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Postmortem Findings in Important Cases

1. HANGING (Asphyxia)

External Findings

• Ligature mark: Oblique furrow (inverted V / inverted U shape), does not completely encircle the neck - runs upward toward the knot. Pale, yellowish-brown, parchment-like due to drying.
• Mark is located above thyroid cartilage (vs. strangulation: below or at cartilage level).
• Congestion and cyanosis of face (in partial/slow death).
• Petechiae - in eyes (conjunctivae), face, and behind ears (Tardieu's spots).
• Tongue may protrude; saliva may dribble from mouth.
• Frothy fluid from mouth/nostrils.
• Pugilistic attitude (boxing posture) if fire/burns also involved.

Internal Findings

• Intimal tear at the carotid bifurcation (Simon's sign) - seen in judicial hanging.
• Fracture-dislocation of 2nd and 3rd cervical vertebrae - "Hangman's fracture" in judicial/drop hanging.
• Rupture of the odontoid process.
• Brain: congestion and petechial hemorrhages.
• Lungs: congested with petechiae on pleura.
• Heart: right side engorged with dark blood.
• Visceral congestion throughout.

Key: In partial hanging - all typical asphyxial signs present. In judicial hanging - cervical fracture + transection of spinal cord is the cause of death.

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2. DROWNING

External Findings

• Maceration of skin - "washer woman's hands" (wrinkled, pale, sodden fingertips/palms/soles).
• Cutis anserina (goose flesh) - due to cold water; persists after death.
• Glove and stocking separation - peeling of skin from hands/feet in prolonged immersion.
• Frothy fluid/foam from mouth and nostrils (mushroom-shaped froth).
• Cyanosis of face, lips.
• Fingernails and hair loosened.
• Algae growth on exposed parts in prolonged immersion.
• Adipocere formation is common.

Internal Findings

• Lungs: Over-distended, waterlogged, pitting on pressure, pale, frothy fluid on cut section (emphysema aquosum). Lungs overlap the pericardium.
• Diatoms found in lung tissue, bone marrow, liver, kidney - confirm drowning.
• Stomach: contains water, sand, mud, algae (if conscious when entered water).
• Haemoconcentration in freshwater drowning (hypotonic water absorbed → red cell lysis → hemolysis).
• Hemoconcentration in salt water drowning (hypertonic → plasma shifts out → hemoconcentration).
• Middle ear hemorrhage.
• Pleural effusion (especially in salt water drowning).

Key Diatom Test: Diatoms in lung AND bone marrow = ante-mortem drowning. Only in lungs = post-mortem immersion.

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3. BURNS & FIRE DEATHS

External Findings

• Pugilistic (boxer) attitude: Muscles contract due to heat → flexion at elbows, knees, wrists, fingers. This is a postmortem change, NOT a sign of antemortem struggle.
• Heat rigor: Stiffening due to heat coagulation of muscle proteins (not true rigor mortis).
• Skin: charring, split wounds (heat lacerations - simulate incised/lacerated wounds).
• Unburnt groove around neck due to collar = may resemble strangulation mark.
• Hair: singed, bulbous ends at intervals; light hair becomes reddish at ~120°C.
• Froth at mouth/nose = victim was alive during fire (breathing hot air → pulmonary oedema).

Signs of Antemortem Burns (vital reactions)

• Soot in airways (trachea, bronchi, alveoli) - strongest evidence victim was alive.
• Carboxyhemoglobin (COHb) >10% in blood.
• Soot on laryngeal mucosa below vocal cords.
• Vital blistering (fluid in blisters contains protein + white cells).

Internal Findings

• Heat hematoma (epidural): Chocolate-colored, honeycomb-appearing clot due to steam bubbles; NOT associated with skull fracture. Mimics extradural hemorrhage. Most common in parietotemporal region.
• Skull: Explosive fractures (round holes in vertex from steam pressure).
• Brain: shrunken, firm, yellow-brown (cooked). Gyri flattened.
• Lungs: congested, oedematous, consolidated, heavy.
• Curling's ulcers: Duodenal stress ulcers (first part of duodenum) in ~10% of extensive burn cases, around day 10.
• Petechiae: pleurae, pericardium, endocardium (unless organs cooked).
• Carbon soot in airways = absolute proof of inhalation during life.

Postmortem lividity color in burns: Pink/cherry-red if COHb present.

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4. POISONING - Postmortem Lividity Colors (Key Memory Table)

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5. CARBON MONOXIDE (CO) POISONING

Postmortem Findings

• Cherry-red / carmine-red postmortem staining (livor mortis) - pathognomonic.
• Blood is cherry-red and does not clot readily.
• All organs and muscles appear bright cherry-red.
• Brain: congested, cherry-red, edematous, petechiae ("ring hemorrhages" around small vessels).
• Bilateral necrosis of globus pallidus - specific for CO poisoning.
• Lungs: bright pink/red, congested, edematous.
• COHb level in blood: >50% = fatal; >70% = rapidly fatal.
• Skin may show blistering (rare).

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6. CYANIDE POISONING

• Bitter almond smell from body, stomach, viscera.
• Bright-red livor mortis (similar to CO but no COHb).
• Organs appear bright red.
• Stomach: brick-red congested mucosa.
• Pulmonary oedema.
• No specific pathognomonic internal change - diagnosis by chemical analysis.

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7. ORGANOPHOSPHATE (OP) POISONING

• Smell of garlic/kerosene from body and stomach.
• Pupillary miosis (small pupils).
• Excessive secretions - froth in airway, lungs oedematous (pulmonary oedema).
• Gastric mucosa: congested, hemorrhagic.
• No pathognomonic finding; cholinesterase levels in blood/brain confirm diagnosis.
• Brain: cerebral oedema.

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8. ARSENIC POISONING

Acute arsenic

• Gastric mucosa: brick-red, thickened, ecchymotic. "Leathery" mucosa.
• Haemorrhagic gastroenteritis.
• Fatty degeneration of liver, kidney, heart.

Chronic arsenic

• Mee's lines (white transverse bands on nails).
• Arsenical melanosis: "rain drop" pigmentation on skin.
• Hyperkeratosis of palms and soles.
• Body well-preserved (arsenic is a preservative).
• Hair and nails: arsenic detected by Reinsch test / neutron activation analysis.
• Peripheral neuropathy changes in nerves.

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9. ALCOHOL (Ethanol) Poisoning

• Smell of alcohol from body, blood, stomach.
• Gastric mucosa: congested, erosions.
• Brain: congested, edematous.
• Fatty liver / cirrhosis in chronic cases.
• Acute: pulmonary edema, aspiration pneumonia.
• Blood alcohol >400-500 mg% = usually fatal.

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10. HYPOTHERMIA (Cold Deaths)

• Postmortem lividity: Pink or pink-red (unusual; due to cold preventing Hb deoxygenation).
• "White deaths" - skin may appear white.
• Bluish discoloration on hands, elbows, knees (frostbite).
• Wischnewski spots (Vishnevsky spots): Brownish-red oval hemorrhagic erosions on the gastric mucosa - pathognomonic for death due to cold.
• Heart: dilatation of right atrium and ventricle; congestion of venae cavae.
• Trachea: frothy, sanguineous fluid.
• Lungs: congested, oedematous, hemorrhages.
• Kidney: acute tubular necrosis.
• Liver/spleen: congested.
• Fat deposition in cardiac and skeletal muscles; focal myocardial necrosis.
• Brain: cerebral oedema.

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11. LIGHTNING STRIKE

• Arborescent (Lichtenberg figures / ferning pattern): Branching, fern-like red/pink marks on skin (pathognomonic).
• Metallic objects on body may be magnetized.
• Clothes may be torn, tattered, or blast off.
• Shoes may be burst.
• Siderosis: Metallic particles deposited on skin.
• Skull: petechiae and fractures.
• Internal: hemorrhages in brain, lungs.
• Tympanic membrane may be ruptured.
• Eyes: retinal hemorrhage, corneal burns.
• Cardiac arrest (ventricular fibrillation).
• Hair may be singed; body may be partially burnt.

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12. ELECTROCUTION (Electrical Burns)

• Joule burns (electrothermal burns): At point of entry/exit. Entry wound = small, depressed, charred, surrounded by pale zone. Exit wound = usually larger, more ragged.
• "Crocodile skin" appearance at contact site.
• Metallic imprint on skin (from the conductor).
• Internal: hemorrhages, myocardial necrosis.

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13. STRANGULATION (Ligature/Manual)

Ligature Strangulation

• Ligature mark: horizontal, completely encircles the neck, below the thyroid cartilage.
• Mark is more deeply defined than in hanging.

Manual Strangulation (Throttling)

• Fingermarks (contusions/abrasions) on neck - multiple oval/circular bruises.
• Petechiae: prominent on conjunctiva, face, eyelids.
• Fracture of thyroid cartilage and hyoid bone (more common than in hanging).
• Hemorrhage into strap muscles of neck.
• Deep hemorrhage at back of neck (posterior cervical muscles).

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14. SMOTHERING

• External: may be no marks on face (especially in infants - overlaying/SIDS).
• Petechiae in conjunctivae.
• Blood-tinged froth from mouth/nostrils may stain bedclothing.
• Absence of injury marks over body in overlaying.

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15. FIREARM INJURIES - Key PM Findings

• Stellate laceration: Contact shot to head - gases expand under skin.
• Powder tattoo: Embedded gunpowder particles in skin (indicates firing within 2 feet).

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16. TRAUMATIC (CRUSH) ASPHYXIA

• Tardieu's spots: Petechial hemorrhages on face, conjunctiva, sclera, lungs, pleura, pericardium.
• Cyanosis of upper body above the line of compression.
• Congestion of head, neck, and face (marked).
• Petechiae above the pressure line - trunk/thorax.

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QUICK MEMORY TABLE: Organ-Specific PM Findings

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COLOUR OF POSTMORTEM STAINING - Quick Reference

• Cherry red = CO poisoning, CN poisoning
• Pink/light red = Cold exposure, refrigerated bodies
• Brown/chocolate = Nitrites, chlorates, aniline
• Dark brown = Phosphorus
• Normal purple = Asphyxia, most deaths

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