POSTMORTEM CHANGES

OBJECTIVES

To know various changes following

death

Factors influencing such changes

Estimationof “Time since death” from

such changes after death

Medicolegal aspects of such changes

Signs of death appear in
following order:

Immediate changes

Early changes

Late changes
 IMMEDIATE CHANGES
(SOMATIC DEATH)

Insensibility and loss of voluntary

power

Cessation of respiration

Cessation of circulation
 EARLY CHANGES
(CELLULAR OR MOLECULAR
DEATH)

Pallorand loss of elasticity of skin

Primary flaccidity of the muscles
Changes in the eye
Cooling of the body or Algor mortis
Post mortem lividity or Livor mortis
Rigor mortis
(DECOMPOSITION AND DECAY)

Putrefaction

Adipocere formation

Mummification
 SUSPENDED ANIMATION
(Apparent Death)
Signsof life are not found: as
functions are interrupted for some
time or are reduced to minimum

Lifecontinues & resuscitation is

successful

Metabolic rate is so reduced that

requirement of individual cell for
oxygen is satisfied through use of
oxygen dissolved in body fluids
Produced voluntarily-Yoga
practitioners

Involuntarily- vagal inhibition

Drowning, electrocution
Newborn infants
Drug poisoning
Sunstroke, freezing of body
(hypothermia)
After anaesthesia, shock
Cerebral concussion, insanity
 EARLY CHANGES
(CELLULAR OR MOLECULAR DEATH)
Pallor and loss of elasticity of skin
Primary flaccidity of the muscles
Changes in the eye
- Loss of corneal reflex
- Opacity of the cornea
- Flaccidity of the eye ball
- State of the pupils
- Changes in the retinal vessels
“Kevorkian sign”- earliest sign of
death
 Post mortem cooling
(Algor mortis)
Does not occur at same rate throughout
body

Postmortem heat production by anaerobic

glycolysis is very low

Heat loss occurs by:

- Conduction: in contact areas
- Convection: at non-contact areas
- Radiation: intense in 1st hour, decreases
later
- Evaporation: only a small fraction
Chart showing Temperature
change in body after death

Curve of cooling is “sigmoid” shaped

Rectum– Ideal place to record
Other sites

NORMAL BODY TEMP - RECTAL TEMP = Approx. time in hours

of death
RATE OF TEMP FALL PER HOUR
 Factors influencing the cooling
of the body

Temperature of the body at the

moment of death
Temperature difference between the
body and surrounding
Clothing and covering
Body built
Air currents and humidity
 Post mortem lividity
(Livor mortis)
Postmortem hypostasis, Postmortem
staining, Suggilations, Vibices
Bluish-purple or purplish-red discolouration
which appears under the skin in most
superficial layers of the dermis of
dependent parts of body after death
Due to capillo-venous distension
Time of appearance: 1-2 Hrs,

well developed: 4 hrs,

max: 6-12 Hrs and
persists until putrefaction sets in.
Extent and distribution
- Contact pallor
- Position:
Primary/secondary
in drowning/assault

- Fixation (due to
coagulation in
capillaries): in 6-8 hrs
Post-mortem Hypostasis
 P M STAIN BRUISE
Situation Dependent Anywhere
parts
Surface Not elevated Elevated
Colour Bluish or Reddish/fresh
purple
Pressure Appears pale No change
Cause Capillo- Extravasation
venous from
distension capillaries
C\s Blood Haemorrhage
confined into tissues
within vessels
MLI Time of Nature of
 Colour of hypostasis

Cherry red – CO poisoning

Bright red – HCN, Burns
Chocolate brown – Chlorates
Dark brown or yellow –
Phosphorus
Bluish-green – Hydrogen sulphide
Bluish violet or purple - Asphyxia
 Medico legal significance

Sign of death
Position of the body
Postmortem interval
Manner of death
Cause of death
 RIGOR MORTIS
(CADAVERIC RIGIDITY)

Stiffening of muscles after death

Muscles after death pass through 3

phases
First stage - Primary flaccidity
Second stage - Rigor mortis

Third stage - Secondary flaccidity

 Mechanism
Nerve impulse

Arrays of actin filaments are drawn

into arrays of myosin filaments, like
pistons into cylinders

Muscles contract

Dependent on ATP
Critical level: 85 % of normal
SARCOMERE
Rigor Mortis
 Rigor mortis (contd)

Time of onset and duration

RULE OF “12”
- starts in 1-2 hrs
- well established in 9-12 hrs
- maintained for 12 hrs
- passes off in another 12 hrs
 Rigor mortis (contd)

Order of appearance and

disappearance

- first in muscles of face and neck

- upper limbs
- chest and abdomen
- lower limbs
 Factors influencing onset and
duration
Temperature-

- rigor persist longer in cold and wet air

- rigor disappears early in hot and dry air

Influence of nature of death

- early in emaciated person, wasting
diseases, septicaemia, enteric fever etc
- delayed in asphyxia, nervous diseases
 Condition of the muscles
Onset is slow and duration
longer in
- healthy and robust muscles and
- muscles at rest prior to death

Onset is rapid if the muscles are

- exhausted or
- fatigued
 DEVELOPMENT in various
AGES
Less than 7 months foetus- does
not develop

Middle aged healthy person-

slowly, well marked

Children and old people-weak

and rapid
Others forms of stiffening
Heat stiffening

Cold stiffening- <3.50 C or 400 F

Cadaveric spasm
 Cadaveric spasm
(or Instantaneous Rigor)

Rare phenomenon
Onset-
instantaneous
Affects-group of
muscles
More likely to be
seen when death
precedes great
muscular exertion
and intense emotion
Cadaveric spasm
 MLI
From things seen firmly grasped in
victim’s hand
 Manner of death
- In suicide: weapon e.g: pistol or knife
- In assault: some part of clothing e.g:
button or hair of assailant

 Cause of death & AM or PM nature

- In drowning, material such as grass,
weeds or leaves indicates antemortem
drowning
 Secondary relaxation
Flaccidity following rigor mortis
Mechanism: Caused by action of
alkaline fluids produced by
putrefaction
Another view: due to solution of
myosin by excess of acid
produced during rigor mortis
Third view: myosin dissolved by a
process of auto-digestion
 LATE CHANGES
[Link]
(DECOMPOSITION)
final stage of dissolution of body tissues
resulting in breaking of complex
organic
body constituents into simpler
inorganic
ones
 By Autolysis
 By Bacterial action
 A. AUTOLYSIS

Softening and liquefaction of

tissues
Aseptic condition-without
bacterial action
Digestive action of enzymes
released from cell
Earliest seen in parenchymatous
and glandular organs
 B. BACTERIAL ACTION
Itis dominant process
Aerobic and Anaerobic micro-organism
Fungus-penicillium and aspergillus
“CLOSTRIDIUM WELCHII’’-releases
enzyme “LECITHINASE’’
“LECITHINASE hydrolysis lecithin
present in cell membrane

- acts on carbohydrate, proteins and fats

and break down various tissues
Other organisms: [Link], [Link],
Streptococcus
Characteristic features of
putrefaction are:

1. Changes in colour of tissues

2. Evolution of gases in tissues

3. Liquefaction of tissues
 SITE OF APPEARANCE & COLOUR
CHANGE
Firstexternal sign:- Greenish
discoloration in right iliac fossa
Haemoglobin Sulphmethaemoglobin
Sulphretted Hydrogen(hydrogen sulphide)

Earliest internal change:- reddish-

brown discolouration of intima of
vessels e.g: aorta
12-18 hrs in summer
1-2 days in winter
Marbling of veins36-48 hrs
Greenish discoloration
Marbling of veins
Marbling of veins
Postmorte
m purge
 2. Development of foul
smelling gas
 Nauseating smell due to development of gas
in intestines mainly hydrogen sulphide

 12-24 hrs in intestine

 24-48 hrs in tissues, cavities and hollow
viscera
 2-3 days-skin slippage
 3-7 days
- bursting of abdomen, teeth may fall
off, - skin slippage in “Glove and
Stocking’’ fashion - hairs and nails may
turn loose
 5-10 days
- Colliquative liquefaction are
prominent
Postmortem blebs &
purge
Postmortem peeling of
skin
Internal phenomenon
As blood decomposes, its colouring
matter transudes into
tissuesgreenish-yellowgreenish-
bluegreenish-black.

Viscera-greasy & softened

Capsules resist putrefaction longer-
thus, viscera like liver, spleen & kidney
converted into bag like structures filled
with thick, turbid fluid material.
Factors modifying
putrefaction
[Link]:
- Temperature
- Moisture
- Air
- Clothing
- Manner of burial
“Casper dictum” 1 : 2 : 8
Air:Water:Earth
Internal:
- Age
- Sex
- Condition of body
- Cause of death
- Mutilation
Putrefaction in water
“Casper dictum” 1 : 2 : 8

Air:Water:Earth
 Warm > cold
 Fresh > salt
 Stagnant > running
 Sewage > normal
 ADIPOCERE
Firstdescribed as “ADIPOCIRE’’
by Fourcroy in 1789
Adipo-fats, Cire-wax
Gradual hydrolysis and
hydrogenation of pre-existing fats
such as olein into higher fatty
acids such as palmitic, oleic,
stearic and hydroxystearic acid-
‘adipocere’
Factors favouring
ADIPOCERE
Abundance of moisture
Presence of bacteria
Optimum temperature
Diminished air
Abundance of adipose tissue
 PROPERTIES
Soft, greasy looking, pale white or
cheese-like
Later hard, dry, brittle and yellow
Rancid or sweetish odour
Seen over subcutaneous fats of
cheeks, breast, buttocks and abdomen
Temperate countries-1 month in
summer
4-6 months in winter
In India, 15 days-1 month
 MLI
Identification
Cause of death
Time since death estimation
Place of disposal
 MUMMIFICATION
Drying and dessication of tissues take
place-sufficient degree to halt
putrefaction
Formation - deprivation of moisture
- free circulation of dry
air - warm dry atmosphere
Time required3 months-1 year
Can be partial / combination of
adipocere and mummification may be
seen
 MLI
Identification
Cause of death
Time since death estimation
Place of disposal
- bodies buried in desert soil,
- hot or dry atmosphere,
- bodies of elderly and infants
concealed in cubboards.
 Changes after death-3

TIME SINCE DEATH(PMI)

-Dr Udaya Shankar B S

 INTRODUCTION

Time of Assault
Directly: Death is instantaneous or
immediately after an assault
Indirectly: Additional findings
e.g: Stage of healing of an injury
 IMPORTANCE
When crime was committed?
It gives Police, a starting point for their
inquiries & allow to deal more efficiently
To exclude some suspects & search for
likely culprits
To confirm or disprove an alibi
To check on suspect’s statements
In Civil cases,
Who inherits property
Whether an insurance policy was
in force

Approx. Range of Time of

Death as considerable
biological variations in individual
cases
All available history
Local physical or environmental factors at
the scene of crime
- Fires & domestic heating
- Open widows
- Atmospheric temperature

- Range of Time--An educated guess, based

on knowledge & experience & subject to
error
 Definition
The interval between death, and the time
of examination of a body— ‘PMI’

Methods: Physical, Chemical,

Biochemical, Histological & Enzymatic
POINTS to be Noted:
Earliestchanges of death
Changes in eye
Cooling of the body
Postmortem lividity
Rigor mortis
Decomposition: putrefaction,
adipocere & mummification
Entomology of the cadaver
GIT
Urinary tract
CSF
Vitreous humour
Blood chemistry
Hair
Scene of death
Physical changes
Stop
Flaccid muscles, loss of elasticity of
skin, absence of ‘look’ of face + still
warm, not rigid, without any
permanent haziness of cornea<1
hr(summer) or <2 hrs(winter)
Changes in eye
Fragmentation of blood columns in retinal
vessels(Kevorkian sign)
IOP- normal: 14-25 g
Soon after death: <12 g
Within half an hour: <3 g
At 2hrs: nil
3-4 hrs: Tache noir
2 hrs: retina pale
6 hrs: hazy, 7-10 hrs: blurred
Cooling of body
Normal 36-37.2
Rectal -36.5-37.5 (0.6 higher than oral)
Variation 1 to 1.5
Sleep- ½ to 1 lower
Rate of cooling: 0.4 to 0.6 per hour for
next 12 to 16 hrs
ENTOMOLOGY of Cadaver
Study of form & behaviour of insects

MYIASIS-a condition caused by

infestation of body by fly maggots

Flies-Musca domestica & [Link]

 EGGS
Pearly-white, 1mm long
120-150 eggs at one sitting
In any natural or traumatically created
shaded orifices
Deposited anywhere when skin
decomposition begins
LARVAE (MAGGOTS)8-24 hrs
White, segmented, 1-2 mm in length at
birth, 12 mm when fully grown
Crawl into interior of body
Produce powerful proteolytic enzymes &
destroy the soft tissues
They burrow under the skin & make
tunnels & sinuses-which hastens
putrefaction
 PUPAE(3-6 days)
Dark-brown, barrel shaped, 6 mm in
length

ADULT (3-6 days)

Complete life cycle from egg to adult

5-6 days in summer & 8-20 days in winter

Body lice-remains alive for 3-6 days

 GIT
Amount of stomach contents
Extent of their digestion
Hour of ‘Last meal’
Depends on: anatomical, physiological,
pathological, psychological, agonal, kind
of food, etc
Marked intra & inter-individual
variability
Modified by
Total quantity of food taken at a meal
Additional snacks taken b/w a meal
Ratio of solid to liquid in the meal
CHO/fat content
Interindividual variability
Intraindividual variability from day to day
Dramatic variations due to psychogenic &
endocrine factors
Stomach contents do not enter the
duodenum after death
Digestion of stomach contents may
continue for some time after death
No significant differences in solid food
emptying rates b/w young & old persons
Rate increases directly with meal weight
 TIMING
Startsto empty-within 10 min
Fluids & semi-fluids-<2 hrs
Light meal 1-2 hrs
Medium meal 3-4 hrs
Heavy meal 5-8 hrs
CHO>Protein>Fat
Milk>Meat & pulses
Meat & vegetables not recognized after 4
hrs
Inhibit GET
Head injury-unconscious/semi-conscious
Physical or mental shock or stress, mental
depression, physical exhaustion
Any illness like pyloric stenosis
During sleep
Coma
Alcohol
Gatro-jejunostomy operation
Hepatic flexure-6-8 hrs
Splenic flexure-9-10 hrs
Pelvic colon-12-18 hrs
Stay there for 6-12 hrs

Stomach-full,
containing undigested
food<2-4 hrs

Urine in bladder-late in night

 CSF
Based mainly on hypoxic damage of
choroid plexus
Concn of K+ increases at a constant rate
in relation to temperature of body during
first 20 hrs
 Antemorte Postmortem Intrepretation
m level level

TSD COD
Glucose •200 mg/100 ml •Hyperglycem
•< 200 mg/100 ia
Spinal fluid ml •Non diabetics
•>150 mg/100 •AM
ml hyperglycemi
a
Lactic Sharp and 10 hours
Acid regular ↑ (Not
reliable)

Inositol 1.7 ± 0.45 ↑ upto 72

mg/100 ml mg/100 ml
Urea Constant, 25- 36 hours Same as
30 mg/100 ml blood level-
urea retention
 Antemortem and Postmortem
values (10.5 hours after death)

Postmortem Antemortem
(mEq/L) (mEq/L)

Sodium 127 142

Chloride 113 125

Potassium 21 2.9
Bicarbonate 9.4 2.6
Calcium 2.4 2.5
Magnesium 2.9 2.0
Phosphorus 5.2 0.8
Vitreous Humor
Levels of ascorbic acid & pyruvic acid
falls
K+ increases
 Vitreous sample collection

VH from both eyes- aspirated under sterile

conditions – 20 gauge hypodermic needle
is used
Needle introduced in eye through outer
canthus 4.5 cm lateral to limbus.
Aspirate 5 ml and transfer to sterile glass
vial.
Replace the vitreous drawn with distilled
water.
 Antemorte Postmorte Intrepretation
m level m
level TSD COD
vitreous half of •Consistent •non
glucose serum level reduction diabetic
•KB+↑glucose •AM
↑glucose
Lactic 160 mg/100 •260 mg/100 •Early •N
acid ml ml PM
•Low values •Sudden
death
BUN Similar to
blood BUN
creatinin 1.2 mg/ 100 Same as AM
e ml
 Electrolytes
Potassium: a highly significant increase
with the increasing time since death in both
the groups which was linear in fashion.
Vitreous K+ levels were significantly
higher in burn casessignificant effect of
temperature at the time of death on the
levels of K+.
K+ levels-increase up to 104 hrs.
It is due to the autolysis of the vascular
choroids and retinal cells of the eye.
 BLOOD-sample collection
Cardiac blood Femoral blood
Blood(20 ml) - heart Femoral blood taken by
(preferably right atrium or cutting the external iliac vein
inferior vena cava) or proximal to the inguinal
another convenient large ligament
vessel
specimen should be placed in milking the distal cut end into
a plain 20mL sterile plastic a plain 20mL sterile plastic
container. container

Preserved with 2% sodium Approximately 5mL of this

fluoride. blood should be placed in a
The site of collection must be fluoride/ oxalate tube
indicated on the label containing 1% sodium fluoride
as a preservative
PM glucose, insulin, pH, Ethanol
oxygen tension, level of
 Blood
Antemortem Postmorte Intrepretation
level m
level
TSD COD
pH 7.35-7.45 6.73 24 hours Rigor mortis
6.43 12 hours
Glucose Glycolysis at CO poisoning,
12.8 mg/ 100 ↑ ICP, URT
ml/hour. obstruction
(hanging),
drowning,
arterio
sclerotic
heart disease
Lactic 1 mEq/L 20 mEq/L 1 hour
acid 50-75 fold 12- 24
hours
Blood 7–21 mg/dL No significant
Urea change
Nitrogen

Creatinin 0.5 to 1.0 No significant

 Electrolytes
Antemorte Postmorte Intrepretation
m level m
level
TSD COD
sodium 135- 145 •Constant •12 hours
mEq/L •Then ↓ •0.9
mEq/L/hour
potassium 3.5-5 mEq/L •↑ markedly •1 hour
•Gradual ↑ •18 mEq/L
chloride 95- •80 -90 •24 hours
105mEq/L mEq/L
Rate of fall:
0.25 – 1
mEq/L/hour.
phosphorus 1-1.5 •20 mEq/L •18 hours
mmol/L
sulphate •Unchanged •24 hours
• ↓ by 20% •Next 2days
 Antemorte Postmorte Intrepretation
m level m
level
TSD COD
Non protein 50 mg/100 <12 hours
N ml <10 hours
Amino acid 14 mg/100 48 hours
N ml
30 mg/100
ml
Ammonia 10-40 1- 3 mg/100 First 8 hours
µmol/L ml
Uric acid 2.4-6.0 5.5 mg/100 6 hours
mg/dL ml 8 hours
6.2 mg/100
ml
Bilirubin 0.3- 1.0 0.2 mg/100 2 hours
mg/dl ml 20 hours
 Antemortem Postmorte Intrepretation
level m
level
TSD COD
Acid 20 times 48 hours
phosphatase
Alkaline 20 to 140 IU/L 10 times 2 days
phosphatase
Amylase 23 to 85U/L 3-4 times 2 days
Transaminase SGOT :0 - 42U/L Linear
SGPT: 0 - 48 U/L increase
Lactic Progressive Upto 60
dehydrogenas increase hours
e
 Antemorte Postmorte Intrepretation
m level m
level
TSD COD
nitrogen •↑ •30 hours
•↓ •>30 hours
•↑ amino acid •20 hours •enzymatic
N breakdown
of proteins
creatinine constant Same as
blood-
evalutes
kidney
function.
ammonia •<1mg/100 •After death
ml •60 hours
•8 mg/100
ml
Uric acid 0.25 – 1.50 •1.7 -2.6 •6 hours
and mcg/mL mg/100 ml
Muscle Enzymes
Myofibrillar protease activity increases
Creatinine phosphokinase decreases
Strong positive correlation b/w ratio of
non-protein nitrogen & total soluble
protein, and also creatinine concn – and
TSD
 HAIR
Hair does not grow after death
Contraction of skin towards hair roots
gives illusion of growth
Sample of chin hair is shaved & length
measured
Time since last shave
Beard hair0.4 mm/day
Nails0.1 mm/day
 SCENE of DEATH
Dates on mail/newspapers/receipts
Dated slips in deceased’s pockets
[Link], diary, cinema-show ticket
When neighbours last saw the person
Degree of coagulation of milk
State of food on a table
State of dress-full/night dress
Stopping time of watch
Radioactive Carbon
C14 accumulates in living organic matter
Steadily maintained
After death, radioactivity gradually
weakens
5,600 yrs to reach half its initial activity
CO2, acetylene, carbon-prepared from
bones-and radioactivity estimated
“Radiocarbon dating”-not useful for
bones less than century old
 Presumption of Death
Inheritance of property
Obtaining insurance money
When person is alleged to have been dead but
body is not found
Indian Evidence Act (S107)—A person is
presumed to be ‘alive’ if there is nothing to
suggest the probability of death within 30 yrs
S108, I.E.A—If proof is produced that the
same person has not been heard for 7 yrs by
his friends & relatives, death is presumed
Presumption of Survivorship
Inheritance of property
when >2 persons die in a common disaster

e.g earthquake, ship-wreck, plane-crash

Who survived longest
Based on facts & evidence available
Age, sex, constitution, nature & severity of
injuries & mode of death
COMMORIENTES-where it cannot be
ascertained who died first
 MCQs
1.) What is the proof of eyes being open for few hours after
death –
a) Kevokian sign
b) Tache noir
c) Both
d) None

2.) In vitrous, what is measured for time since death –

a. Na
b. K
c. Proteins
d. Cl
 MCQs
3.) Algor mortis is–
a) Rise of body temperature after death
b) Cooling of the body
c) Persistent body spasm
d) None

4.) Post mortem caloricity is seen in –

a. Tetanus
b. Cholera
c. Strychnine poisoning
d. All
 MCQs
5.)Colour of PM lividity in hypothermic death –
a) Purple
b) Deep red
c) Cherry red
d) Bright pink

6.) Chocolate brown PM staining is seen in –

a. KCl poisoning
b. Opium poisoning
c. H2S poisoning
d. Cyanide poisoning
 MCQs
7.) Green blue PM discoloration is seen in poisoning of –
a) Cyanide
b) CO
c) P
d) H2S

8.) Nysten’s rule pertains to –

a. Rigor mortis
b. Identification
c. Bullet injuries
d. Putrefaction
 MCQs
9.) Rigor mortis starts in –
a) Right iliac fossa
b) Left iliac fossa
c) Brain
d) Heart

10.) Cadaveric spasm involves –

a. Voluntary muscles
b. Involuntary muscles
c. Both of the above
d. Smooth muscles
 MCQs
11.) Last organ to putrify in males is –
a) Bones
b) Prostate
c) Brain
d) Spleen

12.) In how many hours does a dead body float in India in

summer –
a. 6
b. 12
c. 24
d. 48
 MCQs
13.) Mummification is enhanced by –
a) Moist and dry air
b) Moist and cool air
c) Dry and hot air
d) Dry and cool air

14.) Constituents of a typical embalming solution are all

except –
a. Phenol
b. Glycerine
c. Formalin
d. Ethanol