LEGAL MEDICINE: GENERAL CONSIDERATION CRISBERT |. CUALTEROS, M.D. http:!/crisbertcualteros.page.tl Legal Medicine — is a branch of medicine which deals with the application of ‘medical knowledge to the purposes of law and in the administration of justice. Legal medicine Application of medicine to legal cases. Forensic medicine — Application of medical science to elucidate legal problems. ‘Medical jurisprudence — Knowiedge of law in relation to the practice of medicine. ‘SCOPE: Application of medical and paramedical sciences as ‘demanded by law and administration of justice. NATURE OF THE STUDY OF LEGAL MED: + The abilty to acquire facts, arrange them and draw a conclusion from facts in the administration of justice Medical jurist, Medical examiner, Medicolegal officer, Medicolegal expert =A physician who specializes primariy with medico-legal duties. + Imhotep - 2980 B.C. earliest medico-legal expert DIFFERENCE: ORDINARYPHYSICIAN —MEDICO-LEGAL OFFICER a) InjuryDisease point of view - Treatment Cause b) Examine a Diagnose Testify /justice patient ©) Minor injuries Ignored Records all/ qualify crimePRINCIPLE OF STARE DECISIS: = When the court has once laid an interpretation of law as applied to certain facts, itwill adhere to and apply to all future cases where the facts are substantially the BASIC PRINCIPLES GOVERNING APPLICATION AND EFFECTS OF LAWS: 1. “Ignorantia legis nominem excusat °~ prevent use as defense in violation 2. Law shall have no retro-active effect 3, Rights may be waived, unless the waiver is contrary to law, public order, public policy, morals or good customs, or prejudiced to a third person with a Fight recognized by law. 4. Customs which are contrary to law, public order or public policy shall not be countenanced, 5, Laws are repealed by subsequent ones, and thelr violation or non-observance shall not be excused by dis-use, custom or practice to the contrary. Persons authorized to perform autopsies: 4, Health Officers 2. Medical officer of law enforcement agencies. 3, Members of the medical staff of accredited hospitals. Autopsies shall be performed in the following cases. Required by special laws Order of competent court, mayor, fiscal Written request of police officers SolGen, fiscal disiter to determine cause of death. Written request of nearest kin to ascertain cause of death MEDICAL EVIDENCE ~ the means sanctioned by the rules of coun of ascertaining in a {idicial proceeding the truth respecting a matter of fact. Types of evidence: 4. Autoptic or Real evidence ~ made known to the senses 2. Testimonial evidence — oral under oath 3. Experimental evidence 4. Documentary evidence Methods of preserving evidence:41. Photo, videotape photocopy 4.Manikin method 2. Sketching 5.ln the mind of the witness 3.Description 6. Special methods: embalming DECEPTION AND DETECTION Knowledge of truth is important in the administration of justice, lies solely in the abil to evaluate the statement given by the suspect or witness, Methods of deception detection: 41, Devices which record the psycho-physiological response: ‘a) Use of a polygraph or lie detector machine b) Word association test ©) Psychological stress evaluator 2, Use of drugs that try to“ inhibit the inhibitor” ‘a) Administration of the truth serum, bb) Narcoanaiysis or Narcosynthesis ) Intoxication | 3. Hypnotism 4, By observation 5, Scientific interrogation 6, Confession |. __ RECORDING OF PSYCHO-PHYSIOLOGICAL RESPONSE Nervous control- CNS/ANS — Sym/ParaS ‘Sympathetic — influenced by physical and emotional stimull, effects Parasympathetic — works to restore things A. Use of a Lie Detector or Polygraph = The fear of the subject when not telling the truth activates the symp. = To a series of automatic and involuntary physiological changes which are recorded by the instrument. = Use of control questions > Most reliable & effective questioning technique. = Supplemetary tests:‘2. Peak of tension test - peak of tension on relevant questions ». Guilt complex test - does not response to added relevant quest. «. Silent answer test - subject verbal response creates distortion in the tracing or clearing of the throat. Reason for admissibility to the court of the result of Polygraph exam 4, Have not received the degree of standardization of acceptance. 2, Trier of fact is apt to give almost conclusive weight to the exoerts opinion 3. No way to assure the a qualified examiner administered the test. 4. May waive right against seltincrimination. 5, Ithas many errors, Factors responsible to 25% errors: 1, Nervousness experienced by a subject who is telling the truth + apprehension by the fact that he is a suspect. * over-anxialy to cooperate 2, Physiological abnormalities > BP inc. or dec., Cardiac prob. 3. Mental abnormalities 4. Unreponsiveness in a guilty subject - no fear of detection 5. Attempt to beat the machine Can a person be compelled? No, use of inteligence and other faculties. B. Word association test -Time interval between the words uttered by the examiner and the answer of the subject is recorded. C. Psychological Stress Evaluator when a person is under stress/ying, the microtremor in the voice utterance is moderately or completely suppressed, + degree of suppression varies inversely to degree of psychological stress U,_USE OF DRUGS THAT INHIBIT THE INHIBITOR ~ Not admissible in court ‘A. Administration of truth serum ~ Hyocine hydrobromide given hypodermically until state of delirium which the subject feels a compulsion to answer the question truthfully BB. Narcoanaiysis or Narcosynthesis Sodium amytal or sodium penthotal . Intoxication with alcohol - In wine there is truth ML —-HYPNosISwv. alteration of consciousness, not all subjects can be hypnotized OBSERVATION Physiological and psychological signs and symptoms of guilt a) Sweating, color change ) Dryness of the mouth ©} Excessive activity of adams apple d) Fidgetting ) Peculiar feeling inside Swearing, spotless past record 9) Inablity 6 look at the investigator INTERROGATION - emotional appeal, mutt and jeff technique CONFESSION + expressed acknowledgement of his guilt. TOKYO DECLARATION - contains guidelines to be observed by physician concerning torture, inhuman ‘and degrading punishment.MEDICO-LEGAL ASPECTS OF IDENTIFICATION - determination of the individuality of a person Importance of identifying a person: 4. Inthe prosecution of a crime, the identity of the offender and victim 2, Settlement of estates, retirement, insurance 3. Resolves anxiety of nest of kin, 4, In some transactions ~ sales, release of dead body Rules in personal identification: 1. Law of multiplicity of evidence in identification — greater number of similarities 2. Value of different points of identification — fingerprints , moles Visual recognition of relatives ~lesser value than fingerprints/dental 3.The longer interval between death the more experts are needed in establish the identity. 4.The team to act in shortest time because itis perishable, 5. No rigid rule in the procedure of identification of the person, Methods of identification: 1. By comparison - Id found in the crime scene compared withthe fle. 2, By exclusion IDENTIFICATION OF PERSONS: ‘A. Ordinary methods of identification 41. Characteristics which may easily be changed: a) growth of hair, beard d) grade of profession ») clothing ) Body ornamentations ©) frequent place of visit 2, Characteristics that may not be easily be changed: {3} mental memory ‘) hands and feet 'b) speech, 9) complexion ) gait hh) changes in the eyes d) mannerism i) facies ) handednessef /right |) degree of nutrition Points of identification applicable to both living and dead before onset of Decomposition:Occupational marks — painters have stains Race: Malay:brown, flat nose round face, Round head, Wearing apparel Stature: Tips of middle fingers of both hands extended laterally Tatoo marks Weight ~ not good point ~ changes from time to time Deformities, — injuries leaving permanent deformities, Birth marks moles, scar ‘Age of Scar: Recently formed: Slightly elevated, reddish’bluish, tender to touch Few week-2 months: Inflammatory redness, sof, sensitive 2—6months: brownish, free from contraction, soft > 6 months: white, glistening, contracted, tough ‘Scar formation is delayed by: sepsis, age, depth of wound, mobility May not develop ~ mall, superficial, healed by first intention. 8, Tribal marks, Sexual organs, blood exam ANTHROPOMETRY ( BERTILLON SYSTEM) Alphonse Bertillon = utlizes anthropometrical measurement of the human body for identification. Basis: 1, Human skeleton is unchangeable after 20 years, 2. No two human beings have exactly the same bones, 3. Use of simple instrument Information: 1, Descriptive data ~ color of hair, eyes, shape of nose: 2. Body marks 3. Anthropometric measurement — height 4, Measurement of the head, limbs Portait Parle ( spoken picture) ~ picturesque description of a person Extrinsic factors in identification: 41, ornamentation 2. personal belongings 3, wearing apparel 4. foreign bodies 5. ‘identifcation by close friends, police records, photographs Light as a factor in identification: 1. Clearest moonlight = Less than 16-17 yards Starlight = Less than10-13 yards 2. Broad daylight = Not farther than 100 yards not seen before ‘Almost strangers =recognized at 25 yards3, Flash of firearm inches letters can be read with the aid of the flash of 22 caliber ata distance of 2 feet 4, Flash of lightning ~ sufficient light to identity 5. Atificial ight ~ relative to the intensity of light B. Scientific methods of identification Fingerprinting Dental identification handwriting Identification of skeleton Determination of Sex, Age Identification of blood, blood stains Identification of hair, fibers 4. FINGERPRINTING = most valuable method of identification ‘a) No two identical fingerprints 1 : 64,000, 000, 000 'b) Not changeable - 4" month formed in the fetus = Praclical uses 4) Identity of dead bodies 'b) Prints recovered at crime scene ©) Prints on file for comparison 4) Right thumb print is substitute for signature = DACTYLOGRAPHY : art and study of recording fingerprints as means of id = DACTYLOSCOPY: ait of id by comparison of fingerprints = POROSCOPY : study of pores found on the pappilary friction ridges of skin Fingerprints can't be effaced: as long as the dermis of the bulbs ofthe finger Is not completely destroyed. 2. DENTAL IDENTIFICATION = possibilty of 2 persons to have the same is remote enamels the hardest substance of the body, ‘ullast other tissues in putrifaction 3, HANDWRITING BIBLIOTIC _= Science of handwriting analysis, GRAPHOLOGY : study of handwriting for the purpose of determining the writers personality. character and aptitude.53) eranium placed horizontally 4) Styloid process 5). Forehead 4, IDENTIFICATION OF THE SKELETON human — shape. size, general nature single individual — plurality or excess of bones Height ~ add 1 to 1 Yin. forthe sof tissues Pearson's formula — for the reconstruction ofthe lving stature of long bones Topinard and Rollet = two French anatomist devised a formula for the determination of the height fro males and fernales, Humphrey's table = Table of different height of bones for different ages and their ‘corresponding statures. Manouvrier — made the following co-efficient for the determination of height. Determination of sex of the skeleton: a) Pelvis, d) Femur b) Skull e) Humerus ©) Sternum Difference between Male PELVIS. Femal 1) Construction Heavier Lighter Wall More pronounced Less pronounced 2) Height, Greater Lesser 3) Pubic arch Narrow & less round Widerirounder 4) Diameter of the true pelvis Less Greater '5) Curve ofiliac crest Reaches higher level Lower level 6) Greater Sciatic noten Narrow Wide 7) Body of pubis Narrow Wider 8) liopectinel line Sharp Rounded 9) Obturator foramen Egg:shaped ‘angular 10) Sacrum Short and narrow Long and wide CRANIUM MALE FEMALE 4) Shatt less curve more curve 2) Mastoid process larger smaller mastoid process —_occipital& maxillary bones reston shorter longerisiender higher, more oblique less high, more vertical 96) Supercilary ridges less sharp, more rounded sharper 7) Zygomatic arches more prominent less prominent 8) Lower jaw larger & wider narrower and lighter 9) Face larger in proportion ta cranium ‘smaller Determination of the duration of interment ~All soft tissues in a grave disappear within one year. Basis of the estimate fro duration of interment: 41) Presence or absence of soft issue adherent to the bones. 2) Firmness and weight, britleness, dryness of the bones. 3) Degree of erosion of the surface of the bones. 4) Changes in the clothings, coffin, and painting 5, IDENTIFICATION OF SEX Test to determine the sex: 4, Social test 2. Genital test 3. Gonadal test 4, Chromosomal test ~ barr cells in females Evidences of sex: 1. Presumptive evidence ‘General features, hair in some parts ransvestism ~ Sexual deviation by desire to assume the attire and be ‘accepted as a member of the opposite sex. 2. Highly probabale agina, large breast 3. Conclusive evidence ovary in females, 6. DETERMINATION OF AGE Legal importance a) Aid to identification »b) Determination of criminal liability ©) Determination of ight of suffrage 4) Determination whether a person can exercise elvl rights @) Determination of the capacity to mariage 4) Requisite to certain crimesDetermination of age of fetus: Hess's rule or Haase’s rule a) Fetus of less than 25 cm long- get square root of length in cm, result in months. 'b) > 25 cm. divide the length af the fetus by 5 and the result is the age in month. 7. IDENTIFICATION OF BLOOD AND BLOOD STAINS Legal importance: ') Disputed parentage ») Circumstantial evidence against perpetrator of a crime ©) Determination of the cause of death 4) Determination of the direction of the escape ) Determination of the appropriate time crime was committed 4) Determination of the place of the crime 9) Determination of the presence of certain diseases. Physical examination 'a) Solubility test b) Heat test ¢) Luminescence test: 3 amino-phtalle-acid-hydrazide-HCL, Sodium peroxide . dstiled water > Bluish-white in a dark room Chemical examination: 4) Saline extract ofthe blood plus ammonia — brownish > alkaline hematin 'b) Benzidine test — blue color in white fiter paper ) Guaiacum test ( Van Deen's Dyas or Schombein's test) - blue d) Phenolpthalein test ( Kastle-Meyer test) - pink €) Leucomalachite Green test Microscopic examination ~ saline extract of stain ‘o-chemical tests: 1. Hemochromogen crystal or Takayama test 2. Teichmann’s blood crystals or Hemin crystal test- *= Sodium chloride ~ dark brown rhombic prisms of chloride, hematin formed = best of the micro-chemical test. 3, Acetone-haemin or Wagenhaar testSpectrospcopic examination blood pigments have the power to absorb light of certain length and produce the characteristic absorption bands on the spectrum. Frosh blood ~ oxyhgb, Hab, reduced hematin ‘olders stains ~ methemoglobin, alkaline hematin Biologic examinations 1. Precipitin test ~ blood is human or not 2. Blood grouping ‘Age of blood stains: Hgb converted to Methgb of hematin red to red-brown "= warm weather- within 24 hours 8. IDENTIFICATION OF HAIR AND FIBERS Differences between hair forcibly extracted and naturally shed hair: bulb is iegular , undulating surface, excrescence of dif size and shape HAIR HUMAN ANIMAL Medulla 4. Air network In fine grains large or small sacks 2.Calls Invisible wiout x in H20 Easily visible 3 Fuzz wiout medulla Fuzz w/ medulla Cortex 1 Looks like a thick muff Fairy thin hollow cylinder 2 Pigments in the form of fine grains irregular grains Cuticle 1 thin scales thick scale MEDICO-LEGAL ASPECTS OF DEATH Importance of Death determination: 4, The civil personailty of a natural person is extinguished by death. 2.The property of a person is transmitted to his hei at the time of death. 3. The death of a partner is one of the causes of dissolution of partnership agreement. 4. The death of either the principal or agent is a mode of extinguishment of agency. 5, The criminal labiliy is extinguish by death, 6, The civil case fro claims which does not survive is dismissed upon death of thedefendant, Death - is the termination of ite. Kinds of death: 4. Somatic or clinical death — persistence of vital functions 2. Molecular or cellular death ~ 3 to six hours after cessation of life 3, Apparent death or State of suspended animation ~ transient loss of consciousness in hysteria, uremia, electric shock Signs of death: 4. Cessation of heart action and circulation. Usually he auricle contract after ‘somatic death fro a longer period than the ventricle, last to stop so called ULTIMEN MARIENS. ‘Methods of detecting the cessation of heart action and circulation: ‘a) Examination of the heart- pulse, aucultation, flouro, ECG b) Examination of peripheral circulation Magnus test — application of ligature around the base of the finger bloodless area at site of application dead man no change = Opening of small artery- spurting Icards test. injection of fourescein SQ + greenish yellow discoloration in the whole skin - dead man only in the area of injection Pressure on fingernails = Diaphanous test — fingers are spread wide through a strong light- Red ‘Application of heat on the skin - blister Palpation of Radial pulse Dropping of melted wax 2. Cessation of respiration — more than 3 % minutes Methods of detecting cessation of respiration: a) Observance of movement of chest and abdomen b) With the aid of ste. ©) Examination with a mirror 4) Examination with a feather or cotton fibers ) Examination with a glass of water ) Winslow's test ~ no movement in the image formed by reflecting artificial light on the water in a saucer and placed in the chest I respiration is taking place. 3. Cooling of the body _( ALGOR MORTIS) “After death the metabolic process inside the body ceases.= The progressive fal ofthe body temp. is one of the most prominent signs. = First two hours after death the cooling is rapid. + Fall of temp. of 15 to 20 degrees Fahrenheit is considered as @ certain sign of death, POST-MORTEM CALORICITY - is the rise of temp. of the body after death due to rapid and early putrefactive changes. Usually in the first 2 hours. = seen in cholera, liver abscess, tetanus, RF,Strynine poisoning, Peritonitis A. Conditions connected with the body: Factors delaying the rate of cooling ofthe body: 1. Acute pyrexia disease 2, Sudden death in good health 3. Obesity of person 4. Death from asphyxia 5. Death of the middle age Factors accelerating cooling: 41, Leaness of the body 2. Extreme age 3. Long-standing tines 4, Chronic pyrexial disease with wasting B. Conditions that are connected with the surroundings Factors delaying cooling: 4. Clothings 2, Want of access of air to the body 3, Small room 4, Warm surroundings Factors accelerating cooling: 1, Unclothed body 2. Conditions allowing the access of air 3. Large room permiting the dissipation of heat 4. Cooling more rapid in water than in air Methods of estimating how long a person has been dead from the cooling of the body: 1. If body temp. is normal at the time of death: = the average rate of fall of the temp. during the first 2% hours is % of the difference of the body temperature and that of the air. = the body attains the temp. of the surrounding air from 12 to 15 hours after death in tropical countries,2. Chemical Method ( Schourup’s formula for the determination of the time of ‘death of any cadaver whose CSF is examined for the concentrations of LA... NPN, AA, L’A> 15 mg to 200 mg/100ec rapid in 1st S hours. NPN ine. from 15 to 40 mg/100 coin 1* 18 hours AA. inc. from 1 mg to 12 mg% 1" 15 hours. 4, INSENSIBILITY OF THE BODY AND LOSS OF POWER TO MOVE = may be seen in the living with- apoplexy, epilepsy . trance, catalepsy, hysteria 5. CHANGES IN THE SKIN ~ opacity, flattening, loss of elasticity 6. CHANGES IN AND ABOUT THE EYE 4) Loss of comeal reflex — seen | nlive pts: G.A., uremia, narcotic poisoning ) Clouding of cornea ©) Flaccidity of the eyeball ) Pupil in the position of rest. e) TACHE NOIR DE LA SCLEROTIQUE - spot found in the sclera after, death. 7. ACTION OF HEAT ON THE SKIN feat applied while alive ~ produced blister with serum and redness around the area, = Following combinations of signs show death has occurred: €) Loss of animal heat to a point not compatible with life 'b) Absence of response of muscle stimulus ¢) Onset of rigor morts. (CHANGES IN THE BODY FOLLOWING DEATH 4. CHANGES IN THE MUSCLE — complete relaxation of the whole ‘muscular system, ‘Three Stages After Death: 4) Stage of primary flaccidity ( POST-MORTEM IRRITABILITY) uscle relax, may contract, dilated pupil, sphincters are relaxed presence of molecular life warm place: 1 hour and 51 minutes hemical reaction of muscle is alkaline bb) Stage of post-mortem rigidity ( CADAVERIC RIGIDITY , DEATH STRUGGLE OF MUSCLES OR RIGOR MORTIS) whole body is rigid due to contraction of the muscles. tarts at muscle of neck, lower jaw Reaction is acidic due to inc. of lactic acid develops 3 to 6 hours after death in temperate, earlier in warm last from 2 to 3 days in temperate, warm: 24-48H cold weather18-36H summer c) Stage of Secondary flaccidit (DECAY OF MUSCLES) ‘muscie are flaccid, not respond to stimuli, reaction is alkaline due to dissolution of muscle proteins ‘or Commencement of putrefaction FACTORS INFLUENCING THE TIME OF ONSET OF RIGOR MORTIS (1) Internal Factors 2) State of the muscles healthy ~ appears late = Onset is hastened ‘at hunted animat ‘2 prolonged convulsioningering lines ‘a3 death from. TY, Cholera, Phihisis, typhus b) Age early onset — aged and newborn delayed ~ good health, good muscular development ©) Integrity of nerves == section of the nerve will delay onset, paralyzed muscle (@) External factors a) Temperature Hastened by high temperature > 75 degrees will produce heat stifening b) Moisture = rapidly but with short duration in moist air Conditions simulating RIGOR MORTIS: 1. Heat stifening - > 75 degrees coagulates muscle proteins resulting to rigidity. =" Pugilstc attitude" flexed upper and lower limb jands clenched, flexor stranger than extensors, burned to death 2. Cold stiffening due to solidification of fats when exposed to cold temp. 3, Cadaveric spasm or Instantaneous Rigor instantaneous rigidity due to extreme nervaus tension, exhaustion, injury to the nervous system. = weapon in hand, weedsRIGOR MORTIS CADAVERIC SPASM 4. Time of appearance 3-6H after death Immediately after death 2. Muscles involved All muscles Certain group 3. Occurrence Natural phenomena May or may not appear 4, Medico-legal signif. Approximates time of death Determine nature of death RIGOR MORTIS MUSCLE CONTRACTION 4. Contracted muscle Losses transparency ‘More or less transparent 2. Elasticity Loss elasticity Very elastic 3. Litmus reaction Acidic Neutral or s. alkaline 4, Contraction ‘Absolute flaccidity Possess inherent contraction 2. CHANGES IN THE BLOOD '8) Coagulation of blood jood may remains fluid inside the blood vessels 6-8H after death, ANTE-MORTEM CLOT — POST-MORTEM CLOT 4. Consistency Fim: Soft 2. Surface of blood vessels Raw after clols are removed Smooth, health after 3. Cots Homagenous. Can be stripped can't be stripped off in layers ») Post-mortem Livilty or Cadaveric Livdity , or Post-mortem Suggilation or Post-mortem Hypostasis or Livor Mortis = Stoppage of heart action and loss of tone of b.v. accumulates in dependent areas except in bony areas. ccapilaries coalesce > purplish in color called Post-mortem lividity. Hasten by death due to cholera, uremia, Typhus fever ‘appears 3-6 H after death and fully developed 12 H after death, Physical characteristics of Post-mortem Cadaveric Lividity 1, Occurs in the most dependent areas. 2, Involves the superficial layer of the skin 3, Does not appear elevated from the rest of the skin 4. Color is uniform. 5. No injury of the skin Kinds of Post-mortem Cadaveric Lividity 4. Hypostatic lviity 2. Diflusion iviity Importance of Cadaveric livid 1, One of the signs of death2, Determines the position ofthe body has been changed alter its ‘appearance in the body. 3, Color ofiviity may indicate the cause of death, ‘a) asphyxia — lviity is dark b) CO poisoning ~ pink c) Hemorhage ~ less marked 4) Hydrocyanic acid ~ bright red fe) Phosphorus ~ dark brown 4) Potassium chlorate ~ coffee brown 4. Determines how long the person has been dead 5, Gives us an idea as to the time of death. Points to be considered which may infer the position of the body at the time of death: 4. Posture of the body when found. 2. Post-mortem hypostasis or lvidity 3. Cadaveric spasm CONTUSSION (BRUISE) POST-MORTEM HYPOSTASIS 1. Small bruises — Below epidermis in tue skin In the epidermis or cutis larger ones below this, 2.Cuticle _Abraded by the same violence Unabraded that produce the bruise, 3.Bnuise Appears at the seat or surrounding Always dependent ‘may or may not be dependent 4 Elevated, inflammatory condition Not elevated, blood in bv. CONTUSSION (BRUISE) _ POST-MORTEM HYPOSTASIS 5. Incision shows blood outside the b.v. Blood inside the vessels ‘most certain test of dtference 6 Color variegated Uniform color Internal hypostasis in Visceral organs: 4, Lungs2. Loops of intestine 3. Brain POST-MORTEM LIVIDITY OF ORGANS —_ SIMPLE CONGESTION 1. Postmortem staining in organs Irregular, most dependent parts Uniform, all organs 2. Mucous membrane Dullusterless Not in congestion 3. Inflammatory exudate Not seen Not seen Other changes in the blood 41 Hydrogen ion concentration —acid pH CO2, LA. After 24H alkaline ammonia. 2 Breakdown of liver glycogen leads to accumulation of dextrose inthe IVC and tho right side ofthe heart 3. Rise in NPN and Free A.A. 4. Chemical: = chloride in the plasma/RBC decrease due to extravascular diffusion, in 72H only Yeofits content Mg ~ increases due to diffusion from without. = increases due to dtfusion from the vascular endothelium 3. AUTOLYTIC OR AUTODIGESTIVE CHANGES AFTER DEATH “After death, proteolytic, alycolytic and lipolytic ferments of the glandular tissues continue to act which lead to the autodigestion of organs, 4, PUTREFACTION OF THEBODY “Is the breaking down of complex proteins into simpler components associated \with the evolution of foul smelling gasses and accompanied by the change of Color of the body. Tissue changes in putrefaction: 4. Changes in the color of the tissue Hemalysis of blood within blood vessels > Hgb diffuses through the walls Reddish-brown in color In the tissues > Hab undergo chemical change Greenish-yellow 1* seen at R iliac fossa MARBOLIZATION - prominence of the superficial veins with reddish discoloration which develops on both flanks of the abdomen, neck, and shoulder ok lke “marbled” reticule of branching veins. 192, Evolution of gasses in the tissues (C02, ammonia, H2, Suphurated hydrogen, methane = offensive odor Effects of pressure of gasses of putrefaction: '2) displacement ofthe blood —bleeding in open wounds ») bloating of the body ©) fluid coming out from nostrils, mouth {) extrusion ofthe fetus in a gravid uterus €) floating af the body 3, Liquefaction of the soft tissues Putrefy rapidly: Eyeball, lining of trachea, larynx , brain, stomach, intestine, liver, spleen Putrefy late Highly muscular organs and tissues, Esophagus, diaphragm, heart, lungs. kidneys, U-B., uterus, P.G. Factors modifying the RATE of putrefaction: 4, INTERNAL FACTORS. a) age healthy adults, NB not yet fed, later than infants ») condition of body full grown/obese - rapid , Stliborn- late ©) cause of death infection - rapid 2, EXTERNAL FACTORS, a) Free air 1.1 air: free air hastens decomposition ‘a.2 moderate moisture - accelerates ‘2.3 loaded with septic bacteria — early aerobes, later anaerobic ~ Clostridium welehii= decomposition ) Earth bt dry absorbent soll - retards b.2 moist fertile sol - accelerates .¢) Running water- more rapid than stil water 4) Clothings — early it hastens but delays in the later stage. = tight clothings - delay Factors influencing the changes in the body after burial: 1. state of the body before death - thin slower, mummity 2, time elapsed between death and burial and environment of the body 43. effect of coffin — later 4, clothings and other coverings on the body when buried ~ pressure, insects 205. depth at which the body was buried - greater the later 6. condition and type of soil 7. inclusion of something in the grave which will hasten decomposition-food 8, access of airto the body after burial 9, mass grave ~ rapid 10-trauma to the body ~ violent death - siow CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TEMPERATE REGIONS 4-3 DAYS AFTER DEATH - greenish discoloration over iliac fossa, soft eyeballs 3-5 DAYS. frothy blood from mouth, nostris 8-10 DAYS ~ abdominal distention, nails firm 14-20 DAYS blisters all over the body, maggots. 2.5 MONTHS = skull exposed, orbits empty IN TROPICAL REGION 42HOURS Rigor morts allover, hypostasis, greenish-discoloration caecum 24HOURS Rigor mortis absent all over, abdominal distention 48H Ova of fies, trunk bloated, face discolored 72H Whole body grossly swollen, hairs and nails loose ONE WEEK Soft viscera putrefied TWO WEEKS Soft tissues largely gone ONE MONTH Body skeletonized BEEN SUBMERGED IN WATER FIRST 4 ORS DAYS Gold water tle change, in igor morts FROM 5-7 DAYS Skin on hands, feet is bieached, face faded white 41-2 WEEKS Face swollen and red, skin of hands and feet wrinkled 4.WEEKS Skin wrinkled, nail intact 6-8 WEEKS ‘Abdomen distended, skin of hands! feet come off with nails. Factors influencing the floating of the body in water: ‘age ~ fully developed, well nourished - rapid ‘sex — females floats sooner conditions of the body — obese float quicker ‘season of the year ~ moist hot air — pulrefaction floats due to gas water- shallow and stagnant water of creeks, higher specific gravity = sea water floats sooner than fresh water. higher specific gravity external influence — heavy-wearing apparel - slower o fhens Only teeth, bones and hair remain for an indefinite time. Flat bones disintegrates faster than round bones.‘SPECIAL MODIFICATION OF PUTREFACTION 4. Mummification the dehydration of the whole body which results in the shivering ‘and preservation of the body. ssually occurs when buries in a hot, dry with free access of hot air 2. Saponification or Adipocere fromation ‘condition where the faty tissues of the body are transformed to soft brownish-white substance known as ADIPOCERE at SQ le 3, Maceration softening of the tissues when in fluid medium in the absence of putrefactive mirero-org, seen in death in utero reddish or greenish color, skin peeling off and arms flaccid and trail. HOW LONG APERSON HAS BEENDEAD? —_ DURATION OF DEATH 1. Presence of rigor mortis : 2-3 hours after death 12H fully developed 18:36 H disappears concomitant with putrefaction 2. Prasnce of Post-mortem lvidity 3-6 H after death appears as small petechia-lke red spots 3, Onset of decomposition 24-48 H afier death manifested watery. foul smeling froth, mouth, nostrils. 4, Stage of decomposition 5. Entomology of the cadaver ~ 24 H before eggs are hatched, maggots 6, Stage of digestion = 34H gastric empty 6-8 distal ileum, cecum 7. Presence of live fas in the clothing in the drowning victim —less than 24H 8, State of clothings = pajama , night 9. Changes in CSF 10. Blood clots inside the bw. in 6-8 H after death. 11. Soft tissues of the body may disappear 1 to 2 years after burial Post-mortem conditions simulating disease, poisoning or injury: 1. post mortem hypostasis — contusion, inflammation , poisoning 2, blisters of the cuticle ~ scald and bums 3, swelling, detachment or spiting - injury PRESUMPTION OF DEATH Disputable presumption - not heard in 7 yearsPresumption of death Absence of 7 years except succession 10 years Vessel for 4 years ‘Acmed forces 4 years In danger of death 4 years PRESUMPTION OF SURVIVORSHIP ‘1. under 15 v.0. - older survives 2. above 60 y.o.~ younger 5. under 15, above 60 - former 4 6. ‘over 15 and under 60 y.0. ~ male, older ‘under 15, of over 60 y.0. and the other in between - latter MEDICO-LEGAL INVESTIGATION OF DEATH Inquest Officer — is an official of the state charged with the duty of inquiring into certain matters. in medico-legal examination: manner and cause of death The following officials of the government are authorized to make death Investigations: 1. Provincial and City Prosecutors 2. Judges of the RTC, MTC 3. Director of NBL 4. SolGen Stages of MEDICO-LEGAL INVESTIGATION: 4.Crime Scene Investigation — investigation of place of commission of the crime 2Autopsy ~ investigation of the body of the victim 4. Crime Scene Investigation “place where the essential ingredients of the crime took place. = Person composed the Search Team; '2) Physician ML trained b) Photographer ©) Assistant, evidence collector, note taker 2, Autopsy = comprehensive study of a dead body, in addition to the external examination Post-mortem examination- external exam without incision being made. Purpose of autops} 41, Determine cause of death 2. Correlate clinical diagnosis and symptoms 3. Determine effectiveness of treatment 4. Study the natural course of the disease5, Educate students and physicians MEDICO-LEGAL OR OFFICIAL AUTOPSY: Determine cause, manner, time of death Recovering, identifying, preserving evidentiary material Provide interpretation and correlation of facts related to death Provide factual, objective medical report ‘Separating death due to disease from external causes, Dead body belongs to the state for cases that requires medico-legal autopsy. PATHOLOGICAL AUTOPSY MEDICO-LEGAL AUTOPSY 4. Requirement Consent of next of kin Law that gives the consent 2.Confirmation Clinica findings of research Correlate tissue changes fo criminal act 3..Emphasis Notation at all abnormal findings Etfect of wrongful act 4, Conclusion Summation of all abnormal findings Specific to the purpose 5. Minor Need not be mentioned Included if useful The following manner of death should be Death by violence Accidental deaths Suicides ‘Sudden death of persons who are in good health Death unattended by physician D.O.A. with no clinical diagnosis Death occurring in an unnatural manner uutopsied: Mistakes in autopsy: 1, Error or omission in the collection of evidence for identification 2. Errors or omission in the collection of evidence required fro establishing the time of death 3, Errors or omission in the collection of evidence required fro the medico- legal examination. 4, Errors or omission result in the production of undesirable artifacts or in the destruction of valid evidence. Negative autopsies = ifafter all efforts including gross and microscopic studies and toxicological analysis fail fo reveal a cause of death Negligent autopsy No cause of death is found due to imprudence, negligence, lack of skill, lack of foresightCAUSES OF DEATH Primary purpose of a medico-legal autopsy: Determination ofthe cause of death Death isthe drect and the proximate consequence of the criminal or negligent act. Defense wounds on the victim: Qualify the crime to homicide. Series of cuts in the borders of the wound: Multiple trust- intent to kil Cause of death: is the injury or disease or both which initiates the physiological disturbance resulting toa fatal termination. 1. Immediate or Primary cause of death ~ when injury or disease kils quickly the victim and no opportunity for complications to develop. Ex: extensive brain injury 2. Proximate cause or Secondary cause - the injury or disease was survived. for a longer period Mechanism of death: is the physiologic derangement or biochemical disturbance incompatible with fe which is inated by the cause of death Ex: Hemorrhagie shock, pulmonary depression, cardiac arrest, tamponade metaboile problem. Manner of death: is the explanation as to haw the cause of death arose. 4. Natural death — fatality is cause solaly by disease. Ex: pneumonia, cancer 2.iolent or unnatural death ~ due to injury Medico-legal masquerade- violent deaths may be accompanied by minimal or no extemal evidence of injury or natural death where signs of violence may be present. Degree of Certainty to the cause of death: 4. Structural abnormalities established beyond doubt the cause of death. Ex. SW with H. 2. Degree of probability amounting to the cause of death. Ex: Electrical shock 5. History establishes cause of death and confirmed by anatomic or chemicalfindings. 4, When neither history, laboratory and anatomic findings, taken individually or in combination is sufficient to determine the cause of death but merely speculate ‘as to the cause of death Ex. Crib death among infants. Steps in the Intellectual Process in the determination of the cause of death: 4, Recognition of the structural organic changes or chemical abnormalities responsible for the cessation of vital functions. 2. Understanding and exposition of the mechanism by which the anatomic and ‘other deviations fram normal caused the death Instantaneous physiologic death or Death from inhibition, death from primary shock, Syncope with instantaneous exitus. This! sudden death which is cause within seconds or minute or two after ‘a minor trauma or peripheral stimulation of relatively simple nature, = The peripheral stimulation iniates the cardio-vascular inhibitory reflex. Exc Vagocardiac slowing or stoppage of the heart. Blow to the larynx, solar plexus, scrotum, pressure to the carotid sinus. Diseases with no specific findings of a disease: 1. Sudden infant death syndrome (SIDS) of ery death 2, Sudden unexplained noctumal death (SUND) BOA ~ means actually dead or dying, provided the physician had not been given ample opportunity to arrive at a working diagnosis as to the cause of death, Undetermined. i the physician cannot determine the cause of death. MEDICO-LEGAL CLASSIFICATION OF THE CAUSES OF DEATH 2. Natural death ~ cause by natural disease condition in the body. b. Violent death ‘Accidental death Negligent death Infanticidal death Parricidal death Murder Homicidal deathIf signs of violence are associated with the natural cause of death: * Did the person die of anatural cause and were the physical injuries inflicted immediately after death? = violence applied in a dead person : Impossible crime, *Was the victim suffering from a natural disease and the violence only accelerate the death? = Offender responsible of the death of the victim, riminal liability shall be incurred by any person commiting a felony although the wrongful act dane be different from which he intended. (art no.1 RPC) * Did the victim die of a natural cause independent of the violence inflicted? ~ accused will not be responsible for the death but merely forthe physical injuries he had inficied. Ex. Slapping a person with heart problem, only slight physical injury - fo make the offender liable for the death of the victim, it must be proven that the death isthe natural consequence of the physical inuries inflicted. The following are deaths due to natural causes: 1. Affection of the CNS ‘2. Cerebral apoplexy ~ sudden loss of consciousness followed by paralysis or death due to Hemorrhage from thrombosis or ‘embolism in the cerebral vessels b. Abscess of the brain ©. Meningits of the fulminant type 2. Affection ofthe circulatory system ‘a, Occlusion of the coronary vessels "ost common cause of Sudden death due to natural causes. Fatty or myocardial degeneration of the heart Ruplure of the aneurysm of the aorta Valvular hear disease Rupture of the heart Affections of the Respiratory system ‘a, Acute edema of the larynx Tumor of the larynx © Diptheria d. Edema of the lungs fe. Pulmonary embolism 4. Lobar pneumonia 9. Pulmonary hemorrhage4, Affections of the GIT a. Ruptured PUD b. Acute intestinal obstruction 5, Affections of the GUT ‘2. Acute strangulated hernia 'b. Ruptured tubal pregnancy ©. Ovarian cyst with twisted pedicle 6. Affection of the glands '2. Status thymico-ymphaticus b. Acute hemorthagic pancreatitis 7. Sudden death in young children ‘a. Bronchitis 'b. Congestions of the lungs cc. Acute broncho-pneumonia 4. Acute gastroenteritis @. Convulsion 1. Spasm of the larynx B. Violent death ~ are due to injuries inflicted in the body by some forms of outside force. The physical injury must be the proximate cause of death. ‘That the victim at the time the physical injuries were inflicted was in normal health That the death may be expected from the physical injuries inflicted, That the death ensued within a reasonable time. CLASSIFICATION OF TRAUMA OR INJURIES. Physical injury ~ trauma sustained through the use of physical force, “Thermal injury — injury by heat or cold Eecrioe iary, Seared! sneruy: ‘Atmospheric injury ~ due to change of atmospheric pressure. Chemical injury ~ chemicals Radiation injury radiation Infection —microbic InvasionPENAL CLASSIFICATION OF VIOLENT DEATHS. 1, Accidental deaths ~ due to misadventure or accident. ‘Att. 12 no. 4 RPC Any person who while performing a lawful act with due care, causes an injury by mere accident without fault or intention of causing Ex, Patient died of ATS injection after proper skin test 2. Negligent death — felonies may be committed when the wrongful act is due to reckless imprudence, negligence, lack of skil or foresight. Ex. Surgean left a pack — Homicide through reckless imprudence 3. Suicidal death , destruction of one’s self ~ not punished, unfortunate being. ~ Art 253 RPC Giving assistance to suicide. Punishable because he has no Fight to destroy or assist in the destruction of life of another. 4, Parricidal deaths Att 246 father, mother, child, legilleg) ascendant, descendant, spouse (leg.) 5. Infanticidal deaths — Art. 255 kiling of a child less than 3 days 6. Murder Art. 248 = treachery, consideration, means of inundation, occasion of calamities, © evident pre-meditation, crusty 7. Homicidal deaths Art 249 DEATHS UNDER SPECIAL CIRCUMSTANCES 1. Death caused in a tumultuous affray Art 254 2. Deaths or physical injures inflicted under exceptional ‘circumstances. An 247 2. PATHOLOGICAL CLASSIFICATION OF THE CAUSES OF DEATH ‘a. Death due to syncope ~ fatal and sudden cessation of the action of the heart. . Death from asphyxia ~ a condition in which the supply of oxygen to the blood orto the tissues or to both has been reduced below normal working level. ‘Stage of increasing dyspnea t min Stage of Expiratory convulsion Stage of exhaustion 3 min ©. Death from coma‘SPECIAL DEATHS | Judicial deaths ~ Art. ll Sec.1 Par. 19 Phil, Const. “cruel and ‘unusual punishment shall not be inflicted. ; electracution, hanging, ‘muskelty, gas chamber. 2. Euthanasia or merey killing 3. Suicide ‘Automatism - due {o drug may be considered as accidental rather than suicidal Evidences that will infer death is suicidal: History of depression, mental disease. Previous attempt Injuries are located in areas accessible to hand. Effects of the act of self-destruction may be found in he victim:, empty bottle Presence of suicidal note. Secluded, notin public view. Evidences which rule out H.M, P 4. Death from starvation : Cause may be due to suicidal, homicidal or accidental ‘The human body without food losses 1/24” of its weight daily. ‘And 40% loss>death Factors that influence the length of survival: age, condition of the body, sex, environment. 30DISPOSAL OF THE DEAD BODY ‘Sec.1103 Revised Administrative Code : Persons charged withthe duty of burial 41, Deceased was married: the surviving spouse 2. Ifunmantied : the nearest of kin of the deceased: adults, within the Phil ‘And in possession of sufficient means to defray the necessary expenses. 3, If none of the above ~ municipal authorities, Sec 1104 RAC Right of custody ‘Any person charged by law with the study of burying the body of a deceased person is entitied to the custody of such body for the purpose of burying it, except When an inquest is required by law for the purpose of determining the cause of death. lfcommunicable, the local board of health or local health officer or municipal ccounell Concept of possession ~ the right of custody over a dead body... The right of custody does not mean ownership of the dead body. Executors right of custody superior to the right of spouse dead body. An executor is the person mentioned in a will who will carry on the provision of the wil. In the absence of a testamentary disposition, the right of the surviving spouse is paramount. METHODS OF DISPOSAL OF THE DEAD BODY 1. Embalming ~6 to 8 quarts of antiseptic solutions of formalin, perchloride lof mercury or arsenic which is carried into the intemal carotids and the femoral arteries. 2. Burial or inhumation ‘a, Sec 1092 RAC buried within 48 hours if unembalmod. Within 12 hours, if communicable. Except: 1. Subject of legal investigation. 2. Authorized by the local health authorities that may be buried ‘more than 48H, 3, Impliedly when embalmed. b. Death certificate necessary before burial ‘Sec. 1087 RAC Requirement of Death Gert. and the duty of the physician to issue or the local health officer, or if none by the mayor, ‘secretary, councilor of the municipality to issue the certificate. Sec 91 P.D, 856 Code of Sanitation ; Burial requirement: - death cert, issued by physician. 3«. Permission from the Provincial fiscal or from the municipal mayor. Is necessary if death is due to violence or crime, = Sec. 91(f) P.D. 856 Code of Sanitation ‘Sec. 1094 Revised Administrative Code — Disposition of body and belonging of person dying of dangerous communicable disease. Ex. Meningococcemia in Bagiuo City 1. The body of a person who died of any dangerous communicable disease shall not be carried form place to place except for burial or cremation, 2. Duly of the local health official to disinfect the body before being prepared for burial; the furniture, house, either disinfect or burned if capable of conveying infection, ‘Sec. 91(h) P.D. 856 Code of Sanitation 1. Remains shall be buried within 12 hours after death. Cause of death is {due to a dangerous communicable disease: 2. Not to be taken any piace of public assembly. 3, Only adult members of the deceased are allowed to attend the funeral Sec. 1091 RAG Death Cerificate must be presented before burial ‘Sec. 1099 the placing of the body of any deceased person in an unsealed overground tomb is prohibited unless if permanently sealed, Except: 1. Tombs and vaults which are strictly receiving vaults for bodies or remains awaiting final disposition. 2. Embalmed bodies awaiting final disposition. Sec. 1100 of RAC, Sec. 910 of P.D. 856 Code of Sanitation The depth of the grave must be atleast 1 % meters deep, filed well and firmly. Sec. 2695 RAC Penalizes the desecration of burial premises; tombstone, plant, tree, fence, post or wall, P200/ not greater than 6 months, ‘Sec. 90 code of Sanitation Burial Grounds requirements 1. It shall be unlawful for any person to bury the remains in places other than those legally authorized 2. Atleast 25 meters from any dwelling house and no house shall be Constructed within the same distance from any burial ground. 3, Not within 50 meters from any water source, Other burial requirements: 1. Shipment of remains abroad shall be governed by the rules and regulations of the Bureau of Quarantine.2, The burial or remains in city or municipal grounds shall not be prohibited due to race, nationality, religious or political reasons, 3, Except when required by legal investigation or when permitted by the local health authority, no embalmed remains shall remain unburied longer than 48 hours. FUNERALS ‘Art. 305 CC The duty and the right to make arrangements for the funeral of a relative shall be in accordance with the order of support under Art. 294. Descendants : Eldest Ascendants.: Paternal For support as mentioned in Art. 204 1. Spouse 2. The descendants of the nearest degree 3, Ascendant of the nearest degree 4, Brothers and sisters ‘Art. 306 CC ; In keeping with the social position of the deceased. ‘Art. 307 CC ; In accordance to the expressed wishes of the deceased, Art. 309 CC ; Showing of disrespect to the dead shall be lable to the family of the deceased for damages, materials or moral ‘Art. 132 RPC: Interruption for religious worship. ‘Art 133 RPC: Offending the religious feeling Art. 2219 CC: Provides for the moral damages may be recovered for acts mentioned in Art. 309 CC. LIMITATIONS TO THE FUNERAL RITES 1, Will of the deceased. 2. Burial of a person sentenced to death must nat be held with pomp. 43, Restrictions as to funeral ceremonies in cases of deaths due to communicable disease. 3. Disposing of the dead body in the sea = Provided the deceased is not suffering from dangerous communicable deceased. = Sec. 1093 RAC Permit for conveyance of body to sea for burial 24. Cromation the pulverization of the body into ashes by the application of heat irst must be identified, Permit and in a crematory made for the purpose. NOT GRANTED: 2. Ifthe deceased left a note. Identity of the person is not definite cc. Exact cause of death cannot be ascertained and the need for further inquiry or examination, 5, Use of body for scientific purposes Corpse of prisoners - Any person to be buried for public expense and which is unclaimed for 24 hours, ‘Soc. 98 P.D. 856 Code of Sanitation ‘Special precautions for safe handling of cadavers containing radioactive isotopes. RA 349 as amended by RA 1056 Permission to use Human organs or any pportions of the human body for medical, surgical or scientific purposes Under certain conditions. + in writing, specific use, signed by the grantor and two disinterested witness. ‘Sec. 96 Code of Sanitation; Donation of human organs for medical , ‘Surgical and scientific purposes according to the Sanitation Code Persons permitted to detach human organs: 4. Licensed physicians 2. Known scientist 3, Medical or scientific institutions Requirements for a valid authori 4, Itmust be in writing 2. It must specify the person or institution grated the authorization. 3, Must speaify the organ or part to be removed. 4. Signed by the grantor and two disinterested person. 5. Copy ofthe authorization must be submitted tothe Secretary of Health, EXHUMATION tion ‘The deceased buried may be raised or disinterred upon the lawful order of the proper authorities, Sec 1082 RAC Cemetery permits even to NBI agents Sec. 1097 RAC Exhumation in case of death from dangerous communicable disease after 5 years from burial M‘Soc 92 Code of Sanitation 3 years if non-dangerous communicable disease. Remains shall disinfected before burial Requirements to be satisfied in exhumation: 4, Duration of interment as required. 2, Exhumation permit 3. Compliance of sanitary requirements Procedures followed in MedicoLegal Exhumations: 1. A formal request from any of the law enforcement agency or any person ‘authorized by lav. ‘a. Name of the person, place of interment, date of interment, ‘suspicion as to cause of death. 'b. To determine the cause of death. cc. To determine as to identity of the person. 4. To recover organs or tissues for further examination for : Toxicological analysis Histopath exams. ‘Smears from vaginal canal and blood for alcohol determination 2. Set the date and time of exhumation. if physician has a strong reason to believe that for the justification and sirong probabil. 3, Written request to the Regional director or Secretary of Health. 4. Grave must be propery identified by the person who was present when the body was interred, 5. After opening the coffin, the body must be viewed by any person who can ‘identify the deceased. 6. Actual autopsy and adoption of the procedure is needed to accomplish the purpose of the exhumation. 7. Disinfection of the body and all areas involved must be carried out with the assistance of the local health officer and the retum of the body to the burial place. MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES Physical injury is the effect of some of stimulus on the body. ‘Stab wound the effect is immediate but a blunt object is delayed production on the contusion. Causes of Physical Injuries 41. Physical violence 2. Heat or cold 38Electrical energy ‘Chemical energy 5. Radiation by radioactive substances &. Change of atmospheric pressure Infection 7. 1. PHYSICAL INJURIES BROUGHT ABOUT BY PHYSICAL VIOLENCE = The effect of the application of physical injury on person is the production of wound. A disruption of the anatomic integrity of the tissues of the body. However, not all physical violence will result in the production of wound. Physics of wound production: v2 a. Kinetic energy “Velocity component is the important factor: M16 rifle with a velocity of 3200 fY sec causes damage more than a heavier 38 caller. b. Time = The shorter the period of time needed for the transfer of energy, the greater the lkelinood of producing damage. = Ifa person is hiton the body and the body moves towards the direction of the force applied, the inury is less as when the body is stationary. The longer the time of contact between the object or instrument causing the injury, the greater wll be the dissipation of eneray. ©. Area of transfer = The larger the area of contact between the force applied on the body, the lesser the damage to the body. By applying an equal force, the damage caused by stabbing is greater compared to a blunt instrument 4d, Other factors = The less elastic and plastic the tissue > the greater that a laceration will result. Elasticity : Ability of the tissue to return to its normal sizes and shape after being deformed by a pressure. ‘A force transmitted through a tissue containing fluid wil force the fluid away from the area of contact in all directions equally, frequently causing the tissue to lacerate. 36VITAL REACTION = Itis the sum total ofall reactions of tissue or organ to trauma, either ‘observed micro or macroscopically. a, RUBOR — redness or congestion of the area due to an increase of blood supply 2s a part of the reparative mechanism, b. CALOR - Sensation of heat or increase in temperature. . DOLOR - pain due to involvement of the sensory nerve 4d, LOSS OF FUNCTION- due to trauma, the tissue may not function. ‘The presence of vital reaction differentiates an ante-mortem from a post-mortem injury. EXCEPT: vital reactions not seen even if injury inflicted during ie 1. During agonal state of a living person were cells don't react to the trauma. 2. Sudden death as in sudden coronary occlusion. CLASSIFICATION OF WOUNDS: 1. AS TO SEVERITY ‘2. Mortal wound ~ caused immediately after infliction that is capable of death. Parts of body that are mortal — heart, vessels, CNS, lungs, other organs. . Non-mortal wound - Not capable of producing death after infliction, 2. AS TO KIND OF INSTRUMENT USED 2. Blunt instrument — contusion, hematoma, lacerated wound.b. Sharp instrument ‘Sharp-edge instrument> incised wound Sharp pointed > punctured wound Sharp edge and sharp-pointed > stab c. Wounds brought about by tearing force ~ lacerated wound d. By change in atmospheric pressure — barotraumas. e. Wounds brought about by heat or cold ~ frostbite, scald, burns. ‘4. Wounds brought about by chemical explosion ~ GSW, shrapnel wound ‘9: Wounds brought about by infection. 3. AS TO THE MANNER OF INFLICTION a) HIT — means of bolo, blunt instrument, axe. b) TRUST or STAB ~ bayonet dagger ©) GUN POWDER EXPLOSION - Projectie or shrapnel wound, d) SLIDING or RUBBING or ABRASION 4, AS REGARDS TO THE DEPTH OF THE WOUND a) Superficial - wound involves only the layers of the skin b) Deep - inner structures beyond the layers of the skin. PENETRATING WOUND - Wounding agent did not come out or Piercing a soli organ PERFORATING WOUND - Wounding agent produces communication between the inner and outer portion of the hollow organs, OR piercing or traversing completely a particular part of the body causing communication between the points of entry and exit ofthe instrument or substance producing it 5. AS REGARDS TO THE RELATION OF THE SITE OF APPLICATION OF FORCE AND THE LOCATION OF INJURY ‘Coup Injury ~ Physical injury which is located at the site of the application of force, . Contre-coup injury ~ opposite the site of the application of force. ©. Coup contre-coup injury ~ site and also opposite of application of force. 4d. Locus minoris resistencia - Physical injury not located at the site nor ‘opposite the site of the application of force but in some areas, offering the least resistance to the force applied. Example: Biow in fore head > contusion on the ragion of the eyeball e.Extensive injury ~ Physical injury involving a greater area of the body beyond the site of the application of force. 38Example : Fall or MVA 6. AS TO REGIONS OR ORGANS OF THE BODY INVOLVED Injuries in various parts of the body 7. SPEGIAL TYPES OF WOUNDS '2) DEFENSE WOUNDS —_— Instinctive reaction of self:preservation. > handsifractures b)PATTERNED WOUND Wound in the nature and shape of the instrument. > Wheels abrasions from rope. ©)SELF-INFLICTED WOUNDS - Wound produced on oneself but no intention to end his life. Motive of producing self-inflicted wounds: To create or deliberately magnity an existing injury or disease for pension or workman's compensation To escape certain obligations or punishment. To create a new identi. Gain attention or sympathy. Psychotic behaviour, ‘Some ways of sel mutilation: Head banging or bumping Exposure of body to heat radiation from open fies, radiators. Penetrating nail to chest wall Castration by amputation of the penis ‘Trichotilomania- pulling of body hair LEGAL CLASSIFICATION OF PHYSICAL INJURIES 4. MUTILATION Ar. 262RPC Kinds of mutilation: ‘Intentionally depriving a person, totally or partially of some of the essential organs for reproduction b. Intentionally depriving a person of any part or parts of the ‘human body other than the organs for reproduction. Mutlation to be punishable it must be intentional or not physical injury. MAYHEM ~is the unlawful and violent deprival of another of the use of a part of the body so as to render him less able in fighting, either to defend himself or to annoy his adversary. \Vasectomy/Tubal ligation are not mutilation and a legitimate method of contraception despite the fact that itis done intentionally and deprives a person of his power of reproduction. 9SERIOUS PHYSICAL INJURIES Art. 263 RPC ‘Any person who shall wound, beat or assault another Art. 263 and, administering injurious substance, without intent to kill Art. 264. ‘The main purpose of dividing the provision into four paragraphs 2) Is fo graduate the penalties depending upon the nature and character of the wound inflicted 'b) Their consequences on the person af the victim. 4, Prison mayor ~ because of the physical injuries inflicted, the injured person ‘becomes insane, imbecile, impotent or biind, 2. Prision correctional in its medium and maximum periods - loss of speech, hear or smell ~ loss of eye, hand, foot, arm, leg (08s of the use or incapacitated for the habitual work he used to do. 3, Prision correctional in its minimum and medium periods. = person injured shall be deformed, = lost any other part of the body, incapacitated for more than 90 days. 4, Arresto mayor in its maximum period to prision correctional “ifthe physical injuries shall have cause the lness or incapacity for labor for more than 30 days. Is the offense shall be committed against any of the persons enumerated in ‘Art 246 Or with attendance of any of the circumstances mentioned in Art, 248 = The case covered by subdivision number 1 of this art. Will be punished by reelusion temporal in lis medium and maximum periods. = Subdivision number 2 by Prision correctional in its maximum period to prision mayor in its minimum period, Subdivision number 3 by prision correctional in its medium and maximum = Subdivision number 4 prision correctional in its minimum and medium periods. ‘The provisions of the preceding paragraph shall not be applicable to a parent who shall infict physical injuries upon his child by excessive chastisement. RA 7610. may be committed through a simple negligence or imprudence ADMINISTERING INJURIOUS SUBSTANCE OR BEVERAGES Art 264 RPC Elements: 41. The offender infcted upon another any serious physica injury,2, There is knowledge that the substance or beverage administered is injurious Or took advantage of the victims weakness of credulity, 3, There is no intent to kil in the part ofthe offender. intentional so> frustrated murder. Treachery is inherent in Art. 264 RPC. LESS SERIOUS PHYSICAL INJURIES Art. 265 RPC ‘Any person who shall inflict upon another physical injuries not described in the preceding articles, But which shall incapacitate the offended parly for labor 10 days or more (Or shall require medical attendance for the same period Both of which is 10 days but not more than 30 days and there must be proof to it. ‘The crime of less serious physical injuries may be qualified and a fine of a higher penalty is imposed when 41. There is a manifest intent to insult or offend the injured person. 2. There are circumstances adding ignominy to the offense 3. The victims is the offender's parents, ascendants, guardian, curators, teachers 4. The victim is @ person of rank or person of authority, provided the crime isnot direct assault. P.D. 169 Obligation imposed on Physicians treating persons suffering serious and less serious physical injuries required to report to law enforcement agencies, SLIGHT PHYSICAL INJURIES AND MALTREATMENT Art 266 RPC 1, Arresto menor- when the offender has inflicted physical injuries which ‘shall incapacitate the offended party for labor form 1 to 9 days or shall require medical attendance of the same period 2. Aresto menor or fine not exceeding P200 and censure when the offender hhas cause physical injuries which do not prevent the offended party from engaging in his habitual work nor require medical attendance, 3 Arresto menor in its minimum period or a fine not exceeding P50 when the ‘offender shall il eat another by deed without causing any injury. If there is no evidence to show actual injury or incapacity for labor or Period of medical attendance, the accused can only be guilty of sight physical injures. 41‘So a tender slap on the face, holding the arm tightly, application of pressure in some parts of the body or mild blow which show no sign of physical Violence may sill be considered slight physical injuries or maltreatment. (Parag 3) PHYSICAL INJURIES INFLICTED IN A TUMULTOUS AFFRAY Art 252 RPC Elements: ‘There is a tumultuous affray Paricipants suffered from serious physical injures. ‘The person who infictad serious physical injuries cannot be identified, All those who appear to have used violence upon the person of the ‘offended party shall be penalized by arrest from 5 to 15 days. ‘TYPES OF WOUNDS ( MEDICAL CLASSIFICATION) 1, CLOSED WOUND~ no breach of continuity ofthe skin or mucous membrane. ‘a. Superficial ~ When the wound is just underneath the layers of the skin ‘or mucous membrane, a.1 -PETECHIAE - is a circumscribed extravasation of blood in the subcutaneous tissue or underneath the mucous membrane. Example : mosquito bite, blood disease, hanging ‘8.2 CONTUSSION ~ isthe effusion of blood into the tissues ‘undemeath the skin on account of the rupture of the blood vessels as a result of the application of blunt force or violence. = size of contusion greater than the size of the object. = Location of the contusion is not always the site of application of the force, Example: Black eye> Forehead ‘Medico-legal point of view: ‘A contusion as indicated by its external pattem may correspond to the > shape of the object or weapon used, Extent > the possible degree of violence applied. Distribution> indicates the character and manner of injury as in manual strangulation around the neck.‘Age of Contusion: appreciated from its color change The size tends to become smaller from the periphery to the center ‘and passes through a series of color changes as a result of the > Disintegration of the REC and liberation of hemoglobin. ‘The contusion is red, purple soon after its complete development. 40 5 days > green 7 to 10 days > yellow and gradually disappears on the 14” or 15" day. ‘The ultimate disappearance of color varies from 1 to 4 weeks depending upon the severity and constitution of the body. The color changes starts at te periphery. CONTUSION VS. POST-MORTEM HYPOSTASIS Contusion ‘Below the epidermis in the true skin in small bruises or extravasations, below this in larger anes and often much deeper stl. The epidermis has no blood vessels to be ruptured. Post mortem Hypostasis Inthe epidermis or in the cutis as a simple stain or a showing through the ‘epidermis of the underlying engorged capillaries. Contusion ‘Cuticle was probably abraded by the same violence that produced the bruise. In small punctures such as fleas bites, this is not observed, Post-mortem hypostasis: ‘Cuticle unabraded, because the hypostasis is a mere sinking ofthe blood, there is no trauma, Contusion ‘A.bruise appears at the seat of and surrounding the injury. This may or may ‘not be a dependent par. Post-mortem hypostasis. ‘Always in a part which for the time of information is dependent 2Contusion ‘Often elevated because elevated blood and subsequent inflammation swell the tissues. Post-mortem hypostasis Not elevated, because either the blood is stil in the vessels or at most has simply soaked into and stained the tissues. Contusion Incision shows blood outside the vessels. This is the most certain test of difference and can be observed even in very small bruises. Post-mortem hypostasis Incision shows the blood is stil in its vessels and if any oozing occurs drops. ‘can be sean issuing from the cut mouths of the vessels. Contusion Color variegated. This is only true of bruises that are the same days old due to the changes in the hemoglobin produced during life, Post-mortem hypostasis olor is uniform. The well known change in color produced in blood Extravasated Into living tissues does not occur in dead tissues with the same regularity, Contusion Ifthe body happens to be constricted at or supported on a bruised place, the actual surface of contact may be a litle lighter than the rest of the bruise but will not be white Post-mortem hypostasis Inaplace which would otherwise be the seat of hypostasis pressure of any kind even simple support is sufficient to obliterate the lumen of the venules ‘and capillaries and so to prevent their filing with blood. White lines or patches of pressure bordered by the dark color of hypostasis are produced and marks of flogaings, strangulation, etc. are thus ‘sometimes simulated. FACTORS INFLUENCING THE DEGREE AND EXTENT OF CONTUSSION 41, General condition ofthe patient. 2, Part of the body affected. Fatty tissues, bloody parts > contused easily Fibrous areas, muscle > less 3. Amount of force applied —The greater the force, the more effusion of blood. 4, Disease ~ Contusion may develop with or without application of force. Example: Aplastic anemia, whooping cough5. Age ~ Children and old age tend to bruise easily. 6. Sex — women, obese easily develops unlike boxers, 7. Application of heat and cold The distinction between ante-mortem and post-mortem contusions in an undecomposed body is that in ; 41. Ante-mortem bruising: there is sweling, damage to epithelium, extravasation, coagulation and infitration of the tissues with blood. 2. Postmortem bruising there are no such findings. a3 HEMATOMA fs the extravasation of effusion of boos ina newly formed cavity Underneath the ski, When the blunt instrument hit a hard part of the body lke a bony part wich Is suporfally located. = Force causes the subcutaneous tissue to rupture on account ofthe presence of ahard structure underneath DISTINCTION BETWEEN CONTUSION AND HEMATOMA 41. In contusion- the effused blood are accumulated in the interstices of the tissues undemeath the skin In hematoma blood accumulates in a nowly formed cavity underneath the skin, 1. in contusion, theskin shows no elevation and is ever elevated, the clavation is slight and is on account of inflammatory changes Inhematoma — the skin is always eelevated. 2. Incontusion, puncture or aspiration with syringe ofthe lesion, no blood can be obtained, Inhematoma — shows presence of blood and subsequent depression of the elevated lesion, ‘Abscess, gangrene, hypertrophy, fibroid thickening and even malignancy ‘are potential complications of hematoma. MUSCULO-SKELETAL INJURIES 1. Sprain - partial or complete disruption in the continuity 0s a muscular or ligamentous support of a joint, due to a blow, kick or torsion force. 2, Dislocation — displacement of the articular surface of bones entering into the formation of a joint. 3, Fracture — solution of continulty of bone resulting from violence or some existing pathology. 4s2, Close or Simple Fx ~ no break in continuity ofthe overlying skin, '. Open or Compound Fx — Fx is complicated by an open wound caused by the broken bone which protruded with other tissues of the ‘broken skin. c. Comminuted Fx - Fractured bone is fragmented into several pieces. d. Greenstick Fx ~ Fx wherein only one side of the bone is broken while the other is merely bent. e. Linear Fx —_when the Fx forms a crack usually in flat bones. f. Spiral Fx —break in the bones forms a spiral manner as seen in long ‘bones. 9. Pathologic Fx - Fx caused by weakness of the bone due to disease. 4. Strain ~ the over-stretching instead of an actual tearing or the rupture of a ‘muscle or ligament which may not be associated withthe joint. 5, Sublaxation — Incomplete or partial distocation, INTERNAL HEMORRHAGE - rupture of blood vessels which may cause hemorrhage due to the following: ‘8. Traumatic intracranial hemorrhage. b. Rupture of parenchymatous organs. . Laceration of other part of the body. CEREBRAL CONCUSSION ( COMMOTIO CEREBR! ) = THE JARRING OR STUNNING OF THE BRAIN CHARACTERIZED BY MORE OR LESS COMPLETE SUSPENSION OF ITS FUNCTIONS AS A RESULT OF INJURY TO THE HEAD WHIGH LEADS TO SOME COMMOTION. OF THE CEREBRAL SUBSTANCE. - is more severe when the moving or mobile head struck a fixed hard object, ‘as compared when the head is fixed and struck by a hard moving object. Signs and Symptoms 1, unconsciousness which is more or less complete, 2, muscles are relax and flaccid 3, eyelids are closed and the conjunctivae are insensitive, 4. surface of the body is pale, cold and clammy. 5. respiration is slow and sighing. 6. pulse is rapid, weak faltering and scarcely perceptible o the fingers. 7. temperature is subnormal 8. sphincters are relaxed with unconscious evacuation of the bowel and bladder. 9, reflexes are present but sluggish and in severe cases may be absent. Loss of memory for events just before the injury is a constant effect of cerebral concussion and is of medico-legal importance. 2. OPEN WOUNDS‘a. Abrasion ( Scratch, graze, impression mark, friction mark ) “itis an injury characterized by the removal of the superficial epithelial layer of the skin caused by a rub r fiction against a hard rough object. = Contussion with abrasion = forcible contact before friction occurs. “the shape varies and the raw surface exudes blood and iymph which later dries and forms a protective covering as SCAB or CRUST Characteristics of abrasion: 4. Itdevelops at the precise point ofthe force causing it 2. Grossly or with the aid of a hand lens the injury consists of parallel linear injuries which are in line withthe direction of rub or friction causing it 3, Itmay exhbit the patter of the wounding material 4, Usually ignored by attending physician, Medico-egal viewpoint == abrasions caused by fingernails may indicate struggle or assault and are usually located in the face, neck, forearms and hands. abrasions resulting from fricton on rough surfaces are located in bony parts and are usually associated with contusion or laceration, ature of the abrasion may infer degree of pressure, nature of the rubbing object and the direction of movement. 5. Abrasion heals in a short time and leaves no scar unless if not infected or ifthe whole thickness of the skin is involved. Forms of abrasion 1. Linear abrasion ~ appears as a single line, straight or curve. pinching with fingernails = curve a Sliding the point of a needle = straight near ab. 2. Multitinear ~ develops when the skin is rubbed on a hard rough ‘abject. producing several linear marks parallel to one another. Example: MVA 3. Confluent ~ linear marks in the skin are almost indistinguishable ‘on account of the severity of friction and roughness of the object. 4. Muttiple ~ several abrasions of varying sizes and shapes may be found in diferent parts of the body. Types of abrasion 1, Scratch — caused by sharp pointed object which slides across the skin, like pin, thom or fingernail = Injury usually parallel to the direction of slide. = Fingernail scratch > broad at point of commencement with tailing atthe end. ie contact with rough, hard objects 2. Graze ~ usually caused by for a"resulting to irregular removal ofthe skin surface. ‘course indicated by a clean commencement and tags on the end 3. Impact or imprint abrasion ( patterned abrasion, stamping abrasion, abrasion a la signature) « those whose patter and location provides objective evidence to ‘show cause, nature of the wounding instrument and the manner ‘of assault or death, iarks of grid of radiator, thread marks of wheel, teeth marks. 4, Pressure or friction abrasion — caused by pressure accompanied by ‘movement usually observed in hanging or strangulation, = spiral strands of the rope as seen in the skin in hanging Differential diagnosis: 1. Dermal erosion - gradual breakdown or very shallow ulceration of the skin which involves only the epidermis and heals without scarring. 2. Marks of insects and fishes bites ~ skin inury is iregular with no vital reaction and usually found on angles of the mouth, margins of nose, eyelids and forehead. 3. Excoriation of the skin by excreta — found in infants and the skin lesions heals when the cause is removed. No apparent history of rubbing trauma on the affected area. 4. Pressure sore — usually found at the back at the region of bony prominence. History of longstanding illness, bed ridden. ANTEMORTEM ABRASION POSTMORTEM ABRASION COLOR —reddish-bronze dueto slight —_yellowish and transparent ‘exudation of biood LOCATION any area ‘over bony prominence Rough handling of the cadaver VITAL with intravital reaction ‘shows not vital reaction and REACTION may show remains of damaged is characterized by a separation Epithelium of the epidermis from ‘Complete loss of the former. b. Incised wound (cut, slash, slice) =" produced by a sharp-edged ( cutting) ~ oF sharp-linear edge of the instrument like a knife, razor, bolo, glass etcImpact cut > when there is forcible contact of the cutting instrument with the body surface. Slice cut > when cutting injury is due to the pressure accompanied with movement of the instrument ‘Chopped ar Hacked wound > when the wounding instrument is a heavy cutting instrument ike saber > injury is severe ‘Characteristics of incised wound: Edges are clean cut The wound is straight Usually the wound is shallow near the extremities and deep at the middle portion, Profuse hemorrhage because of the clean cut on the vessels. Gaping is usually present due to the retraction of the edges, Clothes will also show a clean cut if cut by the instrument. Faster healing if without complications. Incised wound made by broken glasses maybe regular, needs to be removed. Changes that occur in an incised wound: 1. After 12 hours — edges are swollen, adherent with blood and with leukocyte infiltration. 2. After 24 hours — proliferation ofthe vascular endothellum and connective tissue cells, 3. After 36 to 48 hours -capillary network complete, fibroblasts running at Fight angles to the vessels, 4, After 310 5 days — vessels show thickening and obliteration. Why a person suffers from incised wou 1. Asa therapeutic procedure. 2. As a consequence of self-defense 3, Masochist may sel-infict incised wounds for sel-gratification 4. Addicts and mental patients ‘Suicidal wounds — usually located in peculiar parts of the body, accessible to the hand. = the most common site is the wrist, radial artery and the neck. Homicidal wounds — usually deep, multiple and involves both accessible and rnon-accessible pars, = dlothing are usually involved = Defense and other forms of wounds are present. 9‘Accidental wounds ~ multiple incised wounds observed on the passenger and driver of MVA due to broken windshields. = kitchen knives in the preparation of food. SUICIDAL WOUNDS HOMICIDAL WOUNDS DIRECTION Oblique from below left ear, Usually horizontal below downwards across front neck the adams apple just above Adams apple SEVERITY Usually not so deep and Usually deep and may cause ‘may only involve trachea, Involvement ofthe cartilage ccarolid and esophagus and bones. SUPERF'L Usually present before the Practically absent but may cuT commencement of deeper rarely be present when the ‘wound. Victim struggled when attacked POSITN OF May be sitting or facing a Usually vietim lying on bed. THE BODY mirror or standing or in other place. WOUNDING Firmly grasp (cadaveric spasm) Weapon is absent WEAPON or found lying beside the viet. BLOOD Bid found in front part of body Bid found at the back of neck DISTRIBUTION Hand smeared with blood, Hands are clean. MOTIVE History of mental depression, Absence of such history Financial, social problems, alcoholism PREVIOUS Hx May be present ‘Always absent (Of SELF-DESTRUCTN 3. STAB WOUNDS ~ is produced by the penetration of a sharp and a sharp edged instrument like a knife, scissors ifthe sharp edge is the one that comes in contact with the skin then itis an incised wound. ~ Ifthe sharp pointed portion frst come in contact, its a stab wound. surface length may reflect the width of the wounding instrument. 30smaller when the wound is not so deep. wider if upon withdrawal is not in the same direction as seen in slashing movement. The presence of an abrasion from the extremity of the skin defect is in line with direction of the slashing movement. ‘The extremities of stab wound may show the nature ofthe instrument used, = a doubled biaded weapon shows both extremities to be sharp, © Assingle bladed weapon — one of its extremities as rounded and contused, rot seen if instrument is quit thi. ‘The direction of the surface defect may be useful in the determination of the possible relative position ofthe offender and the victim when the wound was inflicted. ‘As to whether the wound is sit-ike or gaping depends on the direction of the wound to the Langers line. The depth of the wound may be influence by: 1. size and sharpness of the instrument 2. atea of the body involved 3. the degree of force applied Hemorrhage is always the most serious consequence of stab wound due to the severance of blood vessels or involvement of bloody organs. How to describe stab wound: 4. length of the skin defect ~ edges must be coaptated frst ailing — the direction of withdrawal of the wounding weapon, 2. condition of the extremities ‘sharp extremity > sharpness of the instrument used. If Both extremity are sharp > double bladed weapon is used, 3. condition of the edges. = edges are regular and clean cut> due to one stabbing act, serrated or zigzag in appearance > several stabbing wounds ( series of thrust ‘and withdrawal.) 4. linear direction ofthe wound ~ it may be running vertically, horizontally, or ‘upward medially or laterally. 5. location of the stab wound ~to include exact measurement from anatomical landmarks. 6. direction of the penetration - must be tidimentional 7. depth of the penetration 8. tissue and organs involved st‘Stab wounds may be ‘ASuicidal 1. Located over vital parts of the body. 2. Usually solitary '3. Located over covered parts of the body, the clothing is not involved 4. Stab wound is accessible to the hand of the victim 5. Hand of victim is smeared with blood 6. Wounding weapon is firmly grasp by the hand of the victim, 7. If stabbing is accompanied with slashing movement > the wound taling abrasion is seen towards the hand inficting the injury. 8. Suicide not may be present 8, Presence of a motive for self destruction 10. No disturbance in the death scene with wounding instrument found ‘near the victim, B. Homicidal — stabbing with homicidal intent is the most common Characteristics:1. Injuries other than stab wound may be present 2. Stab wound may be located in any part of the body. 3. Usually more than one stab wound. 4. A motive for stabbing, f none then the offender elther insaneldrugs 55 Disturbance in the crime scene Medical evidence showing the intent of the offender to kill the victim: 1 2. 3 4 8 there are more than one stab wounds ‘stab wounds located in different parts of the body stab wounds are deep Serrated stab wounds means thrust and withdrawal of the wounding \weapon to increase internal damages, irregular or stellate shape skin defects> due to changing direction of the ‘weapon with the portion of the instrument atthe level ofthe skin as the lever.4, PUNCTURED WOUND. is the result of a thrust of a sharp pointed instrument, = External injury is quite small but the depth is to a certain degree.; ice-pick, nail Nature of the extemal injury depends on the sharpness of the end of the wounding instrument: ontusion of the edges> i end is not sharp ‘opening may be> round, elptical, diamond shaped or cruciate = External hemorrhage is limited although internal injuries may be severe.> blood vessels and bloody organs is fatal if no intervention applied. « Site of extemal wound can be easily sealed by dried bid, serum, or clotted bid. Punctured wounds are usually accidental Characteristics: “1. The opening of the skin is very small, wound is much deeper than it is wide, 2. External hemorrhage is limited than internally may be severe. 3. Sealing of external opening is favorable for the growth and ‘multiplication of anaerobic organism like bacillus tetani Homicidal - ‘multiple and usually located in diferent parts of the body. wound are deep there are defense wounds on the victim. signs of struggle in the crime scene, Suicidal - located in areas of the body where the vital organs are located. Usually singular, if multiple located in one area, parts of body involved is accessible by the hand of the victim, clothing usually not involved. wounding is made while the victim is in sitting or standing position , bleeding is towards the lower part of the body or clothing, 6. no disturbance in the rime scene. 7. wounding instrument found near the body. Puncturing wound with puncturing instrument loaded with poison: 4. poison dart ~ cyanide or ricotine 2. fish spines 3. dog bites with hydrophobia virus 4 injection of air and poison as a way of euthanasia, 3S.LACERATED WOUNDS ( TEAR, RUPTURE, STRETCH “PUTOK") 's a tear of the skin and the underlying tissues due to forcible contact with a blunt instrument. May be produced by a hit with a piece of wood, iron bar, fist, stone, butt. Ifthe force is applied to a tissue is greater than its cohesive force and elasticity> the tissue tears and a laceration is produced Characteristic: shape and size of the injury does not correspond to the wounding instrument 2. tear on the skin is rugged with extremities irregular, I-datined, 3. injury developed where the blunt force is applied. 4. borders of the wound are contused and swollen. 5. developed in areas where the bone is superficially located lke scalp, 6. examination withthe aid of hand lens shows bridging tissue joining the edges and hairs bulbs are intact. 7. bleeding is not extensive due to blood vessels are not severed evenly. 8. healing process is delayed and has a tendency to develop a scar. Classification of lacerated wounds: 1 4 Spliting caused by crushing of the skin between two hard object. x: laceration of scalp hit by a bunt instrument, cut eyebrow of a boxer. COverstretching of the skin ‘When pressure is applied on one side of the bone> the skin over the area will be stretched up to a breaking point to cause laceration and exposure of the fractured bone. Inavulsion: the edges of the remaining tissue is that of laceration, Grinding compression ‘the weight and the grinding movement may cause separation of the skin with the underiying tissues. Tearing this may be produced by a semi-sharped edged instrument which causes irregular edges on the wound like hatchet and choppers. Lacerated wounds are rarely suicidal INCISED WOUNDS LACERATED WOUNDS, 34Edges are clean cut, regular, well defined edges are roughly cut, irregular, i+ defined No contusion or swelling around the ‘swelling and contusion around the Incised wounds lacerated wounds Extremities of the wound are sharp, may be extremities are illdefined and Irregular Round, or contused Examination by means of a hand lens hair bulbs are preserved ‘Shows that hair bulbs are cut Healing is faster healing is delayed Caused by sharp edged instrument ‘caused by a blunt instrument GAPING OF WOUND ~ Separation of the edges especially in deep wound may be due to the following: 4. mechanical stretching or dilatation = the presence of a mechanical device on the edges to prevent coaptation will cause separation. Example: drain in an abscess, retractor during ‘operation. 2. oss of tissue due to: ‘2, Destruction due to pressure, inf'ion, cel ysis, burning, chemical reaction. 'b Avulsion or physical or mechanical stretching resulting to separation of a Portion of the tissue. «. Trimming of the edges ~ debridement of the skin which come in contact with the bullet atthe entrance and exit of GSW and removal of necrotic materials. 3. retraction of the edges = undemeath the skin are dense networks of fibrous and elastic connective tissue fibers running on the same direction and forming a pattern more or less present in all persons. = This patter of fiber arrangement is called cleavage direction or lines of cleavage of the skin and their linear representation on the skin is called Langers line. Practical ways of determining how much of the skin surface is Involved in an injury or disease = _ skin functions as a mechanical protection of the body, storage of water. 55= Determination of how much skin is involved is important in the mode of treatment and prognosis especially in burns, contusion = bums of 70% in children and older age group are fatal. le of nine is used. Head and neck 0% 9% fone upper extremity 9% 18% front chest and abdomen 18% 18% posterior chest and abdo 18% 18% ‘one lower extremity front 9% 18% ‘one lower ext(back) S% 18% pudendum 1% 1% Factors responsible for the severity of the wound: 4, Hemorrhage may influence the severity of wound by: a. loss of blood incompatible with life = blood constitutes 1/20 of the body weight of an adult =5 to 6 quarts of blood ( one quart is 946 cc) = loss of 1/10? of its volume will cause no significant change. “loss of one quart> fainting = oss of 1/3 to 2/5" > irreversible shock males can withstand more loss of blood than females. “hypertension causes more excessive and rapid bleeding, 'b, Hemorrhage may result in an increase in pressure in or on the vital organs to affect the normal function. - intracranial hemorrhage cause compression of the vital centers of the brain. - hemopericardium > pericardial tamp hemorrhage to the chest> diminution of the respiratory output>anoxia. cc. Hemorthage may cause mechanical barriers tothe function of organs. = Into tracheo-bronchial lumina> asphyxia + info muscles > disturbance in their contractilty Causes of hemorrhage: ‘a trauma - destruction ofits blood vessel wall natural causes ~ intracerebral hemorrhage (apoplexy)>lenticulstraite br. MCA = Spontaneous subarachnoid hemorthage > saccular berry aneurysm rupture of arteriosclerotic aneurysm 36rupture of esophageal varices = pulmonary hemorthage due to PTB, lung abscess, bronchiectasis ruptured ectopic pregnancy 2, Size of injury - bums greater than 1/3 of the body are fatal 3, Organs involved — usually fatal to heart, brain, lungs. 4, Shock — biow to genitalia, sight burns to young and old. 5, Foreign body or substance introduced into the body - bacterial, viral, foreign body, chemical, TOXIN. 1. snake bites> 2 punctured was at the center ofthe reddened affected area. ‘The venom is injected through its fangs which is connected to the poison land. ‘Snake venom toxicity will depend on: 4. potency of venom injacted 2, amount of venom injected by the fang will depend on “season of the year + the length of time the snake has eaten, «if a snake has just killed its prey> toxic content is smaller. 3, size of the patient 4, immediate treatment instituted. ‘Snake venoms are two principal classes: 1. Neurotoxic ~ primarily paralysis the respiratory and cardiac center of the brain. may cause N.V, ascending paralysis, coma, convulsion, cip arrest 2. Hematoxic - atfects particularly the blood manifestations are pain, swelling on the affected area, IV hemolysis, NV, pulmonary and cardiac edema, Emergency treatment may be incision of the wound to promote more external hemorrhage to drain the venom, tourniquette above the site of the wound placing ice on the bite site ‘sucking the wound to drain venom with the mouth administration of anti-snake venom serum.2. Scorpion venom = venom has toxic, hemolytic, hemorrhagic one punctured wound on the center of a reddened area “pain, edema and reddening 3. Coslenterate sting ( jellyfish ) ~ tentacles penetrate into the skin and cause explosion of the nematocyst ‘and liberation of the venom, extreme pain, Urticarial rash, dilated pupils, paleness, labored breathing 6. Absence of medical or surgical intervention - wound may not be fatal but due to neglect or ignorance of its management, may be serious and fatal FATAL EFFECT OF WOUNDS: 1, Wounds may be directly fatal by reason of: ‘a. hemorthage - nack due to carotid bleed. bb. Mechanical injuries on vital organs ‘e. shock 2, Wounds may be indirectly fatal by reason of 'a. secondary hemorthage following sepsis . specific infection ©. scaring effect . secondary shock NATURE OF DEATH DUE TO SECONDARY CAUSES 41, Changes whose natural sequence are direct & obvious ~ sepsis, telanus 2. Changes producing separate patholagical lesions which in turn proves to be fatal Ex: operation to ligate vessel but died of peritonitis despite dligencelskil 3, Changes where a definite pathological condition was present before the injury. Ex. Person with tumor and stabbed , slab is not capable of death but accused is responsible for his death, 4, Changes where a definite pathological condition of totaly different nature arises after the wounding and the consequential sequence is doubtful Ex. TB meningitis fig blow to the head COMPLICATIONS OF TRAUMA OR INJURY 1. Shock due to injury to nervous system, anoxemia, endothelial damage 2. Hemorrhage 53. Infection fa, from the instrument . from the organs involved in trauma ex. Bowels injured . injury may depress general vitality 4, deliberate intro of micro-organism 4, Embolism 38HEALING OF WOUNDS. 1, Power of the human tissue to regenerate — replaced the destroyed tissue by newly formed similar tissue. Regenerates rapidly : C.T., blood forming tissues surface epith. skin Slow to regenrate:sm, Muscles, neurons of CNS, highly specialized ‘glandular tiss. Time of healing is dependent on: ‘a. vascularity age of person . degree of rest or immobilization nature ofthe injury 2. Aberrated healing process: a. formation of exuberant granulation or proud flesh . keloid formation ©. stricture d, fistula or sinus formation MEDICO-LEGAL INVESTIGATION OF WOUNDS Rule to follow by a physician: 4. all injuries must be described 2. description of wound must be comprehensive, sketch/photograph 3, examination must be influenced be any other information obtained from cthers in making a report or a conclusion. Cutline of the medico-legal investigation of physical injuries: 1. General investigation of the surroundings: ‘examination of place where crime is commited. Examination of clothing, stains, cuts, hair, f.b. in the crime scene Investigations on possible witnesses to the incident Examination of the wounding instrument Photography, sketching, accurate description of the crime scene. 2. Examination of the wounded body ‘2. examinations applicable to living or the dead age of the wound from the degree af healing determination of the weapon used 39reasons for the multiplicity of wounds determination i the wound is accidental, suicidal or homicidal . examination applicable only to the living = determination i injury is fatal = determination injury wil produce permanent deformity ~ determination if wound produces shock + determination if wound produces complications Cc. examination applicable to a dead vietim only + determination if wound is pre-mortem or post-mortem * determination whether wound is mortal or not “determination whether death is accelerated by a disease present at time of injury. + determination whether wound cause by A,S, H 3. Examinations of wound + character of wound : abrasion, hematoma, laceration ete location of wound : from some fixed area > to determine trajectory/course - depth of wound : nat in the living , only if the outer and inner are fixed ~ conditions of the surroundings of the wound - ‘ear GSW ~ buming, tattooing ‘suicidal cuts ~ superficial tentative cuts or hesitation cuts = lacerated wounds ~ contusion on neighboring skin ~ extent of the wound tensive injury ~ marked degree of force applied in the production of the wound. jomicidal cutthroats are deeper, extensive, numerous than ‘suicide = direction of the wound > impt. in the position ofthe victim to the offender number of wounds ~ several> homicidal + conditions of locality degree of hemorrhage ‘evidence of struggle Information as to the position of the body presence of suicide note ‘condition of the weapon ANTE-MORTEM WOUNDS —_—_—POST-MORTEM WOUNDS HEMORRHAGE More profuse, arterial Slight or none, venous due to loss of tone of vessels, ‘Absence of heart action Post-mortem clotting ofblood inside bw. Marks of spouting of blood No spouting of blood ‘from arteries Clotted blood Bid not clotted or sot clot SIGNS OF Inflammation & reparative None INFLAMMATION process ‘Swelling in the area, Effusion of lymph, pus ‘Adhesion of the edges Uniess if vietim is weakened SIGNS OF Fibrin formation No time of repair REPAIR ‘growth of epithelium ‘Scab or scar formation RETRACTION Deep staining of the edges Not deeply stained OF THE EDGES and cellular tissues. can be removed by washing OF THE WOUND which is not removed by washing Edges gape owing to the reaction _ Edges do not gape, but are of the skin and muscle fibers closely approximated to Each other unless ifthe wound is 1 to 2 hrs. after death DETERMINATIONS IF WOUND IS: HOMICIDAL —SUICIDAL ACCIDENTAL ABRASIONS Not common unless Rarely observed Extensive If dragged abrasions MVA Or if victim resisted CONTUSION Rare except when Found in any portion jumping from a height of the body - Fall INCISED Commonly observed Commonly observed Frequent but rarely WOUNDS * depth, location and surroundings. ‘cause of death Points to consider in the determinat'n as to whether the wounds is A, S, H. otexternal signs and circumstances related to the position and attitude of the body when found. location of the weapon or the manner in which it was held the motive in the commission of the erime the personal character of tne deceased the possibilly for the offender to have purposely changed the truth of the condition, other information signs of struggle ‘number and direction of wounds direction of wound nature and extent of the wound state of clothing LENGTH OF TIME OF SURVIVAL OF THE VICTIM AFTER INFLICTION OF THE WOUND degree of healing> signs of repair of wound appear in less than a day after the infliction of injury changes in the body in relation to the time of death >systematic changes In the body = wasting, anemia, bed sore, ‘age of blood stain ~ not reliable testimony of witness when the wound was inflicted. POSSIBLE INSTRUMENTS WHEN USED BY THE ASSAILANT IN INFLICTING THE INJURIES contusion - blunt incised wound ~ sharp-edged instrument lacerated wounds- bunt punctured wounds ~ sharp pointed ‘abrasion ~ body surface is rubbed on a hard surface ‘GSW — the diameter of the wound of entrance may approximate the caliber of the wounding instrument, Could the injury have been inflicted by a special weapon? whic! ‘A physician cant determine that a specific weapon was used in inficting a wound. Itis possible that itis caused by a certain instrument presented He must be cautious in giving categoric statements. h of the injuries sustained by the victim caused death? with conspiracy —no need coz the act of one is the act of allI none- offenders are only responsible for their individual acts. I multiple injuries: which of the wound injured a vital organ, ‘Or if same organ which caused the dagree of damage. Which of the wounds was inflicted first? 1 muliple for the qualification ofthe offense committed. First — treachery , murder Last - homicide Consider 4, relative position of the assailant and the victim when the fist injury was. inflicted on the latter. trajectory/course of the wound inside the body of the victim ‘organs involved and the degree of injury testimony of witness presence of defense wounds ~ inflicted frst. Effect of medical and surgical intervention on the death: If death followed after operation> offender is responsible if death was inevitable and that even with operation death is normal and direct consequence ofthe injury, and the physician is competent and in spite of exercise of degree of diligence sii death is the outcome I death ensued even the wounds are minor, and death due to the negligence fr incompetence of the physician then the offender cant be responsible. Effect of negligence of the injured person on the death I death occurred from complications arising from a simple injury owing to the negigence ofthe injured person in ts proper care and treatment the offender is responsible for the death a person is not bound to submit himsetf to medical tx for the injuries received during the assault, = unless if tis proven that the negligence of the victim is deliberate so ‘offender is not responsible but only for physical injuries, Power of volitional acts of the victim after receiving a fatal injury: iying declaration, attempt to kill the offender after the first blow of the offender Relative position of the victim and assailant when injury was inflicted: 4, location of the wound 2. direction of the wound 3 nature of instrument used in inflicting the injury 4. testimony of the witness:EXTRINSIC EVIDENCES OF THE WOUNDS. 1. evidences from the wounding weapon sition of the weapon - near or grasp by victim \jo0d on weapon - may be stained with blood hair and other substance on weapon 2. evidences in the clothing of the vietim soaked with blood - hemorthage yunpowder - distance iears - struggle 3, evidences derived from the examination ofthe assailant = paraffin test, tears in clothing, blood stains, intoxication etc, 4, evidences derived from the crime scene smount of hemorthage, wounding instrument etc. PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY 1. HEAD AND NECK not be underestimated bleeding from ears, nose, mouth > basal fractures may have normal x-rays yet with severe head injury Factors influencing the degree and extent of head injuries ‘2. nature of the wounding weapon> degree of violence applied ‘depends on the thickness of the scalp and the weight of the weapon. Intensity if the force > intensity and heavy agent ©. point of impact >extensive in fx of vaults at side or back 4. mobility of the skull at the application of force Ifhead is mobile, ree> effect on the brain is due to the shearing ‘movement imparted to the brain. > may produce contusion, laceration without fx It head is fixed and unsupported> jarring movement of the brain is absent but the fracture is extensive, Head injuries are classified as to the site of the application of force:4. Direct or Coup injuries 2. Indirect injuries ‘3. contr-coup injuries 'b. remote injuries — fall hitting buttocks> basal fx «. locus minoris resistencia injury in areas with less resistance 3. Coup-contre-coup injuries (direct and indirect injuries) Wounds in the Scalp: 1. itis dificult to prevent the spread of infection 2. there is proximity of the scalp to the brain 3, there are free vascular connection between the structures inside and outside the brain 4, tis frequently difficult to determine the extent of damage of the skull. FRACTURES OF THE SKULL p. 302 GUNSHOT WOUNDS Death or physical injuries brought about by powdered propelled substances: 1. Firearm shot he injury is caused by the missile propelled by the explosion of the ‘gunpowder located in the cartridge shell and the rear of the missile, yenades ic container wil cause fragmentation of the 2, detonation of high explosives »xplasion inside the met: ‘container. |. FIREARM WOUND = Firearm : 1s an instrument used for the propulsion of a projectil by the expansive force of gasses coming from the buming of gunpowder. (echnical defintion) includes rifles, muskets, shotguns, revolvers, pistols, other deadly weapons. which a builet, ball, shell or other missile may be discharged by means of gunpowder or other explosives. = includes air rile except of small calibers and limited range. = the barrel of any firearm shall be considered as a complete firearm for allpurposes thereof. Penal provisions of laws relative to firearm: Sec. 2692 RAC - unlawful manufacture, dealing in acquisition, disposition or possession of frearms or ammunitions therefore or instrument used or intended to be used in the manufacture of firearms or ammunition. 'b. Sec. 2690 RAC ~ selling of firearms to unlicensed purchaser. «c. Sec. 2691 RAC - failure of personal representative of deceased licensee to surrender frearm, d._ Art, 155 RPC - Alarms and Scandals e.Art, 254 RPC — Discharge of firearms CLASSIFICATION OF SMALL FIREARMS: ‘Smal firearms - are those which propel projectile of less than 1 inch in diameter. 4. a8 to wounding power. = low velocity firearm >muzzie velocity of not more than 1400 ft per sec. Ex. Revolver = high power firearm > muzzle velocity more than 1400 ft. per second > usual is 2200 to 2500 ft per second or more. 2.a8 to nature of the bore: = smooth bore weapon >inside portion of the barrel that is perfectly smooth from the firing chamber to the muzzle, Ex. shotgun = fled bore firearm > the bore of the barrel with a number of spiral lands {and grooves which run parallel with one another but twisted spirally from breech to muzzle. Ex. Miltary rifle 3. as to manner of fring pistol —fired with a single shot Ex. Revolver tifle = may be fired from the shoulder Ex. Shotgun 4, Asto the nature of the magazine = cylindrical revolving magazine — the cartridge is located in a cylindrical ‘magazine which rotates at the rear portion of the barrel Ex. Revolver = vertical or horizontal magazine — the cartridge is held one after another verticaly or horizontally and also held in place by a spring side to side or end to end. Ex. Automatic pistol‘Types of small firearms which are of medicolegal interest: 1. revolver ~ usual muzzle velocity is 600 feat par second 2, automatic pistol ~ self-loading firearm, muzzle velocity of 1200 feet per second 3, fle - muzzle velocity of 2500 feet per second and a range of 3000 feet. 4, shotgun - projectile is a collection of pellets ‘A weapon in order to cause injury must have two principal component parts: 1. the cartridge or ammunition - bullet primer, cartridge case, powder charge 2. firearm — instrument for the propulsion of a projectile force of gases from a ‘buming power. ENTRANCE WOUND EXIT WOUND ‘Appears to be smaller than the missile Always bigger than the missile ‘Owing to the elasticity of the tissue Edges are inverted Edges are everted Usually oval or round depending upon Does not manifest any definite the angle of approach ofthe bullet shape Contusion collar or contact ring is present Absent due to invagination of the skin and spinning of the missile Tattooing or smudging may be present when Absent when firing is near Underlying tissues are not protruding Underiying tissues may be seen Protruding from the wound Always present after fire May be absent, if missile is lodged in the body Paraffin test may be positive Negative