LEGAL MEDICINE: GENERAL CONSIDERATION CRISBERT |. CUALTEROS, M.D. http:/crisbertcualteros.pagett! Lega Medicine -isa branch of medicine which deals with the applicaton of ‘medical knowleage to the purposes of law and in the axiministration of justice Legal medicine — Application of medicine to legal casas Forensic medicine — Applicaton of medical ecience to alucidate legal aroblems, Medical jurisprudence - Knowledge of law in relatonto the practices of medicine. SCOPE: Applicaten of medca and paramadical sciences 2s ‘demanced by law and administration of justice. NATURE OF THE STUDY OF LEGAL MED: ‘The abil to acquire facts, arange them and draw a conclusion fom facts in the administration of justice Medical jurist, Medical examiner, Medicolagal officer, Medicolegal expert =A physician whe specializes primarily with madico-legal duties = Imholep - 2880 B.C. eaillest medicoagal expert DIFFERENCE: ORDINARY PHYSICIAN —-MEDICO-LEGAL OFFICER a) nuryDsease pohtof view Troatrent Cause b) Examine a Diagnose Testy /justoe petiont ©) Minor injuries Ignored Rocords all / quai crimePRINCIPLE OF STARE DECISIS: = Wher the court has once laid sn interpretation of law as applied to cattsin facts, itwiladhere toand apply to all future cases where the facts are substantially the BASIC PRINCIPLES GOVERNING APPLICATION AND EFFECTS OF LAWS: Ignorantia legs nominem excusat * ~ prevent use as defense in violation 2. Law shall have no retro-activa affect. 3. Rights may be waived, unless the walver is contrary 10 law, public order, publi policy, morale ot good custome, or prejudiced io a third paren with a Night recognized by law. 4, Cusioms which arp contrary to law, public erder or public policy shall not be ecuntananced, 5. Laws are repaalod by subsequent onos, and their violaicn or non-cbservance shall not be excused by eis-use, custom er practice to the contrary, Persons authorized to perfomn autopsies: 1. Health Offers 2. Medical oficer of law erforcement agencies. 2. Mambere of the medical staff of seccedted hospitals. Autopsios shall be performed in the following cases. 1. Required by special aws 2. Order of competent court, mayor. fiscal 3. Writen request of pdive officers 1. SolGon, fieeal dicinter te determine cates of death 5. WNriten request of nearest kin to ascertain cause of cea, MEDICAL EVIDENCE = sthe means sarciioned by the miles of court of ascertaning ina |Udhial proceeuing the wuth respecting ametter of fact, Types of evidence: 1 Autcplic of Real evidence —rrade known to the senses 2 Testimonial evdence —— oral under cath, 4. Exoatimental evidence 4. Documentary evidence Methods of preserving evidence:1. Photo, videolape,photocopy —4.Menikn method 2. Skaiching 5.In the mind of the witness 3.Description 6. Special methods: embaimning DECEPTION AND DETECTION Knowledge of tuth is important in the administration of justice, es sclely in the abilty 0 evaluate the statemert given by the suspact or witness. Mothods of deception detection: 1. Devices wich record the psycho-physiolegal response: a) Use of a polygtanh or ie detecior machine bb) Word association tect ¢} Psychological stress evaluator 2.Us drugs thet try to* innit the inhibitor” '9) Administration of the tnth serum bb) Narcoznalysis or Narcasynthesis 6) Intoxication 3. Hypnotism 4. Bycbsenvation 5. Scentifc interrogation 6. Contession |. RECORDING OF PSYCHO-PHYSIOLOGICAL RESPONSE Nervous contral- CNS/ANS — SymiParas Sympathetic — influenced by physical and emotional stimuli, effects Parasympathetic—_works to restore things A. Use ofa Lle Detector or Poyaraon = The fear of tie subject when no tolling the truth activates the aymp. = To a sorios of automatic and involuntary physiological changes which aro recorded by the instrument. = Use of control questions > Most reliabe & effectva questioning technique. = Supplemetary tests:a. Peekof tension test - peak of tension on relevant questions b. Guitcomplex test - doas not rasponse to adced relevant quast ¢. Sent answertest - subject vertal response creates dsicrtion in the tracing erclearing othe throat. Reason for admissibility to the court of the result of Polyaraph exem 1. Have nol reczived the degree of standard-zalion of acceptance. 2 Triot of factis apt to alve almost conclusive weight to the experts opinion 3. No way ta assur the a qualfiad oxaminar administered tho tost. 4. May waive right agalnst set-incriminaton 5. It kas many erore Factors responsible to 25% errors. 1. Nervousness experienced by a subject whe is teling ‘apprehoneian by the fact tnatha ie a cuzpect. = over-anaiely to cooperate 2 Physilogial normals > BP in. ordoc., Cac prob 3. Meréal abnornalltes 4 Unreponsivaness in a guilty subject ~ no fear of detection 5. Allompt to beat the machine rath Gan a person os compelled’? No, use of inieligence and ctherfacultes B. Word associaton test “Time interval between the words uttered by the examiner end the answer of the subjectis recorded C. Psyshological Stress Evaluator when a person is Under stress/ying, the raioratremar in the voice uiterance 'S moderataly of compiately suppressed. - degree of suaprossion vares invorsely to dagree of psychological stress | _USE OF DRUGS THAT INHIBIT THE INHIBITOR ~ Not admissible in court A. Aceinistration of truth secur * Hygcine hydicbrornige given hypodermivally unt stale of deltium which tie subject feela @ compulsion a answer the question truthfully B. Nareoanalysis or Narcosynthesis = Sedium amyiel ar sodium gentiotel . Intoxication wih elcahol - In wine there is ruth HYPNOSISalteration of consciousness, not al subjects can be hypnotized IV. OBSERVATION Physiological and psychological signs end symptoms of gui: 2) Sweating, color change ) Dryness ct the moutn | Excostive activity of adams apple 4d) Fidgetira ©) Peculiar feeling inside 1) Swearng, spotless pest recor 9) Inability ic Ibok at the investigator V. _ INTERROGATION ‘emotional appeal, mutt and jeff technique VL GONFESSION expressed acknowledgement of his gu. TOKYO DECLARATION con‘ains guidelines to be obsarvad by physician concsrring torture, nhuman ‘and degrading punishment.MEDICO-LEGAL ASPECTS OF IDENTIFICATION + determination at the individvally of a persen Importance of icenitlying a person: 1m tha pmeecution ofa crime, tho identity af the offancar and victim 2, Settlement of estates, retirement. nsurance 3. Resolves anxiety of nest of kin 4. In some transaclions ~ salos, release of doad body Rules in personal Identification: 1. Law of muliplichy of evidence in identification — greater number of similarities 2. Value ct different points of icenifieation —fingercrints , males: Visual recogn tion of relatives ~lesser value than fngzipriais/dertl 2.The longer interval between death the more experts ate neoded in eaiablshing the identity. 4.The team to act in shortest time because It Is perishable. 5.No rai rule in the procedure of identficatcn of the person. Mothods of idonticatin: 1. By comparison ~ Id four in tha cme scene compared with the filo. 2. By oxclusion IDENTIFICATION OF PERSONS ‘A. Ordinary methods of identification 1. Characteristics which may easily be changed. 8) gravth of hair, beard 4) grade of profession b) elathing | body amamentations (6) frequent piace of visi 2. Charactorstics that may not be easly be changed: ‘2) mental memory ‘hands anc fest b) speech 9) complexion ©) gait 4) change in the eyoe ‘d)mannerism ) facies e)handedness-let right 2) degree of nutition Pints of identification applicable to beth living and dead before onset of Decomposition:Occupatcrial marks — painters have stains Race: Maay:brown, flat nose rounc face, Round haad, Wear'ng apparel Stature: Tips of middle fingers of beth hands extended laterally Tatoo make Weight ~ net good pont ~ changes trom time to tme Deformities, — Injuries leaving pemnanent defairites Birthmarks moles, scar ‘Aap of Scar: Reconty formed: Slightly slevated, reddichibluich, tonder fo touch Few week-2 montns: Infammatory redness, sof, sensitive 2—8 months: browns, free from contraction, sot > 6 montis: white, glstening, contracted, tough ‘Scar forrraiton s delayed by: seps's. age. dept of wound, mobility May net develop ~ mall, superficiay, healed by fist intention 8. Tribal marks, Sewial organs, blood acam ANTHROPOMETRY ( BERTILLON SYSTEM) Alphonse Bertiion - utlizes anthroponvettical measurement of the human body for identifcaton, Basie: 1. Human skelaton is unchangeable after 20 years. 2. No two human beings have exactly the same bonas. 2. Use of simple inatumert Informaton: 1. Descriptive data — color of hair, ey@s, shape of nose. 2. Body marks 3. Anthropometiic measurement — height 1. Measurement ofthe head, ime Portait Parle (spoken picture) — picturesque description of a person Extringc factors in identification 1. oinamertation 2. personal beiongings 3. eating apparel 4 foreign bodies 5. eniifcation by close trisnds, police records, photographs Light as @ factor in Identification: 1. Clearest mooniight = Less than 16-17 yards Starlight= Less than1-13 yards 2. Broed daylight = Not farther than 100 yarea net seen befors ‘Almost strangers =recognized at 25 yerds3. leat of freerrm inches laters can be read withthe aid ofthe fash of 22 caller ate cistance of 2 feet, 4. Flesh of lightning ~ sufficient ight to identty 5. Arffical ight —ralatve to the nteneity of light B. Scientific methods of identification 1. Fingorprniting 2. Dental idantfcation 3. hangwittng 4 Identification of eleton 5 7. Datermiration of Sax, Age Identification of blood, bicod stains Idertiicetion of hair, ers 1. FINGERPRINTING = most valuable method of identification 1) No two idantcal fngerprnis 1 : 64,000, 000, 000 >} Not changeabie- 4" month forme inthe totus = Practcal uses a) Identy of dead bodies 0) Prints recovered at crime scene @) Prete on fl for comparison {9} Regt thumo pants Substiute ‘cr signature = DACTYLOGRAPAY : art end study of recording fingerrrints as moans of = DACTYLOSCOPY arto id by comparison of fingerbarts, = POROSCOFY : stusy of pores found on the pappilary incon ridges of skin Fingerpinis cant te eftaced ee long a: the dermis of tho bulbe ofthe fngot ie not somplotaly dectroyod 2, DENTAL IDENTIFICATION possiblity of2 persons tn have the sarre is remote = enaunel s Ure tardest substance of the body, oidlast other tissues in pulrifaction 3. HANDWRITING BIBLIOTIC _: Science of handwriting analysis GRAPHOLOGY : study of handwriting forthe purpose of determining the surtore peceonalty, character and apiitude.4. IDENTIFICATION OF THE SKELETON human - shape, size, general nature single individual ~ clurality or excess of bones Height — ade 1 to 4 Yin. for the eafttiseuse Pearson's tcrmula ~ for the raconstructon ot the iving stature of icng tones Topinard and Rollet ‘wo Franch anatomist cavised a forma for the determination of tho height fr males and females. Humphrey's table able of different height of bones for diferent ages and their ‘corresponding siatures, ‘Manouvrler ~ made the folowing co-erfsiant for the de.ermination of height Determination of sex of tho skeleton: 2) Polis b) Skul ©) Siomum Difference between 1) Construction Wal 2) Height 3) Pubic aren 14) Diameter ofthe true pelvis 9) Curve ofilac crest 3) Greater Secale natch 7) Body of puis 8) llopectines! ine 9) Oblurator foramen 10) Sacum: CRANIUM 1) aha 2) Mastoid process 3) cranium placed horizontally ‘est on 4) Styloid process 5) Forehead 4) Femur 2) Humerus Male PELVIS; Female Heaver Lighter More pronounced Less proncunced Greater Lesser Natrow & less round Wider'rounder Less Greater Reaches higherlevel__Lowerlevel Narrow Wide Narow wider Sharp Roundeo Egg:shaped wangula: Short and rarrow Long and wide MALE FEMALE less curve moteeuve larger smaller mastoid process shorter higher, more obique occipital maxillary bones longet/slendor less high, more vertical8) Supercliary fidge loss sharp, more rounded sherper 7) Zygomatic arches more prominant less prominent 8) Lower jaw larger & wider narrower and tighter 8) Face larger in proportion to cranium smaller Determination of the duration of interment: All soft tissues in a grave disappear within one year. Bacie of the extimete fro duration of intermant 1) Presence or absance of soft issue acharent to he bones 2) Firmness ard weight, bitleness, dryness of the bonas. 3) Degree of erosion of the surface of the bones, 11) Changos inthe clothings, coffin, and painting 5. IDENTIFICATION OF SEX Test io determine the sex: 1. Social tast 2. Genta test 3. Gonadal test 4. Chromocoral test — barr cols in fernalee Evidences of sex 1. Presumptive evidence ‘aneral features, hairin some parte = Transvesiism ~ sexual deviaton by cesre to assume the attre and be ‘accepted az a member of the oppaeite sex. 2. Highly proba ‘vagina, large breast 3. Conclusive eviaence ovary in females 0. DETERMINATION OF AGE. Lega importance 2) Aid to identification b) Determinaticn of criminal leballty ‘o) Detarmination of right of suffrage 4) Determination whether @ person can exorcise civil nghts ‘e) Determination ofthe capacity fo marriage Requicite to certain crimes 0Determination of age of fetus: Hesss nila or Haase’s rule 4) Fetus ofless than 25 cmlong- get squareroot of length in om, resutin months b)> 25-cm- divide the length of the fetus by 5 and the result is the age in month. 7. IDENTIFICATION OF BLOOD AND BLOOD STANS Legal importance: a) Disputed parentage ) Circumstantal evidence againat ©) Determination of the cause of death ) Detsrmination of the drection of the escape 2) Determination of tie appropriate time cime was cormmitted {), Dotormination af tho place of he crime 9) Determination of te presence of certan diseases, pottetor of o crive Physical examination ‘2) Solubility tast b) Heat test ) Luminescence tost: 8 amno-phtalic-acit hydrazide: HCL, Sodium peroxide, distiled water > Bluishewhite ina dark room Chemical examination: 4) Saline extact of the blood plus ammcris ~ brownish > alkaline hematin ) Benzidine test - biue cclorin white filior paper 2) Gusiaaum thet( Van Deen's Dyas or Schambein'steet)- blue | Phenolatnalein test ( Kastie-Meyer test) -pink ¢) Leucamalachite Greon fost Microscopic examination sane extract of tain Micro-chemical tests: 1. Herrochromagen crystal or Takayama test: 2.Teicrmann's bcod crystals of Hemin crystel test- ‘Sodium choride dark brown rhombic pss of cHeride, hematin formed 63% of the micra-chemical test 3. Acatone-haemin or Wagenhaar testSpectrospcopic examination = blocd pigmants have the power fo absorb Ight of certain length and produce the ‘charecteristic absorption bands on the spactum. = Fresh blood ~oxphgb. Hgb. reduced heatin = elders etaine — methemoglobin, alkaline hematin Biologic examinations 1. Preciotin test — blood is human ar not 2. Blood grouping Age of blood staine: Higb ecnvertea to Methgh of hematin rad to red-brown, ‘= warm weather: within 24 hours 8. IDENTIFICATION OF HAIR AND FIBERS Difforonees between ait forctly extracted and naturaly shed hair: = bulb is iragular, undulating surface, excrascence of diff, size ana shane HUMAN ANIMAL 1. Air ratwore In tne grains larger small sacks Invisible wiout & in H2O Easily visbie Fuzz wiout medulla Fuzz w/ medulle Looks ikea thick muff Fairy ‘Hin hollow eyindor Pignenisin the formaffine gras iragular grains U thir seals thisk coal MEDICO-LEGAL ASPECTS OF DEATH Importance of Death determination: iv personally of a natural person is extinguished by death, property of 2 person is tansmilted to his heirs al the lime of death. 4. The death of a partner is cne af the causes of dissoluien of partnersnin agreement 4. The death of ether the principal or agen! sa mode of extinguishment of agency. 5. The criminal Webi is extinguish by death. 1, The evi cage fre slaima whiah does net survive io damaged upon death of the 2defendant. Death —is the teunination of ite Kinds of death: 1. Somatic 01 clinical death ~ persisterce of vital functions 2) Molecular a¢ cellular daath — 2 to six hours aftar cozeation of ifs 3. Apparent deaih or Siale of suspended animation — transi! lass of consciousness fr hysleria, uremia, alectric shock Signs of death: 41. Cessation of heart action and circulation., Usually the auricle contract after sematic death fo a longer period than the ventricle, last te stap sa called ULTIMEN MARIENS. ethos of detecting the cessaton of heart action and circulation: a) Examinaton of the heert- pulse, auculation, oure, ECG 2) Examinaton of peripheral circulation = Magnus test ~ application of ature around the base of the tinger blocdless area atste of application doad man —no change = Opening of small artery- spurting = leards test — injection of fourascain SO greenish yellow discotcration in the whole skin ‘doad man only in tye area of injection = Praceure on fingernails, Diaphanous test ~ fingers are spread wide through @ strong light Red Application of heat on the skin - blaster Palpation of Radial puss = Dropping of melted wax 2. Cessation of respiration —more than 3 % minutes Methods of detecting cessation of respiration: 2) Observance of movement of chast and cbdomen ) WNith the ax of stet 2) Examinalion with a mirror 4) Examination with a feather or cotton fers '8) Examination with a glass of water 1) WWinsiows test — no movement in ine image formed by refiectng artical ight on the ator in a saucarand placed in the chest if reepiraton is taking place, 3.Gooling of the body ALGOR MORT'S) ‘Aft death the motabaiie prozeee inside the body coaeae~The progressive fall of the body temp. is one of the most promine: + First wo hours after death the Cooling is rapid. + Fall of temp. of 15 10 20 decrees Fahrenhet is consideredas a vertain sign 9! deeth. igns. POST-MORTEM CALORICITY ~ isthe rse of temp. o' he body ater ceath {due t rapid and early putrefactive changes. Usually in the first 2 hours ‘seen In cholora, iver abscess, tetanus, RF.Strynine polscning, Peritoatie ‘A. Conditions connected with the body: Facters delaying the rate af cooing of tne bed: ‘Acute pytexial dsease ‘Sudden death in good health Obeeity of person Deait trom esonyxia Death of the middle age Facters accalaratirg cooling: 1. Leaneas of he body. 2. Extrome age 3. Long-standing ines 4. Chronic pyresial disease with wasting B. Conditions that are connected with the surroundings Facters delaying cooling: 1. Clethings 2. Want of accass of airto the body 3. Small room 4. Warm surroundings Factors acceleratrg cooling: 1. Unslothed body 2. Gonaiions allowing the access of alr 3. Large roorn parmitiing the dissipation of heat 44. Cooling more rapid in wator than in al Methods of esitmating how long a person has been dead from the cooling of the bod 1. If body temp. normal at the tine of death: =the average ‘ale of fll of fe temp. during the frat 2 % hours is 1 of the cifference of the body temperature and that of the air = the body atteins the temp. of he surrounding air rom 12 to 1S hours after ceath in topeal counties.2. Chemical Method ( Schourua's formule for the determiation of the time of death of any cadaver whose CSF is examined for the concentrations of LA. NPN, AA, A> 16 mgto 200 mgi100c¢ rapid in 1st § hours. = NPN ine ffom 15 to 4) mg/100 ce in 12 1Shoure AA inc. trom 1 mato 1Z ma% 1° 15 rows, 4, INSENSIBILITY OF THE BODY AND LOSS OF POWER TO MOVE may be seen inthe ving with- apoplexy, eplepsy , trance, catalepsy, hysteria 5. CHANGES IN THE SKIN - opacity, flattening, oss of eastcity 6. CHANGES IN AND ABOUT THE EYE 2) Loss of comes! reflox.coan I nlive pis: G.A., uramia, narcotic peisoning ) Gouging of comea ¢) Flaceidiy of tre eyeball 44) Fupi in the positon of rast. ‘) TACHE NOIR DE LA SCLEROTIQUE — spot ound in the sclera after eath. 7. ACTION OF HEAT ON THE SKIN leatapplied while alive — produced blister with serum and redness around the area. lowing ccrnbinations of signs show death has occurred: ‘a) Loss of animal heat io apoint net compatible nit lite bb) Abeance of raspenss of musele atmulus ©) Onset of rigor merts, CHANGES IN THE BODY FOLLOWING DEATH 1. CHANGES IN THE MUSCLE ~ complete relaxation of the whole muscular eyetom, ‘Three Stages After Death: 4) Stage of primary flacetdity ( POST-MORTEM IRRITABILITY) ‘muscle relax, may contract, diated pupil, sphincters are retaxod presence of molecular Ife = warm place, Lhour end 31 minutes = chamioa reaction of muscle ie akealne ) Stage of post-mortem rigidity ( CADAVERIC RIGIDITY . DEATH STRUGGLE OF MUSCLES ORRIGOR MORTIS) whole hedy is gid die to contraction of the muscles, starts at muscle of neck, lower jaw Reaciien is acidic due to inc. of lactic acid develope 9 to 6 hours alter death n temperate, sarler in verm = last ftom 7 10 3 days in temperate, warm: 24-4 cod weather40-964 summer 2) Stage of Secondary flaceidity or Commencement of putrefaction (DECAY OF MUSCLES) "= muscle ere flaccid, nol respond t stimuli, reaction ie alkaline ‘due to aissoluton of muscle protens FACTORS INFLUENCING THE TIME OF ONSET OF RIGOR MORTIS ) Internal Factors, 4) State of the musclos jeathy— appears lata nsat is hastened hi 2.1 hunted animal 8.2 pralanged convuleion/ingaring ilhoee 2.3 death flom- TY, Cholera, Phihisis, yohus b) Age ‘early crset— aged snd nawhorn = delayed — good heath, good muscular development ©) bntegmty of rerves = section of the nerve will delay onset, paralyzed muscle (2) Extemal factors, 13) Temperalure Hastoned by high temparature > 75 dagroos will produce heat stffaning bj Moisture = rapidly but with chart duration in mist air Conditions simulating RIGOR MORTIS: 1. Hea’ stifening - > 75 dogrocs coagulatos: muscle proteins resuling t rigidly Pugiistic atthude”flaxed upper and lower mb = hands denched, flexor sironger tian extensors, burned to death 2 Cold stiffening = dus to solidfication cf fats whan exposed to cold temp. 3. Cacaveric spasm or Instantaneous Rigor instantaneous rigidity due to extrems nervous tension, exhaustion, injury to the nervous system, = weapon inhand, weedsRIGOR MoRTIS. CADAVERIC SPASM 41. Time of appearance 3.6H afier death Immediately ater daath 2.Muscles Involved Al muscles Geran group 3. Occurrence Natuel phenomena Nay cr may not aopear 4. Medeeo-lagal eignf. Approxirraies tme of ceath Determine nature of daath RIGOR MORTIS MUSCLE CONTRACTION 1. Contracted m Lossestianspareney Mora or oss transparent 2. Elasticity Loss elasticity Very eastic 3.Uunus reacion Acidic Neuval oF sl. akalne 4. Contraction ‘Absolute faceidity Poseose inharent contraction 2. CHANGES IN THE BLOOD 'a} Goaguiation o! blood Jeod may remaine fluid ineide the bload vezeale 8H after death. ANTE-MORTEM CLOT — POST-MORTEM CLOT 1. Consistency Firm: Soft 2. Surface of blocd vessels Raw alter clots ae removed Smooth, health after 3. Clots Homogenous Can bo sirpped cant be stipped off inlayers b) Post mortem Lvidity or Cadaverie Livicty, or Post meriem Suggilaien Post-mortem Hypostasis or Lwvor Morts stoppage oi heart action and loes of fone of bv. accumulates in dependent araas excep: in bony areas. apillanes coalesce > purpish in cole zalled Post-mortem tivity iasten by death due to ciolera, uremia, Typhus lever =appoare 2 €H after death and fully doveloped 12 H after death. Physical characteristics of Post-mortem C adaverle Lividity 1. Occurs in tho most dependent aroat. 2. involves the supatticial layer of the skin 3. Does nol eppear elevated from the vest ofthe skin. 1 Color uniform 5. No injury ofthe skin Kinds of Post-mortem Cadaveric Lividity 1. Hypostate Iviity 2. Diffusion lividty Importance of Cadavoric lividity: 1. One of tne signs of death2. Determines the position of the bedy has been chengod after i's appearance in the body. 3. Color of icity may indicate the cause of death. a) asprysie ~ Ividity is dark b) CO poisoning — fink o) Hemormhage ~ less marked 4d) Hycrocyanic acid bright red 9) Phosahorus - dark brown 4). Potassium chiorate - coffee brown 4. Determines now long the person has been dead 5 Gives us an idea ae to the time of decth Polnis to be considered which may infer the position af the body et the time of death: |. Posture ofthe body when found. 2. Postmoiter hypostasis of lividity 3. Cadaveric spasm CONTUSSION (BRUISE) POST-MORTEM HYPOSTASIS 1. Sinall bruises — Below epidermis in true ckin In the apideris or culls larger ones. - below this, 2.Cuticle ——-Abraded by tha same violence —_Unabraded ‘that produce the bruise. 3.Bruiee —Appeare at tho eeat or surounding Alwaye dopendent may of may not be dependent 4 Elevaiod, inflanmatary condton Not elavated, biccd in bw. CONTUSSION (@RUISE) —_ POST-MORTEM HYPOSTASIS. 5. Incision shows bioad outside the by. Blood inside the vessels, ost certain test of diferance 6 Color variegated Unitom coor Internal hyposteais in Visceral o 1 Lungs2. Loops of intestine 3. Bran POST-MORTEM LIVIDITY OF ORGANS SIMPLE CONGESTION 1..Postmortem Siairing in orgars regular, most dependent parts Uniform, al organs 2. Mucous membrane Dull ustertess Not in congestion 3.Infammatory exudate Not seen Not seen Other changes in tre blood 1. Hydrogen ion concentration ~acid pH COZ, LA., After 24H alkane ammonia. 2. Breckdown of Iver glycogen leads to accumulation of daxtrose inthe IVC and the tight side of ne heart. 3. Rise in NPN and Free A.A, 4. Chomical = chlida in tha plasma/RBC dacrazsa due p axtrevascularciftusion, in ‘72H only % of is conte. Mg ~ increases duo to diffusion from without K = increases due to diffusion trom the vascular encothelium, 3. AUTOLYTIC OR AUTODIGESTIVE CHANGES AFTER DEATH “fle: death, proteolytic, alycolytc and lipo vile ferment cf the glanculsr tasues continue te act which lead to the auredigestion of organs. 4, PUTREFACTION OF THEBODY + Is the breaking down of complox protsins into simoler componenis associated with the ovolution of foul smelling gasses and accompanied by the change of color of the booy, Tissue changos in putrefaction: 1. Changes In the color of the Ussue Hereljsis of blaed within bond vessels > Hgb difluase trough the walle Redish-brown in colar In the tissues > Hab undergo chemical change: Greenish-yellow 1* seen at A Hee fossa MARBOLIZATION ~ prominence of the supertcial veins with reddisn discoloration which develogs an beth flanks ofthe abdemen, neck, and shoulder = look lite “marbled” reticle of branching veins 02. Evolution of gasses in the tissues (Coz, ammone. H2, Suphurated hydrogen, methane.= offensive odor Effects of otessure of gasses of ourrefaction: ') displacement of fie blood - bleeding in open wounds ») bloatng of the body ©) fuie coming out fom nostris, mouth 4) exttusion of the fetus in a gravid uterus «) flocting of the body 3. Liquefaction ofthe soft tissues Dutrafy rapidly : Eyeball, lining of trachea, larynx, drain, stor Intestine, Iver, spleen Putrefy late Highly muscular organs and Essues, Esophagus, diaphragm, heart, Lings, kidnoys, UB., uterus, °.G. Factors modifying the RATE of putrefaction ALINTERNAL FACTORS. a) age healthy adults, NB net yet fed, later than infants ) condtion of body: ull growniodese — rapid , Stilbomn- lee ©) cause of death» :infecton rapid 2. EXTERNAL FACTORS 2) Free ait 2.1 alt: rea air hastens decomposition a2 moderato moisture - accelorates 3 loaded with septic bacteria early aerobes, later anaerobic Crestidium walehii= decorpacition b) Earth bf dry absorbent soil - retards b.2 moist fertle sell - accolorates ©) Runny water- more rapid than stil water 6) Clathinge — early it nactene butdolays in the leter stage. = tight lethings - delay Factors influencing the changos in the booy after burial: 1. slate of the body before death — thin slower, murrmity 2. time elapsed between death and burial and envrorment ofthe body 2. affect of cofin— lator 4. slomnings and other covenngs on the bedy when buriad ~ pressure. insects 20depth at wach the body was buried - greater the later cendition and type of sol inclusion of something in the grave which will hesten decomposiion-food access of ai fo the body ater burial masa greve— rapid 0. trauma fo ihe body ~ viclert deatn- Sow CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TEMPERATE REGIONS, 1-3 DAYS AFTER DEATH - greenish aiscovcration ovar Hlac fossa, sat eyeballs 3:5 DAYS -fiothy blood from mouth, nesiris 8-19 DAYS ~ebdominal distention, nals frm 14.20 DAYS blstare all evar the body, maggate 25 MONTHS: = Scull exposed, orbits empty IN TROPICAL REGION 12HOURS —Rigormortis al aver, hypostasis, greenish-discoloration caecum 24 HOURS —Rigermortis absent all over, abdominal dsention 45H Ova of es, trunk bloated, face discolored 72H \Vihole body grassly swollen hairs andinals joose ONEVWEEK Soft viecara putrofieg TWO WEEKS Sot tis suas largely gone ONEMONTH Ecdy skeletonzed BEEN SUBMERGED IN WATER FIRST 4 OR 6 DAYS Cold waterlitle chango, in fgormerts FROM 5-7 DAYS Skin on hands, feet s beached, face faded white 1-2 WEEKS Face swollen and red, shin of hands and feet wrinklod 4. WEEKS Skin winked, nail intact 6 -BVEEKS Abdomon distonded, ekn of hande/ Feet cama effwith naile Factors Influencing the floating of the body in water: 1. age ~ fully developed, well nourished - rapid 2. sex— females floats secner 3. condions ofthe body — obese Nuat quicker 1. season of the year — mist hot air - patefaction - feats due to gas 5. ater shallow and stagnant water ofcimeks, highes specific gravity sea water floats sccner than fresh water, higher specific gravity ©. external influence — heayy-wearing eppatel - slower Only teeth, bones and hair remain for an indeAite time. Flat tones disintegrates faster than round bones. 21SPECIAL MODIFICATION OF PUTREFAGTION 1. Murmmification ssthe dehydration of the whole body which results in the shivering end preservation of the body. = usually oooure when bures in a hot, dry wth free accose ofhot ar 2. Saponification of Adipocere from: ‘a condition whore tne fay tissues of the body are transformed ta soft brownish-anite subsiancs known as ADIPOCERE at SO level. 2. Mecoration ftaning of the tissues wren in flulé macium in the ebsence of putrstactve mirero-org, seen in death in utaro —reaaish or greerish color, skin peeing off and arms flaced end frail HOW LONG A PERSON HAS BEEN DEAD? DURATION OF DEATH 1. Presence of ger mortis : 2-8 hours afior death 12 H fully devaloped 48-06 H diseppeers concomitant with puttefection 2. Prosnce of Postimertom lvdity 346 H after deeth ‘zopears as sina petechiavlice red spots 2. Onest of decomposition 24-48 H afer death manifested watery. foul smeling froth, mouth, nostrs, 4, Stage of decomposition 5. Ertcmelogy of the cadaver - 24 H before egas are hatched. magacts 6. Stace of digestion ~ 34H gastric omoty 5-8 distal jloum, cocum 7. Presence of Iveflies in the clothing in the crowning victrn —less than 24H 8. State of ciothings = pajama , night 9. Changes in CSF 10. Bcod clots inskdo the b.v. in @-B Halter coath. 11. Sof tissues ofthe body may disappear 1 10 2 years after burial Post.mertem conditions simulating disease, poisoning ar injury: 1. post mortern hypostasis — conlusion, rflammation poisoning 2. blisters of the cuticle ~ scald and burrs 3. swelling, delechment or spiting - injury PRESUMPTION OF DEATH Diaputale preeumption not heard in 7 yearsPresumption of death Absence of T years except succassion 10 years Vessel for 4 years Armed forces 4 years Ih danger cf death 4 yeare PRESUMPTION OF SURVIVORSHIP under 15 y.0.— older survives above 60 y.0- younger Under 15, above 60 - former ‘over 18 and under 60 y.0. -male, caer under 15, or over 60 y.c. and the other in between -lattar MEDICO-LEGAL INVESTIGATION OF DEATH Inquest Officer - 5 an official of the state cherged withthe duty of inquiring into eran matters. - inmedico-lagel examination: manner and cause of death The following officials of the governmont are authorized to make death Investigations: 1. Provincial avd City Prosecutors 2. Judges ofthe RTC, MTC 3. Director of NBI 4. SolGen Stages of MEDICOLEGAL INVESTIGATION: 4.Cilme Scene Investigation ~ investigation of place of commission of the crime 2.Aubpsy ~ investigation of the body of the victim 1.Grime Scene investigation placo where the easental ingredients of te crime tock place. - Person compesad tha Search Team: ‘) Physician MLI trained 5) Photographer 2), Aeciatant, ovidonee ecllactor, nate taker 2. Autopsy comprehensive study of adead vody, in addition to the extemal examination Post-mortem examination- external eam without incision being made. Purpose of autop: 1. Determine cause of death 2. Correlate elinical diagnes's and symptcms 3. Determine effectiveness of treatment 1 Study the natural course of the digoaco5. Educate students and physicians MEDICO-LEGAL OR OFFICIAL AUTOPSY: Determine cause, manne’, time of death Recovering, identifying, preserving evicentiary matotal Provide interretaton and correlation o tacts reiated to death Provide factual, ebjective medical report ‘Separating death dus to cisease from external causes. Dead body belongs 1o tie state for cases that requires medco-1egal auiopsy. PATHOLOGICAL AUTOPSY MEDICO-LEGAL AUTOPSY 1. Requirement Coneont of nxt of kin Law that givee the conzont 2.Contumation —Ginical findings of research Corieiate issue changes to criminal act 3. Emphasis Netation atall abnormal findings Effect af wronghul act 4.Conslusion Summation of al abnormal findings Spectic to the rurpose 5. Minor Need not be mentioned Included if useful The following manner of death should be autopsied: Death by vilence: Accidental ceaths Suicides Sudden death of persons who are in gcod health Daath unaitanded by physician D.OA. with no clinical daanosis Death ccourring in an unraiural manner Mistakes in autopsy: 1. Eirar or emiselon in the collection of evidence fer identification 2. Etrors or omission in the collection of evidence required fo establishing the tme of death 3. Etrors or orrission in the collection of evidence ‘equred fro the medico- ‘egal examination 4. Eirors or ermission resul i the production of undestiable aiiiacis arin tha destructon of vaid evidence Negative autopsies i afier all efforts including gross and microscopic studies and toxicological analysis fal to raveal a cause of dsath Negligent autopsy No sauce of doats ie found due to imprudence, negligence, lack of ak, lack of toresont 4CAUSES OF DEATH Primary purpose of 2 medicolegal autopsy Determination ofthe cause ofdoath Dea isthe drect anc the proximate conseryence of the ofminal or negtcent act. Defanse wounds on the victim Quaify he cme to homede Seras of cuts in te borders of the wound: Multole tusk intent tol Cause of death: ic tha injury or disaace ar kath which initiates the physiclagieal disturbance resuting 19a fatal termination. 4. Immediate 0: Primary cause of death - when injury 0 disease Kils quickly {he victim arci no opportunity for cornplizatians to develop, Exsextens ve brain injury 2. Proximato cause or Socondary causa - the injury 0° disease was eurvived for a longer period Mechanism of deatty is the physiologic derangement or dischem(cal disturbance Incompatible with Ife which is intiated by the cause of death, Ex: Hemorrhagic shock, pulmonary depression, cardiac arrest, tamponacia metabalis problem, Manner of death: 's the explanation as fo how the cause of death arcas. {Natural death ~ fatality is cause solely ay disease. Ex: paumona, cancer -2.Miolont or unnatural death — due to inry, Modico-logal maequorado- vislant deaths may be accompaniad by minimal or no external evicerce of inury or natural deain where signs of Volence may Ue presen Degree of Certainty to the cause of death, 1. Structural abnormalitos established beyond doubt the cause of death. Ex. SVP wibH 2. Degie® of probablity amounting to the cause of death. Ec: Electrical shock 3. History cotablishes cause of death and caniimmed by aratomic or chemical 2sfindings. 4, Vihar raither history, laboratery and anatomic findings, taken individually or in comaination is sufficient to determine the cause of doath but merely speculate ‘ste the cause of death, Ex. Crib death among infants. Steps in the Intellectual Process in the determination of the cause of death: 1. Recognition of the structural organic changes or chemical abnormaites responsible or tre cessation of vital functons 2. Unddoratanding end expositicn of the mechanism by whe’ the anatomic and ‘ther deviations fram norma eausad the death Instantaneous physiologic death or Death fram inhibition, death from primary shock, Syncope wih instantaneous exitus. This f sucdan death wich is cause within seconds ar minute or two after a minor teurma or peripheral stimulation of relatively simple nalwre. Tho poriphorsl stimulation initiates tho cardio-vascular inhibtery reflow. Ex: Vagocardiac slowing or stoppage of the heat, Blovr tothe larynx, solar plexus, scrotum, pressure to the caret sinus. Diseases with no specific findings of a disease: 1. Sudden iniant death syndrome (SIDS) or enb death 2. Sudden urexplained nocturnal deata (SUND) DOA— means actually dead 01 dying, provicied the physic'an had not aeen given ample opporunity io arrive at 2 working dlagnosis as to the cause of ceath Undetermined - ha physician cannot datermine the causa af doats MEDICO-LEGAL CLASSIFICATION OF THE CAUSES OF DEATH «2, Natural death ~ cause by natural disease condition inthe body ». Violent death ‘Accidental death Negligent death Infanticidal death Parricidal death Nurder Homicidal ce h 2%If signs of violence ere aasocieted with the natural couse of death: = Did the person dle ofa natural cause and were the prysical injuries inflicted immediately after death? Miclence applied in a dead pereon : Imposable crime * Was tho victim sufforing from a natural disease and the violence only accelerate the deatn? Difander reeponsible ofthe death of the victim. = Grimral latilty shall be incurred by any parson comriting a falony though the wrongful act done be different from which he intended. ‘Ard no.1 RPC) * Did the victim die of a natural cause independent of the violence Inflcted? “accused will ct be respansible for the death but mately fr the physical uuries he had inflicted. Ex. Slapping a parson with heart groblem, only slight physical injury to make the offondor liabls for the dosth of the victim, t must be proven that ‘he death is the natural consequence of the physical injuries inficted. ‘The following are deaths due to natural causes: 1. Affection of the CNS ‘2, Cerebral apoplexy ~ sudden loss of ccnaciousnes fcllowed by oaralysis or death due to Hemorrhage from thrombosie or ‘embolism in the ce‘eoral vases. b. Abecese of te brain © Maningiis of the fulminant type 2. Affection of the circulatory system ‘3. Oreluion of tha corenary vessels ‘=ingst common Cause of Sudden death due to natural causes. Falty of mpocardial degeneration of the heart Rupture of the anourysrn of the aorta Valvular hear! disease Rupture of te heart Affections of the Respiratory system ‘Acute edama of the larynr Tumor of tre larynx Diptheria Edema of the lungs Pulmonary embolism Lober pnaumonia Pulmonary nemormags n4. Affactions of the GIT ‘a. Ruptured PUD Acute intestinal obstruction >. Atections of he GUT 2. Acute slrarguiated hernia . Ruptured tubal pregnancy © Ovanan cyst with tanstoe pedicle 6. Affoction of the glands Status thymie-lymphaticus b. Acute hemomhagic pancreatitis Sudden death in young chiren Bronchits Congestions of the lungs ‘Acule brenshe-pneumoria ‘Acute gastroenteritis Convuision Spasm of the larynx B. Violont death ~ fe du to Injries inficted in the body by some forms ot outsice force ‘The physical injury must 2e the proximate cause of death. = That the victim at the time the physical injuries were inficted was in normal helt That the ceath may be expected trom the physical injuries inficted. ‘That the coath ensued within a reasonable tine. CLASSIFICATION OF TRAUMA OR INJURIES Physical inuy - tauma sustained threugh the use of physical force “Thaimal injury — injury by heat or cold Electrical inuury - electrical ena-gy ‘Aunaspheic injury — due to change of almospieric pressure, Chemiies! injury — chemioale Rad ation injury —raciation Infecton — microbic invasion 28PENAL CLASSIFICATION OF VIOLENT DEATHS 1. Aesidantal deaths — due to miasdventure or accident, Art 129, 4 RPC Any person who while performing a lawlu! act with dus cae, causes an Injry by mare accident without faut or hiontion of causing It Ex. Patient ded of ATS injocton after proper skin test 2. Negigant death —felonias aay be commited when the vrongiul act ie due to rackless imprudence, nagigence, lack of Skil of foresight. Ex. Surgeon iefta pack - Homicide through recklass imprudence 4 Sucidal death , destniction of cna's self not punished, unfortunate being, [Art 253 RFC Giving assistance to suicide. Punishatle because he has no tight to destroy or assist in the destruction of lie of another 4. Pertcidal deaths Art 246 father, mothat, chid, (lagilog) aecandant, des idant, spouse (log) 5. Infanticidal deaths ~ Ar. 255 kiling ofa cad less than 3 days 6. Murder Art 248 treachery, consideration, means of inundation, occasion of calemities, evident pre-medtation, cruelty 7. Homicidal deaths art 249 DEATHS UNDER SPECIAL CIRCUMSTANCES: 1, Death caused in ¢ tumultuous afray Art 251 2. Deaths or physicel injuries inficted under exceptional ereumetanees Art 247 2. PATHOLOGICAL CLASSIFICATION OF THE CAUSES OF DEATH ‘a. Death due to syncope — fatal and sudden cossation of the action of the neart bb. Death from asphyxia — a cendition in which the supply of oxygen to the load or to the lissues er fo both has deen reduced below normal working evel Stage of increasing dyspnea ria Stage of Expratery convuision Stage of exhauston 31min 2, Death from coma 20SPECIAL DEATHS 1, Juetetat deaths — Art Il Sec.’ Par. 19 Phil. Const. “crual and Unusual punishment shail not be inficted. ; electrocution, nenging ‘muskoiry, gas chamor 2. Euthanasia or mercy killing 3. Suicide ‘Automatism- cue to drug may be considered as accicental rather than sual Evidences that will infer death is s ae 1. History of depression, mental disease. 2) Previous attampt 3. injuries are bated in areas accessible to hand. 4. Effects of the act of self-destiuction may be found in the ict: empty Dottie Presence ofsuicival note. Secluded, nol in public view. Evidences which rule out HIM, P 4. Death from starvation : Cause may be due to Suicidal, homicidal or accidental The hurman body without fond insses 1/2 And 40% lossedeath ‘ofits weight daly Facters that influence the length of survival:age, condtion of the body, sex, ‘envronment. 20DISPOSAL OF THE DEAD BODY Sec.1103 Revised Administrative Cade : Persons charged ith the duty of burial 1. Deceased was married: the surviving spouse 2. ifunmanied the nearest ofkin ofthe ceceased; adults, within the Phil [And in possassion of suffisiant moans to daffay the recostary axpances. 3. fone of the above — municipal authorities. Sec 1104 RAC Right of custody ‘Any person charged by lawuwith the study of burying the body of a daceased persen is entlied to the custody of such body for the purpase of burying it, except when en inquest s required by law for the purpose of determing the cause of death If communicable, the local board of heatth or local heath oficer or municioal council. Concept of possession — the right of cusiody overa dead body.. The right of ‘cusiody does not mean ownership of the deac body. EXecut0rs night of custoay superior 10 the mnt of spouse dead body. An executor is the person mentoned in a wil who will cairy on the provision of the will In the absonce of a tostamantary disposition, tho right of the surviving spouse is paramount, METHODS OF DISPOSAL OF THE DEAD BODY 1. Embalming- 6 to 8 quar's of antiseptic solutions ef formalin, perchloride of meretry oF arsenic which is cared into the internal carotids and the Femoral arieriag 2. Burial or inhumation ‘2. See 1092 RAC buried within 48 hours if unembaimed Within 12 hours, if commmunicable Except: 1. Subject of agal investigation. 2. Authorized oy the local nealtn authorise that may be buried more than 48H. 3. Impliodly when embalmed. b, Death certfeate nacessary befcre butia: Sec. 1087 RAC Requrement of Death Cert and the duty of physician f iesue orthe local health officer, ar none by ts mayor, Secretary, counciir of the munic pally to Issue tne certficat2.. Sec 91 P.D. 855 Code of Sanitation ; Burial requirement = docth eert, issued by physician u€¢ Permstion from the Provincial fiscal or from the munisiaal mayor Is necessary if death is due to violence or crime. = Sec. 91(t) P.D. 856 Code of Sanitation Sec. 1094 Revised Administrative Code — Disposition of body and belonging of person dying of dangerous communicable diseas Ex. Moningacoceemia in Bagiuo City 1. Tho body of a person who died of any dangorcus communicable disease shall not be carried form place to piace axcept for burial or cremation, 2. Duty af the local heath official to dsinfect the beay befora oaing prepared for burl: the furniture, house, either disinfect or oumad if Capable of conveying infection, Sec. 31(h) P.D. 690 Code of Sanitation 1. Remains shall be buried within 12 hours aftet death. Cause of death is due to a dangerous communicable disease 2. Not to be tacen any place of public assambly 3. Only adult members of he deceased are allowed to attend the funeral Sec. 1091 RAC Death Gertiicate must be presented hefore burial Sec. 1099 the plecing of the body of any deceased pereon in an uncoaled ‘overground tomb is prohibited unless if parrmanantly sealed Except: 1. Tomes and vauits which are stietly receiving vauits for bodies or roman anaiting final disposition 2. Embaimed bodies awaiting final aispestton. See. 100 of RAC, See. 910 of P.D. 856 Code of Sanitation The dapih ct the grave must be at least 1 % moters deep, tiled well and fem. Sec. 2695 RAG Penalizes the desecration of burlal premses; tombstone, plant, ‘ree, fence, post or wall. P200/ro! greater than 6 montis, Sec. 90 code of Sanitation Burial Grounds requirements 1. Itshall be unlawful for any person to bury Ue remans in places other tran those legally authorized 2. Al least 25 meters fram any dwelling house and no house shall be ‘constructed within the sama distance from any burial ground. 3. Not within 59 meters from any water scarce. Other burial requirements: 1. Shipment of remains abroad shall be governed by the rules and ‘regulations af the Bureau ef Quarantine2. The butial oF remains in city or municipal grounds shall not be prohibited due to race, rationalty, religious or political reasons. 3. Except whoa required by legal investigaton ar whe permitted o the local health authorty, no embalmed remains shall remain unburned longer than 4B hours, FUNERALS Alt, 30566 The duy and tie tight to make arrangements for the funeral of a relative shall be in aecordance with the ordar of eupport under Art. 204 Descancants : Eldest Ascondants. : Peternal For support as mentioned in Art. 294 4. Spouse 2. The descendants of the nearest degree 3. Ascandantof the nearest degree 4. Brothers anc sisters Art, 306. CG ; In keeping wih the social postion of the deceased, Art, 907 €€ ; In accordance lo the exprosted wishes of the deceaved. Ait, 309 €¢ ; Showing of disrespect to the dead shall be lable to the iernily of the deceased for damages, materials or mecral Art, 132 RPG: Inierruotion fr relgious worstip. ‘Art 133 RPC: Offending the religious feeling Ait 2219 CC: Provides for the moral damages may be recovered for acis| montioned in Act 200 CC. LIMITATIONS TO THE FUNERAL RITES. 1. Willof the deceased 2. Bulla! of a person senlerved to death must nol be eld wih pomp. 2. Restrictions ax to funeral ceremonies in eases of deaths dus fo Sommunicable disease 3. Disposing of the dead body in the sea Provided the deceased ‘snot suffering from dangerous communcable deceased. See. 1003 RAC Permit for conveyance of body to 988 for bial 24. Cremation is the pulverizetion of the kody infe ashes by the application of heat First must be Identified, Permit anc ira crematory made forthe purpose. NOT GRANTED: Ifthe deceased left a note. . Identty of tre porson is net detirito, ©. Exact cause of death cannot ba ascertained and the need for further inquiry or examination. 5. Use or body for scientine purposes = Corpse of prisenars + Any person to be buried for public expense and which is unclaimed for 24 Sec. 98 P.D. 856 Code of Sanitation ‘Spacial precautions for safe handing of cadavers containing radioactive Isotopes RA 349 as amended by RA 1056 Porricsion to uss Human orgars or any portions of the human body for medical, surgical cr scientific purposes Under certain conditions, inwwrting, apectic uee, signed by the grantor and twe disinterested witness, Sec. 96 Code of Sanitation; Donation of human organs for medical , surgical and ecient purposes according to the Sentation Code. .ons permitted to detach human organs: 1. Licensed physicians 2. Knowr scentist 3, Medical or scientific institutions Requirements for a valid authorization 1. It musi be in wing 2. It musi spocify the person or insiliuiion grated the authorization, 3) Must spacity the organ or part to be removed 4. Signe by the grantor and iwodsinterested perso 5. Copy of the authoszatcn rmust heaubraitted tothe EXHUMATION aryot Heath ‘The deceased buried may be raised oF distierted upon the lawful ord ofthe praperauthortice Sec 1082RAC Cemetary parmits even to NBI agerts Sec.1097 RAC ——_Exhumalion in case of ceath fromdangerous sommuncable disease after 5 yoars fram burial uSec $2 Code of Sanitation 3 years if non-dangercus communicable disease Romain shall disinfected before burial Requirements te be satisfied in exhumation: 1. Duration of nerment as required. 2, Exhumation permit 3. Compliance 6f sanitary requirements Procedures followed in MedicoLegal Exnumations: 1. Aformal recuast from any of the law erforcemant agency or ary pareon autharizea by law. a. Name of the person, place of intsiment, date of interment, suspicion as fo cause of death b. Ta determine the cause af death c. To determine as ‘0 identity of te person 4d. To vecover organs or Ussues for further examination for Tosieclogical analysis, = Histopath exams = Sineers from vaginal canel and blood fer alcohol determination 2. Set the date end time of exhumation, if physician has a strong reason to Deleve thet for the ustifcaion and strong probabsliy, 3. WWriten request to tha Ragional diractot ar Secretary of Health 4. Grave mustbe properly identitied by the person who was present when tha body was interred. 5. Aer opening the coffin, the bedy must be viewed by any person who ean ‘dantify the deceased. 6. Actual autopsy and adoption of the procedure is needed to accomplish the purpose of the exhumation 7. Disinfection of fhe body and all areas invalved must be carried aut with the assistance of the local heath officar and the return of the body to the burial placa MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES Physical injury : is tho effect of some of stimulus an the body. tab wouind the affect is immediata but a Dnt object 5 delayed production on the contusion. Causes of Physical Injuries 41. Physical vielence 2. Haat or eald asElectical energy Chamical anergy Radation by radioactive substances Change of atnospheric pressure Infacton 1. PHYSICAL INJURIES BROUGHT ABOUT BY PHYSICAL VIOLENCE = The affect ofthe application of physical injury on parson is the production of wound. = A datupiion of the anatomic integrily of the tiseuse of the body. However, not all physcal ieience wil result in tha presuction af wound, Physics of wound producto mv2 a Kinetcenergy “Velocty compenent is the impotant factor: M10 rile with a velocity of $200 fU sec causes damage mate than a hoavior 38 calor. b. Time = The shorter the potiod of ime needed forthe transfer cf energy, the greater ths Iitelinood of praducing damage. = Ifa person is hit an the body and the body moves towards the directon ofthe force applied. the injury is lees aa when the body is siationary = The lenger the tre of contac! between the oject or instrument causing the injury, the greatorwil be the diseipation of energy. ©. Area af tanstor = The larger the area of contact between the force appliecon the bbody, the loscer the damago to the body. = By applying an equal force, the darrage caused by siapbing is {greater compared io a blun! instrument d. Other factors = The lass elastic and plastic the tissue > the greater that a Jacerallon will resul. = Blasticity ality ofthe tssue to return te ts normal sizes and shape after, bbehg deformed by a preaaute. = A force transmitted through tssue containing fluid wil ‘orce the flud away from the area of cortact in all diecions ecualy, frequently causing the tiseus te lacerate. 16VITAL REACTION = Iii the sum tctalof all reactions of tissue or organ to trauma, ether cbasrved mier> or macroszopicslly. ‘a, RUBOR - ‘ednoss of congestion of he area due fo an increase of blood Supply as a patt of the roparative mechanism. , GALOR - Sensation of neat or increase n temperaiure. ©. DOLOR - pain due to involvement of the sansory nerve d. LOSS OF FUNGTION- ducts trauma, the tissue may not function. The presence o vila weaction diferentiates an ante-mortem (rom a post-mortem injury. EXCEPT: vital reactions not seen even if injury inflicted durng ie: 1. During agoral state ofa living person were cells cont react io the trauma 2 Sudden death ae in audden coronary occlusion. CLASSIFICATION OF WOUNDS: 4.48 TO SEVERITY a, Moft| Wound — caused Immediately after nticton that s sapable ot Pars. of bey that as ara heat sects, NS, unger ogane . Nonmcrtal wound ~ Nol capabve of producing death afer nitiction, 2. AS TO KINDGF INSTRUMENT USED 2. Blunt instrument - contusion, hematoma, lacerated wound ”b. Sharp instrument Sharp-edga instrument> incised wound Sharp ponted > punctured wound Sharp edge and. sherp-oointed > stab ‘2, Wounds brought about by tearina force — lacerated wound 4. By change in almoepheric pressure - barotiaumas, 2. Wounds brought about by neat 91 cold frostote, scald, burns. {. Wounds brought about by chemical explosion — GSW", shrapnel wound {9. Wounds brought cout by infection, 3.AS TO THE MANNER OF INFLICTION a) HIT—means of bolo, blunt instrurrent, axe. bb) TRUST or STAB — aayono! daggor ¢) GUN PONDER EXPLOSION ~ Projectile or shrapnel! wound 4) SLIDING or RUBBING or ABRASION 4. AS REGARDS TO THE DEPTH OF THE WOUND fa). Superficial - wound involves only the layers of the skin. b) Daep - inner structures beyond the layors of the skin PENETRATING WOUND - Wounding agent did nol come out or Piercing a sold organ, PERFORATING WOUND — Wounding agent produces communication between the nner and outer portion ofthe hollow organs. OR piercing o traversing completely a particular part of the body causing communication between the pointe of exlry and ‘ext ofthe instrument or substance producing t 5. AS REGARDS TO THE RELATION OF THE SITE OF APPLICATION OF FORCE AND THE LOCATION OF INJURY a. Coup Injury — Physical injury whichis located al thesite of the application of force. . Centre-coun injury — appasite the site of the application of forca 12. Coup contra-caup injury —ate and also apposite of application of fore. 4. Locus minoris resistencia - Physical injury not iocatad at the sta nor ‘apposite the sile of the applicetion of force butin some areas cffarng the laast rasistanca to the fores applind Example: Blow in fore head > contusicn on theregion of the eyeball ‘2 Extonsive injury ~ Physical injury involving a groster area of the body beyond! the site ofthe appileation of force. 8Example : Fall or NVA 6. AS TO REGIONS OR ORGANS OF THE BODY INVOLVED Injures in various oarts of the body 7. SPECIAL TYPES OF WOUNDS 2)DEFENSE WOUNDS ——_~ Instinctive reaction of solf-preservation. > handsstractures D)PATTERNED WOUND —— YYound ntie nature angshape of ne instrument. > Wheele,abracione fom rope. SELF-INFLICTED WOUNDS - Wound produced on oneself but no Intenton to end hs lie. Note of producing setinnicted wounds: To create or deliberately magnify an existing injuty or disease for pension or warkman's compensaton. To sscape certain obligations or punishmant To create a new identity Gain atention or sympathy. Psychotic benaviour, Some ways of self-mutlation: 1. Head banging or bumping 2. Exposure of body to heat radiaton fiom open fr, radiators 3. Penetrating nal to chest wall 4. Castration by amputation of the penis 5. Trichctitomania- pulling of body heir LEGAL CLASSIFICATION OF PHYSICAL INJURIES 1. MUTILATION 1 282REC Kinds af mutation: a. intentionally depriving a pe’son, totally 0: partaly cf some of the essential aigans for repraduction, b. Intentionally depriving a person of any part or paris of th human body ather than the crgans for reproduction Nutiation to ve punishable I must be Ftealional or net physical injury. MAYHEN - is the uniawéul and violent deprival ofanother af the use of par of the body so as to render himless able in fgniing, =ther to defend himself of to ernay his adversary. Vasectomy/Tubal ligation ere not mutilation and @ laglimate metro of ‘coniraceplion despite the fact thalit is dane intentionally end denrives 2 person of his power of reproduction. 0SERIOUS PHYSICAL INJURIES Art. 253 RPC Any person who shal wound, beat ot assault another Art. 253 and ‘acministoring injurious substance, without intent to kil Ar. 264 ‘The main purpose of dividing the provision into four paragraphs 2) Is {0 graduate the penalties deponcing upon tno nature and character of the wound nflcted bb) Thelr consequences on tie person of ihe vicum 1. Prison mayar - because of fe physical inunes infictad, te injured person becomes insane, imbacie, impotent or did, 2. Priston comectional nite medium and mexmum perloce “loss of speech, hear of sel loss of eye, hand, foot. arm, leg) loss of the use of incapacitated fcr the hatitual work he used lo de. 3. Prision conectional nits minimum ard mecium periods “parson inured shall be deforred lost any other part of tie body, incapacitated for more than 90 days. 4. Arresto mayer in te maximum period to pricion correctional “ithe physical injures shall have cause the llness or incapacity for labor for more than 30 days. Is the offense shall be commit2d against any of the persons enumerated in Ait. 243 Or with attondance of any of the croumstances mentioned in Art. 248 = The case covered by subdivision number 1 of his at. Wille purishad by reclusion tempore! ins medium end maximum periods. = Sundivision nambor 2 by Psion corractinnal in te matimum pared to prsion mayor ints rainimum pera. = Sutdivision number 3 by pesion corractonal in its mecium and maxinum Subdivision number 4 pisicn correcional ivits minrrur and mediam potiods ‘The provisions af the preceding paragraph shall rot be applicable a parent \aha shall infist physical injaies upen his child by excessive chaatosmant. RA 7610. Itmay be committed through @ simple negigence or imprudence. ADMINISTERING INJURIOUS SUBSTANCE OR BEVERAGES At 254 RPC Element 1. The offencer inticted upon another any serious physical inury. 402. There is knowledge thal the substance or beverage administered is injurious Or took advantage of the victims weakness of creduity. 3. There is ne intent to kil Fn the part of te offender. \fintentional so> frustrated murder. Treachery s inherent in Art. 264 RPC LESS SERIOUS PHYSICAL INJURIES Art. 265 RPC ‘Any person who shall infct upon another physical inuries ret daseribad in the preveang aricies, = Butwhich shal incapacitate tha offended party forlaber 10 days or mora 0: shall require medical aitercance forthe same period Both of which ir 10 daye butnot more than 20 days and there must be proof to I. ‘The crime of lex serious physical injures may be qualfied and a fine of a higher penaty is imposed when: ‘Thora is a maniestiintont to incut or offand the inured porson, 2. There are circumstances adding ignominy to the offense. 5. The viciins isthe offender's paren's, ascendants, guardian, curators, teachore 4. The vein is a person of rank or parson of authcrty, provided the crime is not drect assault P.D. 169 Obligation imposed on Physicians treating persons suffering serious and lees eorious physical injurise required tc roportto law enforcement agencioe SLIGHT PHYSICAL INJURIES AND MALTREATMENT Art 266 RPC 1. Arresto meno when the offendernas Filicied physical injures which shall incapacitate the oflended party for labor form 1 to 9 days of shall require medical attendance of the same poriod 2. Aresto menor or frie net exceeding P20) and censure when the offender hae cause physical inaties which do not prevent the offended perty from engaging in his hagtual work nor require mecical attendance 2. Arroata merorin ite minimum poriad ora fine netoxeeeding PEO when the offender sval il treat arcther by deed without causing any intr, It there ‘sino evidence to show actual injury or incapacity forlebor o period of medical ettandance, the accused can only be gully of eight anyeical inuries. 4802 toncer slap on the face, holding the arm tigity, application of prassure in some parts of the kedy or mild biow which show no sign of physical ioletice may stll be considered sight physical injuries or maltreatment. (Perag 3) PHYSICAL INJURIES INFLICTED IN A TUMULTOUS AFFRAY Art 252 RPC Elamant: 41. There is a tumultuous affiay 2. Participants etffarad from Serious phyeieal injuries 3. The person wh inflicted serious physical injuries cannot be ider te. 4 Allthose whe appear to have used violsace upon the person of the ‘offended party shall be penalized by arrest from 5 \o 15 days. TYPES OF WOUNDS (MEDICAL CLASSIFICATION) 1. CLOSED WOUND ~ no broach of continutty of te skin of mucous membrane. ‘a Superficial When tho wound i just undorneath the layors of tho skin ‘oF mucous membrane a -PETECHIAE - is a crcumserbed extravasation of bleed in the subcutaneous tissue or undemeath the mucous membrane. Example : mosqute bite, blood disease, hanging 2 - GONTUSSION —Is tne fusion of blood into ine tissues underneath the skin on account of the 1uplure of the bicod vessds as a result of the application of Lunt force ot violance. = size of contusion greater than the sza of the object = Location of the contusion is not always the site of application of the force. Example: Black eya> Forohoad Medic o-eqai point of view ‘Aconiusion a0 indicated by its extemal patiotn may coeepand to the > shape of the abject or weapon used. Extent > the possible degree af violence appied. Distribution» indicates the charac'er and menner of injury 2s in manual ‘trangulation around the neck.‘Age of Conlusion: appreciated Fem its color change ‘The 9ze tends to become smaller from the paviphery to the center ‘and passes through a series of color changes as aresuitof the > Disintegration of the REC ardliberation of hemoglobin. ‘The contusion is red, purple soon aterite complete development, 410 5 days > graon to 10 days > yellow and gradually disappears cn tho 14" ot 15" day, ‘Tho utimata disappearance of coler varies fram 1 te 4 weeks ‘depending upon the severity and constitution of the body. ‘The cob changes siarts at the periphery. CONTUSION VS. POST-MORTEM HYPOSTASIS. Contusion Below the epidermis in the true skin in small bruises or extravasetions, Delaw this in laiger ones and often much daeper sti The epidermis has no blood vessels to Oe ruptured. Post mortem Hypostasis: In the opiderms or in tho cutis as a simple stain ora showing twough the epidermis of the underlying engorgec cepilaries. Contusion Cuticle was probably abraded by the same violence that produced the buice. In small punctures such as fleas bites, this nol observed. Postmortem hypostasis Cuticle unabraded, because the hypestanis is'2 mera sinking of the blood, there is no trauma Contusion ‘A bruise appears at tha seat of and surrounding tha injury. This may or may ‘not be a dependent part. Post-mortem hypostasis ‘Always in @ part wnich for the time of information is depencent aContusion fen elevated because elevated blood and subsequent inflammration swell the tissues. Post-mortem hypostasis, Not elevated, because ether the blood is sillin the vessels oral most has ‘Smply soakod into and stainod the tissue. Contusion Incision shews blood outside the veasele. The is the moet certain test of ‘afference and can be anserved aven in very small erulses, Post-mortem hypostasis ineision chaws the blood ic ein ite vozeele and f any cazing scours drops san be seen issuing from the cut mouths of he vessels. Contusion or variegated, This is only trun of bruises that ara the sama days cid due ‘0 the changes in the hemogiabin produced during li Post-mortem hypostasis Color is uniiorm. The wel known change in color produced in blood Exlravasated Into living tissues does nol occurin dead tissues wity the same regulanty. Contusion ifthe body hagpens to be constricted at or eupported an a bruised place, ‘he actual surface of eantact may be a ite lighterthan the rast ofthe bruias Dut will not be white Post-mortem hypostasis ‘na place wnich would otherwise be the seat of nypcsiasis pressure of any kd even srnple supports sufficient to obliterate the |umen of the venules, ‘and capilares and eo to prevent thai filing with blood. \Viite lines or patches of pressure berderad by the dark color of hypostasis are produced and marks 6! foggings. stiangulation, oie. are thus somatimas simulated FACTORS INFLUENCING THE DEGREE AND EXTENT OF CONTUSSION 1. General cordition of the patient 2. Bart of the kody affected, Fatty tissuns, bloody parts > contused easily Fibrous areas. muscle > less. 3. Amount of force applied —The greaterthe force, the more eflusion of blood. 4. Diseaze ~ Contusion may dovelop wits or without application of fore Example: Aplastiz anemia, wnaoping cough5. Age ~ Children and old ege tend to bruise easily. 6 Sex—worren, obese easily develops untke boxars 7. Application of heat and co The distinetion between ante-mortem and post mortem contu: undecomposed body is that in 1. Anto-mortem bruising: thera is sweling, damage to epithelium, xtravasaten, ‘CoagUation and inf ation of the tissues with blood. 2. Post-mortem bruising there are no eucs findings. a3 HEMATOMA 'sthe extravasation ar effusion cf blood in anewly ‘ormed cavily Lindemoath the ekin. W/henthe blunt hetrument ha hard part af the body Ike a bony part which is superficially cated, Force causes the sudculansous tissue to rupture on account of tre presance of a hard structure undorneath. DISTINCTION BETWEEN CONTUSION AND HEMATONA. 1. In contusicr- the effused blood are accumulated nthe interstices of the lissues underneath the skin Inhomatoma blood accumulates in a newly formed cavity underoath the skin. 1. in contusicn, theskin shows no clevaton and is ever elevated, ho slovation is slight and is on account cf inflammatery shanges In hematoma ~ the skin is always eelevated. 2. In contusion, puncture ar aspiration with syringe of the lesion, no blood ‘ean be obtaned Ii hematoma —shows presence of blocd and subsequent depression of the elovatec lation, ‘Abscess, gangrene, hypertrophy, flbiod thickening and even malignancy ‘are poterial complications of hemetorna. MUSCULO-SKELETAL INJURIES 1. Sprain - partial or complete disruption nthe continaty os a muscular or igementous support ofa joint, due to a blow, kick crtorsion force 2. Dislocation — displacement ofthe artieular surface of ona antering into the formation ofa joint. 3. Fracture —solution of continuity of bone resulting from violence or some oniating pathelogy. 4s2. Close oF Simple Fx —no break i continuity of the overlying shin. . Opan a1 Compourd Fx — Fx is complicated by an opan wound ‘caused by the brocen bone which protrudes wih otter issues of the broken skin. ©. Comrrinuted Fx — Fractured bone is fragmen‘ed into eaveral pi 4. Greenstck Fx ~Fx wherein only one side o! i bane is Eraken while the otheris meraly bent. 8. Linear Fx when the Fx forms a srack usually in flat bones. Spiral Fx — break in the bones forms a spiral manner as seen in long bones. 9. Pathoiogi Fx - Ft ceused by weakn 1 oF the bone dus te dia 4. Strain the over-stretching instead of an actual tearing or the rupture of a ‘muscle or igament which may not be associated wth the joint. 5. Subiaxation ~incomplet# oF pana cslocation. INTERNAL HEMORRHAGE ‘rupture of blood vessels which may cause hemenhage due to he Following: ‘a. Traumatic intecranial hemorhage. Rupture of parenchymatous organs ©. Lateration af cther part of the ody, CEREBRAL CONCUSSION ( COMMOTIO CEREBRI) = THE JARRING OR STUNNING OF TKE BRAIN CHARACTERIZED BY MORE OR LESS COMPLETE SUSPENSION OF ITS FUNCTIONS ASA RESULT OF INJURY TO THE HEAD WHICH LEADS TO SOME COMMOTION OF THE CEREBRAL SUBSTANCE ib more sovere when the moving or mobile head etruck a fixed herd object as compares wnen the head is fxed and siruck by a hard moving abject. Signs and Symptoms Unconeeiauenoce whieh ie more arloce completa, ‘muscles are retax and flaccid ayelids are closed and tve conjunctivae are insenstive, surface of the body Is palo, cold and clammy, respiration is slow and sighing, pulse is tavid, weak, faliering and scercely perceptbe tothe Migers. femperature iy subnermal. Sphincters are relaxed with Unconscious evacuation af the bowel and bladder. 9. ‘reflexes ate present but sluggish and in severe coses may be ebsent Loss of memory for events just before the injury is @ constant effect of ‘cerebral coneusson and is of mecicn-legal importance. 2. OPEN WOUNDS 46a. Abrasion (Scrateh, graze, improssion mark, friction mark ) "itis an injury characterized by the removal of the euperticial sgitolisl layer of the skin caused by a rub r frciion against a hard rough object. = Contuesien with abrasion = forcible contact before Fiction occurs the shape varies and the raw surtace exudes blood and Iymoh which later dries and forme a protoctive covering as SCAB at CRUST. Characteristics of abrasion: 1. Tdevelops atthe precise pohtof the force causing It 2. Greesly or withthe aid ofa hand lens the injury consieie of perallel near irjunes which ars in ine wih te diracton of rub or fricton causing it 3. Bmay exhibit the pattern of tne wounding material 4. Usually ignated by attending prysician. Neciea legal vewpoint = abrasions caused by fngerialss may indLeate suuggl2 oF assault and are usualy located in the face, neck, forearms and hands = abrasions resating from friction on rough surfaces are lecated in bony parts and are usually associated wih contusion or laceration = ratur of the abrasion may infor dagroe of pressure, nature of the rubbing object and the direction of movement. 5. Abrasion heals in a short tims and leaves nc scar unless Fnot Infected ori ha whole thickness of the skin Is involved Forms ef abrasion 1 Linear abrasion — appears as. single line, atight of curve inching with fngernails = curve a = siding the point of a neodl» = etraight inear ab. 2.Mult-tinear — dovelops whon tho skin is rubbed on a hare rough ‘object producing several linear marks parallel to one another, Examele: NVA 3. Convert —linear marks in the shin are almost indistingushable ‘on account ofthe severity of rision and roaghnass of tho object. 4. Multiple - several abrasions of varying Szes and shapes may be found in diferent ports af the body. ‘Types of abrasion 1. Scratch ~ caused by sharp pointed abject hich slides across the skh lke pin, thom oF fingernail = Injury usually parelle| to the direction of slide. = Fingemail scratch > broad al point of commencement wit tailing at tho ond. 2. Graze — usualy caused by ‘oreible contact with rough, hard objects a”resulting t ireguler removel of the skin surface. = course indicated by a clean commencement and tags on tha and 3. kmpact or imprint abrasion ( patterned abresicn, stamping abrasion, abrasion a la signature) - those whose patlain end location provides cbjactve evidence to Show cause. nature of the wounding Instrument and the manner ofassaut or death = marks of fid of radiator, throad marks of wheal, teotn marks 4, Proesure or ficton abrasion ~ caused by pressure accompanied by overnent usually observed in hanging or stargultion, pial strands of the rope as eon hi the skin in hanging, Differential diagnosis: 4. Dermal erosion - gradual treakdown or very shallow ulzeration of the sskin which Invelves only the epidermis and heals without scarring, 2. Marks of insects and fishs bites ~ skin Injury is irregular with no vital reaction and ustally found on angles of the mouth, margins of ose, eyelids end forehead. 3. Excoriaton of the skin by excreta — found in infants ard the skin lesons heals when the cause is removed. No apparent history of rubking trauma cn the affected area 4. Proseure sore — usually found at the back at the region of bony prominence. History of longstanding illness, bed ridden. ANTENORTEM ABRASION POSTMORTEM ABRASION COLOR —recdsh-bronze duet slight —_—_yollowisn and transparent ‘exudation of blood LOCATION any area, ‘over bony prominence Rough handling of the cadaver vir, with intravital reacton shows not vtal reaction and REACTION may show remains of damaged Is characteiized by 2 separation Epithelium ‘ofthe epidermis irom Complata loss of the famer b. Incised wound ( cut, slash, slico| = produced by a sharp-edged ( cuting) — oF sharp-lincar edge of the instrument lke a tnife, razor, belo, lass ett. aa 5 ‘ = Impact cut> when thera is foreibla contact cf the eutiing instrument with the body surface. Siice cut > when cutting injury is due to the pressure accompanied with movement of tha instrument = Chopped or Haocea wound > when the wounding instument is a heavy culling inetument ike sabor > nury is sevoro Charactaristies of incised wounct Edges are dean cut. The wound i etraight Usually Ue wound Is shallow near the extremities end deep at ne migule portion, Profuse hemorthage bezause of the clean cut on the vessels, Gaping is usually presant due to the ratraction of the edges Clothes wil also show a clean cut f cat by the instrament. Fastar healing if without complications. Incised wound made by broken glasses maybe iregular, needs to be removed. Changes that occur in an incised wound: ‘After 12 hours — edges are swollen, acherent with bod andwiti leukocyte infitration. ‘Aftar 24 hours — praiferation ofthe vascular endothelium and ecnnactive tissue cells. ‘2ftor 26 to 48 hours capiliary network complete, flbroblasts running at Fight angles to the vassals ‘Atior 3 to 5 days — ves sols show thickening ane okieration Why a porton euffare from ineized wound: Asa therapeutic procedure ‘As a consequance of sal-dafen Masochist vay selfinflct ncisad wounds for ‘Addicts and mental patienis, I-gratification Suisidel wounds — usually Ineated in paculiat pata af the bedy, acceasialato the hand the mast commen sita is the wrist, radial artary and the neck. Homicidal wourds — usualy deep, multiple 2nd involves both accassible and non-accessible parts clothing are usually invelved Defense and other forms of wounde ere procent. 40Accidental wounds multiple incised wounds observed on the passenger and drivar of MVA dus ‘o broken whdshields ‘chen knivas in the preparation of food. SUICIDAL WOUNDS HOMICIDAL WOUNDS DIRECTION Oblique from below loft 2ar, Usually horizental blow owawards across frant neck the adams apple just above Acams epple SEVERITY —Ucually nat ee deap and Usually deep and may caues may only involve trachea, Inyolvament of me cartlage ‘carotid and esophagus and banes, SUPERF'L Usually present batora the Practicelly absant but may cur ‘commencement of deeper rarely be present when the ‘wound Victim siruggled when attacked POSITN OF Maybe siting of facing a Usually vitim lying on bed THE BODY —irror or etanding ‘rin cthor place, WOUNDING Firmly grasp (cadaveric spasm) Weapon s absent WEAPON or found iying baside the victim, BLOOD _Bld foundin front part of body Bld found at the back of neck DISTRIBUTION Hand smeared with blood. Hands ave clean. MOTE History of mental degtession, Absence of such tistary Financial, cocka probleme, aiceholiom PREVIOUS Hx May bo present ‘Aiways absent OF SELF-DESTRUCTIN 3. STAB WOUNDS - is produced by the peretration of a sharp and a sharp ‘edged instrument like aknife, scissors. ‘fthe sharp adge Is the one that comes in contact wif the skin than itis an incised weund Ifthe sharp pointed porton fist come in contact, & Sa stab wound, = surtare length may reflect ihe width ofthe wounding instrument. <0= smallar when the wound is not go deep = wider if upon withdrawal is not in the same direction as seen n slashing movement. The presence ofan abrasion from the estromity of the Skin defect sn Ine with diectcnot te slashing movernert. ‘The exremilles of stay wound rray show the nature of the nstument used, ‘a doubled biaded weapon chows bath extremities to be sharp. | single bladed weapon one of iis exiremiias as ‘cunded and conus, not seen if instrumert is quit thin, ‘The diraction of the eurfaca dofest may bo useful in the determination of tho ossblerelallve positon of the offender and tne victim when the wounc was, inflicted. [As to whether the wound is site or gaping depands on the direction of the ‘wound to the Lange's tine, ‘The depth of the wound may be influence by: 4, size and sharpness of the instrument. 2. area of the body involved 3. the dagree ct force applied Hemorthage is always the most serious consequence ef slab wound due to the severance of blood vessels or involvement of blaady organs. How te deserike stab wound: 4. length of the skin dofect - edges must 96 coaptatod first Talling — tte direction cf withdrawal ofthe wounding weapon, ‘A. consition ofthe exiremitee sharp extremity > sharpness of the instrument used. If Bot) extremity are sharp > double bladed weapon is usec. 3. condition of the edges, fedgas are ragular and clean cuit» due to ane stabbing act = Serrated or zigzag In appeararice = several stabbing wounds ( series cf thrust and withclawal.) 4. lingardirection of the wound ~ t may be running vertically, horizontally, o upnard medally or laterally 5, location f the stab wourd to Inclide exact maasurement from anatomical landmarks. 6. direction of the penetration ~must be trdimentional 7. depth of the penetration 8. tissue and organs involved st‘Stab wounds may be: ‘ASuicidal 1. Located over vital parts of the boty. 2 Usually soltary '3. Located over covered pars of the body, the coining is rot nvolved 4. Stoo wound ie acosecible to the hand af the velim 5. Hane of victim is smeared with blood 6. Wounging weapon is firmly grasp by the hand of the victim. 7. If stabbing is accompanied with slashing movement S the wound taling abrasion ie eon towarde tho hand inflicting the injury 8. Suicds not may be present 9, Presence of a mative for self cestruction, 10. No disturbance in tha daath scane wi wounding instrument found reer the viet. B. Homicidal - stabbing with homicidal intent is the mest common Characteristics: Injuries other than stab wound may be present 2, Stab weund may be located in any part of the kody. 3. Usually more than one stab wound 4. Amotive for stabbing, Fone then the offender either insane/druge 5. Disturhancs in the erime acane ical evidence showing the intent of the offender to «ill the vict ‘tare arerrere than one stab wounds stab wounes located in clfferent parts 0! te body ‘tab wounce are deep serrated stab wounds means thrust and withdrawal of ne wounding ‘weapon to crease intemal damages Trregular or stellata shape skin defects due to charging direction of the ‘weapon with the portion ofthe instrumant atthe level of the skin as the lever4. PUNCTURED WOUND - is the result of thrust of e sharp ponted ingtrument. = Extotnal injury i quite emall but the depthie to a certain degree. iee-pick, nail - Natura ofthe external injury depends on the sharpness of the ond of the wounding Instument = contusion of the edges f and is net sharp pening may be> round, elliptical, dlariona shapad or cruciate. - External heorthage is limited athough intoral injuries may be severe.> blood voreele and blondy argane ie fatal ne intervention appliod = Sile ef external mound can be easily sealed by dried bld, serum, or cletled Lid. Punctured wourrds are usually accidental Cheracteriatics: 1. Tho cponing ofthe skinis vory errall, wound is much dooper than it is wice, 2, Extemal hemorshage ‘s limited then intemally may be severe 2. Sealing of external opaning ie favorable for the growth and muttipication of anaerobic organism ike baclLis tetan. Homicidal - 1. muiple and usually located in diferent parts of the body, 2. wound are deep 2, thore are defense wounds on the viet. 4. signs cf strugale in the crime scene. Suicidal « 1. located in aroae of the body where the vital eryane are located. 2. usualy singular, f multiple locatec in one area, 3. paris of body involved is access be by the hand of the vic. 4. doting usually no: involved. 5. wounding is made while the victin isin siting o° standing pasitian , bleeding Is towards the lower partof the ody 0: clothing, no disturoancs in the ctime acene wounding instrument found near the body. Puncturing wound with puncturing instrument loaded with poison: 1. poison dart - eyanida or nicotine 2. Tish spines 3. dog bites with hydrophobia virus 4. injaoton of air and poison as a way of euthanasia. 25.LACERATED WOUNDS ( TEAR, RUPTURE, STRETCH ‘PUTOK") ‘8a tear of tre skin and the underlying issues dus tc forcible contact with abluntinstrament. May be produced by a Fitwitha piace of wood, iron bar, fist, stone, but Ifthe force 1s aoplied toa tissue 1s greater than its echesive force anc tlasticity> the tissue tears and a laceration is produced. Charactoristie: 1. shape and size ofthe Inury does not correspond Wo te wounding instrument 2. tear on tha skin is rugged with extremities irregular, i-datred 3. injury devaloped where the blunt ‘cree is appted. 4. borders of the wound are contused and swel 5 ci develcped in aroae where the bane is eupoficially located. ike ecalp. ‘examivaton wih We aid of hand lens shows brigging ussue Joining the edges and haits bulbs are intact. 7. blopding is not extonsive due to blood vessels are not severed everly 6. healing process fs delayed and has a tendency to develop a scar. Classification of lacerated wounds: 1. Spitting caused by crusting of the sien between to hard objects xc laceration of scalp hit by a bunt irsirument, cut eyebrow of a boxer. 2. Overstrotching of the sich When pressure is applied on one side of the bone> the skin over the area will bo stretched up to a breaking point te cause laceration and exposure ofthe fractured bone, In avulsion: the edges of the remaining tissue is that of laceration, 2. Grinding compraesion ‘he weight and the gindirg movement may cause separation of he skin sith the underlying tissues. 4 Tearing = his may be produced by a semsharped edged instrament which causes irregular ecges on the wound lke hatchat and choppers Laceraled wounds are rarely suicidal INCISED WOUNDS: LAGERATED WOUNDS <4Edges are clean cut, gular, wall defined edges are roughly cut, regular il defined No contusion or ewelling around the enelling and contusion around the Incise wounds lacerated wounds Extromites of the wound are sharp, may be extremities are ilkdefiied and irregular Found, of contused Examination by means of ahand ans hair tubs are preserved ‘Shows that hair oulas are cut He ling ie factor healing ie dalayed Caused by sharp edged instrument caused by a blunt instument GAPING OF WOUND Separation ef the edges especially in deep wound may be dus to the folewing: 1.mechanical stretching or dilatation the prosence of a mechanical dovice on the edges te provent coaptation will causa separation Example: dram in an abscess, retractor curing operation, 2. lose of tissue due to: 2. Destruction due to pressure. inftion. cell ysis. burning, chemical reaction. . Avulsion er physical or mechanical at-etching resuling to separation of a potton of tha tissus. ¢ Trimming ofthe edges ~ debridamont cf the skin waich come in contact with the bullet at the entrance ard exit of GSW" and removal of necrotic atenals. 3. retraction of tne edges lundemeath the skin are danse networks of fibrous and elastic connective tiseue fibers running on the same direcion ana forming a patisin more or Jos pracent in all pareane This pattem of ber arrangement is called cleavage diiection oF Ines of leavage cfthe ain anc their naar representation on the skin s called Langer 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 tha body. storage of water ssDetetmination of how much shin i inyclved is important in the made of treatment and prognosis especially in burns, contusion, burs of 70% in eriidran and older ace group are fatal = rule of nine ie u Head end nock 0% =o fone upper extremity 18% fiont chest and abdomen 18% 13% posterior chesi and abdo 18% 13% no lowerexiremiy front 9% 18%. ‘one lower ext(vack) 3% © 18% pudendum 1% 1% Factors responsible for the severity of the wound: 1. Homerthage may influance the severity of wound by: 1. loss of blood incompatible with Ife blood constitutes 1/20 of the body weight of an adult t0 6 quarts o! blood (one quart is S45 ce) “oss of 1/10" of ts volume will cause nos ghificant change. = loss of one quart> fainting = 'bss of 1/3" 10 2/5" > reversible shock males can withstand more loss of blood than females “hypertension causes more excessive and rapid bleeding b. Hemanhage may resultin an increase in pressure in or on the vial ‘organs to affect the normal function infracranial hemorrhage cause corrpression ofthe vital centers of the brain homosericardium = pericardial tomp “hemo'rnage to the chest> diminution of tha raspiratory outout>anowa, ..Hemomtiage may cause mechanicel barriers to the function ef organs. into tracheobronchial lumina» aephyxia - Into muscles > olsturbance in the r contractiiy Causes ofhemorhoge: 2. trauma destruction ofits blood vassel wall b. natural causes = intracerebral hemorrage apoplexy > lenticuosiraite br. MCA Spontaneous eubarachnoid hemerihage > cacculer kerry anuryem rupture of artenoscieratic aneurysm, ssrupture of esophageal varices =pulmarary hemorhage dus fo PTA, lung abscess, bronchiec‘asis, “ruptured ectopic preanancy 2. Size of injury -burne greater than 1/2" of the body are fetal 8. Organs involved ~ usually fatal o heart, bein, lunge: 4, Shock ~ blow to gonitalia, sight burns fo young and oid 5. Foreign body er eubetance intreducad into the body - bacterial, veel, foraign body, chemica,, TOXIN. 1. emake bitee> 2 punctured wude at tho cantor of the reddaned affected area, The veriom 's injected through is fangs which is connected to the aoison gland, Sheke venom toxicity will depend on: 1. patency of vonom injoctad 2. amount of venem injacted by the fang wil depend on season of the year the length of me te snake hes eaten, =H Snake has just toxic content s smaller. 3. alee of the patient 4. mmediate teatment instituted, Shake venoms are two principal classes: 1. Nourotoxle — primarily paralysis the respiratory and cardiac centor efthe brain. ~ may cause N.Y. ascending paralysis, coma, convulsion, cip arrest 2 Hematoxic - affects partcuary the blooc manfectation are pain, eweling on tho affected area, homolysc, N.Y, pulmonary and cardiac ederna Emergency treatment may be 1 incision of the wound to promote more atteral hemorrhage to drain the tourniquetie above the sits of the wound placing Ice on the bite ste sucking the wound fo dran venom with the mouth adminietition of ant-enake venom serum. 92. Scorpion venom = vanom has toxic, hemolyic, hemorrhagic = one punctured wound o1 the center of a reddened area ~ pain. edema and reddening 5. Coelenterate sting (jellvish ) ~'tenlacles penetrate ini the skin and cause explosion of the newalocyst ‘and Iberaton of the verom, - extreme pain. Urticarial rash, dilated pupils, paloness. labored sreathing 5. Abeonce of madical of eurgical intervertion — wound may not be fetal but due to neglect or norance of iis management, may be Serious and fatal FATAL EFFECT OF WOUNDS: 1. Vlounds may ke directly fatal ay reacon of: ‘a. bemorthage ~ neck due 1b carat bleed. by Mechanical injuries on vila! organs © shock 2. Wounds may be indireclly fate by reason o!: ‘secondary hemorrhage fcllowing sopsis specific infection scarting effect secondary chock ATURE OF DEATH DUE TO SECONDARY CAUSES. 1. Changes whose natural sequence are direct & cbvous ~ sepsis. tetanus 2. Changes producing separate patholagisal lesions which in tur proves fo e fatal Ex: operaten to gate vase! but died of peritonitis despite diigorve/skill 3. Changes where a detinte pathological condition was prasant batore the Injury. Ex. Porson with tumor and stabbed . stab is nat capabie cf death but accused is tespor'sbie for his death 1. Changoe where a dofinie pathologizel condition oftetally diferant nature arises aiterthe wounding and the consequential Sequence is ccUDtUl Ex. TE meningitis % blow to the head COMPLICATIONS OF TRAUNA OR INJURY 1. Shack dus to injuryto nervous ayatem, anocemia, endcthelial damage 2. Herorthage 3. Infaction . from the insirument . from the organs involved in trauma ax. Bowels injured c. inlury may depress general vitality deliberate intro of micro-organism 4. Emiboliem seHEALING OF WOUNDS 1. Power of the human tissue to regenerate — replaced the destroyed tissue by newly formed similar tissue, Regeneretes rapidly : C.1. biood forming tissues.surtace eoith. skin Slow to regonrato.sm. Muscles, nourons of CNS, highly specialized Glandur iss. “Time of nealing is dependent on. a. vascularity D. age of perscn ¢. degree of rest or immobilization 4. nature of tre njury 2. Aberrated tealing process: 4. formation of exuberant granulation or proud flesh . keloid formation ©. stricture 4, fistula oF sinas formation MEDICO-LEGAL INVESTIGATION OF WOUNDS. Rule to follow by a physician: 1. all injuties must be described 2. dascritian of wound must be comprehensive, sketch/photagraah 3. examination must be infuenced be any ther information obtained from others in making a report or a conclusion. Outline of the medico-legal investigation of physical injuries: 41. Conoral investigation of tho eurroundinge! ‘examination of place where crime is commited Examination of clothing, stains, cuts hair fb. inthe crime scene Investigations on possible witnesses to the incident Examination of the waunding instrument Photography, sketching, accurate description of tie cime scene. 2. Examination of the wounded body a. examinatons appicapie to living or the dead ~ ege of the wound from the cegree of heatng = determination a the weapon sod 0~ reasons for the multiplicity of wounds + determination fthe wound is accidental, suicidal or homicidal 'bexaminaton applicable oniy to the living ~ datarminaton if injury ia fatal = determinaton it wry wil p°ccuce permanent deformniy © determination if wound produces shock - dotorminaton if wound producos complications examination appicable 10 a dead yisum only “ dptarmiration if wound ie pra-mortem of post morta determination whethar wound is merta oF not = ptermiration whathar death is accalarated by a disease prasent at time of injury, - dotarmination whethor wound cause by AS, H 3. Examinations of wound “ character of wound : abrasion, hemaiema, laceration ete location of wound: fem tome feo 2raa > to delemmine lajectory/course - dopth of wound : notin the ving, only if the cuter and inner aro fixed = conditions of the surrcundings of the wound - = rear GSW — burning, tatloong ‘suicidal cuts ~ superficial tentative cule or hesitation outs lacerated wounds — contusion on naignberng skin extent of the wound = extensive injuty ~ marked degree of force applied in te production af the wound. = herricidal cutthroats are deeper. extensive, numerous than ‘suicide = tection of the wound > impt. inthe positon of the victim to te offender ~ number of wounds — several> homicidal = conditions of locality dagrae of hemorhage ovidonce of struggle infermation as to the postion of the body presanice of sulcds note ‘orcition ofthe weapon ANTE-MORTEM WOUNDS —-POST-MORTEM WOUNDS: HEMORRHAGE More profuse, arterial Slight ornone, venous ‘due to ess of tone of vessels, ‘Abaonce of heart action Postmmoriam clotting otblood inside b.v Marks of spouting of blood ‘rom arteries Cloted boos SIGNS OF _ Inflammation & reparative INFLAMMATION process ‘Swaling in ne area, Effusion of ymah, pue Adnesion aftne eages Uniess if victim is weakened SIGNS OF Fibrin formation REPAIR growth of epitnetium Scab or seat formation RETRACTION Deep staining of the edgos OF THEEDGES end cellular issues OF THE WOUND. which is not removed by washing Edges gape owing fo the reaction ofthe okin and mussie fibers No spouting of bicod Bd not cloted.or sott clot Nore No time of repar Not dep stained can be removed by washing Edges do not gape, but are lossy approximated to Each other uniess ifthe ‘wounds 1 to 2 hve after death DETERMINATIONS IF WOUND IS: HOMICIDAL = SUICIDAL ACCIDENTAL, ABRASIONS Notcommon urless Rarely observed —Extensiva Wdragged abrasions: MVA OL F victin resistes CONTUSION Rate except when Found in any postion jumping froma height of the body - Fall INCISED WOUNDS Commanly observed Commonly obsawed Frequert out rarely “depth, location and surroundings ‘cause of death Points to consiver in the determinat’n as to whether the wounds is A. S. a1. axtarnal signs and circumstances relztad to the positonand atitude of tha ody when found. \ccation of the weapon or the manner in which it wes held the motive in the commission of the crime the personal character cf the deceasec the possibly forthe offender to have purpotely changed the tuith of the cenaiton. 6. other information slans of struggle umber and diraction of wounce recon of wound natura and extent of the wound state of clothing LENGTH OF TIME OF SURVIVAL OF THE VICTIM AFTER INFLICTION OF THE WOUND 1. agree of healing> signs of rapairof wound appaar in less than a day afer the nflicton oF injury. 2. changes in tha body in rotation to the time of death ssystomatic changes inthe body = wasting, anemia, bed sore 3. age of biaod stain ~ not reliable 44. teatimony af witness whon the wourd was infited, POSSIBLE INSTRUMENTS WHEN USED BY THE ASSAILANT IN INFLICTING THE INJURIES contusion — biunt incised wound - charp-edged inetumont lacerated wounds- biunt punctured wounds — sharp pointed abrasion ~ body surface Is rubbed on a hard surface GSW the diameter of tha wound of antrance may approximata the caliber of tie wounding instrument Could the injury have been inflicted by a special weapon? A physician cant determine that a specifc weapon was used in ificting 2 ‘wound. tis possible that tis caused by acertain instument presented He must be cautious in gving categoric statements Which of the injuries sustained by the victim caused death? with conspiracy —no need coz the act ot ane 18 the act of alMW rone- offender ere only responsible for thei individual acts 1H mulipe injures: which of the wound injure a vital ergen, (Or if same organ which caused fhe degree of damage. Which of the wounds was inflicted first? If mattiae for tho qualification cf the offense commited. Frst—troachory, murdor Last nomicide Cone der 11 lative position of the 2ssailant and the victim when the frstinjury was Inficted on the latter, ‘ralectory/course of the wound inside the body ofthe victim ‘ergane involved and the degree of nury testimory of wines presence 0! defense wounds — inficted frst sen Effect of medical and surgicalintervention on the death: Ii death followed after operetion> offerdo’ ia response be if death was inavitablo and thet oven with operation death «normal and diract consequence ‘of the injury, and the physician is competent and in spe cf exercise oF degree of difigence stil death is the outcome {teath ensued even the wounds are minor, and death due to thanagigence ‘or Incompetence of the physician then the offender cant be responsible. Effect of negligence of the injured person on the death fdoath occurred from complications arising from a ciple injury owing to the nagligancs of tne injured person ints proper care and treatmant the offenderis responsible for tho doth a person Is not bound io submit himsell to medical for the injuries received duting the assault = unless ff tis proven that ite negigence of the cin is delinerate so fferderis not rasponsibia but onl for physical injuries. Power of volitional acts of the victim after receiving a fatal injury: = dying declaraten, attempt to kil the offendar after the frst blow of Relative position of the victim and assailant when injury was in 1. location of the wound 2. direction of the wound 3. nature of instrument used in inflicting the injury 4. toatimony af the witnese aEXTRINSIC EVIDENCES OF THE WOUNDS 1. evidences from the wounding weapon position ofthe weapon - near orgrasp by victim =blood on weapon - may be stained with blood har anc other substance on weapon 2. evidences inthe clothing ef the victim soaked wh blood - hemomhage gunpowder distance =teare-sinuggle 3. evidences derived from the examination of the assailant Jarafin test, fears in clothing, blood stains, intoxication ets. 4. evidences derived from the crime scens mount ofhemorthage, woundirg instrument alc. PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY 4. HEAD AND NECK = nat he underestimated bleeding from ears, nose, mouth > basal fractures may have normal xrays yet with severe head injury Factors influencing the degree and extent of head niuries 1. nature of the woundng weapon> degree of violence appliod deponds on the thickness of the scalp andthe weight of the weapon, b._Intensiy ifthe force > intensity and heavy agent ©. point oFimpact “axtencive inf of vaults at eido or back 4, mobiity ofthe skal at the appl cation of fora IF head is mobile free> effecton the brain b due to the shearing movemant imparted fo the brain > may produce contusien, laceratian wthout fx \fheadis fixed and uneupported> jarring movement ofthe brain ie absent ‘facture Is exensive Head injurias ara classified as ta the site of the application of farce:41. Ditost or Coup injuries 2 Inciract injuring @. contr-coup injuries . rerrate injuries fell hitting buttock s> basal ©. loeue minarie resistencia - injury in areas wit lo 8. Coup-contre-coup injures ( dvect and indrect inunes) Wounds in the Sealp: 1. iLis Gicut ‘0 prevent the spread ofintecton 2. there ie prosimity of the ecelp to tha brein 43. thare are free vascular connection between the Structures insice and outside the drain 4. ts frequent dificult io cetermine the extent of derrage of the skull FRACTURES OF THE SKULL p. 302 GUNSHOT WOUNDS: Death or physical injuries brought about by powdered propelled substences: 1. Firearm shot = the InlUry 'S caused by the missile propetied by the expioson of the gunpowder located in the cartridge shell and the rear ofthe missile 2. dotonation of igh explosives - grenades = exploson inside the rrelallc cortainer will cause fragmentation of the container. |. FIREARM WOUND = Firearm °is an instrumant used for the propulsion of a prejectle by the expansive force of gasses coming from the burning of guripowder (echnical defniten) reudas niles, muskets, shotguns, revolvers, pistols, other deacly weapons which e builet, ball, shell orother missile may be discherged by means of unpowder or athar explosives, = includes air fle except of small calbers and limited rarge. = the barrel cf any frearm shell considered as a complete tearm tor al ‘spurposes thereof, Penal provisions of laws relative to firearm: 2, Sec 2602 RAC unlawful manufacture, decling in acauistion lszestion oF oossession of freerms or armunttons therefore or instument used oF intended to be used in the manufactura of firearns or ammurition, b. Sec 2680 RAC selling of reams to unlicersed purchaser. ©. Sec 2681 RAC- fallura of personal reprasentative of deceased licansee to surrender firearm, 4. Art 155 RPC- Alarms and Seandale Alt, 254 RPC - Discharge of fieaims CLASSIFICATION OF SMALL FIREARMS: Smal freamms~ r® those which propel projectile of less than + inch in diameter. 4.28 to wounding pewer: = [bw veloaty ‘irearm >muzzle velocity of not more than 1400 tt par sec. Ex. Revolver = high power frearm> muzzle velocty more than 1400ft. per second > usual ia 2200 to 2500 per ascond cr mere 2ias fo nature of the bore) = smooth bore weapon >inside portion ofthe barrel tatis perfectly smooth from the firing chamber to the muzzie, Ex. shotgun = tifled bore lirearm > the bore of the barrel witi a number of spiral lands and groovee which run garallal with one anatier bu: twisted eprally from breech to muzzie. Ex Miltary rf 3. as to manner cf fiting =pislol- fred witha single shot Ex. Revolver, Fle — may be fred from the shoulderEx. Shoigun 4. Asto the natura of the magazine ~ oylindricel revolving magazine the cattidge is lccated in a eylindical magazine which rotates al the raar perton of the barrel Ex. Revolver = vertical or horizontal magaz_ne ~ the cartridge is neld one after another vertically 07 honzontaly and also hald in place by a spring aide to side or ena to end Ex Automate pista‘Types of small firearms which are of mecdico-legal interest: 1. revolver — usual muzzle velocity is 600 feet per second olf loading firearm, muzzle vast 2. automatic ato! second ‘of 1200 feat per 3. ‘fle - muzzle velocity of 2500 feet por second and a range of 3000 feet. 4. shotgun - project is a collection of peliats Aweapon in order te cause injury must have two principal component pans: 4. the cartidge o ammunition - bullet phmer, cartridge casa, powder chargs 2. firearm instrument for the propulsion of a projectie force of gases fom a buming powder. ENTRANCE WOUND Appears to be strailer tan the missle Owing to the elasticity of the tissue Edges are inverted Usual oval or round dependirg upon the angle of approach of the bullat Contusten collar of contact ring i present due ta invaginaticn of the skin {and spnning of the missila Tatiosing or smudging may bo peecont whan ‘when fring ts near Unceriying tissues are nat protuding Always present a fire Paraffin lest may be positive EXT WOUND ‘Always tigger than the missile Edges ara averted Does nat manifest ary definite shape Aboont Abeent Underying tissues may be Prottuding from the wound May be absent, if missile is edged in the body Negative @INSTANCES WHEN THE SIZE OF THE WOUND OF ENTRANCE DO NOT APPROXIMATE THE CALIBER OF THE FIREARM. In Gstant fre, the rule is that the diameter of the GSW of entrance is almost the same as the caliber of the wounding firearm exceot: 1. Factors which make the wound of entrance bigger than the caliter: ‘a. incantact ornear fro . deformity of the Eullet which onterod ©. ullat might havo entered the skn sidawise acute angular approach of ne outlet 2. Factors which make the wound of entrance smaller than the ezlibar 2. fragmentation ofthe bullet kefors panstating the skin Bb. contraction of the elastic tissues of the skin Other svidences or findings used to determine entrance of GSW 1. examination of the clothing, f involved in tho course of the bulet 2. fabric shows punch in dasiniction b. paricle of gunpowder 2. examination of the intemal injures caused by the bullet ‘a. bone fragments, carilage, soft tissues are driven away from entrance wound . destruction of the bene is oval. with sharp edges. at the exit tis lregular, biggerand bevaled «.testimeny of witness Determination of the trajectory of the bullet inside the kody of the victim ‘1.external examination ‘a shape of wound of ontranco ‘hen bullets fred at right angle wih the skin> the wound of entrance fs cioular except in caze of near fir. ‘fired a} another angie itis oval when the oulat is deformed no such characteris ‘observed, findings wil be ba. shape anu uistibution of te contusion collar ‘contusion collar ia widest at the aids of the actte angle of approach of the bullet = ifthe bullet hits the skin perpendiculariy> collar wil have a unform width around the OSW except when bullet is deformed or ia azar fre. difference in evel between the entence and exit wounds 4. by probing the wound of entrance - net with teo much force osternal examination actual dissection and tracing the coursa of the wound at autopsy b. fracture of tenes and course in visceral organs ¢- Iccation of tne fragments and lead particle 4. xcray exam 3. other evidences to show trajectory 4. elaine diferance in the vertcal locaticn of entrance end exit inthe clothing b- relative postion and distance of the assailant from the victim in tha econstruction of re-enaciment of ne crime. ¢. testimony of wines EXIT WOUNDS OR OFFSHOOT WOUND. Does rot show characteristic shape unk the entrance wound dus io the absence of external support beyond the skin go the bullet tends to tear or shattor tha skin Shorec GSW of ext: if prossed on hard object [ke when vietim is Wing Wound of exis circular or nearly creuiar with abrasion ODD AND EVEN RULEIN GSW the numberof entrance and exit wound is even eo preaummption that no bullet is ledge in the body. = verified by x-ray How to determine the number of fires made by the offender: 1. determination of the number of spert shells 2. datorminalien of entrance wounds in the bedy of the vietim — number of entrance vicunds may not show the exact number of fire: a. notal fire made may hit the bed of the viethn . the bullet may in the course ofite fight hit a hard object shareby splitting it and each fragment m2y produce saparats wounds of centiance, © Bulla! may have periorated a pa'tof the body and then made ancther waund in some other parts of the bey 3. number of shats heard by the witness Instances when the number of GSW of entrance Isles than the number of GSW of exit in the body of the victim: “4. a bullet might have entered the body out spit inio several fragments, each of which made separate ext. 2. one of the bullets might have entered a natural orifice of the body. Ex. 2. thare might be two or more bullate which entered the kody through 3 ‘Sommon entrance and later making incl Vdual extt wounds 4. ‘nnear shotwith a shotgun, the pellots might Lave entered in a common ‘wound and ater d sporsed while inside the body ard making separate ‘wounds of nit Instances when the number of GSW of entrance Ie more than the number of G51 of exit in the body of the victim: |. when one or more of ine bullet Is not through and tough andthe bullet's Tedged in the body. 2uwhon all of tho bulleis produce through and through wounds but one or ‘rore mada an axitin the natural orfices of the body. 3. when different shots procuced different wounds of entrance but wo of mor shots produced a common exit wound, Instances when there is no GSW of exit but the bullet is not found i body of the victim: the 1. when the bullet is lodged in the GIT and expelled through the bowel or ledgad in fis pharynx and expelled through the mouth, 2. near fre with a blank catiage produced wound of entrance but no slug may be recovered, 3. tha bullet may antar the wound of entrance and upon hiting the bona the Course is ceflocted to have the wound of entrance as tho wound of ext Antemortem GSW - hemorthage. swelling, vtal reaction = microscopealy: congestion and leucocytc infiltration, Problems confronting Forensic Physician inthe identification of GSW: 1. alteration ofthe lesion cus to natural orocess:drying of wound, infr, healing pro. ‘medical ard surgical intarvantion: referto clinical record of pationt ‘embalming problems mierent to the injury itself ‘cray exer - migratory, external souvenirs 70The effects of the clothing on the movement of the builet depend on: 1. number of layers of fabrc between the muzzle end subjacent sin 2. natura of the fabric; clossly woven 3. muzzle- clofing aistance: Examination of the external wearing apperel of the victim of GSW may significant in Investigation because: 1. itmay establish the possible range of the fire: a.contact fire ear in ihe Ching covering the skin. Tuers turn outward away trom body = soa! deposil, gunpowder latlooing, buming of fibers around the turned fiber uzzie imprint dirt and greasy deposit may be wipe out and visible inthe tom clathing >not contact put near shet = same wih (a) except for absence of muzzle imprnt and beyend flame range far fie ‘there is a hole tear with inward direction of the thread 2. itmay be usefulin the determination as fo which is the Doint of ertry an of enitef the bulet. Entry: the fiver are inverted. 3. it may be useful in locating the bullat Specisl consideration on bullets 1. souvenir butet 2. ult migration 3. tandom bulot EVIDENCES SHOWING THAT THE GUNSHOT WOUNDS MAY RE SUICIDAL Shot fred in.a closed lacked room, crogen uninhatited placa deat open rear the place victim wes found Shot fired with the muzzle of the gun in contact withthe part of body valved ‘ocalion of entrance wound accessible part of body shot usualy solitary ‘rection of re is compatinie withthe trayectory of hulet 1? 8 3 10. 1 personal history may reveal social, economic, business or meritel problem ‘ahich cannot be sole gunpowcer presence in the hand ofthe victim entrance vreund usualy does not contain clothing Fingerprints of victim on the butt -Suleide nove at the vicinity 12ina disturbance in the place of death Russian roulete fortunate vicim has no predetermined desire oF selt- destruction EVIDENCES THAT GSW IS HOMICIDAL site of wound of entrance haz no point of election fie Is made when the victim Is al Some dsiance signs of stiuggle or defense wounds disturbance in the surroundings ‘wounding firearm usually not found in the scene cf the crime testimony af witness EVIDENCES TO SHOW THAT GSW IS ACCIDENTAL 1 2 3 4 tually one shot no special area of body Invowved consideraten on the testimony of the assailant and determination as to ‘whether it's possible by knowing the relative postion of the victim festimany af the witness POINTS TO BE CONSIDERED AND INCLUDED IN THE REPORT OF THE PHYSICIAN 1 2 3 4 8 uInplete desctiption of the wound cf entrance and exit ‘ccatian ofthe wound; pat of body invelved, dictonze of wound fom ‘midline, distance of wound from heel or buttock direction and length of the bullet track Digans er iesues involved in ite course: location of the missile, if ladgad in the body diagram. Photograph, sketch w drawng showingthe locallon nd pumber af wounds QUESTIONS THAT A PHYSICIAN IS EXPECTED TO ANSWER IN COURT; 1 2 2 4 COULD WOUND THE WOUND BE INFLICTED BY THE WEAPON PRESENTED 70 HIM? AT WHATRANGE WAS IT FIRED? WHAT WAS THE DIRECTION OF THE FIRE? IST SELF-INFLICTED?ARE THERE SIONS OF STRUGOLE? DID THE VICTIM DIE INSTANTANEOUSLY? |S IT POSS ELE FOR THE VICTIM TO FIRE OR RESIST THE ATTACK AFTE THE INJURY WAS SUSTAINED? 8. WHERE VIAS THE POSTION OF THE ASSAILANT AND THE VICTIM WHEN THE SHOT WAS FIRED? The caliber may be inferred from tho diameter of the wound of antrance. Determination of the length of survival of the victim: natura of the GSW Drgans invavea prasance or absence of infection amount ef bicod loss physical conciton ofthe pationt Capacity of a vietim to perform volitional acts — depends upon the area of the body involved, invalvement of vital rans anc the rasistance of tha vist DETERMINATION AS TO THE LENGTH OF TIME A FIREARM HAD BEEN FIRED 1. odor of the gas inside the barrel 2. sherical changes inside tho barrel 3 avidences that may be deduced trom the wounc DETERMINING WHETHER THE WOUNDING WEAPON IS AN AUTOMATIC. PISTOL OR A REVOLVER 1. location of tre empty shells ~revclver the empty shells are ‘cund in the cylincrical magazine chamber afer the fre 2. natura 9! the spent shell - automatic firearm = Eulet is copper jacketed 3. natura of tho base of the cartridge or spent shal = baso of ¢ tovolvor has a wider diameter than that of the cylindrical body to Keep the cartridge etay in the magazine chamber. It may be possible for a person who is accustomed to the sounds of fears of differant calibers to identify the frearm by the sound profucad It ie not possible to datermine tha direction of tha ahat by determining the ditecicn of the sound except when the flash er the person fring the shot is seen atthe time the shot was fred, GSW may not be a near fire or may not appear to be naar fire: 1. when a Gevice is setup to hold the firearm and io enable it to be discharged ata long range by the vic. 2. hen the GSW of entrance dase no! show charactersstice of a near shot Decause the clothing are inierposed between the vicim and the firearm n3. when the examining physician failed to distinguish between a near or far Shot wound) 4. when the productof a near shot has been washed out ofthe wound. Kray Faciitale the location and extraction of the wound eas fragmentation and ts location shows bore involvement like fractura reveal trajectory of the buet shows affect ofthe bullet wound, lice hemerrha: laceration SHOTGUN WOUNDS: Isa shoulder fred firearm having a barrel thatis smoot-bored and is intended {or the fring of a changed compound af ane 0° more balis & pelos, Moasure tho distance between the two farthest shotipollets) in inches and subtract one, the number obtained will give the muzzle-target distance in yards. Determination of the presence of gunpowder and primer components: Importance: 1. Determination of the distance of the gun muzzle frem the vietin’s body ‘whan fired, Usually net more than 24 inches when trod. 2. Determining whether a person has fred a firearm. ~ dorsum of the hand = motalisrocidues, burning and unburned gunpoadar = in sucide found in the palm Procaduras in datermining the prasence of gunpowder: 1. Gross exarninetion use of hand lens ~ Fire black poade! — not conclusive 2! Nieraseapic examination 5. Chemical test 4Tests for the Presence of Powder residues 1. On the skin — Dorsum o the hand or Wound of entiance Dermat nitrate test ( Paraffin test, Diphenyiamine test. Lung’s test Gonzales’ test) motted paraffin hoatod at 150 degrees fahenneit —Lung’s reagent mal particles wth nitrate or ritite > blus reaction ot oonclusive: feriizers, cosmetcs, clgaretes, urine = Nogative i not conclusive: therough waehing 2. Onelotnings Walker's test ( C-acid test, H-acld test) = glstey photographie paper fixed in hypocolution for 20 min to remove the siver sais and washied for 45 min, and dries. Tests for the presence of Primer Components ~ metalic primer residues ike barium, antimony, and lead {Harrison and Gilroy test ‘Cotton ena moistened with 0.1 melar HCl to gather the primer component, Reagent scdium rhodisonate yields red color with the primer components. \dd 1.5 HCI to the red area> blue-violet or pink in lead or baum lacks specificity, sensitivty 2, Noutron Astivation Analysis (NAA) ample obtained by paraffin or by washing with cilute acid Extromey sensitve, even with smal quantity 2. Flamolees Ator je Abeorption Spectroscopy FAAS) 4, Use of Scanning electron microscope with a Linked Xray analyzer‘THERMAL INJURIES OR DEATHS ‘ara thoze cauted by deviation from normal temperature, capable of producing ceallularcr tissue changes in the body. ~ Exposure to severe cold Frost tite = expacure ta high !emparature = burning scalding 1. DEATH OR INJURY FROM COLD “nat common inthe Philippines = Primary cause of death: Decrease dissosiaton of 02 fram Hab in the RBC Diminished pow! of the tissu to uillze O2 ~ Cold damp a's more fatal than cold dry a =Wemen are mors resistant to cold > greaterdeposits of SO fats Effesto of COLD: A. Local effect ( Frostbite, Immersion foot, Trench foot } ‘1 —Blanching , paleness of he skin due to vaseuerspasm. 2°~Erthyma, edema, swelling due to vascular dilatation, paralysis and inerecoad eopillaty parmeabilty 3*~ Blister formation 4° — Necros s, vascular occlusion, thrombosis and gangrene. Nicroscopieally: Vacuolization, degonsration of epidermal cells Necrosis of the college of the Sa tissue Occlusion ofthe veesale due fo clumping of REC Systemic effects: ~ Reflex in neture due to the stimulation and paralyas of the nerves =Pulmanary Cardiae acten is slowad down duo te earchral anowa> resulling t lethargy, Gelivum, conwuisions, come or death. 2. DEATH OR INJURY FROM HEAT — effect may be local or general Classifications of Heat Injury: 4a) Ganaral or Systamee affects: 1 Hoat cramps: a2 Heal exraustion 9.3 Hoat etrake bj Local effects: b.1 Scaling b2 Burn Eectical, lightning = Radiation GENERAL OR SYSTEMIC EFFECT: death usually accidental 1. Hoa crampe(Minars Camp, Firemans Camp, Stroker's camp) %6Involuntary speamod c painful contraction of muscles due to dehydration and accessiva loss of chlorides by sweating ~ Ti: Fluids with chlorides 2. Heat Exhaustion ( Heat collapse, Syncopal Fever, Hoat syncope, Heat prestration) Due to heart faite, cause:Hoat precipitated by exertcnwarm clothes '4dden eynsopo, faca turas pale, dim vision, Tx! removal from the heated area 2. Heat stroke (Sunstroke,Hest Hyperpyroxia, Comatous form Thotnis Fover) ‘Working in lisverdiiaied places with dry ternperature ar expos.ura to ha sun LOGAL EFFECTS OF HEAT 1. Seald: Caused by hat liquid “The Injury by scalding fs not severe as burns: ‘. Scalding fouid runs on the body surface — distributing the hea! b. Easily cools off ‘© Temperature not as high except : oils and moiten matas 2. Thormal burns: Caused by hoat or chom-cal substances ike fire, radiant heat, ‘Picton, sold substances, electnaty Classification of burns) DUPUYTREN'S CLASSIFCATION 4 Doge -erythoma ze” vesicle formation ae destruction of the cutice, part of true skin, painful a whole skin is destroyed. ulceration, net painful 5° —deap fascia, muscles e conarring cf he limbs BURNS SCALDS 1.CAUSE Dry heal fare, neatee sold Moist heat — yu steam ‘anlant heat 2. LOCATION ‘Atorabove the site ofcontact Ocaurs at or bsbw 3. SINGEING. cf hairs present Absent 4, BOUNDARY GF NORMAL Net clear Distnct 5. INJURY Severe Limited S.CLOTHINGS Involved Not burned Proofs that the victim was ALIVE BEFORE burned to DEATH: 1. Presence of carbon particles in the ar passage. 2. Increase caibox ySremoglabin bloud leve. 73. Deimal erytiema, edema end vesicle formation 4. Subendocardial eft ventricular hamorhage BURNS ANTE. MORTEM BURNS POST MORTEM BURNS A.BUSTERS Abunda! alouminfchloridas ‘Scarty albumir/chiorides 2.AREA OF Around the antemortom bun = Absant INFLAMMATION 3. BASE OF Red Not much change in color THE VESICLE 4-TRACHEO. —_Parliclae of goat or carton No finding BRONCHIAL LUMEN 5. BLOOD Abundance of carboxy-Hb Absent Difforential diagnosis of blistors: 1. Dus to putretacton —fluid content is blood stained watery uid + asso. mith puliefacive changes in other parts of body. 2.Duato disease -heat by tha size, disirbution 3.Dusto fnetion —_- Hx of aapication of heat 3. Chemical bums Characteristics of lasions: ‘Absence cf vesication ‘Staining of te skin or clothing by he chemical b 2. Presence af the chemical eubetance 1. Ulcerative patces of the skin t Inflammatory redness 0! the skin surface Delayed healing CHEMICAL BURNS. ‘THERMAL BURNS 1. BUSTERS Absent Present Z.SKIN/CLOTHINGS Stained by chemicals No staining ‘Shows chemical cause ot corrasion AnsentSUBSTANCE 4, LESION Borders are distinct Diffused Charactariatic lesione by different cher 4a, Suiphuric acid ( Oil of Vitro!) ost interes action, considerable destiuction icarations where acid fowed, clothings destroyed Jackish brown sloughs b. Nitric acid Clothing Is dastroyed, brown yellow or yeliouish brown slough c.Hydroclorie acid jot so destructive = intense rrtation, localized ulceration red or reddish-gray, 4. Caustic soda and Potash = Carrosive aston on the tissues with kleeched appearance 4. Electrical burne — Contact burns, spark bums, Flach burns. 5. Radiation bums ~ ay, UV light burns PHYSICAL INJURIES OR DEATH BY LIGHTINING AND ELECTRICITY Lightning — is an electrical charge from the aimoaphere. “4 millon ‘cits! 2000 amperes Elements of lightning that produces *Direct effect from the electiical charge. Surface flash bums from the discharge - electrical into heat enargy Mechanical effect — exoansion of air > laceration Compression effect - “sedgehammer blow’ Spasmodic contraction of cerebral vessels > shock Electricity - main causa of death is shock Above 300 vols are Ike the eftectorligntiing, Factors which infiuance the effect of electrical shock: Personal idiosyncracy — personal cerdition Disease — cardiac dis. Is prone [Antic pation of shock — Can withstand Sleep ~ Increases resisiance [Amperage cr intensily of the electical current — principal factor 70-80 in AC and 250 in DC. 5. Resistance of he body 7. Nalure of curtent— AC is more dangerous B. Earthing: shook is enhanced 9 1 Duration of sontact 0. Point of entry — left more dangerous than the right Mechanism of death in electrical shock: 4.Ventticular fib ~ leads to rupture of muscie fibers 2. Respiratory faiure due to bultar paralysis, 2° Necranical aaphyxia due to vielent and prolangad canvsion. Motallization: - epocific feature of electrical injury. he metal of fre conductcrs volatlizec and particles of the metal are driven, into the epidermis causing darkening of the skin Delayed effects of electrical injurioe: necrosis of ne area devalops into gangrene Damaged arterias bacomes brite, fisble and fable to rupture Narvous injurive - rovrograde armnesia, homiplogia, May enter ‘hehaad > cataract DEATH OR PHYSICAL INJURIES DUE TO CHANGE AF ATMOSPHERIC PRESSURE ( BAROTRAUMA) Inctease of atmospheric pressure (Hypetbarism) ‘Normal atmospheric pressure at sea levelis 760 millimeters of He. = Henry's Law =" At constant temperature, the amount of gas dissolved in 2 liquid is directly proportional te the pressure” so= As he goas deeper thera will ba an incraase in the amourt of cas dissolved inthe blood and other body fluids. = Hfascert is made rapidly, the diver will sufi: from the effecte of the sudden Felease of the cases from the body fluids. = feleased of air bubbles in the circulation anc act as embot in dtferoat parts of the body causing interstitial emphysema, pulmonary eratolism, in big joints caled bends. Decrease of atmospheric pressure (Decompression) 1. Hypobarism— athigh atitudes the atmaspherie pressure is loa and more gas wilbe liberated by the body fui. = roleace of gasces rozulle to: a) Bends — joint anc muscular pan b) Chckes — Substernal distress, non-productive coughing €) Substernal emphysema — 9) Trapped gas 2. Anoxia Hypoxia folt at 8000-18,000 fet evel ~ Alera greater than 34,000 feet be provided with 02 AIRCRAFT INJURIES AND FATALITIES. 1. Daring the fight {a Alliude: Hy pobariom ( Decompression) ' Speed ~ spetial disorientation ; sudden change of draction ata speed of 500 milas drains brain fram blood to the Iawat paris» unconsccusnene ©) Toxmns - CO, COZ saturates cabin resuttina to asphvcia 4d) Temperaiure - At 25,000 foot 40 dogrve below zero: ‘rast bite, froezing 9 Pra-existing disease — Coronary dis/Hen fatal due io sudden chenge env, 2. During crash fatalities occur us. dunn take-off anc landing Fx, Rupture ofthe heart dus to emprostion DEATH BY ASPHYXIA, ‘Asphyxia — Applied to all forms of violent death due to Interference with process ofrespration Conditians in which the supply af 02 to the blead or tiasues ar both has been reduced below normal ‘evel ‘Types of asphyatal death: 1. Anoxie doath Fellute of arterial bioad to be nomally saiurated with 2 cus to: 2) Braathing in an atmosphate with incufielont O2- High altitude stb) External obstruction ofthe ait passage traumatic crush asphyxia ©) Paralysis of the respiraincy center — poisoning, injury, anesthesia ‘6) Mechanica interference of the passage of air- drowning, asthma €) Shunting 91 blood 2. Anemic anoxic death Decrease capacity ofthe blood to carry 02 duo to Hge, CD poisoning Lew Hgb 3, Stagnant anoxic death Falure of c¥cualion due to Heart failure, shosk, arterial venous obstraston 4.Histotoxie anoxic death Fallure of the cellar oxidative process, cannot be ulllized in the tissues. Cyanide Phases of asphyxlal death: {.Dyspneic phase ~ Breathing i rapid and deep, PR ine. Rise of BP due to lack of O2 ané reiention of CO2 2. Convulsive pheae — Cyancsis more pronounced, pupis dilated, unconscious ~ Tardieu spots =poloctia /hgos in tho viecaral organs + due to stimulation of GNS by COZ 3. Apneie pha: = Breathing & shallow, gasping = Due to paralysis of respiratory center Sirangulatons: by ligature, manual st-angulation, eal forms -pelmar Suffocation: choking Asphysia by pressure on the chest 2 3 4. Asphyxia by crowning 8. Mephyaie by hroepirable gazcee A. ASPHYXIA BY HANGING Not necessary the whole body is suspended: Pressure at sido of neck Mechanism of death: Air passage is constrictad by pressure cf the rone 1s Compression of carotids, jugs, Sup. Laryry nerve Cereb. anoxia Causes of death in hanging: ‘Simple asphyxia by bocking the ait passage. Congestion of the veriaus blood vessels in the brain. Lack of arterial alood in tha brain ‘Syncope due ‘o pressure on the vagus and carotic sinus, Inury in the spinal column Combinafon of the above,Hanging ia ente-mortern: Vital reactior= principal erterion 41. Redness ot ecchymosis at the sits of ligature 2. Eechymoais of the pharynx and epigiotts. . Line of redness orrupture ofthe intima of the carotid artery 4. Subplewl hg B. ASPHYXIA BY STRANGULATION. Tightenod by force not the weight HANGING STRANGULATION WITH LIGATURE AHYOID BONE Frequent injured ——_—Frequanty spared DIRECTION Invertec ¥-shape Usually horizontal OF LIGATURE NARK S.LIGATURE —Atlovel of Hyoid bow Below larynx LOCATION 4. LIGATURE —Deopest opposiio the knot Uniform depth GROOVE 5. VERTEBRAL Frequently obsewved Not observed INJURY Manual atrangulation or throttling: form of aso1yxial daatn where the constricting forces the hand: ._ASPHYXIA BY SUFFOCATION = Occlusion of air from tne lungs by closure of air openings ‘or obstruction of the alr passageway from the external openings to the alr Smothering: ‘Avoem of aaphytial desth causa by closing the external respiratory orifices, Overiaying — mos common in chidren : pressure of pillows Gagging — application of materials to prevent airto have access to mouth and nostri. Plastc bag suffocation @Chol Form of suffocation by the impaction of FB. in tre respiralcry passage D. ASPHYXIA BY SUBMERSION OR DROWINING = Form of aspnyxa where the resiris and mouth has Submerged in watery fut. Time required fer doath in drowning: Submersion for 1 ¥ minutes ccnsidered fa‘al + Averege Line required for death n drawning Is 2 to 9 minues. Emargency treatment in Drowning 1. Sctasfer's mathod-Face down, prone pasition:operato’ exerts pressure In ribs 2. Syvester's method: Lying on his back, esiride over bagy, swinging arms Post-mortem finangs: 1. External findings. 12) Net clothes. pale face, FB. clinging on slen surface by) “Cutis ansetine’ of “goose flesh" skinis pale, contiacted NOT Dxtic {¢} WNashorworan's hands and foot ~ ckin of hands & foa':bleached NOT Dxtic {¢) Postmortem Ivity ~marked in the head, neck and chest ©) Presence of frmly-clenched hands with objects ~ Person was alive at frst 4} Payeical injures for struggle (9) Suleidal drowning — Pieces ot stone 2. Intornal findings A. RESPIRATORY SYSTEM 1 ‘Emphysema aquosum”— Lungs are cistended overlapping the heart = Due to imitation made by the inhaled water on the mucous membrane of theo air passage which stmulate the secretion of mucous. 2. “Edema aquosum"~ Due Entrance of water Into alr sacs, Lungs are doughy 3. *Champignon d’ecume” — whitish foam accumulates in the mouth/nestnis = Due: abundance of mucaus secretion = One ofthe incications thal death was due to drowning. “Trachec-broncral lumen — congested. flleg with froth Blocd stained fluid found inside chest cavty, Seotion lungs shows fluid wih bloody eth.B,_HEART 1. Bath sides of haart may be fllad or amptied with blood 2, Sat water drowning ~ Blood chicride contont is greater than left aide. Fresh water- Blood chloride is more | the rgnt side. FRESH RIGHT Gottier’s Test Quertitalive determination of the chloride contont of the blood in the right and loft vanticle ofthe hoar.: Differenco of at loast 25 mg. ©, STOMACH Prosenas food fh the stomach but absence cf water Death is rapid submersion made after death. Impossioie for water to get nto the stemach it body is submerged aftar deat FINDINGS CONCLUSIVE THAT THE PERSON DIED OF DROWNING 1 The presence of F.B. in the hands ofthe vicum. The clenching of tiehands is a manifestation of cadaveric spasra in tl offer of tho victim to save himsalt from drowning. 2. Ihorease in volume (emphysema aqucoum) ‘edoma of the Lungs | edema aquosum) 3 Presence cf waler in the stomach 4. Prosonce cffrofy, foam, F-B. inthe ait passage found in the medium \where the vistm was found 5 Presence cf water in the middle ear due to violent ingoiration when the mouth is fll of water, Floating of the kody in drowning: -Within 24 H duate the decomoosition which causes the accumulation of gas in tha body, the booy floats = Body is flexed besause of the dominance cf the flexor muscles “tote de nogel”— bronze color af head and nack; face az tha mast desendent portion of the body. >. = sttuggla, motive, articles found near the place, phys. injuries Suicidal D= note yeavy objec's. mentality, Hy of previous attempt Accdetial = Absence of violence in the body., exclusion ef sulcide, winesses E. COMPRESSION ASPHYXIA ( TRAUMATIC CRUSH ASPHYXIA) ~ Form of asphyxia where the Free exchange ef air in the lungs ia prevented by tha immabiity of tha chest and abdomen due ‘0 extamal pressure of crush injury Homicidal =offender kneels 01 the chest = Accdental = pinned between two big objecis Burking ~ Inventad by Burke and Hare= murcer for the sale fo medical schools~ Kneela ot sits on the chest and the Handa close the mouth and nostils Death by crucifixion: alternatva raising and lowering of the body leads to ‘exhaustion, unconsciousness ard death from asohyxie = (C mm are stretched F, ASPHYXIA BY BREATHING IIRESPIRABLE GASES 1..Carbon monoxide " silont killor”, colorless. insolubia in water and alcohol ~ formed by the incomplete combustion cf carbon fuel. Main action 1s 02 deprivaton, Qualitative tast for CO in the blood 2) Kunkel test — 4 volume of water + 3x ts volume of 1% tannic acid ~ erimson red If postive b) Potassium Ferrocyanide test— bright red ©) Spectroscope exam 0) Gas chromatograph ) intrased analysis 2. Carbon dioxide - C02, Carbonic acid gas “Blown out of the lungs durng respiration - Product of complete comtustion of carbon containing compounds Erd reault of frmentation & decomposition of organic mattors.- soptic tank The inhalation of pure CO2 may cause immediate vagal inhibition with sasm of thegattis and death. = manele, poorly ventlated rooms, Tests for the presence of CO2 1. Barium nitrate —whtte precipitate of Barium carbonate wih carbonic acid Ziaiver nirate —whke ppt. of silver carbonate when carboric acid ie added 3. Hydrogen sultide (2S, Sulphuretted hydrogen } = retten egg odor Formed during docemposifon process of arganie eubstancae containing sulphur = Causes titanic convusion, delrium, coma, death 4. Hydrogen eyanide — ona of the most tox, rapid acting gas = Fowied by the audiion of acid to polassurn or sodum salt of cyanide “Found in plarte; eaves of eharry laurel, aitar almond, kernals af common cherry, plum, peaches, ofcinary bamboo shoals, cavtain ail seed and beans = Contains AMY GDALIN whch in the presence of water and natura anyzme EMULSIN is readily decorposed to HYDROCYANIC ACID, glucose and benealdahyde. 10-80mg of Hydrogen cyanide is fatal death in 2 to 10 rin. 5.Sufur dioxide -Heavier than air, pungen odor ~ amplayed as disinfectant, Bleaching agent. 86found in eruation of volcano WAR GASES Classification based on the physiological ection = eauzes ititation with copious flow of teare a) Cnioracetphene (C.A.P.) b) Bromeberzy/ cyanide (B.B.C.) o High concentration — iitation of respiraiory passages, \ungs, VN Vesicant af Bstering Gas — contact wth skin cause blab or bister formation a) Mustard gas (Dichordiethy! sulfide, yellow cross, Yperte) b) Lewisite ( CHeravinyl-cichiorarsine) - Lung Iitants (Asphyxiant or choking gas) “Dysnea, lightness ofthe crest, coughhg, coma , death a) Chiorine ( Cl2)~ yellowish green gas b) Phosgene (COCI2) «¢) Chloropierir| 4) Diphosgone 4. Sternutator nasal iritants of vomiting gases 5. Paralysants —Novve gas - ike organophos phates 6. Blood poisons — CO. H2S. Hydrogen cyarice DEATH OR PHYSICAL INJURIES DUE TO AUTOMOTIVE CRASH OR ACCIDENT Factoro reaponcible to an Automotive Crach A. HUMAN FACTOR ( DRIVER) |. Mental attitude: reckless driving, fatigue, inexperience Percapive defect Delayed reaction ume Diseas Chemical factor | ENVIRONMENTAL FACTOR = Puur visibly, puotly maintained 1vads, rain, bind intersection 2. MECHANICAL FACTOR: Poor brake, wort out tire 4. SOCIAL FACTOR: Speed. insurance 5. PEDESTRIAN Injuries and Death on the Driver and Passengers: 1.First collision: thaimeact of the moving vehicle with another ar fixed object ‘The MOVING VEHICLE ~rap ily decelerates and stops after impact. = The degree ofddamage depends: a) spead_b) part af vohicle invehved 72. Second collision: Impact of unrestrained eccupants with the vehice inarior st ol., Occupants move same direction/velocity towerds point of pact 2) Front impact> Occupanis move forwerd.. ) Side impact (eavere) > moves to tha ede that wee involved in the 1*!Col >The passenger naarest io twill surfer the most. ©) Rear impact crash Acceleralion-deceleralion injury or whiplash (6) Roll over erash (Turn ture impact) = Ifvehiclo i not put into @ stop after the 1% Cal > the unrastrained ‘occupants will continue to stnke to seme pans of the vahicle merit. Pedesirian-Vehicle Collision Death of Phyeical Injuries to podectrian 1.Paimaty impact— Contact win venicie 2. Secondary impact ~ Subsequent impact of he pedestian tothe greund ‘Aecouris for the multiple injuries 3. Run over Injurias 4. Fiend eun Injuries se