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 Customs which are contrary to law, public order or public policy shall net be ountenanced, 5, Laws are repealed by subsequent ones, and their violation or non-observance shal not be excused by dis-use, custom or practice to the contrary.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‘a. Close or Simple Fx - no break in continuity of the overlying skin, . Open ar Compound Fx - Fx is complicated by an open wound caused by the broken bone which protruded with other tissues of the broken skin ©. Comminuted Fx - Fractured bone is fragmented into several pieces. 4. Greenstick Fx ~ Fx wherein only one side of the bone is broken while the other is merely bent. ‘e. Linear Fx - when the Fx forms a crack usually in fat bones. 1. Spiral Fx break in the bongs forms a spiral manner as seen in long bones. 19. Pathologic Fx — Fx caused by weakness of the bone due to disease. 4. Stain ~ the over-stetching instead of an actual tearing or the rupture of a muscle or ligament which may no! be associated with the join. 5. Sublaxation — Incomplete or partial dslocation. INTERNAL HEMORRHAGE rupture of blood vessels which may cause hemorthage dus to tie following: ‘a. Traumatic intracranial hemomrhage. . Rupture of parenchymatous organs. ©. Laceration of other part of the body. CEREBRAL CONCUSSION ( COMMOTIO CEREBRI) = THE JARRING OR STUNNING OF THE BRAIN CHARACTERIZED BY MORE ORLESS COMPLETE SUSPENSION OF ITS FUNCTIONS ASA, RESULT OF INJURY TO THE HEAD WHICH LEADS TO SOME COMMOTION OF THE CEREBRAL SUBSTANCE, =i more severe when the moving ar mobile head struck a fixed hard object ‘as compared when the head is fixed and struck by a hard moving object, Signs and Symptoms Unconsciousness which is more or less complete. muscles are relax and flaccia. eyelids are closed and the conjunctvae are insenstive surface of the body 's pale, cold and clammy. respiration is slow and sighing pulse is rapid, weak, faltering and scarcely perceptible to the fingers. Temperature is subnormal sphincters are relaxed with unconscious evacuation of the bowsl and. bladder. 98. reflexes are present but sluggish and in severe cases may be absent. Loss of memory for events just before the injury is @ canstant effect of cerebral concussion and is of medico-legal importance. 2. OPEN WOUNDS 46a. Abrasion ( Scratch, graze, impression mark, friction mark ) “tis an injury characterized by the removal of the superficial opitrolia! layer of the skin caused by a rub friction against a hard rough object. ~ Contussion with abrasion = forcible contact before friction occurs, the shape varies and the raw surface exudes blood and iymoh which later dries and forms a protective covering as SCAB ot CRUST Characteristics of abrasion: 1. It dovolaps at the procise point ofthe forcs causing it 2. Grassly or with the aid of a hand lens the injury consists of parallel linear injuries which ate inline witn the direction of rub of friction causing it may exhibit the pattern of the wounding materia Usually ignored by altending physician. Medico-lagal viewpoint = abrasions caused by fingatnals may indicate struggle or assault and are usualy tocatod in the face, neck, forearms and hands. = abrasions rasulting fram friction on rough surfaces are located in bony parts and are usually associated witn contusion or laceration. nature of the abrasion may infer degree of pressure, nature of the rubaing abject and the direction of movement, 5. Abrasion heals in a short time and leaves ro scarunless if nat Infected or if the whole thickness of the skin is involved, Forms of abrasion 1. Linear abrasion — appears as a single line, straight or curve. inching with fingernails = curve a. Siding the point of a needle = straight inear ab 2. Mullingar — develops when the skin is rubbad on a hard rough object producing several near marks parallal to one another. Example: MVA 3. Confluent ~ linear marks in the skin are almost indistinguishable ‘on account of the severity of friction and roughness of the object 4. Multiple — several abrasions of varying sizes and shapes may be found in differant parts of tha body. Typos of abrasion 1, Scratch — caused by sharp pointed abject which slides across the skin, lke pin, thom oF fingernail = Injury usualy parallel tothe direction of side. = Fingemail scratch > broad at point of commencement with talling at he end. 2. Graze — usually caused by forcible contact with rough, hard objects‘sulting to irregular removal ofthe skin surface. Course indicated ty a clean commencement and tags on the end. 3 Impact or imprint abrasion ( patterned abrasion, stamping abrasion, ‘abrasion @ la signature) - those whose pattern and location provides abjective evidence to show cause, nature of the wounding instrument and the manner of assault of death ‘marks of grid of radiator, thread marks of whee!, teeth marks. 44, Pressure or friction abrasion - caused by pressure accompanied by movement usually observed In hanging or strangulation. pial strands of the rope as seen in the akin in hanging, Differential diagnosis: 1. Dermal erosion - gradual breakdown or very shallow ulceration of the skin which Invalves only the epidermis and feais without scaming 2. Marks of insects and fishes bites ~ skin injury Is Irregular with no vital reaction and usually found on angles of the mouth, margins of rose, eyelids and forehead. 3. Excoriaton of the skin by excreta — found in infants and the skin lesions heals when the cause is removed No apparent history of rubbing traurna. on the affected area, 4, Proscuro sore — usvally found at the back at he region of bony Prominence. History of longstanding ilness, bed ridden. ANTEMORTEM ABRASION POSTMORTEM ABRASION COLOR ——_reddish-bronze due to slight —_yellowish and transparent ‘onudation of blood LOCATION any area over bony prominence Rough handling of the cadaver VITAL with intravital reaction shows not vital reaction and REACTION may show remains of damaged is characterized by a separation Epithalurn ‘ofthe epidermis from Complete loss of the former. b. Incised wound ( cut, slash, slice) = produced by a sharp-edged ( cutting) oF sharp-tinear edge of the instrument like a knife, razor, bolo glass ete. 4sImpact cut > whan there is forciole contact of te cuting inetument with the body eurfaca, Siice cut > when cutting inury is due to the pressure accompanied ‘with movement of the instrument Chopped or Hacked wound > when the wounding instrument is a heavy cufling instrument like saber > injury is severe Characteristics of incised wound: Edges are clean cut The wound is straight Usually the wound Is shallow near the extremities and deep at the middle portion, Profuse hemorrhage because of the clean cut on the vessels. Gaping is usually present due to the retraction of the edges. lathes will also show a clean cut f cut by the instrument. Faster heaiing if without complications. Incised wound made by broken glasses maybe irregular, needs to be removed. Changes that occur in an incised wound: 1. Afior 12 hours ~ edges are swollen, adherent with blood and with leukocyte infitration 2. Aiter 24 hours — proliferation of the vascular endothelium and connective tissue cells. 3. After 36 lo 48 hours ~capillary network complete, fibroblasts running at fight angles to the vessels 4. After 3 to 5 days — vassels show thickening and obliteration. Why 2 person suffers from incised wound: ‘Asa therapeute procedure. As a consequence of self-defense Masochist may selfinfict ncised wounds for sel-gratifcation, Addicts and mental patients. ‘Suicidal wounds — usualy located in peculiar parts of the body, accessible to the hang, ‘the most common site isthe wrist, radial artary and the neck. Homicidal wounds ~ usually deen, rultisle and involves both accessible and non-accessiole parts. = clothing are usually involved = Defense and other forms of wounds are present. 0‘Accidental wounds ~ mutiple incised wounds observed on the passenger and driver of MVA dus to broken windshialds. kitchen knives in the proparation of food. SUICIDAL WOUNDS. HOMICIDAL WOUNDS DIRECTION Oblique from below left ear, Usually horizontal below Gownwards across front neck the adams apple just atove Adams apple SEVERTY — Usually nol so deap and Usually deep and may cause may only involve vachea, involvement of the cartlage carotid and esophagus ‘and bones, SUPERFL — Usually present before the Practally absent but may cur commencement of deeper rarely be present when the wound victim struggled when attacked POSITN OF May be siting or facing a Usually victim lying on bed THE BODY — mitror or standing rin other place, WOUNDING Fitmly grasp (cadaveric spasm) Weapon is absent WEAPON of found lying beside the victim, BLOOD —__ Bld found in front pat of body Bld found at the back of neck. DISTRIBUTION Hand smeared with blood. Hands are clean, MOTIVE History of mental depression, Absence of such history Financial, social problems, alcoholism PREVIOUS Hx May be present Aways absent (OF SELF-DESTRUCTN, 3. STAB WOUNDS ~ is produced by the penetration of a sharp and a sharp edged instrument tke a knife, scissors, = ifthe sharp edge is the one that comes in contact with the skinthen itis an incssed wound, = the sharp pointed portion first come in contac, itis a stab wound. = surface length may reflect he width of the wounding instument. 50= smaller when the wound is not so deop, = wider i upon withdrawal isnot in the same direction as seen in slashing movement. The presence af an abrasion from the extremity of the skin defect is inline with direction af the slashing movement, The oxtromitios of stab wound may show the nature of the instrument used, ‘a doubled bladed weapon shows both extremities to be sharp. A single biaded weapon - one of ts extremities as rounded and contused not seen if instrument is quite thin. The diraclian of the surface defect may be useful in the determination of the possible relative position of the offendar and the victim when the wound was Inflctod ‘As to whether the wound is sit-ike of gaping depends on the direction of the ‘wound to the Langers line The depth of the wound may be influence by: 1. size and sharpness ofthe instrument 2. atea of the body involved 3. the dagree of force applied Homormhage is always the most serious consequence of stab wound due to the severance of bload vessels or involvement of bloody organs. How to describe stab wound: 1. length of the skin defect - edges must be coaptated first Taling - the direction of withdrawal of tho wounding weapon. 2. condition of the extremities sharp extremity > sharpness of the instument used. If Both extremity are sham > double bladed weapon is used 3. condition of the edges. = edges are regular and clean cut> due to one stabting act. = Serrated or zigzag in appearance > several stabbing wounds ( series of thrust ‘and withdrawal.) 4. linear direction of the wound ~ it may be running vertically, horizontally, of upward medially or laterally 5. location of he stab wound ~ to include exact measurement from ‘anatomical landmarks direction of the penetration — must be tridimentional depth of the panattation lissue and organs invalvedStab wounds may be: ‘ASuicidal 1. Located over vital parts of the boy. 2. Usually soltary 3. Located over covered paris ofthe body. the clothing is not invalved 4. Stab wound is accessible to thehand of the victim 5. Hand of victm is smearea with blood 6. Wounding weapon is firmly grasp by the hand of the victim. 7. If stabbing is accompanied with slashing movement > the wound tailing abrasion is seen towards the hand inflicting the injury. 8. Suicide not may be present 8, Prosence of a motive for salf destruction. 10, No distureance in te death scene with wounding Instrument found near the victim I~ stabbing with homicidal intent is the most common /31 Injuries olher than stab wound may be present 2. Stab wound may be located in any part of the body. 3. Usually more than one stab wound 4. Amotive for stabbing, i none then the offender eithor insaneidrugs 6, Disturbance in the crime scene Medical evidence showing the intent of the offender to kill the victim: 1. there are more than one stab wounds stab wounds located in differant parts of the body stab wounds are deep serrated stab wounds means thrust and witndawal of he wounding ‘weanon to increase internal damages. iregular or stellate shape skin defects> due to changing direction of the ‘weapon with the portion ofthe instrument at he level of the skin as the4, PUNCTURED WOUND - is the result ofa thrust of a sharp pointed instrument. = External injury is quite small but the depths to a certain degree: jea-pick, nail = Nature of the external injury depends on the sharpness of the end of the ‘wounding instrument: ‘contusion of the edges> if end is not sharp ‘opening may be> round, eliptical, diamond shaped or cruciate. = Extemal hemorthage is fmited although internal injuries may be severe.> blood vessels and bloody organs is fatal ma intervention applied - Sito of extornal wound can be easily sealed by died bid, serum, or clotted HG. - Punctured wounds are usually accidental Characteristics: 1. The opening of the skinis very smell, wound is much deeper than it is wide, 2. Extemal hemorthage is limited than internally may be severe 3. Sealing of axtornal opening is favorable for the growth and ‘multplication of anaerobie organism like bacillus tetari Homicidal - multiple and usually located in diferent parts of the body. wound are deep there ate defense wounds on the viet. signs af struggle inthe crime scene. Suleidal - located in areas of the body where the vital organs are located. usually singular, if multiple located in one area. parts of body involved is accessible by the hand of the victim ‘lothing usually not involved wounding is made while the victim isin siting o standing position , bleeding is towards the lower part of the body or clothing, no disturbance in the crime scene. ‘wounding instrument found near the body. Puncturing wound with puncturing instrument loaded with poison: 41. poison dart = cyanide oF nicotine 2. fish spines 3. dag bites with hydraphobia virus 4. injection of air and poison as a way of euthanasia,‘S.LACERATED WOUNDS ( TEAR, RUPTURE, STRETCH “PUTOK”) ig a tear of the skin and the underiying tissues duc to forcible contact with ‘a blunt instrument. May be produced by a hit with a piece of wood. ion bar, fst, stone. but. = Ifthe force is applied to a tissue is greater than its cohesive force and elasticity> the tissue tears and a laceralion is produced. Characteristic: "1 shape and size of the injury doos not correspond to the wounding instrument tear on the skin is rugged with extremities irregular, i-defined. injury developed where the blunt force is applied bordats of the wound are conlused and swollen. developed in areas where the bone is superficially locatedlike scalp ‘examination with the aid of hand lens shows bridging tissue joining the edges and hairs bulbs are intact. 7. bloeding is not extensive dus to blood vessels are not sovered evenW. 8, healing process is delayed and has a tendency to develop a scar. Classification of lacerated wounds: 4. Splting caused by crushing of the skin betwoan two hard objects. Exc laceration of scalp hit by a bunt instrument, cut eyebrow of a boxer. 2. Overstretching of the skin = When pressure is applied on one side of the bone> the skin over the area willbe stretched up to a breaking point fo cause laceration and exposure of the fractured bona. = Inavulsion: the edges of the remaining tissue is that of laceration. 3. Grinding compression the weight and the grinding movement may cause separation of the skin with the underlying issues, 4 Tearing {this may be produced by a semi-sharped edged instument which causes Irregular edges on the wound Ike haicnet and choppers. Lacerated wounds are rarely suicidal INCISED WOUNDS LACERATED WOUNDS.Edges are clean cut, regular, well defined edges are roughly cut, roguiar, I dofines No contusion or swelling around the ‘welling and contusion around the Incised wounds lacerated wounds Extremides of the wound ae sharp, may be extremities are il-defined and irregular Round, or contused Examination by means of a hand lens hair bulos ate preserved ‘Shows that hairbulbs are cut Healing is faster healing is delayed Caused by sharp edged instrument caused by a blunt instrument GAPING OF WOUND = Separation of the edges especially in deep wound may be due to the folowing: 4. mechanical stretching or dilatation = the presence of a mechanical device on the edges to prevent coaptation will cause separation. Example: drain in an abscess, retractor during operation. 2, loss of tissue due to: 1, Destruction due to pressure, inftion, cell ysis, burning, chemical reaction, b. Avulsion ar physical or mechanical slretching resulting to separation of a portion ofthe tissue. ¢. Trimming of the edges ~ dabridement of the skin which come in contact with the bullet at the ontrance and exit of GSW and removal of necrotic matorals. 3, retraction of the edges = undemeath the skin are dense networks of fibrous and elastic connective tissue fibers running on the same direction and forming a paltern mare or less present in all persons = This pattem of fiber arrangement is called cleavage direction of lines of cleavage of the skin and their near representation on the skin is called Langer tineDetermination of how much skin is involved is important in the mode of treatment and prognosis especially in burns, contusion. = burns of 70% in children and older age group are fatal rule of nine is used. Head and neck 9% 9% fone upper extremity 9% 18% font chest and abdomen 18% 18% posterior chest and abdo 18% 18% ene lower extremity front 8% 18% ‘one lower ext{back) 18% pudendum 1% 1% Factors responsible for the severity of the wound: 4 Hemorrhage may influence the severity of wound by: 2. loss of blood incompatible with Ife = blood constitutes 1/20 of the body weight of an adult. 5 to 6 quarts of blood ( one quart is 948 oc) “oss of 110" of ts volurne will cause no significant change. = loss of one quart fainting = loss of 1/2" to 2/5" > irreversiale shock = males can withstand more loss of blood than females “hypertension causes more excessive and rapid bleeding. . Hemorrhage may result in an increase in pressure in ar on the vital ‘organs to affect the normal function. intracranial hemiorthage cause compression ofthe vital centers of the brain -hemopericardium > pericatdal tamp “hemorrhage to tre chest> diminution of the rasgiratory output>anoxia, .. Hemorrhage may cause mechanical barriers to the function of organs. Into tracheo-bronchial lumina> asphyxia Inte muscles > disturbance in their contractity. Causes of hemorrhage: ‘a trauma destruction ofits blood vessel wall ». natural causes “intracerebral hemarthage(apaplexy)> lenticulostraite br. MCA * Spontaneous subarachnoig hamorthage > saccular berry aneurysm “rupture of arterioscierotic aneurysm- rupture of esophageal varices - pulmonary hamorrhags duo to PTB, lung abscoss, bronchiectasis “ruptured ectopic pregnancy 2. Size of injury -burns greater than 1/3 of the body are fatal 3. Organs involved — usually fatal to heat, brain, lungs 44, Shock — blow to genitalia, sight burs to young and oid, 5, Foreign body or substance introduced into the body - bacterial, ial. foreign body, chemical TOXIN. 1. snake bites> 2 punctured wds al the center of the reddened affected ara ‘The venom is injected through its fangs which is connected to the poison giana. ‘Snake venom toxicity will depend on: 4. potency of venom injected 2. amount of venom injected by the fang will depend on “season of the year “the length of time the snake has eaten, Ifa snake has justkilled lis prey> toxic content is smaller. 3. size of the patient 4. immediate treatment instituted. ‘Snake venoms are two principal classes: +, Neurotoxic - primary paralysis the respiratory and cardiac center of the brain = may cause N.V, ascending paralysis, coma, convulsion, clp arrest 2, Homatoxic - affects particularly the blood ~ manifestations are pain. swelling cn the affected area, IV hemolysis, N.Y, pulmonary and cardiac edema. Emergency treatment may be 1. incision of the wound to promote more external hemortage to drain the toutniquette above the site of the wound placing ice on the bite site Sucking the wound fo drain venom with the mouth administration of antisnake venom serum.2. Scorpion venom ~ venom has toxic, hemolytic, hemorhagic ~ one punctured wound on the center of a reddened area pain, edema and reddening 3. Coelenterate sting (jellyfish ) ~ tentacles penetrale into the skin and cause explasian of the nematocyst and liberation of the venom. - extreme pain. Urticarial rash, diated pupils, paleness, labored breatiing 6. Absence of medical or surgical intervention — wound may not be fatal but ‘due to neglect or ignorance of its management, may be serious and fatal FATAL EFFECT OF WOUNDS: 4, Wounds may be direcly fatal by reason of a. hemorthage neck due to carotid bleed. . Mechanical injuries on vital organs «. shock 2, Wounds may be indirectly fatal by reason ot: '. secondary hemorrhage following sepsis, . specific infection ©. starting affect 4d. secondary shock NATURE OF DEATH DUE TO SECONDARY CAUSES 1. Changes whose natural sequence are direct & obvous — sepsis, tetanus 2. Changes producing separate pathological lesions which in turn proves to be fatal Ex: operation to ligate vessel but died of peritonitis despite diigence/skill 3. Changes where a definite gathological condition was present before the injury. Ex. Person with tumor and stabbed , stab is not capable of death, but accused is. responsible for his death. 4. Changes where a definite pathological condition of totally different nature arises after the wounding and the consequential sequence is doubtul Ex. TB meningits fg biow to the head COMPLICATIONS OF TRAUMA OR INJURY 4. Shock due to injury to nervous systern, anoxemia, endothelial damage 2. Hemorrhage 3. Infection from the instrument from the organs involved in trauma ex. Bowels injured injury may depress general vitality deliberate intr of micro-organism 4, EmbolismHEALING OF WOUNDS 1. Power of the human tssus to regenerate ~ replaced the destroyed tissuo by newly formed similar tissue Regenerates randy : C.T., blood forming tissues, surface epith. skin Slow fo magenrate:sm, Muscles, neurons of CNS, highly specialized glandular tiss, Timo of healing is dependent an: a. vascularity '. age of person c. degree of rest or immobilization nature ofthe injury 2. Abertated healing process formation of exuberant granulation or proud flesh koloid formation stricture fistula or sinus formation MEDICO-LEGAL INVESTIGATION OF WOUNDS: Rule to follow by a physician: 4. allinjuties must be described 2. description of wound must be comprehensive, sketch’photograph 3. examination must be influenced be any ether information obtained from ‘others in making a repor! ora conclusion, Outline of the medico-logal investigation of physical injurios: 1, Gonoral investigation of the surroundings: ‘examination of piace where crime is committed. Examination of clething, stains, cuts, hair, fb. in the crime scene Investigations on possible witnesses to the incident Examination of the wounding instrument Photography, sketching, accurate dascription ofthe crime scene. 2, Examination of the wounded body ‘2. examinations applicable to Iving or the dead “age of the wound from tne degree of healing ~ deternynation af the weapon used 39roasons for the multiplicity of wounds to determine trajectory/course = depth of wound : notin the living , only ifthe outer and inner are fixed ~ conditions of the surroundings of the wound - hear GSW — burning, taltoding suicidal cuts — superficial tentative cuts or hesitation cuts = lacerated wounds ~ contusion an neighboring skin extant of the wound extensive injury ~ marked degree of force applied in the production of the wound. homicidal cutthroats are deeper, extensive, numerous than suicide + direction of the wound > impt. in the position ofthe victim to the offender + number of wounds ~ several> homicidal - conditions of locality degree of hemorrhage ‘evidence of struggle information as to the positon of the body presance of suicide note ‘condition of the weapon ANTE-MORTEM WOUNDS —POST-MORTEM WOUNDS HEMORRHAGE More profuse, arterial due lo loss of tone of vessels, ‘Absence of heart action Postmartem clotting of Slight of none, venous Cyblood inside bw. Marks of spouting of blood No spouting of blood from arteries Cloted blood Bid not catted,or soft clot SIGNS OF Inflammation & reparative None INFLAMMATION process ‘Swelling in the area Effusion of lymph, pus ‘Adhesion ofthe edges Unless if victim is weakened SIGNS OF Fibrin formation No time of repair REPAIR growth of epithelium Scab or scar formation RETRACTION _ Deep staining of the edges Not deeply stained OF THE EDGES and celular tissuse can be removed by washing OF THE WOUND. whichis not removed by washing Edges gape owing to the reaction Edges do nol gape, but are of the skin and muscle fibers closely approximated to Each other uniess ifthe wound is 1 to 2hrs ‘afer death DETERMINATIONS IF WOUND IS: HOMICIDAL — SUICIDAL ACCIDENTAL ABRASIONS Not common unless Rarely observed Extensive dragged abrasions MVA Orif victim resisted CONTUSION Rare except when Found in any portion jumping froma height of the body - Fall INCISED Commonly observed Commonly observed Frequent but rarely WOUNDS “depth, location and surroundings cause of death Points to consider in the determinat'n as to whether the wounds is A, S, H. ol‘oxtornal signs and circumstances related to the position and attitude of the body whan found. location of the weapon or the manner in which it was held the motve in the commision of the crime the personal character of the deceased the possibilly forthe offender to have purposely changed the truth of the ‘condition ‘other information signs of struggle umber and alirection of wounds direction of wound nature and extent of the wound Slate of clothing LENGTH OF TIME OF SURVIVAL OF THE VICTIM AFTER INFLICTION OF THE WOUND 1 2 degree of healing> signs of repair of wound appear in less than a day ater the Infetion of injury, changes in the body in relation to the time of death >systematic changes in the body = wastng, anemia, bed sore age af blood stain —nol reliable testimony of witness when the wound was inflicted POSSIBLE INSTRUMENTS WHEN USED BY THE ASSAILANT IN INFLICTING THE INJURIES. 1 2 3 4 5 6 contusion — blunt inc'sed wound — sharp-edged instrument lacerated wounds- blunt Punctured wounds — sharp pointed ‘abrasion — body surface 's rubbed on a hard surface GSW — the diameter of the wound of entrance may approximate the callber of the wounding instrument, Could the injury have been inflicted by a special weapon? ‘Aphysician cant dotermine that a specific weapon was used in inflicting a ‘wound Itis possible that itis caused by a certain instrument presented He must be cautious in gwing categoric statements Which of the injuries sustained by the vietim caused death? If with conspiracy — no need coz the act of ane is the act of alIf none- offenders are nly responsible for their individual acts. | muttipi injuries: which of the wound injured a vital organ. rif same organ Which caused the degree of damage. Which of the wounds was inflicted first? I mutipie for the qualification of the offense committed. First - weachaty , murder Last - homicide Consiaer: 1. relative position of the assailant and the victim when the fist injury was inflicted on the latter. trajactoryleourse of he wound inside the body ofthe victim ‘organs involved and the degree of injury testimony of wines presence of defense wounds ~ inflicted fst. Effect of medical and surgical intervention on the death: If death followed after aperation> offender is responsible f death was inevitable and that even with operation death is normal and direct consequence of the injury, and the physician is competent and in spite of exercise of degree of diligence stil death is the outcome If death ensued even the wounds are minor, and death due to the negigence cr Incompetence of the physician then the offender cant be responsible Effect of negligence of the injured person onthe death Ideath occured fram complications arising from a simple injury owing to the negligence of the injured person in iis proper care and Veatmerk the offender is responsible for the death a person is nat bound to submit himself to medical tx forthe injurios received during the assault = unless if tis proven that the negligence of the victim Is deliberate so offender is not responsible but only for physical injures. Power of volitional acts of the victim after receiving a fatal injury: ying declaration, attempt to kl the offender after the frst blow of the offender Relative position of the victim and assailant when injury was inflicted: location of the wound 2. direction of the wound 3. alure of instrument used in inficting the injury 4. testimony of the winass,EXTRINSIC EVIDENCES OF THE WOUNDS 1. evidences trom the wounding weapon osition of the weapon - near or grasp by victim ood on weapon - may be stained with blood hair and other substance on weapon 2. evidences in the clothing of the victim soaked with blood - hemorrhage junpowder - distance ara - struggle 3. evidences derived from the examination of the assailant Jarafin tes{, tears in clothing, blood stains, intoxication ete. 4. evidences derived from the crime scene ‘amount of hemorrhage, wounding instrument ete. PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY 4. HEAD AND NECK = not be underestimated = blecding from cars, nose, mouth > basal fractures may have normal x-ays yet with severe head injury Factors influencing the degree and extent of head injuries ‘2. nature of the wounding weapon> degree of violence applied depends on the thickness of the scalp and the weight of the weapon. b._Intansiy if te force > intensity and heavy agent 6. point of Impact >extonsive in fx of vaults at side or back 4d. mobility ofthe Skul at the application of force it head 's mobile, free> effect an the brain 's due to the shearing movement imparted to the brain > may produce contusion, laceration without fx If head Is fixed and unsupported> jarring movement of tha brain is absont but the fracture is extensive, Head injuries are classified as to the site of the application of force: 64, Direct oF Coup injuries 2. Indiract injuries. a. contr-coup injuries . remote injuries - fal hiting buttocks> basal fx ¢. locus minoris resistencia - injury in areas with less resistance 3. Coup-contre-coup injuries | direct and indirect injuries) ‘Wounds in the Scalp: 1. tis dificut to prevent the spread of infection 2. there is proximity of the scalp to the brain 5. there are free vascular connection between the structures inside and ‘outside the brain 4. itis frequently difficult o determine the extent of damage of the skull FRACTURES OF THE SKULL p. 302 GUNSHOT WOUNDS Death or physical injuries brought about by powdered propelled substances: 1. Firearm shot he injury is caused by the missile propelled by the explosion of the gunpowder located in the cartidge shell and the rear of the missile 2. detonation of high expiosives - grenades sxplasion inside tho metalic container will cause fragmentation of the container. 1 FIREARM WOUND = Firearm + is an instrument used for the propulsion of a projectile by the expansive force of gasses coming from the buming of gunpowder. (technical definition) = Includes rifles, muskets, shotguns, revclvers, pistols, other deadly weapons ‘which a bullet, ball, shell or other missile may be discharged by means of ‘aunpowder or other explosives. = includes air ifle except of small calibers and limited range = the barrel of any fraarm shall be considered as a complete firearm for all 6spurposes therect, Ponal provisions of laws relative to firearm: ‘a. Sec. 2802 RAC - unlawful manufacture, dealing in acauistion, disposttion or possession of firearms or ammunitions therefore or instrument used or intended to be used in he manufactute of firearms or ammunition, b. Soc. 2680 RAC - solling of itoarms to unlicensed purchaser. 1c. Sec. 2691 RAC- failure of personal representative of deceased licensee to surrender firearm. d._ Art 155 RPC - Alanns and Scandals ‘e.Art. 254 RPC - Discharge of firearms CLASSIFICATION OF SMALL FIREARMS: ‘Small firearms - are those which propel projectile of less than 1 inch in diameter. 4. a8 to wounding power: low velocity frearm >muzzle velocity of not more than 1400 ft per sec Ex. Rovolver =high power firearm > muzzie velocity more than 1400 f. per second: > usual is 2200 to 2500 ft per second or more. 2.as to nalure of the bore: = smooth bore weapon >inside portion of the barrel that is perfectly smooth ‘rom the fring chamber to the muzzle. Ex. shotgun = riled bore firearm > the boro ofthe barral witn a number of spiral lands ‘and grooves which run parallel with one another but twisted spirally from breech to muzzle. Ex Miltary rifle 3, as to manner of fring pistol - fired with a single shot Ex. Revolver Fila ~ may be firad from the shoulder Ex. Shotgun 4, As to the nature of the magazino = cylindrical revolving magazine — the cartridge is located in a cylindrical magazine which rotates at the rear portion af the barrel Ex. Revolver = vertical or horizantal magazine — the carliage is held one after another Vertically or horizontally and also held in place by a spring side to side or end to end. Ex. Automatic pistol 66Typos of small firearms which are of modico-logal intorost: 1. revolver — usual muzzle veloctty is 600 feet per second 2. automatic pistol ~selt-loading firearm. muzzle velocity of 1200 feet per second 3. tifle = muzzle velocity of 2500 feet per second and a range of 3000 feet, 4, shotgun - projectile is a collection of pelts ‘A.weapon in order to cause injury must have two principal component parts: 4. the cartidge or ammunition - bullet primer, cartridge case, powder charge 2. frearm instrument for the propulsion of a projectile farce of gases fram a burning powder ENTRANCE WOUND ‘Appears to be smaller than the missile (Owing ta the elasticity ofthe tissue Edges are inverted Usually oval or round depending upon the angle of approach of the bullet Contusion collar or contact ring is present due to invagination of the skin and spinning of the missle Tattooing or smudging may be present when when firing is near Underlying tissues are not protruding ‘Always present after fre Paraffin test may be positive EXIT WOUND Always bigger than the missile Edges are everted Does nat manifest any detinte shape Absent Absent Underlying tissues may be Protruding from the wound May be absent, if missile Is lodged in the body Negative 67INSTANCES WHEN THE SIZE OF THE WOUND OF ENTRANCE DO NOT APPROXIMATE THE CALIBER OF THE FIREARM, In distant fre, the rule is that the dlamoter of the GSW of entrance is almost the same as the callber of the wounding firearm excent 4. Factors which make the wound of entrance bigger than the caliber: ’. in contact or neat fie b. deformity of the bullet which entered ‘c. bullet might have entered the skin sidawise ‘4. acute angular approach of the bullet 2, Factors which make the wound of entrance smaller than the caliber 2. fragmentation ofthe bullet before penetrating the skin b. contraction of the elastic tissues of the skin thor evidences or findings used to determine ontrance of GSW 1. examination of the clothing, if involved in the course of the bullet 2. fabric shows punch in destruction ». particle of gunpowder 2, examination of the intemal injuries caused by the bullet ‘a. bone fragments, cartilage, soft tissues are driven away from entrance wound b. destruction of the bone is oval, with sharp edges at the oxttitis imegular, biagor and bevelled ©. testimony of witness Determination of the trajectory of the bullet in 4. extemal examination 2. shape of wound of entrance = when bullets fred at right angio with tho skin> the wound of entrance is circular except in case of near fire. it fired at another angle . itis oval when the bullet is deformed no such characteristics findings will be observed. le the body of the: b. shape and distibution of the contusion collar ‘antusion collar is widest atthe side of the acute angle of approach of the bullet. = ifthe bullot hits the skin perpendicularly» collar wil have a uniform width around the GSW except when bullet is deformed or in near fire. «. difference in level between the entrance and exit wounds, 4. by probing the wound of entrance — not with too much fore 6s2, Internal examination {2 actual dissection and tracing the course of the wound at autopsy '. fracture of bones and course in visceral organs C.location of bone fragments and lead particle d.xray exam 3. other evidences fo show trajectory '2. relative diference in the vetical location of entrance and exit in the clothing b. relative position and distance of the assailant from the victim in tie reconstruction of re-enactment of the crime. «testimony of witness EXIT WOUNDS OR OFFSHOOT WOUND. Doos not show characteristic shape unlike the ontrancs wound duo to tha absence of external support bayond the skin so the bullet tends to tear or shattor the skin ‘Shored GSW of exit if pressed on a hard object like when victim is lying: Wound of exit is citcular or neariy circular with abrasion. ‘ODD AND EVEN RULEIN GSW the number of entrance and exit wound is even so presumption that no bullets lodge in the body. eriied by x-ray How to datermine the number of fires made by the offender: 1. determination of the number of spent shells 2. determination of entrance wounds in te body of the vietim — number of entrance wounds may not show the exact number of fre a. notallfire made may hit the body of the victim b. the bullet may in the course of ts fight hit a hard object thereby spitting itand each fragment may produce separate wounds of entrance ‘e. Bullet may have perforated a part of the body and then made ‘another wound in some other parts of the body. 3. number of shots heard by the witness, Instances when the number of GSW of entrance is less than the number of GSW of exit in the body of the 61. a bullot might have entered the body but spit into several fragmonts, each of which made soparate oxi 2. one of the bullets might have entered a natural orifice of the body. Ex. nose 3. there might be two or more bullets which entered the body through @ ‘common entrance and later making individual exit wounds 4. in near shot with a shotgun, the pellels righ! have entered in a common ‘wound and later dispersed while inside the body and making separate wounds of exit. Instances when the number of GSW of entrance is more than the number of GSW of exit in the body of the victim: 41. when one or more of the bullet is not through and through and the bullat is lodged inthe body. 2yhen all ofthe bullats produce through and through wounds but one or mare made an exitin the natural onfices of the body. 3. when different shots produced different wounds of entrance but two of more shots produced @ common exit wound. Instances when there is no GSW of exit but the bullet is not found in the body of the vietim: 1. when the bullet is lodged in the GIT and expelled through the bowel or lodged in the pharynx and expelled through the mouth. 2. ear fre with a blank cartridge produced a wound of entrance but no slug may be recovered 3. the bullet may enter the wound of entrance and upon hitting the bone the ‘course is daflacied to have the wound of entrance as the wound of ext. Antemortem GSW — hemorrhage. swelling. vital reaction = microscopically: congestion and leucocytic infiltration. Problems confronting Forensic Physician in the Identification of GS\ 1. alteration of the lesion duo to natural process:drying of wound, ifn healing proc, ‘medical and surgical intervention: refer to clinical record of patient ‘embalming problems inherent to the injury sell X-ray exam — migratory, external souvenirs 70‘The offects of the clothing on the movement of the bullot dopond on: 1. number of layers of fabric between the muzzle and subjacent skin 2. nature of the fabri; closely woven 3. muzzle- clothing distance Examination of the external wearing apparel of the victim of GSW may be significant in investigation because: 4. iimay establish the possible range of the fire: a.contact fire tear in the clothing covering the skin, fbers turn outward away from body ‘soot doposit, gunpowder tattooing, burning of flsors around the tumed ‘ber = muzzle imprint dirt and greasy deposit may be wipe out and visible inthe tom clothing b.not contact but near shot = same with (a) except for absence of muzzle imprint and beyond flame range o.far fro = there is @ hole tear with inward direction of tre thread 2. it may be useful in the determination as to which is the point of entry and of fexitof the bullet. Enity- the fiber are inverted, 3, ltmay be useful in locating the bullet Special consideration on bullets 1. souvenir bullet 2. ballet migration 3. tandem bullet EVIDENCES SHOWING THAT THE GUNSHOT WOUNDS MAY BE SUICIDAL shot fired ina closed locked room, or open uninhabited place. death open near the piace victim was found shot fired with the muzzle of the gun in contact with the part of body involved location of entrance wound accessible part af body shot usually soltary direction of fire fs compatible with the trajectory of bullet 77. personal history may reveal social, economic, business or marital problem which cannot be solv. 8. gunpowder presence in the hand of the victim 9. entrance wound usually does not contain clothing ‘G.fingerprints of vietim on the butt 41. suicide note at the vicinity 42.no disturbance in the place of death Russian roulette destruction infortunate victim has no predetermined dosire of solt: EVIDENCES THAT GSW IS HOMICIDAL 4. site of wound of entrance has no point of election 2. firais made when the victim is at Some distance 3. signs of struggle or defenso wounds 4. aisturbance in the surroundings 5. wounding firearm usually not found in the scene of the crime 6. testimony of witness EVIDENCES TO SHOW THAT GSW IS ACCIDENTAL 4. usually one shot 2. no special area of body involved 3. consideration on the testimony of the assailant and detarmination as to ‘whether itis possible by knowing the relative postion of the victim 4. testimony of the wines POINTS TO BE CONSIDERED AND INCLUDED IN THE REPORT OF THE PHYSICIAN, 1. complete descriation of the wound of entrance and exit 2. location of the wound: part of body involved. distance of wound from midline, distance of wound from heel or buttock. direction and length of the bullet track ‘organs or issues involved in its course location of the missile, iflodged in the body diagram. Photograph, skelch ot drawing showing the location and number ‘of wounds, QUESTIONS THATA PHYSICIAN IS EXPECTED TO ANSWER IN COURT; 1. COULD WOUND THE WOUND BE INFLICTED BY THE WEAPON PRESENTED TO HIM? 2. ATWHAT RANGE WAS IT FIRED? 3. WHAT WAS THE DIRECTION OF THE FIRE? 4, IS TT SELF-INFUCTED?ARE THERE SIGNS OF STRUGGLE? DID THE VICTIM DIE INSTANTANEOUSLY? IS IT POSSIBLE FOR THE VICTIM TO FIRE OR RESIST THE ATTACK AFTE THE INJURY WAS SUSTAINED? 8, WHERE WAS THE POSTION OF THE ASSAILANT AND THE VICTIM WHEN THE SHOT WAS FIRED? The callver may be inferred from the diameter of the wound of entrance. Determination of tho longth of survival of the victim: nature of the GSW ‘organs involved presence or absence of infection ‘amount of Hood loss physical condition of the patient Capacity of a victim to perform volitional acts - depands upan the area of the body involved. involvement of vital organs and the resistance of the victm. DETERMINATION AS TO THE LENGTH OF TIME A FIREARM HAD BEEN FIRED +. odor of the gas inside the barrel 2. chemical changes inside the barrel 3. evidences that may be deduced from the wound DETERMINING WHETHER THE WOUNDING WEAPON IS AN AUTOMATIC PISTOL OR A REVOLVER 1. location of the empty shells — revolver the empty shells are found in the cylindrical magazine chamber after the Fre 2. nature of the spent shel! — aulomatic firearm = bullet is copper jacketed 3. nature of the base of the cartridge or spent shell = base of a revolver has a wider diamoter than that ofthe cylindrical body to keop the cartridge stay in the magazine chamber. It may be passible for a person who is accustomed to the sounds of frearms of different calibers to identify the firearm by the sound produced, Its not possible to determine the direction of te shot by determining the directon of the sound except when the flash or the parson firing the shot is seen at the time the shot was fred, GSW may not be a near fire or may not appear to be near fire: 1. when a device is setup to hold the firearm and to enable it to be discharged al a lang range by the viel 2. when the GSW of entrance doss not show characteristics of a near shot because the clothing are interposed between the victim and the firearm.3. when the examining physician failed to distinguish between a near or far shot wound 4. when the productof a near shot has bean washed out ofthe wound. X-ray faciltale the location and extraction of the wound reveals fragmentation and its location shows bone involvernant ike fracture rovoal tra ectory of the bullet shows effect ofthe bullet wound, ike hemorthage, escape of sir, laceration SHOTGUN WOUNDS Isa shoulder fired froarm having a barrel that is smooth-bored and is Intended for the fring of a changed compound of one or more balls or poets. Measure the distance between the two farthest shotipellets) 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: ‘+. Determination of the distance of the gun muzzle fram the vietin’s body whan fred. Usually not more than 24 inches when fred. 2. Determining whether a person has fred a firearm. ~ dorsum of the hand ‘metalic residues, burning and unburned gunpowder in suicide found in the palm Procedures in determining the presence of gunpowder: 4. Gross examination use of hand lens ~ Fine black powder ~ nol conclusive 2, Microscopic examination 3. Chemical test 4Tosts for the Prosonco of Powdor residues 1. On the skin ~ Dorsum of the hand or Wound of entrance Dermat nitrate test ( Paraffin test, Diphenylamine test, Lung’s test Gonzales’ tes!) melted paraffin heated at 150 degrees fahrenheit — Lung's reagent mall partclas with nitrate or nitrite > bive reaction ot conclusive: ferilizers, cosmetics, cigarettes, urine Negative is not conclusive: thorough washing 2. On clothings Walker's test ( C-acid test, H-acid test) = glassy photographic paper fixed in hyposolution for 20 min to Femove the sivar Salts and washed for 45 min, and dries. Tests for the presence of Primer Components ~ metalic primer residues like barium, antimony, and lead 4.Harrison and Gilroy test :Cotion swab moistened with 0.1 molar KCI to ‘gather the primar component. Reagent sodium thodisonate yields red color with the primer components, ‘Add 1.5 HCI to the red area> plue-violet or pink in lead or barium lacks specificity. sensitivity 2. Neutron Activation Analysis (NAA) = Sample obtained by paraffin or by washing with dlute acid Extremely sensitive, even with small quantity 3. Flameless Atomic Absorption Spectroscopy (FAAS) 4. Use of Scanning electron microscope with a Linked X-ray analyzer 5THERMAL INJURIES OR DEATHS ~ are thase caused by deviation from normal temperature, capable of producing ccallularor issue changes in the body. = Exposure to savere cold Frost bite ~ exposure to high temperature = burning scalding 4, DEATH OR INJURY FROM COLD. not common in the Philippines = Primary cause of death: Decrease dissociation of 2 from Hgh in the RBC Diminished power of the tissue to ullize 02 = Cold damp air is more fatal than cold dry ar. © Women aro more resistant to cold > groater daposis of SO fats. Effects of COLD: ‘A. Local effect ( Frostbite, Immersion foot, Trench foot) lanching, paleness of the skin due to vascular spasm, 2" Erthyma, edema, swelling due to vascular dilatation, paralysis and increased capillary permeabilly 3*~ Blister formation 4° — Necrosis, vascular occlusion, thrambosic and gangrono, Microscopically: Vacuolization, degeneration of epidermal cells Necrosis of the collage of the SA tissue Occlusion of the vessels due to clumping of RBC B. Systemic effects: = Reflex in nature due to the stimulation and paralysis of the nerves Pulmonary .Cardiac action is slowed down due tp corobral anoxia> resulting to lethargy, delirium, convulsions, coma or death. 2, DEATH OR INJURY FROM HEAT - effect may be local or general Classifications of Heat Injury a) General or Systemic effects: a1 Heat cramps 2.2 Hoat exhaustion 2.3 Hoat stroke ) Local effects at Scalding b2 Burns ermal namical Beciical igntning Raglation GENERAL OR SYSTEMIC EFFECT: death usually accidental 1, Heat cramps{ Miner's Camp, Firemans Camp, Stroker’s camp) 16= Involuntary s pasmodie painful contraction of muscles due to dehydration and excessive loss of chlorides by swoating Tee Fluids with chlorides 2, Heat Exhaustion ( Heat collapse, Syncopal Fever, Heat syncope, Heat prostration) Due to heart failure, cause:Heat precipitated by exerlion/watm clothes ddan syncope, face tums pale, dim vision = Te removal from the heated area 3. Heat stroke(Sunstroke,Heat Hyperpytexia,Comatous form,Thermic Fever) ~ Working in il-vertiated places with dry temperature or exposure to the sun LOCAL EFFECTS OF HEAT 4. Scald: Caused by hot liquid The injury by scalding snot severe as burns: a. Sealding liquid runs on the body surface ~ dis tibuting the heat b. Easily cools off ©. Temperature not as high except :olls and molten metals 2, Thermal burns: Caused by heat or chemical substances like fire, radiant heat, friction, solid substances, electricity, Classification of burns’ DUPUYTREN'S CLASSIFCATION 1 Degree ~arythema 2+” vesicle formation 34 destruction ofthe cuticle, part of trus skin, painful e whole skin is destroyed. ulceration, not painful 5* — — deep fascia, muscles 8 = charring of the limbs BURNS SCALDS 1, CAUSE Dry heat tame, hoated sats Moist Neat — feud, stoam acta Peat 2, LOCATION Ator above the site ofconiact Occurs at or below 3, SINGEING of hair is present Absent 4, BOUNDARY OF NORMAL Not clear Distinct 5, INJURY Severe Limited 6.CLOTHINGS Involved Not burned Proofs that the victim was ALIVE BEFORE burnod to DEATH: 4. Presence of carson patticles in the air passage, 2. Increase carboxy-hemaglobin blood level3. Dormal erythorra, edema and vesicle formation 4. Subendocardial left ventricular hemorrhage. BURNS ANTE-MORTEM BURNS POST MORTEM BURNS {BLISTERS Abundant albuminichlorides Scanty albuminichlorides 2.AREAOF — Aroundthe antemortem burn Absent INFLAMMATION 3, BASE OF Res Not much change in color THE VESICLE 4 TRACHEO- Particles of soa! or carbon No findings BRONCHIAL LUMEN 5, BLOOD ‘Abundance of carboxy Hab Absent itferential diagnosis of blisters: 4, Due to putrefaction — fluid content is blood stained watery fluid asso. with pulrefactive changes in ather parts of body. 2.Duetodisease —_- heat by the size, distribution 3. Due tofretion _- Hx of applicaton of heat 3, Chemical buns Characteristics of lesions: ‘a. Absence of vesication b. ‘Staining of tho ckin or clothing by the chemical '@, Presence of the chemical substance 4. Ulcerative patches of the skin Inflammatory redness of the skin surface 1. Delayed healing CHEMICAL BURNS THERMAL BURNS 4. BLISTERS, Absent Present 2. SKIN/CLOTHINGS Stained by chemicals No staining S.ANALYSIS OF Shows chemical cause of corrasion Absent 8‘SUBSTANCE 4, LESION Borders are distinct Diffused Characteristic lesions by different chemicals: 2, Sulphuric acid ( Oil of Vitriol) 108 intense action, considerable destruction Jcerations where acid fowed, clothings destroyed lackish-brown sloughs . Nitric acid Clothng is destroyed, trown = yeliow or yellowish brown slough ©. Hydrocloric acid 1 80 destructive itonse Iritation, localized uceration red or reddish-gray. d. Caustic soda and Potash ‘rrosive action on the tissues with bleached arpearance 4, Electrical burns - Contact burns, spark bums, Flash burns 5, Radiation bums ~ x-ray, UY light bums PHYSICAL INJURIES OR DEATH BY LIGHTNING AND ELECTRICITY htning — is an electrical charge from the atmosphere, “1 million volts/ 2000 amperes. Elements of lightning that produces injury: ~Diract effect from the electrical charge. Surface flash burns from the discharge - electrical into heat energy. Mechanical effect - expansion of air > laceration Compression offect — “sledgehammer blow ‘Spasmadic contraction of cerebral vessels > shock Elvetricity - main cause of death is shock Above 300 votts aro like the effect of lightning, Factors which influence the effect of electrical shock: Personal idiosyncracy — personal condition Disease — cardiac ds. Is prone Anticipation of shock - Can withstand Sleep — increases resistance Amperage or intensity ofthe electrical current — principal factor = 70-80 in AC and 250 in DC. 6. Resistance ct the body T. Nature of current — AC Is more dangerous 8. Earthing- shock is enhanced 8 1 Duration of contact 0. Point of entry ~ left more dangerous than the right Mechanism of death in electrical shock: 1 Ventricular flo — leads to rupture of muscle bors 2. Respiratory failure due to bulbar paralysis 3, Mechanical asphyxia due to vielent and prolonged convulsion. Metallization: - specific feature of electrical injury the metal of the conductor is volatiizad and particles of the metal are driven into the epidermis causing darkening af the skin Delayed effects of electrical injuries: Necrosis of the area develops into gangrene Damaged arteries becomes britle, Fable and liable to rupture Nervous injuries ~ retrograde amnesia, hemiplegia May enter the head > cataract DEATH OR PHYSICAL INJURIES DUE TO CHANGE AF ATMOSPHERIC PRESSURE ( BAROTRAUMA) Increase of atmospheric pressure ( Hyperbarism) -Normal atmosphere press ire at sea level is 760 millimeters of Ho. - Henry's Law =“ At constant temperature, the amount of gas di 2 liquid Is directly proportional to the pressure’ %0= As he goes daeper thoro wil bs an inerease in the amount ‘of gas dissolved in the blood and other body fluids. = Ifascent is made rapidly, the diver wil suffer from the effects of the sudden release of the gasses from the body fluids. = teleased of air bubbles in the circulation and act as emboll in diferent parts of the body causing interstital emphysema, pulmonary embolism, in big joints callod bands, Decrease of atmospheric pressure (Decompression) 1. Hypobarism — at high altitudes the atmospheric pressure is lower and more gas will be lberated by the body fluid = release of gasses resuils to ‘a) Bends — joint and muscular pain b) Chokes ~ Substemal distoss, non-productive coughing ¢) Substernal emphysema — 4) Trapped gas, 2. Anoxia- Hypoxia felt at 6000-15,000 feet level ~ Airotatts greater than 34,000 feet be provided with 02 AIRCRAFT INJURIES AND FATALITIES 4, During the fight 2) Alltuda: Hypobarism ( Decompression) ») Speed — spatial disorientation : sudden change of direction at a speed of 500 miles drains brain from blood to the lower parts> unconsciousness ¢) Toxins ~ CO, CO2 saturates cabin resulting to asphyxia 4) Temperature - At25,000 feet 40 degree below zera: frost bite freezing '2) Pre-existing disease ~ Coronary dis./Hpn fatal due to sudden change env. 2. During crash ~ fatalities oceur us. during take-off and landing, - Fx, Rupture of the heart due to empression. DEATH BY ASPHYXIA — Applied to all forms of violent death dus to interference with process of respiration = Corditians in which the supply of 02 to the blood or issues or both hhas been reduced below normal level Asphyxi ‘Types of asphyxial death: 1, Anoxic death Failure of arterial blood to be normally saturated with 02 due to: ‘a) Breathing in an atmosphere with insufficient O2- High altitude 8) Extornal obstruction of the air passage - traumatic crush asphyxia ©) Paralysis ofthe respiratory conter ~ poisoning, injury, anosthesia 4d) Mechanical interference of the passaga of ai- drowming, asthma ) Shunting of blood 2. Anemic anoxic death Decrease capacity of the blood to cary 02 due to Hge, CO poisoning, Low Hgb 3, Stagnant anoxic death Fallure of circulation dua to Heart failure, shock, arterial vonous obstruction 4,Histotoxie anoxic death Failure ofthe cellular oxidative process, cannot be utilized in the tissues. Cyanide Phases of asphyxial death: “.Dyspnole phase ~ Breathing is rapid and doop, PRinc., Riso of BP “due to lack of O2 and retention of COZ 2, Convulsive phase — Cyanosis more pronounced. pupi's diated, unconscious = Tardieu spots =petechia shges in the visceral organs ~ due to stimulation of CNS by COZ 3. Apnale phase — Breathing is shallow, gasping = Due to paralysis of respiratory center Classification of Asphyxia: 4. Hanging) 2. Sangulations: by igalure, manual strangulation, spl forms ~palmar 3. Suffocation: choking 4. Asphyxia by drowning 5. Asphyxia by pressure on the chest 6. Asphyxia by irespirable gasses A. ASPHYXIA BY HANGING ‘Not necessary the whole body is suspended: Pressure at side of neck Mechanism of death: Air passage is constricted by pressure of the rope { Compression of carotids, jugs, Sup. Laryng nerve> Cereb. anoxia Causes of death in hanging: ‘Simpio asphyxia by blocking the air passago. Congestion of the venous blood vessels in the brain Lack of arterial blood in the brain ‘Syncope due to pressure on the vagus and carotid sinus Injury in the spinal column Combination of the above,Hanging Is ante-mortom: 1. Redness or ecchymosis at tho site of ligature. 2. Ecchymosis of tne pharynx and opidlotts. 3. Line of redness or rupture of the intima of the carotid artery 4. Subpleural hges. B. ital reaction= princigal ertorion ASPHYXIA BY STRANGULATION - Tightened by force nat the weight HANGING STRANGULATION WITH LIGATURE. ‘.HYOID BONE Frequently injured ‘Frequently spared 2DIRECTION — Inverted V-shape Usually horizontal OF LIGATURE MARK 3.LIGATURE —Atlovel of Hyoid bone Below larynx LOCATION, 4. LIGATURE Deepest opposite the knot Uniform depth GROOVE 5. VERTEBRAL Frequently cbseved Not observed INUURY Manual strangulation or throttling: form of asphyxial death where the constricting force is the hand ._ASPHYXIA BY SUFFOCATION ~ Occlusion of air from the lungs by closure of air openings ‘oF obstruction of the air passageway from the external openings to the air sacs, ‘Smothering: =A form of asphyxial death cause by closing the external respiratory orifices. COvorlaying - most common in children : pressure of pilows Gagging - application of materials to prevent air to have access to mouth and nostils Plastic bag suffocationChoking- Form of suffocation by the Imgaction of F.B. in the respiratory passage. D._ASPHYXIA BY SUBMERSION OR DROWINING = Form of asphyxia where the nostrils and mouth has submerged in watery fluid Time required for death in drowning: = Submersion for 1 ¥% minutes considered fata ~ Average time requited for death in drowning is 2 to § minutos. Emergency treatment in Drowning 4. Schaefer's method-Face down, prone post on:operator exerts pressure in ribs 2. Syhester's method: Lying on his back, astide over body, swinging arms Post-mortem findings: 1. Extornal findings a) Wet clothes. pale face, F.8. clinging on skin surface ) “Cutis anserine” or "goose flesh” — skin's pale, contracted NOT Dxtie c] Washerwoman’s hands and feet - skin of hands & feet:bleached NOT Dxtic 4) Postmortem lividity ~ marked in the head, neck and chest f) Presence of fimly-clenched hands with objects - Person was alive at fest 1) Physical injures for struggle 4g) Suicidal drowning — Places of stone 2, Internal findings ‘A. RESPIRATORY SYSTEM 1. “Emphysema aquosum’” ~ Lungs are distended overlapping the heart Due to irritation made by the inhaled water on the mucous membrane of the air passage which stimulate the secretion of mucous, 2. "Edema aquosum’— Due-Entrance of water into airsacs, Lungs are doughy 3. *Champignon d’ocume” - whitish foam accumulates In the mouthinostrls Duo: abundance of mucous secretion = One of the indications that death was due to drowning. 4, Tracheo-bronchial lumen ~ congested, filed with froth 5. Blood stained fluid found inside chest cavity 6, Section lungs shows fluid with bloody froth oaB._ HEART 1. Both sides of hoart may be filed or emptied witn blood. 2. Salt water drowning — Blood chioride content is areater than loft sido. Fresh water- Blood chiorde is more I the right side. FRESH- RIGHT Gettler's Test: = Quaniitaive determination of the chloride content ofthe biood in the right and laftventrie of tie heart: Difference of at least 25 mg. c. STOMACH ~ Presence food in the stomach but absence of water.> Death is rapid or submersion made after death. Impossible for water to get into the stomach if body is submerged atter death. FINDINGS CONCLUSIVE THAT THE PERSON DIED OF DROWNING 1, The presenca of F.B. In the hands of the victim. ‘Tho clenching of the hands is a manifestation of cadaveric spasm in the offort cf the vietim to save himself trom drowning. 2. Increase in volume (emphysema aquosum) edema of the lungs ( edema aquosum) 3. Presence of water in the stomach 4. Presence of froth, foam, F.B. in the ar passage found in the medium where the victim was found, 5. Presence of water In the middle ear due to violent inspiration when the ‘mouth is full of water. Floating of the body in drowning: Within 24 H due to the decomposition which causes the accumulation of gas in the body, the body floats - Body is flexed bocauss of the dominance of the flexor muscles “"tete de negri” — bronze color of head and neck: face as the most dependent portion of the body, Homicidal D. = struggle, motive, articles found near the place, phys. injuries Suicidal D.= note, heavy objects, meniality, Hx of previous attempt Accidental = Absence of violence in the bady., exclusion of suicide, wilesses E. COMPRESSION ASPHYXIA ( TRAUMATIC CRUSH ASPHYXIA) - Fon of asphyxia where the free exchange of air n the lungs is prevented by the immobiity of the chest and abdomen due to external pressure or crush injury - Homicidal =offender kneels on the chest + Accidental = pinned between two big abjects ‘murder for the sale to medical schools Burking ~ invented by Burke and Har 8s- Knoels or sits on the chast and the hands close the mouth and nostris, Doath by crucifixion. alternative raising and lowering of the body loads to ‘exnaustion, unconsciousness and death from asphyxia = IC mm are stretched F. ASPHYXIA BY BREATHING IIRESPIRABLE GASES 4. Carbon monoxide “ silent killer, colorless, insolubie in water and alcoho! “formed by the incomplete combustion of carbon fuel Main action is 02 doprwvation Qualitative test for CO in the blood 1) Kunkels test ~ 4 volume of water + 3x its volume of 1% tannic acid “erimsan red if positive b) Potassium Ferocyanide test - bright red ¢) Spectroscope exam 4d) Gas chromatograph ©) Infra-red analysis 2, Carbon dioxide - C02, Carbonic acid gas = Blown out ofthe lungs during respiration + Product of complete combustion of carbon cantaining compounds + End result of fermentation & decomposition of organic matters.- saptic tank = The inhalation of pure CO2 may cause immediate vagal inhibition with spasm of the glottis and doath. = manhole, poorly ventiated rooms Tests for the presence of CO2 4, Barium nitrate — white precipitate of Barium carbonate with carbonic acid 2. siver nitrate — white ppt. of silver carbonate when carbonic acid is added 3. Hydrogen sulfide (H2S, Sulphurotted hydrogen ) = rotton ogg odor = Formed during decomposition process of organic substances containing sulphur - Causes titanic convulsion, delirium, coma, death 4, Hydrogen cyanide — one of the most toxic, rapid acting gas = Farmed by the addition of acid to potassium or sodium salt of cyanide = Found in plants; leaves of cherty laurel, bittar almond, kernels of common cherry, plum, peaches, ordinary bamboo shoots, certain al seed and beans ~ Contains AMYGDALIN which in tie prosence of water and natura eryzme EMULSIN is readily decomposed to HYDROCYANIC ACID, glucose and benzaldehyde. {60-20 mg of Hydrogen cyanide is fatal, death in 2 to 10 min, 5, Sulfur dioxide - Heavier than air, pungent odor ~ employed as disinfectant, bleaching agent, 86found in eruption of volcano WAR GASES Classification based on the physiological action 1. Lacrimator or Tear gas — causes iritation with copious flow of tears, 4) Chioracetphene (CA.P.) b) Bromoberzyl cyanide (B.B.C.) ¢) Eth! lodoacetate ( KS.K.) High concentration — iritation of respiratory passages, lungs, V.N 2, Vesicant of Blistering Gas ~ contact with skin cause bleb or bister formation 8) Mustard gas ( Dichiordiethy| sulfide, yellow cross, Yperte) bb Lewisite ( Chloroviny/-dichlorarsine) 3. Lung irritants ( Asphyxiant or choking gas) ~ Dysnea, tightnoss of the chost, coughing, coma , death 2 Chiorine ( Ci2) - yellowish green gas ') Phosgene (COCI2) ©) Chlorapicrn 4) Diphosgene Sternutator nasal irritants of vomiling gases Paralysants — Nerve gas - like organophos phates Blood poisons — CO, H2S, Hydrogen cyanide DEATH OR PHYSICAL INJURIES DUE TO AUTOMOTIVE CRASH OR ACCIDENT oan Factors responsible to an Automotive Crash A. HUMAN FACTOR ( DRIVER) Mental atitude: reckless driving, fatigue, inexperience Porcapive defect Delayed reaction time Disease Chemical factor ENVIRONMENTAL FACTOR “Poot visibility, poorly mainiained roads, rain, blind intersection 3, MECHANICAL FACTOR: Poor brake, worn out tres SOCIAL FACTOR: Speed, insurance PEDESTRIAN Injuries and Death on the Driver and Passengers: jon: the impact of the moving vehicle with another or xed object = The MOVING VEHICLE rapidly decelerates and stops after impact. ‘The dagree of damage depends: a) speed. b) part of vehicle invalved 72, Second collision: Impact of unrestrained occupants with the vehicie interior = ist Cal., Occupants move same drocton/velocity towards point of impact a) Front impact Occupants move forward. ) Side impact ( severe) > moves to the side that was involved in the 1% Col. >The passenger nearest to it will suffer the most. ©) Rear impact erash - Acceleration-deceleration injury or whiplash 4d) Roll over crash ( Turn turtle impact ) itvehicle Is not put into a stop after the 1* Col. > the unrestrained ‘occupants will continue to strike to some parts of the vehicle interior. Pedestrian-Vehicle Collision: Death or Physical Injuries to pedest 4.Plimary impact ~ Contact with vehicle 2. Secondary impaci ~ Subsequent impact of the pedestrian to the ground ‘Aceunts for tho rutile injuries 3, Run over Injuries 4, Hit and run Injuries 88