LEGAL MEDICINE: GENERAL CONSIDERATION CRISBERT I. CUALTEROS, M.D. http:/Ierisbertcualteros.page.t! Legal Medicine —is @ branch of medicine which deals uith the application of ‘medical knowledge to the purposes of law and in the administration of justice, Legal medicine Application of medicine to legal cases. Forensic medicine — Application of medical science to elucidate legal problems. Medical jurisprudence — Knowledge of law in relation to the practics of modicine. ‘SCOPE: Application of modical and paramedical sciences as ‘demanded by law and administration of justice. NATURE OF THE STUDY OF LEGAL MED: = The ability to acquire facts, arrange them and draw a conclusion from facts in the administration of justice. Medical jurist, Medical examiner, Medicolegal officer, Medicolegal expert =A physician who specializes primarily with medico-lagal duties, = Imhotep ~29808.C. earliest medicotegal expert DIFFERENCE: ORDINARY PHYSICIAN _‘MEDICO-LEGAL OFFICER a) Injury/Discase point of view - Treatment cause b) Examine a Diagnose Testify ! justice patient ¢) Minor injuries Ignored Records all/ quality crimePRINCIPLE OF STARE DECISIS: = When the court has once laid an interpretation of law as applied to cortain facts, Itwill adhere to and apaly to all future cases where the facts are substantialy the same. BASIC PRINCIPLES GOVERNING APPLICATION AND EFFECTS OF LAWS: 1. “lanorantia logis nominom excusat *— prevent use as defense in violation 2, Law shall have no retro-active effect, 3. Rights may be waived, unless the waiver is contrary to law, public order, public policy, morals or good customs, or prejudiced o a third person wih a Fight recognized by law. 4. Customs which are contrary to law, public order or public policy shall net be ountenanced, 5, Laws are repealed by subsequent ones, and their violation or non-observance shal not be excused by dis-use, custom or practice to the contrary. Persons authorized to perform autopsies: 1, Health Officers 2. Medical officer of law enforcement agencies. 3. Members of the medical staff of accredited hospital, Autopsies shall be performed in the following cases. Required by special laws Order of competent court, mayor, fiscal Writen raquast of palica officers SolGen, fiscal disinter to determine cause of death ‘Whiten request of nearest kin to ascertain cause of death. MEDICAL EVIDENCE ~ is the means sanctioned by the rules of court of ascertaining in a judicial proceeding the truth respecting a matter of act Types of evidenca: 4. Autoptic of Real evidence - made known to the sensos 2. Testimonial evidences oral under oath 3. Experimental evidence 4, Documentary evidence Methods of preserving evidence:1. Photo, videotase,photocopy —4.Manikin mathod 2. Sketching in the mind of the witness 3.Doserption 6. Spocial methods: embalming DECEPTION AND DETECTION Knowledge of truth is important in the administration of justice, les solely in the abilty to evaluate the statement given by the suspect or witness, Methods of deception detection: 4, Devices which record the psycho-phys ological response: 2a) Use of a polygraph or ils datector machine b) Word association test ¢) Paychdlogical stress evaluator 2. Use of drugs that try to" inhibit the inhibitor” a) Administration of the truth serum b) Narcoanalysis or Nareosynthesis, ¢} Intoxication 3. Hypnotism 4, By observation 5. Scientific interrogation 6, Confession |. RECORDING OF PSYCHO-PHYSIOLOGICAL RESPONSE Nervous control-CNSIANS — SyrvParaS. ‘Sympathetic - influenced by physical and emotional stimuli, effects Parasymoathetic - works to restore things ‘A, Use of a Lie Detector or Polyaraah = The fear of the subject when not telling the truth activates the symp. = To series of automatic and involuntary physiological changes which are recorded by the instrumant = Use of contal questions > Most reliable & effective questioning technique. = Supplemetary test:‘a. Poak of tonsion test - peak of tonsion on relevant questions b. Gull complex tost - does not response to added rolovant quest ©. Silent answer test - subject verbal response creatos distortion in the tracing ar clearing of the throat. Reason for admissibility to the court of the result of Polygraph exam 1, Have nol recaived the degree of standardization of acceplance 2. Trier of fact is apt to give almost conclusive weight to tie experts opinion 3. No way to assure the a qualid examiner administered the test 4. May waive right against soit-incrimination, 8. Ithas many errors, Factors responsible to 25% errors Nervousness experienced by a subject who is telling the truth + apprehension by the fact that he isa suspect over-ansiaty to Cooperate 2, Physiological abnormaltios > BP inc. or dec., Cardiac prob. 3, Mental asnormaliios 4, Unreponsiveness in a guilty subject ~ no fear of detection 5. Attempt to beat the machine Can a person be compelled” No, use of intelligence and other faculties. B. Word association test Time interval between the words uttered by the examiner and the answer of the subject is recorded C. Psychologica Stress Evaluator = when a person is under stress/lying, the microtremor in the voice ullerance is moderately or completely suppressed. = degree of suppression varies inversely to degree of psychological stress U, USE OF DRUGS THAT INHIBIT THE INHIBITOR ~ Not admissible in court ‘A. Administration of truth serum ~ Hyacine hydrobromide given hypodermically until state of delirium which the subject feels a compulsion to answer the question trufully. B. Narcoanalysis of Narcosynthosis ~ Sodium amytal or sodium penthotal . Intoxication with alcohol - In wine there is truth u,HYPNosiSwv. vi - alteration of consciousness, not all subjects can be hypnotized OBSERVATION Physiological and psychological signs and symptoms of gui: 3) Sweating, color change 1b) Dryness of the mouth c) Excessive axtvly of adams apple 4d) Fidgetting @) Peculiar feeling inside f) Swearing, spotless past record 4g) Inability to look at the investigator INTERROGATION = emotional appeal, mult and jeff technique CONFESSION exaressed acknowledgement of his gui. TOKYO DECLARATION ~ contains guidelines to be observed by physician concerning torture, inhuman and degrading punishment.MEDICO-LEGAL ASPECTS OF IDENTIFICATION = determination of the individually of a person Importance of identifying a person: 4. In the prosecution of a rime, the identity of the offender and victim. 2, Settlement of estates, retirement, insurance 3. Resolves anxety of nest of kin. 4 In some transactions ~ sales, release of dead body Rules in personal Identification: 4. Law of mulipicy of evidence in identification - greater number of similarities 2. Valus of different points of identification — fingororints . molos ‘Visual recognition of relatives -lesser value than fingerprints/dental 3.The longer interval betweon death the more exaerts aro neadd in establishing the identity, 4.The team to act in shortest time because itis perishable. 5. No rigid rule in the procedure of identification of the person. Methods of identification: 1. By comparison ~ Id found in the crime scone compared with the fi. 2. By exclusion IDENTIFICATION OF PERSONS ‘A. Ordinary methods of Identification 1. Charactoristics which may easily be changed: 8) growth of hair, beard 4) grade of profession b) clothing 2) body omamentations ) frequent place of visit 2. Charactetistics that may no! be easily be changed: a)mental memory ‘hands and feat ) speech 2) complexion ©) gait h) changas in the eyes 44) mannerism i) facies 2) handedness-eftiright i) degree of nutrtion Points of identification applicable to both living and dead before onset of Decomposition:(Occupational marks ~ painters have stains Race: Malay:brown, flat nose round face, Round head, Wearing agparel Stature: Tips of middie fingers of both hands extended laterally Tatoo marks Weight — not good point — changes from me to time Deformities, » injures leaving permanent deformities, Birth marks’ moles, sear ‘Age of Scar: Recently formed: Sighty elevated. reddish/bluish, tender to touch Few week-2 months: Infammatory redness. soft, sensitive 2—6 months: brownish, free from contraction, soft > B months: white, glistening, conlractad, tough ‘Scar formation is delayed by: sepsis, age, depth of wound, mobility May not develop — mall, superficial, healed ty first intention 8. Tribal marks, Sexual organs, biood exam ANTHROPOMETRY ( BERTILLON SYSTEM) Alphonse Bertillon = ullizes anthropometiical measurement of the human body fot identification Basis 1. Human skeleton is unchangeable after 20 years. 2. No two human beings have exactly the same bones. 3. Use of simple instrument Information: 1. Descriptive data ~ color of hai, eyes, shape of nase. 2. Body marks 3. Anthropomettic measurement — height 4. Measurement of the head. limbs Partai Parle (spoken picture) ~ picturesque description of a person Extrinsic factors in identification: 4. omamentalion personal belongings ‘wearing apparel {orsign bodies 2 3 4 5. identification by close tends, police records, photographs ight as a factor in identification: 4. Cleaves! moonlight = Less than 16-17 yards Starlight = Less than10-19 yards 2, Broad daylight = Not farther than 100 yards not sean before ‘Almost strangers =recognizad at 25 yards3, Flash of fream Inches letters can be road with tho aid of the flash of 22 callbor ata distanca of 2 fect. 4. Flash of lightning ~ sufficient light to identity 6. Artificial ight ~ relative tothe intensity of ight B. Scientific methods of identification Fingerprinting Dental identification handwriting Identification of skeleton Determination of Sex. Age Identification of blood, biood stains Identification of hai, fbers 4, FINGERPRINTING = most valuable mathod of identifcation. 2) No two identical fngorprints 1 : 64,000, 000, 000 b) Not changeabie- 4" month formed in the fetus = Practical uses ‘) Identity of dead bodies b) Prints recovered al crime scene ) Prints on flle for comparison 4) Right Uiumb prints substitute for signature = DACTYLOGRAPHY : art and study of recording fingerprints as means of id = DACTYLOSCOPY: art of id by comparison of fingerprints = POROSCOPY : study of pores found on the papillary friction ridges of skin Fingorprints can't be effaced: 6 long as the dermis of the bulbs of the finger is not completely destroyed. 2, DENTAL IDENTIFICATION possibilty of 2 persons to have the same is remote enamelis the hardest substance of he body, ‘outast other tssuas in putrifaction 3, HANDWRITING. BIBLIOTIC =: Science ofhandwriting analysis GRAPHOLOGY : study of handwriting for the purpose of determining the writers personality, character and aptitude.4, IDENTIFICATION OF THE SKELETON human — shape, size, general nature single individual ~ plurality or excoss of bones Height — add 1 to 4 ¥ in. forthe soft tissues Pearson's formula — for the reconstruction ofthe living stature of long bones Topinard and Rollet two French anatomist devised a formula for the determination of the height fro males and females. Humphrey's table = Table of different height of bones for different ages and their ‘corresponding stalures = made the following co-efficient for the determination of height. Dotermination of sox of the skeloton: a) Pelvis, 4) Femur ) Skull e) Humerus 9) Stermum Difference between Male PELVIS Female 1) Construction Heavier Lighter Wal More pronounced Loss pronounced 2) Height Greater Lesser 3) Pubic arch Narrow & less round Widerfrounder 4) Diameter of the tue pelvis Less Greater 5) Curve ofiiac crost_ Reaches higher level Lower level 6) Greater Sciatic notch Narrow Wide 1) Body of pubis Narrow Wider 8) llopectineal Ine Sharp Rounded 9) Obturator foramen Egg-shaped triangular 40) Sacrum Short and narrow Long and wide CRANIUM MALE FEMALE 4) Shatt less curve more cuve 2) Mastoid process larger smaller 3) cranium placed henzontally mastoid process occipital& maxillary bones reston 4) Styloid process shorter longerislender 5).Forehoad higher, more oblique —_—_less high, more vetical6) Suporcitary ride less sharp, more rounded sharper 7) Zygomatic arches ‘more prominent loss prominent 8) Lower jaw larger & wider narrower and lighter 8) Face larger in proportion to eranium smaller Determination of the duration of interment = All sof tissues in a grave disappear within one year. Basis of the ostimate tro duration of interment: 1) Presence or absence of soft tissue adherent to the bones. 2) Firmness and weight, britleness, dryness of the bones. 3) Degree of erasion of the surface of the bones. 4) Changes in the clothings, coffin, and painting 5, IDENTIFICATION OF SEX Test to determine the sox: 1. Social test 2. Genital test 3. Gonadal test 4. Chromosomal test - barr cells in females Evidences of sex 1. Presumptive evidence ;eneral features, hair in some parts Tansvestism ~ sexual deviation by desire to assume the attire and be accepted as a member of he opposite sex 2, Highly provabale agina, large breast 3, Conelusive evidence ‘ovary in females 6, DETERMINATION OF AGE Legal importance a) Ald to identification b) Determination of criminal tabilty ©) Determination of right of suffrage 4d) Determination whether a person can exercise civil rights fe) Determination of the capacity to marriage 1) Requisite to certain crimes toDetermination of age of fotus: Hess's rule or Haase's rule a) Fetus ofless than 25 cm ong. get square root of lonath in em, result in months b) > 25 om- divide the length of the fetus by 6 and the result is the age in month 7. IDENTIFICATION OF BLOOD AND BLOOD STAINS Legal importane 'a) Disputed parentage b) Circumstantial evidence against perpetrator of a crime ¢) Determination of the cause of death 4d) Determination ofthe direction of the escape fe) Determination of the appropriate lime crime was commilled ) Determination of the place of the crime {9) Determination of the presence of certain diseases, Physical examination ‘) Solubility test b) Heat test ‘o) Luminescence test: 3 amino-phtalic-acid-hydrazide-HCL, Sodium peroxide . distiled water > Bluish-white in a dark room Chemical examination: a) Salina extract of the blood plus ammonia ~ brownish > alkaline hematin ) Benzidine test — blue color in white fiter paper c), Guaiacum test ( Van Deen's Dyas or Schombein’s test) - blue 4) Phenolothalein test ( Kastie-Meyer test) - pink ) Leucomalachite Green lest Microscopic examination = saline extract of slain Micro-chamical tess: 1, Hemochromogen crystal or Takayama test 2. Teichmann’s blood crystals or Hemin crystal test- ‘Sodium chloride — dark brown rhombic prisms of chloride, hematin formed est of the micro-chemical test. 3. Acetone-haemin or Wagenhaar test‘Spoctrospcopie examination = blood pigments have tho power to absorb light of certain length and produce the characteristic absorption bands on the spactum. Fresh blood — axyngb, Hab, reduced hematin ‘olders stains ~ methemoglobin, alkaline hematin Biologic examinations 1. Preciptin test —blood is human or nat 2. Blood grouping ‘Age of blood stains: Hob converted to Methgb of hematin red to red-brown = waim weather- within 24 hours 8, IDENTIFICATION OF HAIR AND FIBERS Differences between hair forcioly extracted and naturally shed hair: ~ bulb is irregular , undulating surface, excrescence of dif, size and shage HAIR, HUMAN ANIMAL Medulla 4. Alr natwork In fine gains large or small sacks 2. Cells Invisible wrout in #20. Easily vislolo 3 Fuzz wiout medulla Fuzz w/ medulla Cortex 1 Looks like a thick muff Fairy thin hollow cylinder zt Pigments in the form of fine grains irregular grains Cuticle 1 thin scales thick scale MEDICO-LEGAL ASPECTS OF DEATH Importance of Death determination: 4, The civil parsonality of a natural petsen is extinguished by death, 2.The property of a person is transmitted to his heirs at the time of doath. 3, The death of a partner is one of the causes of dissolution of partnership agreement. 4, The death of either the principal or agent is a mode of extinguishment of agency 5, The criminal labiliy is extinguish by death. 6. The clull case fro claims which does not survive is dismissed upon death of the Rdefendant Death ~ is the termination of life Kinds of death: 1. Somatic or clinical death — persistence of vital functions 2. Molecular or celular doath ~ 3 to six hours after cassation of Ife 3. Apparent death or State of suspended animation — ‘transient loss of consciousness in hysteria, uremia, electric shock Jans of death 4. Cessation of heart action and clreulation., Usually the auricle contract after ‘somatic daath fro a longer period than the vontrica, ast to stop so called ULTIMEN MARIENS. Methods of detecting the cessaton of heart action and circulation: ‘a) Examination of the heart- pulse, aucultation, tlouro, ECG b) Examination of peripheral circulation = Magnus test ~ application of ligature around the base of the finger ‘bloodless area at sito of application doad man ~ no change = Opening of small artery- spurting = Ieards tes! — injection of flourescein SQ greenish yellow discoloration in the whole skin = dead man only inthe area of injaction Prossure on fingernails, = Diaphanous test ~ fingers are spread wide through a strong light Red Application of heat on the skin - bister Pabpation of Radial pulse Dropping of meited wax jon = more than 3% minutes Methods of dotocting coseation of respiration: ‘a) Observance of movernent of chest and abdomen. b) With the aid of stet ¢) Examination with a mirror 4d) Examination with a feather or cotton fbers 2) Examination with a glass of water 1) Winslow's test - no movernent in the image formed by reflecting artificial light on the water in a saucer and placed in the chast Ifrespiration Is taking place. 3, Cooling of the body —_( ALGOR MORTIS) = Aller death the metabolic process inside the body ceases,The progressive fall ofthe body tomp. Is one of the most prominent signs. - First two hous after death tho cooling is rapid, - Fall of tamp. of 15 to 20 dearees Fahrenheit is considered as a certain sign of death. POST-MORTEM CALORICITY - is the rise of ternp. of the body after death due to rapid and early putrefactive changes. Usually in the frst 2 hours. = seen in cholera, liver abscess, tetanus, RF Strynine poisoning, Perktonitis A. Conditions connected with tho body: Factors delaying the rate of ecoling of the body: Acute pytexial disease Sudden death in good health Obesity of person Daath from asphyxia Death of the micdlo ago Factors accelerating cooling: 1. Leaness of the body 2. Extreme age 3. Long-standing illness 4. Chronic pyrexial disease with wasting B. Conditions that a connected with the surroundings Factors delaying cooling: 1. Clathings 2. Want of access ofairto the body 3. Small mom 4. Warm surroundings Factors accelerating cooling 1. Unclothed body 2. Conditions allowing the access of ait 3. Large room permiting the dissipation of heat 4. Cooling more rapid in water than in a Methods of estimating how long a person has been dead from the cooling of the bod 1. If body tomp. is normal atthe time of death: = the average rate of fall of the temp. during the frst 2% hours is ¥ of the difference of the body temperature and that of the air. = the body attains the temp. of the surrounding air from 12 to 15 hours after death in tropical countries2. Chemical Mothod { Schourup’s formula for the detarmination of the time of oath of any cadaver whose CSF is examined for the concentrations of LA., NPN AA LA> 1 mg to 200 mg/100ce rapid in 1st § hours. NPN inc. from 78 to 40 ma/t00 cc in 1* 1 hours AA in. from 1 mg to 12 mg% 1° 15 hours. 4, INSENSIBILITY OF THE BODY AND LOSS OF POWER TO MOVE = may be s2en in the living with- apoplexy, epllopsy , trance, catalopey, hysteria 5. CHANGES IN THE SKIN — opacity, fattening, loss of elasticity 6. CHANGES IN AND ABOUT THE EYE a) Loss of comeal reflex — seen In lve pls: G.A., uremia, narcotic poisoning ') Clouding of cornea ©) Flaccidity of tho eyeball 4) Pupilin the position of rost. ¢) TACHE NOIR DE LA SCLEROTIQUE - spot found in the sclera atter death. 7. AGTION OF HEAT ON THE SKIN {eal applied while alive — produced blister with serum and redness around the area ‘ollowing combinations of signs show death has occurred: a) Loss of animal heat to a point not comeatibie with life b) Absence of response of muscle stimulus ©) Onset of rigor mortis, CHANGES IN THE BODY FOLLOWING DEATH 1. CHANGES IN THE MUSCLE ~ completo relaxation of the whole muscular aystom. Three Stages After Death: ‘) Stage of primary flaccidity ( POST-MORTEM IRRITABILITY) muscle relax, may contract, dilated pupi, sphincters are relaxed presence of molecular life warm place: 1 hour and 51 minules ‘chemical reaction of muscle is alkaline b) Stage of post-mortem rigidity ( CADAVERIC RIGIDITY , DEATH STRUGGLE OF MUSCLES OR RIGOR MORTIS) whale body is gid due to contraction of the muscles starts at muscle of neck, lower jaw Reaction is acidic due to ine. of lactic acid develops 3 {0 6 hours after death in temperate, earlier in warm last from 2 to 3 days in temperate, warm: 24-48H cold weather18-36H summer ©) Stage of Socondary flaceidity or Commencement of putrefaction (DECAY OF MUSCLES) muscle are flaccid, not respond to stimuli, reaction is alkaline due to dissolution of muscle proteins FACTORS INFLUENCING THE TIME OF ONSET OF RIGOR MORTIS. (1) Intornat Factors 2) State of the muscles eathy ~ appears late = Onset is hastened in ‘at hunted anima ‘22 prolonged convulsionilingering lines 2.3 death from. TY, Cholera, Phihisis, yohus >) Ago = early onset - aged and newborn ‘delayed ~ good health, good muscular development ©) Integnty of nerves = section of the nerve will delay onset, paralyzed muscle (2) Extemal factors a) Temperature = Hastened by high temperature > 75 degrees will produce heat stiffening ) Moisture apidly but with short duration in moist air Conditions simulating RIGOR MORTIS: 1, Heat stiffening - > 75 degrees coagulates: muscle proteins resulting to rigidity * Puglstic attitude" flexed upper and lower limb hands clenched, flexor stronger than extensors, bumed o death 2. Cold stiffening = dus to solidification of fats whan exposed to cold temp, 8, Cadaveric spasm or Instantaneous Rigor = instantaneous rigidity due to extreme nervous tension, exhaustion, injury to the nervous system. = weapon in hand, weedsRIGOR MORTIS CADAVERIC SPASM. 4. Tims of appearance 3.6H after death Immediately aftar death 2\Musclesinvolved All musclos Cortain group 3. Occurrence Natural phenomena May or may not appear 4, Medico-legal signif. Approxitates time of death Determine nature of death RIGOR MORTIS MUSCLE CONTRACTION 4, Contracted muscle Losses transparency More or less transparent 2. Elasticity Loss elastity Very elastic 3. Litmus reaction Acidic Neutral ors alkaline 4. Contraction ‘Absolute faccidity Possess inherent contraction 2. CHANGES IN THE BLOOD. ') Coagulation of blood jood may remains fluid inside the blood vessels 6-BH after death, ANTE-MORTEM CLOT — POST-MORTEM CLOT 4. Consistency Firm Soft 21 Surface of Blood vessels Raw after clots are removed Smooth, health after 3. Ghats Homogenous Gan te stripped ‘cantbe striped off in layers ) Post-mortem Lividity ar Cadaveric Lividity , or Postmortem Suggilation ‘or Post-martem Hypostasis or Livar Mortis toppage of heart action and loss of fone af bv. accumulates in dependant areas except in bony areas. apillaies coalesce > purplish in color called Post-mortem lividity aston by death duo to cholera, uremia, Typhus fevar ppears 3 ~6 H after death and fully developed 12 H after death. Physical characteristics of Post-mortem Cadaveric Lividity Occurs in the most dependent areas. Involves the superficial layer of the skin Does no! appear elevated from the rest of the skin. Color is uniform. NNo injury of tho skin Kinds of Post-mortem Cadaveric Lividity 1. Hypostatic ivdity 2. Diffusion lvidity Importance of Cadaverie lividity: 1. One of the signs of death2. Determines the position of the body has been changed after i's appearance in the body. 3. Coior of lividty may indicate the cause of oath a) asphyxia —Iividity is dark b) CO poisoning ~ pink 1c) Hemonthage ~ less marked 4d) Hydrocyanic acid - bright red 'e) Phosphorus — dark brown 1). Potassium chlorate — catfes brown 4. Datermines how long the person has been dead 5. Gives us an idea as to the time of death Points to be considered which may infer the position of the body at the ime of death: 1. Posture of the body when found. 2. Postmortem hyposiasis or liviity 3. Cadaveric spasm CONTUSSION (BRUISE) _POST-MORTEM HYPOSTASIS. 41. Small bruises ~ Below epidermis in true skin In the epidermis or cutis larger ones. - below this 2.Culicle -Abraded by the same violence Unabraded that produce the bruise. 3. Bruise Appearaat the seat or surrounding Always dependent may of may not be dependent 4 Elevated, inflammatory condtion Not elevated, blood inb.v. CONTUSSION (BRUISE) POSTMORTEM HYPOSTASIS. 5. Incision shows blood outside the bv. Blood inside the vassels = most cortain test of differance 6 Color variegated Uniform color Internal hypostasis In Visceral organs: 1. Lungs2. Loops of intastine 3. Brain POST-MORTEM LIVIDITY OF ORGANS —_SIMPLE CONGESTION 4, Postmartem slaining in organs regular, most dependent parts Uniform, all organs 2, Mucous membrane Dulljusteriess Not in congestion 3. Inflammatory exudate Not seen Not seen Other changes inthe blood 4 Hydragen ion concentration acid pH CO2, LA, After 24H alkaline ammonia 2. Breakdown of iver glycagen leads fo accumuation of dextrose in the IVC and the right side of te heart 3, Riso in NPN and Free A.A, 4, Comical chloride in the plasma/RBC decrease due to extravascular ditfusion, n 72 Honly ¥ ofits content. Mg — inczeases due to diffusion from without K = increases due to difusion from the vascular endothelium, 3, AUTOLYTIC OR AUTODIGESTIVE CHANGES AFTER DEATH ‘Afiar death, proteolytic, alycalytic and lipolytic ferments of the glandular tissues continue to act whch lead to the autodigestion of organs, 4, PUTREFACTION OF THEBODY “Is the breaking down of complex proteins into simpler components associated ‘with the evolution of foul smalling gas ses and accompanied by the change of color of the body. Tissue changes in putrefaction: 4. Changes in the color of the tissue Hemolysis of blood within blood vessels > Hgb diffuses through the walls Reddish-brown in color Inthe tissues > Hab undorgo chemical change Greenish-yalow 1* seen atR liac fossa MARBOLIZATION - prominence of the supertical veins with reddish discoloration which develops on both flanks of the ‘abdomen, nack, and shoulder look lke “marbled” raticule of branching veins.2, Evolution of gasses in the tissuos (C02, ammonia, H2. Suphurated hydrogen, methane.= offensive odor Effects of pressure of gasses of putrefaction: 'a) displacement of the blood — bleeding in open wounds b) bloating of the body ‘) fluid coming out from nostrils, mouth 4) extrusion of the fetus ina gravid uterus ) floating of the body 3. Liquefaction of the sof tissues Pultely rapidly: Eyeball, ining of trachea, larynx. brain, stomach, intestine, ver, spleen Putrofy late: Highly muscular organs and tissues, Esophagus, laphragm, heart, lungs, kidneys, U.B., utonus, P.G. ing the RATE of putrefaction. {INTERNAL FACTORS a) age healthy adults, NB net yet fed, later than infants b) condition of body : full gown/obose rapid , Stiiborn- late ©) cause of death infection - rapid 2. EXTERNAL FACTORS a) Free air a1 air: fee ar hastans decomposition 22 moderate masture - acealerates 23 loaded with septic bacteria - early acrobes, later aragroblc ~ Clostridium welehii= decomposition b) Earth bt dry absorbent soll - retards 5.2 maist fertile sal- accelerates ) Running water- mare rapid than sill water 4d) Clathings — early it hastens but delays in the later stage. = tight clothings - delay Factors influencing the changes in the body after burial 1. state of the body before death — thin slower, mummity 2. lime elapsed between dealh and butial and environment of the body 3. effect of coffin — later 4. clothings and other coverings on the body when buriad - pressure, insects 20ddopth at which the body was buried - greater the lator condition and tygo of soll Inclusion of something inthe grave which will hasten decomposition-food ‘access of air to the body after burial mass grave ~ rapid (0.trauma to the body — violent death - slow CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TEMPERATE REGIONS. 1-8 DAYS AFTER DEATH greenish discoloration over ilac fossa. soft eyeballs, 3-5 DAYS, frothy blood from mouth, nostris 8-10 DAYS, abdominal distention, nails firm 14-20 DAYS. “blisters all over the body, maggots. 2-5 MONTHS - skull exposed, orbits empty IN TROPICAL REGION 12HOURS Rigor mortis all over, hypostasis, greenish-discoloration caecum 24HOURS Rigor mors absent all over, abdominal distention 43H Ova of fies, trunk bloated, face discolored 72H Whole body grossly swollen, hairs and nails loose ONEWEEK Soft viscera putrefied TWO WEEKS Soft tissues largely gone ONEMONTH Body skolotonized BEEN SUBMERGED IN WATER FIRST 4 OR 5 DAYS Cold water litle change, in igor mortis FROM5—7DAYS Skin on hands, feot is bleached, face faded white 4-2 WEEKS Face swollen and red, skin of hands and fest wrinkled 4 WEEKS ‘Skin wrinkiod, nail intact 6-8 WEEKS ‘Abdomen distended, skin of hande’ feet come off wth nails Factors influencing the floating of the body in water: ‘age — fully developed, well nourished - rapid sex — fermales floats sooner conditions of the body — obese float quicker season of the year — moist hot air — putrefaction —floais due to gas water- shallow and stagnant water of creeks, higher specific gravity ea water floats sooner than frash water, highor specific gravity 6. external influence ~heavy-weating apparel - slower Only teeth, bones and hair remain for an indefinite time. Fiat bones disintegrates faster than round bones,‘SPECIAL MODIFICATION OF PUTREFACTION 4, Mummification is tho dehydration of the whole body which results in the shivering and preservation of the body. isually occurs when buries in a hot. dry with free access of hot air 2. Saponification or Adipacere fromation a condition where the faly tissues of the body are transformed to soft brownish-white substance known as ADIPOCERE at SQ le\ 3. Maceration softening of the tesues when in flud medium in the absence of putretactive mircro-org, seen in death in utero = reddish or greenish color, skin peeling off and arms flaccid and frail HOW LONG A PERSON HAS BEEN DEAD? DURATION OF DEATH 1. Presence of rigor morts : 2-3 hours after death ‘12H fully developed 18-36 H disappears concomitant with putrefaction 2, Presnce of Postmortem lividity 36 Hafter death appears as small pelechia-like red spots 3, Onset of decomposition 24-48 Hafter death manifested watery. foul smelling froth, mouth, nostrils 4, Stage of decomposition 5, Entomology of the cadaver ~ 24 H before eggs are hatched, maggots 6, Stage of digestion = 3.4 H gastric ematy 6.8 distal leu, cecum 7. Prosance of lve flies in the clothing in the drowning victim loss than 244 8, State of clothings pajama . night 8. Changes in CSF 10. Blood clots inside the b.v. in 6-8 H ater death, 11. Soft tissues of the body may disappear 1 t0 2 years after burial Post-mortem conditions simulating disease, poisoning oF Injury: 1. post mortam hypostasis ~ contusion, inflammation , poisoning 2. blisters of the cuticle — scald and burns 3. swelling, detachment or spitting - injury PRESUMPTION OF DEATH Disputable presumption - nat heard in 7 yearsPresumption of death ‘Absonce of 7 yoars excapt succession 10 yoars Vossel for 4 years ‘Armed forces 4 years In danger of death 4 years PRESUMPTION OF SURVIVORSHIP 4. under 15 y.0. ~ older survives 2, above 60 y.0.- younger 3. under 18, above 60 - forner 4. over 15 and under 60 y.o. ~ male, older 5. under 15, or aver 6Dy.0, and the other in between - later MEDICO-LEGAL INVESTIGATION OF DEATH Inquest Officer — is an official ofthe state charged withthe duty of inquiring into certain matters in medico-lagal examination: manner and cause of death The following officials of the government are authorized to make death Investigations: 1. Provincial and City Prosecutors 2. Judges of the RTC, MTC 3. Director of NBT 4. SolGen Stages of MEDICO-LEGAL INVESTIGATION: 1.Ctime Scane knvestigation ~ investigation of place of commission ofthe crime 2.Autopsy investigation of the body af the victim 4. Crime Scene Investigation “place where the essential ingredients of the crime took place. = Person composed the Search Team: a) Physician MILI trained b) Photographar ©) Assistant, evidence colloctor, note takor 2. Autopsy ~ comprehensive study of a dead body, in addition to the extemal examination Post-mortem examination- external exam without incision being made Purpose of autop: 1, Determine cause of death 2. Correlate clinical diagnosis and symotoms 3. Determine effectiveness of treatment 4. Study the natural course of the disease5. Educate students and physicians MEDICO-LEGAL OR OFFICIAL AUTOPSY: 1. Determine cause. manner, tme of death 2. Recovering, identifying, preserving evidentiary material 3. Provide interpretation and correlation of facis related to death 4. Provide factual, objective medical report 5. Separating death dus to disease from external causes. Dead body belongs to the state for eases that raquires mosico-logal autopsy. PATHOLOGICAL AUTOPSY MEDICO-LEGAL AUTOPSY 4. Requirement Consent of next of kin Law that gives the consent 2.Confirmation Clinical findings of rasearch Correlate lissue changes to erminal act 3, Emphasis Notation atall abnormal findings Effect of wranatul act 4, Conelusian Summation of al abnormal fingings Specific to the purpose: 5. Minor ‘Need nat be mentioned Included if usetul ‘The following manner of death should be autopsied: Death by violence Accidental deaths Suicides ‘Sudden death of persons who are in good health Death unattended by physician D.O.A. with no clinical diagnosis, Death occurring in an unnatural manner Mistakos in autopsy: 1, Ear or omission in the collection of evidence for identincation 2. Errors or omission in the collection of evidence required tro establishing the time of death 3. Emrors or amission in the collection of evidence required fro the medico- legal examination, 4. Ears or omission result in the production of undesirable arbfacts orin the destruction of valid evidence. Nogative autopsios = ifafter all efforts including gross and microscopic studies and toxicological analysis fall to reveal a cause of death, Negligent autopsy No cause of death Is found due to imprudance, negligence, lack of ski, lack of foresight.CAUSES OF DEATH Primary purpose of a medico-legal autopsy: Determination of the cause of death DDoath isthe dract and the proximate conaquanes ofthe criminal or negizent act. Defense wounds on the vietim: Quaity the crime to homicide. ‘Series of cute in the borders of the wound: Multple tust- intent to kil Cause of death: isthe injury or disease or both which initiates the physiological disturbance resuiling to a fatal termination 1. Immediate or Primary cause of death — when injury or disease kills quickly the victim and no opportunity for complications to develop. Ex: extonsive brain injury 2. Proximate cause or Secondary cause - the injury or disease was survived for a longer period Mechanism of death: is the physiologic derangement or biochemical disturbance incompatible wit life which is initiated by the cause of death Exc Hemorrhagic shock, pulmonary depression, cardiac arrest, tamponade mataboile probior. Manner of death: s the explanation as to how the cause of death arose. 1. Natural death — fatality ‘s cause solely by disease. Ex: pneumonia, cancer 2.Vident or unnatural death — due to injury Medico-legal masquerade- violent deaths may be accompanied by minimal or ‘no external evidence of injury or natural death where signs of violence may bo present Degree of Certainty to the cause of death’ 4. Structural abnormalities established beyond doubt the cause of death, Ex. SW with H 2, Degree of probability amounting to the cause of death. Ex: Electrical shock 3, History establishes cause of deah and confirmed by anatomic or chemicalfindings 4, When neither history, laboratory and anatomic findings, taken individually or in combination is sufficient to determine the cause of death but merely speculate 8 to the cause of death. EX. Crib death among infants, ‘Stops in the Intellectual Process in the determination of the cause of death: 4. Recognition of the structural organic changes or chemical abnormalities responsible for the cessaton of vital functions. 2. Understanding and exposition of the mechanism ty which the anatomic and other deviations from normal caused the death Instantaneous physiologic death or Daath from inhibition, death from primary shock, Syncope with instantaneous exitus. “This fs sudden death which 's cause within soconds or minute or two aftor @ minor rauma or pericheral stimulaton of relatively simple nature, ~The peripheral stimulation initates the cardio-vascular inhibitry reflex Ex: Vagocardiac slowing or stoppage of the heart Blovr to the larynx, solar plexus, scrotum, pressure fo the carotid sinus Disoases with no specific findings of a disoas 4. Sudden infant death syndrome (SIDS) of erib death 2. Sudden unexplained nocturnal death [SUND) DOA - means actually dead or dying, provided the physician had not been given ample opportunity to arrive al a working diagnosis as to the cause of death Undetermined - ifthe physician cannot datermine the cause of death. MEDICO-LEGAL CLASSIFICATION OF THE CAUSES OF DEATH a. Nalural death ~ cause by natural disease condition in the body. b. Violent death ‘Accidental doath Negligent death Infanticidal death Parricidal death Murder Homicidal deathIf signs of violence are associated with the natural cause of death: * Did tho porson dio of a natural cause and wore tho physieal injurios inflicted immediately after death? - violence applied in a dead person : Impossible crime. * Was the victim suffering from a natural disease and the violence only aceolerate tho death? Hfender responsible of the death ofthe vitim. Criminal iabilty shall be incurred by any person commiting a felony although the wrongful act done be different from which he intended (att no.1 RPC) id the victim die of a natural cause independent of the violence inflicted? = accused will nt be responsible for the death but merely for the chysical Injuries ne had inflicted. Ex. Slagping a person with heart problem, only sight physical injury. to make the offender liable for the death ofthe victim, it must be proven that the 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 consciousness followed by paralysis or death due to Hemorrhage from thrombosis or embolism in the cerebral vessels. b. Abscess of the brain . Meningitis of the fulminant type 2, Affection of the circulatory system 2. Occlusion of the coronary vessels most common cause of Sudion death due to natural causes, b. Fatty of myocardial degeneration of the heart. Rupture of the aneurysm of the aorta 4d. Valvular heart disease fe. Ruplure ofthe heart Affactions of tie Respiratory system a, Acute edema of the larynx . Tumor ofthe larynx &. Diptheria 4d. Edema of the lungs fe. Pulmonary embolism © Lobar pneumonia 9. Pulmonary hemorthage4, Affactions of the GIT 2. Ruptured PUD ». Acute intestinal obstruction 5, Affections of fhe GUT ’a. Acule slrangu ated hernia b. Ruptured tubal pregnancy ©. Ovarian cyst with twisted pedicle 6, Affection of the glands a. Status thymico-iymphaticus b. Acute hemomhagic pancreattis, 7. Sudden death in young children a. Bronchitis b. Congestions of the lungs ©. Acute broncho-pneumonia 4d. Acute gastroenteritis fe. Gonvulsion 1. Spasm of the larynx B. Violent death “are due fo inuries inflicted in the body by some forms of outside force ‘The physical injury must be the proximate cause of death = That the victim at the time the physical injuries were inflicted was innormal health ‘That the death may be expected from the physical injuries inflicted ‘That the death ensued wihin areasonable lime CLASSIFICATION OF TRAUMA OR INJURIES Physical injury - trauma sustained through the use of physical force. Thermal injury — injury by heat or cold Electrical injury ~ electrical energy. ‘Atmospheric injury - due lo change of atmospheric pressure ‘Chemical injury - chemicals Razdiation injury — radiation Infecton ~ micrabic invasionPENAL CLASSIFICATION OF VIOLENT DEATHS. 1, Accidental deaths — due to misadventure or accident. ‘Art. 12 no. 4 RPC Any person who while performing a lawful act with due care, causes an injury by mere accident without fault or intention of causing it Ex. Patient died of ATS injaction after proper skin test 2. Negligent death — felonies may be committed when the wrongful act is due to Teckless Imprudence, negigence, lack of skill or foresight. Ex. Surgeon left a pack — Homicide through reckless imprudence 3, Suicidal death , destruction of one's self not punished, unfortunate being. = Act 253 RPC Giving assistance to Suicide, Punishable because he has no right{o destroy or assist in the destruction of Ife of another. 4, Particidal deaths Art, 246 father, mother, child, (/egillleg) ascendant, descendant, spouse (leg.) 5. Infanticidal deaths — Art 255 killing ofa child less than 3 days 6. Murder Art. 248 treachery, consideration, means of inundation, occasion of calamtts, evident premeditation, cruelty 7. Homicidal deaths Art 249 DEATHS UNDER SPECIAL CIRCUMSTANCES 41. Death caused in a tumultuous affray Art 251 2. Deas or physical injuries inficted under exceptional iroumstances. At 247 2, PATHOLOGICAL CLASSIFICATION OF THE CAUSES OF DEATH ‘a. Death due to syncope ~ fatal and sudden cessation of the action of the heart . Death from asphyxia - a condition in which the supply of oxygen to the blood ort the tissues or to both has been reduced below normal working level Stage of increasing dyspnea 1 min Stage of Expiratory convulsion Stage of exhauston 3 min .. Death from coma 2»SPECIAL DEATHS |, Judietal deaths — Art. Il Sec.1 Par. 19 Phil. Const. “cruel and Unusual punishment shall not be inficted. ; electrocution, hanging, ‘musketry, gas chamber. 2. Euthanasia or merey killing 3, Suicide ‘Automatism - due to drug may be considered as accidental rather than suicidal Evidences that will infor death is suicidal: 1. History of dopression, mental dissase. 2. Previous attomat 3) Injuries are located in areas accessible to hand. 4. Effects of the act of self-destruction may be found in the victim:, empty bottle 5, Presence of suicidal note, 6. Secluded, notin public view. 7. Evidences which rule out H.M, P 4. Death from starvation : Cause may be due to suickal, homicidal or accidental. The human body without food loss es 1/24" ofits weight dally. ‘And 40% loss>death Factors that influence the length of survival: age, condition of the body. sex, environment. 30DISPOSAL OF THE DEAD BODY ‘Sec.1103 Revised Administrative Code : Persons charged with the duty of burial 1, Deceased was married: the surviving spouse 2. Ifunmartied : the nearest of kn of the deceased; adults, within the Phi ‘And in possession of sufficient means to defray the necessary expanses. 3. none of the above ~ municipal authorties. Sec 1104 RAC Right of custody ‘Any person charged by law with the study of butying the body of a deceased person is entitled to the custody of such body for the purpose of burying it, except when an inquest is required by law for the purpose of determining the cause of doath. {if communicable, the local board of health oF local health officer or municipal council Concept of possession — the right of custody overa dead body. The right of custody does not mean ownership of the dead body. Executors right of cusiody superior to the right of spouse dead body. An executor Is the person mentioned in ail who will carry cn the provision of the wil. In the absence of a tostamentary disposition, the right of tho surviving spouse is paramount METHODS OF DISPOSAL OF THE DEAD BODY 1. Embalming - 6 to B quarts of aniiseplic solutions of formalin, perchloride ‘of mercury 0° arsenic which is carried into the internal carotids and the femoral ators. 2, Burial or inhumation ‘8. Sec 1092 RAC buried within 48 houre if unemealmed. Within 12 hours, if communicable, Except: 1. Subject of legal investigation. 2. Authorized by the local health authoritias that may be buried ‘more than 48H, 3. impliedly when embalmed, b, Death certificate necessary before burial Sec. 1087 RAC Requirement of Death Cert. and the duty of the physician to issue or the local health officer, or f none by the mayor, secretary, councilr of the municipaliy to issue the certificate ‘Sec 91 P.D. 856 Code of Sanitation ; Burial requirement ~ death cert, Issued by physician 31¢, Permission from the Provincial fiscal or from the municigal mayor. Is necessary if death is due to viclance or crime. = Sec. 91(f) P.D. 856 Code of Sanitation ‘Sec, 1094 Revised Administrative Code - Disposition of body and belonging of person dying of dangerous communicable disease Ex. Meringocoecemia in Bagiua City 1. “The body of a person who died of any dangerous communicable disoase shall not be cartiad form piace to place except for burial or cremation. 2. Duty of the local health official to disinfect the body before being Prepared for burial; the furniture, house, either disinfect or bummed if Capable of canveying infection. ‘Sec. 91{h) P.D. 856 Code of Sanitation 1, Remains shall be buried within 12 hours after death. Cause of death is ‘due to a dangerous communicable disease: 2. Not to be taken any place of public assembiy. 3. Only adult members of the deceased are allowed to attend the funeral Sec. 1091 RAC Death Certificate must be presented before burial ‘Sec. 1099 the placing of the body of any deceased person in an unsealed ‘overground tomb is prohieited unless if permanently sealed, Except: 1. Tombs and vaulte which are strictly receiving vaults for todies or remains avraiting final disposition 2, Embalmed bodies await ng final disposition ‘Sec. 1100 of RAC, Sec. 91@ of P.D. 856 Code of Sanitation ‘The depth of the grave must be at least 1 % meters daep, filed well and firmly. ‘Sec. 2695 RAC Poralizes the desecration of burial premises; tombstone, plant, tree, fence, poat or wall. P200/ not greater than & months. Sec. 90 code of Sanitation Burial Grounds requirements “. Itshal be unlawful for any person to bury the remains in places ather fran those legally authorized 2. Atleast 25 maters from any dwelling house and no house shall be Constructed within the same distance from any burlal ground, 3. Not within 50 meters trom any water cource. Other burial requirements: 4. Shipment of remains abroad shall be govatned by the rules and regulations of the Bureau of Quarantine,2. The burial or remains in city or municipal grounds shall not be prohibited ‘duo to race, nationality. religious or pollical reasons. 3. Except when required by legal Investigation or whan permitted by the local health authorty, no embalmed remains shall remain unburied longer than 48 hours. FUNERALS ‘Art. 305 CC The duty and the right to make arrangements for the funeral of a relative shall be in accordance with the order of eupport under Art, 294. Descendants : Eldest Ascendanls. : Paternal For support as mentioned in Art. 294 Spouse ‘The dascendants of the nearest degree ‘Ascondant of the nearest degrea Brothers and sisters Art, 306 CC ; in keeping with the social posttion ofthe deceased Art. 307 CC ; In accordance to the expressed wishes of the deceased, ‘Art, 309 CC ; Showing of disrespect to the doad shall be lable to the family of the deceased for damages, materials or mora ‘Art. 132 RPC: Interruption for religious worship. ‘Art 133 RPC: Offending the religious feeling ‘Art. 2219 CC: Provides for the moral damages may be recovered for acts, mentioned in Art, $09 CC. LIMITATIONS TO THE FUNERAL RITES Willof the deceased 2 Bural ofa person nentence to death must not be held with pomp. 3. Restrictions as to funeral ceremonies in cases of daaths due to communicable disease, 3. Disposing of the dead body in the sea ~ Provided the deceased is nat suffering from dangerous communicable deceased. = See. 1093 RAC Permit for convayance of body to sea for burial4. Cromation ~'s the pulverization of the body into ashes by the application of heat. First must be identifi, Permit and in a crematory made for the purpose. NOT GRANTED ‘a. Ihe deceased left a nate. b. Identity of the person is nat definite ¢. Exact cause of death cannot be ascertainad and the need for further inquiry or examination. 5. Use of body for scientific purposes = Cornse of prisoners Any person to be buried for public expense and which is unclaimed for 24 hous ‘Soc. 96 P.D. 856 Code of Sanitation ‘Special precautions for safe handling of cadavers containing radioactive 'sotopes, RA 349 as amended by RA 1056 Permission to use Human organs or any portions of the human body for medical, surgical or scientific purposes Under cetlain conditions, + In.writing, specific use, signed by the grantor and two disinterested witness. Soc. 96 Code of Sanitation; Donation of human organs for medical , surgical and scientific purposes according to the Sanitation Code. Persons permitted to detach human organs: 4, Licensed physicians 2. Known scientist 3. Medical or sciantifc institutions Roquirements for a valld authorization 1, It must be in writing 2. It must specify the person or institution grated the authorization. 3, Must specify the organ or part to be removed 4. Signed by the grantor and two disinterested person. 5. Copy ofthe authorization must besubmited othe Secretary of Health EXHUMATION “The deceased buried may be raised or disinterred upon the lawful order ofthe proper authorities, Soc 1082 RAC —_Comoiory permits even to NBI agents Sec.1097 RAG Exhumation in case of death from dangerous communicable disease after § years from burial M‘Sec 92 Code of Sanitation 3 years if non-dangerous communicable disease. Remains chal dsinfacted before burial Requirements to be satisfied in exhumation: 4. Duration of interment as required. 2. Exhumation permit 3. Compliance of sanitary requirements Procedures followed in MedicoL.ogal Exhumations: 1. A formal request trom any of the law enforcement agency or any person ‘authorized by law. 1. Name of the person, place of interment, date of interment, suspicion as to cause of death. b. Todetermine the cause of death, ‘¢. To determing as to identity of the person 4d. To recover organs or tissues for furthor examination for = Toxiccagical analysis, = Histopath exams ‘Smears from vaginal canal and bicod for alcohol determination 2. Set the date and time of exhumation, if physician has a strong reason to believe that for the justification and strong probably 3. Witan request to the Regional director or Secretary of Health, 4. Grave must be properly identified by the person who was present when the body was interred. 5. Afler opening the caffin, the body must be viewed by any person who can identify the deceased. 6. Actual autopsy and adaption of the procedure is needed to accomplish the purpose of the exhumation, 7. Disinfection of the body and all areas involved must be carried out with the assistance of the local health officer and the return of the body to the burial place MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES Physical injury :is the effect of some of stimulus on the body. Stab wound the affect is immediate but a blunt object is delayed production on the contusion. Causes of Physical Inju 1. Physical violence 2. Heat or coldElooctical enoray Chemical energy Radiation by radioactive substances Change of atnosphenc pressure Infecton 1. PHYSICAL INJURIES BROUGHT ABOUT BY PHYSICAL VIOLENCE = The effect of the apolication of physical injury on person is the production of wound. ‘A disruption of the anatomic integrity of the tissues of the body. However, not all phye cal violence will result in the production of wound. Physics of wound production: v2 a. Kinetic energy “Velocity component s the important factor: IMi6 rife with a velocity of 3200 fV sec causes damage more than a heavier 38 caliber b Time = The shorter the pariod of time needed for the transfer of energy, the greater the lkelibood of producing damage. = If porson is hit on the body and the body moves towards the direction of the force applied, the injury is less as when tne body is stationary. = The longer the time of contact between the object or instrument ‘causing the injury, the greater wil be the dissipation of energy. ©. Areaof transfer = The larger the area of contact between the force applied on the body, the lesser the damage to the body. = By applying an oqual force, the damage caused by stabbing Is ‘greater compared to a blunt instrument. 4. Other factors = The less elastic and plastic the fissue > the greater that a laceration will result. Elasticity : Abilty of the tiscue to retum to its normal sizes and shape after being deformed by a pressure, = A force transmitted through a tissue containing fluid wil force the fluid away from the atea of contact in al directions equally, {frequently causing the tissue to lacerate 36VITAL REACTION = It's the eum total ofall reactions of tissue or organ to trauma, either ‘observed micro or macroscopically ‘a. RUBOR - redness of congestion of the area due to an increase of blood supply as a part of the reparative machanism. b. CALOR ~ Sensation of hoat or incroase in temperature. .DOLOR - pain due to involvement of the sensory nerve. 4. LOSS OF FUNCTION: due to trauma, the tissue may not function Tho presence of vital reaction diferentiates an ante-mortem from a post-mortom Injury. EXCEPT: vital reactions not seen even if injury inflicted during Ie 1, During agonal state of a living person were cells don t react to the trauma 2, Sudden death as in sudden coronary occlusion. CLASSIFICATION OF WOUNDS: 1. AS TO SEVERITY a. Mortal wound caused immediately after infliction that is capable of death, Parts of body that are mortal - heart, vessels, CNS, lungs, other organs. b. Non-mortal wound - Not capable of producing death after infliction 2. AS TO KIND OF INSTRUMENT USED 2. Blunt instrument — contusion, hematoma, lacorated wound, 7b. Sharp instrument ‘Sharp-edge instrument> incised wound ‘Sharp pointed > punctured wound Sharp edge and sharp-pointed > stab ‘c. Wounds brought about by tearing force —lacerated wound <4. By change in atmospheric pressure ~ barotraumas, ‘e, Wounds brought about by haat or cold frostbite, scald, burns. {Wounds brought about by chemical explosion - GSW, shrapnel wound {9. Wounds brought about by infection. 3, AS TO THE MANNER OF INFLICTION a) HIT= means of bolo, blunt instrument, axe. b) TRUST or STAB - bayonet dagger ¢) GUN POWDER EXPLOSION ~ Projectile or shrapnel wound. 4) SLIDING of RUBBING or ABRASION 4, AS REGARDS TO THE DEPTH OF THE WOUND fa). Superficial - wound involves only the layers of the skin. 1b) Deep —inner structures beyond the layers of the skin. PENETRATING WOUND - Wounding agent did not come out or Prercing a solid organ, PERFORATING WOUND ~ Wounding agont produces. communication between the inner and outer portion of the hollow organs, OR piercing or traversing completely a particular part of the body causing communication between the points of entry and text of the instrument or substance producing it ‘5, AS REGARDS TO THE RELATION OF THE SITE OF APPLICATION OF FORCE AND THE LOCATION OF INJURY €. Coup Injury ~ Physical injury which is located at the site of the application of force. b. Contre-coup injury ~ opposite the site of the application of force ©, Coup contre-coup injury ~ site and also opposite of application of force. 4. Locus minoris resistencia — Physical injury not located at the site nor ‘opposite the site of the application of force but in some areas: fering the least resistance to the force applied. Example: Blow in fore head > contusion on the region of the eyeball ‘@ Extensive injury - Physical injury involving a greater araa of the body beyond the site of the application of force 38Examplo : Fall or MVA. 6, AS TO REGIONS OR ORGANS OF THE BODY INVOLVED Injures in various parts of the body 7. SPECIAL TYPES OF WOUNDS ‘)DEFENSE WOUNDS = — Instinctive reaction of sell-preservation. > hands/ractures D)PATTERNED WOUND —— Woundiin the nature and shape of the Instrument. > Wheels abrasions from rope. ©)SELF-INFLICTED WOUNDS - Wound produced on oneself but no intention to end his Ke Motive of producing self-inflicted wounds: 1. To create oF deliberately magnify an existing injury or disease for pension or workman's compensation To escape certain obligations or punishment. To create a new identity Gain attention or sympathy. Psychotic behaviour, ‘Some ways of set/-mutiation: Head barging or bumaing Exposuro of Body to heat radiation fram open fires, radiators Penetrating nail to chest wall Castration by armoutation of the penis Trichotilomania- pulling of body hair LEGAL CLASSIFICATION OF PHYSICAL INJURIES 4, MUTILATION =An.262RPC Kinds of mutilation: 4. Intentionally dopriving a parson, totaly or partialy of some of the essential organs for reproduction, '. Intentionally depriving a person of any part or parts of the human body other than the organs for reproduction, Mutilation to be punishable it must be intentional or nol physical injury MAYHEM isthe unlawful and violent deprival of another of the use of a part of the body so as to render him|ess able in fighting, oithar {0 defend himself or to annoy his adversary. \Vasectomy/Tubal ligation are not mutilation and a legtimate method of contraception despite the fac! that its dane intentionally and deprives a person of his power of reproduction. 9SERIOUS PHYSICAL INJURIES Art. 263 RPC ‘Any person who shall wound, beat or assault another Art. 263 and administering injurious substance, without intent to kill At. 264. “The main purpose of dividing the provision info four paragraphs a) Is lo gaduate the penalies depending upon the nature and character of the wound inflicted ) Thai consequencas on the person of the vic. 1. Prison mayor — because of the physical injuries inflicted. the injured person becomes insane, imbecile, imrotent or alind 2. Prision catractional inits medium and maximum periods, “loss of speech, hear or smell loss of aye, hand, foot, arm, leg loss of the use crincapacitated for the habitual work he used to do, 3, Phision correctional in te minimum and medium periods. ~ person injured shall be deformed. -lost any other part of the body, incapacitated for more than 90 days. 4, Atrasto mayor in ts maximum period to prision correctional =I the physical injuries shall have cause the ilness or Incapacity for labor for moro than 30 days, Is the offense shall be committed against any of the persons enumerated in ‘Art 246 Or with allendance of any of the ciccumstances mentioned in Art. 248 = The case covered by subdivision number 1 ofthis art. Willbe punished by reclusion temporal in is mediurn and maximum periods. = Subdivision number 2 by Prision correctional in its maximum period to Prision mayor in its minimum period, Subdivision number 3 by prision correctional in its medium and maximum = Subdivision number 4 prision correctional in ts minimum and medium periods ‘The provisions of the preceding paragraph shall rot be applicable to a parent ‘who shall inflict physical injuries upon his child by excessive chastisament, RA 7610, It may be committed through a simple negligence or imprudence. ADMINISTERING INJURIOUS SUBSTANCE OR BEVERAGES Art 264 RPC Elemenss: ‘+. The offender inficled upon another any serious physical injury, 402. Thoto is knowlodgo that the substance or beverage administorod Is injurious Or took advantage of the victims weakness of credulty. 3. There is no intont to kil in the part ofthe offender. If intentional so> frustrated murder. Treachery is inherent in Art. 264 RPC LESS SERIOUS PHYSICAL INJURIES Art. 265 RPC ‘Any person who shall inflt upon another physical injuries not described in the procoding articles, But which shall incapacitate the offended party forlabar 10 days or more Or shall require medical allendance for the same period Bath of which is 10 days but not more than 30 days and there must be proof tot The crime of less serious physical injuries may be qualified and a fine of a higher ponalty is imposed when: 41, There is a manifest intent to insult or offend the in ured person. 2. There are circumstances adding ignominy to the offense, 3. The victims is the offender's parents, ascendants, guardian, curators, teachers. 4, The vietin is a person of rank or parson of authority, provided the erime Is not direct assaut. P.D. 169 Obligation imposed on Physicians treating persons suffering serious and less serious physical injuries required to report to law enforcement agencies. SLIGHT PHYSICAL INJURIES AND MALTREATMENT Art 266 RPC 1, Arresto menor. when the offender has inflicted physical injurias which shall incapacitate the offended party for labor form 1 to 9 days or shall require medical attendance af the same period 2. Aresto menor or fine not exceeding P200 and censure when the offender has cause physical injuries which do not prevent the offended patty from engaging in his haaitual work nor require medical attendance. 3. Arrosta monor in its minimum period or a fine not exceeding P50 when the Offender shall il treat another by deed without causing any injury. It there is no evidence to show actual injury or incapacity for labor or petiod of medical allendance, the accused can only be gully of sight physical injuries, 41So. tender stap on the face, holding the arm tight, application of prossure in some parts of the body or mild blow which show no sign of physical Violence may sill be considered sight physical injuries or maltreatment. (Parag 3 ) PHYSICAL INJURIES INFLICTED IN A TUMULTOUS AFFRAY Art 252 RPC Elements 41. There is a tumultuous affray 2. Participants suffered from serious physical injuries 3. The person who inflicted seriaus physical injuries cannot be identified 4 ‘All those who appear to have used violence upon the parson of the offended party shall ba penalized by arrast fram 5 to 15 days. TYPES OF WOUNDS (MEDICAL CLASSIFICATION) 1. CLOSED WOUND ~ no breach of continuity ofthe skin or mucous membrane. 2, Superficial - When the wound is just underneath the layers of the skin (oF mucous memerane, a4 -PETECHIAE - is a circumscribed extravasation of blood in the ‘subcutaneous tissue of undemeath the mucous membrane Example : mosquito bite, blood disease, hanging 82 - CONTUSSION — is tho effusion of blood into the tissues underneath the skin on account af the rupture of the blood ‘vessels as a result ofthe application of blunt force or vislence. size of contusion greater than the size of the object. Location of the contusion is not always the site of application of he force. Example: Black eye> Forehead Medic egal point of view: ‘contusion as indicated by its extemal pattern may correspond to the > shape of the object or weapon used. Extent > the possible degree of violence applied. Distrbution> indicates the character and manner of injury as in manual strangulation around the neck‘Ago of Contusion: appreciated trom its color change ‘Tho size tends to bacome smaliar from the periphery to the center ‘and gasses through a series of color changes as a result of the > Disintegration of the RBC and liberation of hemoglobin The contusion is ted, purple soon afler its complete development. 4.0 5 days > green T to 10 days > yellow and gradually disappears on the 14" or 15° day. ‘The ultimate disappearance of color varies from 1 to 4 weeks ‘depending upon the severity and constitution of the body. The color changes starts al the periphery CONTUSION VS. POST-MORTEM HYPOSTASIS. Contusion Below the epidermis in the true skin in small bruises or extravasations, below this in larger ones and offen much deeper stil ‘The epidermis has no blood vesse's to be ruptured Post mortem Hypostasis, In the epidermis or inthe cutis as a simple stain or a showing tough the epidermis of the underlying engorged capillaries, Contusion Cuticle was probably abraded by the same violence that produced the bruise. In small punctures such as fleas bites, this is not observed, Postmortem hypostasis Cuticle unabraded, because the hypostasis is a mere sinking of the blood, thers is no trauma. Gontusion ‘A bruise appears at the seat of and surrounding the injury. This may or may not be adependent part. Post-mortem hypostasis “Always in a part which for the time of information is dependant.Contusion (Often slevated because elevated blood and subsequent inflammation swell the tissues, Post-mortem hypostasis Nol elevated, because either the blood is sillin the vessels or al most has simply Soaked into and stained the tissues. Contusion Incision shows blood outside the vessels. This the most certain test of difference and can be observed even in very small bruises. Post-mortem hypostasis Incision shows the blood is sll in ils vessels and if any oozing accurs drops ‘can be s2en issuing from the cut mouths of tre vessels Contusion Color variegated. This is only true of bruises that are the same days old due to the changes in the hemoglabin produced during lite. Post-mortem hypostasis Color is uniform. The well known change in color produced in blood Extravasaled Into ving tissues does not occur in dead tissues with the same ragularky. Contusion It the body happens to be constricted at or supported on a bruised place, the actual surface of contact may be a litle lighter than the rest ofthe bruise but will not be white Post-mortem hypostasis Ina place which would otherwise be the seat of hypostasis pressure of any kind even simple support is sufficient to obliterate the lumen of the venules and capillaries and s0 to prevent the‘ filing with blood, White lines or patches of pressure bordered by the dark color of hypostasis are produced and marks of foggings, strangulation, etc. are thus sometimes simulated. FACTORS INFLUENCING THE DEGREE AND EXTENT OF CONTUSSION 1. General consition of the patient. 2. Part of the body atfected. Fatty tissues, bioody parts > contused easily Fibrous areas, muscle > less 3. Amount of force applied ~The greater the force, the more effusion of blood. 4, Disease — Cortusion may davelop with or without aplication of force Example: Aplastic anemia, whooping cough 45. Age — Children and old age tond to bruise easily, 6. Sox— women, obose easily develops unlike boxers. 7. Application of haat and cold The distinction between ante-mortem and post-mortem contusions in an undecomposed body is that in 4. Anle-mortem bruising: there is swelling, damage to epithelium, extravasation, coagulation and infration of the tissues with blood 2. Post-mortem bruising there are no such findings, 23 HEMATOMA is the extravasation of effusion of blood in anewly formed cavity tndemeath the skin. When the blunt instrument hit a hard part of the body lika a bony part which is superficially located. Force causes the subcutancous tissue to rupture on account of the presence of a hard structure underneath, DISTINCTION BETWEEN CONTUSION AND HEMATOMA, 1. In contusion- the effused blood are accumulated in the interstices of the tissues underneath the skin In hematoma biood accumulates in a newly formed cavity underneath the skin, In contusion, theskin shows no elevation and is ever elevated, the clevation is slight and is on account ofinfammatory changes In hematoma ~ the skin is always eelevated, In contusion, puncture or aspiration with syringe of the lesion, no blood ‘can be obiained. In hematoma — shows presence of blood and subsequent depression of the elevated lesion, ‘Abscess. gangrene, hypertrophy, fibroid thickening and even malignancy ara potential complications of hematoma. MUSCULO-SKELETAL INJURIES 1. Sprain - partial or complete disruption in the continuity os a muscular or ligamentous support of a joint, due to a blow, kick or torsion force. 2, Dislocation - displacement ofthe articular surface of bones entering into the formation of a joint. 3. Fracture — solution of continuity of bone resulting from violence ot some ‘existing pathology. 45