOT A
UNIVERSALLY ACCEPTABLE THEORY because in
rigor mortis there is only stiffening and no
shortening.
- Till 1 hour( molecular death it may dilate with
atropine but don’t react to strong light.
5. Retinal vessels: Show fragmentation or
segmentation of blood column in retinal vessels
within few minutes and last for 1-2 hours.
- Can be seen with ophthalmoscope.
- It is dye to loss of blood pressure following loss of
circulation.
6. Chemical changes: Post mortem chemical
anlysis of vitreous humor show a steady rise on
Potassium levels in decomposition pattern ( low
Sodium and chloride and elevated Potassium) – Due
to cell disintegration of cell.
Formula suggested by Sturner-
PMI= 7.14 X K concentration( m.Eq./ L) - 39.1
4.COOLING OF BODY:( ALGOR MORTIS): Heat
loss is by -> By CONVECTION, CONDUCTION,
EVAPORATION
FACTORS AFFECTING HEAT LOSS:
1. Body weight and surface area- rapid in extremes of age
2.Proportion of fat- slow in obese persons and vice versa-
fat a bad conductor of heat
3. Covering layers around body
4. Difference between body and ambient temperature- rate
is more when the difference is more.
5. Environment- well ventilated place, moisture= rapid
cooling
In India rate is 0.5 to 0.7 per hour.
FORMULA: Time in hours
= Normal Body temperature – rectal temperature
Rate of temperature fall per hour

For example,
Normal Body temperature is 37.2 degree
Celsius
Rectal Temperature is 30.2degree Celsius ,
Rate of fall is 0.5
TSD= 37.2 – 30.2 = 7 / 0.5 = 14 hours
POST MORTEM CALORICITY: raised
temperature after death.

Causes: 1.Thermo-regulatory disturbance-

sunstroke, air embolism
2. Muscular over activity- tetanus,
strychnine poisoning
3. Bacterial activity- Cholera ,
septicemia
5.POST MORTEM LIVIDTY: ( PM HYPOSTASIS,
PM STAINING, LIVOR MORTIS, CADAVER
LIVIDITY)

DEFINITION:
It is purplish red discolouration on the surface of
dependent parts of body due to capilo-venous
distension after death.

MECHANISM: Due to accumulation of blood in

toneless distended blood vessels. It reflects the
colour of Hb.
WHAT MEANS DEPENDENT PARTS?

POSITION DEPENDENT PARTS

1. Supine - Back of shoulders, chest, buttocks, thigh

2. Prone – Face, front of chest& abdomen, thighs
3. Standing- Both hands, male genitals, soles
4. Kneeling- Both knee, front of legs, toes.
TIME OF APPAEARENCE AND
DISAPPEARENCE

Beginning- 30 minutes
Confluence patches- 1-4 hours
Fixation- 4-12 hours( due to coagulation)
Disappearance- about 24 hours
--> Press the thumb on stained area if it fades
and reappears on withdrawal – not fixed.
--> No change on pressure by thumb- fixed.
CAUSES OF EARLY ONSET OF
POST MORTEM LIVIDITY:

Persons who die from conditions in which

there is circulatory failure which permits
some ante mortem pooling of blood in
superficial vessels- cholera, typhus fever,
tuberculosis, uremia and prolonged illness.
 CAUSES OF DELAYED ONSET:

1. Anaemia
2.large amount of IV fluids
3. Massive blood loss
4. Lobar pneumonia( rapid clotting)
In dark complexed person it may be
difficult to appreciate in early stage.
 Interpretation of colour of lividity:

1. Deep purple- in asphyxia due to

increase in amount of reduced Hb.

2. Bright red- in cyanide poisoning due to

cyan meth haemoglobin

3. Pink- in cabon monoxide poisoning due to

carboxy Hb.
4. Chocolate brown – in Potassium chlorate
poisoning due to methhemoglobin.

5. Reddih brown – in Nitrite poisoning .

6. Yellow or dark brown – in Phosphorous poisoning.

7. Pale or less prominent- anemia, pneumonia.

 DIFFERENCE BETWEEN :
LIVIDITY & CONGESTION
1. Position- dependent parts only irrespective of position
2. Distribution- irregular Uniform
3.Inflammation- absent present
4. Hollow viscera like stomach:
Alternate areas of staining Diffuse.

( On stretching of hollow viscus)

DIFFERENCE BETWEEN
LIVIDTY & BRUISE

1. Margins- sharply defined ill defined

2. Surface- Not swollen oedematous
3. Colour change- no change Changes with age
4.Pressure- Blanches till not fixed No chage
5. On cut section- no extravasation extravasation of
blood
MEDICOLEGAL IMPORTANCE OF
POST MORTEM LIVIDITY:

1. It is a reliable sign of death.

2. Indicates body position at death and any
alteration in body position later on.
3.Peculiar colour may indicate particular poisoning.
4. May indicate time since death – fixed or not.
 6. CHANGES IN MUSCLES:

1. STAGE OF PRIMARY FLACIDITY:

- Generalised relaxation lasting up to 2-3 hours after death
2. STAGE OF RIGOR MORTIS:
- Charecterised by stiffness
3. STAGE OF SECONDARY FLACIDITY:
-With disappearance of rigor mortis , muscles again becomes
flaccid.
 RIGOR MORTIS / CADEVERIC RIGIDITY:

DEIFNITION:
It is a state of post mortem stiffening in both voluntary and
involuntary muscles following the period of primary
flaccidity
MECHANISM: Each muscle comprises of myofibril –
made up of proteins- Actin and myosisin in interdigiting
arrays. ATP is required to maintain relaxation of muscle
which is absorbed by muscle in state of relaxation and
utilised for contraction. After death , some amount of ATP
Is available till molecular death. But after that as it not
available to maintain relaxation the acto-myosin
complex develops stiffness and produces muscular
rigidity which disappears with autolysis of muscle fibres
after some duration.
SEQUENCE: Proximo-distal progression and
disappearance in same sequence.
 TIME OF ONSET, PERSISTANCE AND DIAPPEARENCE:

SEASON WINTER SUMMER AVERAGE

0NSET Slow- 2-6 rapid – 2-3 2-6 hrs
COMPLETION 6-24 3-18 6-12
PERISTANT 24-48 18-36 12-24
DISAPEARENCE 48-72 36-48 24-36

RULE: When rigor mortis sets in early, it remains for shorter time and
disappears early.
When it sets in late, remains for longer time and disappears
slowly.
 FACTORS AFFECTING ONSET, DURATION
AND DISAPPEARENCE OF RIGOR MORTIS:

1. AGE: Extremes of age earlier & for shorter duration.

2. ENVIRONMENTAL TEMPERATURE:
Slow- in cold , rapid in hot environment
3. MUSCULAR STATE:
Rapid in thin body, slow in more muscular body.
4. CAUSE OF DEATH: EARLTY LATE
Cholera, typhoid, TB, cancer, nephritis Pneumonia, asphyxia
CO, CO2, Arsenic
 HOW RIGOR MORTIS IS TESTED?
- By gen tally bending various joints:
Perception Interpretation
- Free movement Not present
- Moves with little force Present in moderate form
- Moves with more force Present in strong form
NOT present in a part tested - Not appeared or
disappeared.
If distal parts show rigidity – Developed & disappeared.
If proximal parts show rigidity – Not developed.
 DIFFERENCE BETWEEN
RIGOR MORTIS & HEAT STIFFENING

1. Cause: Loss of AT.P. Temperature > 65

2. Onset: In sequence Rapid and diffuse
3. Mechanical: will revert rigidity rupture of muscles
extension
4.Result: Actin-myosin complex coagulation of proteins
5.Disappearance: in sequence, Uniform with onset
at various duration of putrefaction
 DIFFERENCE BETWEEN
RIGOR MORTIS AND COLD STIFFENING

1.Cause: ATP loss temperature < 3-4

2. History: Non specific ice caves, glacier
3. Body fluids : Liquid frozen
4. Disappearance: sequence & on thawing it goes
duration & RM appearers.
CADAVERIC SPASM:
DEFINITION:

The group of muscles that were contracted just before

death, become stiff and rigid without passing into stage
of primary relaxation.
MECHANISM: Obscure. Probably, due to over activity
just before death ATP gets exhausted and muscles
pass into state of rigidity.
CIRCUMSTANCES: excitement, cerebral hemorrhage,
 fear, injury to nervous system, cranial gunshots,
convulsant poisons, efforts by a submerging victim.

MEDICO LEGAL ASPECTS:

1. Affects only a group of muscles.
2.A drowning victim may firmly grasp weeds, grass .
3.In suicide by cranial gunshot wound leading to sudden
death the weapon may be grasped in the hand.
4.Muscles does not develop rigor mortis and rigidity
disappears with putrefaction.
CHART showing major changes to estimate time since
death

cooling
37 Rigor mortis
Temperature

decom

lividity

TSD- 0 6 12 18 24 30 36 42 48 54
LATE CHANGES:DECOMPOSTION
-- Result of two processes- Autolysis and putrefaction
AUTOLYSIS: ( Auto= self, lysis= break down)
After death, permeability of cell membrane increases which
allows release of various enzymes in cytoplasm:
-- Proteolytic, glycolytic and lipolytic action without bacterial
action, temperature affects its rate- slow by cold & vice versa
EARLY IN:
Parenchymatous tissue, brain and glandular tissue.
Leads to liquefaction necrosis of tissue.
PUTREFACTION:
By Fauna- out side body & inside body
flies, maggots, microbes anaerobic flora- intestines
-- Produced by bacterial enzymes, anaerobic variety and also from
fungi. Cl. Welchi is the main causative organism which causes:

1. Haemolysis
2. Liquefaction of blood clots
3. Disintegration of tissue
4 Gas formation

-- Other microbes: Streptococi, Staphylococi, B. Proteus, B. Coli

-- They spread through vessels as proteins and carbohydrate act

as culture media for the.
 ENZYMES AND THEIR ROLE IN PUTREFACTION:
Lecithinase produced by Cl Welchi hydrolyses the lecithin
of the cell membrane.
FACTORS FAVOURING BACTERIAL ACTIVITY:
1. loss of protective mechanism
2. Open skin wounds
3. Fall in oxygen and rise in hydrogen
4. Fluidity of blood and carbohyrates & proteins in
blood.
5. Pre existing infection before death
 CHARECTERISTIC FEATURES OF PUTREFACTION:
1. COLOUR CHANGE
2. EVOLUTION OF GASES
3. LIQUEFACTION

1. COLOUR CHANGE: In the early stage, due to diffusion of Hb

through the vessels the tissue shows red or brown colour.
In the tissue Hb derivatives combine with Sulphur containing
compounds forming sulphmeth haemoglobin and change the
colour into greenish black.
As the caecum is the most superficial part of intestine this
change is perceived first there in about 12-18 hours in summer
and 1-2 days in winter.
This discolouration further spreads over entire abdomen,
genitals, chest, neck, face arms and leg.
MARBLING EFFECT OR APPEARENCE:

The putrefactive bacteria spread more easily in fluid and

tend to colonise venous stem. The superficial veins get
stained reddish puple due to haemolysis of red cells .
This stained vascular channels against back ground of
pale dermis give the surface the “ MARBLING
EFFECT”. It becomes prominent in 36-48 hours after
death.
MARBLING EFFECT- Prominent toneless superficial veins
filled with hemolysing blood against pale dermis.
The clotted blood becomes fluid and which cause
disappearance of post mortem lividity . Later this colour
change spread all over the body.

2. EVOLUTION OF GASES: The complex proteins and carbohydrate

compound s disintegrate and produce gases life:
AMONIA, CARBON MONOXIDE, CARBON DIOXIDE, HYDROGEN
SULPHIDE, PHOSPHORATED HYDROGEN, METHANE,
MERCAPTANE.
Collection of these gases in loops of intestine leads to distension of
abdomen,So, on opening the abdominal cavity these gases come out
with force and hissing sound.
This gases entrapped in closed area go on accumulating
and lead to :

1. Protrusion of eye balls

2. Swollen appearance of face
3. Oozing out of fluids from orifices like nose mouth, ear,
anus and vagina.
4. Post mortem blisters due to separation of layers of
epidermis.
5. Expulsion of fetus in pregnant woman.
6. Protrusion of rectum through anus.
7. Post mortem blister formation due to separation of layers of
epidermis..
8. Loosening of hair, teeth and nails.

9. Protrusion of cavity contents from open wounds.

10. Pealing of cuticle leading to DEGLOVING & DESOCKING
OF SKIN OF HANDS AND FEET RESPECTIVELY.
-- Post mortem luminescence ( shining look) is due to light
producing organisms like:
PHOTOBACTERIUM FISCHERI, ARMILARIA MALLEA( fungi)
-- Bodies submerged under water surface due to gases.
A DECOMPOSING DEAD BODY- Swollen appearance,pealing
of epidermis ,brown discolouration and blisters.,
 3.LIQUEFACTION ( & SKELETONIZATION)-
Colliquative putrefaction starts in 5-10 days and all soft
tissue start loosing their normal architecture. The concerned
cavity gets filled with liquefied tissue materials.

SEQUENCE OF PUTREFACTION IN ORGANS

1. Larynx and trachea
2. Stomach, intestine and spleen DEPENDS ON TISSUE
3. Liver and lungs COMPOSITION- BLOOD,
4. Brain FIBROUS , CARTILAGENOUS
4. heart FLUID RICHNESS
5. Kidney, bladder
6. Prostate , uterus
7. Skin, muscles and bones.
SKELETONISATION: The time required for completion
depends mainly on factors like post mortem eating by

carnivorous animals like jackals, dogs, vultures etc. They

eat away soft tissues and produce “ Gnawing effect”
which are tissue defects devoid of hemorrhage.
The bones decay with loss of proteins and ultimately
complete conversion of all ORGANIC materials into
INORGANIC materials – in “panch mahabhut”
FACTORS AFFECTING RATE OF PUTREFACTION:
1. TEMPERTAURE
2. MOISTURE
3. AIR

4. CLOTHINGSAND COVERINGS
5. AGE
6. BUILT
7.CAUSE OF DEATH
8. DEGREE OF MUTILATION:
9. CASPER’S DICTUM: Rate of putrefaction:

Above earth Under water Under earth

8 2 1
 MUMMIFICATION: It is a modification of process of
putrefaction in which shrivelling and drying of dead
body occurs due to dehydration of water.

FACTORS NECESSARY:
1. Absence of moisture in the air
2. Persistent action of dry air.
APPWARENCE:
- Shrunken skin, dry, leathery, fragile and rusty brown in colour
-- skin adheres tightly to bony prominences
-- involves exposed parts first, later even internal organs
CHARECTERISTICS:
-- Body is odour free,
-- 3 months to 1 year required for completion
-- Features and wounds are well preserved.
CIRCUMSTANCE:
- Bodies trapped in closed room or cupboard, graveyard
-- Death due to chronic arsenic or antimony poisoning- dehydration before
death..
MEDICOLEGAL IMPORTANCE:
1. Identity can be established as features are well preserved..
2. Cause of death can be concluded as the wounds are preserved.
3. Gives idea about time since death.
ARTIFICIAL MUMMIFICATION - EMBAMMING.
 ADIPOCERA ( SAPONIFICATION): is a modification of
putrefaction in which the fatty tissue are converted into
insoluble soap - adipocere.

CIRCUMSATNCES:
- Damp and warm environment.
- There is gradual hydrolysis and hydrogenation of fats into
PALMITIC ACID
OLEIC ACID --> combines with calcium and ---> forms insoluble
STEARIC ACID ammonium ions soaps
HYDROXY STEARIC ACID
BACTERIAL ACTION: Cl. Pefringens produces Lecithinase which leads to
hydrolysis and hydrogenation. Later on with saponification the environment
becomes acidic which prevents bacterial action and hence putrefaction
gets arrested and does not progress.

PROPERTIES:
- Strong amonical smell in early stage followed bt sweetish
offensive smell
- Fresh adipocere is soft, moist, whitish and translucent.
- Old adepocere is dry , hard, cracked yellowish in colour and
brittle.
- Insoluble in water but dissolves in ether and alcohol.
- It is inflammable and burns with yellow flame.
TIME REQUIRED :
--3-4 weeks in summer in temperate countries
-- On average 3-6 months
-- May persist for years if left undisturbed.

DISTRIBUTION:
-- Fat depots – superficial to deep in direction.
-- Face, female breast, buttocks, pericardial- mesentric – pancreas ets

MEDICO LEGAL APPLICATION:

1. Help in establishing identity as features are preserved.
2. May help in ascertaining cause of death from wounds.
3. Gives idea about time since death.
 OTHER PARAMETERS TO DICIDE TIME SINCE DEATH:

1. ENTOMOLOGY OF CADAVER:( FORENSIC ENTOMOLOGY)

Flies --> eggs --> larvae or maggots --> pupae--> adult fly
few minutes + 8-12 hr + 4-5 days + 3-5 days
COMMON SITES: natural orifices and wounds.
ROLE: Maggots produce proteolytic enzymes which help in
destruction of tissue. They crawl into deeper parts by making
furrows and further expose deeper parts to air.
APPLICATION: Time since death by stage and number of
generations.
2. CONDITION OF STOMACH CONTENTS:
Examination of stomach contents can give an idea about time of
last meal taken or after how much time after consuming food the
victim died. Normal gastric emptying time = 2 hours.
FACTORS TO BE CONSIDERED FOR SUCH OPINION:
1. Age
2. Amount of food
3. Type of food- solid or liquid
4. Contents of food- carbohydrate / fats / proteins
5. Vomiting or gastric lavage just before death
6. Expulsion of contents due to putrefaction.
7. Seasonal variation and GIT disease
3. POST MORTEM CHEMISTRY:
Samples : Blood, urnine , CSF, peritoneat / pericardial fluid,
VITROUS HUMOUR.
TYPES:Electrolytes mainly – almost all tests.

Pattern Na Cl K Urea
Dehydration - +++ +++ N +

Uremic - N N N +++

Low salt - -- - -- - -- N

Decomposition - ---- -- ++++ N

EXHUMATION: Lawful digging out of already buried body from
grave yard.
NO TIME LIMIT FOR EXHUMATION IN INDIA.
AUTHORITY: Order of executive magistrate.
WHY DEAD BODY IS EXHUMED?
1. Suspicious crime, need of further investigations.

2. Claims and compensation matters

3. Unlawful burial.

PROCEDURE:
- EXECUTIVE MAGISTRATE + POLICE + DOCTOR

- Identification of g graveyard and grave

- Conducted in day light.

- Sample of soil to be collected : ABOVE , BELOW, RIGHT, LEFT, FRONT& BACK

- Identification of coffin

- Identification of body

- Care in lifting & transportation- so a s to avoid damage.

DISINFECTANTS SHALL NOT BE SPRINKLED.

SECOND AUTOPSY:

- Documents of first autopsy

- If possible the first autopsy surgeon sholud be called upon.

- Discrepancies between two- Condition of body, time since

death, time between two autopsies shall be considered

before giving a contradicting opinion.

 EXAMINATION OF SKELETONISED AND MUTILATED
BODIES:
1. Whether Human or animal?
- Comparative Anatomy, Precipitin test

2. Belongs to one or more than one individual?

3. Sex, age, stature and other identity points

4. Manner of separation:

NATURAL, CUT, SERRATED, LACERTED

5. cause of death

6. Time since death

TIME SINCE DEATH AND RADIO ACTIVE
CARBONANALYSIS:
The C 14 levels are constant during life of an individuals and starts reducing

after death where it reaches to half level after 5600 years. Not helpful in

routine medico legal cases but only for Archaeological purposes.

FOR MEDICO LEGAL PURPOSE:

Nitrogen

Amino acids

Pro lines

Fluorescence

Benzidine

Gel diffusion

0 10 20 30 40 50 100 200 400 800

PRESUMPTION OF DEATH:
The question may arise in following cases:
1. Insurance claims
2. Inheritance of property
3. Resolving partnerships
--> S.107 &108 of IEA : If a person is proved to have been
alive within 30 years, the legal presumption is that he is still
alive, unless it is proves that the person has not been heard
of for 7 years by those who would normally have heard of
him.
PRESUMPTION OF SUVIVOR SHIP:
-- When more than one natural heirs of each other die in a
common event. i.e. Air-crash, shipwreck, earthquake etc.

Consequences : If X has made will of his property to Y instead

of heirs of X. Now , if X survived Y, his property will go to heirs
of X and not to heirs of Y. Because Y died during lifetime of X,
then he has lost his claim under will .
Following factors shall be considered to decide who survived
whom:
1 Post mortem changes.
2. Nature of injuries.
 CONTD.----

3. Age
4. Sex
5. History of previous major illness
6. Cause of death.
--- - - - - - - - - - - XOX- - - - - - - - XOX - - - - - - - - - - - -