Various, generally optically visible, signs of death (signa mortis) have been described since ancient times. Up until the 18th century, “signs of death” were mostly not understood to be the (diagnostic) signs of an occurrence, but - as in Hippocratic medicine - primarily (prognostic) indications of an impending death.
In the forensic examination of a corpse, among other things, determining the time of death is important for further police investigations. Earlier and later, signs of death are used, namely the temperature of the corpse and supravital reactions.
Knowledge of supravital reactions is of crucial importance, as individual cells and tissues can react to external influences during what is known as intermediate life for many hours after brain death has occurred.
The determination of brain death as a recognized by the legislature sign of death occurring is a human individual especially before harvesting organs for purposes of organ transplantation is of particular importance. The period between brain death and the death of the last body cell is referred to as intermediate life .
Are indications of brain death that has occurred
- wide, light-rigid pupils
- a cerebral areflexia (the absence of brain-controlled reflexes ), whereby spinal reflexes (reflexes treated by the spinal cord) are often still preserved
- a zero line in the EEG
- a circulatory arrest in the cerebral arteries ( vertebral arteries and carotids ) detectable by means of angiography or Doppler sonography
Safe death signs
In general, certain signs of death are sufficient to determine when death has occurred. These can be divided into early and late signs.
- brain death
- Dead spots (Livor mortis) appearing about 20–60 minutes p. m. ( post mortem , i.e. after death has occurred)
- Rigor mortis (rigor mortis, rigor mortis), starting decreasing the muscles of mastication and in the further course of the lower limbs. The chronological order is important, since the muscles can also freeze at the same time, for example, if you are hypothermic.
- The so-called injuries that are incompatible with life, such as the separation of the head and trunk, the complete severing of the trunk as a result of a serious accident or injury by weapons, charring of the body
- Putrefaction and putrefaction , mostly together with
- Most of the body is colonized by fly and beetle maggots , ants or corpse-eaten by rats , predators or fish . Together with decomposition, this can lead to skeletonization .
- Adipocire , the formation of corpses or fat wax in the absence of air, which can stop the disintegration of the body by excluding air or
- Mummification of the body or individual limbs due to lack of water, in a dry environment.
Unsure signs of death
Uncertain signs of death are all those phenomena that can also be found in living individuals, on the other hand inevitably p. m. occur.
- lack of breathing
- missing pulse
- Cooling down of the body (at a suitable ambient temperature), see also Algor mortis
- Pale skin
- complete paralysis of all muscles with missing pupillary reflexes and other areflexia , so possibly also
- Opening of the sphincter muscles (urine, feces)
- Corneal opacity
- Corpse pallor (Pallor mortis)
- Deadly Cold (Algor mortis)
- Zero line EEG
Special feature of rescue medicine
The so-called zero-line electrocardiogram (ECG) occupies a special position between certain and uncertain signs of death in rescue medicine. If, when an unsuccessful attempt at resuscitation is aborted, an emergency doctor does not find any certain signs of death in the narrower sense, he would have to continue with the resuscitation (up to 60 minutes) and wait for the certain signs of death to occur. However, the emergency doctor has to supervise further emergencies at short notice, which is why in some German countries the recording of a ten-minute zero-line EKG is required as sufficient. This can be justified with the assured assumption that after ten minutes without a “recorded heart action” there is no more spontaneous reactivation of the heart. Until the emergency doctor arrives (with the necessary equipment), the rescue service personnel will continue the resuscitation as long as there are no certain signs of death.
- Thanatology : Science of the psychological and sociological aspects of death and dying
- Reinhold A. Frowein et al. a .: Determination of death - time of death. In: Johann-Christoph Student (Ed.): Die, Tod und Mrauer - Handbook for accompanying persons. 2nd Edition. Herder, Freiburg 2006, p. 227 ff.
- Helene Schadel: " ANATO". Studies on the concept of death in ancient philosophy and medicine. (Medical dissertation Würzburg 1974) Wellm, Pattensen, now with Königshausen & Neumann, Würzburg, 1975 (= Würzburg medical-historical research. Volume 2), ISBN 3-921456-01-0 , pp. 94–114.
- Daniel Schäfer : Signa mortis. Ancient specifications and late medieval characteristics. In: Würzburg medical history reports. Volume 16, 1997, pp. 5-13; here in particular p. 5 f.