Tag Archives: Death

MORTIS – UNDERSTANDING BODY CHANGES AFTER DEATH

AA5Many crime writers mistakenly believe there’s a precise science to pronouncing time of death (TOD). There is a progressive process, but the sequence and time intervals are influenced by many factors. To craft convincing death scenes, authors need to know how a body actually breaks down.

Mortis is the anatomical term for changes in a body after the moment of death. Medically, that’s when the central nervous system gets unplugged and oxygenated blood is no longer delivered to the tissues, which naturally start recycling. The five types of mortis are:

  • Rigor – stiffening of muscles

  • Livor – settling of blood

  • Algor – change in temperature

  • Palor – change in color

  • Decomp – breakdown in tissue

AA6All these mortis conditions are integral to a decomposing process. Death is a part of life and decomposition is a part of death. Just as life is not always predictable, neither is estimating the post-mortem interval (PMI) between when death anatomically occurred and when first examination of the body begins.

Death investigations work on a triangle of Body – Scene – History. It’s a holistic approach to determining cause of death (COD) and it’s the coroner’s responsibility to answer five universal questions:

  • Who is the deceased?

  • Where did they die?

  • When did they die?

  • What caused their death?

  • What was the means of death?

AA7Some people are confused about the difference between cause and means. Cause is the medical reason. In this fellow’s case the cause of death would be traumatic brain injury. Means is the mechanism or physical reason – gunshot wound to the forehead.

There can be thousands of causes of death, but there are only five classifications:

  • Natural

  • Accidental

  • Suicide

  • Homicide

  • Undetermined

AA8How this ties into mortis is that satisfying the five universal questions, great weight is placed on interpreting the body’s condition when first examined. This is where understanding the mortis process is so important and a lot of the interpretation comes from years of experience.

The proper pronunciation of the mortis states puts emphasis on the first syllable and it’s a long ‘I’ (RYE-gore).

Let’s look at each one.

Rigor Mortis is the stiffening of muscles. It’s caused by the body’s energy source, adenosine triphosphate (ATP), being depleted. With no energy left to keep the muscles flexible, they naturally go to a rigid state until another enzyme begins the breakdown of tissue and relaxation returns.

AA10Immediately upon death, the body enters a brief period of primary flaccidity where it’s dead limp. Depending on many factors, temperature and body mass being the big ones, the muscle stiffening begins in 1- 2 hours, first setting into the eyelids, jaw, and neck. It proceeds to the limb joints and extremities after 4-8 hours and fixes in the organs in about 12 hours. Rigor releases in a reverse sequence and can be absent in as little as 12 hours or can stay for days, again depending on factors.

Livor Mortis is the pooling of blood caused by gravitational settling once the heart stopped pressurizing the vascular system. It’s evident by purplish-red blotching where blood is free to pool and blanched-white where pressure points restrict it. Lividity, as it’s also known, sets in between 30 minutes to 1 hour after death and ‘fixes’ in about 8-12 hours. ‘Fixing’ is the entire settling where blood has coagulated and no longer runs free.

Algor Mortis is the change in body temperature. A cadaver will always achieve ambient temperature, regardless of time. A normal, living human’s core temperature is 36 Celsius (98.6 Fahrenheit) but the scene temperature could be anywhere above or below. In a cold environment, the body will drop to equilibriate. In a hot environment, it will rise. Here’s where so many peripheral factors come into play. Body size. Layered Clothing. Air movement. And the list goes on. A rule of thumb is that a body’s temperaature will change about 1 degree Celsius per hour.

AA11Palor Mortis is the change of color. Live humans are pretty much a reddish tinge due to oxygenated blood flowing (different tones for different races). Immediately upon death, a bluing phase occurs, following by a grey, then a white, and it can be a rainbow of colors as decomposition takes over.

Decomp, or decomposition, is not really a true class of mortis – rather it’s the culmination of the four mortis processes which leads to a breakdown of the body tissues and a return to nature.

Decomposition is a complex and unpredictable thing. There are two processes that morph into one:

  • Putrefaction – action of bacteria on body tissues

  • Autolysis – body breakdown by endogenous substances

AA9In most deaths these two work in tandem, starting with a breakdown in internal organs which produces gas. This causes bloating and skin discoloring, as well as the foul odor from purging or ‘gassing-off’. As the muscle tissues change, the skin begins to dislodge, the joints become loose enough to disarticulate, fats become liquefied, and bones become exposed. Advanced decomp can become skeletonized, mummified, or consumed – again depending on so many factors, which all start from the mortis process.

The changes in a human’s body after death can be just as varied as their experiences in life.

Biological, environmental, and circumstantial factors will shape your death, just like they’re shaping your life.

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I originally wrote this post for Kristen Elise, PhD, on her blog site at MurderLab.com. I think it’s useful information for other crimewriters so I shared it here at DyingWords. Here’s the link to the original post on Kristen’s site:

http://www.murderlab.com/2015/07/mortis-understanding-body-changes-after.html

CRUCIFIXION — THE ANATOMICAL CAUSE OF JESUS CHRIST’S DEATH

This material is based on an article by Dr. C. Truman Davis and first published by the Christian Broadcasting Network. This appears to be a very factual look at how Jesus Christ really died.

A29Some time ago after reading Jim Bishop’s The Day Christ Died, I realized that for years I’d taken the Crucifixion more or less for granted — I’d grown callous to its horror by a too easy familiarity with the grim details and a too distant relationship with Jesus. Now, at Easter, it occurred to me that even with a significant background in medical death investigation, I didn’t know anything about the actual anatomical cause of Jesus Christ’s death.

The Gospel writers don’t help us much on this point because crucifixion and scourging were so common during their lifetime that they apparently considered a detailed description unnecessary. So we have only the concise words of the Evangelists: “Pilate, having scourged Jesus, delivered Him to them to be crucified — and they crucified Him.”

I have no competence to discuss the infinite psychic and spiritual suffering of the Incarnate God atoning for the sins of fallen man. I honestly don’t understand that. But I was curious about investigating the physiological and anatomical aspects of the Lord’s passion in detail.

A34What did the body of Jesus of Nazareth actually endure during those hours of torture? 

This led first to a study of the practice of crucifixion itself; that is, torture and execution by fixation to a cross. I’m indebted to many who’ve studied this subject in the past — especially Dr. Pierre Barbet, a French surgeon who’s done exhaustive historical and experimental research and written extensively on the subject.

Apparently, the first known practice of crucifixion was by the Persians. Alexander and his generals brought it back to the Mediterranean world — to Egypt and to Carthage. The Romans learned the practice from the Carthaginians and (as with almost everything the Romans did) rapidly developed a very high degree of efficiency and skill at it. A number of Roman authors (Livy, Cicer, Tacitus) comment on crucifixion. Several innovations, modifications, and variations are described in the ancient literature.

A25For instance, the upright portion of the cross (or stipes) could have the cross-arm (or patibulum) attached two or three feet below its top in what we commonly think of as the Latin cross. The most common form used in Jesus’s day, however, was the Tau cross, shaped like our T.

In this cross, the patibulum was placed in a notch at the top of the stipes. There is archeological evidence that it was on this type of cross that Jesus was crucified. Without any historical or biblical proof, Medieval and Renaissance painters have given us our picture of Christ carrying the entire cross. But the upright post, or stipes, was generally fixed permanently in the ground at the site of execution and the condemned man was forced to carry the patibulum, weighing about 110 pounds, from the prison to the place of execution.

A7Many of the painters and most of the sculptors of crucifixion also show the nails through the palms. Historical Roman accounts and experimental work have established that the nails were driven between the small bones of the wrists (radial and ulna) and not through the palms. Nails driven through the palms will strip out between the fingers when made to support the weight of the human body. The misconception may have come about through a misunderstanding of Jesus’ words to Thomas, “Observe my hands.” Anatomists, both modern and ancient, have always considered the wrist as part of the hand.

A titulus, or small sign, stating the victim’s crime was usually placed on a staff, carried at the front of the procession from the prison and later nailed to the cross so that it extended above the head. This sign with its staff nailed to the top of the cross would have given it somewhat the characteristic form of the Latin cross.

A27But the physical passion of Christ began in Gethsemane. Of the many aspects of this initial suffering, the one of greatest physiological interest is the bloody sweat. It is interesting that St. Luke, the physician, is the only one to mention this. He says, “And being in agony, He prayed the longer. And His sweat became as drops of blood, trickling down upon the ground.”  Every ruse (trick) imaginable has been used by modern scholars to explain away this description, apparently under the mistaken impression that this just doesn’t happen. A great deal of effort could have been saved had the doubters consulted medical literature.

Though very rare, the phenomenon of Hematidrosis, or bloody sweat, is well documented. Under great emotional stress of the kind Jesus suffered, tiny capillaries in the sweat glands can break, thus mixing blood with sweat. This process might well have produced marked weakness and possible shock.

A17After the arrest in the middle of the night, Jesus was brought before the Sanhedrin and Caiphus, the High Priest. It’s here the first physical trauma was inflicted. A soldier struck Jesus across the face for remaining silent when questioned by Caiphus. The palace guards then blindfolded him and mockingly taunted him to identify them. As each passed by, they spat upon Jesus and struck him in the face.

In the early morning — battered, bruised, dehydrated and exhausted from a sleepless night — Jesus was taken across the Praetorium of the Fortress Antonia, the seat of government of the Procurator of Judea, Pontius Pilate. Pilate passed responsibility to Herod Antipas, the Tetrarch of Judea. Jesus apparently suffered no physical mistreatment at the hands of Herod and was returned to Pilate.

It was then, in response to the cries of the mob, that Pilate ordered Bar-Abbas released and condemned Jesus to scourging and crucifixion.

A15There is much disagreement among authorities about the unusual scourging as a prelude to crucifixion. Most Roman writers from this period do not associate the two. Many scholars believe that Pilate originally ordered Jesus scourged as his full punishment and that the death sentence by crucifixion came only in response to the taunt by the mob that the Procurator was not properly defending Caesar against this pretender who allegedly claimed to be the King of the Jews.

Preparations for the scourging were carried out when Jesus was stripped of his clothing and his hands tied to a post above his head. It’s doubtful the Romans would have made any attempt to follow the Jewish law in this matter but the Jews had an ancient law prohibiting more than forty lashes. The Roman legionnaire stepped forward with the flagrum (or flagellum) in his hand. This is a short whip consisting of several heavy, leather thongs with two small balls of lead attached near the ends of each. The heavy whip was brought down with full force again and again across Jesus’ shoulders, back, and legs.

A16At first, the thongs cut through the skin only. Then, as the blows continued, they cut deeper into the subcutaneous tissues producing first an oozing of blood from the capillaries and veins of the skin then finally spurting arterial bleeding from vessels in the underlying muscles. The small balls of lead produced large, deep bruises which were broken open by subsequent blows. Finally, the skin of Jesus’s back would be hanging in long ribbons and the entire area an unrecognizable mass of torn, bleeding tissue.

When it was determined by the centurion in charge that Jesus was near death, the beating finally stopped.  The half-fainting Jesus was untied and allowed to slump to the stone pavement, wet with his own blood.

A10The Roman soldiers saw a great joke in this provincial Jew claiming to be king. They threw a robe across his shoulders and placed a stick in his hand for a scepter. They still needed a crown to make their travesty complete so flexible branches covered with long thorns (commonly used in bundles for firewood) were plaited into the shape of a crown and pressed into Jesus’s scalp. Again, there was copious bleeding — the scalp being one of the most vascular areas of the body.

After mocking Jesus and striking him across the face, the soldiers took the stick from his hand and struck him across the head, driving the thorns deeper into his scalp. Finally, they tired of their sadistic sport and the robe was torn from his back. Already having adhered to the clots of blood and serum in the wounds, its removal would have caused excruciating pain just as in the careless removal of a surgical bandage. It was almost as though Jesus were whipped again and the wounds once more began to bleed.

A22In deference to Jewish custom, the Romans returned his garments. The heavy patibulum of the cross was tied across Jesus’s shoulders and the procession of the condemned Christ, two thieves, and the execution detail of Roman soldiers headed by a centurion began a slow journey along the Via Dolorosa.

In spite of Jesus’s efforts to walk erect, the weight of the heavy wooden beam, together with the shock produced by copious blood loss, would be too much. He stumbled and fell. The rough wood of the beam gouged into the lacerated skin and shoulder muscles. Jesus tried to rise but his human muscles were pushed beyond their endurance. 

The centurion, anxious to get on with the crucifixion, selected a stalwart North African onlooker, Simon of Cyrene, to carry the cross. Jesus followed, still bleeding and sweating the cold, clammy sweat of shock until the 650-yard journey from the fortress Antonia to Golgotha was finally completed. Jesus was offered wine mixed with myrrh, a mild analgesic mixture. He refused to drink. Simon was ordered to place the patibulum on the ground and Jesus was quickly thrown backward with his shoulders against the wood.

A9The legionnaire felt for the depression at the front of Jesus’s wrist. He drove a heavy, square, wrought-iron nail through the wrist and deep into the wood. Quickly, he moved to the other side and repeated the action, being careful not to pull his arms too tightly, but to allow some flexion and movement. The patibulum was then lifted in place at the top of the stipes and the titulus reading “Jesus of Nazareth, King of the Jews” was nailed in place.

Jesus’s left foot was now pressed backward against his right foot and with both feet extended, toes down, a nail was driven through the arch of each, leaving his knees moderately flexed.

Jesus was now crucified.

As he slowly sagged down with more weight on the nails in the wrists, excruciating pain would have shot along Jesus’s fingers and up the arms to explode in the brain — the nails in the wrists putting pressure on the median nerves.

A35Jesus would have pushed himself upward to avoid this stretching torment and he’d have placed his full weight on the nail through his feet. Again, there would be searing agony of the nail tearing through his nerves between the metatarsal bones of the feet.  At this point, as his arms fatigued, great waves of cramps would have swept over Jesus’s muscles, knotting them in deep, relentless, throbbing pain. With these cramps would come the inability to push himself upward.

Hanging by his arms, the pectoral muscles would be paralyzed and Jesus’s intercostal muscles would be unable to act.

As air could be drawn into the lungs but not exhaled in this position, Jesus would have fought to raise himself in order to get even one short breath. Finally, carbon dioxide would build up in his lungs and in the blood stream — the cramps would partially subside. Spasmodically, Jesus would push himself upward to exhale and bring in the life-giving oxygen.

A1Jesus would have experienced several hours of limitless pain, cycles of twisting, joint-rending cramps, intermittent partial asphyxiation, and searing pain where tissue was torn from his lacerated back as he moved up and down against the rough timber.

Then another agony began — a terrible crushing pain deep in the chest as Jesus’s pericardium slowly filled with serum and began to compress the heart.

This is documented in the 22nd Psalm, 14th verse: “I am poured out like water, and all my bones are out of joint; my heart is like wax; it is melted in the midst of my bowels.”

A19It was now almost over. The loss of tissue fluids had reached a critical level — Jesus’s compressed heart struggling to pump heavy, thick, sluggish blood into the tissue — his tortured lungs making a frantic effort to gasp in small gulps of air — the markedly dehydrated tissues sending their flood of stimuli to his brain.

Jesus gasped “I thirst.” 

Another verse from the prophetic 22nd Psalm refers to this. “My strength is dried up like a potsherd; and my tongue cleaveth to my jaws; and thou has brought me into the dust of death.” A sponge soaked in posca, the cheap, sour wine which is the staple drink of the Roman legionaries, was lifted to his lips but Jesus apparently didn’t take any liquid.

A40Jesus’s body was now in extremes — he would be able to feel the chill of death creeping through his tissues. This realization brought out his words, possibly little more than a tortured whisper. “It is finished.”  Jesus’s mission of atonement was completed and, finally, he could allow his body to die. With one last surge of strength, Jesus would again press his torn feet against the nail, straighten his legs, take a deeper breath, and utter a last cry. “Father! Into thy hands I commit my spirit.”

In order that the Sabbath not be profaned, the Jews asked that the condemned men be dispatched and removed from the crosses. The common method of ending a crucifixion was by crurifracture — the breaking of the leg bones. This prevented the victim from pushing himself upward — the tension could not be relieved from the muscles of the chest and rapid suffocation occurred. The legs of the two thieves were broken but when the soldiers came to Jesus they saw this was unnecessary.

Apparently, to make doubly sure of death, the legionnaire drove his lance through the fifth interspace between Jesus’s ribs — upward through the pericardium and into the heart.

A41The 34th verse of the 19th chapter of the Gospel according to St. John reports, “And immediately there came out blood and water.” That is, there was an escape of watery fluid from the sac surrounding the heart. This is solid postmortem evidence that Jesus died not the usual crucifixion death by suffocation. The actual anatomical cause of Jesus Christ’s death was heart failure due to shock and constriction of the heart by fluid in the pericardium.

This is our glimpse — including the medical evidence — of that epitome of evil that man has exhibited toward man and toward God.

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DYING WITH DIGNITY

SAS_ChurchLet’s face it. We’re all going to die one day. You. Me. Our parents. Our children. Friends. Neighbours. Co-workers. Even our pets. It makes me wonder why we have so much trouble accepting the inevitable, especially in artificially prolonging life when a person’s entire quality of life is gone, never to return, and they spend their final days in suffering – not just pain and discomfort, but in a total loss of their dignity as a human being.

During my time as a coroner I heard from a lot of family members about the agony that not only the deceased suffered in their final days, but what the ones left behind endured. Inevitably that led to discussions about the ethics of euthanasia.

Death2Euthanasia was also a topic behind closed doors within my medical and legal colleagues. Without question, there are cases of assisted suicide that are overlooked by the authorities and I’m sure that some of the ‘natural’ deaths in seniors care homes are ‘helped along’ by a generous dose of pain killer.

Several years ago I watch as my ninety-five year old mother wasted away in the final months of her long and fulfilled life. It was absolute agony, not so much for Mum, because she was medicated to the point of being mostly unconscious, but for myself and other family members. To see such a vibrant person being ‘punished’ by dragging out her journey to everlasting peace and tranquility was heartbreaking.

I did a lot of soul searching during that time.

Death7I’ll admit that it was tempting to intervene and put Mum out of her misery. I know that’s what she wanted, because we’d had that discussion, but the legal ramifications were far too serious to consider bringing that monster into the family. So, we just bided our time while she literally wasted away in a nursing home bed until her life and dignity exhausted.

I wouldn’t treat my dog that way. When his quality of life is gone, I’ll take him into the vet and have him put to sleep. After all, it’s the humane thing to do.

So why are we so cruel to our fellow humans?

Death4I say the problem lies right in the hands of our legal system. Not our ‘justice’ system. Our ‘legal’ system.

There’s a fine line between the moral and practical approach to death. It’s the moral tail that wags the practical dog in the debate over euthanasia and it needs to be put to rest.

Don’t get me wrong. I’m not advocating involuntary euthanasia or playing God against a terminally ill person’s wishes. That’s a ‘slippery slope’ for society to slide down. I’m talking about the legalization of medically assisted suicide, or mercy killing, when the patient – in sound mind – has clearly expressed their desire to be euthanized when their quality of life has expired.

Death6We’ve been using Do Not Resuscitate (DNR) orders for years and our system totally accepts the moral and legal reasoning behind them. We also ‘pull-the plug’ on people who are brain dead but their body still functions.

What I want for myself, and I’ve told my next-of-kin this, is a Put Me Out Of Misery (PMOOM) order. When my quality of life is gone, the last thing I want to do is unnecessarily delay the inevitable. Out of sheer respect for my dignity, somebody please give me a push over the edge.

I believe it’s the humane thing to do, but that’s just my opinion.

What do you think? I’m dying to hear your words.