Chapter IV

MEDICOLEGAL ASPECTS OF DEATH

of Death
civil of a natural person is extinguished by death:
The civil personality is extinguished by death. The effect of
death upon the rights and obligations of the deceased is deter-
mined by law, by contract and by will (Art. 42, Civil Code).
The property of a person is transmitted to his heirs at the time of

Succession is a mode of acquisition by virtue of which the

property, rights and obligations to the extent of the value of the
inheritance of a person are transmitted through his death to
another or others either by will or by operation of law (Art. 774,
Civil Code).
death of a partner is one of the causes of dissolution of
partnership agreement:
Dissolution (of a partnership) is caused. (5) by the death of
any (Art. 1830, Civil Code).
death of either the principal or agent is a mode of
ment of agency:
Agency is extinguished. (3) By death, civil interdiction,
insanity or insolvency of the principal or of the agent. (Art.
1919, Civil Code).
criminal liability of a person is extinguished by death:
How criminal liability is totally extinguished — Criminal liability
is totally
By death of the convict, as to the personal penalties; and as
to pecuniary penalties, liability therefore is extinguished
only when the death of the offender occurs before judg-
ment.
(Art. 89, Revised Penal Code).
The civil case for claims which does not is dismissed upon
death of the defendant:
When the action is for recovery of money, debt or interest
thereon, and the defendant dies before the final judgment in the
court of the First Instance, it shall be dismissed to be prosecuted
in the manner especially provided by these rules (Rule 3, Sec. 21,
Rules of Court).
112 LEGAL MEDICINE
Notice to creditor to be by court — Immediately after
granting letters, testamentary or of administration, the court shall
issue a notice requiring all persons having money claims against the
decedent to file them in the office of the clerk of said court (Rule
86, Sec. Rules of Court).
is the termination of life. It is the of all
the vital functions without possibility of It is an irre-
versible loss of the properties of living matter. Dying is a continuing
process while death is an event that takes place at a precise time.
The ascertainment of death is a clinical and not a legal problem.
Previously, complete and persistent cessation of heart action and
respiration is the standard criteria in the deter-
mination of death, but the following events in the recent years led to
the development of uncertainty of the moment of
1. The increasing use of mechanical resuscitative devices which can
maintain respiration and cardiac functions almost indefinitely.
Heart vitality may be maintained by coronary perfusion or its
rhythm by defibrillation or pace maker. Breathing can be sus-
tained by a respirator or pulmonator.
2. There is an increasing demand of organs for transplantation. Vital
organs can now be transplanted and the shorter the time space be-
tween the death of the donor and the transplantation process, the
more is the chance of success of surgery. It becomes a problem as
to when the donor dies for the immediate removal of the organ to
be transplanted. The surgeon must see to it that the donor is dead
before the organ to be transplanted is removed, otherwise he may
be held liable if done prematurely.
3. Coma following administration of excessive doses of modern
sedatives and hypnotics could be mistaken for death. Coma
induced by barbiturates could be mistaken for death because it
clinically appears to have eliminated breathing and heart action,
chill the body and makes weak or totally non-existent.
Based on the Criterion Used in its Determination, Death may be:
1. Brain Death — Death occurs when there is coma,
of electrical brain activity and complete of all
the vital functions without possibility of resuscitation.
2. Death — Death occurs when there is
tinuous and persistent cessation of heart action and respiration.
Cardio-respiratory death is a condition in which the physician and
the members of the family pronounced a person to be dead based
on the common sense or intuition.
 ASPECTS OF DEATH 113

3. Some countries or states provide both brain and

bases in an alternative or way in the determination of the
moment of death. In 1970, the state of Kansas became the first
to enact a statute which specifies more clearly the accepted
alternatives for defining death. Section 1, Chapter 378 of the
Kansas Statute provides the following:
"A person will be considered medically and legally dead if, in
the opinion of a physician, based on ordinary standards of medical
practice, there is the absence of spontaneous respiratory and
cardiac function and, because of the disease or condition which
caused, directly or indirectly, these functions to cease, or because
of the passage of time since these functions ceased, attempts at
resuscitation are considered hopeless; and, in this event, death will
have occurred at the time these functions ceased.
Second, a person will be considered medically or legally dead if,
in the opinion of a physician, based on ordinary standards of
medical practice, there is the absence of spontaneous brain func-
tion; and if based on ordinary standards of medical practice,
during reasonable attempts to either maintain or restore spon-
taneous circulatory or respiratory function in the absence of afore-
said brain function, it appears that further attempts at resusci-
tation or supportive maintenance will not succeed, death will have
occurred at the time when these conditions first coincide. Death
is to be pronounced before artificial means of supporting res-
piratory and circulatory function are terminated and before any
vital organ is removed for purposes of
Brain Death:
Inasmuch as there are no universally accepted criteria yet to
establish a condition of brain death, the following proposal or
recommendations are made by different committees or bodies:
1. According to the Harvard Report of 1968, the following are the
characteristics of
a. Unreceptivity and unresponsibility — There is a total
ness to externally applied stimuli and inner need and complete
unresponsiveness — our definition of irreversible coma. Even the
most intense painful stimuli evoke no vocal or other response,
not even a groan, withdrawal of his limb, or quickening of
respiration.
b. No movements or breathing — Observations covering a period of
at least 1 hour by physicians is adequate to satisfy the criteria
of no spontaneous muscular movements or spontaneous res-
piration or response to stimuli such as pain, touch, sound, or
114 LEGAL MEDICINE

light. After the patient is on a mechanical respirator, the total

absence of spontaneous breathing may be established by turning
off the respirator for three minutes and observing whether there
is any effort on the part of the subject to breath spontaneously.
(The respirator may be turned off for this time provided that at
the start of the trial period the patient's carbon dioxide tension
is within the normal range, and provided also that the patient
had been breathing room air for at least minutes prior to the
trial).
No — Irreversible coma with abolition of central
nervous system activity is evidenced in part by the absence of
elicitable reflexes. The pupil will be fixed and dilated and will
not respond to a direct source of bright light. Ocular move-
ment (to head turning and to irrigation of the ears with ice
water) and blinking are absent. There is no evidence of postural
activity (decerebrate or other). Swallowing, yawning, vocal-
ization are in abeyance. Corneal and pharyngeal reflexes are
absent. As a rule the stretch or tendon reflexes cannot be
elicited, i.e. tapping the tendons of the biceps, triceps and
pronator muscles, quadriceps and gastrocnemius muscles with
the reflex hammer elicits no contraction of the respective
muscles. Plantar or noxious stimulation gives no response.
d. Flat electro-encephalogram — Of great confirmatory value is
the flat or E.E.G. We must assume that the elec-
trodes have been properly applied, that the apparatus is func-
tioning normally, and that the personnel in charge are com-
petent.
All of these tests shall be repeated at least 24 hours later with
no change. It is emphasized that the patient be declared dead
before any effort is made to take him off the respirator, if he is
then on a respirator.
2. In the Ad Hoc Committee of Human Transplantation
convened under the auspices of the Institute of Forensic Sciences,
Duquesne University School of Law adopted the proposed criteria
for the determination of death otherwise known as Philadelphia
and the following were
a. Lack of responsiveness to internal and external environment.
b. Absence of spontaneous breathing movements for 3 minutes,
in the absence of and while breathing room air.
No muscular movements with generalized flaccidity and no
evidence of postural activity or
d. Reflexes and response:
Pupils fixed and dilated, non-reactive to strong stimuli.
 ASPECTS OF DEATH 115
(2) Corneal reflexes absent.
(3) or other pressure response absent (both pain
response and decerebrate posturing).
(4) Absence of snouting or sucking response.
No reflex response to upper airway stimulation.
No reflex response to lower airway stimulation.
No ocular response to ice water stimulation of the inner
ear.
(8) No deep tendon reflexes.
(9) No superficial reflexes.
No plantar responses.
e. Falling arterial pressure without support by drugs or other
means.
f. electro-encephalogram (in absences of hypothermia,
anesthetic agents and drugs intoxication) recorded sponta-
neously and during auditory and tactile stimulation.
It is further laid down that these criteria shall have been
present for at least 2 hours and that death should be certified
by two physicians other than the physician of a potential
organ recipient Legal Medicine, Francis
Ann & Bernard Lucas, ed. 3rd ed. p. 51-52).
Other Set of Criteria to Establish Brain Death:
1. Mohandas and Chou made a summary of the criteria of
brain death which was accepted by the University of Minnesota
Science Center.
2. The Ottawa General Hospital (1970) set up guidelines for the
criteria of cerebral death.
3. In France the Council of Ministers published a decree
which adopted the official definition of death on recommen-
dation of the French Academy of Medicine.
Although the consideration of brain death is the most ideal
criteria, the difficulty and practicability of its application is a prob-
lem. Electro-encephalogram which is the most reliable instrument
to determine brain activities is not available in many places. Even
if available, the number of competent persons to apply the instru-
ment and the interpretation of the results is quite limited.
The use of the criteria of brain death may only be applied to
those persons who are potential organ donors.
 LEGAL MEDICINE

f KINDS OF DEATH
)MATIC DEATH OR CLINICAL DEATH:
This is the state of the body in there is per-
sistent and continuous cessation of the vital functions of the
brain, heart and lungs which maintain life and It occurs
the moment a physician or the other members of the family
declare a person has expired, and some of the early signs of
death are present. It is hardly possible to determine the exact
time of
Immediately after death the face and lips become pale, the
muscles become flaccid, the sphincters are relax, the lower jaw
tends to drop, the eyelids remain open, pupils dilate and the
skin losses its elasticity. The body fluid tends to gravitate to the
dependent portions of the body and the body heat gradually
the temperature of the surroundings.
OR CELLULAR DEATH:
After cessation of the vital functions of the body there is still
life among individual cells. This is evidence by the pre-
sence of muscles movements and other
functions of individual cells.
About three to six hours later, there is death of individual cells.
This is known as molecular or cellular death. Its exact occurrence
cannot be definitely ascertained because its time of appearance is
influenced by several factors. Previous state of health, infection,
climatic condition, cellular nutrition, etc. influence its occurrence.
OR "STATE OF SUSPENDED
This condition really death merely loss
consciousness or temporary cessation of the vital of the
body on account of disease, external stimulus or other forms of
It may arise especially in uremia, catalepsy
and electric shock.
It may be induced voluntarily as has been cited by foreign
authors (Col. who could be able to pass into a state
of pulselessness for half an hour). Involuntary suspension is
shown in still-birth. A newly born child may remain at the state
of suspended animation and may die unless prompt action is
taken. A person who has been rescued from drowning may
appear dead but life is maintained after continuous resuscitation.
It is important to determine the condition of suspended ani-
mation to prevent premature burial. There are records of cases
wherein person was pronounced dead, placed in a coffin and
 ASPECTS OF DEATH 117
later angrily rise from it and walk unaided. The relative has sent
death notice and placed wreaths near his coffin (Daily Mail
England, 1948).

B. SIGNS OF DEATHS
OF HEART ACTION AND CIRCULATION:
There must be and continuous cessation of the heart
action and flow of blood in the whole vascular A tem-
porary suspension of the heart action is still compatible with life.
The length of time the heart may cease to function and is still
maintained depends upon the length of time it is readily
established and upon the oxygenation of blood at the time of the
suspension. general rule, if there is no action for a
period of minutes death is regarded as
Respiration ceases frequently before the stoppage of heart
contraction and circulation. Usually the auricle of the heart
contracts after somatic death for a longer period than the ventricle.
And the auricle is the last to stop, hence called
In judicial hanging, the heart continues to beat for twenty
minutes or half an hour after the individual has been executed
although its beating is irregular and feeble. In decapitation of
heart beating is present for an hour after decapitation
has taken place.
Methods of Detecting the of Heart Action and Circu-
lation:
a. Examination of the Heart:
Palpation of the Pulse:
Pulsation of the peripheral blood vessels may be made at
the region of the wrist or at the The pulsation of the
vessels is synchronous with the heart beat. Occasionally the
pulsation is very imperceptible and irregular that the exa-
miner experience much difficulty.
(2) for the Heart Sound at the Precordial Area:
The rhythmic contraction and relaxation of the heart is
audible through the stethoscope. Heart sound can be
audible during life even without the aid of a stethoscope by
placing the ear at the precordial area.
Errors in the Method of Determining Heart Action:
(a) The heart itself may, like other muscles, be in a state of
apparent and not real death.
(b) The heart sound may not always be appreciable to the
ear even with the aid of the stethoscope.
118 LEGAL MEDICINE

in Auscultation may be Encountered in:

(a) Stout person.
(b) Fatty degeneration of the heart.
(c) Pericardial effusion.
Examination:
Fluoroscopic examination of the chest will reveal the
shadow of the heart in its rhythmic contraction and relaxa-
tion. The shadow may be enlarged and the excursion made
less visible due to pericardial effusion.
(4) By the Use of Electrocardiograph:
The heart beat is accompanied by the passage of electri-
cal charge through the impulse conducting system of the
heart which may be recorded in an electrocardiograph
machine. The electrocardiograph will record the heart beat
even if it is too weak to be heard by auscultation. This is
the best method of determining heart action but quite

b. Examination of the Peripheral Circulation:

(1)
A ligature is applied around the base of a finger with
moderate tightness. In a living person there appears a
bloodless zone at the site of the application of the liga-
ture and a livid area distal to the ligature. If such ligature
is applied to the finger of a dead man, there is no such
change in color. The color of the area where the ligature
is applied will be the same as that one distal to it. There
may be no appreciable change of color if a living person
is markedly anemic.
( 2 ) Opening of Small Artery:
In the living, the blood escapes in jerk and at a distance.
In a dead man, the blood vessel is white and there is no
jerking escape of blood but may only ooze towards the
nearby skin. When bigger arteries are cut, blood may flow
without pressure continuously.
(3) Icard's Test:
This consists of the injection of a solution of fluorescein
subcutaneously. If circulation is still present, the dye will
spread all over the body and the whole skin will have a
greenish-yellow discoloration due to flourescein. In a dead
man, the solution will just remain at the site of the injection.
This test should be applied only with the use of the daylight
as the color is difficult to be appreciated with the use of
artificial light.
 ASPECTS OF DEATH 119

(4) on the Fingernails:

If pressure is applied on the fingernails intermittently,
there will be a zone of paleness at the site of the appli-
cation of pressure which become livid on release. There
will be no such change of color if the test is applied to a
dead man.
(5) Diaphanous Test:
The fingers are spread wide and the finger webs are
viewed through a strong light. In the living, the finger webs
appear red but yellow in the dead. The finger webs may
appear yellow in a strong light even if living in cases of
anemia or carbon monoxide poisoning.
(6) Application of Heat on the Skin:
If heated material is applied on the skin of a dead man,
it will not produce true blister. There is no sign of con-
gestion, or other vital reactions. But if applied to a living
person, blister formation, congestion, and other vital
reactions of the injured area will be observed.
(7) Palpation of the Radial Pulse:
Palpation of the radial artery with the fingers, one will
feel the rhythmic pulsation of the vessel due to the flow of
blood. No such pulsation will be observed in a dead man.
(8) Dropping of Melted Wax:
Melted sealing wax is dropped on the breast of a person.
If the person is dead, there will be no inflammatory edema
at the neighborhood of the dropped melted wax.
CESSATION OF RESPIRATION:
Like heart action, cessation of respiration in order to be con-
sidered as a sign of death must be continuous and persistent. A
person can hold his breath for a period not longer than 3-1/2
minutes. In case of electrical shock, respiration may cease for
sometime but may be restored by continuous artificial respiration.
In the following conditions there may be suspension of res-
piration without death ensuing.
a. In a purely voluntary act, as in divers, swimmers, etc. but it
cannot be longer than two minutes.
b. In some peculiar condition of respiration, like Cheyne-Stokes
respiration, but the apneic interval cannot be longer than
fifteen to twenty seconds;
In cases of apparent drowning;
d. Newly-born infants may not breathe for a time after birth and
may commence only after stimulation or spontaneously later.
 LEGAL MEDICINE

of Detecting of
a. Expose the chest and abdomen and observe the movement
during inspiration and expiration.
b. Examine the person with the aid of a stethoscope which is
placed at the base of the anterior aspect of the neck and hear
sound of the current of air passing through the trachea during
each phase of respiration.
Examination with a Mirror:
The surface of a cold-looking glass is held in front of the
mouth and nostrils. If there is dimming of the mirror after
a time, there is still respiration. The dimming of the cold
mirror is due to the condensation of the warm moist air exhaled
from the lungs if respiration is still going on. However, it must
not be forgotten that the dimming of the mirror may be due to
the expulsion of the air from the lungs due to the contraction
of the diaphragm in rigor mortis. Ordinarily there is no dimming
of the mirror when the subject is dead.
d. Examination with a Feather or Cotton Fibers:
Place a fine feather or a strip of cotton in front of the lips
and nostrils. If there is movement of the or cotton not
due to external air, respiration is present. The feather or cotton
fibers will be blown away during expiration and towards the
nose and mouth during inspiration. This is not a reliable test
as the slightest movement of outside air or nervousness of the
observer will move the feather or cotton fibers.
e. Examination with a Glass of Water:
Place a glass half full of water at the region of the chest. If
the surface of the water is smooth and stable, there is no
respiration taking place, but if it waves or water movement is
observed, then respiration is taking place. This is not a good
test because of the difficulty of preventing movement of the
place where the body lies.
f. Test:
There is no movement of the image formed by reflecting
artificial or sun light on the water or mercury contained in a
saucer and placed on the chest or abdomen if respiration is
not taking place. The reflection is utilized to magnify the
movement of the surface of mercury or water.
COOLING OF THE BODY (ALGOR MORTIS):
death the metabolic process inside the body No
more heat is produced but the body loses slowly its temperature
by by conduction to the surrounding atmosphere.
 ASPECTS OF DEATH

The progressive fall of the body temperature is one of the

prominent signs of death.
The rate of cooling of the body is not uniform. It is rapid
during the first two hours after death and as the temperature of
the body gradually approaches the temperature of the surround-
ings, the rate becomes slower.
It is difficult to tell exactly the length of time the body will
assume the temperature of the Several factors
influence the rate of fall of the body temperature.
The fall of temperature may occur before death in the follow-
ing conditions:
a. Cancer
b. Phthisis
Collapse
The fall of temperature of 15 to 20 degrees is con-
sidered as a certain sign of death.
Caloricity is the rise of temperature of the body
after death due to rapid and early putrefactive changes or some
internal changes. It is usually observed in the first two hours
after death.
Post-mortem may occur in the following conditions:
a.
b. Yellow fever.
Liver
d. Peritonitis.
e. fever.
Rheumatic fever.
g. Tetanus.
h.
i. Strychnine
Factors Influencing the Rate of Cooling of the
a. Conditions that are connected with the body:
(1) Delaying Cooling:
(a) Acute
(b) Sudden death in good
(c) Obesity of
(d) Death from
(e) Death of the middle
(2) Factors Accelerating Cooling:
(a) Leanness of the body.
(b) Extreme
(c) Long-standing or lingering
Chronic disease associated with
122 LEGAL MEDICINE

b. that are connected with the

(1) Factors Delaying Cooling:
(a)
(b) Want of access of air to the body.
(c) Small
(d) Warm
(2) Factors Accelerating Cooling:
(a) Unclothed body.
(b) Conditions allowing the access of air.
(c) Large room permitting the dissipation of
Cooling more rapid in water than in
Methods of Estimating How Long a Person Has Been Dead From
the Cooling of the
a. When the body temperature is normal at the time of death,
the average rate of fall of the temperature during the first two
hours is one-half of the difference of the body temperature and
that of the air.
During the next two hours, the temperature fall is one-half of
the previous rate, and during the succeeding two hours, it is
one-half of the last mentioned rate.
As a general rule the body attains the temperature of the
surrounding air from 12 to 15 hours after death in tropical
countries (Medical Jurisprudence and Toxicology by Modi,
12th 121).
b. To make an approximate estimate of the duration of death
from the body temperature, the following formula has been
suggested:
(Normal Temperature) — (Rectal Temperature)

Approximate number of hours

after death
This formula is only applicable to cases where the rectal
temperature has not yet assumed the temperature of the sur-
roundings, otherwise, the result will be constant.
Chemical
formula for the determination of the time of death
of any cadaver whose fluid is examined for the
concentrations of lactic acid (L.A.), non-protein nitrogen
(N.P.N.) and amino acid and whose axillary temperature
has been taken at the time the cerebro-spinal fluid has been
removed.
 MEDICO- LEGAL ASPECTS OF DEATH 123
T+ N.P.N. — 15 —1
16.7 7.35
4
T — temperature 1 axillary temperature
The lactic acid content of the cerebro-spinal fluid rises from
to over 200 per 100 cc. The rise is rapid during the
first 5 hours following death.
The non-protein nitrogen (N.P.N.) increases from 15 to 40
mg. per 100 cc. the first 15 hours. This test is modified
by ante-mortem anemia and rapid cooling of the body.
Amino-acids (A.A.) increases from 1 mg. to 12 mg. percent
during the first 15 hours, but the result is modified by rapid
cooling of the body.
Limitations of the Formula:
a. The method is only applicable to adults, as the rate of bio-
chemical change in a child is far more rapid than in adult. It is
the value to person over the age of 15 years.
b. The cerebrospinal fluid must be free of blood, the presence of
which raises the lactic concentration.
Injuries must not have allowed the escape of cerebrospinal
fluid.
d. Death must have within a period 15 hours prior to
the withdrawal of the sample of cerebrospinal fluid, as after
that time the changes in the concentration per time unit be-
come irregular (Modern Trend in Forensic Medicine by Keith
Simpson, pp. 83-84).
INSENSIBILITY OF THE BODY AND LOSS OF POWER TO MOVE:
After death the whole body is insensible. No kind of stimulus
is capable of letting body have voluntary movement.
This condition must be observed in conjunction with cessation
of heart beat and circulation and cessation of respiration.
The insensibility and loss of power to move may be present
although living, in the following conditions:
a. Apoplexy.
b. Epilepsy.

d.
e. Cerebral concussion.
f. Hysteria.
124 LEGAL MEDICINE

IN THE SKIN:
The following are the changes undergone by the skin after death:
a. The skin may be observed to and due to
the absence of circulation. Areas of the skin specially the most
dependent portions will develop livid discoloration on account
of the gravitation of blood.
of Elasticity of the Skin:
Normally when the body surface is compressed, it readily
returns to normal shape. After death, application of pressure
to the skin surface will make the surface flattened. Applica-
tion of pressure with the finger tip will produce fitting impres-
sion like one observed in edema.
Post-mortem Contact Flattening — On account of the loss
of elasticity of the skin and of the post-mortem flaccidity of
muscles, the body becomes flattened over areas which are in
contact with the surface it rests. This is observed at the region
of the shoulder blades, buttocks and calves if death occurs
while lying on his back. Certain degree of pressure may be
applied on the face immediately after death and may be mis-
taken for traumatic deformity.
of the Skin:
Exposure of the hand of a living person to translucent
light will allow the red color of circulation to be seen under-
neath the skin. The skin of a dead person is opaque due to
absence of circulation.
d. Effect of the Application of Heat:
Application of melted sealing wax on the breast of a dead
person will not produce blister or inflammatory reaction on
the skin. In the living, an inflammatory edema will develop
about the wax.
6. CHANGES IN AND ABOUT THE
a. Loss of Corneal Reflex:
The cornea is not capable of making any reaction to what-
ever intensity of light stimulus. However, absence of corneal
reflex may also be found in a living person the following condi-
tions:
General
(2)
(3) Uremia.
(4)
(5) Narcotic Poisoning.
(6) Local
 ASPECTS OF DEATH 125
b. Clouding of the Cornea:
The normal clear and transparent nature of the cornea is
lost. The cornea becomes slightly cloudy or opaque after death.
If the cornea is kept moist by the application of saline solution
after death, it will remain transparent. Opacity of the cornea
may be found in certain diseases, like cholera, and therefore
is not a reliable sign of death.
Flaccidity of the Eyeball:
After death, the orbital muscles lose their tone making the
tension rapidly fall. The eyeball sinks into the
orbital fossa. Intra-orbital tension is low.
d. The Pupil is in the Position of Rest:
The muscle of the iris loses its tone. The pupil can not
react to light. The size of the pupil varies at the time of death,
however, if contracted, it may infer poisoning by narcotic
drugs. A relaxed iris may be found in life in the following
conditions:
Action of drugs like atropine.
(2) Uremia.
(3) Tabes
(4) Apoplexy.
e. Ophthalmoscopic Findings:
(1) The optic disc is pale and has the appearance of optic
atrophy.
(2) The remaining portion of the fundus may have a yellow
tinge which later changes to a brownish-gray or slate color.
(3) The retina becomes pale like the optic disc.
(4) The retinal vessels become segmented, no evidence of blood
flow.
The retinal veins and arteries are
f. de la
After death a spot may be found in the sclera. The spot
which may be oval or round or may be triangular with the base
towards the cornea and may appear in the sclera a few hours after
death. At the beginning it is yellowish but later it becomes
brown or black. This is believed to be due to the thinning of
the sclera thereby making the pigmented choroid visible.
OF HEAT ON THE SKIN:
This test is useful to determine whether death occurred before
or after the application of heat.
The heat is applied to a portion of the leg or arm. If death is
real, only a dry blister is produced. The epidermis is raised but
126 LEGAL MEDICINE

on pricking the blister, no fluid is present. There is no redness of

the surrounding skin. In the living, the blister contains abundant
serum and area of vital reaction (congestion) on the skin around
is present.
The Following of Signs Show Death Occurred:
a. Loss of animal heat to a point not compatible with life.
b. Absence of response of muscle to stimulus.
Onset of rigor mortis.

CHANGES IN THE BODY FOLLOWING DEATH

IN THE MUSCLE:
After death, there is complete relaxation of the whole muscular
system. The entire muscular system is contractile for three to six
hours after death, and later rigidity sets in. Secondary relaxation
of the muscles will appear just when decomposition has set in.
The Entire Muscular Tissue Passes Three Stages After Death:
Stage primary flaccidity (post-mortem muscular
The are relaxed and capable of contracting when
The pupils are dilated, the sphincters are relaxed,
there incontinence of urination and defecation.
Stage of post-mortem rigidity (Cadaveric rigidity, or Death
struggle of muscles or Rigor Mortis):
body becomes rigid due to the contraction of the
develops three to six hours after death and may
last our to thirty-six hours.
Stage of secondary flaccidity or commencement of putrefaction
(Decay of muscles):
The muscles flaccid, capable of responding
to mechanical or electrical stimulus and reaction becomes
alkaline. ~
Stage of Primary Flaccidity or Period of Muscular
Immediately after death, there is complete relaxation and
softening of all the muscles of the body. The extremities may
be flexed, the lower jaw falls, the eyeball loses its tension, and
there may be incontinence of urination and defecation.
To determine whether the muscles are still irritable, apply
electric current and note whether there is still irritability of the
muscles. Normally during the stage of primary flaccidity, the
muscles are still contractile and react to external stimuli,
mechanical or electrical owing to the presence of molecular
life after somatic
 ASPECTS OF DEATH

This stage usually lasts about three to six hours after death.
In warm places, the average duration is only one hour and fifty-
one minutes (Mackenzie cited by Modi, p. 122).
Chemically, the reaction of the muscle is alkaline and the
normal constituents of the individual muscle proteins are the
same as in life.
b. Stage of Rigidity, or Cadaveric Rigidity, or Death
Stiffening, or Struggle of or rigor mortis:
Three to six hours after death the muscles gradually stiffen.
It usually starts at the muscles of the neck and lower jaw and
spreads downwards to the chest, arms, and lower limbs. Usually
the whole body becomes stiff after twelve hours. All the
muscles are involved — both voluntary and involuntary. In the
heart, rigor mortis may be mistaken for cardiac hypertrophy.
Chemically, there an increase of lactic acid and phosphoric
content of the muscle. The reaction becomes acidic. There is
no definite explanation as to how such contraction of muscles
occurs although it has been proven that there is coagulation of
the plasma protein.
In the view point, post-mortem rigidity may be
utilized to approximate the length of time the body has been
dead. In temperate countries it usually appears three to six
hours after death, but in warmer countries it may develop
earlier.
In temperate countries, rigor mortis may last for two or
three days but in tropical countries the usual duration is
twenty-four to forty-eight hours during cold weather and
eighteen to thirty-six hours during summer. When rigor mortis
sets in early, it passes off quickly and vice versa.
Factors Influencing the Time of Onset of Rigor Mortis:
Internal Factors:
(a) State of the
Rigor mortis appears late and the duration is longer
in cases where the muscles have been healthy and at
rest before It has been observed that in the
following the onset of rigor mortis is hastened:
i. Animal having been hunted to
Prolonged convulsion and lingering illness.
iii. Death from typhoid fever, typhus, cholera and
phthisis.
128 LEGAL MEDICINE

(b) Age:
Rigor mortis has early onset in the aged and
The onset is delayed in good health and good muscular
development.
(c) Integrity of the
Section of the nerve will delay onset of rigor mortis
as shown in paralyzed muscles.
(2) External Factors:
(a) Temperature:
The development of rigor mortis is accelerated by
high temperature a temperature above will
produce heat stiffening.
(b) Moisture:
Rigor mortis commences rapidly but the duration is
short in moist air.
Conditions Simulating Rigor Mortis:
Heat Stiffening:
If the dead body is exposed to temperatures above
75°C it will coagulate the muscle proteins and cause the
muscles to be rigid. The stiffening is more or less perma-
nent and may not be easily affected by putrefaction. The
body assumes the with the lower and
upper extremities flexed and the hands clenched because
the flexor muscles are stronger than the extensors.
Heat stiffening is commonly observed when the body of
a person is placed in boiling fluid or when the body is
burned to death.
Cold Stiffening:
The stiffening of the body may be manifested when
the body is frozen, but exposure to warm condition will
make such stiffening disappear. The cold stiffening is due
to the solidification of fat when the body is exposed to
freezing temperature. Forcible stretching of the flexed
extremities will produce a sound due to the frozen synovial
fluid.
Cadaveric Spasm or Instantaneous Rigor:
This is the instantaneous rigidity of the muscles which
occurs at the moment of death due to extreme nervous
tension, exhaustion and injury to the nervous system or
injury to the chest. It is principally due to the fact that the
last voluntary contraction of muscle during life does not
 ASPECTS OF DEATH

stop after death but is continuous with the act of cadaveric

rigidity.
In case of cadaveric spasm, a weapon may be held in the
hand before death and can only be removed with difficulty.
For practical purposes it cannot be possible for the mur-
derer or assailant to imitate the condition. In cadaveric
spasm, only group of muscles are involved and they are
usually not symmetrical.
The findings of weapon, hair, pieces of clothing, weeds
on the palms of the hands and firmly grasped is a very
important medico-legal point in the determination whether
it is a case of suicide, murder or homicide. The presence
of weeds held by the hands of a person found in water
shows that the victim was alive before
Instantaneous rigor may also be found following inges-
tion of cyanide but usually it is generalized and
Strychnine may produce the same but rigidity appears
after ingestion.
Between Rigor Mortis and Cadaveric
Time of Appearance:
Rigor mortis appears three to six hours after death,
while cadaveric spasm appears immediately after death.
Involved:
Rigor mortis involves all the muscles of the body
whether voluntary or while cadaveric spasm
involves only a certain muscle or group of muscles and
are asymmetrical.

Rigor mortis is a natural phenomena which occurs

after death, while cadaveric spasm may or may not appear
on a person at the time of death.
Significance:
Rigor mortis may be utilized by a medical jurist to
approximate the time of death, while cadaveric spasm may
be useful to determine the nature of the crime.
Distinctions Between Muscular Contraction and Rigor Mortis:
Contraction Rigor
(1) Contracted muscle is Muscle in rigor
more or less transparent, losses this
or rather translucent. and becomes opague.
(2) It is very elastic, (2) It has lost this elasti-
 LEGAL MEDICINE

capable of restoration city and readily main-

to its original form as tains a distorted posi-
soon as the distorting tion.
force has ceased to act.
(3) In reaction to litmus, it (3) It is distinctly and con-
is either neutral or slight- stantly acid (until de-
ly alkaline, and any re- co m po s i ti o n is ad-
duction in this alkali- vanced) owing to the
nity is very speedily development of sarco-
removed. and other acid
metabolites.
(4) If the contraction be (4) If rigor be over-
overcome by mechani- come by mechanical
cal force, the muscles absolute
though they may re- corresponding in degree
main for a time un- with the amount of
contracted, possess still mechanical movement,
their inherent power at once ensues, and
of contraction; they there is no power to
may then keep the limb resume the old position
fixed in a new position nor any new one, except
or allow a return to so far as gravity may
the old position. cause a new position.
This flaccidity is per-
manent till decompo-
sition destroys the
muscles.

(From: Taylor's Principles and Practice of Medical

dence, Vol I, p. 179).
Stage of Secondary Flaccidity or Secondary Relaxation:
After the disappearance of rigor mortis, the muscle becomes
soft and flaccid. It does not respond to mechanical or electrical
stimulus. This is due to the dissolution of the muscle proteins
which have previously been coagulated during the period of
rigor mortis.
This body while at the stage of rigor mortis, if stretched or
flexed to become soft, will no longer be rigid. This condition
f the muscles is not secondary flaccidity.
CHANGES IN THE BLOOD:
a. Coagulation of the
The stasis of the blood due to the cessation of circulation
 ASPECTS OF DEATH 131
enhances the coagulation of blood inside the blood vessels.
Blood clotting is accelerated in cases of death by infectious
fevers and delayed in cases of asphyxia, poisoning by opium,
hydrocyanic acid or carbon monoxide poisoning. The clotting
of blood is a very slow process that there is a tendency for the
blood to separate forming a red clot at the lower level and
above it is a white clot known as chicken-fat clot.
may remain inside the blood vessels after death
for 8 hours.
Between Ante-mortem from Clot:
Ante-mortem Clot
Post-mortem Clot
(1) Firm in consistency.
(2) Surface of the (2) Surface of the blood
vessel raw after smooth and
clots are removed. after the clots
are removed.
(3) Clots homogenous in (3) Clots can be stripped
construction so it can- off in layers.
not be stripped into
layers.
(4) Clot with uniform color. (4) Clot with distinct layer.
or Cadaveric or Post-mortem
or Post-mortem Hypostasis or Mortis:
The stoppage of the heart action and the loss of tone of
blood vessels cause the blood to be under the influence of
gravity. Blood begins to accumulate in the most dependent
portions of the body. The capillaries may be distended with
blood. The distended capillaries coalesce with one another
until the whole area becomes dull-red or purplish in color
known as post-mortem If the body is lying on his
back, the lividity will develop on the back. Areas of bone
prominence may not show lividity on account of the pres-
sure.
If the position of the body is moved during the early stage
of its formation, it may disappear and develop again in the
most dependent area in the new position assumed. But if
the position of the body has been changed after clotting or
the blood has set in or when blood has already diffused into
the tissues of the body, a change of position of the body will
not alter the location of the post-mortem lividity.
Ordinarily, the color of post-mortem lividity is dull-red or
pink or purplish in color, but in death due to carbon monoxide
132 LEGAL MEDICINE

poisoning, it is bright pink. Exposure of the dead body to cold

or hot may cause post-mortem lividity to be in
color.
The lividity usually appears three to six hours after death
and the condition increases until the blood coagulates. The
time of its formation is accelerated in cases of death due to
cholera, uremia and typhus fever. Twelve hours after death,
the post-mortem lividity is already fully developed. It also
involved internal organs.
Physical Characteristics of Post-mortem Lividity:
It occurs in the most extensive areas of the most dependent
portions of the body.
(2) It only involves the superficial layer of the skin.
It does not appear elevated from the rest of the
(4) The Color is uniform but the color may become greenish
at the start of decomposition.
(5) There is no injury of the skin.
Kinds of Post-mortem

The blood merely gravitates into the most dependent

portions of the body but still inside the blood vessels and
still fluid in form. Any change of position of the body
leads to the formation of the lividity in another place.
This occurs during the early stage of its formation.

This appears during the later stage of its formation

when the blood has coagulated inside the blood vessels
or has diffused into the tissues of the body. Any change
of position will not change the location of the lividity.
Importance of Cadaveric Lividity:
It is one of the signs of death.
(2) It may determine whether the position of the body has
been changed after its appearance in the body.
(3) The color of the lividity may indicate the cause of death.
a. In the lividity is dark.
b. In carbon monoxide poisoning, the lividity
is bright pink.
Hemorrhage, anemia — less
Hydrocyanic acid — bright
Phosphorus — dark
Potassium chlorate, Potassium bichromate —
chocolate or coffee brown.
 ASPECTS OF DEATH 133
If the body is found for considerable time in
snow or ice the lividity is bright red.
(4) It may determine how long the person has been dead.
(5) It gives us an idea as to the time of death.
Points to be considered which may infer the position of the body
at the time of
a. Posture of the body when found:
The body may become rigid in the position in which he
died. Post-mortem lividity may develop in the assumed posi-
tion. This condition may occur and is of value if the state and
position of the body was not moved before rigidity and lividity
took place.
b. Hypostasis
Hypostatic lividity will be found in areas of the body which
comes in contact with the surface where the body lies. If there
is already coagulation of blood or if blood has already diffused
into the tissues of the body, a change of position will not alter
the location of the post-mortem lividity.
Cadaveric Spasm:
In violent death, the attitude of parts of the body may infer
position on account of the spasm of the muscles.
(1) In drowning, the victim may be holding the
sea weeds.
(2) In suicide, the wounding weapon may be grasped
tightly by the hands.
Between Contusion (Bruise) and Hy-
postasis:
(Bruise) Post-mortem Hypostasis
a. Below the epidermis in the a. In the epidermis or in the
true skin in small bruises or cutis, as a simple stain or
extravasations, below this in a showing through the epi-
ones, and often much dermis of underlying en-
deeper still. The reason is gorged
obvious, viz., that the epider-
mis has no blood-vessels to
be ruptured.
b. Cuticle was probably abraded b. Cuticle because
by the same pro- the hypostasis is a mere
duced the bruise. In small sinking of the blood; there
such as flea bites, is no trauma.
this is not observed.
134 LEGAL MEDICINE

A bruise appears at the seat Always in a part which for

of and surrounding the the time of formation is
This may or may not be a dependent, i.e., at a place
dependent part. where gravity ordains it.
d. Often elevated, because the Not elevated, because either
blood and sub- the blood is still in the vessels
sequent inflammation swell or, at most, has simply soaked
the tissues. into and stained the tissues.
e. Incision shows blood outside Incision shows the blood is
the vessels. This is the most still in its vessels; and if any
certain test of difference, and oozing occurs drops can be
can be observed even in very seen issuing from the cut
small bruises. mouths of the vessels.
f. Colour variegated. This is Colour uniform. The well-
only true of bruises that are known change in colour
some days old; it is due to (green, yellow, etc.) pro-
the changes in the haemoglo- duced in blood extravasted
bin produced during life. into living tissues does not
occur in dead tissues with
the same regularity.
g. If the body happens to be In a place which would other-
constricted at, or supported wise be the seat of a hypos-
on, a bruised place, the tasis pressure of any kind,
actual surface of contact even simple support (the
may be a little lighter than wrinkling of a shirt or
the rest of the bruise, but tie, garters, etc.) is sufficient
will not be white. to obliterate the lumen of
venules and capillaries, and
so to prevent their filling
with blood. White lines
or patches of pressure bor-
dered dark color of a
hypostasis are produced and
marks of floggings, strang-
ulation, etc., are thus some-
times simulated.
(From: — Taylor's and Practice of Medical Jurispru-
dence, 11th ed. 1949, Vol I, p. 175-176.
Internal Hypostasis in Visceral Organs:
lividity also occurs in the internal The
principal organs affected are the loops of the intestine
and brain. It may in some instances be mistaken for disease.
 ASPECTS OF DEATH

hypostasis in the organs may have the pathological

appearance in the visceral organs. In the heart, it may simulate
coronary occlusion while in the lungs it may appear like pneu-
monic changes. The intestine may be reddened to appear like
strangulation.
Differences between Post-mortem Lividity of Organs and Simple
Congestion:
a. Post-mortem staining in organs is irregular and occurs in the
most dependent parts, while congestion is generally uniform
and found all over the organs.
b. The mucous membrane in post-mortem staining (lividity) is
dull and lusterless, but not so in congestion.
In post-mortem staining (lividity) inflammatory exudate is not
seen, and areas of redness alternating with pale areas will be
found if a hollow is stretched out and held in front of
a light. This is not seen in cases of simple congestion.
Distinctions between Post-mortem Lividity from Hemorrhage
of Scurvy, Phosphorus Poisoning, or Purpura:
a. History Before Death:
History will reveal the presence of scurvy, phosphorus
poisoning or purpura.
b. Time of Appearance:
In cases of scurvy, purpura or phosphorus poisoning, the
skin lesion is present even before death, while in cases of post-
mortem lividity it only appears after death.
Location:
In post-mortem lividity, it is only present in the most de-
pendent portions of the body, while in scurvy or phos-
phorus poisoning, the lesions may be found and distributed
all over the skin or organs.
Other Changes in the
a. Hydrogen ion Concentration — After death the Ph of the blood
and tissues drops because of the terminal accumulation of
and glycolysis with accumulation of phosphoric
acid and lactic acid, and splitting off of and fatty
acids.
After about 24 hours, the reaction become alkaline due to
the production of ammonia from enzymatic protein breakdown
and the rise of serum concentration of nonprotein nitrogenous
components.
b. The breakdown of liver glycogen leads to the accumulation of
in the vena cava and right side of the heart.
136 LEGAL MEDICINE

There is a rise of non-protein nitrogen and free

d. Chemical — The chloride in the plasma and red blood cells falls
due to the diffusion so that after 72 hours it is
only of its content.
Magnesium content increases as a result of diffusion from
without.
Potassium increases owing to diffusion from the vascular
endothelium.
3. AUTO LYTIC OR CHANGES AFTER DEATH:
After death, proteolytic, glycolytic and lipolytic ferments of
glandular tissues continue to act which lead to the
of organs. This action is facilitated by weak acid and higher
temperature. It is delayed by the alkaline reaction of the tissues of
the body and low temperature. Their early appearance is ob-
served in the parenchymatous and glandular
Autolytic action is seen in the maceration of the dead fetus in-
side the uterus. The stomach may be perforated, glandular tissues
become soft after death due to autodigestion and the action of
autolytic enzymes.
Microscopic examination of the tissues under the influence of
autolytic enzymes shows disintegration, swelling or shrinkage,
vacuolization and formation of small granules within the cyto-
plasm of the cells. There is also a change in the staining capacity
and become desquamated from the underlying layers (Legal
Medicine by Gradwohl, p.
4. PUTREFACTION OF THE BODY:
Putrefaction is the breaking down of the complex proteins into
simpler components associated with the evolution of foul smelling
gasses and accompanied by the change of color of the body.
Tissue in Putrefaction:
The following are the principal changes undergone by the soft
tissues of the body in the process of
a. in the Color of the Tissue:
A few hours after death, there is hemolysis of the blood
within the blood vessels and as a result of which hemoglobin is
liberated. The hemoglobin diffuses through the walls of the
blood vessels and stains the surrounding tissues thereby im-
parting a red or reddish-brown color.
While in the tissues, the hemoglobin undergoes chemical
changes and various derivatives of hemoglobin are formed. On
account of these chemical changes the tissue color is gradually
 ASPECTS OF DEATH 137
changed to greenish-blue, or greenish-black
color.
The earliest change is greenish color of the skin seen at the
region of the right iliac fossa and it gradually spreads over the
whole abdominal wall. Blood later into the cavities
of the body.
— It is the prominence of the superficial veins
with reddish discoloration during the process of decomposition
which develops on both flanks of the abdomen, root of the neck
and shoulder and which makes the area look like a
reticule of branching veins. This is observed easily among dead
persons with fair complexion.
b. Evolution of in the Tissues:
One of the products of putrefaction is the evolution of gases.
Carbon dioxide, ammonia, hydrogen, sulphurated hydrogen,
hydrogen, and methane gases are formed. The
offensive odor is due to these gases and also due to a small
quantity of
The formation of gases causes the distention of the abdomen
and bloating of the whole body. Gases formed in the subcu-
taneous tissues and in the and neck cause swelling of the
whole body. Small gas bubbles are found in solid visceral
organs and give rise to the "foamy" appearance of the organs.
Effects of the Pressure of Gases of Putrefaction:
(1) of the Blood:
There may be post-mortem bleeding in open wounds on
account of the increased pressure inside the body brought
about by the accumulation of gases. The post-mortem
lividity be shifted to other parts of the body. The
heart may empty itself of
(2) Bloating of the Body:
On account of the accumulation of the body is
and swollen. The eyes may be protruding from
its the tongue may come out of the mouth, and
the face is black with thick lips having the appearance of
a negro (tete de
( 3 ) Fluid Coming Out of Both Nostrils and Mouth:
Fluid coming out of both nostrils and mouth is usually
in the form of froth. It is due to the putrefaction of the
upper and respiratory tracts.
( 4 ) Extrusion of the Fetus in a Gravid
On account of the increased intra-abdominal pressure,
the contents of the gravid uterus may be expelled, but this
138 LEGAL MEDICINE

event is quite doubtful when the product of conception is

full term because of the difficulty of expulsion.
There is more likelihood for the uterus to rupture inside
the abdominal cavity.
(5) Floating of the Body:
The specific gravity of a decomposed body is much less
as compared with a recently dead. This is brought about by
the increase of gaseous content and increase in volume due
to bloating without any increase in
Liquefaction of the Soft Tissues:
As decomposition progresses, the soft tissues of the body
undergo softening and liquefaction. The eyeballs, brain, stomach,
intestine, liver and spleen putrefy rapidly, while highly muscular
organs and tissues relatively putrefy late.

in water with bloating of the whole body, blackening of the face and
attitude of the extremities at the time of recovery.

Factors Modifying the Rate of Putrefaction:

a. Internal Factors:
(1) Age:
Healthy adults later than infants. It may be
late in a newborn infant who have not yet been fed. Marked-
ly emaciated person has the tendency to mummify.
 ASPECTS OF DEATH

Condition of the
Those of the full-grown and highly obese persons decom-
pose more rapidly than skinny ones. Bodies of still-born
are usually sterile so decomposition is retarded.
(3) of Death:
Bodies of persons whose cause of death is due to in-
fection decompose rapidly. This is also true when the
diseased condition is accompanied with anasarca. Bodies
whose sudden death is not due to microorganism decom-
pose late.
b. External Factors:
(1) Free Air:
(a) Air — The accessibility of the body to free air will
hasten decomposition.
(b) Moderate Moisture — Moderate amount of moisture will
accelerate decomposition, but excessive amount will
prevent the access of air to the body thereby delaying
decomposition. Moisture is necessary for the growth
and multiplication of bacteria, however, if the eva-
poration of fluid is marked, there will be mummifica-
tion of the tissues and putrefaction will be
(c) Condition of the Air — If the air is loaded with septic
bacteria, decomposition will be hastened.
(d) Temperature of the Air — The optimum temperature
for specific decomposition is 70°F to 100°F. Decom-
position does not occur at temperatures below 32°F
or about 212°F.
(e) Light — The organism responsible for the putrefaction
prefers more the absence of light.
(2) Earth:
Dry absorbent soil retards decomposition while moist
fertile soil accelerates decomposition.

Decomposition in running water is more rapid than in

still water. Bacteria-laden pools will accelerate decom-
position.
(4 )
Clothings initially hasten putrefaction by maintaining
body temperature but in the later stage, clothings delay
decomposition by protecting the body from the ravages
of flies and other insects. Tight clothings delay putrefaction
140 LEGAL MEDICINE

due to the diminution of blood in the area on account

of pressure.
Physical Changes of the Body during Putrefaction in Chronological
Order:
a. External
Greenish discoloration over the iliac fossa appearing after
one to three days.
(2) Extension of the greenish discoloration over the whole
abdomen and other parts of the body.
(3) Marked discoloration and swelling of the face with bloody
froth coming out of the nostrils and mouth.
(4) Swelling and discoloration of the or of the vulva.
Distention of the abdomen with gases.
Development of bullae in the face of varying sizes.
(7) Bursting of the bullae and denudation of large irregular
surfaces due to the shedding of the epidermis.
(8) Escape of blood-stained fluid from the mouth and nostrils.
Brownish discoloration of the surface veins giving an
arborescent pattern on the skin.
Liquefaction of the eyeballs.
Increased discoloration of the body generally and progres-
sive increase of abdominal distention.
Presence of maggots.
(13) Shedding of the nails and of the hairs.
(14) Conversion of the tissue into semi-fluid mass.
(15) Facial feature unrecognizable.
(16) Bursting the abdomen and thoracic cavities.
dissolution of the body.
b. Internal Changes:
(1) Those which Putrefy Early:
(a)
(b) Lining of the trachea and larynx.
(c) Stomach and intestines.
(d)
(e) Liver.
(f) Uterus (if pregnant or in puerperal
(2) Those which Putrefy Late:
(a) Esophagus.
(b) Diaphragm.
(c) Heart.
(d) Lungs.
(e) Kidneys.
(f) Urinary
 ASPECTS OF DEATH 141
(g) Uterus (if not
(h) Prostate
Organs rich in muscular tissues resist putrefaction longer than the
parenchymatous organs with the exception of the stomach and
intestines which by reason of their contents at the time of death
decompose quickly.
Factors Influencing the Changes in the Body after Burial:
a. State of the Body Before Death:
An emaciated person at the time of death will decompose
slower as compared with well-nourished individual when placed
under the same conditions and circumstances. Skinny person
has more tendency to mummify, especially at the regions of
extremities.
b. Time between Death and Burial and Environment of
the Body:
If the temperature of the surroundings at the time of death is
conducive for the growth and multiplication of bacteria, then
the longer the time such body is exposed to such condition
the faster is the decomposition. However, if the body has been
frozen to death for quite a time, there will be retardation of
body decomposition. The presence of filthy, pultaceous and
organic materials in the surroundings coupled with the presence
of light and optimum temperature will enhance the decom-
position.
Effect of Coffin:
The use of a coffin will delay decomposition if it is air-
tight and hard. If soft and weak, water can easily percolate at
the floor and top, thus it will not serve the purpose. The body
in a coffin usually decompose later as compared with the body
which is
d. Clothings and Any Other on the Body when Buried:
Clothings and other body coverings delay decomposition.
Most often the covered portions of the body are well preserved
for sometime. The most probable reasons why clothings
retard decomposition are:
It affords some protection from insects and aids
formation keeping the body under it continuously moist by
absorbing water from the soil.
(2) The pressure of the clothings on the body.
e. Depth at which Body Buried:
As a general rule, the greater the depth the body been
buried, the better is the preservation. There is aeration in
 LEGAL MEDICINE

shallow grave and this is a conducive invitation for and

other animals. The changes of temperature of the body on
account of the changing weather conditions is more marked
in shallow graves.
Condition and Type of Soil:
Dry, arid and sandy soil promotes mummification of the
body. The presence of straw or other organic matters that will
introduce more bacteria will accelerate decomposition.
g. Inclusion of Something in the Grave which will Hasten Decom-

Some organic materials, like food are sometimes included

with the dead body inside the coffin because of their super-
stition that it will be utilized by the departed soul in its life
hereafter. Its inside the coffin will accelerate pu-
trefaction.
h. Access of Air to the Body After Burial:
Air may hasten evaporation of the body fluid and promotes
mummification. Bacteria-laden air will promote decomposition.
Humid air will enhance adipocere formation. However, acces-
sibility of air means also accessibility of insects and other
scavengers which will promote destruction of the soft tissues of
the body.
Mass
This is seldom seen, except in mass massacre, war and in
plane crash. There is relatively rapid decomposition of the

j. Trauma on the
Persons dying from infection decompose rapidly while those
dying of violent death decompose relatively slow.
On account of the presence of several factors which modify
decomposition of the body after death, it is quite difficult to
make an estimate as to the duration of death of a decomposed
body without considering those different elements influencing it.
Chronological Sequence of Putrefactive Changes Occurring in
Temperate Regions:
Putrefactive Changes Time
a. Greenish discoloration over the
iliac fossae. The eyeballs are soft
and yielding. 1 to 3 days after death.
b. Greenish discoloration spreading
over the whole abdomen, external
genitals and other parts of the
 ASPECTS OF DEATH

body. Frothy blood from the

mouth and nostrils. 3 to 5 days after death.
Abdomen distended with gas.
Cornea fallen in and concave.
Purplish red streaks of veins
prominent on the extremities.
Sphincters relaxed. Nails firm. 8 to 10 days after death.
Body greenish-brown. Blisters
forming all over the body. Skin
peels off. Features unrecog-
nizable. Scrotum distended.
Body swollen up owing to
distention. Maggots found on the
body. Nails and hair loose and
easily detached. 14 to 20 days after death.
Soft parts changes into a thick,
semi-fluid black mass. Skull
exposed. Orbits empty. 2 to 5 months after death.
Medicine, cited by Modi, Medical
dence and Toxicology, 12 p. 134).
Chronological Sequence of Putrefactive Changes Occurring in
Tropical
Time Since Death Condition of the Body
hours Rigor mortis present all over. Hypostasis
well-developed and fixed. Greenish dis-
coloration showing over the caecum.
24 hours Rigor mortis absent all over. Green dis-
coloration over whole abdomen and
spreading to chest. Abdomen distended
with gases.
48 hours Ova of flies seen.
Trunk bloated. Face discolored and
swollen. Blisters present. Moving
maggots seen.
72 hours Whole body grossly swollen and
Hair and nails loose. Tissues
soft
One week Soft viscera putrefied.
Two weeks Only more resistant viscera distinguish-
able. Soft tissues largely gone.
One month Body skeletonized.
144 LEGAL MEDICINE

(From: in 2nd
p. 25).
Body decomposition in warm countries, according to Lambert,
will reduce the whole body to a skeleton in a month's time when
exposed to air. In water, putrefaction proceeds twice as slowly
as it is in air. When the body is buried, the rate depends on the
mode of burial. In deep burial with coffin, putrefaction proceeds
from four to six times as slowly as compared with that one in
air, but with shallow burial, it is very slightly retarded.

Decomposition - Soft tissues of the chest and head have disappeared while
those of the abdomen and extremities are mummified.

Chronological Sequence of Putrefactive Changes When the Body

Has Been Submerged in Water:
Putrefactive Changes Time
a. Very little change if water is
cold. Rigor mortis may persist. First four or five days.
b. The skin on the hands and feet
became sodden and bleached.
The face appears softened and
a faded white color. From five to seven days.
Face swollen and red. Greenish
discoloration on the eyelids, lips,
neck and sternum. Skin of the
hands and feet wrinkled. Upper
 ASPECTS OF DEATH

surface of brain greenish in

color. One to two
d. Skin wrinkled. Scrotum and penis
distended with gas. Nails and
hair still intact. Lungs emphy-
sematous and covered the heart. Four
e. Abdomen distended, skin of
hands and feet come off with
nails like a glove. Six to eight weeks.
of cited by Modi, Medical Jurisprudence
and Toxicology, 12th ed. 1957, p. 138).
Factors Influencing the Floating of the Body in Water:
a. Age:
Bodies of fully-developed and well-nourished newly-born
float relatively rapid.
b.
Women float sooner than men. This is due to the lightness of
female bones and greater of fat, hence lesser specific
gravity.
Conditions of the
Stout persons float quicker than skinny, lean and thin
bodies. Bodies with loose clothings will soon come to the
surface.
d. Season of the Year:
The moist hot air of summer is very favorable for putre-
faction. Putrefaction makes the body bloat on account of gas
formation, hence it will accelerate floating of the body.
e. Water:
Dead body floats in a shallow and stagnant water of creeks
or pond sooner than in deep water of running stream. The stag-
nant water has higher specific gravity than clear water, so it is
easy for the dead body to overcome it by gas formation. Body
floats sooner in sea than in fresh water on account of the high
gravity of sea water.
f. External
The presence of heavy-wearing apparel or the addition of
weight in the pockets or attached to the body by means of
rope or string will delay the floating of the body.
of Putrefaction When the Body is in Water:
a. Face and neck or sternum.
b. Shoulders.
146 LEGAL MEDICINE

Arms.
Abdomen.
e. Legs.

Decomposition — The whole body almost skeletonized

Influence of Bacteria in
Decomposition is due to action of bacteria in various tissues of
the body. During the early period of decomposition, aerobic
activities are prominent. Later, the facultative aerobes and anae-
robes are present. In the advanced stage, the activities of the
are the most prominent with the production of gasses.
The softening of the tissues is the result of bacterial action,
proteolytic and autolytic ferments.
The microorganism that plays an important and dominant
role in decomposition is Clostridium This bacteria starts
to grow in parenchymatous organs. It is responsible for the dis-
integration of cytoplasm, destruction of nuclei and generation of
gases in the cells.
Other bacteria which participate in tissue destruction during
the period of decomposition
a. Bacillus
b. Bacillus vulgaris.
Bacillus
d. Bacillus aerogenes
 ASPECTS OF DEATH 147
Other Destructive Agents During Decomposition:
a.
Maggots (Larvae):
The presence of maggots is dependent upon the acces-
sibility of the body to adult flies. The flies lay eggs which
after a time is hatched to form maggots. The maggots have
a strong desire to live in damaged skin surface. Maggots
may also be observed in bodies buried in shallow graves
and even in floating decomposed bodies in water pools.
(2) Adult Flies:
The common house flies are They devour
the juicy areas of portions of the body. Destruction
by adult flies is observed better when the body is found on
surface ground.
b. Reptiles:
Lizards and snakes are attracted to dead bodies and eat the
soft tissues. Small bones may be fractured in the process and
may be mistaken for injuries during the life time of the de-
ceased.
Rodents:
Rats and mice will nibble the skin and other tissues and may
show injuries. The bones may also be attacked
and showed certain degree of erosions.
d. Other Mammals:
The dogs may participate in the destruction of the soft
tissues especially in cases where the victim is lying on the
ground. In most instances, the different parts of the body is
scattered and separated from one another. A part may be
missing or seen in some far distant places. In India, jackals
also participate in the destruction of decomposed tissues.
e. Fishes and
If the body is in water, fish of almost all species and crus-
tacean will be feeding on the soft tissues. Man-eating fishes
like sharks may devour the whole body of a person.
f.
As a general rule, molds do not destroy the dead bodies but
their growth cause disfigurement and minor superficial lesions
on the skin.
After a period of time, all of the soft tissues of the body will
disappear. Only the teeth, bones and hair will remain. These
tissues will remain for an indefinite The
bones may show signs of disintegration by the diminution of
 LEGAL MEDICINE

weight and erosion of the epiphysis. Flat bones disintegrate

faster than round bones. The degree of ossification is also a
factor in the bone destruction.

Death in the sea with post-mortem erosion of the face due to the activities
of the fishes and other aquatic animals.

SPECIAL MODIFICATION OF PUTREFACTION:

a. Mummification:
Mummification is the dehydration of the whole body which
results in the shivering and preservation of the body. It usually
occurs when a dead body is buried in a hot, and arid place with
dry atmosphere and with free access of hot air. In most cases,
the natural physical appearance is not modified, hair may be
kept intact although there may be change in color of the skin.
The internal organs may be shrunken, hard and with a dark-
brown or black color. If the whole fluid contents of the body
has evaporated, preservation is for an indefinite time but the
whole body may become brittle, weight markedly reduced
and may later be destroyed by pulverization.
Mummification is observed in warm countries where eva-
poration of body fluid takes place earlier and faster than
decomposition. Death in like in Egypt, the body has
more tendency to mummify. However, a mummified body
may after a time be attacked by moths and ins causing
destruction.
 ASPECTS OF DEATH 149
Kinds of Mummification:
(1) Natural Mummification;
When a person is buried in hot, arid, sandy soil, there will
be insufficient moisture for the growth and multiplication
of putrefactive bacteria. The body will become dehydrated
and mummified which is caused by the forces of nature.
(2) Artificial Mummification:
The principles involved in artificial are:
(a) Acceleration of the evaporation of the tissue fluid of
the body before the actual onset of decomposition.
(b) Addition of some body preservatives to inhibit decom-
position and to allow evaporation of fluid. This is made
by treatment of the body with arsenic, formalin, resin-
ous or tarry materials.

b. Saponification or
This is a condition wherein the fatty tissues of the body are
transformed to soft brownish-white substance known as adi-
pocere. The layer of subcutaneous tissue is the frequent site of
its formation. It occurs naturally in the visceral organs and
even in non-fatty tissues of the body like the muscles.
Adipocere is a waxy material, rancid or moldy in odor,
floats in water, and dissolves in ether and alcohol. With diluted
solution of copper sulfate, it gives a light greenish-blue color. It
is inflammable and burns with a faint yellow flame. When
distilled it produces a dense oily vapor.
Some Theories on the Formation of Adipocere:
(1) The fats of the body split into glycerol and fatty acids.
The fatty acids combine with calcium, magnesium, potas-
sium, sodium, and ammonium salts to form an insoluble
soap. These ester of fatty acid somehow delay body de-
composition and make the body greasy to touch.
There is gradual hydrogenation of pre-existing fat in the
body like to higher fatty acids. Hydrogenation
causes remarkable swelling and stiffening of the fats. The
new hydrogenated fat is quite stable but on exposure to
air becomes yellow, hard and brittle.
Factors Influencing Adipocere Formation in Earth
(1) State of Health Before Death:
Adipocere formation depends primarily on the presence
of fat in the body of the deceased. It is difficult for
 LEGAL MEDICINE

pocere to develop in the state of extreme emaciation.

Areas of the body where fat is abundant develop adipocere
recognizable through the naked eye rapidly as compared
with the other The amount of water in the surround-
ings is not very essential to the phenomena. Water of the
body may be drawn from the muscles and internal organs.
(2) Time between Death and Burial:
Generally, the longer the space of time interval between
death and burial, the greater is the degree of adipocere
formation. This is further accelerated when the body is
subjected to autopsy. Exposure of the internal organs
to external elements promotes enzymatic and bacterial
actions in the process of hydrolysis and glycerol
(3) Effect of the Coffin:
The coffin has air space and if crudely made, it may
allow water to come in contact with the body surface
thereby enhancing of fat. If water has been freely
admitted, colliquative putrefaction will develop for a
longer time thus making adipocere formation scanty.
(4) Presence of Clothings and Other Coverings of the
Adipocere formation is found to be more advanced
under clothings or other body coverings, especially if the
clothings are tight.
(5) of Soil:
Dry soil is conducive to mummification. Sufficiently
moist soil accelerates adipocere formation.
(6) Access of Air to the Body After Burial:
The disturbance of a body in the grave shortly after
burial or before the formation of adipocere prolongs its
formation.
Mass Grave:
There is more tendency for adipocere formation when
several bodies are located in a grave because of the abun-
dance of moisture.
Maceration:
This is the softening of the tissues when in a fluid medium
in the absence of putrefactive microorganism which is frequent-
ly observed in the death of the fetus en
When the fetus dies en utero, provided that the death of the
fetus is not due to attempted abortion or rupture of the mem-
brane, the child is enclosed by the membrane in sterile con-
 ASPECTS OF DEATH
Putrefaction does not take place and the fetus becomes
soft. The softening of the body may be due to the action of
the autolytic and proteolytic enzymes and ferments.
The appearance of the fetus is typical. The is disco-
lored either reddish or greenish with the skin off and
the arms flaccid and frail. As maceration advances, there is
brownish-red discoloration of the skin. There may be blister
formation and the odor is somewhat rancid. For a definite and
appreciable degree of maceration to take place, it requires about
twenty-four hours.

DURATION OF DEATH
In the determination as to how long a person has been dead from
the condition of the cadaver and other external evidences, the
following points must be taken into
1. Presence of Rigor Mortis:
In warm countries like the Philippines, rigor mortis sets in
from 2 to 3 hours after the death. It is fully developed in the
body after 12 hours. It may last from 18 hours to 36 hours
and its disappearance is concomitant with the onset of put-
refaction.
2. Presence of
Post-mortem lividity usually develops 3 to 6 hours after
death. It first appears as a small red spots which
later coalesce with each other to involve bigger areas in the
most dependent portions of the body depending upon the
position assumed at the time of death.
3. Onset of Decomposition:
In the Philippines like other tropical countries, decompo-
sition is early and the average time is 24 to 48 hours after death.
It is manifested by the presence of watery, foul-smelling froth
coming out of the nostrils and mouth, softness of the body and
presence of crepitation when pressure is applied on the skin.
4. Stage of
The approximate time of death may be inferred from the
degree of decomposition, although it must be made with extreme
caution. There are several factors which modify putrefaction of
the body. For the stage of decomposition and the approximate
time after death, see tabulations (supra p.
5. Entomology of the Cadaver:
In order to approximate the time of death by the use of the
flies present in the cadaver, it is necessary to know the life cycle
152 LEGAL MEDICINE

of the flies. The common flies undergo larval, pupal and adult
The usual time for the egg to be hatched into larva is
24 hours so that by the. mere fact that there are maggots in the
cadaver, one can conclude that death has occurred more than
24 hours.
6. Stage of Digestion of Food in the Stomach:
It takes normally 3 to 4 hours for the stomach to evacuate its
contents after a meal. The approximate time of death may be
deduced from the amount of food in the stomach in relation to
his last meal. This determination is dependent upon the amount
of food taken and the degree of tonicity of the stomach.
The extent of the gastric emptying and the progression of the
meal in the tract can be useful in estimating the
time of death. However, the position and condition of the dece-
dent's last meal is influenced by the following factors:
a. Size of the Last Meal — The stomach usually starts to empty
within ten minutes after the first mouthful has entered. A
light meal leaves the stomach within 1-1/2 to 2 hours after
being eaten. A medium-sized meal will require 3 to 4 hours.
A heavy meal is entirely expelled into duodenum in 4 to 6
hours.
b. Kind of Meal — Liquid move more rapidly than semi-solid and
the latter more rapidly than solids.
Personal Variation — Psychogenic can prevent
departure of the meal from a stomach for several hours, contra-
riwise, a stomach may enhance entry of food into
the duodenum.
d. Other Factors:
Kinds of Food Eaten — Vegetables may require more time
for gastric digestion. The less fragmentation of the food
will require more time to stay in the stomach. The ab-
sence or insufficiency of pepsin and other digestive fer-
ments will delay the food in the stomach. Absence or
insufficiency of the gastric hydrochloric acid content
and lesser amount of liquid consumed with solid food
will likewise delay gastric evacuation.
The head of the meal ordinarily reaches the distal ileum and
cecum between 6 and hours after eating.
The conclusion may be of value in the estimation of death if
one is familiar with the decedent's eating habit and meal time,
quantity of the last meal and the interval between the last two
meals.
 MEDICO-LEGAL ASPECTS OF DEATH

7. of Live Fleas in the Clothings in Drowning Cases:

A can survive for approximately 24 hours submerged in
water. It can no longer be revived if submerged more than that
period. In temperate countries, people use to wear woolen
clothes. If the body is found in water, the fleas may be found
in the woolen clothings. The fleas recovered must be placed in
a watch glass and observed if it is still living. If the fleas still
could move, then the body has been in water for a period less
than 24 hours. Revival of the life of the fleas is not possible if
they are in water for more than 24 hours.
8. Amount of Urine in the Bladder:
The amount of urine in the urinary bladder may indicate the
time of death when taken into consideration, he was last seen
voiding his urine. There are several factors which may modify
urination so it must be utilized with caution.
9. State of the Clothings:
A circumstantial proof of the time of death is the apparel
of the deceased. If the victim is wearing street clothes, there
is more that death took place at daytime, but if in
night gown or it is more probable that death occurred
at night time.
10. Chemical in the Cerebrospinal Fluid Hours Fol-
lowing Death):
a. Lactic acid increases from 15 mg. to 200 mg. per 100 cc.
b. nitrogen increases from to 40 mg.
concentration rises from 1 to 12% following death.
Clotting and of Blood:
Blood clots inside the blood vessels in 6 to 8 hours after death.
Decoagulation of blood occurs at the early stage of decom-
position. The presence of any of these conditions may
the approximate duration of death.
12. or Absence of Soft in Skeletal Remains:
Under ordinary condition, the soft tissues of the body may
disappear 1 to 2 years time after burial. The disappearance of
the soft tissues varies and are influenced by several factors.
When the body is found on the surface of the ground, aside
from the natural forces of nature responsible for the destruction
of the soft tissues, external elements and animals may accelerate
its destruction.
Condition of the Bones:
If all of the soft tissues have already disappeared from the
remains, the degree of erosion of the epiphyseal ends of
154 LEGAL MEDICINE

long bones, pulverization of flat bones and the diminution of

weight due to the loss of animal matter may be the basis of the

Simulating Disease, Poisoning or

a. Post-mortem hypostasis simulating contusion or inflammation
or poisoning.
b. Blister of the cuticle simulating scalds or burns.
Swelling, detachment or splitting of the skin simulating
injury.

E. PRESUMPTION OF DEATH
Rule 131, Sec. 5(x), Rules of Court:
Disputable
That a person not heard from for seven years, is dead.
Presumption of Death:
Art. 390, Code and Sec. 5(x), Rule 131, Rules of Court:
After an absence of seven years, it being unknown whether or
the absentee still lives, he shall be presumed dead for all purposes,
except for those of succession.
The absentee shall not be presumed dead for the purpose of
opening his succession till after an absence of ten years. If he dis-
appeared after the age of seventy-five years, an absence of five years
shall be sufficient in order that his succession may be
Art. 391, Civil Code and Sec. 5(x), Rule 131, Rules of Court:
The following shall be presumed dead for all purposes, including
the division of the estate among the heirs:
A person on board a vessel lost during a sea voyage, or an
aeroplane which is missing, who has not been heard of for
four years since the loss of the vessel or aeroplane.
(2) A person in the armed forces who has taken part in war, and
has been missing for four
(3) A person who has been in danger of death under other circum-
stances and his existence has not been known for four years.
Art. 392, Civil Code:
If the absentee appears, or without appearing his existence is
proved, he shall recover his property in the condition in which it
may be found, and the price of any property that may have been
alienated or the property acquired therewith; but he cannot claim
either fruits or
 ASPECTS OF DEATH

F. PRESUMPTION OF SURVIVORSHIP
Sec. 5(jj), Rule 131, Rules of Court:
When two persons perish in the same calamity, such as wreck,
battle, or conflagration, and it is not shown who died first, there
are no particular circumstances from which it can be inferred, the
survivorship is presumed from the probabilities resulting from the
strength and age of the sexes, according to the following:
1. If both were under the age of fifteen years, the older is pre-
sumed to have
2. If both were above the age of sixty, the younger is presumed
to have
3. If one is under fifteen and the other above sixty, the former
is presumed to have
4. If both be over fifteen and under sixty, and the sexes be dif-
ferent, the male is presumed to have survived; if the sexes be the
same, then the older;
5. If one be under fifteen or over sixty, and the other between
those ages, the latter is presumed to have survived.
Art. 43, Civil
If there is a doubt, as between two or more persons who are called
to succeed each other, as to which of them died first, whoever
alleges the death of one prior to the other, shall prove the same; in
the absence of proof, it is presumed that they died at the same time
and there shall be no transmission of rights from one to the other.