Somatic ,molecular and Sudden Death.

Introduction

• Thanatology  is  the  branch  of science  which  deals  with  study of death,  it  deals with death in all  aspects
• Death denotes  death  of human  being (46  IPC).  It is  defined  as cessation  of  life  or  cesation  to  exist.  

Death is  of two  types

1. somatic  death  (systemic  death  or  clinical death)
2. molecular  death  (cellular  death).

Somatic death (svstemic  death  or  clinical death)

• It  is  the  complete  and irreversible  stoppage  of  the  circulation, respiration and  brain  functions (bishop’s  tripod  of life).
• Also called as clinical death or systemic death, Somatic death is characterized by complete loss of sensibility and the ability to move.
• Somatic  death  is  due  to  stopped  aerobic  processes.  However,  anaerobic  enzymatic  processes  are  still  continuing,  hence : Muscles still  respond  to  mechanical, elecfiical and  thermal  stimuli.
• Signs of  brain stem  (lower)  destruction:- Apnea,  pulse  rate invariant  and unresponsive  to  atropine.
• Absent  of  brainstem  reflexes  :  Pupillary  reflex,  oculovestibular reflex, corneol  reflex, pharyngeal and tracheal  reflexes.

 

Somatic death is diagnosed by establishing the following three facts:

1. Cessations of heart beating – careful auscultation of precordium for the heart sounds by a stethoscope continuously, for 5 minutes, and then repeating it thrice, at an interval of 5 minutes. A flat electrocardiogram (ECG) may also confirm it.
2. Cessation of breathing – by thorough auscultation of the chest for the breath sounds using a stethoscope.
3. Cessation of brain activity – by the dilated fixed pupil  and absence of pupillary and corneal reflexes. A flat Electroencephalogram (EEG) would confirm it

Molecular  death (cellular  death)

• It occurs  after  somatic  death.  lt  refers  to  death  of all  individual  cells.
• It occurs  when even  anaerobic  processes  stop, due to  non  availability  of  ATP.
• The vital centres of the brain die in about 5 minutes), while the muscle tissue lives up to 3 to 4 hours, after the cessation of the circulation.
• Early signs : Changes in  skin  and eye,  cooling  of  the  body, post-mortem  lividity,  changes  in muscles  (e.g. primary  relaxation,  rigor  mortis).

Suspended  animation  (sudden  death)

• It  is  apparent  death. i.e. signs  of life  are  not  found  as the  functions  are  interrupted  for  some time  or reduced  to  minimum.
• The person is  not dead, i.e.  there  is  no somatic  death, brain death or molecular  (cellular)  death.
• Life continues  and  resuscitation  is  successful  in such  cases The condition  lasts  from  few seconds  to  l/2  an hour  or more.
• It  may be  found  in  Electrocution, Drowning. Sudden death occurring after maxillary sinus irrigation is due to Air embolism

Hydrocution or immersion syndrome refers to sudden death in water due to vagal inhibition as a result of:

• cold water stimulating the nerve endings of the surface of the body
• horizontal entry into the water with a consequent strike on the epigastrium
• cold water entering eardrums, nasal passage, and the pharynx and larynx which cause mucosal nerve ending stimulation.

 

Medicolegal Implications of Death

1. Declaration of death – declaration of death has importance because wrong declaration of death and shifting  the body for cremation/ burial or at mortuary may land the doctor in trouble.
2. Certification of death – a doctor have to certify death  of a person and death certificate cannot be issued unless death of the person is confirmed.
3. Disposal of the body – mistake in diagnosis and certification of death may cause difficulty for proper disposal of dead as per religious affiliation.
4. Organ transplantation – cadaveric organs or tissues for transplantation cannot be retrieved from a person unless the person is certified to be dead.
5. Presumption of death – vide infra

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