Post Mortem Changes

Signs of Death & Postmortem changes after death:

1. Immediate Changes
2. Early Changes
3. Late Changes
Immediate Changes:
4. Permanent Cessation of Brain function.
5. Complete Cessation of Circulatory function.
6. Permanent cessation of Respiratory function.
Suspended Animation
It is a condition in which the metabolic needs and vital functions of the
body are reduced to such a low level that they can’t be appreciated by clinical
examination and the person appears apparently death.
Such persons are actually not dead and can be revived by resuscitation.
Features:
1. Pulse is not palpable,
2. Heart sounds not audible,
3. Respiratory movements are not visually perceptible and
4. Reflexes are either absent or not possible to elicit
Examples:
1. Voluntary- by yogis
2. Involuntary – drowning, electrocution, heat stroke, typhoid fever, new
born hypothermia etc.
Early Changes:
1. Changes in the eye
2. Changes in the skin
3. Cooling of the body/Algor mortis
4. Post mortem lividity/Hypostasis
5. Rigor mortis/Cadaveric rigidity
1. Changes in the eye:
1. Opacity of cornea
 Cornea becomes opaque in 6 hrs - Dry, Cloudy and opaque
 Cornea can be harvested within this six hour for transplantation.
2. Sclera – Tache Noire
 If the eyelids are left open, desiccation of sclera occurs leading to
triangle shaped brownish discoloration of areas on either side of cornea
known as Tache Noire
3. Flaccidity of eyeball:
 Intra Ocular tension falls, eye balls become flaccid and sinks.
 Normal IOP is 15 – 20 mm hg; after 2 hrs – 12 mm hg, 3 hrs - 10 mm hg, 4
hrs – 8.5 mm hg, 8 hrs – 5 mm hg
4. Pupils:
 Fully dilated in the early stage and constricted later due rigor mortis of
constrictor muscles.
5. Retinal:
 Blood flow in the retina becomes discontinuous and segmented.
 This is known as rail roading phenomenon or Kevorkian Sign
 The color of retina becomes pale after death and the paleness increases
with time.
2. Changes in the skin:
 Pale and Ashy white appearance
 Loss of Elasticity
 Lips become dry, brownish and hard due drying.
 Wounds will not gape if it is inflicted after death
 Wounds caused during life will retain their characteristic features.
3. Cooling of the body/Algor mortis:
Cooling of the body after death due to
 Loss of thermo - regulatory mechanism of the body which maintains
the body temperature
 Imbalance between heat production and heat loss.
 Loss of heat of body to surrounding till it balances with
environmental temperature by means of
• conduction
• convection and
• radiation,
For the first two hours after death, there is some heat production due to
utilization of stored ATP molecules and by anaerobic glycolysis.
 Due to which there is
little or no fall in body
temperature during initial
two hours and then rate of
cooling is fast during next
few hours and later slows
down.
Temperature is recorded by
Chemical thermometer- Thanotometer 25 cms inserted in anus.
Rectal temperature at the time of death – Rectal
temperature at the time body found
Time since death = -------------------------------------------------------
Rate of fall in temperature
Factors affecting rate of cooling:
1. Environmental temperature
Rate of fall of body temperature is faster in winter and cold environment
when compared with summer and hot climate
2. Build / body surface area
Rate of fall of body temperature is faster in babies due to larger body
surface area per body weight compared to adults
3. Physique / Fat Content
Rate of fall of body temperature is faster in persons with lean body mass
as body fat acts as a body heat insulator.
4. Environment – Air, water
Rate of fall of body temperature is faster in body found in free flowing
water body compared to stagnant water body as moving water reduces
the body temperature
5. Position of body:
Rate of fall of body temperature is slower in body which lies in curled up
position as it reduces the loss of heat to environment.
6. Coverings:
Rate of fall of body temperature is slower in body covered with thick
clothes.
Post Mortem Caloricity
Is a condition in which the temperature of body after death instead of
decreasing it increases.
 Causes
 Body lying in open hot summers
 Infections – cholera, malaria, tetanus, typhoid septicaemia
Temperature already increased at the time of death
Metabolism of micro-organisms continuing after death
Other causes:
 Strychnine poisoning
 Sun stroke
4. LIVOR MORTIS:
It is the reddish-purple discoloration of the most superficial layer of the
dermis due to accumulation of fluid blood in the dependent area of body after
death.
Other terms:
 Livor lividity, Post mortem Hypostasis, Post mortem Staining
Suggillation, Lucidity, Vibices, Darkening of Death.
Mechanism of appearance:
 It occurs after death when circulation stops.
 When circulation stops, the blood gets stagnated.
 Gravity now acts on the stagnant blood and pulls it to the lowest
accessible areas.
Fixation of Livor mortis:
 Post mortem staining starts to appear as patches within 1 – 2 hrs, the
multiple patches merges with each other by 4 – 6 hrs
 The gravitated blood coagulates and gets fixed to surrounding tissues by 6
– 10 hrs.
 And thereby the post mortem staining is fixed by 6 hrs.
 Suppose
• If the body is changed to a new position within 6 hours of death,
then the hypostasis patches disappears and occurs in the new
dependent areas.
• If the body is changed to a new position after 6 hours of death, then
the hypostasis stays in the same original areas.
Distribution of lividity:
 Most commonly, when body lying on the back,
 • It is present all over the back except over areas of contact flattening,
like occipital scalp, shoulder blades, mid back, buttock, posterior
thighs, calves and heels wherein the tissue is compressed by
supporting bed preventing accumulation to blood
 Prone position
• It is present in front of the body except, forehead, nose, chin, cheek
(if face is turned), chest, lower abdomen, anterior thighs, knees and
toes points.
 Vertical position as in hanging
• It is seen most markedly in feet, legs and to lesser extend in the
distal parts of arms and hands.
 If the body is seen in moving water like river
• The body is in constant change of position and hence there will be
no formation of hypostasis as the body is not allowed to rest for
gravitation of blood to occur.
Color of hypostasis:
 It depends on the amount and state of hemoglobin of the red cells.
a. Pink color:
• Death due to Hypothermia.
• Exposure to cold in agonal period.
• Refrigeration of body in mortuary immediately after death.
The pink color of the hypostasis is due to oxygenated hemoglobin.
b. Cherry Red color:
• Seen in cases of death by carbon monoxide poisoning.
• Due to carboxy hemoglobin.
c. Brick red color:
• Seen in cases of death by cyanide poisoning.
d. Brownish red color:
• Seen in cases of death by nitrate poisoning.
e. Dark brown or yellow color:
• Seen in cases of death by phosphorus poisoning.
f. Pale bronze color:
• Seen in death by infection by clostridium prefringens.
g. Greenish brown color:
• Seen in death by infection by clostridium welchii.
 h. Green color:
• Seen cases of death due to hydrogen sulfide.
Medico-Legal Importance:
• It is a reliable sign of death
• Information about the position of the body at the time of death
• Time since death can be estimated
• Color suggest the cause of death
• Distribution of lividity gives information about the manner of death
Changes in the Muscles
1. Primary relaxation/ Flaccidity
2. Rigor mortis/Cadaveric rigidity
3. Secondary relaxation
1. Primary relaxation:
Starts immediately after death with generalized relaxation of muscle tone:
• Drop of lower Jaw
• Eye balls lose their tension
• Pupils are dilated
• Joints are flabby
• Smooth muscle relaxation- incontinence of Urine and Feces
2.Rigor Mortis/ Cadaveric rigidity
• It is generalized stiffening of the muscles of the body, both voluntary and
involuntary after death due to formation of permanent actin myosin cross
bridges.
• This phenomenon comes immediately after the muscles have primarily
relaxed.
Mechanism of development:
During alive, for contraction and relaxation of muscles,
• Calcium – required for formation of actin myosin bridge -Contraction
• ATP - required for breaking the actin myosin bridge - Relaxation
Immediately after death,
• Stored ATP is used – relaxed state of muscles in Primary Relaxation
• Calcium stored in Sarcoplasmic reticulum- released – actin myosin
bridge formation – contraction of muscles.
• Absence of ATP – no breaking of bridges – formation of permanent
actin myosin cross bridges.
• Generalized stiffening of all voluntary and involuntary muscles.
Progression of rigor mortis:
 • It starts in muscles around eyelids – facial and neck muscles – muscles of
trunk and upper limb – muscles of lower limb – lastly in muscles of fingers
and toes
• Rigor mortis disappears also in same order as it appeared.
Time of Onset:
• Temperate climates – 3-6 hours
• Tropical climates – 1-2 hours
Duration it Lasts for:
• Temperate climate – lasts for 2-3 days.
• Tropical climate – 24 – 48 hours in winter
18 - 36 hours in summer
• In general In - 12 hours develops
For - 12 hours maintains
And - after 12 hours passes of
Circumstances modifying the Onset and Duration of Rigor mortis:
1. Age-
 Rigor Mortis is very rare in premature infants.
 Rigor mortis is slow in adolescence and healthy adults
2. Muscular condition and activity before death-
• Onset is slow and duration is longer
• In muscular & healthy persons
• In dry and cold condition
• Onset is early and disappears soon.
• In wasting disease & great exhaustion- cholera, plague, T.B, Cancer
• Warm and moist air condition
Conditions Simulating Rigor-Mortis:
1. Cadaveric Spasm:
Also called as instantaneous rigor, wherein only a group of muscles
which are active just before death go into a state of sudden stiffens
immediately after death without the phase of primary relaxation.
Usually seen in cases of violent death as in
a. Drowning case – hand clutching grass and weeds
b. Suicide by shooting – hand grasping the gun tightly
Other conditions:
2. Heat Stiffening
3. Cold Stiffening
4. Gas stiffening in putrefaction
 Late Signs Of Death
1. Decomposition / Putrefaction.
2. Adiopocere formation / Saponification.
3. Mummification.
1. Decomposition / Putrefaction
Last stage in the resolution of the body, from the organic to the inorganic
state resulting in softening & liquefying of the body tissue.
Mechanism of autolysis:
• Rise of autolytic enzyme levels in the tissue cells after death.
• Action of bacterial enzymes on tissue components –
carbohydrates/fat/proteins.
Characteristic features:
a. Colour changes:
• Greenish to black discoloration- ‘Sulph-meth-haemoglobin’ formed by
H2S due to microorganisms in the large intestine.
• Greenish discoloration of skin over caecum and flanks – first sign of post
mortem.
• Discoloration spreads - front of abdomen, external genitals, chest, neck,
face, arms and legs – spreads whole body in 24-36 hrs.
• Discoloration of vessel walls due to pigmentation from decomposed
blood over the shoulder and groin. Arborescent pattern- ‘Marbling’
b. GASES OF PUTRIFACTION
• H2S, ammonia, phosphate, CO2 and methane
• Under the skin and hollow viscera - 18-36 hrs.
• in solid viscera - 24-48 hrs.
• Causes pseudo rigidity, exerts pressure.
• More gases accumulation, body floats in water.

Pressure effects of putrefactive gases:

• Displaces the diaphragm upwards.
• Shifting of the area of hypostasis.
• Bloating of the abdomen, face and genital.
• Changes in appearance of genitals.
• Liquefied tissue mixes with gases producing froth
• Extrusion of fluid from the mouth and nose.
Insect activity- Entomology:
 • After 18-36 hrs - Flies lay eggs over the decomposed body- nose, mouth,
vagina and anus.
• After 24-36 hrs - eggs hatch into larvae or maggots, enter the body and
destroy the tissues.
• After 4-5 days – maggot develop into pupae.
• After 7-8 days – pupae develop into adult fly.
Other changes following
• Fall of teeth
• Separation of skull sutures
• Liquefied brain matter oozes out.
• ‘Colliquative putrefaction’ – this process takes place between 7-14 days.
Internal post-mortem changes
Early putrefaction - 24-48hrs
Larynx, trachea, brain of infants, stomach, intestines, spleen, omentum and
mesentery, liver and adult brain.
Late putrefaction - 2-3 weeks
Heart, lungs, kidneys, bladder, oesophagus, pancreas, diaphragm, blood
vessels, prostate, testis and non-gravid uterus, ovaries.
ADIPOCERE
• Modification of the process of putrefaction in the dead body is (checked
and is replaced) adipocere formation.
• Due to Hydrolysis of body fat into fatty acids.
• Forms saturated fatty acids - palmitic, stearic, hydroxyl-stearic, olic acids
with the help of Bacterial fat splitting enzyme Lecithinase and moisture.
• Adipocere tissue has appearance of Yellowish white, greasy wax with
rancid smell.
• It forms at any site where fatty tissue is present.
Requirements:
• Time required, in summer-3 wks, in tropics-5 to 15 days.
• Humid climate & warm temperature
• Still air
• Bacteria producing fat splitting enzymes.
Medico legal importance:
• Facial features maintained – Identification
• Ante-mortem Wounds preserved – helps in finding weapon and
cause of death
 MUMMIFICATION
• Another modification of the process of putrefaction in the dead body is
(checked and is replaced) Mummification.
• It is a peculiar type of dehydration of dead body where its soft parts
shrivel up but retain the natural appearance & the features of the body.
• Rusty brown colour, dry, leathery skin adherent to bones.
• Internal organs get transformed into a thick brown mass.
Requirements:
• Time required - 3 months to 1-2 yrs
• Dry and hot climate.
• Free flowing air currents.
• Bodies buried in shallow graves, in dry sandy soils.
Medico legal importance:
• Facial features maintained – Identification
• Ante-mortem Wounds preserved – helps in finding weapon and
cause of death.
Time since death/ post mortem interval
• Important clue for investigation of time.
• It helps to apprehend the person likely to be involved.
Post mortem changes helpful to ascertain time since death are;
a. -cooling of the body
b. -post mortem lividity
c. -rigor mortis
d. -decomposition changes
e. Contents of stomach and bowels
f. Contents of urinary bladder
g. Biochemical changes
h. Circumstantial evidence