Chapter 4: Medico-Legal Aspects of Death

Question 1

What is thanatology?

Answer 1

Thanatology is a branch of science that deals in death in all its aspects.

Question 2

Define the physiological time of death

Answer 2

The physiological time of death is when the victim’s vital functions actually ceased.

Question 3

What is the legal time of death?

Answer 3

The legal time of death is the time recorded on the death certificate.

Question 4

What is the estimated time of death?

Answer 4

The estimated time of death is the time the medical examiner estimates that death occurred.

Question 5

Define Post Mortem Interval

Answer 5

The time elapsed from the moment of death until the corpse is examined is known as Post mortem interval.

Question 6

Define death

Answer 6

Death is defined as the irreversible cessation of life, insensibility, inability to move and permanent and complete stoppage of functions of vital organs of the body-known as tripod of life: Brain, Heart and Lungs.

Question 7

Enumerate the diagnosis of death

Answer 7

1. Stoppage of respiration
2. Absence of pulse
3. Absence of heart beat
4. Fixed dilated pupil

Question 8

Enumarate the diagnosis of Brain Stem Death

Answer 8

• Deep coma for at least 6 hrs
• Absence of any typical posture due to decortications or decerebration.
• No epileptic movement
• Absence of spontaneous respiration, when disconnected from ventilator.
• Fixed dilated pupil.
• No motor response.
• Abolition of corneal, gag, vestibule-cephalic, vestibulo-ocular and bronchial stimulation reflexes.

Question 9

What are the two stages of death? Define each.

Answer 9

The two stages of death are:
1. Somatic death
2. Molecular death

Somatic Death
It refers to the death of the tissue, system or body and is Clinical death, as a whole. It coincides with the death of the brain stem.

Molecular Death
It is the death of all individual cells within the body. It follows 2-3 hrs after somatic death.

Question 10

How is somatic death diagnosed?

Answer 10

1. Permanent and complete cessation of function of brain — flat E.E.G
2. Permanent and complete cessation of function of heart — flat E.C.G
3. Permanent and complete cessation of function of the lungs — negative Winslow’s Test, Mirror Test, Feather Test etc.

Question 11

How is molecular death diagnosed?

Answer 11

1. Muscle does not respond to strong stimuli.
2. Pupil does not respond to stimuli and drug.
3. It is associated with early and late sign of death.

Question 12

In medico-legal aspects, when is a person considered dead?

Answer 12

A person is dead when somatic death has occurred hence a death certificate can be issued for the disposal of the body.

Question 13

For organ donation purposes, when do organs need to be removed?

Answer 13

The organs for transplantation must be removed from the deceased before the onset of molecular death.
* Liver — within 15 mins
* Kidney — within 45 mins
* Heart — within 1 hr
* Cornea — within 3 hrs

Question 14

Differentiate perimortem wounds and antemortem wounds

Answer 14

Perimortem wounds are wounds caused during the supravita period or at or near the time of death.

Antemortem wounds are wounds caused during before death.

Question 15

As per Gordon, what are the four (4) modes of death?

Answer 15

1. Anoxic anoxia — due to lack of oxygen.
2. Anemic anoxia — due to reduced oxygen carrying capacity of the blood.
3. Stagnant anoxia — due to defective blood circulation.
4. Histotic anoxia — due to defective utilization of oxygen by tissue.

Question 16

As per Xavier Bichat, what are the modes of death?

Answer 16

As per Xavier Bichat, a French physician, irrespective of what the remote cause of death may be, there are three modes of death.
1. Coma: Death due to failure of brain function.
2. Syncope: Death due to failure of heart function.
3. Asphyxia: Death due to failure of lungs function.

Question 17

What are the immediate signs of death?

Answer 17

Immediate Signs: the earliest signs of death
* Stoppage of function of nervous system
* Insensibility and loss of both sensory and motor function.
* Loss of reflexes, no response and no tonicity of the muscles.
* Pupils are dilated.
* Complete stoppage of respiration.
* Complete stoppage of heart beat.

Question 18

What are the early signs of death?

Answer 18

Early Signs: appears after 3-24 hrs of death
1. Skin: becomes ashy white, pale ,loses elasticity, lips are dry, brownish and hard due to drying
2. Eye: loss of corneal reflex, corneal opacity, flaccidity of the eye ball, segmentation of the retinal blood columns.
3. Cooling of the body: Algor mortis
4. Post mortem lividity: livor mortis
5. Rigor mortis.

Question 19

What is Algor Mortis?

Answer 19

Algor Mortis
The body starts cooling after 1-2 hrs after death and attains atmospheric temperature in 12-15 hrs. while internal body parts take 18-24 hrs to cool.

Question 20

What is Postmortem Lividity?

Answer 20

Postmortem Lividity or Livor Mortis
Due to gravitational force the blood flow to the dependent parts of the body, causing stagnation of blood in the toneless, dilated capillaries resulting in bluish purple staining.

It starts appearing after 1 hr of death as small coloured patches. After 6 hrs it becomes fixed.

Question 20

What is Rigor Mortis?

Answer 20

Rigor Mortis
It is the changes the muscles under go after death. It is defined as contraction, stiffening, shortening and opacity of the muscles after death.

Happens 12 hours after death

Question 20

Enumarate the sequence of rigor mortis

Answer 20

1. Primary relaxation or flaccidity.
2. Rigor mortis or Cadaveric rigidity.
3. Secondary relaxation.

Question 21

What is Cadaveric Spasm?

Answer 21

It is a condition where in a group of muscles, which were in contraction or spasm at the time of death, continue to be in spasm even after death.

Question 22

What are the late signs of Cadaveric Spasm?

Answer 22

Manifests after 24 hrs after death It involves
1. Decomposition or Putrefaction
2. Adipocere or Saponification
3. Mummification.

Question 23

What is Decomposition or Putrefaction?

Answer 23

It is a process by which complex organic body tissue break down into simpler inorganic compounds or elements due to the action of saprophytic micro-organisms.

Question 24

What are the essential requirements for decomposition

Answer 24

a. Warmth
b. Air
c. Moisture
d. Cloth
e. Surface injury
f. Manner of burial

Question 25

How long does decomposition take?

Answer 25

1. 10-20 days: black putrefaction occurs which is when noxious odour is released from the body parts undergoing a black discoloration.
2. 2 weeks: abdomen is bloated, the internal gas pressure is maximum.
3. 3 weeks: tissues have softened, organs and cavities are bursting.

Question 26

What is Casper’s Dictum?

Answer 26

It gives the rate at which a dead body decomposes. The rate of decomposition in soil water air is equivalent to 1:2:8.”According to an old rule of thumb (Casper‟s dictum) one week of putrefaction in air is equal to two weeks in water and eight weeks burried in soil, given same environmental temperature.

Question 27

What are the medico-legal importance of Casper’s Dictum?

Answer 27

1. It is the surest sign of death.
2. Can help in establishing time of death.
3. Cause of death may remain unknown in advance stage of putrefaction.

Question 28

What are the medico-legal importance of Adipocere Formation?

Answer 28

1. Body appearances, features are retained which helps in establishing identity of the body.
2. All injuries are well preserved which helps in assessing the various causes of death.
3. It can help in establishing the time and place of death.

Question 29

What is Adipocere Formation

Answer 29

It is formed by the anaerobic bacteria, hydrolysis of fat in tissue, such as body fat in corpses. It occurs most often in women or obese adult and children. Fat is transformed to fatty acids by the process of hydrogenation.

Question 30

What are the essential requirements of Adipocere Formation?

Answer 30

1. Absence of air
2. Excess of moisture
3. Warmth

Question 31

What is the time required for Adipocere Formation

Answer 31

It takes 5-15 days in our country for adipocere formation.

Question 32

Define mummification

Answer 32

Mummification is the rapid dehydration and shriveling of the dead body from evaporation of water, with preservation of natural appearances and features of the body.

Question 33

What are the essential requirements of mummification?

Answer 33

1. Absence of moisture
2. Excess of air
3. Warmth

Question 34

What is the time required for mummification?

Answer 34

The time required for complete mummification of a body varies greatly from 3-12 months or longer.

Question 35

When do physicians consider a person medically or legally dead?

Answer 35

A person will be considered medically and legally dead if:
* there is the absence of spontaneous respiratory and cardiac function (brain death);
* there is the absence of spontaneous brain function (cardio-respiratory death)

Question 36

What are the characteristics of brain death?

Answer 36

Death occurs when there is deep-irreversible coma, absence of electrical brain activity and complete cessation of all
the vital functions without possibility of resuscitation.

The following are the characteristics of “irreversible coma”:
1. Unreceptivity and unresponsibility
2. No movements or breathing
3. No reflexes
4. Flat electro-encephalogram (flat EEG)

(Source: Harvard Report of 1968)

Question 37

Enumerate the signs of death

Different from the ‘immediate’ signs of death

Answer 37

1. Cessation of Heart Action and Circulation