Post mortem changes notes by dr. armaan singh

1. POST MORTEM CHANGESPOST MORTEM CHANGES
Notes By- Dr. Armaan SinghNotes By- Dr. Armaan Singh
Signs of DeathSigns of Death
AndAnd
Postmortem changes after deathPostmortem changes after death
 Immediate ChangesImmediate Changes
 Early ChangesEarly Changes
 Late ChangesLate Changes

2. Immediate changesImmediate changes
• Permanent Cessation of Brain functionPermanent Cessation of Brain function
• Complete Cessation of Circulatory functionComplete Cessation of Circulatory function
• Entire and permanent cessation of RespiratoryEntire and permanent cessation of Respiratory
functionfunction

3. Permanent Cessation of Brain function:Permanent Cessation of Brain function:
• Loss of Sensations; viz,Loss of Sensations; viz,
touch, pain and temperaturetouch, pain and temperature
• Loss of reflexesLoss of reflexes
• Total loss of E.E.G. RhythemTotal loss of E.E.G. Rhythem
• Confirmation of Brain- stem deathConfirmation of Brain- stem death

4. Brain –stem death:Brain –stem death:
• The patient must be comatose state at least sixThe patient must be comatose state at least six
hours.hours.
• No Abnormal Decorticate or decerebrateNo Abnormal Decorticate or decerebrate
postures should be presentpostures should be present
• All brain-stem reflexes must be absentAll brain-stem reflexes must be absent..

5. • Pupils should be fixedPupils should be fixed
• No Corneal reflexNo Corneal reflex
• Absent of the oculo-cepralic reflexAbsent of the oculo-cepralic reflex
• Absent vestibulo-ocular reflexesAbsent vestibulo-ocular reflexes
• No Motor responsesNo Motor responses
• No Gag reflexNo Gag reflex
• No Respiratory movementsNo Respiratory movements
After disconnection of ventilator.After disconnection of ventilator.

6. Complete Cessation of Circulatory FunctionComplete Cessation of Circulatory Function
• Magnus’s testMagnus’s test
• Finger nail testFinger nail test
• Diaphanous testDiaphanous test
• Icard’s Fluorescein testIcard’s Fluorescein test
• Heat testHeat test
• Artery incision testArtery incision test
• A flat E.C.G. for a continuous period of fiveA flat E.C.G. for a continuous period of five
minutesminutes

7. Entire and permanent cessation of respiratoryEntire and permanent cessation of respiratory
functionfunction
• Mirror testMirror test
• Feather testFeather test
• Winslow’s glass water test.Winslow’s glass water test.

8. Suspended AnimationSuspended Animation
It is a condition in which the vital functions of the bodyIt is a condition in which the vital functions of the body
are at such a low level that they cannot be appreciatedare at such a low level that they cannot be appreciated
by clinical examinationby clinical examination
Apparent deathApparent death
This may last few seconds to minutes.This may last few seconds to minutes.
Voluntary- by yogisVoluntary- by yogis
Involuntary – drowning, electrocution, heat stroke,Involuntary – drowning, electrocution, heat stroke,
typhoid fever etc.typhoid fever etc.

9. Early ChangesEarly Changes
• Changes in the eyeChanges in the eye
• Changes in the skinChanges in the skin
• Cooling of the body/Algor mortisCooling of the body/Algor mortis
• Post mortem lividity/HypostasisPost mortem lividity/Hypostasis
• Rigor mortis/Cadaveric rigidityRigor mortis/Cadaveric rigidity

10. Changes in the eyeChanges in the eye

Corneal Changes;Corneal Changes;
• Loss of Clear GlisteningLoss of Clear Glistening
• Dry, Cloudy and opaqueDry, Cloudy and opaque
• Loss of reflexesLoss of reflexes
• Light reflex abolishedLight reflex abolished
• Intra Ocular tension falls, eye balls become flaccidIntra Ocular tension falls, eye balls become flaccid
and sink in the orbitand sink in the orbit
• Blood flow in the retina becomes dotted andBlood flow in the retina becomes dotted and
segmented looksegmented look..

11. • Optic disc looks pale.Optic disc looks pale.
• Pupils fully dilated in the early stage and constictPupils fully dilated in the early stage and constict
later due rigor mortis.later due rigor mortis.
• Brownish discolouration of the sclera due to cellularBrownish discolouration of the sclera due to cellular
debris and dustdebris and dust
Taches NoiresTaches Noires

12. Changes in the SkinChanges in the Skin
• Loss of its translucencyLoss of its translucency
• Pale and Ashy white appearancePale and Ashy white appearance
• Loss of ElasticityLoss of Elasticity
• Wounds will not gape if it is inflicted afterWounds will not gape if it is inflicted after
deathdeath
• Wounds caused during life will retain theirWounds caused during life will retain their
characteristic features.characteristic features.

13. Cooling of the bodyCooling of the body
• Imbalance between heat production and heatImbalance between heat production and heat
loss.loss.
• Loss of heat of body by means of conductionLoss of heat of body by means of conduction
convection and radiation, till it balances withconvection and radiation, till it balances with
the temperature of surroundings.the temperature of surroundings.
• Rate of cooling is fast during first few hoursRate of cooling is fast during first few hours
and later slows.and later slows.

14. • Temperature is recorded by ChemicalTemperature is recorded by Chemical
thermometer- Thanotometer 25 cms.thermometer- Thanotometer 25 cms.
• Recording of temperature :Recording of temperature :
Normal temp. – Rectal temp.Normal temp. – Rectal temp.
Rate of temp. fall/hourRate of temp. fall/hour
• Variation of body temperatureVariation of body temperature
• Conditions in which heat may be retained orConditions in which heat may be retained or
increased.increased.

15. - Sun stroke and pontine haemorrhage, disturbedSun stroke and pontine haemorrhage, disturbed
heat regulating mechanism.heat regulating mechanism.
- Tetanus and strychnine poisoning, due toTetanus and strychnine poisoning, due to
increase in heat production in the muscle.increase in heat production in the muscle.
- Acute bacterial or viral infection, lobarAcute bacterial or viral infection, lobar
pneumonia, typhoid fever, encephalitis, etc.pneumonia, typhoid fever, encephalitis, etc.
- Intense asphyxial conditions- rise of temp byIntense asphyxial conditions- rise of temp by
2-3 c at death2-3 c at death
““ Postmortem Caloricity”Postmortem Caloricity”

16. The rate of cooling of the body is modified byThe rate of cooling of the body is modified by
the following conditions;the following conditions;
• AgeAge
• Condition of the bodyCondition of the body
• Mode of deathMode of death
• SurroundingsSurroundings
• Environmental temperatureEnvironmental temperature

17. Postmortem LividityPostmortem Lividity
It means discolouration or staining of the skinIt means discolouration or staining of the skin
and organs after death due to accumulation ofand organs after death due to accumulation of
fluid blood in the dependent parts of the body.fluid blood in the dependent parts of the body.
Post mortem staining/Hypostasis/Suggilation/Post mortem staining/Hypostasis/Suggilation/
Vibices/ Livour mortis.Vibices/ Livour mortis.
1- 3 hr. Starts1- 3 hr. Starts
6-8 hr. Fixes.6-8 hr. Fixes.

18. • Commencement of LividityCommencement of Lividity
• Development of lividityDevelopment of lividity
• Fixation of lividityFixation of lividity
• Site of distributionSite of distribution
• PatternPattern
• ExtentExtent
• Difference between lividity and bruise.Difference between lividity and bruise.

19. Medico-Legal ImportanceMedico-Legal Importance
• It is a reliable sign of deathIt is a reliable sign of death
• It gives the information about the position ofIt gives the information about the position of
the body at the time of deaththe body at the time of death
• Time since death can be estimatedTime since death can be estimated
• Colour suggest the cause of deathColour suggest the cause of death
• Distribution of lividity may give theDistribution of lividity may give the
information about the manner of deathinformation about the manner of death

20. Changes in the MusclesChanges in the Muscles
• Primary relaxation/ FlaccidityPrimary relaxation/ Flaccidity
• Rigor mortis/Cadaveric rigidityRigor mortis/Cadaveric rigidity
• Secondary relaxationSecondary relaxation

21. Primary relaxationPrimary relaxation
Starts immediately after death with generalisedStarts immediately after death with generalised
relaxation of muscle tone:relaxation of muscle tone:
• Drop of lower JawDrop of lower Jaw
• Eye balls lose their tensionEye balls lose their tension
• Pupils are dilatedPupils are dilated
• Joints are flabbyJoints are flabby
• Smooth relaxation- incontinence of Urine andSmooth relaxation- incontinence of Urine and
Faeces.Faeces.

22. Rigor Mortis/ Cadaveric rigidity :Rigor Mortis/ Cadaveric rigidity :
This phenomenon comes immediately after theThis phenomenon comes immediately after the
muscles have lost the power of contractilitymuscles have lost the power of contractility
and is irreversible changes in the muscles ofand is irreversible changes in the muscles of
the body, both voluntary and involuntary.the body, both voluntary and involuntary.
MyofibrilsMyofibrils
Myosin and ActinMyosin and Actin
Adenosine Triphosphate – A.T.P.Adenosine Triphosphate – A.T.P.

23. Time of Onset :Time of Onset :
Temperate climates – 3-6 hoursTemperate climates – 3-6 hours
Tropical climates – 1-2 hoursTropical climates – 1-2 hours
• Rigor mortis generally occurs when body isRigor mortis generally occurs when body is
cold.cold.
• Not related to nerves actionNot related to nerves action
• Develops in paralysed limbs alsoDevelops in paralysed limbs also
• First appear in involuntary musclesFirst appear in involuntary muscles
• Last to be affected finger and toes muscles.Last to be affected finger and toes muscles.

24. Duration :Duration :
* Temperate climate – lasts for 2-3 days.* Temperate climate – lasts for 2-3 days.
• Tropical climate – 24 – 48 hours in winterTropical climate – 24 – 48 hours in winter
18 - 36 hours in summer18 - 36 hours in summer
• In general – 1-2 hours sets onIn general – 1-2 hours sets on
for , 12 hours developsfor , 12 hours develops
for - 12 hours maintainesfor - 12 hours maintaines
and after 12 hours passes ofand after 12 hours passes of

25. Circumstances modifying the Onset andCircumstances modifying the Onset and
Duration of Rigor mortis.Duration of Rigor mortis.
Age- Rigor – Mortis is very rare in prematureAge- Rigor – Mortis is very rare in premature
infants.infants.
Rigor –mortis is slow in adolescentRigor –mortis is slow in adolescent
and healthy adultsand healthy adults
Muscular conditon and activity before death.Muscular conditon and activity before death.
Onset is slow and duration is longer in muscularOnset is slow and duration is longer in muscular
and healthy body at rest.and healthy body at rest.

26. Manner of death :Manner of death :
• In wasting disease and great exhaustion-In wasting disease and great exhaustion-
cholera, plague, typhoid, T.B. Cancer etc. thecholera, plague, typhoid, T.B. Cancer etc. the
onset is early and disappears soon.onset is early and disappears soon.
• In diseases – Pneumonia, asphyxia andIn diseases – Pneumonia, asphyxia and
nervous conditions- onset is delayednervous conditions- onset is delayed
Atmospheric condtions:Atmospheric condtions:
• In dry and cold air-onset slow and lost for longIn dry and cold air-onset slow and lost for long
time. Warm and moist air onset is rapid andtime. Warm and moist air onset is rapid and
duration short.duration short.

27. Conditions Simulating Rigor-MortisConditions Simulating Rigor-Mortis
• Heat StiffeningHeat Stiffening
• Cold StiffeningCold Stiffening
• Cadaveric SpasmCadaveric Spasm
Secondary Relaxation :Secondary Relaxation :
• Muscles become soft and FlaccidMuscles become soft and Flaccid
• Do not respond to a mechnical and electricalDo not respond to a mechnical and electrical
stimulus.stimulus.

28. Late Signs Of DeathLate Signs Of Death
 Decomposition / Putrefaction.Decomposition / Putrefaction.
 Adipocere formation / Saponification.Adipocere formation / Saponification.
 Mummification.Mummification.

29. Decomposition / PutrefactionDecomposition / Putrefaction
 Last stage in the resolution of the body,from theLast stage in the resolution of the body,from the
organic to the inorganic state, is a certain sign oforganic to the inorganic state, is a certain sign of
death.death.
AUTOLYSISAUTOLYSIS
 Rise of enzyme levels in the tissue cells afterRise of enzyme levels in the tissue cells after
death.death.
 Softening & liquefying of the body tissue.Softening & liquefying of the body tissue.
 Starts 3-4 hrs after death and continues for 2-3Starts 3-4 hrs after death and continues for 2-3
days.days.

30. BACTERIAL ACTIONBACTERIAL ACTION
 Action of bacterial enzymes on tissueAction of bacterial enzymes on tissue
components – carbohydrates/fat/proteins.components – carbohydrates/fat/proteins.
 Bacterial growth – warmth,moisture areBacterial growth – warmth,moisture are
conditions favourable.conditions favourable.
 Clostridium welchii, streptococci, E coli, BClostridium welchii, streptococci, E coli, B
proteus.proteus.

31. CHARACTERISTIC FEATURESCHARACTERISTIC FEATURES
COLOUR CHANGESCOLOUR CHANGES
 Greenish discoloration of skin over caecumGreenish discoloration of skin over caecum
and flanks after death appears 18-24 hrs.and flanks after death appears 18-24 hrs.
 Greenish to black discoloration-Greenish to black discoloration-
‘Sulphmethahaemoglobin’ formed by H2S‘Sulphmethahaemoglobin’ formed by H2S
due to microorganisms in the largedue to microorganisms in the large
intestine.intestine.
 Appears early in summer & delayed inAppears early in summer & delayed in
winter.winter.

32.  Discoloration spreads- front of abdomen,Discoloration spreads- front of abdomen,
external genitals, chest, neck, face, armsexternal genitals, chest, neck, face, arms
and legs – spreads whole body in 24-36 hrs.and legs – spreads whole body in 24-36 hrs.
 Discoloration of vessel walls due toDiscoloration of vessel walls due to
pigmentation from decomposed blood overpigmentation from decomposed blood over
the shoulder and groin.the shoulder and groin. ArborescentArborescent
pattern- ‘Marbling’pattern- ‘Marbling’

33. GASES OF PUTRIFACTIONGASES OF PUTRIFACTION
 Development of gases under the skin andDevelopment of gases under the skin and
hollow viscera 18-36 hrs. 24-48 hrs in solidhollow viscera 18-36 hrs. 24-48 hrs in solid
viscera.viscera.
 HH22S, ammonia, phosphated hydrogen, COS, ammonia, phosphated hydrogen, CO22
and methane.and methane.
 Causes pseudo rigidity, exerts pressure.Causes pseudo rigidity, exerts pressure.
 More gases accumulation, body floats inMore gases accumulation, body floats in
water.water.

34. PRESSURE EFFECTS OF PUTREFACTIVEPRESSURE EFFECTS OF PUTREFACTIVE
GASESGASES
 Displaces the diaphragm upwards.Displaces the diaphragm upwards.
 Discolored fluid and liquefied tissue mixes withDiscolored fluid and liquefied tissue mixes with
gases producing froth.gases producing froth.
 Bloating of the features.Bloating of the features.
 Shifting of the area of hypostasis.Shifting of the area of hypostasis.
 Changes in skin, hair and wound.Changes in skin, hair and wound.
 Extrusion of fluid from the mouth and nose.Extrusion of fluid from the mouth and nose.
 Emptying of the heart.Emptying of the heart.
 Changes in appearance of genitals.Changes in appearance of genitals.

35. APPEARANCE OF MAGGOTSAPPEARANCE OF MAGGOTS
 Flies lay eggs over the decomposed body-Flies lay eggs over the decomposed body-
nose, mouth, vagina and anus in 18-36 hrs.nose, mouth, vagina and anus in 18-36 hrs.
 After 24-36 hrs eggs hatch into larvae orAfter 24-36 hrs eggs hatch into larvae or
maggots, enter the body and destroy themaggots, enter the body and destroy the
tissues.tissues.
 After 4-5 days develop into pupae.After 4-5 days develop into pupae.
 After 7-8 days into adult fly.After 7-8 days into adult fly.

36. OTHER SEQULAEOTHER SEQULAE
 Fall of teethFall of teeth
 Separation of skull suturesSeparation of skull sutures
 Liquefied brain matter oozes out.Liquefied brain matter oozes out.
 ‘‘Colliquative putrifaction’Colliquative putrifaction’ – this process– this process
takes place between 7-14 days.takes place between 7-14 days.

37. INTERNALLYINTERNALLY
STOMACHSTOMACH
 Dark red patches over the wallsDark red patches over the walls
 Perforation due to autolysisPerforation due to autolysis
LIVERLIVER
 Softens and flabbySoftens and flabby
 Becomes spongyBecomes spongy ‘Foamy liver’‘Foamy liver’

38.  Early putrefaction 24-48hrsEarly putrefaction 24-48hrs
Larynx, trachea, brain of infants, stomach,Larynx, trachea, brain of infants, stomach,
intestines, spleen, omentum and mesentery,intestines, spleen, omentum and mesentery,
liver and adult brain.liver and adult brain.
 Late putrefaction 2-3 weeksLate putrefaction 2-3 weeks
Heart, lungs, kidneys, bladder, esophagus,Heart, lungs, kidneys, bladder, esophagus,
pancreas, diaphragm, blood vessels,pancreas, diaphragm, blood vessels,
prostate, testis and non gravid uterus,prostate, testis and non gravid uterus,
ovaries.ovaries.

39. FACTORS MODIFYING PUTREFACTIONFACTORS MODIFYING PUTREFACTION
 EXTERNALEXTERNAL
Warmth and clothingWarmth and clothing
 Putrefaction begins at 10°Putrefaction begins at 10°C and occursC and occurs
rapidly at 37rapidly at 37°°C.C.
 Freezing point – bacterial growthFreezing point – bacterial growth
inhibited and putrefaction will not occur.inhibited and putrefaction will not occur.
 Clothing hastens putrefaction initiallyClothing hastens putrefaction initially
and protects against flies and insects.and protects against flies and insects.

40. MoistureMoisture
 Help in rapid multiplication of organisms.Help in rapid multiplication of organisms.
 Bodies recovered from water if left in air,Bodies recovered from water if left in air,
decomposes rapidly.decomposes rapidly.
AirAir
 1 week in air = 2 weeks in water = 8 weeks1 week in air = 2 weeks in water = 8 weeks
buried – ‘Casper dictum’buried – ‘Casper dictum’

41. Manner of burialManner of burial
 In air tight coffins, very little change ofIn air tight coffins, very little change of
body for long periods.body for long periods.
 Without coffins, putrefaction is very rapid.Without coffins, putrefaction is very rapid.
 Bodies in deep graves putrefy very slow.Bodies in deep graves putrefy very slow.
 Bodies buried in lime, decomposition isBodies buried in lime, decomposition is
retarded.retarded.
 Bodies in sandy and porous soils areBodies in sandy and porous soils are
conducive to mummification.conducive to mummification.

42. INTERNAL FACTORSINTERNAL FACTORS
 Age and condition of the bodyAge and condition of the body
 SexSex
 Mode of deathMode of death

43. ADIPOCEREADIPOCERE
 Modification of the process of putrifactionModification of the process of putrifaction
in the dead body is (checked and isin the dead body is (checked and is
replaced) adipocere formation.replaced) adipocere formation.
 Hydrolisation of fatty tissue into fatty acids.Hydrolisation of fatty tissue into fatty acids.
 Bacterial fat splitting enzymes and moistureBacterial fat splitting enzymes and moisture
are essential – Lecithinase.are essential – Lecithinase.
 Composed of saturated fatty acids byComposed of saturated fatty acids by
palmitic, stearic, hydroxystearic, olic acidspalmitic, stearic, hydroxystearic, olic acids

44.  Yellowish white, greasy wax with rancidYellowish white, greasy wax with rancid
smell.smell.
 It forms at any site where fatty tissue isIt forms at any site where fatty tissue is
present.present.
 Time required, in summer-3 wks, in tropics-Time required, in summer-3 wks, in tropics-
5 to 15 days.5 to 15 days.
 M.L.I.M.L.I. – to establish the identity– to establish the identity
- cause of death- cause of death
- time since death- time since death
- place of death- place of death

45. MUMMIFICATIONMUMMIFICATION
 It is a peculiar desiccation of a dead bodyIt is a peculiar desiccation of a dead body
where by its soft parts shrivel up but retainwhere by its soft parts shrivel up but retain
the natural appearance and the features ofthe natural appearance and the features of
the body.the body.
 Rusty brown color, dry, leathery skinRusty brown color, dry, leathery skin
adherent to bones.adherent to bones.
 Internal organs get transformed into a thickInternal organs get transformed into a thick
brown mass.brown mass.

46.  Mummification occurs in bodies buried inMummification occurs in bodies buried in
shallow graves, in dry sandy soils.shallow graves, in dry sandy soils.
 Time – 3 months to 1-2 yrsTime – 3 months to 1-2 yrs
 M.L.I.M.L.I. – Identification– Identification
- Cause of death- Cause of death
- Time since death- Time since death
- Place of death- Place of death

47. Time since death/ post mortemTime since death/ post mortem
intervalinterval
 Important clue for investigation of time.Important clue for investigation of time.
 It helps apprehend the person likely to beIt helps apprehend the person likely to be
involved.involved.
 Point to be ascertained are;Point to be ascertained are;
-cooling of the body-cooling of the body
-post mortem lividity-post mortem lividity
-rigor mortis-rigor mortis
-decomposition changes-decomposition changes

48. - Contents of stomach and bowelsContents of stomach and bowels
- Contents of urinary bladderContents of urinary bladder
- Biochemical changesBiochemical changes
- Circumstantial evidenceCircumstantial evidence

49. Thank youThank you