Death Project

DEATH Death: - Defined as cessation of life ie total stoppage of blood circulation and a cessation of coordinated functions of the organism as a whole. - Permanent stoppage of cardio pulmonary (f) s or cerebral death (stedmaus) - A human body with irreversible cessation of total brain (f), according to usual and customary standards of medical practice, shall be considered dead (Am. Bar Association) Death occurs when the soul leaves the body. Death on neurological grounds first criteria DeathTwo types of death: 2 Somatic death: • The person irreversibly loses it’s sentient personality • Unable to be aware of (or to communicate with) it’s environment • Unable to appreciate any sensory stimuli • Unable to initiate any voluntary movement b) Cellular death: • State in which the tissues and their constituent cells are dead • They no longer (i)/have metabolic activity • It follows ischaemia and anoxia upon cardiorespiratory failure • Is a process, not an event. • Different tissues die at different rates, cerebral cortex muscle connechive tissues. DEATH ON NEUROLOGICAL GROUNDS – FIRST CRITERIA The first criteria was

put forward in early 1966 at CIBA symposium in London. These criteria were used to diagnose brain 1. Complete bilateral mydriasis 2. Complete absence of reflexes; natural and to pain 3. Complete absence of spontaneous respiration five minutes after respirator taken off. 4. Falling BP requiring increasing amounts of vasopressor drug. Flat EEG. Based on these criteria the first heart transplant was performed in October 1967. HARVARD CRITERIA OF BRAIN DEATH (1968) 1. Unreceptivity and unresponsivity. 2. No movements (observe for 1 hour). 3. Apnoea (3 minutes off ventilator). 4. No reflexes - fixed dilated pupils - No brainstem reflexes - No spinal reflexes 5. Flat EEG (of great confirmatory value) at 5 uv/mm 6. No change after 24 hours MINNESOTA CRITERIA OF BRAIN DEATH 1. No spontaneous movement. 2. Apnoea (4 minutes off ventilator). 3. No brainstem reflexes: Dilated fixed pupils, corneal, Ciliospinal, Dolls, eye, gag, caloric, tonic neck reflex. 4. Status unchanged after 12 hours. 5. Irreparable brain damage. UNITED KINGDOM CRITERIA OF BRAIN DEATH (1976) 1. Conditions: Deep coma, drugs metabolic and endocrine causes, hypothermia excluded. Apnoea. Irremediable structural brain damage. 2. Testes: Absent brain stem reflexes, fixed pupils, corneal, caloric test, gag, apnoea test. 3. Other considerations: Repeat examination depends on injury. EEG not necessary. Spinal reflexes irrelevant. The Faculties produced another memorandum in 1979 stressing the point that identification of brain death meant

death irrespective of heart beat. All appropriate diagnostic and therapeutic procedures done. Drugs, hypothermia and remedial lesions excluded.Criteria: (Present for 30 minutes, at least 6 hours after onset of coma and apnoea).Coma with cerebral unresponsivity,Apnoea,Dilated pupils,Absent cephalic reflexes,Electrocerebral silence.Confirmatory TestAbsence of cerebral blood flow. PRESIDENTS COMMISSION 1981In July 1981, the Presidents Commission for the Study of Ethical Problems inMedicine and Biomedical and Behavioural Research proposed a new definition ofdeath. it was called the Uniform Detemination of Death Act and was endorsed bythe American Medical Association, American Bar Association, the NationalConference of Commissioners on Uniform State Laws, the American Academy of Neurology and the American EEG Society (22).It stated: An individual who has sustained either, 1. Irreversible cessation of circulatory and respiratory functions or 2. Irreversible cessation of all function of the entire brain including the brain stem is dead.Absent cerebral function;Deep coma unreceptive and unresponsive. Absent brain stem function;Pupils, corneal, oculocephalic, vestibular, oropharyngeal reflexes and apnoe.Reversible causes excluded.No change with repeat test. JAPANESE CRITERIA OF BRAIN DEATH 1985 Prerequisite : Irreparable brain lesion detected by CT scan.Exclusion : 5 6. Children under 6. Hypothermia. Drug intoxication. Endocrine and metabolic disorders.Criteria : Deep coma (Glasgow scale 3) Apnoea, confirmed by apnoea test. Fixed pupils larger than 4 mm. Absent corneal, ciliospinal, oculocephalic, vestibular, pharyngeal and cough reflexes.Iselectric EEG: Observation : At least 6 hours. CONFIRMATORY TESTS : BRAIN DEATH1. EEG2. Blood flow study : Conventional angiongram. Isotope. DSA Doppler3. Evoked potential : Brain stem Somatosensory4. Imaging CT Scan MRI scan RECOMMENDATIONS: 1. That the concept and entity of brain death be recognized and accepted; and that brain death means death. 2. 2 The diagnosis of brain death is a clinical one and no confirmatory test is necessary. The exception to this is only for children because of the greater ability of children’s brain to withstand damage. 3. specialists who are experienced in diagnosing brain death are qualified to certify. 4. 4 Doctors involved in organ transplantation are not allowed to certify brain death. Hospitals where brain death are certified shall have a committee that functions as coordinating body responsible for general policies, to train and accredit staff, counseling and oversee facilities. 5. To brain death guidelines should be reviewed every 5-10 years to accommodate new knowledge and contemporary practice. CHANGES AFTER DEATH forensic importance: in relation to the estimation of p.m interval : possible interference with the body : indication as to the COD1 ) COOLING OF THE BODY (Penurunan suhu tubuh) reliable up to 24 hrs after death time of death not time of injury rectal temp. to be taken ASAP when body is foundvariables to be considered : - initial body T - ambient T - activity prior to death - death in sleep - infection - asphyxial deaths - pontine haemorrhage - fat + air embolism - aspirin poisoning - hypothermiarate of body cooling affected by:*ventilation (air movement + humidity) *heavy bed clothes + clothings *infants + elderly (S/A): body dimension *body posture *immersion deaths *gen. body built (body fat) *infestation with maggots 7

8. -The Newton’s Law of Cooling (the rate of cooling is proportional to the differencein T between the body surface + its surrounding) did not apply to the human body-Marshall confirmed the ‘double exponential’ or ‘sigmoid’ shape of the rectalcooling curve-the rate is variable depending on above factors-a chemical thermometer is used to measure rectal T (precaution in possiblesexual interference)-The use of Henssge’s nomogram for estimating time since death using a singlerectal T-The use of Al Alousi cooling curves for estimation of PMI2) HYPOSTASIS (Lebam mayat) - AKA p.m lividity, staining, suggilation -when circulation ceases, gravity acts on stagnant blood, pulling to lowestaccesible areas, rbc initially (gives bluish red colour of hypostasis), then plasma(dependent oedema contributing to blisters)-initially blotchy, then confluent over dependent areas-obvious within 1/2 hrs, marked about 6 hrs, fixed within 4-12 hrs-pattern depends on posture of body after death-most commonly over the back except over P areas (skin remains white as vasc.channels are compressed over these areas)-in hanging, hypostasis most marked distally (eg. below waist + elbows)local P can exclude hypostasis + produce distinct pattern eg; irregular linearmarks by folds of bed linen, pattern of fabric from coarse cloth, tight belts,brassiere straps, elastic waist bands, socks, skin folds in the neck of the obese-important in determining position of body after death-of limited value in estimating time since death-in gen; it becomes more pronounced as PMI lengthens-elderlies, infants, anaemia + haemorrhage causes slight staining / none at all-colour may signify underlying problems: depends on state of oxygenation atdeath, presence of reduced Hb results in darker tint(eg; congestive, hypoxic deaths)examples : cherry pink in CO poisoning (OxyHb), drowning (nb; refrigeratedbodies) : brownish red in methHbaemia (cyanide poisoning) : pale bronze mottling in septic abortions (Cl.perfringens) : rain drops punctate pigmentation in arsenic poisoning- colour of hypostasis varies even from different areas of the same body!Timing + permanence of hypostasis: 8 9. If body is moved into a different posture, the primary hypostasis may either:a) remain fixedb) may move completely to the new dependent zones/c) may be partly fixed + partly relocated- controversy about its ability to undergo subsequent gravitational shift whenhypostasis is already establishedHypostasis in other organs:-hypostasis in the intestines may mislead to mesenteric infarction / strangulation- hypostasis at the back of lungs-within posterior wall of LV (early MI)-Prinsloo + Gordon artefact: haem. post. to oesophagus may mislead to dx ofstrangulationHypostasis VS Bruising:-regular diffuse engorgement of surface vessels in dependent areas of the bodywith horizontal margin vs localised/ circumscribed areas in bruising-fresh bruise may be swollen, raised over surface, a/w abrasions-hypostasis in most superficial layer, bruise is deeper + fixed- to incise the suspect area (whether intravascular/ infiltrating tissues outsidevessels)-problem arise when decomposition sets in3) RIGOR MORTIS (Kaku mayat)-dt ATP breakdown + accumulation of lactate + PO4 in Ms resulting in stiffening +M shortening-ATP is converted to ADP, PO4 is used in phosphorylation reaction, convertingglycogen to lactate (release E)-RM is initiated when ATP conc. falls to 85% of normal + rigidity of M is at itsmax. when it declines to 15%-has some use in determing time since death-first apparent in small muscle groups as smaller joints are more easilyimmobilised-in gen. starting with the jaw, facial Ms + neck, then wrists, ankles, knees, elbows+ hips-within 6 hrs: RM developing- from 6-12 hours: RM at its peak + remains constant up to18 hours-18-36 hours: RM begins to fadeOnset of RM may be accelerated / retarded by many factors;a) feverb) physical activity (exercise) shortly before death (as in assault)c) environmental T, (freezing envir. suspends formation of RM)d) electrocution (Krompecher + Bergerioux)-infants, cachexic + elderlies may never

develop RMIn an average temperate condition, the following may be used as arough guide : 9 10. * if the body feels warm + flaccid, its been dead less than 3 hours*if the body feels warm + stiff, its been dead from 3-8 hours*if the body feels cold + stiff, its been dead from 8-36 hours*if the body feels cold + flaccid, its been dead for more than 36 hoursRigor mortis in other organs ;-iris: modifying pupil constriction/ dilatation p.m-ventricles: simulating LVH-dartos muscles: results in extrusion of semen from urethral meatus-in erector pili muscles: beard growing p.m!Heat + cold stiffening:-the ‘pugilistic attitude’ + opistothonus of a burnt body (flexors have greater Mmass as compared to extensors)-below -5 ° C stifffening occurs in addition to solidification of subcutaneous fat- true RM may supervene as body is warmed up4) POST MORTEM DECOMPOSITION (Perubahan lanjut)- a mixed process ranging from autolysis of indiv. cells by intern. chemicalbreakdown to tissue autolysis from liberated enzymes, + from external processesintroduced by bacteria + fungi from intestines + envir.- it varies from body- body, envir. - envir., even one part of the body to anotherdivided into subclasses: putrefaction, mummification, adipocere formation,maceration-rate of decomposition depending on variables : climate (tropical vstemperate regions) : environmental T (moisture) : clothing : COD : immersion : earth burial 10 11. - estimation of the TOD in a decomposed body is extremely difficult4a) PUTREFACTION (Pembusukan mayat)-initially there is discoloration of the abdomen (RIF) where bacteria laden caecumis (36-48 hrs)-marbling (bacterial colonisation of venous system, haemolysis of blood, stainingof the vessel walls) on thigh, sides of the abdomen, chest + shoulders- skin slippage + blister formation (clear, pink, red serous fluid) which leaves,slimy pink epidermis when burst, tattooes made more visible-Gen. gas formation in abdomen, genitalia, neck + face (protrusion of eyeballs,tongue etc) making identification difficult/ impossible-purging of bloody fluids from the orifices-may be heavily blood stained-different rates of decomposition of intern. organs (intestines, pancreas, spleenvs prostate + uterus)- coronaries with atheromatous change may be preserved in decomposed bodiesP.m predators and infestation by maggots (entomology studies)-complex life cycles of the insects may be used to determine at least the min.time since death by studying the stage of maturationthis is modified by a no. of factors including climatic + geographic-used since 18th century (Megnin’s Faune des Cadavres)-information to be made to entomologist include the nature of environment wherebody was found, the weather especially ambient T of the area during which thebody was discovered, (as maturation of insects are markedly altered by climaticconditions)-the Diptera (including bluebottles, greenbottles + common houseflies) arecommon insects found on relatively fresh bodies-the bluebottle (Calliphora viccinia) is the most frequent invader of dead flesh +lay eggs only in daylight, they also lay eggs on the living, esp. in debilitated/wounded victims-the complete cycle lasts about 1824 days from egg to adults-conversely the common housefly (Musca domestica) prefers to lay eggs onalready decomposed flesh, although it is more attracted to garbage + manuresthan to cadavers- whole cycle lasts about 14 days (from egg to adults) emphasizing thatvariations in the ambient T. make considerable differences in the rate ofmaturation-materials to be collected include maggots, adults, pupae and empty pupaecases (live and fixed)-expert knowledge + strict identification of the species is needed before definiteopinions upon min. times since death are offered.-immersion slows decomposition (lower ambient temp., protected from insect +small animal predators) 11

12. -decomposition in interred bodies is delayed due to lower T, protection frompredators + lacks oxygen.-topography of the burial site vs type of soil-deep burial preserves corpse better than shallow/ clandestine burial as it iscolder, excludes air better, + not directly affected by rain-the make of the coffin preserves the body, hence allowing exhumation severalyears later4b) ADIPOCERE FORMATION (Adiposer)- p.m conversion of body fat-partial/ irregular/ may be generalised-esp. over the face (cheeks + orbits), breasts, abdominal walls + buttocks-dt hydrolysis + hydrogenisation of adipose tissue, leading to formation of waxy,greasy substance (when recent) or brittle chalky material (months + years)composed of palmitic, oleic, stearic acids together with glycerol- colours from off-white, to pinkish, grey/ greenish grey dt staining with productsof decomposition-smell of earthy, cheesy + ammoniacal-favourable conditions include moisture + warmth-anaerobes such as Cl. perfringens produce lecithinase, facilitateshydrogenisation + hydrolysis-medicolegal significance ; it allows the form of the body, facial features(used in identification), even injuries such as bullet holes to be retained inrecognisable forms-adipocere formation is grossly visible as early as 3 weeks with 3 months as thetypical period4c) MUMMIFICATION (Mumifikasi)- like other modes of decomposition, it can be partial/ generalised + can co-existwith them in different areas of the same bodycan only occur in dry environment, usually, but not exclusively also a warmplace with moving air current-can occur in freezing conditions, partly due to dryness of the air which inhibitsbacterial growth-commonly occur in hot, desert zones-there is desiccation, brittleness of the skin, which is stretched tightly across bodyprominences such as cheekbones, costal margins + hips-skin is discoloured (brown), becomes leathery with secondary colonisation bymolds may add patches of white, green/black (adding to p.m artefact)-skin, underlying tissues + internal organs becomes hardened, body is preserved 12 13. thus allowing possible identification in concealed homicides, mummified fetuses /newborns + major injuries to be preserved 5. STOMACH EMPTYING AS A MEASURE OF TIME SINCE DEATH (Kandungan gaster)-this method is too uncertain to have much validity-the effect of a physical/mental shock/stress during the digestion process whichcan completely inhibit digestion, gastric motility + pyloric openingThe following frustrates the use of gastric emptying as a measure oftime since death;a) digestion may continue some time after deathb) the physical nature of the meal has profound effect on emptying time i.e solidvs liquidc) the nature of the food i.e fatty food + strong alcohol causes delay in gastricemptyingd) systemic shock/stress can slow / stop gastric motility + digestive juicesecretion as well as holding the pylorus firmly closed* what is valid is the nature of the last meal which is useful in establishing theTOD 6. THE USE OF VITREOUS HUMOUR CHEMISTRY IN TIMINGDEATH-most useful chemical estimation performed on vitreous fluid for PMI interval is K-serum K rises rapidly after death, impossible to evaluate the status ofpremortem K levelin contrast to serum + csf, vitreous K levels rise linearly following death-external factors that influence the validity of the test; sampling T analytical instrumentation body T-the ambient T during PMI is probably the predominant factor in determining thedegree of slope at which the vitreous K conc. increases during the p.m interval-The K conc. from either eye differ by a considerable amount-forcible aspiration from too near the retina, cellular fragments will distort thevalues because the K reaches the vitreous by leaching out from the retina-K higher in persons dying of chronic illness with nitrogen retention (due to premortal electrolyte disturbances in patients with metabolic disorders-the rise in infants is much faster Sturners equation

VIOLENT DEATH FROM DIFFERENT FORMS OF APNCEA (ASPHYXIA). This includes death from Suffocation, Strangulation, Hanging and Drowning, in all of which life is destroyed chiefly,if not exclusively,by apncea or asphyxia. All these modes of violent death possess certain points in common, while, at the same time, each of them is distinguished by individual peculiarities, which render a separate consideration desirable. Their common properties will be first briefly considered. In all cases of apncea, it will be remembered that death begins in the lungs, and that this is brought about simply by excluding the air (oxygen) from these organs. This is accomplished by numerous and diverse means : as by mechanical pressure upon the throat or thorax, as in throttling; by a ligature around the throat, as in hanging and strangling; by the flow of water into the windpipe, as in drowning; by foreign bodies getting into the larynx and trachea, as in choking; by being shut up in a box (entombed alive), or buried under ruins, or a sand bank, or snow drift ; or by some disease of the throat, as oedema of the glottis,membranous croup, etc.;" all of which produce death simply by arresting the function of respiration.Likewise, there are exhibited certain signs or phenomena, both before and after death, which indicate death by apncea. These are lividity of the lips,fingers,and other etixetrs,emiand generally of the whole face, together with a swollen appearance of the countenance ; convulsive movements of the arms and legs,at first partly voluntary, but soon becoming spasmodic and involuntary, as seen in the struggles to breathe ; the veins become turgid ; the pulse,at first full and rapid, soon becomes feeble ; there is often frothingat the mouth, which may, at times, be tinged with blood ; there is frequently turgescence of the genital organs, with involuntary discharge of semen, urine and faeces. Abortive attempts at respiration are made for awhile, but finally these cease, and the heart at last ceases to pulsate. Consciousness is lost very early, although in the earliest stage there is a remarkable activity of the senses ; the memory is surprisingly acute, so that the events of a ltifmeseem to be crowded into a moment. But this stage only lasts for a very brief space of time ; such is the mteonstyi of persons who have been rescued from drowning, or who have been cut down from hanging, and of those who have experimented upon themselves by partial strangulation. This kind of death is rapid,not requiring more than three to five minutes, though there are some apparent exceptions in the case of drowning. These will be referred to ahefrte-r. The post-mortem appearances in all these varieties of death by apncea are, in the main, very similar. These are lividity of the lips,fingersand other parts of the body, as seen before death ; in drowning, the face is apt to be pale ;sometimes, likewise, in /tanging. The venous system is egeranlly full of blood. The right side of the heart, together with the lungs, is usually gorged with dark blood; the mucous membrane of the bronchial tubes deeply congested.In young persons, the blood vessels of the lungs will often be found empty, and the lungs emphysematous, from the violent efforts made to respire. Minute extravasations of blood (ecchymoses) are found in the mucous and serous

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DEATH & ITS MEDICO-LEGAL IMPORTANCE INTRODUCTION Definition Types (iii) Changes after death (iv) Time since death (v) Duties of a doctor

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DEFINITION According to The Registration of Births and Deaths Action, Section 2 (b), I.P.C death is defined as the permanent disappearance of all evidence of life at any time after live birth has taken place. TYPES Somatic/ Systemic/ Clinical Cellular/ Molecular Somatic/ Systemic/ Clinical Death (i) The complete and irreversible stoppage of the circulation, respiration and brain functions (Bishop’s tripod of life) (ii) Heart lung bypass machines, mechanical respirators and other devices have changed this medically in favour of a new concept called “brain death” i.e. irreversible loss of cerebral function. Cellular/ Molecular Death (i) The death of cells and tissues individually after the stoppage of vital functions. (ii) Nervous system dies rapidly, Vital centres of the brain in about 5 minutes and the Muscles in about 1-2 hours depending on the residual oxygen. (iii) Accompanied by cooling of body, changes in the eyes, muscles etc. CHANGES AFTER DEATH Early (Somatic Death) Insensibility and loss of voluntary power (Loss of EEG Rhythm) Cessation of respiration Cessation of circulation (Loss of ECG Rhythm) Early (Cellular death) Cooling of body (Algor mortis) Changes in the eye (iii) Changes in the skin (iv) Post-mortem lividity/ hypostasis (Livor mortis) (v) Changes in the muscles Primary flaccidity of muscles Rigor mortis/ Cadaveric rigidity (c) Secondary relaxation Late (Decomposition and decay) Putrefaction Adipocere formation Mummification COOLING OF BODY (ALGOR MORTIS (i) Cooling occurs at a rate of 2-2.5°F per hour in first hour, 1.5-2°F for first 12 hours and then by 1° for next 12-18 hours (ii) Body cools by: Radiation (transfer of heat to the surrounding air by infrared rays) Convection (transfer of heat through moving air currents) Conduction (transfer of heat by direct contact with another object) SIGNIFICANCE OF ALGOR MORTIS (i) Usually assumed that the body temperature at the time of death is normal, but in individual cases it may be subnormal or markedly raised. (ii) Sub-normal temperature: Hypothermia, Congestive cardiac failure, Massive hemorrhage, and Shock. (iii) Raised temperature: Heat stroke, Acute bacterial and viral infections, and Hemorrhage, Tetanus and Strychnine poisoning (iv) Estimation of time since death CHANGES IN THE EYE / OCULAR CHANGES (i) Corneal film- Loss of corneal and light reflexes (ii) Scleral discoloration (Taches noires) (iii) Corneal cloudiness (iv) Corneal opacity (v) Endophthalmos (Flaccidity of eyeballs) (vi) PupilsInitially dilated, Later constricted (vii) Retinal vessels- Fragmentation or segmentation of blood columns CHANGES IN THE SKIN Pallor Loss of elasticity POST-MORTEM LIVIDITY/ HYPOSTASIS (LIVOR MORTIS) (i) Occurs when the circulation stops. Gravity acts on the stagnant blood and pulls it to the lowest part of the body (ii) Visible 30-60 minutes after death (iii) RBCs settle and skin below turns red (iv) In 6-10 hours, color becomes permanent (v) Advanced stages- Skin capillaries burst Hemorrhage Petechial hemorrhages/ Tardieu Spots (Purple spots on skin) SIGNIFICANCE OF LIVOR MORTIS Reliable sign of death Position of the body at the time of death and if it has been altered Estimation of time since death Colour may suggest the cause of death Distribution suggests circumstances at time of death CHANGES IN MUSCLES (a) PRIMARY FLACCIDITY: - Relaxation of all the muscles of the body- Lower jaw falls, eyelids loose tension, joints become flexible. Contact flattening: Body flattens over areas which are in contact with surface on which it rests - Muscles are relaxed as long as ATP content remains sufficiently high to permit the splitting of actin-myosin cross bridges CHANGES IN MUSCLES (b) RIGOR MORTIS/ CADAVERIC RIGIDITY: - The gradual onset of stiffening of muscles without shortening - Appears 2-4 hours a after death and is completed by 6-12 hours - First appears in involuntary muscles and then in voluntary muscles

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MECHANISM OF RIGOR MORTIS C6H12O6 + 6O2 6H2O + 6CO2 + 36 ATP Muscles need ATP for actin and myosin to interact After death- Body uses ATP, but stops making it Due to deficiency of ATP, conversion of glycogen into lactic acid occurs. Excess of lactic acid causes cross-linking of actin and myosin, resulting in rigor mortis FACTORS AFFECTING ONSET AND DURATION OF RIGOR MORTIS Age Nature of death Muscular state Atmospheric conditions CONDITIONS SIMULATING RIGOR MORTIS Heat Stiffening Cold Stiffening Cadaveric spasm SIGNIFICANCE OF RIGOR MORTIS Sign of death Estimation of time since death Position of body at time of death PUTREFACTION Decomposition of the body from organic to inorganic state, resulting in accumulation of putrefactive gases in the tissues, which causes false rigidity Brought about by 2 processes: (a) Autolysis (b) Bacterial action SEQUENCE OF PUTREFACTION Colour changes Development of foul smelling gases Pressure effects of putrefactive gases Appearance of maggots Other sequelae ADIPOCERE FORMATION/ SAPONIFICATION Transformation of unsaturated liquid fats to a yellowish-white, greasy, wax-like substance (saturated solid fats), with a sweetish rancid odor due to hydrogenation and hydrolysis of fats A moist, anaerobic environment is required for the formation of adipocere SIGNIFICANCE OF ADIPOCERE Establishment of identity of a person Cause of death Estimation of time since death Place of death MUMMIFICATION (i) Modification of putrefaction characterized by the dehydration or desiccation of the tissues. (ii) The body shrivels and is converted into a leathery or parchment-like mass of skin and tendons surrounding the bone. (iii) Particularly seen in the groins, around the neck, and the armpits SIGNIFICANCE OF MUMMIFICATION Establishment of identity of a person Cause of death Estimation of time since death Place of death ESTIMATION OF TIME SINCE DEATH Glaister equation states that the approximate time since death can be calculated by: 98.4% - Measured rectal temperature 1.5 ALGOR MORTIS OCULAR CHANGES LIVOR MORTIS (i) First apparent about 20-30 minutes after death (ii) Fixed after about 10-12 hours (iii) Repositioning the body, e.g. from the prone to the supine position, will result in a dual pattern of lividity since the primary distribution will not fade completely RIGOR MORTIS RIGOR MORTIS If the body feels warm and flaccid, the body has been dead less than 3 hours If the body feels warm and stiff it has been dead 3-8 hours If the body feels cold and stiff, it has been dead 8-36 hours If the body feels cold and flaccid it has been dead for more than 36 hours LATE CHANGES Time required for Saponification and Mummification varies greatly. Complete by 12 months DUTIES OF A DOCTOR Doctor must issue death certificate if death is due to any natural cause, stating the exact cause of death Doctor must not charge fees for issuing a death certificate Doctor should avoid technical terms. Rather he/ she should state his opinion briefly and clearly DUTIES OF A DOCTOR (iv) If death is due to any unnatural cause, the doctor must not issue a death certificate but report this to the police (v) In order to avoid issuing a certificate in death from any unnatural cause, the doctor should thoroughly inspect the body for all signs of death

Four Categories of Death These four categories of death are: Natural Causes: Quite simply when the body ceases to function of its own accord or if there are mitigating medical factors such as terminal illness, heart

disease or the like, which would bring about death - this is generally referred to as death by natural causes. Homicide: The taking of one human life by another human being by means of pre-meditated murder. The term pre-meditated means to have purposely planned and executed the murder of another human being in cold blood whilst trying to elude capture by the authorities. Accidental Death: As the term would suggest the death of an individual by means other than natural death, murder or suicide. Accidental death can sometimes be manslaughter - murder but committed out of an involuntary act of violence towards another. Likewise accidental death can also be categorised as death by misadventure. This means that the victim has died by accident either whilst doing something they should not have been doing or by taking risks that would put them in mortal danger. A lot of extreme sports participants have died and their deaths have been classified as death by misadventure because of the extreme nature of their pastimes. Suicide: The deliberate taking of one's own life due to extreme emotional distress often brought about by severe depression. Suicide is neither accidental nor is it classified as death by misadventure simply because the individual has set about on a course of action that would end with their own inevitable death. Normally this would occur by means of drug overdose, the cutting of one's wrists to induce uncontrollable bleeding, or indeed stepping out in front of a moving vehicle. Why Categorise Death? These four reasons for death are often called upon as a means test for a pathologist when he or she is required to determine how a person died. They will look at the evidence both physical and trace to try and determine which category best fits the manner in which the deceased passed away. Of course if there are visible wounds such as a gunshot wound or a knife wound then the most likely cause of death would be attributed to Homicide - or Murder. It could be possible however that accidental death is the most likely explanation as many people have died from firearms related wounds whilst cleaning or maintaining them. For the most part the pathologist will concern themselves with how the victim died and will use this as a means upon which to base their final findings. Throughout all of these types of death an autopsy will have to be performed in order to provide concrete proof that the pathologist - and indeed the police officers involved with investigating the death - is correct in their assumptions.