Death and Changes after Death
SUDDEN DEATH
The defi nition of sudden death varies according to the au-thority and convention. Accordingly, death occurring within 24 hour from the onset of symptom was considered as sud-den death.60 Many clinicians disagree with the defi nition as they feel that the period is too long, as many have witnessed death within minutes to hours after admission to hospital.
Thus a comprehensive defi nition was proposed as “a death which is not known to be caused by any trauma, poisoning or violent asphyxia and where death occurs all of sudden or within 24 hour of the onset of terminal symptoms”.
Etiopathology
The incidence of sudden death is about 10 percent of all causes of death. The causes of sudden natural death are given in Table 7.21.
Circumstances
The sudden deaths or many prefer to call it as unexpected deaths, have actual or potential medicolegal signifi cance in re-spect to establish the cause and manner of death. The role of forensic expert is often vital in such deaths. The sudden or un-expected deaths usually fall under the following two categories:
1. Deaths occurring in persons who were being clinically examined for prolonged duration without adequate or satisfactory diagnosis or
2. Deaths occur due to any illness of brief duration and the treating doctor has little opportunity to analyze factors responsible for the causation of disease.
Whenever such body is referred to forensic expert, a com-plete autopsy should be done with relevant investigation to ascertain the cause of death.
Table 7.20: Material required for collection of entomological sample
Forceps Glass vials Ethyl alcohol
Ice cream cartons or equivalent Vermiculite or other inert material Insect net - Coarctation of aorta Central nervous system - Hemorrhage
- Rupture of ectopic pregnancy Miscellaneous
A
REFERENCES
1. Perper JA. Time of death and changes after death: Part 1: ana-tomical considerations. In: Spitz WU (ed) Spitz and Fisher’s Medicolegal investigation of Death, 3rd edn. 1993. Charlas C Thomas Publisher, USA. 14-50.
2. Nandy A. Death and postmortem changes. In: Principles of Forensic Medicine, 2nd edn. 2005. New Central Book Agency (P) Ltd., Calcutta. 133-73.
3. Vij K. Death and its medicolegal aspects. In: Textbook of Forensic Medicine and Toxicology, 3rd edn. 2005. Reed Elsevier India Pvt. Limited, New Delhi. 105-48.
4. The Editors. The practice of medicine. In: Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL (eds) Harrison’s Principles of Internal Medicine, Vol.1, 14th edn. 1998. McGraw-Hill, New York. 1-6.
5. Subrahmanyam BV. Death and Medicolegal aspects. In:
Forensic medicine, Toxicology and Medical Jurisprudence, 1st edn. 2004. Modern Publishers, New Delhi. 28-54.
6. Gordon I, Shapiro HA. The diagnosis and the early signs of death: the phenomenon that occurs after death. In: Forensic Medicine-A Guide to Principles, 2nd edn. 1982. Churchill Livingstone, Edinburgh. 1-63.
7. Dikshit PC. Moment of death. In: Textbook of Forensic Medicine and Toxicology, 1st edn. 2007. Peepee Publishers and Distributors (P) Ltd., New Delhi. 35-46.
8. Shepherd R. The medical aspect of death. In: Simpson’s Forensic medicine, 12th edn. 2003. Arnold, London. 27-36.
9. Reddy KSN. Death and its causes. In: The Essentials of Forensic Medicine & Toxicology, 22nd edn. 2003. K. Suguna Devi, Hyderabad. 108-21.
10. Parikh CK. Medicolegal aspects of death. In: Parikh’s Textbook of Medical Jurisprudence and Toxicology, 5th edn. 1995. CBS Publishers and Distributors, Bombay. 130-79.
11. The Transplantation of Human Organs Act 1994 (42 of 1994).
12. Diagnosis of brain death. Statement issued by the honorary secretary of the conference of medical Royal Colleges and their Faculties in the United Kingdom on 11 October 1976.
BMJ 1976; 2:1187-8.
13. Park K. Principles of epidemiology and epidemiologic methods.
In: Park’s Textbook of Preventive and Social Medicine, 14th edn. 1995. M/S Banarsidas Bhanot Publishers, Jabalpur. 45-106.
14. Arora K. The Registration of Birth and Death Act, 1969 (18 of 1969). Professional Book Publishers, New Delhi. 2007.
15. Adelson L. Homicide by cervical compression and by drown-ing, asphyxial deaths. In: The Pathology of Homicide, 1974.
Charles C Thomas, USA. 521-75.
16. Roy IS. Intra ocular pressure and glaucoma. In: BM Chatterjee’s Handbook of Ophthalmology, 4th edn. 1992. CBS Publishers and Distributors, Delhi. 162-201.
17. Behera A, Das S, Das GS. Eye is the spy of forensic medicine.
Medicolegal Update 2005; 5:43-5.
18. Kevorkian J. The fundus oculi and the determination of death.
Am J Pathol 1956; 32:1253-67.
19. Kevorkian J. The fundus oculi as postmortem clock. J Forensic Sci 1961; 6:231.
20. Wroblewski B, Ellis M. Eye changes after death. Br J Surg 1970; 57:69-71.
21. Singh D, Prashad R, Prakash C, Bansal YS, Sharma SK, Pandey AN. Determination of time since death from vitre-ous potassium concentration in subjects of Chandigarh Zone of North-West India. Int J Medical Toxicol Legal Med 2001;
4:12-7.
22. Gelfand JA, Dinarello CA. Fever and hyperthermia. In: Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL (eds) Harrison’s Principles of Internal Medicine, Vol.1, 14th edn. 1998. McGraw-Hill, New York. 84-9.
23. Bhat VJ, Palimar V, Kumar PG. Reliability of postmortem lividity as an indicator of time since death in cold stored bod-ies. Medicolegal Update 2006; 6:5-7.
24. Bohnert M, Weinmann W, Pollak S. Spectrophotometeric evaluation of postmortem lividity. Forensic Sci Int 1999;
99:149-58.
25. Suhani MN, Shahrom AW, Zarida H. Electrical excitation of skeletal muscle for the estimation of time since death in the early postmortem period. J Forensic Med Toxicol 2006;
23:1-6.
26. Ganong WF. Excitable tissue: Muscle. In: Review of Medical Physiology, 19th edn. 1999. Prentice-Hall International, London. 60-79.
27. Forster B. The contractile deformation of skeletal muscle in rigor mortis. J Forensic Med 1963; 10:133-47.
28. Dalal JS, Tejpal HR, Chanana A, Kaur N. Medicolegal study of rigor mortis to estimate postmortem interval. J Indian Acad Forensic Med 2006; 28:49-51.
29. Saukko P, Knight B. The Pathophysiology of death. In:
Knight’s Forensic Pathology, 3rd edn. 2004. Arnold, London.
52-97.
30. Krompecner T, Bergerioux C. Experimental evaluation of rigor mortis. VII. Effect of ante and postmortem electrocution on the evolution of rigor mortis. Forensic Sci Int 1988; 38:27-35.
31. Pillay VV. Thanatology. In: Textbook of Forensic Medicine &
Toxicology, 14th edn. 2004. Paras Publishing, Hydrabad. 95-112.
32. Haglund WD, Sorg MH (ed). In: Forensic Taphonomy, 1st edn. 1997. CRC Press, Florida.
33. Dogra TD, Sinha A, Ajmani ML. Death and postmortem changes. In: Ajmani ML (ed) Embalming, Principles and Legal Aspects, 1st edn. 1998. Jaypee Brothers, New Delhi. 72-80.
34. Kamath MA. Examination of the living – examination of the dead. In: Medical Jurisprudence and Toxicology, 6th edn. 1960.
The Madras Law Journal, Madras. 86-121.
35. Camps FE, Robinson AE, Lucas BGB. Changes after death. In:
Gradwohl’s Legal Medicine, 3rd edn. 1976. John Wright and sons Ltd Publications and distributed by Year Book Medical Publications, INC., Chicago. 78-100.
36. Simpson K. Changes after death. In: Forensic Medicine, 6th edn. 1972. The English Language Book Society and Edward Arnold (Publishers) Ltd, Great Britain. 7-17.
37. Brondum N, Simonsen J. Postmortem red colouration of teeth.
A retrospective investigation of 26 cases. Am J Forensic Med Pathol 1987; 8:127-30.
A
38. Rentoul E, Smith H. The medicolegal aspects of death. In:
Glaister’s Medical Jurisprudence and Toxicology, 13th edn.
1973. Churchill Livingstone, Edinburgh. 113-39.
39. Galloway A, Brikby WH, Jones AM, Henry TE, Parks BO.
Decay rates of human remains in an arid environment. J Forensic Sci 1989; 34:607-16.
40. Mathiharan K, Patnaik AK. Postmortem changes and time since death. In: Modi’s Medical Jurisprudence and Toxicology, 23rd edn. 2005. LexisNexis Butterworths, New Delhi. 423-62.
41. Rodriguez WC, Bass WM. Decomposition of buried bodies and methods that may aid in their location. J Forensic Sci 1985; 30:836-52.
42. Evans WED. Adipocere formation in a relatively dry environ-ment. Med Sci Law 1963 a; 3:145-8.
43. Pfeiffer S, Milne S, Stevenson RM. The natural decomposition of adipocere. J Forensic Sci 1998; 43:368-70.
44. Thurston G. Death. In: Mant AK (ed). Taylor’s Principles and Practice of Medical Jurisprudence, 13th edn. 2000. B I Churchill Livingstone, New Delhi. 29-38.
45. Evans WED. Some histological fi ndings in spontaneously pre-served bodies. Med Sci Law 1962; 2:155-60.
46. Coe JI, Curran WJ, Hyg SM. Defi nition & time of death.
In: Curren WJ, McGarry AL, Petty CS (edn.) Modern Legal Medicine, Psychiatry and Forensic Science, 1st edn. 1980. F.A.
Davis Company, Philadelphia. 141-69.
47. Takatori T, Yamaoka A. The mechanism of adipocere forma-tion 2. Separaforma-tion and identifi caforma-tion of oxo-fatty acids in adi-pocere. Forensic Sci 1977 b; 10:117-25.
48. Mant AK, Furbank R. Adipocere – a review. J Forensic Med 1957; 4:18-35.
49. O’Brien TG, Kuehner AC. Waxing grave about adipocere:
soft tissue change in an aquatic context. J Forensic Sci 2007;
52:294-301.
50. Simonsen B. Early formation of adipocere in temperate cli-mate. Med Sci Law 1977; 17:53-5.
51. Forbes SL, Stuart BH, Dent BB. The effect of the burial environ-ment on adipocere formation. Forensic Sci Int 2005; 154:24-34.
52. Mellen PF, Lowry MA, Micozzi MS. Experimental observa-tions on adipocere formation. J Forensic Sci 1993; 38:91-3.
53. Forbes SL, Stuart BH, Dent BB. The effect of the method of burial on adipocere formation. Forensic Sci Int 2005; 154:44-52.
54. Ajmani ML. Mummifi cation. In: Embalming, principles and legal aspects, 1st edn. 1998. Jaypee Brothers, New Delhi. 81-5.
55. Patel F. Artefact in forensic medicine: Scrotal mummifi cation.
J Clin Forensic Med 2003; 10:263-6.
56. Lord WD, Burger JF. Collection and preservation of forensi-cally important entomological materials. J Forensic Sci 1983;
28:936-44.
57. Introna F Jr., Lo Dico C, Caplan YH, Smialek JE. Opiate analysis in cadaveric blowfl y larvae as an indicator of narcotic intoxication. J Forensic Sci 1990; 35:1-3.
58. Gunatilake K, Goff ML. Detection of organophosphate poi-soning in a putrefying body by analyzing arthropod larvae. J Forensic Sci 1989; 34: 3-7.
59. Kashyap VK, Pillay VV. Cadaver insects of India and their use in estimation of postmortem interval. Indian J Forensic Sci 1988; 2:17-20.
60. Luke JL, Helpern M. Sudden unexpected death from natural causes in young adults. Arch Pathol 1968; 85:10-7.
61. Siboni A, Simonsen J. Sudden unexpected natural death in young persons. Forensic Sci Int 1986; 31:159-66.
62. Gormsen H. Sudden unexpected death due to myocarditis.
Acta Pathol Microbiol Scand (suppl.) 1955; 105:30-48.
63. Sarkioja T, Hirvonen J. Causes of sudden unexpected death in young and middle aged persons. Forensic Sci Int 1984; 24:247-61.
64. Jay GW, Leestma JE. Sudden death in epilepsy. Acta Neurol Scand (suppl.) 1981; 82:1-66.
65. Balăzic J, Rott T, Jancigaj T, Popovic M, Zajfert-Slabe M, Svigelj V. Amnoitic fl uid embolism with involvement of the brain, lungs, adrenal glands and heart. Int J Legal Med 2003; 117:165-9.
Introduction
It is often said, injuries are never mute; they mostly express in form of pain and exist with their injured features. The only difficulty with them is their language and one who interpret them; they speak, else persist in scars indefinitely, revealing the past.
In medical jargon, injury is used synonyms with trauma or wound but their meaning is not same. An injury is any damage to any part of the body due to application of mechanical force. Wound is defined the forcible solution of the continuity of any tissue of body by mechanical force.
Trauma is an insult to the state of well-being and the insult may be physical or mental.1
Perception of injury to medical man is different from a legal professional. The definition of injury given above is sufficient for medical man. However, legally injury will include “any lesion, external or internal caused by violence, with or without breach of continuity of skin”. Thus, the legal conception of wound is more extensive than medical one.
Wound has neither been defined nor been included in any of the statues of law in India. In place of ambiguous term wound, law uses the term ‘hurt’. Hurt means, “Whoever causes bodily pain, disease or infirmity to any person is said to cause hurt (Section 319 of IPC).2
Definition and features
Section 44 of IPC defines injury as “any harm caused ille-gally to a person in body, mind, reputation or property”.
Salient features of this definition
1. This definition of injury has wider meaning. It has not only included bodily harm but also incorporated mental suffering and harm caused to reputation or property.
2. Use of term “illegal”: here the word illegal is included in definition. The implications of this inclusion are that not all injuries caused are illegal. It means, there are some injuries, which are legal for example, if surgeon is doing operation; he inflicts surgical incision over patient with consent. Here, the surgical incision is not an illegal injury because it is caused for the benefit of patient.
Classification
Injuries are classified in many ways such as:
I) According to Causative Forces A) Mechanical injuries
1. Blunt force injuries – Abrasion – Contusion – Laceration
– Fracture and dislocations of teeth/bone 2. Sharp-edged weapon injuries
– Incised wounds – Chop wounds
3. Piercing weapons – stab wounds 4. Firearm weapons – firearm wounds.
B) Thermal Injuries 1. Due to cold
– Frost bite – Trench foot – Immersion foot 2. Due to heat
– Burns – Scalds