Forensic Medicine

Forensic medicine the science that deals with the application of medical knowledge to legal question. Clinical Forensic Medicine - involves an application of clinical methods for the administration of justice. Paulus Zacchias father of legal medicine as well as father of forensic psychiatry. Medical Ethics deals with the moral principles which should guide members of the medical profession in their dealings with each other, their patients and the state. Medical Etiquette deals with the conventional laws of courtesy observed between members of the medical profession.A doctor should behave with his colleagues as he would have them behave with himself. Hippocrates - father

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Inqu irie s

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Skin P roblem s

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of medicine, discussed lethality of wounds and formulated medical ethics. Forensic Pathology - deals with the study and application of the effects of violence or unnatural disease in its various forms in or on the human body, in determining the cause and manner of death in case of violence, suspicious, unexplained, unexpected, sudden, and medically unattended death. Pathology - is the precise study and diagnosis of disease. Pathologist - a medical doctor who conducts an autopsy. Autopsy - post mortem examination of a corpse. Other names of an autopsy post-mortem examination necropsy -particularly as to non human body autopsia cadavarem obduction Objectives of Autopsy 1. To find out the time of death. 2. To find out the cause of death. 3. To find out the manner of death, whether accidental, suicidal or homicidal.

1. 2. 3. 4.

4. To establish the identity of the body. 5. In new born infants, to determine live birth or viability. Exhumation - is the digging out of an already buried body from the grave. Disease - is an abnormal condition affecting the body of an organism. Cadaver - also called corpse, is a dead human body. Carcass - dead body of an animal. Injury - is damage to a biological organism which can be classified on various bases. wound - is a type of injury in which the skin is torn, cut, or punctured or where blunt force trauma causes a contusion. Classification of wound 1. open wound - is a break in the skin's surface resulting in external bleeding. 2. closed wound - the skin is not broken open and remains intact. Classification//Cate gories of open wounds 1. incised wound caused by a clean,

sharp edged object such as a knife, razor or a glass splinter.

2. laceration - irregular tear like wound caused by some blunt trauma.

3. abrasion - (grazes) superficial wound in which the top most layer of the skin is scraped off. Are often caused by a sliding fall into a rough surface.

4. puncture wound caused by an object puncturing the skin such as nail.

5. penetration wound - caused by an object such as a knife entering and coming out from the skin.

6. gunshot wound caused by a bullet or similar projectile driving into or through the body. There may be two wounds, one at the site of entry and one at the site of exit generally referred to as through and through.

Classification/Categ ories of closed wound 1. contusions commonly known as bruises, caused by a blunt force trauma that damages tissue under the skin.

2. hematoma - called blood tumor, caused by damage to a blood vessel that in turn causes blood to collect under the skin.

3. crush injury caused by a great or extreme amount of force applied over a long period of time.

4.

Ante Mortem - before death. Post Mortem - scientific term for after death. Cadaver tag - an identification tag attached to the cadaver containing tag number, name if identified, date/time and place of recovery, date/time of incident, gender, other pertinent information and name of the investigator. In articulo mortis - at the point of death. Rigor mortis - stiffening of the body after death. lividity - process through which the body's blodd supply will stop moving after the heart has stopped pumping it around the inside of the deceased. Necrophagus - this type of organism feeds directly on decomposing tissue. 37 degrees celsius or 98 degrees fahrenheit - average body temperature. 4 Categories of Death natural causes homicide/killing accidental death suicide Vital signs -are measures of various physiological statistics often taken by health professionals in order to assess the most basic body functions. body temperature pulse rate/heart rate blood pressure respiratory rate Death - cessation of all biological functions that sustains a living organism. Causes of death 1. old age 2. predation - biological interaction where a predator (organism that is hunting) feeds on its prey (the organism that is attacked). 3. malnutrition 4. disease 5. accidents 6. injury Signs of death cessation of breathing cardiac arrest - no pulse livor mortis - settling of the blood in the lower dependents of the body. algor mortis - reduction in body temperature following death. rigor mortis - the limbs of the corpse become stiff and difficult to move.

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6. decomposition - reduction into simple form of matter accompanied by strong unpleasant odor. Cadaveric Spasm - sudden rigidity of the muscle immediately after death. A rare form of muscular stiffening that occurs at the moment of death,persists into the period of rigor mortis and can be mistaken for rigor mortis. Other Names of cadaveric Spasm 1. Instantaneous rigor 2. Cataleptic rigidity 3. Instantaneous rigidity 4. Death grip 5. Post Morten spasm When does the stiffness of death begin to disappear? after 36 hours. What is the rate of temperature change to a body after death? after one hour,body temperature drops 1 to 1 1/2 degrees per hour. Dying Declaration - is a testimony that would normally barred as hearsay but may nonetheless be admitted as evidence in certain kinds of cases because it constituted the last words of a dying person. Nemo Morituros Praesumitur Mentiri - a dying person is not presumed to lie. Zombie - an animated corpse brought back to life by mystical means such as witchcraft. Coffin Birth - (post Morten fetal extrusion) - is the expulsion of a non viable fetus though the vaginal opening of the decomposing body of a pregnant woman as a result of the increasing pressure of the intra abdominal gases. Code of Hammurabi - King of Babylon (4000 to 3000 BC) is the oldest known medico legal code. Bologna, Italy - where the first medico-legal autopsy was done. Bartolomeo de Varignana - conducted the first medico-legal autopsy in Italy in 1302. Fortunato Fedele - an Italian physician who in 1602 published the first book on forensic medicine. Inquest - is the legal or judicial inquiry to ascertain a matter of fact. Euthanasia - (mercy killing) - it means producing painless death of a person suffering from hopelessly incurable and painful disease. It is not allowed by law in the Philippines. Malingering/Shamming - means conscious, planned feigning or pretending disease for the sake of gain. The Rule of Haase - is used to estimate age of fetus.The length of the fetus in cm. divided by five, is the duration of pregnancy in months. Forensic Entomology - is the use of insects and their arthropod relatives that inhabit decomposing remains to aid in legal investigations.

What are the 5 stages of insect development? 1. Eggs 2. Larvae 3. Prepupae 4. Pupae 5. Adult fly What are the 2 methods of biological forensics are concerned with? entomology and DNA. Residence time - this defines how long an insect colony has been at a corpse. The body farm - used for entomological experiment. This place exists at the University of Tennessee.

Forensic Medicine Notes

CHAPTER I GENERAL CONSIDERATIONS Legal Medicine - the application of medicine to legal cases Forensic Medicine - concerns with the application of medical science to elucidate legal problems Medical Jurisprudence - denotes knowledge of law in relation to the practice of medicine Medical Jurist - A physician who specializes or is involved primarily with medicolegal duties Imhotep - earliest medicolegal expert Antistius - first police surgeon Paulus Zacchias - father of forensic medicine Types of Medical Evidence - TAPED 1. Autoptic/Real Indecency and Impropriety Repulsive objects and those offensive to the senses 2. Testimonial Ordinary witness Expert witness

3. Experimental 4. Documentary 5. Physical Dying Declaration - exception to hearsay rule Methods of Preserving Evidence - PSDMPS 1. Photography - most practical, useful and reliable means of preserving evidence 2. Sketching 3. Description 4. Manikin method 5. Preservation in the Mind of the Witness 6. Special methods CHAPTER II DECEPTION DETECTION Methods of Deception Detection A. Devices which record the psycho-physiological response 1. Lie detector - physiological changes that occur in association with lying. Phases: a. Pre-test Purpose of the interview b. Actual interrogation and recording through the instrument Irrelevant questions Relevant questions Control questions c. Post test d. Supplementary Peak-of-tension - test given if not yet informed of the details of the offense Guilt complex - test applied when response to relevant are similar in consistency examiner cannot determine if subject is telling the truth Silent Answer - asked to answer silently 2. Use of Word Association Test 3. Use of Psychological Stress Evaluator (PSE) - detects, measures and graphically displays the voice modulations that we cannot hear.

B. Use of Drugs that Inhibit the Inhibitor 1. Administration of Truth serum - hyoscine hydrobromate 2. Narcoanalysis or Narcosynthesis - psychiatric sodium amytal or sodium penthotal 3. Intoxication with alcohol - in vino veritas - in wine there is truth C. Hypnosis - alteration of consciousness and concentration in which the subject manifests a heightened of suggestibility while awareness is maintained. D. Observation - signs and symptoms - SCEDFSPINS Sweating Color change Excessive activity of the Adams apple Dryness of mouth Fidgeting Swearing to the truthfulness of his assertion Peculiar feeling inside Inability to look at the investigator straight in the eye Not that I remember expression Spotless past record E. Scientific Interrogation - the questioning of a person suspected of having committed an offense or of persons who are reluctant to make a full disclosure of information in his possession which is pertinent to the investigation Suspect -person whose guilt is considered on reasonable ground to be practical possibility Witness - person requested to give information concerning the incident Techniques in Interrogation: BLEMS 1. Bluff on split-pair - all suspects are interrogated separately and the results of individual statements are not known to one another. 2. Lengthy time-consuming narration 3. Emotional appeal - sympathetic and friendly to subject 4. Mutt and Jeff - 2 investigators who acts Mutt (arrogant and restless) and Jeff (sympathetic, kind and friendly) 5. Stern approach - utilizes harsh language and immediate response is demanded. F. Confession - an expressed acknowledgment by the accused in a criminal case of

the truth of his guilt as to the crime charged or of some essentials thereof. 1. Extra-judicial - made outside of court Voluntary and Involuntary 2. Judicial - confession of an accused in court Tokyo Declaration - guidelines to be observed by physicians concerning torture and other cruel, inhuman and degrading treatment or punishment in relation to detention and imprisonment. CHAPTER III MEDICOLEGAL ASPECTS OF IDENTIFICATION Identification - determination of the individuality of a person or thing. Importance of Identification of a Person: 1. ID of offender and victim must be established 2. ID of missing or presumed dead persons to facilitate settlement of transmission of rights 3. ID resolves anxiety of next-of-kin 4. ID in transactions Law of Multiplicity of Evidence in Identification - the greater number of points of similarities and dissimilarities of two persons compared, the greater is the probability for the conclusion to be correct. Methods of Identification 1. By comparison - post-mortem records to compare with ante-mortem records Latent fingerprints Dental findings 2. By exclusion - if 2 or more persons have to be identified and all but one is not yet identified, then the one whose identity has not been established may be known by the process of elimination. Ordinary methods of Identification 1. May easily be changed GCFGBC a. Growth of hair, beard or mustache b. Clothing c. Frequent place of visit

d. Grade or profession e. Body ornamentations 2. May not be easily changed MSGMHCCFLD a. mental memory b. speech c. gait d. mannerism e. hands and feet f. complexion g. changes in the eyes h. facies i. left or right-handedness i. degree of nutrition Applicable to Living and Dead WORSTSMIDBTBS 1. Weight 2. Occupational Marks 3. Race 4. Stature Tips of the middle fingers of both hands with the arms extended laterally approximately equals the height 2x the length of 1 arm +12 inches from the clavicle and 1.5 inches from the sternum = approximate height 2x the length of the vertex of the skull to the pubic symphysis is the height Length of forearm from tip of olecranon process to the tip of the middle finger is 5/19 of the height. 8x the length of the head = approximate height 4. Tattoo marks 5. Scars 6. Moles 7. Injuries leaving permanent results - amputation, improper union of bones 9. Deformities 10. Birth marks

11. Tribal marks 12. Blood examination 13. Sexual organ Anthropometry (Bertillon System) - Alphonse Bertillon devised a scheme utilizing anthropometrical measurement of the human body as the basis of identification. Portrait Parle (spoken picture) a verbal, accurate and picturesque description of the person identified. Scientific Methods of Identification Aspects of Identification Requiring Scientific Knowledge A. Fingerprinting - most valuable method of identification because there are no 2 identical fingerprints and fingerprints are not changeable. Dactylography - art and study of recording fingerprints Dactyloscopy - art of identification by comparison of fingerprints Poroscopy - study of the pores found on the papillary or friction ridges of the skin B. Dental Identification Adult has 32 teeth and each tooth has 5 surfaces Enamel of the teeth is the hardest substance of the human body The greater the degree of tissue destruction, the greater the importance of dental characteristics C. Handwriting Bibliotics - science of handwriting analysis, it is the study of documents and writing materials to determine its genuineness or authorship Bibliotist - handwriting expert/qualified question document examiner Graphology - the study of handwriting for the purpose of determining the writers personality, character and aptitude. Movements in Writing - finger, hand, arm and whole arm D. Identification of Skeleton Whether the remains are of human origin or not Whether the remains belong to a single person or not Height, sex, race, age Length of interment or length of time from date of death Presence or absence of ante-mortem or post-mortem bone injuries

 Congenital deformities and acquired injuries on the hard tissues causing permanent deformities Determination of the sex of the skeleton The following bones must be studied - pelvis, skull, femur, humerus and sternum E. Determination of Sex - Importance: As an aid in identification Determine whether an individual can exercise certain obligations vested by law to one sex only Marriage or the union of man or woman Rights granted by law are different to different sexes Certain crimes wherein a specific sex can only be the offender or victim Tests to Determine the Sex: 1. Social 3. Gonadal 2. Genital 4. Chromosomal Problems in Sex determination Gonadal agenesis - sex organs never developed True hermaphrodism - bisexuality both gonads present Evidence of Sex: Transvestism - form of sexual deviation characterized by an overwhelming desire to assume the attire and be accepted as a member of the opposite sex. 1. Presumptive Female a. hips broader than shoulders b. small build c. breasts developed d. not prominent Adams apple e. striae present f. pubic hair straight stops at mons veneris g. hair absent on face, abdomen and chest h. skull is lighter, smaller/thin h. skull is longer, heavier and thick bones g. present (beard and moustache) Male a. vice versa b. larger build c. not developed d. prominent e. absent f. thick, curved extending up to umbilicus

bones, heavi, smooth i. trunk abdominal larger j. thighs conical 2. Highly probable evidence Possession of vagina, uterus in female and penis in male Developed and large breasts in female Muscular development and distribution of fat in the body 3. Conclusive evidence Presence of ovary in female and testis in male F. Determination of Age Growth of pubic hair, beard and moustache Changes of the breast in female Development of the voice Changes in colour of the hair Grade or year in school or college Menstruation in women Degree of mental development Manner of dressing, self-beautification and social life Atheromatous changes of blood vessels, opacity of the lens and cornea Wrinkleness of the skin usually appears after 40 G. Identification of Blood and Blood Stains H. Identification of Hair and Fibers CHAPTER IV MEDICOLEGAL ASPECTS OF DEATH Importance of Death Determination Civil personality of natural person extinguished by death Property of person transmitted to heirs at time of death Death of partner one of the causes of dissolution of partnership agreement Criminal liability of person extinguished by death Death - termination of life, the complete cessation of all the vital functions without i. smaller j. Cylindrical

possibility of resuscitation, an irreversible loss of the properties of living matter. 1. Brain death - deep irreversible coma, absence of electrical brain activity and complete cessation of all the vital functions without possibility of resuscitation Characteristics Unreceptivity and unresponsiveness No movements or breathing No reflexes Flat electro-encephalogram 2. Cardio-respiratory death - there is a continuous and persistent cessation of heart action and respiration Kinds of Death 1. Somatic or Clinical Death - state of body which there is complete, persistent and continuous cessation of the vital functions of the brain, heart, and lungs which maintain life and health 2. Molecular or Cellular Death - after cessation of vital functions of body there is still animal life among individual cells, after 3-6 hours later, there is death of cells. 3. Apparent death or state of suspended animation - not really death but a transient loss of consciousness or temporary cessation of the vital functions of the body on account of disease, external stimulus or other forms of influence. Signs of Death 1. Cessation of Heart Action and Circulation a. examination of the heart b. examination of the peripheral circulation Magnus test - a ligature is applied around the base of the finger (bloodless zone) 2. Cessation of respiration 3. Cooling of the body (algor mortis) - progressive fall of body temperature is one of the most prominent signs of death Factors influencing the rate of cooling of the body: conditions connected with the body conditions connected with the surroundings. 4. Insensibility of the body and loss of power to move 5. Changes in the skin - pale and waxy

6. Changes in and about the eye - tache noir de la sclerotique Changes in the Body following death: 1. Changes in muscle a. primary flaccidity b. post mortem rigidity c. secondary flaccidity or commencement of putrefaction Conditions Stimulating Rigor Mortis heat stiffening cold stiffening cadaveric spasm or instantaneous rigor - occurs at the moment of death due to extreme nervous tension and injury to the nervous system Distinction between Rigor Mortis and Cadaveric Spasm RM Appears 3-6 hrs All muscles of body Natural phenomenon Utilized by medical jurist 2. Changes in Blood a. coagulation of blood b. post-mortem or cadaveric lividity/postmortem hypostasis importance of cadaveric lividity: one sign of death may determine whether the position of the body has been changed color of lividity may indicate the cause of death may determine how long the person has been dead gives an idea as to the time of death 3. Autolytic or autodigestive changes after death 4. Putrefaction of the body - the breaking down of the complex proteins into simpler components associated with the evolution of foul smelling gases and accompanied by the change of color of the body. CS Appears immediately after death Only certain muscle or group May or may not appear To determine the nature of crime

to approximate time of death

Duration of Death ROPES 1. presence of Rigor mortis 2. Onset of decomposition 3. presence of Postmortem lividity 4. Entomology of the cadaver 5. Stage of digestion of food in the stomach CHAPTER V MEDICOLEGAL INVESTIGATION OF DEATH Inquest Officer - an official of the state charged with the duty of inquiring the manner and cause of death of a person. Stages of Medicolegal Investigation 1. Crime scene investigation - investigation of the place of commission includes setting of crime and adjoining places of entry and exit of both offender and victim. Methods of conducting search SDSWZ strip, double strip or grid, spiral, wheel and zone 2. Autopsy - comprehensive study of a dead body performed by a trained physician, employing recognized dissection procedure and techniques, body is opened and internal examination is conducted postmortem exam is only external exam of the dead body without incision although blood and other fluids may be collected. Kinds of Autopsy 1. Hospital or non-official autopsy - with consent from relatives fro the purposes of: providing correlation of clinical diagnosis to symptoms determining the cause of death determining the effectiveness of therapy studying the natural course of disease process educating students and physicians 2. Medicolegal or official autopsy for purposes of: determining the cause, manner (mode) and time of death recovering, identifying and preserving evidentiary material providing interpretation and correlation of facts and circumstances related to

death provide a factual objective medical report separating death due to external cause for protection of the innocent Manners of Death that should be autopsied VASUGIO 1. death by Violence 2. Accidental death 3. Suicide 4. death Unattended by a physician 5. death In hospitals or clinic (DOA-dead on arrival) 6. death Occuring in an unnatural manner Negative Autopsy - if after all efforts, including gross and microscopic, fail to reveal a case of death and does not yield any definite cause of death Negligent Autopsy