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DEATH
By: dr. Hafsa salame
Forensic Pathology at Jordan University Hospital
TYPES OF DEATH
Somatic death
BRAIN DEATH
.
There is no gag reflex to a catheter placed in the larynx
and trachea.
There are no respiratory movements when the patient is
disconnected from the ventilator with an arterial PCO2
level in excess of 50 mmHg as a stimulus to breathing.
Testing must be performed with a body temperature not
less then 35C to avoid hypothermia simulating brainstem
damage.
Deep coma
All brainstem reflexes are
absent, with fixed dilated and
unreactive pupils. Corneal
reflexes are absent
Neuromuscular
blocking agents
excluded
No motor
responses to
painful stimuli
Mechanical
ventilation
No gag reflex
mummification
Death
adipocere
cremation
Putrefaction
Assist
Animal predators
Assist
Complete dissolution
unless fossilized
Skeletenization
Insect
activity
Chemical
changes in
body fluids
(electrolyte
s)
Eye changes
Skin
changes
Muscles
Gastric
Late
Algor
mortis
(cooling)
Livor mortis
(hypostasis
)
Rigor
mortis
Very late
Decompos
ition
13
1. Loss of the corneal and light reflexes leading to insensitive corneas and fixed
unreactive pupils.
2. The light reflex is lost as soon as the brainstem nuclei suffer ischemic failure.
3. The pupils usually assume a mid dilated position, which is the relaxed neutral
position of the pupillary muscle, though they may later change as a result of
rigor.
4. The pupils may lose their circular shape after death as a result of uneven
relaxation.
Emission of semen is also found in Some deaths; the presence of semen cannot
be used as an indicator of sexual activity shortly before death.
Regurgitation is a very common feature of terminal Collapse and it is a common
complication of resuscitation.
HANGING
Hypostasis will be
most marked in the
feet, legs and to
lesser extent in the
hands and distal
part of the arms
Epilepsy or
drinkers
TIMING OF HYPOSTASIS
May not appear at all, especially in infants, old people or those with anemia.
Hypostasis can appear within half an hour of death or it may be delayed for many hours.
Once hypostasis is established if the body moved the primary hypostasis may be :
Remain fixed
Completely moved to new dependent areas
Or partially stay fixed and partially moved
So this is useful in crime investigations if hypostasis not related to the position Of body
but this is not always useful because hypostasis was still mobile for at least 3 days.
The lungs almost always show a marked difference in color from front to
back, the anterior margins being pale and the posterior edges lying in the
paravertebral gutters being dark blue. Also congestion and edema being
more marked posteriorly.
The myocardium often shows a dark patch in the posterior wall of the left
ventricle that must not be mistaken for early infarction.
finally to decide.
If autolysis happened it is almost impossible to differentiate
Bruises (Ecchymosis)
Dependant areas
Any where
Raised
Not change
RIGOR MORTIS
DEFINITION : Temperature-dependent Physicochemical change that occurs
within muscle cells As a result of lack of oxygen. The lack of oxygen means
That energy cannot be obtained from glycogen via glucose Using oxidative
phosphorylation and so adenosine Triphosphate (ATP) production from this
process ceases And the secondary anoxic process takes over for a short
Time but, as lactic acid is a by-product of anoxic respiration, The cell
cytoplasm becomes increasingly acidic. In the face of low ATP and high
acidity, the actin and Myosin fibers bind together and form a gel. The outward
Result of these complex cellular metabolic changes Is that the muscles
become stiff.
RIGOR MORTIS
The flaccid period immediately after death is variable, but commonly extends to between
3 and 6 hours
The sequence of spread of rigor is also variable but tends to affect the jaw, facial muscles
and neck before being obvious in the wrists and ankles, then the knees, elbows and hips.
Depending on environmental temperature
Usually infants, the cachectic and the aged, may never develop recognizable Rigor mortis
Rigor spreads to involve the whole muscle mass, reach a maximum within 6-1 2 hours.
The duration of full rigor may be 18-36 hours
If t he body feels cold and is flaccid, it has been dead more than 36
hours.
This crude estimate should never be used as a definitive
CADAVERIC SPASM
DEFINITION : A rare form of muscular stiffening that occurs at moment of death,
persists into the period of rigor mortis , and can be mistaken with it . usually
associated with violent death happening under extremely physical circumstances
with intense emotions.
Cadaveric Spasm
Onset is instantaneous.
Duration is a few hours, until it is replaced by
rigor mortis.
Intensity comparatively very strong.
predisposing factors: Excitement, fear,
fatigue, exhaustion, nervous tension,
contraction of Muscles at time of death.
Selected muscles
37
DECOMPOSITION
Decomposition may differ from body to body, from environment
to environment, and even from one part of the same corpse to
another
Dead bodies are usually returned, through reduction into their
various components, to the chemical pool that is the earth
SUBCLASSES OF DECOMPOSITION
Putrefaction : the commonest rout of decomposition .in an average
temperate climate may be expected to begin at about 3 days in the
unrefrigerated corpse.
Definition : a stage produced mainly by the action of proteolytic enzymes
released from dead body cells and bacterial enzymes, mostly anaerobic
organisms derived from the bowel. Other enzymes are derived from fungi,
such as penicillium and aspergilla's and sometimes from insects, which may
be mature or in larval stage. The chief destructive bacterial agent is cl.
Stages of putrefaction
6. Bloody fluid out of all body orifices : after 2-3 weeks due to hemolysis and
increase pressure
7. Heavy maggot infestation : produce enzymes that hasten autolysis
Skin marbling
MAGGOT INFESTATION
INTERNAL DECOMPOSITION
This occurs at much different period
Adrenal medulla , pancreas , intestine wall autolyse within hours
BURIAL
The effects and the time scale of the changes following
Burial are so variable that little specific can be said
Other than buried bodies generally decay more slowly,
Especially if they are buried deep within the ground.
FORMATION OF ADIPOCERE
Adipocere is a waxy substance derived from the body fat In
most instances the change of adipocere is partial and irregular
MUMMIFICATION
It is drying of the tissues can coexist with other modes of decomposition in
different areas of the same body.
More likely than the other modes of decomposition to extend over the whole
corpse.
Mummification can only occur in a dry environment, which is usually , also a
warm place.
Mummification can occur in freezing conditions, partly because of the
dryness of the air and partly because of the inhibition of bacterial growth.
The most widely known forms of mummification are those in hot, desert
zones
POST-MORTEM DAMAGE BY
PREDATORS
Animal predation is part of the natural food chain
The beasts varying from ants to foxes, and from bluebottles to lizards.
Foxes can drag parts of a body away to a distance of at least 2 miles.
The type of damage from canine and rodent predators is usually obvious, as
the local removal of large amounts of flesh is usually accompanied by
evidence of teeth marks
The postmortem nature of which is obvious from the lack of bleeding or an
inflamed marginal zone
Mice rarely attack bodies, but may help to remove the dried, crumbling tissue
of a mummified corpse
The most active tissue removers are maggots, the larval stage of bluebottles
and flies
The maggots are voracious and energetic, first exploring the natural
passages, such as mouth and nostrils, then burrowing into the tissues. They
secrete digestive fluids with proteolytic enzymes that help soften the tissues,
burrowing beneath the skin, and sinuses that hasten putrefaction by
admitting air and access to external micro-organisms
The ant, which can attack the body soon after death before putrefaction
begins. A common place for ant attack is around the eyelids, lips and on the
knuckles. The lesions are superficial ulcers with scalloped, margins. They
can be mistaken for ante-mortem abrasions, but their position, margins and
lack of bleeding or inflammatory changes usually make them easily
recognizable.
SKELETELIZATION
In temperate zones the bones will remain solid & heavy with the preservation
of bone marrow in long bones for a number of years, that can sometimes be
suitable for specialist DNA analysis.
After 40-50 years:
Bone surface becomes dry & brittle.
Marrow cavity will be empty.
67
TIMING OF DEATH
Body temperature (body cooling )Algor mortis
Dead body becomes progressively Colder after death
The center or 'core' of the body cannot begin to cool Until a
'temperature gradient' is set up by the cooling at the Skin
surface. As the tissues are poor heat conductors, this Gradient
takes a variable time to become established and Therefore a
thermometer placed near the core (usually in The rectum) will
not register a fall for some time. This is the Well-known
'plateau',
plateau
When death occurs, Heat transfer within the body through the circulation
ceases. Metabolic heat production, occurring mainly in the muscles And
liver, does not cease uniformly and some heat generation Continues
for a variable time. As soon as the supply of Warmed blood ceases with
cardiac arrest, the skin surface Immediately begins to lose heat.
Factors affecting
body cooling
Obesity
environmental
temperature.
Clothing type of
material, position
on the body or
lack of it.
Winds, draughts,
rain, humidity etc.
Site of reading of
body
temperature(s).
Posture of the
body extended or
curled into a fetal
position.
Body temperature at
Requirements
to use
No strong
fever or
general
hypothermia
No high
thermal
conductivity
of surface
beneath the
body
No strong
radiation
No certain
severe changes
of cooling
conditions
between time of
death and body
examination
GASTRIC EMPTYING
The following factors frustrate the use of gastric emptying As a measure
of time since death:
Digestion may continue for some time after death.
The physical nature of a meal has a profound effect on Emptying time: the more
fluid the consistency, the Faster the emptying.
The nature of the food modifies emptying time, notably Fatty substances, which
markedly delay the opening of The pylorus. Strong alcohol, such as spirits and liqueurs,
Also irritate the mucosa and tend to delay emptying.
Indeed, they may lay eggs on the living, especially when the victim (man or
animal) is debilitated or wounded.
Single bluebottle may lay up to 300-2000 eggs
The eggs are laid on moist areas, such as the eyelids, canthi of the eyes,
nostrils, lips, mouth, genitals and anus. If there are any open wounds or
weeping abrasions, these may also be colonized. The eggs are yellow and
banana-shaped, about 1.7 mm in length.
The common house fly is different in that, unlike the bluebottles, it prefers to
lay its eggs on already decomposed flesh, though it is more attracted to
garbage than to cadavers.
The eggs are much smaller and white rather than yellow.
The whole lifecycle is about 14 days at about 20c,
12 days
8-14 hours
6 days
2-3 days
are stable post-mortem, with little variation even up to 100 hours after
death, so the diagnosis of ante-mortem nitrogen retention is quite reliable.
The vitreous fluid (humour ) is much to be preferred to blood for Postmortem chemical analyses. Vitreous is far less contaminated By body
autolysis and is remote from the large Organs and blood vessels of the
abdominothoracic cavity.
After death, intracellular potassium leaches from the Retina through the
now permeable cell membranes, into the Vitreous body, naturally with an
uneven distribution Depending on the distance from the wall of eyeball
(which Is why all or a substantial proportion of the fluid should be
Withdrawn for analysis, to obtain a mean level). If fragments Of retina are
aspirated by the syringe, due to excessive Suction, then a falsely
elevated potassium measurement will Be obtained.
Generally speaking, the vitreous Potassium method is of most use after
the first 24-36 Hours, when other methods have ceased to have
application. Although the errors are great, some information can Be
derived for up to 100 hours post-mortem.
bleeding in
Autolytic rupture of the stomach can occur postmortem In both child and
adult, described by john Hunter in the eighteenth century. This so-called
Heat fractures of the bones, either skull plates or long bones, may be
seen in victims of severe fires, but are not evidence of ante-mortem
violence. Also in conflagrations, the 'heat hematoma' within the burned
skull can resemble an extradural hemorrhage of ante mortem origin. The
site is often at the vertex or occiput; however, unlike the usual parietal
hemorrhage, there is no fracture line crossing the middle meningeal
artery, the usual cause of a true extradural bleed.
RESUSCITATION ARTEFACTS
atria and even ventricles, septal rupture and valve damage. The great
vessels can suffer severe trauma, marrow emboli in the pulmonary
vessels have also been reported after cardiac massage
Bruising of the face and neck, finger marks and nail Marks on
the face and neck, and damage to the lips and Inner gums
from mouth-to-mouth resuscitation, when The face and neck
have been gripped by hands. Damage To lips, gums, teeth
and pharynx can occur from the Introduction of an artificial
airway or endotracheal tube, Especially in difficult, hurried
emergency situations. Injuries to the larynx, even including
fracture of the Hyoid and thyroid cornuae, can occasionally
occur From these procedures, which are difficult to Distinguish
from manual strangulation if the Circumstances are obscure.
Puncture marks for venipuncture may be Confused with injection marks in drug
dependence. The introduction of intravenous cannulae into veins In the neck
may cause large hematomata and more Diffuse bleeding into the tissues
alongside the larynx.
The effects of injected