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15 Postmortem Changes II

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14 views

15 Postmortem Changes II

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lovachapie
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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DEPARTMENT OF FORENSIC MEDICINE

NKPSIMS&RC, Nagpur
PURPOSE STATEMENT
At the end of the class, II MBBS student should be able to know:

 Late postmortem changes

 Putrefaction

 Decomposition

 Adipocere formation

 Mummification
LEARNING OBJECTIVES
Sr. Teaching Objectives Domain Level
No.

1. Late signs of death Cognitive Must know

2. Putrefaction Cognitive Must know

3. Decomposition Cognitive Must know

4. Adipocere formation Cognitive Must know

5. Mummification Cognitive Must know


LATE SIGNS OF DEATH
 Decomposition / Putrefaction.

 Adipocere formation / Saponification.

 Mummification.
DECOMPOSITION /PUTREFACTION

 Last stage in the resolution of the body from the organic to


the inorganic state

 A surest sign of death.

 It involves 2 processes, autolysis & putrefaction


AUTOLYSIS
 Rise of enzyme levels in the tissue cells after death.

 Softening & liquefying of the body tissue without


bacterial action.

 Starts 3-4 hrs after death and continues for 2-3 days.

 Early changes occur in parenchymatous & glandular


tissues & in brain.
PUTREFACTION
 Action of bacterial enzymes on tissue components –
carbohydrates/fat/proteins.

 Bacterial growth– warmth, moisture are favorable


conditions.

 Anaerobic bacteria, Clostridium welchii, streptococci, E


coli, B Proteus.

 Due to fall in O2 & rise in Hydrogen ion concentration.


CHARACTERISTIC FEATURES OF
PUTREFACTION
1. Colour changes in the tissues

2. Development of Foul smelling gases

3. Liquefaction of tissues
CF OF PUTREFACTION
1. COLOUR CHANGES

 Externally, greenish discoloration of skin over caecum and


flanks after death appears 18-24 hrs.

 Internally, greenish discoloration of undersurface of liver.

 Greenish to black discoloration due to


‘Sulphmethaemoglobin’ formed by H2S due to
microorganisms in the large intestine.

 Appears early in summer (12-18 hrs) & delayed in winter (1-2


days).
CF OF PUTREFACTION
 Discoloration spreads- front of abdomen, external genitals,
chest, neck, face, arms and legs – spreads whole body in 24-36
hrs.
 The earliest change—Reddish brown discoloration of vessel
walls (aorta) due to pigmentation from decomposed blood.
 Greenish brown discoloration of superficial veins over the
roots of limbs, thighs, shoulders, chest & neck due to
hemolysis of red cells—stains vessel wall—giving Marbled
appearance
CF OF PUTREFACTION
2. GASES OF PUTREFACTION

 Development of gases under the skin and hollow viscera 18-36


hrs., 24-48 hrs in solid viscera.

 H2S, ammonia, phosphated hydrogen, CO2 and methane.

 Causes pseudorigidity, exerts pressure.

 More gases accumulation, body floats in water.


CF OF PUTREFACTION
PRESSURE EFFECTS OF PUTREFACTIVE GASES

 Displaces the diaphragm upwards.

 Discolored fluid and liquefied tissue mixes with gases


producing froth.

 Bloating of the features.

 Shifting of the area of hypostasis.


CF OF PUTREFACTION
PRESSURE EFFECTS OF PUTREFACTIVE GASES

 Changes in skin, hair and wound.

 Extrusion of fluid from the mouth and nose.

 Emptying of the heart.

 Changes in appearance of genitals.

 Fall of teeth & separation of skull sutures


APPEARANCE OF MAGGOTS
 Flies lay eggs over the decomposed body- nose, mouth, vagina
and anus in 18-36 hrs.

 After 24-36 hrs eggs hatch into larvae or maggots, enter the
body and destroy the tissues.

 After 4-5 days develop into pupae.

 After 7-8 days into adult fly.

 Maggots are having proteolytic enzymes


LIQUEFACTION OF TISSUES
 Colliquative putrefaction begins from 5-10 days or
more after death.

 Tissues become soft, loose and converted into thick,


semi-fluid, black mass.

 Skeletonization: Vary from body to body.


INTERNAL CHANGES
STOMACH

 Dark red irregular patches over the walls

 Perforation due to autolysis

LIVER &SPLEEN

 Softens and flabby

 Becomes spongy ‘Foamy liver’


INTERNAL CHANGES
 Early putrefaction (24-48hrs)

Larynx, trachea, brain of infants, stomach, intestines,


spleen, omentum and mesentery, liver and adult brain.

 Late putrefaction (2-3 weeks)

Heart, lungs, kidneys, bladder, esophagus, pancreas,


diaphragm, blood vessels, prostate, testis and non
gravid uterus, ovaries.
FACTORS MODIFYING
PUTREFACTION
 EXTERNAL

1. Temperature:

 Putrefaction begins above 10°C and occurs rapidly at 38°C.

 Freezing point – Bacterial growth inhibited and putrefaction


will not occur.

2. Clothing:

 Clothing hastens putrefaction initially by maintaining body


temp above and also protects against flies and insects.
FACTORS MODIFYING
PUTREFACTION
3. Moisture

 Help in rapid multiplication of organisms.

 Bodies recovered from water if left in air, decomposes rapidly.

4. Air

 Hastens putrefaction

 1 week in air = 2 weeks in water = 8 weeks buried – ‘Casper


dictum’
FACTORS MODIFYING
PUTREFACTION
5. Manner of burial

 In air tight coffins, very little change of body for long periods,
without coffins, putrefaction is very rapid.

 Bodies in deep graves putrefy very slow.

 Bodies buried in lime, decomposition is retarded.

 Bodies in sandy and porous soils are conducive to


mummification.
INTERNAL FACTORS
1. Age: Body of newborn who have been not fed slowly putrefy
and child who have been fed putrefy rapidly and of old
people slowly.

2. Sex: No effect

3. Condition of the body: Fat & flabby--Early

4. Cause of death

5. Mutilation of body
ADIPOCERE (SAPONIFICATION)
 Modification of the process of putrefaction of the dead body.

 Hydrolysis & hydrogenation of fatty tissue into fatty acids


which combine with Ca & NH4 ions—Adipocere—inhibit
putrefaction.
 Bacterial fat splitting enzymes and moisture are essential –
Lecithinase.
 Adipocere is composed of saturated fatty acids by palmitic,
stearic, hydroxystearic, oleic acids
 It is delayed by heat & hastened by cold
PROPERTIES OF ADIPOCERE
 Yellowish white, soft, greasy wax with sweetish smell.

 It is inflammable.

 It forms at any site where fatty tissue is present.

 Time required: Summer-3 wks, in tropics-5 to 15 days.

 It persists for years or decades.

 MLI: To establish the identity as features preserved

Cause of death

Time since death

Place of death
MUMMIFICATION
 Modification of putrefaction.

 It is a peculiar desiccation of a dead body where by its soft


parts shrivel up but retain the natural appearance and the
features of the body.

 Rusty brown color, dry, leathery skin adherent to bones.

 Internal organs get transformed into a thick brown mass.


MUMMIFICATION
 Mummification occurs in bodies buried in shallow graves, in
dry sandy soils.
 Factors necessary for mummification are:
1. Absence of moisture
2. Dry & warm air
 Time – 3 months to 1-2 yrs
 M.L.I. – Identification
- Cause of death
- Time since death
- Place of death
TIME SINCE DEATH/ PM INTERVAL
 Point to be ascertained are;

1. Cooling of the body

2. Postmortem lividity

3. Rigor mortis

4. Decomposition changes

5. Contents of stomach and bowels

6. Contents of urinary bladder

7. Biochemical changes

8. Circumstantial evidence
SUMMARY
• Late changes are putrefaction, adipocere formation &
mummification

• Adipocere & mummification are modification of putrefaction

• Adipocere is hydrolysis & hydrogenation of fatty tissue into


fatty acids which combine with Ca & NH4 ions.

• Mummification is a peculiar desiccation of a dead body where


by its soft parts shrivel up but retain the natural appearance
and the features of the body.
REFERENCES
Textbooks:

 The essentials of Forensic Medicine and Toxicology by Dr. K.


S. N. Reddy, 33rd edition, 2014.

 Modi’s Medical Jurisprudence and Toxicology, 21st edition


1992.

 Principles of Forensic Medicine by Apurba Nandy, 2nd edition,


2004.
UNIVERSITY QUESTIONS
 What is death? What are the different types of changes after
death? Describe adipocere formation in detail. (6 M)

 What is death? What are the different types of changes after


death? Describe putrefaction in detail. (6 M)

 Mummification (4 M)

 Adipocere formation (4 M)

 Decomposition (4M)
THANK
YOU
ACKNOWLEDGEMENT
Department wishes to acknowledge with thanks

 Efforts of Dr. Arti Kasulkar for making this LRM

 Staff of the department for content validation

 MET department for guidance & format validation

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