MEDICO-LEGAL ASPECTS OF DEATH 2.

exam of peripheral circulation

Death-termination of life; complete cessation of all the vital functions w/o a)Magnus test
possibility of resuscitation (irreversible) -living-bloodless zone at site of application of ligature and
livid area distal to ligature
Importance of determination of death: -dead-no change in color
1. Civil personality is extinguished by death. (A. 42,CC) b)opening of small artery
2. The property of a person is transmitted to his heirs at the time of death. -living-blood escapes in jerk and at a distance
(succession) -dead-blood ooze towards the nearby skin
3. The death of a partner is one of the causes of dissolution of partnership. c)Icards test
4. The death of either the principal or agent is a mode of extinguishing -living-dye spreads and skin will have greenish-yellow
the agency. discoloration due to flourescein
5. The criminal liability of a person is extinguished by death. -dead-solution remains at site of injection
6. The civil case for claims which does not survive is dismissed upon the d)pressure on the fingernails
death of the defendant -living-zone of paleness at site of application of pressure
e)diaphanous test
Kinds of death: -living-finger webs appear red
1. Somatic/clinical death-complete, persistent and continuous cessation of -dead-finger webs appear yellow
vital functions of the brain, heart, lungs which maintain life and health f)application of heat on the skin
2.Molecular/cellular death-death of individual cells 3-6 hrs after -living-vital reaction, blister formation
3.Apparent death/state of suspended animation-transient loss of -dead-no vital reaction, no blister formation
consciousness or temporary cessation of the vital functions of the body on g)palpation of radial pulse
account of disease, external stimulus or other forms of influence h)dropping of melted wax
-importance-prevention of premature burial
-usually, if there is no heart action for a period of 5 min. death is
Signs of death: regarded as certain
1.cessation of heart action and circulation
2.cessation of respiration -usually the auricle contracts after somatic death for a longer period
3.cooling of the body (algor mortis) than the ventricle and the auricle is the last to stop(ultimen mariens)
4.insensibility of body and loss of power to move
5.changes in and about the eye Methods of detecting cessation of respiration:
6.action of heat on the skin 1.observe the movement of the chest and abdomen during resp.
2.use of stethoscope
Methods of detecting the cessation of heart action and circulation: 3.use of a mirror-dimming of mirror due to condensation of warm
1.exam of the heart moist air exhaled
a)palpation of the pulse 4.use of a feather/cotton fibers-movement of feather/cotton fibers
b)auscultation of the heart sound at precordial area 5.use of a glass of water-movement of water
c)flouroscopic exam 6.Winslows test-movement of image
d)use of electrocardiograph-best method
 Cooling of the Body (Algor Mortis)
-progressive fall of body temperature-one of the most prominent signs
of death
-rapid during the 1st 2 hrs. after death
Post-mortem caloricity
-rise of temperature of the body after death due to rapid and early
putrefactive changes or some internal changes
-ex. cholera, liver abscess, tetanus, etc.
Methods of estimating the time of death:
1.ave. fall of temperature during the 1 st 2 hrs.-1/2 of difference of body
temp. that of air
2.(normal temp.) 98.4 F-(rectal temp.) divide by 1.5=approx. no. of
hrs. after death
3.chemical method-Schourups formula-CSF
-lactic acid-rises from 15mg to over 200mg per 100cc; rapid
during 1 st 5 hrs. after death
-non-protein nitrogen-increases from 15 to 40mg per 100cc
during 1 st 15 hrs.
-amino acids-increases from 1mg to 12mg percent during
first 15 hrs.
Insensibility of the Body and Loss of Power to Move
-may be present in the living in cases of-apoplexy, epilepsy, trance,
catalepsy, cerebral concussion, hysteria
Changes in the Skin:
1.skin is pale and waxy-looking-absence of circulation
-livid discoloration-gravitation of blood
2.loss of elasticity of skin
Post-mortem Contact Flattening
-bec. of elasticity of skin and flaccidity of muscles after death,
the body flattens over areas in contact with surface it rests
-shoulder blades, buttocks, calves
3.opacity of the skin-absence of circulation
4.effect of application of heat-no blister/inflammatory reaction
Changes in and about the Eye:
1.loss of corneal reflex
2.clouding of the cornea
3.flaccidity of the eyeball-loss of muscle tone
4.pupil cannot react to light-loss of muscle tone
5.ophthalmoscopic findings-pale optic disc, change in the color of the
fundus, pale retina segmented retinal vessels
6tache noir de la sclerotique-oval, round or triangular spot in the
sclera
which may be brown or black
Action of the Heat on the Skin-no redness or blister or dry blister may be
present
Changes in the Body after Death:
1.changes in the muscle
3 Stages of Muscular Changes
1.stage of primary flaccidity/post-mortem muscular irritability
-muscles are relaxed and capable of contracting when stimulated
2.stage of post-mortem rigidity/cadaveric rigidity/death struggle/rigor
mortis
-contraction of muscles; develops 3-6 hrs. after death and may
last
from 24-36 hrs.
3.stage of secondary flaccidity/commencement of putrefaction/decay
of muscles
-muscles no longer capable of responding to stimulus
Stage of Primary Flaccidity
-complete relaxation and softening of all muscles; may react to
stimuli due to molecular life; lasts about 3-6 hrs. after death;
alkaline reaction
Stage of Post-mortem Rigidity
-3-6 hrs. after death the muscles gradually stiffen which usually
starts at the muscles of the neck and lower jaw; whole body
becomes stiff after 12 hrs.; acidic reaction due to increase in lactic
acid and phosphoric content
of the muscle; coagulation of plasma protein
-used to approximate the time of death
 position of the body has been changed, color may indicate the
Conditions simulating Rigor Mortis: cause of death
1.heat stiffening-coagulation of proteins
2.cold stiffening-solidification of fat 3.Autolytic/Autodigestive Changes
3.cadavric spasm/instantaneous rigor-extreme nervous tension or -proteolytic, glycolytic and lipolytic ferments of glandular tissues,
injury to chest facilitated by weak acid and high temperature
-maceration of dead fetus inside the uterus
-medico-legal-findings of weapon, hair, pieces of clothings, etc.
firmly grasped in the hand 4.Putrefaction of the body
-breaking down of complex proteins into simpler components ass.
Rigor Mortis Cadaveric Spasm w/ the evolution of gases and there is a change in color of body
-appears 3-6 hrs after death -appears immediately after death -swelling of the whole body, foamy appearance of organs
-involves all muscles -certain muscle or group off -liquefaction of tissues
muscles -bacteria-C. welchii
-natural phenomena -may or may not appear -modification of putrefaction-mummification, saponification or
-approximate the time of death -determine the nature of the crime adipocere formation, maceration

Determination of the duration of death

Muscular Contraction Rigor Mortis 1.rigor mortis-warm countries-2-3 hrs after death
-muscle is transparent -muscle is opaque 2.post-mortem lividity
-elastic -loss of elasticity 3.onset of decomposition-warm countries-24-48 hrs after death
-litmus-neutral or slightly alkaline -acid 4.stage /degree of decomposition
-still possess inherent power -absolute flaccidity 5.entomology of the cadaver-maggots-death occurred >24 hrs
of contraction 6.stage of digestion of food-amount of food in stomach
7.presence of live fleas in clothings in drowning cases-a flea can
Stage of Secondary Flaccidity survive for about 24 hrs submerged in water
-due to dissolution of muscle proteins which have previously 8.amount of urine in the bladder
been coagulated 9.state of clothings
10.chemical changes in the CSF
11.presence/absence of soft tissues in skeletal remains
2.Changes in the Blood 12.condition of the bones
a)coagulation of blood
-blood may remain fluid inside the blood vessels after death
for 6-8 hrs
b)Post-mortem Lividity/cadaveric lividity/post-mortem suggilation
or post-mortem hypostasis or livor mortis
-blood accumulates in the most dependent parts of the body
-dull red or purplish in color
-appears 3-6 hrs after death
-importance-one of the signs of death, may determine if the
 Presumption of Death -recovering, identifying and preserving evidentiary mat.
Presumption of Survivorship -providing interpretation and correlation of facts and
circumstances related to death
MEDICO-LEGAL INVESTIGATION OF DEATH -providing a factual, objective medical report for law enforcement,
prosecution and defense agencies
Officials of the government authorized to make death investigations: -separating death due to disease from death due to external cause
1.provincial and city prosecutors for protection of innocent
2.RTC judges
3.MTC judges Instances when autopsies are performed:
4.NBI director 1.reqiured by law
5.chief of police of the city of Manila 2.order of competent court, mayor, provincial or city prosecutor
6.Solicitor General 3.written request from police authorities
4.solicitor gen., provincial or city prosecutor, as authorized by law,
Stages of Medico-Legal investigation: shall deem it necessary to det. The cause of death
1.crime scene investigation 5.written request from nearest next of kin to det. Cause of death
2.autopsy
CSI-investigation of the place of the commission of crime Who are to perform autopsies:
-importance-recovery of evidence which may lead to the identity 1.health officers-provincial and rural health officers
of offender or may lead to the cause or manner of 2. medical officers of law enforcement agencies
of death 3.members of the medical staff of accredited hospitals
-interview witnesses
Autopsy Instances when autopsy should be performed:
-comprehensive study of the dead body performed by a trained 1.death by violence
physician using recognized dissection procedures/techniques 2.accidental death
-kinds-hospital, medico-legal 3.suicides
4.sudden death of persons who are apparently in good health
Hospital or non-official autopsy 5.death unattended by physician
-w/ the consent of the deceased persons relatives 6.death in hospitals or clinics wherein non cause of death is unknown
-purposes-determination of the cause of death 7.death occurring in unnatural manner
-correlation of clinical dx and clinical sx
-determination of the effectiveness of tx
-studying the natural course of disease process
-educating students and physicians

Medico-legal or official autopsy

-purposes-determining the cause, manner and time of death
MEDICO-LEGAL CLASSIFICATION OF THE CAUSES OF DEATH
1. natural death
2. violent death-accidental, negligent. infanticidal, parricidal, murder,
homicidal
Natural death
-caused by a natural disease condition in the body
-w/ concomitant physical injuries-necessary to det. whether the
physical injuries would accelerate the death, or the injuries itself
developed independently and produced the death or death is due
to natural cause
Violent death
-physical injury-proximate cause of death
a. Death under special circumstances-tumultuous affray, under
exceptional circumstances, euthanasia, judicial death, death due to
starvation
b. Death by asphyxia
-interference in the process of respiration
Types of asphyxia:
1.asphyxia by hanging
-suspension of the body by ligature which encircles thee neck
and the constricting force is the weight of the body
-ante-mortem-vital reaction
-ecchymosis at site of ligature, of the pharynx and epiglottis,
rupture of the intima of carotid artery, subpleural,
subepicardial punctiform hemorrhages

Accidental death 2.asphyxia by strangulation

-beyond the bounds of human foreseeable consequences -compression of the neck w/ the use of ligature which is tightened
-exempting circumstance by
a force other than the weight of the body
Negligent death -constricting force applied is the hand (throttling)
-due to reckless imprudence, negligence, lack of foresight or lack -garroting, mugging
of skill
-not exempt from liability 3.asphyxia by suffocation
-smothering-closure of the ext. respiratory passages by the use of
Suicidal death hand
-person who assists is liable/punishable under the law or by some other means
-overlaying-most common accidental smothering in
Parricidal death children; due to pressure of the
-killing of a father, mother, or child whether legitimate or beddings and
illegitimate, or any of his ascendants or descendants or his spouse pillows or from unconscious or
drunken
Infanticidal death parent
-killing of a child less than 3 days of age -choking-impaction of foreign body in the respiratory passage
-caf coronary
Murder
-w/ qualifying/aggravating circumstances 4.asphyxia by submersion or drowning
-nostrils and mouth are submerged in any watery fluid for a time to
prevent the free entrance of air into the air passage and lungs
-death occurs in 2-5 min.
Homicide -champignon docume
-w/out qualifying circumstances - Gettlers test
 -det. of chloride content of the blood in the right and left lethal injection
ventricles 2.euthanasia or mercy killing-acceleration of death of a person
of the heart suffering from an incurable and distressing disease
-difference of at least 25mg-drowning occurred in fresh or salt -crime-giving assistance to suicide (A253 RPC)
water pool -murder
- floating of body in drowning-decomposition-accumulation of gases
Death from Starvation
5.asphyxia by compression (traumatic/crush asphyxia) -loss of 40% of the weight results to death
-immobility of the chest and abdomen due to ext. pressure -length of survival-w/out food and water-not more than 10 days
-burking-murdering of people to be sold to medical schools -w/ water-50-60 days
-death by cricifixion-traumatic asphyxia
Disposal of the Dead Body
6.asphyxia by breathing irrespirable gases Persons charged w/ duty of burial:
1.surviving spouse
carbon monoxide 2.nearest kin of the deceased
-carboxyhemoglobin-limits the O2 carrying capacity of the 3.municipal authorities
blood,
prevents release of O2 from oxyhemoglobin Right of custody to dead body
-main cause of death-deprivation of O2 -any person charged by law w/ the duty of burying the body,
except when an inquest is required by law or death is due to
carbon dioxide a dangerous communicable disease
-drainage pipes, deep wells, sewage tanks
-cause f death-deficiency of O2 supply to the brain Methods of disposal of the dead body:
1.embalming
hydrogen sulfide 2.burial/inhumation
-sewer, septic tanks drainage pipes, deep wells -death due to dangerous communicable disease must be buried
-decomposition process of organic substances containing sulfur w/in 12 hrs. after death

hydrogen cyanide death certificate

-one of the most toxic and rapid acting gases -necessary before burial
-death occurs in 2-10 min. -issued by physician in attendance, local health officer,
mayor, secretary or councilor of the municipality
sulfur dioxide
-pungent odor
-disinfectant, bleaching agent

Special deaths:
1.judicial death-electrocution, hanging, gas chamber, musketry,