OF HEART ACTION AND CIRCULATION:
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. Howwhat-ever, 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 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
flow.
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.
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 Cadaveric Spasm or Instantaneous Rigor:
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.
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.
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:
Involved:
Significance:
Contraction Rigor
(1) Contracted muscle is more or less transparent, or rather translucent.
(2) It is very elastic,
Muscle in rigor losses this
and becomes opague.
(2) It has lost this
elasti-LEGAL MEDICINE capable of restoration
to its original form as soon as the distorting force has ceased to act.
(3) In reaction to litmus, it is either neutral or slight-ly alkaline, and any re-duction in this alkali-nity is very speedily removed.
(4) If the contraction be overcome by mechani-cal force, the muscles though they may re-main for a time un-contracted, possess still their inherent power of contraction; they may then keep the limb fixed in a new position or allow a return to the old position.
city and readily main-tains a distorted posi-tion.
(3) It is distinctly and con-stantly acid (until de-c o m p o s i t i o n is ad-vanced) owing to the development of with the amount of mechanical movement, at once ensues, and there is no power to resume the old position nor any new one, except so far as gravity may 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
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
of and surrounding the
This may or may not be a dependent part.
d. Often elevated, because the blood and sub-sequent inflammation swell the tissues.
e. Incision shows blood outside the vessels. This is the most certain test of difference, and can be observed even in very small bruises.
f. Colour variegated. This is only true of bruises that are some days old; it is due to the changes in the haemoglo-bin produced during life.
g. If the body happens to be constricted at, or supported on, a bruised place, the actual surface of contact may be a little lighter than the rest of the bruise, but will not be white.
Always in a part which for the time of formation is dependent, i.e., at a place where gravity ordains it.
Not elevated, because either the blood is still in the vessels or, at most, has simply soaked into and stained the tissues.
Incision shows the blood is still in its vessels; and if any oozing occurs drops can be seen issuing from the cut mouths of the vessels.
Colour uniform. The well-known change in colour (green, yellow, etc.) pro-duced in blood extravasted into living tissues does not occur in dead tissues with the same regularity.
In a place which would other-wise be the seat of a
In a place which would other-wise be the seat of a