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Death & changes after death

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Death & changes after death

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Death & changes after death

  1. 1. Post mortem changes After Death Dr SM Arman Hossain
  2. 2. CHANGES AFTER DEATH/ POST MORTEM CHANGES Changes after death or postmortem changes which occurs after death are related to somatic death and some are related to molecular death. Accordingly some of them comes immediately, some comes early, and some late.
  3. 3. POST MORTEM CHANGES 1.Immediate Changes 2.Early Changes 3.Late Changes
  4. 4. Immediate change after death 1. Stoppage of function of nervous system. 2. Stoppage of respiration. 3. Stoppage of circulation.
  5. 5. Early changes after death 1. Facial pallor. 2. Loss of elasticity of skin. 3. Primary relaxation of the muscles. 4. Changes in the eye. 5. Cooling of the dead body. 6. Post mortem staining. 7. Rigor mortis or postmortem rigidity.
  6. 6. Late changes 1. Putrefaction or ordinary decomposition. 2. Adepocere formation 3. Mummification.
  7. 7. IMMEDIATE CHANGE I.Stoppage of function of nervous system. 1.The subject has no sense. 2.There is loss of both sensory and motor function. 3.Loss of all reflexes. 4.No tonicity of muscles. 5.Pupils are widely dilated. 6.Confirmation by EEG
  8. 8. IMMEDIATE CHANGE II. Stoppage of respiration With somatic death there is total stoppage of respiration. Tests for stoppage of respiration test: 1.No respiratory movement will be visible. 2.No respiratory movement can be appreciated by palpation. 3.No breathing sounds can be heard by auscultation. 4. Feather/cotton test & mirror test
  9. 9. IMMEDIATE CHANGE III. Stoppage of circulation. Tests for circulation : 1.Stoppage of circulation can be examined by examining radial, femoral and carotid pulsation. 2.Auscultation of heart for presence orabsence of heartbeat. 3.Confirmation E.C.G test.
  10. 10. EARLY CHANGES AFTER DEATH 1. Facial pallor: a) After death due to stoppage of circulation, blood drains from capillaries and small vessels to big ones , so the face appears pale and bloodless. b) In agonizing death where there is obstruction of venous return due to compression over the neck as in case of strangulation, face will be congested and cyanotic.
  11. 11. EARLY CHANGES AFTER DEATH 2. Loss of elasticity of skin This occurs due to loss of tonicity of the skin muscles. 3.Primary relaxation or flaccidity of muscles After death muscles loss there tonicity and becomes flaccid, joints are loose and chest will become flattened. During this stage of primary relaxation muscular tissues are still alive and they will still respond to electrical stimuli.
  12. 12. EARLY CHANGES AFTER DEATH 4.Changes in the eye a) With death eyelids usually close due to loss of tone of muscles of the eyelid. b) Haziness of the cornea: Cornea will become hazy due to drying and desiccation and deposition of dust over the cornea. But this haziness will passes of if water is poured over the cornea. The cornea will become permanently hazy due to decomposition after 10 to 12 hours after death. c) With death corneal and papillary reflexes are lost.
  13. 13. EARLY CHANGES AFTER DEATH d) Shape of the pupil: Ordinarily the shape of the pupil is circular but after death there is loss of tone and elasticity so the shape of pupil may change. The shape of the pupil on the two side may be different. e ) Loss of ocular tension: Ocular tension falls rapidly after death and within half an hour it becomes zero. f) Changes in the retina: Within 10 to 15 seconds the retinal veins appears to be segmented due to cessation of circulation.
  14. 14. EARLY CHANGES AFTER DEATH g)Fragmentation of blood volumes in the retinal vessels will appear after death and it can be seen only in retina by ophthalmoscope. h)This fragmentation usually occurs all over the body but it can be seen only in retina. i)The retina will appear pale and disc outline will appear hazy and become blurred in 7 to 10 hours.
  15. 15. EARLY CHANGES AFTER DEATH 5. Cooling of dead body/Algor mortis: • Algor mortis is the process by which the body cools after death. Cooling takes place only if the ambient temperature is cooler than the body temperature at the time of death. • Algor mortis is the process by which the body cools as heat production ceases and body heat is lost to the environment. Bodies in which the ratio of the surface area to body mass is large cool more quickly (eg, bodies of thin people and infants cool more quickly than bodies of obese persons).
  16. 16. Cooling of the dead body • There are several formulas for estimating the rate of postmortem cooling; however, with all these formulas, it is assumed that death occurs in temperate conditions and that the decedent had normal ante mortem body temperature (i.e. the antecedent body temperature actually varies from 93.74°–100.04°F, as determined rectally). • These formulas tend to give a sense of scientific accuracy to the examination and can be misleading. A general rule of thumb is that the body loses heat at an average of 1.5°-2°F during the first 12 hours after death . However, the rate of cooling is dramatically affected by the circumstances of death, most significantly, by the environmental and body temperatures. A body will only cool to the environmental temperature; a body lying in 105°F during the summer would not be expected to cool at all—in fact, in such circumstances, the body’s temperature would increase.
  17. 17. Cooling of the dead body (a) After death the body temperature falls gradually and after some hours it tends to be equal to the temperature of its immediate environment. (b) The fall of temperature of the cadaver occurs due to the fact that after death there is no heat generation due to loss of all physical, chemical and metabolic function of the body and there is constant loss of body heat until it comes to the level of environmental temperature.
  18. 18. Cooling of the dead body (c) Loss of heat occurs by process of conduction, convection and radiation. (d) There is NEWTON’S LAW regarding loss of heat of the body: Newton’s law states that loss of heat of the body is directly proportional to the temperature difference between the surface of the body and its surrounding at an instant time . (e) Measurement of inner core temperature is important than outer core temperature. (f) Site of the body used to record the inner core temperature is Rectum –4‖ above the anus, and sub hepatic region. (g) The rate of fall of temperature on average is about 0.4 to 0.7 degree farenheightin summer/ hour.
  19. 19. Factors that influence the cooling of a dead body 1. Atmospheric temperature: The more the difference between the temperature of the dead body and atmospheric temperature the more is the rate of fall of body temperature. 2. Media of disposal: The rate of cooling differs according whether it is in atmospheric media or in water media or buried under ground, cooling is earliest in water media and latest in buried bodies. 3. Body built: A thin build body losses heat rapidly and for a fatty body retention of heat is longest. 4. Sex: Female bodies retain body heat for a comparatively longer period.. 5. Clothing: A body well covered with cloths retain body heat for a longer time. 6. Air movement : Air movement causes quick fall of temperature. 7. Dry whether: Dry whether itself promotes rapid heat loss by promoting evaporation of body fluid
  20. 20. Medicolegal importance of Cooling of dead body 1. Cooling of dead body is a sign of death. 2. Time of death can roughly be estimated. 3. Cooling of the dead body delays the process of rigor mortis and decomposition..
  21. 21. Post mortem caloricity There are certain conditions in which instead of promoting the process of cooling of the dead body the body temperature is either high at the time of death or increased for sometime after death is known as post mortem caloricity.
  22. 22. Cause of post mortem caloricity 1. Post mortem glycogenolysis: Breakdown of glycogen after death produces up to 140 calories ,which can increase the body temperature at an instant time by 3.6 degree F. or 2 degree C. 2. Infectious disease :Infectious disease or septicaemia, bacteremiamay cause rise of temperature due to post mortem production of heat by infective organism. 3. Death due to convulsive disorder:Tetenus, strychnine poisoning may cause rise in PM temperature. 4. Death due to heat stroke. 5. High atmospheric temperature: The dead body may absorb heat and raise the temperature of the dead body if atmospheric temperature is higher.
  23. 23. EARLY CHANGES AFTER DEATH 6.Post mortem hypostasis/post mortem staining/ Post mortem lividity/Livor mortis/Vivices. It is the bluish or reddish purple discoloration due to capillovenous distension with blood at the undersurface of skin of the dependent part of the body, due to settling of the blood under the force of gravity when the blood circulation ceases.
  24. 24. Livor mortis/Post mortem hypostasis Livor mortis is the purple-red coloration that appears on dependent portions of the body other than areas exposed to pressure after the heart ceases to beat. It results from the settling of the blood under the force of gravity (see the image ) Livor mortis on the posterior aspects of the body is caused by settling of the blood because of gravity when the body is in a supine position.
  25. 25. Livor mortis/Post mortem hypostasis • Livor mortis usually appears 30 minutes to 2 hours after death, though it may appear sooner in cases of severe heart failure in which the antemortem circulation was sluggish. After a PMI of 8– 12 hours, red cells extravasate from the vessels into the surrounding soft tissue. Until that time, the application of pressure to an area of livor will result in blanching of the skin (as depicted in the image ). • Pressure on unfixed livor results in blanching of the coloration. • After that period, livor may blanch with forceful pressure but will eventually not blanch, at which time it is considered fixed. Movement of a body before the complete fixation of livor will result in the redistribution of lividity into the newly dependent areas of the body. If there is partial fixation of the livor at the time the body is moved, it is to be expected that the original pattern of distribution of residual livor would remain, as shown in the following image.
  26. 26. Livor mortis/Post mortem hypostasis Causes of formation of P.M Hypostasis a) Stoppage of circulation. b) Stagnation of blood in the blood vessel. c) Tendency to sink under the force of gravity. d) Volume of blood in circulation. e) Length of time the blood remains fluid after death.
  27. 27. Livor mortis/Post mortem hypostasis Formation of post mortem staining/PM Hypostasis: a) When the body is left undisturbed without change of position the staining starts appearing in small patches at the dependent part of the body, gradually the patches will increase in size and form uniformly large stained areas. b) It will develop within 4 hours and reaches maximum between 6 to 12 hours.
  28. 28. Fixation of Livor mortis/Post mortem hypostasis 1. After formation of P.M staining if the body is still left undisturbed for a period of another 5 –6 hours then the staining will get fixed. b) If the position of the body is disturbed after fixation of the staining then the staining will not change its position and will remain more or less same. c) Fixation of post mortem staining was for a long time thought to be due to intravascular coagulation of the settled blood. But in practice clotting will not occur in small veins and capillaries. d) Actually fixation of P.M. staining occurs due to certain factors: (1) After formation of P.M. staining blood cannot pas through the capillaries due to cessation of circulation. (2) By the time there has been total settling of rigor mortis is well established and the muscles will obliterate big vessels passing through the muscles. So the blood cannot pass through these vessels.
  29. 29. Factors influencing the formation of P.M. hypostasis 1.Fixed and undisturbed position of the dead body . 2.Excessive loss of blood P.M. staining will not be appreciated. 3.In severely anemic subject P.M. staining will not be prominent. 4.Post mortem staining is more prominent in fair complexioned person and less prominent in dark complexioned person. 5. It is intense in asphyxia. 6.It is less prominent in wasting disease due to reduced amount of blood. 7.It is less marked in lober pneumonia
  30. 30. Livor mortis/Post mortem hypostasis • As post mortem staining occurs externally on the dependent part of the body • It also occurs at the dependent part of all the internal organs of the body. • In drowning cases P.M staining may appear on the face and neck if it is submerged in stagnant water because head is heavier than the body. But in flowing water the position of the body will constantly change hence there is no fixed dependent part of the body so there may be no post mortem staining.
  31. 31. Medico legal importance of PM Staining a)Formation of post mortem staining is a sign of death. b) From P.M. staining time passed after death can be roughly estimated. c) From distribution of P.M staining the position of the dead body can be determined. d) Post mortem staining can be confused with bruises.
  32. 32. Medico legal importance of PM Staining e) Cause of death can be determined:- 1. P.M staining found in the neck and face ,lower part of upper and lower limb then it can be said that death was due to hanging. 2. From color of P.M staining cause of death can be determined. -In CO poisoning the stain is pinkish. -In HCN poisoning the color is cherry red. -In CO2 poisoning the color will be deep blue. -In Phosphorus poisoning the color is dark brown. -In H2S poisoning the color is greenish blue. -In case of death due to exposure to cold the color is bright red.
  33. 33. DD of PM staining: 1.PM staining 2.Bruise 3.Congestion 4.Antemortem hypostasis
  34. 34. Difference between bruise & PM hypostasis: Features Bruise PM Hypostasis Swelling +ve -Ve Abrasion +ve -Ve Color changes due to healing +ve -Ve On incision Extravasation of blood is present under skin Blood within blood vessels
  35. 35. Ante mortem hypostasis Ante mortem hypostasis may be found in persons with feeble circulation if he has not changed his position for some hours.
  36. 36. Tardieu spots Tardieu spots are petechial and purpuric hemorrhages that develop in areas of dependency secondary to the rupture of degenerating vessels under the influence of increased pressure from gravity (see the images). As the postmortem interval lengthens, Tardieu spots develop in areas of lividity, such as this individual's shoulder area, as decomposing capillaries rupture.
  37. 37. Tache noire • Tache noire is the dark, red-brown stripe that develops horizontally across the eyes when the eyelids are not closed after death. It is a drying artifact that may mimic trauma (see the image ). • Tache noire develops when the eyelids are not completely shut and postmortem drying occurs.
  38. 38. EARLY CHANGES AFTER DEATH 7.RIGOR MORTIS OR CADEVERIC RIGIDITY Rigor mortis is that state of muscles of dead body when they becomes stiff or rigid with some degree of shortening. • Rigor mortis is the postmortem stiffening of the body’s muscles. • It may or may not involve some degree of actual shortening of the muscles. • In most cases, rigor mortis begins within 1-2 hours after death; • it begins to pass after 24 hours (see the image).
  39. 39. Rigor mortis
  40. 40. Rigor mortis • Rigor affects both smooth and skeletal muscles, including the myocardium (simulating hypertrophy), hair follicles (resulting in cutaneous "goose bumps") (see the image below), and seminal vesicles (resulting in postmortem semen release from the penile meatus). • Rigor mortis of the erector pilae can result in postmortem "goose flesh." • Rigor mortis first appears approximately 1-2 hours after death. Progressive stiffening occurs for approximately 12 hours, persists for approximately 12 hours, then diminishes over the next 12 hours as tissues break down as a result of autolysis and putrefaction. • Rigor mortis may be used to deduce the position of the decedent if the body has been moved after the development of rigor mortis. If rigor mortis is broken by manipulation before becoming fully fixed, it may reform in the new position. • The estimation of the strength of rigor mortis is often rated on a scale of 0–4 and is highly subjective.
  41. 41. Rigor mortis Rigor mortis develops as the body’s energy source (adenosine triphosphate[ATP]) is depleted. Muscle fibers require ATP for relaxation; once depleted, actin and myosin proteins remain complexed, resulting in stiffening of the muscles. Rigor mortis is thought to develop in all muscles simultaneously; however, it is most evident first in the smaller muscle groups, such as the jaw, after which rigor mortis typically occurs in the upper extremities and then the lower extremities, as in the following image.
  42. 42. Mechanism of formation of Rigor mortis a) Muscles fibers contain bundles of myofibrils which consist of 2 types of protein filaments actin and myosin. b) These 2 types of filaments are arranged in inter digitation arrays. c) One type of filament extending in between the filaments of other. d) During life the muscle fibers also appears soft and supple . Maintenance of softness, suppeleness extensibility of the muscle is due to presence of ATP. e) With Nervous stimulation breakdown of ATP occurs to ADP and phosphate.
  43. 43. Mechanism of formation of Rigor mortis f) This process of breakdown of ATP causes lliberation of energy which causes contraction of muscle fibers. g) But during life very soon there is resynthesize of ATP from ADP and phosphate by the process of phosphorylation. h) After death there is continuous breakdown of ATP. So long glycogen s available there is re synthesis of ATP. Once glycogen is exhausted there is no further re synthesis of ATP is possible and the muscle losses it softness, elasticity and extensibility due to formation of viscid actinomysin complex giving rise to the formation of state of rigor mortis in the muscle.
  44. 44. Onset of rigor mortis a) R.M. first appears in heart muscle . b) R.M.first appears in the muscles of the eyelid and chronologically in the muscles of the face ,neck, jaw. Thorax, upper limb the abdomen and lower limb. c) It comes last in small muscles of fingers . Duration of Rigor mortis: a) 18 to 36 hours in summer, 24 to 48 hours in winter. b) In general rigor mortis sets in 1 to 2 hours after death is well developed from head to foot in about 12 hours , is maintained for 12 hours and passes off in about 12 hours.
  45. 45. Rigor mortis Factors influence the formation of rigor mortis a) Age. R.M does not develop in foetus of less than 7 month of intrauterine age. b) Physique. R.M comes early and passes of early in thin built subject .In well built subject it comes late and stays longer. c) Atmospheric temperature. At high temperature R.M comes early and passes of early. In cold temperature it comes late and stays longer.
  46. 46. Rigor mortis d) R.M appears early passes of early in death due to exhaustive and convulsive disease. e) In death due to wasting disease R.M comes early and passes of early. f) In death due to strychnine and hydrocyanide poisoning R.M comes early and goes late.
  47. 47. Rigor mortis Medico legal importance of Rigor mortis a) It is a sign of death. b) R.M. gives good idea about time since death. c) Position of the body can be determined. d) R.M indicates the molecular death of a person.
  48. 48. Differential diagnosis of stiffening of a dead body a) Cadaveric spasm or instantaneous rigor. b) Heat stiffening c) Cold stiffening d) Gas stiffening e) Rigor mortis
  49. 49. Cadaveric spasm It is a condition in a dead body in which the muscles of the body which were in a state of strong contraction immediately before death continues to be so contracted at the moment of death and after death without passing through the stage of primary relaxation. The spasm involves only one or a group of muscles of he body. The spasmodic contraction of muscles reflex ante mortem state of mind, fatigue, nervous exhaustion.
  50. 50. Cadaveric spasm Cadaveric spasm is an uncommon and disputed form of rigor that develops immediately upon death, usually after strenuous activity. One theoretical example would be a drowning victim’s hand clutched around a swatch of grass growing on the water’s edge. In such cases, it is presumed that the decedent was in profound lactic acidosis at the time of death as a result of violent struggle and went into rigor mortis immediately. a
  51. 51. Cadaveric spasm Cause of cadaveric spasm 1. Exhausted ATP. 2. Failure of chemical process required for active muscular relaxation. 3. Adrenocortical exhaustion which impairs synthesis of ATP.
  52. 52. Cadaveric spasm Medico legal importance of cadaveric spasm 1.It reflects the last act of the person performed before and at the time of death. 2. Sometimes the cause of death can be determined. 3. Sometime the nature of death can be guessed,e.g . If the weapon is found in a tight grip of the hand and the position of the hand matches with commission of suicide then it can be said the person has committed suicide.
  53. 53. Heat stiffening a)If death occurs due to 2nd and 3rd degree burn or if the dead body is subjected to exposure to more than 65 degree C. then there will be coagulation of muscle protein and the body will become stiff in which the flexor muscles will take the upper hand giving rise to a condition known as pugilistic attitude or boxers attitude. b) Presence of charring will be present. c) Presence of blister will also be present.
  54. 54. Cold stiffening a) Occurs in extreme cold atmosphere. b) There will be freezing of body fluid. c) Due to hardening of body fat. d) Body temperature will be below 0C, there will be cracking sound or crepitation of the joints if manipulated and if the body is left in ordinary temperature then rigor mortis will appear.
  55. 55. Gas stiffening Gas stiffening will occur due to decomposition. So there will b discoloration, swelling and foul smell will be found.
  56. 56. LATE CHANGES AFTER DEATH 1. Putrifactionor/ordinary decomposition. 2. Adepocere formation 3. Mummification.
  57. 57. Putrefaction or ordinary decomposition • It is the process by which the complex nitrogenous substance in the body are converted into simpler ones by the action of proteolytic enzymes of the tissue and living saprophytic organism. Or • It can be defined as a process by which the complex organic body tissue breaks down into simpler inorganic compound due to action of ferments produced by saprophytic microorganism or due to autolysis.
  58. 58. Putrefaction or ordinary decomposition 1. After death the body’s protective function are absent and its defense barrier is lost. 2. Saprophytic microorganism which cannot invade the living body during life can invade after death due to loss of physical and metabolic activities. 3. Some body chemical and enzymes which are helpful agent during life and takes part in different metabolic process in the absence of physiological control after death starts acting adversely.
  59. 59. Putrefaction or ordinary decomposition 4. So the body is subjected wear and tear. 5. So long the rigor mortis continues the gross anatomical structure is maintained. 6. But beyond this stage the gross body structure starts breaking down.
  60. 60. MEDICOLEGAL IMPORTANCE OF DECOMPOSITION 1. Decomposition is the surest sign of death. 2.From the stage of putrefaction time passed after death can be determined. 3. Advanced decomposition obliterates identity. 4. Advanced decomposition also obliterates cause of death of the deceased.
  61. 61. Cause of decomposition 1. Autolysis:-Autolysis means self digestion by the enzymes released after death from tissue cell. 2. Living saprophytic microorganism:- Cl. Welchii, Streptococci, Staphylococci, B. Proteus, B. Coli.
  62. 62. Stages of putrefaction: 1.Colour Changes 2. Formation of putrefactive gases 3. Appearance of maggots 4. Colliquative putrefaction
  63. 63. Stage of putrefaction 1. Color changes :- This changes first observed externally in the abdominal skin over the region of caecum, where there is greenish discoloration due to conversion of hemoglobin into sulphmethhaemoglobin by the action of hydrogen sulphide with hemoglobin. This color appears in 12 to 18 hours in summer. This greenish discoloration gradually spreads to whole abdomen, external genitalia, neck, face ,arms and legs.
  64. 64. Color changes The abdomen develops a green discoloration after 24–36 hours, usually in the right lower quadrant first (the location of the cecum). An example of this is below. Early decompositional changes are manifested by green discoloration over the abdomen.
  65. 65. Purge fluid Purge fluid is decomposition fluid that may exude from the oral and nasal passages as well as other body cavities (see the image ). Postmortem purge fluid exudes from the oral and nasal passages; no traumatic injuries were uncovered at autopsy.
  66. 66. Marbling of skin • Marbling may develop with the delineation of the vasculature as a result of the reaction of hydrogen sulfide produced by bacteria with hemoglobin from the lysis of erythrocytes, as shown below. Bloating of the body occurs as a result of bacterial gas production; in intemperate conditions, bloating occurs over a period of 2–3 days. Bloating causes distortion of both the body and face. • Marbling outlines the vasculature in this decedent as the postmortem interval lengthens. • Gas (eg, hydrogen sulfide, methane) forms in the organs and subcutaneous tissues as well as the body cavities. Epidermal vesicle formation and skin slippage occur as the epidermis separates from the underlying dermis. The body becomes diffusely discolored green-black, often obscuring the race of the decedent (see the following image).
  67. 67. Color changes in Decomposition • Decomposition is the postmortem process of endogenous autolysis and putrefaction from external and primarily internal bacterial sources (see the image ). • Decomposition is a process of autolysis and putrefaction.
  68. 68. Color changes in Decomposition Decomposition advances with green discoloration of the skin, generalized bloating (beginning in the abdomen), and vesicle formation with subsequent skin slippage.
  69. 69. Color changes in Decomposition • Degloving of the skin of the palms and soles typically occurs during decomposition, as well as in cases involving thermal exposure (ie, fires) and immersions (see the following example). • Postmortem degloving of the hand. • The epidermis commonly retains enough ridge detail to allow fingerprints to be obtained, which assists in the identification of the decedent, as demonstrated below.
  70. 70. Stage of putrefaction 2.Development of foul smelling gases: Simultaneously with appearance of greenish discolouration there will be nauseating and unpleasent smell due to formation of putrefactive gases and these are sulphurettedhydrogen, CO2, marsh gas , ammonia, and phosphorettedhydrogen. Due to these gases there will be nauseating and unpleasant smell.
  71. 71. Stage of putrefaction 3.Appearance of maggots: •If putrefaction continues then flies are attracted and lay eggs. •These eggs will hatch in 24 hours to form larvae or maggots. •This maggots will hatch within 4-5 days to pupae. •Pupae in another 4 -5 days to form an adult fly.
  72. 72. Appearance of maggots Like any putrefying dead animal, dead human body attracts houseflies and other insects which lays egg which turns into maggots. The lifecycle of common housefly • Eggs (18-36 hours) • Hatching larva (24 hours) • Rapid growth into maggots (4-5 days) • Pupa (5thday) • Flies (6-10 Days)
  73. 73. Appearance of maggots The eggs hatch in 1–2 days. The larvae (ie, maggots) consume tissue and grow through 3 larval stages, known as instars, as demonstrated in the image below. Young maggots resemble fly eggs but are mobile. In this case, fly eggs were laid in the moist environments of the partially open eyes, eares, and mouth. The eggs hatched and migrated across the face.
  74. 74. Appearance of maggots The proteolytic enzymes secreted by large numbers of maggots work to increase the rate of tissue breakdown. The larvae pupate in approximately 1-2 weeks; adult flies emerge in another 2 weeks, as seen in the following 2 images. These timelines, however, vary greatly with the species and environmental factors; in some cases, a forensic entomologist may need to be consulted to assist in estimating the PMI.
  75. 75. Appearance of maggots Fly pupae such as these are often recovered away from the body, because maggots migrate before pupation; these should be recovered from the death scene if the time of death is in question. Fly pupae on a decedent; note the presence of other insects.
  76. 76. Stage of putrefaction 3.Colliquative putrefaction: It begins from 5-10 days after death. • The abdomen will burst, stomach and intestine will protrude and in children the thorax also burst. • The tissue becomes soft, loose and converted into semifluid mass. • The tissues will be separated from bones. • The cartilage ligaments are softened and ultimately the bones are destroyed.
  77. 77. FACTORS WHICH INFLUENCE PUTRIFACTION EXTERNAL FACTORS 1. Atmospheric temperature: • High atmospheric temperature promotes early decomposition. • The optimum range of decomposition is 21—38 degree C. • Decomposition virtually ceases below 0 degree C. and above 48 degree C. • Optimum temperature helps decomposition in two ways, By chemical breakdown and by promoting the growth of organism.
  78. 78. FACTORS WHICH INFLUENCE PUTRIFACTION 2. Moisture: • Moisture promotes decomposition by promotes the growth of organism. • Absence of moisture decomposition will be slow. • If the body dries up it will prevent putrefaction and will cause mummification.
  79. 79. FACTORS WHICH INFLUENCE PUTRIFACTION 3. Air: • Stagnant air promotes decomposition. • Air movement retards the process of decomposition by evaporating the body fluid. 4. Clothing: Clothing slightly reduce the rate of decomposition by preventing invasion of the body by air borne organism.
  80. 80. FACTORS WHICH INFLUENCE PUTRIFACTION 5. Environment: • If the body is submerged in water the process of decomposition will be slow due to cooling . • In buried body the rate of decomposition varies according to the depth of grave. • In surface burial the rate of decomposition is more. In deep burial the rate of decomposition is less. 6. Invasion of the body by insects and animal will promote the process of decomposition.
  81. 81. FACTORS WHICH INFLUENCE PUTRIFACTION INTERNAL FACTORS 1.AGE: In case of intrauterine death decomposition is aseptic and only by way of autolysis. In infants and children the decomposition is rapid. 2.SEX: Female body will decompose rapid due to retaining of body heat due to abundance of fatty tissue. 3.CONDITION OF BODY : Thin emaciated body decomposes late then a well nourished body due to less fluid content which promotes growth of organism. 4. CAUSE OF DEATH : If death is due to infection or septicemia decomposition is rapid. 5. SURFACE INJURY : Dead bodies having external injuries will decompose earlier because due to invasion of microorganism from outside.
  82. 82. EFFECTS OF PUTREFACTION 1.Alteration of feature. 2.Discharge of fluid. 3.Formation of post mortem blisters & blebs. 4.Distension of body cavities and organs. 5.Inflation of soft tissues. 6.Expulsion of food and faeces. 7.Post mortem delivery of fetus. 8.Prolapse of rectum and uterus. 9.Post mortem bleeding from cut end of vessels. 10.Emptyness of cardiac chambers. 11.Accumulation of serosanguinous fluid in the serous cavities. 12.Shifting of post mortem staining.
  83. 83. PRESSURE EFFECT OF PUTREFACTIVE GASES 1.Bloating features: The face becomes so swollen and altered in color that identification become impossible due to cellular inflation. The breast in female and penis and scrotum in male becomes enormously swollen. 2.Shifting of areas of hypostasis: Post mortem staining will be weakened. It may shift in other areas.
  84. 84. PRESSURE EFFECT OF PUTREFACTIVE GASES 3.Changes in skin and wounds. Putrefactive blisters will appear under the skin.These may be confused with blister of burn.Wounds will begin to bleed again. 4.Extrusion of fluid from the mouth. Due to distension of stomach fluid will come out from nose and mouth. 5.Changes in appearance of genitals. The female genital appears to be pendulous and may be mistaken as a sign of sexual assault.The fetus may be expelled from pregnant uterus.
  85. 85. Maceration Maceration is a process that occurs in cases of intrauterine demise, as shown in the following image. It is an autolytic process noticeable several days after an intrauterine death caused by endogenous fetal enzymes; because the fetus is typically sterile, putrefactive bacteria usually do not play a role. Exceptions include cases in which the fetus had an infection, such as chorioamnionitis or congenital pneumonia; in such cases, the fetus may show more characteristic signs of decomposition. Maceration after retention of an intrauterine fetal death. Typically, the macerated fetus shows dark pink to brown discoloration of the skin, followed by skin slippage without gaseous bloating. As maceration progresses in utero, joints loosen and the skull plates separate; characteristically, the skull plates override their sutures, which to the inexperienced examiner may mimic head trauma. Once expelled from the uterus, the fetus or infant may become colonized by environmental bacteria, adding a putrefactive component to subsequent postmortem changes.
  86. 86. Maceration
  87. 87. SAPONIFICATION/ADEPOCERE FORMATION ADEPOCERE FORMATION • It is the modified putrefaction in which the body fat is converted into a brown wax like substance which occurs in bodies submerged under water for an appreciable time or buried in moist grave or water lodged soil. • For some period this change was used to be termed as saponification on the ground and belief that the change occurs due to formation of soap in the fatty tissue. This idea now stands rejected and the original name ―adepocere change‖ is again in use. • This term indicates that the properties of the changed fatty tissue is in between fat and wax.
  88. 88. ADEPOCERE FORMATION • Adipocere formation typically occurs in bodies submerged in water or in warm, humid environments. The tissues are converted into a waxy, pasty material as a result of the reaction of clostridial enzymes with tissue fatty acids, as seen in the following image. • Adipocere has developed in this person who was sealed in a barrel containing water and buried for over 5 years.
  89. 89. MECHANISM OF ADEPOCERE FORMATION. • In this the fatty tissue of the body change into a substance known as adipocere.This change is due to the gradual hydrolysis and hydrogenation of pre existing fat into higher fatty acids e.g. Palmitic,Stearic, and hydroxyl stearic acid by the help of intrinsic lipase and by bacterial enzyme. • Normally the body at contains only about 0.5% free fatty acids. But in adepocere change this figure may rise to 70% or more.So the chemical reaction essentially involves change of fat to higher fatty acids like palmitic acid, stearic acid and hydroxyl stearic acid.
  90. 90. PHYSICAL PROPERTIES OF ADIPOCERE 1.The change is whitish or grayish white in color. 2.It has a sweet rancid smell. 3.It is soft and waxy in consistency when fresh, but brittle when old. 4.It burns with yellow flame. 5. It dissolves in ether and alcohol. 6. When treated with KOH it liberates a little ammonia. 7. Due to this change the body buoyancy is increased and the body floats on water.
  91. 91. TIME REQUIRED FOR ADIPOCERE FORMATION 1.The shortest time is about 3 weeks. 2.It takes about 3-6 weeks for an adult limb and 12 month for whole body to be converted into adepocere. 3.In cold environment it requires 3 week to 3 month.
  92. 92. DISTRIBUTION OF ADEPOCERE 1.At first it forms in patches and the gradually increases in size. 2.The change s well marked over those part where there is excess deposition of fatty tissue e.g. on the check, over the female breast and buttock. 3.In case of a female body this change will be seen almost all over the body due to presence of good amount of subcutaneous fat in the body.
  93. 93. FACTORS WHICH INFLUENCE ADEPOCERE FORMATION 1.Atmospheric or environmental temperature. Heat favours and cold retards the process of adipocere change in the body.High atmospheric temperature help in two ways:- a)It directly promotes the chemical reaction required for the change. b)High atmospheric temperature helps in invasion of the fatty tissue Cl. Wellchii, which liberates lecithinase that helps breakdown of the fat cells.
  94. 94. FACTORS WHICH INFLUENCE ADEPOCERE FORMATION 2. Moisture. Moisture or water is essential for the chemical reaction to occur. 3. Air movement. This retards the process of adepocere formation by:- (a)Evaporation of the body fluid. (b)By reducing the body temperature.
  95. 95. FACTORS WHICH INFLUENCE ADEPOCERE FORMATION 4. Running water. In case of submerged body running water retards the process of Adepocere formation by constantly washing out the electrolyte from the surface of the body which are necessary for completion of the change. 5. Youth. 6. Obesity. 7. Bacterial activity.
  96. 96. MEDICOLEGAL IMPORTANCE OF ADIPOCERE CHANGE 1. It is another surest sign of death. 2. It also gives rough idea about the time passed after death. 3. Identification of the subject is possible even after long period. 4. Cause of death can be ascertaind long after death. e.g. injuries over the body remains intacts and can be recognized even after long period. 5. Idea about the place of disposal of the body can be made.
  97. 97. MUMMIFICATION MUMMIFICATION It is the drying and shriveling of the body tissue due to rapid dehydration of the body in a dry and hot climate and which retains the natural appearance of the body. TIME REQUIRED FOR MUMMIFICATION. It varies from 3 weeks to 3 months.
  98. 98. MUMMIFICATION • In mummification there is rapid drying of the dead body due to environmental factors. • The soft tissue becomes dark, hard and stay preserved. • The dry and hard skin gets almost adhered with the underlying bones. • The mummification of the skin becomes somewhat translucent due to absorption of liquefied subcutaneous fat. • The internal organs reduce in their size and they cannot be identified Individually.
  99. 99. MUMMIFICATION • Two less common variants of decomposition are mummification and adipocere formation. The former process occurs in warm, dry environments where the tissues rapidly desiccate and resist the typical "wet" decomposition. With mummification of the body, external injuries may be preserved, though the size of wounds may be distorted, as demonstrated below. • Mummification of this homicide victim occurred after she remained in a secure bedroom in August in the southeastern United States for almost 2 weeks with no air conditioner. Mummification preserved the numerous stab wounds and incised wounds, allowing accurate postmortem assessment of her injuries.
  101. 101. FACTORS FAVOURING MUMMIFICATION 1. Hot atmosphere. 2. Dry atmosphere. 3. Free air movement. Help rapid evaporation of body fluid. 4. Contact of the body with absorbing media, e.g.lying over the sand. 5. Absence of dampness. 6. Marked dehydration before death.
  102. 102. MEDICOLEGAL IMPORTANCE It is one of the surest sign of death. It gives a rough idea about time passed after death. Identification can be done long after death.Because normal anatomical structure is maintained, old scar, deformities, tattoo marks may be detected. Cause of death can be detected. Injuries can be detected after long time. The place of disposal of the dead body can be guessed.
  103. 103. POST MORTEM INTERVAL POST MORTEM INTERVAL The interval between death and the time of examination of a body is known as post mortem interval.
  104. 104. IMPORTANCE OF P.M. INTERVAL 1.To know when the crime was committed. 2.It gives the police a starting point for their inquires. 3.It might enable to exclude some suspect. 4.Also to check on a suspects statements.
  105. 105. POINTS FOR DETERMINATION OF P.M. INTERVAL 1.Cooling of the body. 2.Post mortem lividity. 3.Rigor mortis. 4.Progress of decomposition. 5.Entomology of the cadaver. 6) Gastrointestinal & urinary tract. • Bulk of the meal leaves the stomach within 2 hours. • The head of the meal reaches the hepatic flexure in about 6 hours. • Splenic flexure in 9 to 12 hours. • Pelvic colon in 12 to 18 hours.
  106. 106. POINTS FOR DETERMINATION OF P.M. INTERVAL 7) Vitreous humour 8) Blood • Potassium, phosphorus and magnesium levels rise after death. • Sodium and chloride levels decrease. • Ammonia, lactic acid and bilirubin levels rise after death. 9) Cerebrospinal fluid • Lactic acid concentration rises from normal 15 mg % to over 200 mg % in 15 hours after death. • Amino acid rise from 1 to 12 mg% in 15 hours. • Glucose values decreases. 10) Pericardial fluid 11) Bone marrow
  107. 107. POINTS FOR DETERMINATION OF P.M. INTERVAL 12) Hair Hair does not grow after death. A rough estimation of the time since the last shave can be made , for beard hair grows at the rate of 0.4 mm per day. 13) The scene of death The dates on newspaper, state of food on the table, the state of dress should be noted as regard whether the person is fully dressed or in the night dress. 14) Radioactive carbon C14 half life 5600yrs. *Consider effect of keeping cadavers in refrigerating chamber/other preservatives/situations.
  108. 108. Skeletonization • Skeletonization usually requires months to occur in temperate conditions, but it may develop in less time if larger predators have access to the body (see the following image). Larger predators may remove body parts and create postmortem artifacts, such as gnaw marks on bones. The application of anthropologic studies is helpful in assessing the decedent’s gender, race, size, and age. Unless antemortem injuries affect the bony structures, evidence of the cause of death in some cases may be completely lost as a result of skeletonization and the loss of soft tissue. • This skeleton is that of an adult man who had been missing for 1.5 months during the late fall in the southeastern United States. He was found in a wooded area. Although the skeleton was mostly intact, gnaw marks were evident on several ribs.
  109. 109. Skeletonization
  110. 110. Thanks to all
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Death & changes after death


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