CHANGES AFTER DEATH AND DETERMINING THE TIME SINCE

DEATH
Time of (or since) death cannot be assessed with mathematical accuracy. The sooner you do the
examination of the body after death, the closer your approximate estimate to the exact time of
death. The evidence of witnesses as to when the deceased was last seen alive is not always
reliable. After a careful assessment of ALL the scientific data, an opinion should be given about
the time since death. This is mostly of investigational value rather than of evidential value.

Three types of data must be considered to assess the time since death:
1. Progress of changes that occur after death.
2. Cessation of bodily functions at the moment of death
3. Association factors

Progress of changes that occur after death

Early changes
General muscular flaccidity with ability to respond to stimuli.

Eye changes:
• Immediate
o Corneal and light reflex absent (also absent in anesthesia)
o Trucking of blood in retinal vessels
• 2 h - eyeball tension lost
• 4 - 5 h - cornea becomes cloudy (if eyes open)
• 8 - 10 h - cornea becomes cloudy (if eyes closed)

When sclera remains exposed, two yellow triangles of desiccated discoloration appear on each
side of cornea within a few hours, becoming brown or almost black. This is called `tache noire'.

Hypostasis
Discoloration of the dependent parts of the body due to gravitation of blood in the vessels after
death.

Starts in about 30 minutes. Well-marked in 4 - 6 hrs. Complete within about 12 hrs.

The pattern of hypostasis depends on the posture of the body after death. If the body is moved
and dumped in a different position within about 12 hours hypostasis may be seen in two
different positions because original hypostasis may not "move" because it is "fixed".

The color of hypostasis may be a guide to the cause of death - severe terminal anoxia (deep
blue), carbon monoxide poisoning (bright pink), cyanide poisoning and hypothermia (pink or
red).

*If tight clothing has been removed a few hours after death, the areas covered by them appear
lighter than the rest of the skin.

1
Professor Ravindra Fernando
Rigor Mortis
This is a state of rigidity of Muscles that sets in a few hours after death. Every muscle in the body,
voluntary and involuntary, undergoes rigor mortis, including the heart muscle, erector pilae
(causing cutis anserine or goose skin) and dartos of penis.

To maintain the normal state of muscle, contraction and relaxation ATP is necessary. When
sufficient oxygen is not available lactic acid tend to accumulate due to anaerobic respiration.
When lactic acid level reaches a certain level and when the ATP level is 15% the muscles go into
an irreversible state of contraction known as rigor mortis. This stiffening is accompanied by
shortening of the fibers. The period of delay before the onset is due to some resynthesize of ATP
from glycogen.

Time of appearance of rigor mortis

Eye lids - 2 hours. Lower jaw and neck - 2 to 4 hours.

Then rigor appears to pass upwards to the face and down to chest, shoulder, abdomen and
limbs. It develops centrifugally in the limbs. The whole body, except for fingers and toes is in
rigor in about 7 to 8 hours. Fingers and toes appear to be involved in 10 to 12 hours. A body is
in a state of complete rigor for 12-18 hours when putrefaction commences. Rigor disappears in
the same order it appeared in muscle group except in lower jaw where it lasts a longer time.
Rigor may not be present after 36 to 48 hours.

If rigor mortis is broken by extending or flexing a limb it will not reappear.

Factors affecting onset of rigor mortis

a. External temperature: If the temperature of the environment is high rigor mortis appear
quickly. In cold weather rigor mortis is delayed.

b. Activity before death: If there was violent exercise or a struggle before death the rigor
mortis sets in quickly because ATP is already depleted, and muscles may be already short
of oxygen supply for cellular respiration.

c. Extremes of age - rigor mortis is rapid

Conditions resembling rigor mortis

Heat stiffening
All muscle proteins in the body are coagulated at temperatures around 1500 F. When a body is
subjected to temperatures above the coagulation point of muscle protein, rigidity is produced.
This is far more intense than the rigidity of rigor mortis. Changes in posture can be seen due to
muscle contraction. The body may assume the appearance known as 'pugilistic attitude' with
hands clenched arms flexed at elbows, knees bent and head slightly extended. The posture
resembles the position adopted by a person engaged in a fight Heat stiffening persists until
putrefaction occurs.

Cold stiffening
When a body is frozen, body water is converted to ice which stiffens the body. When the body
thaws in a warmer temperature rigor mortis appears rapidly.

2
Professor Ravindra Fernando
Cadaveric spasm
This is a very rare condition. If present it is extremely useful. It is a condition of rigidity that
occurs in a group of muscles which has been active at the moment of death. Cadaveric spasm is
observed in certain types of deaths.
a. Sudden deaths under emotionally tense situations.
e.g. - suicide with shooting or cut-throat - weapon tightly grasped in the hand.
In drowning - twigs and vegetation firmly grasped in the hand. ("dying man clutching at
a straw")

b. Sudden death associated with exertion and exhaustion.

e.g. - soldiers at war - guns tightly held in the hand.

c. Sudden death associated with injury to nervous system.

e.g. - head injury

Cadaveric spasm is the strongest and most conclusive proof that an object gripped in the hand
was thus gripped at the moment of death. It is impossible for the condition to be imitated by
putting a weapon in the hand by someone after death, for example to simulate suicide. Object
tightly grasped by cadaveric spasm require more force to be extracted compared to one grasped
by rigor mortis which can be released by 'undoing' fingers as there is no tight grip. Cadaveric
spasm passes off when putrefaction is advanced. Therefore, cadaveric spasm, if present,
indicates the cause and circumstances of death. It shows what the deceased did at the moment
of death.

Fall of temperature
Normal body temperature is 98.40 F. The environmental temperature is around 800 F. Therefore,
after death the body temperature falls to the level of environmental temperature. (Heat
production continues for about 1/2 h after death. Then the temperature starts falling. If we draw
a graph of temperature against time it will assume a sigmoid curve shape)

For post-mortem work we consider the rectal temperature which is about 990 F normally. This is
not constant. The body temperature varies according to the time of day and will be lowest in the
morning between 2 a.m. and 6 a.m. and highest in the afternoon at 4 - 6 p.m.

Exercise causes a rise in body temperature for about half an hour.

Of all changes that occur in a dead, body cooling to the temperature of surroundings was the
first to be used as an index of time of death. The rate of loss of heat from a cadaver offer a
reliable method of estimating time of death up to a period of about 16 - 24 hours.

Factors affecting rate of heat loss

Time since death:
In the first hour or so after death heat loss is slow due to heat production. After that
temperature falls rapidly for some time. As the body temperature approaches the surrounding
temperature, the rate of loss slows down. (temperature difference is less) - see graph.

3
Professor Ravindra Fernando
Factors in the body itself:
• Cause of death – If there was heat generation before death cooling is slow (e.g. fever,
aspirin poisoning, violence, exercise). In severe bacterial infections and brain stem
hemorrhages temperature may even rise after death.
• State of the body – Fat is a bad conductor of heat and therefore the greater the quantity
and the more general the distribution of the body fat, the slower will be rate of cooling.
Young women commonly have more fat in subcutaneous tissues than young males. A
thin or emaciated person will cool more rapidly because he has no subcutaneous fat.
• Relationship between surface area and weight – If the surface area is more heat is lost
rapidly. Infants, who generally have a bigger surface area compared to the weight, cool
at a faster rate.
• Dampness – If the body is damp cooling is rapid.

External factors:
• Clothing or coverings – cooling slow
• External temperature – If the external temperature is low, rate of cooling is rapid. The
rate of cooling is roughly proportional to the difference in temperature between the
body and its surrounding.
• Humidity – If the humidity is high rate of cooling is slow.
• Ventilation – body lying in a well-ventilated room will cool rapidly because the freely
circulating air will carry away the air warmed by the body.
• Presence of sun, shade, rain, etc.
• Other heat factors – fire, air conditioning, refrigerator.
• Burial in earth – cooling is rapid compared to air usually but depends on the moisture of
the earth.
• In water – cooling is about twice the rate of a body exposed to air.

Determination of time of death from fall of temperature

The following formula is used.
𝑇𝑖𝑚𝑒 𝑠𝑖𝑛𝑐𝑒 𝑑𝑒𝑎𝑡ℎ (𝑇𝑆𝐷)
𝐵𝑜𝑑𝑦 𝑡𝑒𝑚𝑝𝑒𝑟𝑎𝑡𝑢𝑟𝑒 (99℉) − 𝑅𝑒𝑐𝑡𝑎𝑙 𝑇𝑒𝑚𝑝𝑒𝑟𝑎𝑡𝑢𝑟𝑒 (℉)
=
𝐴𝑣𝑒𝑟𝑎𝑔𝑒 𝑟𝑎𝑡𝑒 𝑜𝑓 𝑓𝑎𝑙𝑙 𝑜𝑓 𝑡𝑒𝑚𝑝𝑒𝑟𝑎𝑡𝑢𝑟𝑒 𝑝𝑒𝑟 ℎ𝑜𝑢𝑟 𝑖. 𝑒. 𝐴𝑅𝐹 (℉/ℎ)
In Colombo, ARF = 0.6-0.8 oF/h

Practical aspects
At a "scene of crime/death" take the rectal temperature using a chemical thermometer. Wait
for an hour without disturbing the environment. Take the temperature again. After another hour
take the temperature again. During the two hours do not remove the thermometer.
Initial temperature - 91.0 0F (6 PM)
After 1st hour - 90.2 0F (7 PM)
After 2nd hour - 89.4 0F (8 PM)

Hourly rate of fall:

• 91.0 - 90.2 = 0.8 0F
• 90.2 - 89.4 = 0.8 0F
99 − 91
𝑇𝑆𝐷 = = 10 ℎ
0.8
4
Professor Ravindra Fernando
Time of death 6 PM - 10 hours = 8 AM

Initial period of slow cooling not considered.

Give a range, e.g. 7 - 9 AM
Consider other factors.

Putrefaction
This final stage in the changes following death is characterized by breaking down of all soft tissue
with evolution of foul-smelling gases. This is due to:
• Bacterial enzymes secreted mostly from anaerobic organisms derived from bowel.
Bacteria from air, water and soil also secrete enzymes
• Autolytic enzymes of the body itself which leak out from cells after death, and
• Animal action - chiefly insects; other animals like rats, dogs, fish, crocodiles etc. may also
hasten the putrefactive process by mutilating the tissues.
Various organic chemical compounds are formed during putrefactive process and some of these
are responsible for the unpleasant smell.

Signs of putrefaction
1. 18 - 24 h: Greenish discoloration of the skin of RIF or lower abdomen with a slight
offensive smell. (RIF - Caecum)

2. 30 - 48 h: The discoloration spreads across the whole abdomen.

3. 48 - 72 h: Appearance of purplish red lines over the trunk, the root of neck, upper arms
and thighs. These lines are due to the decomposition and hemolysis of blood in the veins.
This appearance is called "marbling". Abdomen is distended at this stage. Neck is swollen.
Coarse blood-stained froth present in nose and mouth. Blisters or vesicles appear.

4. >4 day: Blisters enlarge, coalesce and rupture releasing foul smelling fluid. The epidermis
peels off easily. The subcutaneous tissues are filled with gases. Hair and nails loose. The
whole body is distended. Tongue and eyeballs are protruded. The epidermis of hands
and feet peel off - glove and stocking form. Identification is difficult.

This state lasts for several days depending on various factors affecting the putrefactive process.
Ultimately all tissues liquefy and are destroyed except bones. Internal organs also undergo
putrefaction. Hollow organs will be distended, and solid organs also are filled with gases. There
will be fluid accumulations in the chest and abdominal cavities.

The gases in the abdomen increase the pressure and lungs are forced upwards and decomposing
blood escapes from mouth and nostrils. Stomach contents may also be forced upwards into the
mouth. Rectum, bladder and pregnant uterus may be emptied by the internal pressure built up
by gases. Internal organs like intestines, stomach, liver, spleen and brain putrefy early. Lungs,
heart, kidneys, bladder, prostate, testis, uterus and ovaries putrefy slowly.

Putrefactive process is quickened by insects and other animals by destroying the tissues. The
maggots will rapidly eat the putrefying tissues.

5
Professor Ravindra Fernando
Factors affecting the rate of putrefaction
The temperature of the environment:
Higher the temperature more rapid the putrefaction is. But in very high temperatures, e.g. ≥1200
F, the tissues rapidly dry-up and bacterial growth stops, and putrefaction does not progress.
At 320 F (freezing point) putrefaction completely stops. A dead body can be preserved
indefinitely in refrigerators, snow, ice or freezing soil.

Moisture:
Putrefaction is rapid when there is lot of moisture. The body contains enough moisture for the
putrefactive bacteria. A human body weighing 60 kg has about 40 kg of water. In an edematous
body putrefaction is rapid (heart/renal failure).

Access to air:
Bacteria need oxygen for growth. Access to air helps putrefaction.

Presence of clothing and wrappings:

Clothing initially hastens the putrefaction by maintaining a high body temperature helping
bacteria. Clothing delays putrefaction by protecting the body from flies and insects.
Tight clothing delays putrefaction because the pressure reduces the amount of blood in the
tissues.

Cause of death:
In deaths from septicemia, intestinal obstruction and septic abortions putrefaction is rapid
because there are already bacteria in the body.
Putrefaction is said to be slow in deaths due to arsenic, organophosphate and mercury
poisoning.

Age and built:

The bodies of newborn or still born infants are normally sterile and therefore putrefaction is very
slow.
If the newborn is fed, because of organisms entering the body, putrefaction is rapid.
In adults, thin bodies putrefy slowly, and fat bodies putrefy comparatively fast.

Mutilation of tissues:
If there was severe bleeding before death putrefaction is slow.
If injuries expose large areas of tissue putrefaction is rapid.

Access to animals:
The presence of insects, rats or other animals will hasten putrefaction.

Putrefaction of bodies in water

Putrefaction is slow in water compared to air. When a body is floating in water head floats lower
than the rest of the body. Therefore, blood, gravitates to head and neck and these areas putrefy
quicker than the rest of the body. Putrefaction is rapid in stagnant or polluted water compared
to fresh, running water. Crabs, fish or crocodiles may attack the body and hasten the putrefactive
process. Although the putrefaction is slow in water once the body is taken out it putrefies rapidly.

6
Professor Ravindra Fernando
Adipocere
This postmortem change is not commonly seen. The term adipocere means fat and wax. The
properties of adipocere are intermediate between fat and wax. Adipocere is a greyish-white
greasy friable substance with an unpleasant rancid smell. It floats in water and is soluble in
alcohol and ether.

Adipocere is formed by the hydrolysis and hydrogenation of body fats after death by the action
of bacterial enzymes. The main constituent of adipocere is palmitic acid. There are other
saturated fatty acids also.

Adipocere will form wherever there is body fat. Water is essential for its formation.
Face, buttocks, abdominal wall, chest and limbs of fat bodies are the commonest sites.

Adipocere is formed in bodies that are in water or buried in water-logged soil. The temperature
should be reasonably high for this process.

Adipocere formation may be seen in about 3 weeks. Adult limb may be converted to adipocere
in about 3-6 months. Adult body may be converted to adipocere in about 12 months. These
times depend on the temperature.
The formation of adipocere is similar to the hydrogenation of vegetable fats in the manufacture
of margarine, both consisting of the hydrogenation of unsaturated fatty acids.

Medico-legal significance
Estimation of time of death
Conditions of burial
Body features may be identified
Injuries can be recognized

Mummification
This is the conversion of the tissues into a dried, shrivelled form. Dry warm atmosphere or burial
in such conditions favor mummification.
Lack of moisture and high temperature prevents proliferation of putrefactive organisms and
body tissues mummify. If a body is buried under a fireplace or hot, dry sand mummification may
occur.
The tissues dry up and lose water during mummification. Sometimes certain parts only may
show mummification. The mummification of infants is common because to conceal the birth
they may be buried soon after birth in warm dry places. Due to lack of organisms at birth
putrefaction does not take place rapidly.

Medico-legal significance
Estimation of time of death – mummification takes place within weeks of death. This is a rough
estimate only.
Conditions of burial.
Injuries may be recognized.

7
Professor Ravindra Fernando
Skeletonization
The extremities of the limbs (hands and feet) may skeletonise in 7 days.
It may take 3-4 weeks for complete skeletonization of a body in air without animal attacks.
The skeleton will be heavy, moist, oily, emanating a putrefactive odor and will contain fleshy
tags, capsules and ligaments.
At 3 months the bones may be disarticulated, lighter, less moist and oily, little putrefactive odor.
May be free of flesh tags but may contain ligaments etc.
At 12 months the bones are light, dry, no odor and free of ligaments. Drilling may produce bone
flakes.
Very old bones are porous, and drilling will result in powdery bone formation

Biochemical changes
The body fluids undergo changes after death. The amount of blood sugar, blood urea, lactic acid
and electrolyte levels change. Studies of blood, CSF and vitreous humor were made to correlate
with time since death. However, the results are unreliable.

Some scientists have found vitreous potassium levels to be a useful guide to assess the time of
death. But there is no confirmatory evidence to support that theory.

Cessation of bodily functions at the moment of death

Passage of food along the GIT
Stomach starts emptying within about 10 minutes after the first mouthful of a meal. A full rice
and curry meal takes about 6-8 hours to be completely expelled from the stomach. A small meal
obviously will be emptied quicker than a large meal.

In the small intestine the head of a solid meal progresses at the rate of about 6- 7 feet per hour.
It reaches the end of small intestine in about 3-4 h. At the ileocecal junction it may stagnate for
about an hour.

The head of the meal reaches hepatic flexure of colon in about 6 hours, splenic flexure in about
9-12 hours and the pelvic colon in about 12-18 hours.

If the time of the last meal is known, by a careful examination of the gastro-intestinal tract for
the head of the meal, the time of death can be approximately estimated.

Factors modifying the rate of passage of food

• Consistency of the meal – liquids fastest and solid meals slowest
• Nature of the meal – a spiced meal travel faster than a fatty meal. Strong alcohol, such
as spirits and liqueurs irritate the mucosa and tend to delay emptying. Fat and oil slow
the rate of pyloric opening.
• Quantity of the meal – a large quantity will remain for a longer time.
• Condition of the GIT – diarrhea or digestive disorders may vary the rate of passage.
• Shock – any nervous or systemic shock or stress mediated through the parasympathetic
(vagus) system can slow or stop gastric motility and digestive juice secretion as well as
holding the pylorus firmly closed. The intestines may increase the motility with stress.
Severe head injuries may completely stop passage of food.

8
Professor Ravindra Fernando
Medico-legal significance
Estimation of time of death – not a very reliable method.
Nature of last meal – food particles can be identified.
To confirm whether a person took a meal at a particular time – this is useful to prove or disprove
a statement of a witness.

Excretion of urine
Normal rate in a healthy adult is about 1 ml/min. If the time a person passed urine for the last
time prior to death is known, the time elapsed since can be estimated from the amount of urine
present in the bladder. This will help to assess the time since death.
However, the rate of secretion of urine is not constant, and depends on a person's fluid intake,
time of the day and kidney function etc. Therefore, this is not a very reliable method to assess
the time of death.

Growth of hair
Facial hair grows at a rate of about 0.4 mm/day. Therefore, if the time a person had his last shave
is known, time elapsed since then and the time of death can be assessed by the length of the
facial hair. This again is not reliable.

Association or incidental factors

Any other evidence associated with the body or its surroundings at the time of death may be
useful to estimate the time of death.

Entomology of the cadaver

Type of clothing worn
Lights switched off or on
Delivery of letters, newspapers, milk etc.
Time the wristwatch has stopped

9
Professor Ravindra Fernando