MEDICO LEGAL ASPECT OF INJURIES

FORENSIC 6F
(Forensic Medicine 1)

October 30, 2020

GROUP 4
ABAD, Josh
BALANGTO, Vivienne Jane F.
CRISTOBAL, Jed Orven (Leader)
GUADANA, Kurt Lennard
MABANSAG, Eunice N. (Dropped)
NAPADAO, Jethro Shane
PALANGYOS, Dave John
SEMON, Geraldine B.
SUPAN, Danielle Pamela R.
TAMI-ING, Nhilpher B.
BFSci-2A

Manner of Reporting: Pre-recorded Video

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MEDICO-LEGAL INVESTIGATIONS OF WOUNDS
 Rules to follow by a physician:
1. All injuries must be described
2. Description of wound must be comprehensive, sketched, or photographed
3. Examination must be influenced by any other information obtained from others in making a
report or a conclusion.
 Medico-legal investigation of physical injuries:
1. General investigation of the surroundings:
a. Examination of place where the crime is committed.
b. Examination of clothing, stains, cuts, hair, and foreign bodies in the crime scene.
c. Investigations on possible witnesses to the incident.
d. Examination of the wounding instrument.
e. Photography, sketching, or accurate description of the crime scene.
2. Examination of the wounded body
a. Examinations applicable to living or dead
 Age of the wound from the degree of healing.
 Determination of the weapon used.
 Reasons for the multiplicity of wounds.
 Determination if the wound is accidental, suicidal, or homicidal.
b. Examination applicable only to the living
 Determination if the injury is fatal.
 Determination if the injury will produce permanent deformity.
 Determination if the wound produces shock.
 Determination if the wound produces complications.
c. Examination applicable only to a dead victim
 Determination if the wound is pre-mortem or post-mortem.
 Determination whether the wound is mortal or not.
 Determination whether death is accelerated by a disease present at time of injury.
 Determination whether wound is cause by accidental, suicidal, or homicidal.
3. Examinations of Wound
a. Character of the Wound
 Abrasion
 Hematoma
 Laceration
 Contusion
 Incised Wound
 Stab Wound

b. Location of the Wound

 It should be from a fixed area.
 To facilitate reconstruction.
 To determine the trajectory or course of the wounding weapon inside the body.
c. Depth of the Wound

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  It is measurable if the outer wound and inner end is fixed.
 Exception: abdomen
d. Conditions of the Surroundings of the Wound
 Gunshot Wounds: contact fire of burning, tattooing
 Suicidal Cuts: superficial tentative cuts or hesitation cuts
 Lacerated Wounds: contusion on neighboring skin.
e. Extent of the Wound
 Extensive injury-marked degree of force applied in the production of the wound.
 Ex. Homicidal cut throats cases are deeper than in cases of suicide.
f. Direction of the Wound
 To determine the relative position of the victim and the offender.
 Ex. Incised wound
g. Number of Wounds
 Indicative of homicide or murder.
h. Conditions of Locality
 Degree of hemorrhage
 Evidence of struggle
 Information as to the position of the body
 Presence of suicide note or letter
 Condition of the weapon
 Determination Between Ante-Mortem and Post-Mortem Wounds

Ante-Mortem Wounds Post-Mortem Wounds

Hemorrhage
Signs of Inflammation
Signs of Repair
Retraction of the Edges
-More profuse, arterial due to -Slight or none, venous
loss of tone of vessels, -No spouting of blood
absence of heart action post- -Blood not clotted, or soft
mortem clotting of blood clot
inside blood vessels.
-Marks of spouting of blood
from arteries
-Clotted blood
-Inflammation and reparative -None
process.
-Swelling in the area,
effusion of lymph, pus
adhesion of the edges unless
if victim is weakened.
-Fibrin formation -No time of repair
-No time of repair growth of
epithelium scab or scar
formation
-Deep staining of the edges -Not deeply stained can be
and cellular tissues can be removed by washing.
removed by washing. -Edges do not gape but are
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 -Edges gape owing to the closely approximated to each
reaction of the skin and other unless if the wound is
muscle fibers. 1-2 hours after death.

 Determination if the wound is:

As to the Nature of Homicidal Suicidal Accidental

the Wound
Inflicted:
a. Abrasions -Not common unless -Rarely observed -Extensive abrasions
if dragged or if
victim resisted.
b. Contusions -Rarely observed, -Found in any
except if done by portion of the body,
jumping from a height. due to a fall and
forcible contact with
hard objects.
c. Incised Wounds -Commonly -Commonly observed -Frequent but rarely
observed in depth, cause of death. observed.
location and
surroundings.

 Points to consider in the determination as to whether the wound is accidental, suicidal, and
homicidal.
1. External signs and circumstances related to the position and attitude of the body when found.
2. Location of the weapon or the way it was held.
3. The motive in the commission of the crime.
4. The personal character of the deceased.
5. The possibility for the offender to have purposely change the truth of the condition.
6. Other information:
 Signs of struggle
 Number and direction of wounds
 Direction of wounds
 Nature and extent of the wound
 State of clothing
 Length of the time of survival of the victim after infliction of the wound
1. Degree of healing
 Signs of repair of wound appear in less than a day after the infliction of injury.
 The injured portion of the body undergoes chemical and physical changes.
 The capillaries are dilated, and edema develops at once.
 Migration of white cells from capillaries to damaged area.
 Fibroblasts begin to proliferate with formulation of the granulation tissues.
2. Changes in the body in relation to the time of death
 Systematic changes in the body.
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  Basis as to how long a person survived:
 Degree of the following:
o Wasting
o Anemia
o Condition of the face
o Bed sore formation
3. Age of the blood stain
 Physical color changes of the skin.
 It is not reliable.
4. Testimony of witness
 Actual eyewitness may testify to the exact time the wound was inflicted.
 Medical evidence is merely corroborative.

 Possible Instruments used by the Assailant in Inflicting the Injuries

Nature of Wound Wounding Instrument

1.Contusion Blunt Instrument
2. Incised Wound Sharp-edged Instrument
3. Lacerated Wound Blunt Instrument
4. Punctured Wound Sharp-pointed object
5.Abrasion Rough hard surface
6.Gunshot Wound The diameter of the wound of entrance may
approximate the caliber of the wounding
firearm.

 A physician can’t determine that a specific weapon was used in inflicting a wound.
 It is possible that it is caused by a certain instrument presented.
 A physician must be cautious in giving categoric statements.
 Which of the injuries sustained by the victim caused death?
o If with conspiracy, there’s no need because the act of one is act of all.
o If none, the offenders are only responsible for their individual act.
o If multiple injuries, which of the wound injured a vital organ or if same organ which caused the
degree of damage.
 Which of the wounds was inflicted first?
o If multiple for the qualification of the offense committed.
 First- treachery, murder

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  Last-Homicide
o Factors:
1. Relative position of the assailant and the victim when the first injury was inflicted on
the latter.
2. Trajectory or course of the wound inside the body of the victim.
3. Organs involved, and degree of injury sustained by the victim.
4. Testimony of witnesses.
5. Presence of defense wounds on the victims.
 Effect of Medical and Surgical Intervention on the Death
o The offender will still be held responsible if it can be proven that death may result even without
operation by physician.
o If the victims merely received minor wounds but death resulted on account of negligence of the
physician, the offender is free from liability. The latter will be responsible only to physical
injuries inflicted prior to such case.

 Effect of Negligence of the Injured Person to the Death

o If death occurred from complications arising from a simple injury owing to the negligence of the
injured person in its proper care and treatment, the offender is still responsible for the death.
o A person is not bound to submit himself to medical examination for the injuries received during
the assault.
o Unless if it is proven that the negligence of the victim is deliberate, so offender is not responsible
but only for physical injuries.
 Power of Volitional Acts of the Victim after Receiving a Fatal Injury
o Dying declaration, attempt to kill the offender after the first blow of the offender.
o Medical witness determines victim’s capacity to perform volitional acts.
o Fatal injuries which may not hinder to perform volitional acts:
 General Rule: Severe injury of the brain and cranial box produces unconsciousness, but
after a while the victim maybe capable of performing volitional acts.
 Wounds of the big blood vessels like carotid, jugular or aorta do not prevent the person
from exercising voluntary acts.
 Penetrating wound of the heart.
 Relative Position of the Victim and Assailant when Injury was Inflicted
o Location of the wound
o Direction of the wound
o Nature of instrument used in inflicting the injury
o Testimony of witness
 Extrinsic Evidences of the Wounds
o Evidences from the Wounding Weapon
 Position of the weapon – near or grasp by the victim
 Blood on weapon – maybe stained with blood
 Hair and other substances on weapon
o Evidences in the Clothing of the Victim
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  Soaked with blood-hemorrhage
 Gunpowder-distance
o Evidences Derived from the Examination of the Assailant
 Paraffin test
 Tears in clothing
 Blood stains
 Fingernails
 Degree of intoxication, mental condition, physical power
o Evidences Derived from the Crime Scene
 Condition of surrounding objects
 Amount of hemorrhage
 Identifying articles
 Wounding instrument
 Physical Injuries in the Different Parts of the Body
1. Head and Neck
 It should not be underestimated
 Bleeding from ears, nose, mouth, basal fractures
 It may have normal x-rays yet with severe head injury
 Factors influencing the degree and extent of head injuries:
i. Nature of the wounding weapon- the degree of violence applied depends on
the thickness of the scalp and the weight of the weapon.
ii. Intensity of the force-the intensity and heavy agent
iii. Point of impact-extensive in fractures of vaults at side or back
iv. Mobility of the skull at the application of force
 If head is mobile or free, the effect on the brain is due to shearing movement imparted
to the brain.
 It may produce contusion or laceration without fracture.
 If head is fixed and unsupported, jarring movement of the brain is absent, but the
fracture is extensive.
 Head injuries are classified as to the site of the application of force:
i. Direct or Coup injuries
ii. Indirect injuries or Contre-coup injuries
 Remote injuries-fall hitting buttock, basal fracture
 Locus Minoris Resistencia – injury in areas with less resistance
 Coup-contre-coup injuries – direct and indirect injuries
2. Wounds in the Scalp
 It is difficult to prevent the spread of infection.
 There is proximity of the scalp to the brain.
 There is free vascular connection between the structures inside and outside the brain.
 It is frequently difficult to determine the extent damage of the skull.
 Gunshot Wounds
 Death or physical injuries brought about by powdered propelled substances:

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 1. Firearm shot – The injury is caused by the missile propelled by the explosion of the
gunpowder located in the cartridge shell and the rear of the missile.
2. Detonation of high explosives – this are grenades, explosion inside the metallic
container will cause fragmentation of the container.
 Firearm Wound
 Firearm – It is an instrument used for the propulsion of a projectile by the expansive force of
gases coming from the burning of gunpowder.
- It includes rifles, muskets, shotguns, revolvers, pistols, other deadly weapons which a
bullet, a ball, shell or other missile may be discharged by means of gunpowder or other
explosives.
-It includes air rifles except of small calibers and limited range.
-The barrel of any firearm shall be considered as a complete firearm for all purposes
thereof.
 Penal Provisions of Laws Relative to Firearm:
 Sec. 2692 RAC- Unlawful manufacture, dealing in acquisition, disposition or possession of
firearms or ammunitions therefore or instrument used or intended to be used in the manufacture
of firearms or ammunition.
 Sec. 2690 RAC- Selling of firearms to unlicensed purchaser.
 Sec. 2691 RAC- Failure of personal representative of deceased licensee to surrender firearm.
 Art. 155 RPC – Alarms and Scandals
 Art. 254 RPC – Discharge of firearms
 Classification of Small Firearms:
 Small firearms – It propel projectile of less than 1 inch in diameter.
1. As to Wounding Powder
 Low velocity firearm, the muzzle velocity of not more than 1400 ft. per second.
Example: revolver
 High power firearm, the muzzle velocity is more than 1400 ft. per second. The
usual is 2200-2500 ft. per second or more.
2. As to nature of the bore:
 Smooth bore weapon, inside portion of the barrel that is perfectly smooth from
the firing chamber to the muzzle. Example: Shotgun
 Rifled bore firearm, the bore of the barrel with several spiral lands and grooves
which run parallel with one another but twisted spirally from breech to muzzle.
Example: Military rifle
3. As to manner of firing
 Pistol – fired with a single shot. Example: revolver
 Rifle – may be fired from the shoulder. Example: Shotgun
4. As to the nature of the magazine
 Cylindrical revolving magazine, the cartridge is in a cylindrical magazine which
rotates at the rear portion of the barrel. Example: revolver
 Vertical or horizontal magazine, the cartridge is held one after another
vertically or horizontally and held in place by spring side to side or end to end.
Example: automatic pistol
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  Types of small firearms which are medico-legal interest:
 Revolver – usual muzzle velocity is 600 ft. per second
 Automatic Pistol- self-loading firearm, muzzle velocity of 1200 feet
 Rifle- muzzle velocity of 2500 ft. per second and a range of 3000 ft
 Shotgun- projectile is a collection of pellets
 A weapon in order to cause injury must have two principal component parts:
 Cartridge or ammunition – bullet primer, cartridge case, powder charge
 Firearm- instrument for the propulsion of a projectile force of gases from a burning powder
ENTRANCE WOUND EXIT WOUND

-It appears to be smaller than the -Always bigger than the missile
missile
-Owing to the elasticity of the tissue
-Edges are inverted -Edges are everted

-Usually oval or round depending -Does not manifest any definite the
upon the bullet shape angle of approach

-Contusion collar or contact ring is -Absent

present due to invagination of the
skin and spinning of the missile
-Tattooing or smudging maybe -Absent
present when firing is near

-Underlying tissues are not -Underlying tissues maybe seen

protruding protruding from the wound

-Always present after fire -Maybe absent, if missile is lodged

in the body

-Paraffin test maybe positive -Negative

 Instances when the size of the wound of entrance do not approximate the caliber of the firearm
 In distant fire, the rule is that the diameter of the gunshot wound of entrance is almost the same
as the caliber of the wounding firearm except:
1. Factors which make the wound of entrance bigger than the caliber:
a. In contact or near fire
b. Deformity of the bullet which entered
c. Bullet might have entered the skin sidewise
d. Acute angular approach of the bullet
2. Factors which make the wound of entrance smaller than the caliber:

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 a. Fragmentation of the bullet before penetrating the skin
b. Contraction of the elastic tissues of the skin
 Other evidences or findings used to determine entrance of gunshot wound
 Examination of the clothing, if involved in the course of the bullet
1. Fabric shows punch in destruction
2. Particle of gunpowder
 Examination of the internal injuries caused by the bullet
1. Bone fragments, cartilage, soft tissues are driven away from entrance wound.
2. Destruction of the bone is oval, with sharp edges at the exit it is irregular, bigger and
beveled.
 Testimony of the witness
 Determination of the trajectory of the bullet inside the body of the victim
1. External examination
a. Shape of the wound of entrance
 When bullet is fired at right angle with skin, the wound of entrance is circular
except in case of near fire.
 If fired at another angle, it is oval.
 When the bullet is deformed no such characteristics findings will be observed.
b. Shape and distribution of the contusion collar
 Contusion collar is widest at the side of the acute angle of approach of the bullet.
 If the bullet hits the skin perpendicularly, collar will have a uniform width
around the gunshot wound except when bullet is deformed or in near fire.
c. Difference in level between the entrance and exit wounds
d. By probing the wound of entrance, not with too much force
2. Internal examination
a. Actual dissection and tracing the course of the wound at autopsy.
b. Fracture of bones and course in visceral organs.
c. Location of bone fragments and lead particle.
3. Other evidences to show trajectory
a. Relative difference in the vertical location of entrance and exit in the clothing.
b. Relative position and distance of the assailant from the victim in the reconstruction of re-
enactment of the crime.
c. Testimony of witness
 Exit Wounds or Offshoot Wound
o Does not show characteristic shape unlike the entrance wound due to the absence of external
support beyond the skin so the bullet tends to tear or shatter the skin.
o Shored gunshot wound of exit: if pressed on a hard object like when victim is lying, wound of
exit is circular or nearly circular with abrasion.
 Odd and even Rule in Gunshot Wound
o If the number of entrance and exit wound is even so presumption that no bullet is lodge in the
body
o How to determine the number of fires made by the offender:
 Determination of the number of spent shells.
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  Determination of entrance wounds in the body of the victim. Number of entrance wounds
may not show the exact number of fires:
a. Not all fire made may hit the body of the victim
b. The bullet may in the course of its flight hit a hard object thereby splitting it and
each fragment may produce separate wounds of entrance.
c. Bullet may have perforated a part of the body and then made another wound in
some other parts of the body.
 Number of shots heard by the witness
 Instance when the number of GSW of entrance is less than the number of GSW of exit in the body
of the victim:
1. A bullet might have entered the body but split into several fragments, each of which
made separate exit.
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 a common entrance
and later making individual exit wounds.
4. In near shot with a shotgun, the pellets might 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 victim:
1. When one or more of the bullets is not through and through and the bullet is lodged in the
body.
2. When all the bullets produce through and through wounds but one or more made an exit
in the natural orifices of the body.
3. When different shots produced different wounds of entrance, but two or more shots
produce a common exit wound.
 Instances when there is no GSW of exit, but the bullet is not found in the body of the victim:
1. When the bullet is lodge in the GIT and expelled through the bowel or lodge in the
pharynx and expelled through the mouth.
2. Near fire 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
deflected to have the wound of entrance as the wound of exit.
 Ante-mortem gunshot wound (hemorrhage, swelling, vital reaction)
o Microscopically: congestion and leucocytic infiltration.
 Problems confronting Forensic Physician in the identification of gunshot wound:
1. Alteration of the lesion due to natural process: drying of wound, infection, and healing
process.
2. Medical and surgical intervention refers to clinical record of patient.
3. Embalming
4. Problems inherent to the injury itself.
5. X-ray examination and migratory, external souvenirs.
 Examination of the external wearing apparel of the victim of gunshot wound may be significant in
investigation because:
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 1. It may establish the possible range of the fire:
a. Contact fire
 Tear in the clothing covering the skin, fibers turn outward away from the
body.
 Soot deposit, gunpowder tattooing, burning of fibers around the turned fiber.
 Muzzle imprint
 Dirt and greasy deposit may be wipe out and visible in the torn clothing.
b. Not contact but near shot
 Same with contact fire except for absence of muzzle imprint and beyond
flame range.
c. Far fire
 There is a whole tear with inward direction of the thread.
2. It may be useful in the determination as to which is the point of entry and of exit of the
bullet. Entry- the fiber is inverted.
3. It may be useful in locating the bullet.
 Special Consideration on Bullets
1. Souvenir Bullet – a bullet that remains embedded in the body for a long time.
2. Bullet Migration -
3. Tandem Bullet – When two projectiles are expelled from a firearm barrel in a single pull of the
trigger.
 Evidences Showing that the Gunshot Wounds maybe Suicidal
1. Shot fired in a closed locked room, or open uninhabited place.
2. Death open near the place the victim was found.
3. Shot fired with the muzzle of the gun in contact with the part of the body involved.
4. Location of entrance wound accessible part of the body.
5. Shot usually solitary.
6. Direction of fire is compatible with the trajectory of bullet.
7. Personal history my reveal social, economic, business or marital problem which cannot be
solved.
8. Gunpowder presence in the hand of the victim.
9. Entrance wound usually does not contain clothing.
10. Fingerprints of victim on the butt.
11. Suicide note at the vicinity
12. No disturbance in the place of death.
 Russian roulette – unfortunate victim has no pre-determined desire of self-destruction.
 Evidences that Gunshot Wound is Homicidal
1. Site of the wound of entrance has no point of election.
2. Fire is made when the victim is a t some distance.
3. Signs of struggle or defense wounds.
4. Disturbance in the surroundings.
5. Wounding firearm usually not found in the scene of the crime.
6. Testimony of witness.
 Evidences to Show that Gunshot Wound is Accidental
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 1. Usually one shot.
2. No special area of body involved.
3. Consideration on the testimony of the assailant and determination as to whether it is possible by
knowing the relative position of the victim.
4. Testimony of the witness.
 Points to be Considered and Included in the Report of the Physician
1. Complete description of the wound of entrance and exit.
2. Location of the wound; part of the body involved, distance of wound from midline, distance of
wound from heel or buttock.
3. Direction and length of the bullet track.
4. Organs or tissues involved in its course.
5. Location of the missile, if lodged in the body.
6. Diagram: Photograph, sketch or drawing showing the location and number of wounds.
 Questions that a Physician is Expected to Answer in Court
1. Could the wound be inflicted by the weapon presented to him?
2. At what range was it fired?
3. What was the direction of the fire?
4. Is it self-inflicted?
5. Are there signs of struggle?
6. Did the victim die instantaneously?
7. Is it possible for the victim to fire or resist the attack after the injury was sustained?
8. Where was the position of the assailant and the victim when the shot was fired?
 The caliber may be inferred from the diameter of the wound of entrance.
 Determination of the length of survival of the victim:
1. Nature of gunshot wound.
2. Organs involved
3. Presence or absence of infection
4. Amount of blood loss
5. Physical condition of the patient
 Capacity of a victim to perform volitional acts depends upon the area of the body involved, involvement
of vital organs and the resistance of the victim.
 Determination as to the Length of Time a Firearm had been Fired
1. 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. The location of the empty shells, in the revolver the empty shells are found in the cylindrical
magazine chamber after the fire.
2. Nature of the spent shell and automatic firearm, the bullet is copper jacketed.
3. The nature of the base of the cartridge or spent shell, the base of a revolver has a wider diameter
than that of the cylindrical body to keep the cartridge stay in the magazine chamber.
 It may be possible for a person who is accustomed to the sounds of firearms of different calibers to
identify the firearm by the sound produced.
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 It is not possible to determine the direction of the shot by determining the direction of the sound except
when the flash or the person firing the shot is seen at the time the shot was fired.
 Gunshot Wound may not be a near fire or may not appear to be near fire:
1. When a device is set up to hold the firearm and to enable it to be discharged at a long range by
the victim.
2. When the gunshot wound of entrance does not show characteristics of a near shot because the
clothing is 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 product of a near shot has been washed out of the wound.
 X-ray
 Facilitate the location and extraction of the wound.
 Reveals fragmentation and its location.
 Shows bone involvement like fracture.
 Reveal trajectory of the bullet.
 Shows effect of the bullet wound, like hemorrhage, escape of air, laceration.
 Shotgun Wounds
 Is a shoulder fired firearm having a barrel that is smooth-bored and is intended for the firing of a
changed compound of one or more balls or pellets?
 Measure the distance between the two farthest shot (pellets) 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:

o Importance
1. Determine of the distance of the gun muzzle from the victim’s body when fired. Usually
not more than 24 inches when fired.
2. Determining whether a person has fired a firearm, dorsum of the hand. The metallic
residues, burning and unburned gunpowder. In suicide, it is found in the palm.
 Procedure in determining the presence of gunpowder:
1. Gross examination use of hand lens and fine black powder are not conclusive
2. Microscopic examination
3. Chemical Test
 Test for the Presence of Powder residues
1. On the skin – Dorsum of the hand or Wound of entrance
Dermal nitrate test (paraffin test, Diphenylamine test, Lung’s reagent)
- Melted Paraffin heated at 150 degrees Fahrenheit- Lung’s reagent
- Not conclusive: fertilizer cosmetics, cigarettes, urine
- Negative is not conclusive: thorough washing
2. On clothing
-Walker’s Test (C-acid test, H-acid test)
-Glossy photographic paper fixed in hypo solution for 20 min to remove
the silver salts and washed for 45 min. and dries.
 Tests for the presence of Primer Components + metallic primer residues like barium, antimony,
and lead.
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 1. Harrison and Gilroy test: cotton swab moistened with 0.1 molar HCI to gather the
primer component.
- Reagent sodium rhodizonate yields red color with the primer components. Add
1.5 HCI to the red area, blue-violet or pink in lead or barium.
- lacks specificity, sensitivity
2. Neutron Activation Analysis (NAA)
- Sample obtained by paraffin or by washing with dilute 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

MEDICOLEGAL ASPECT OF THERMAL INJURIES

 THERMAL INJURY is defined as tissue injury due to application of heat in any form to the external or
internal body surfaces This destruction can occur from thermal energy, chemical reactions, electricity, or
the response to cold.
 GENERAL CLASSIFICATION OF THERMAL INJURIES
1. DRY HEAT- flame
- CHARACTERISTICS OF DRY HEAT:
-Does not bleed
- hard to touch
-very painful
-coagulated and roasted patches area
-burnt cloths
2. MOIST HEAT- scalds
-liquids (pressure steam at high temperature
-erythema
-extensive vesication of large sizes
-no deposit of carbonaceous material
-skin and mucosa blister
3. COLD INJURIES
4. CHEMICALS- corrosives
-strong acids/alkalis
-destroying texture of tissue
-vitriolize
5. ELECTRIC CONTACT
6. RADIATION BURNS- x-rays, ultraviolet rays
 DEATH OR INJURY FROM HEAT - effect may be local or general

CLASSIFICATIONS OF HEAT INJURY:

a) General or Systemic effects:
a.1 Heat cramps
a.2 Heat exhaustion
a.3 Heat stroke

15
 b) Local effects:
b.1 Scalding
b.2 Burns
 Thermal
 Chemical
 Electrical, lightning
 Radiation

GENERAL OR SYSTEMIC EFFECT: death usually accidental

1. HEAT CRAMPS (Miner’s Camp, Fireman’s Camp, Stroker’ s camp)
- Involuntary spasmodic painful contraction of muscles due to dehydration and excessive loss of
chlorides by sweating; depletion of salt is main cause. Ex. Fluids with chlorides
2. HEAT EXHAUSTION (Heat collapse, Syncopal Fever, Heat syncope, Heat prostration)
- Due to heart failure, cause: Heat precipitated by exertion/warm clothes
-Sudden syncope, face turns pale, dim vision
-pulse is weak, rapid
- respiration is shallow
-low blood pressure
-temperature may or may not rise
- death results from heart failure
Treatment: rehydration, salt supplements, shifting to cooler environment
3. HEAT STROKE (Sunstroke, Heat Hyperpyrexia,Comatous form,Thermic Fever)
- Working in ill-ventilated places with dry temperature or exposure to the sun

LOCAL EFFECTS OF HEAT

1. SCALD
- Caused by hot liquid
- The injury by scalding is not severe as burns:
a. Scalding liquid runs on the body surface ± distributing the heat
b. Easily cools off
c. Temperature not as high except: oils 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 CLASSIFICATION

FIRST DEGREE erythema

SECOND DEGREE vesicle formation

THIRD DEGREE destruction of the cuticle, part of the skin, painful

FOURTH DEGREE whole skin is destroyed, ulceration, not painful

16
 FIFTH DEGREE deep facia, muscles

SIXTH DEGREE charring of the limbs

BURNS SCALDS

CAUSE Dry heat- flame. Heated sold radiant Moist heat-liquid, steam
hear

LOCATION At or above the site of contacts Occurs at or below

SINGEING Of hair is present absent

BOUNDARY OF Not clear distinct

NORMAL

INJURY severe Limited

CLOTHINGS involved Not burned

 PROOFS THAT THE VICTIM WAS ALIVE BEFORE BURNED TO DEATH:

1. Presence of carbon particles in the air passage.
2. Increase carboxyhemoglobin blood level
3. Dermal erythema, edema and vesicle formation.
4. Subendocardial left ventricular hemorrhage.

BURNS ANTE-MORTEM POST-MORTEM BURNS

BURNS

AREA OF Around the antemortem absent

INFLAMMATION burn

BASE OF THE VESICLE red Not much change in color

DIFFERENTIAL DIAGNOSIS OF BLISTERS:

1. Due to putrefaction - fluid content is blood stained watery fluid associated with putrefactive changes
in other parts of body.
17
 2. Due to disease - heat by the size, distribution
3. Due to friction - history of application of heat
3. CHEMICAL BURNS
- heat by the size, distribution
- Chemical burns are injuries to the skin, eyes, mouth, or internal organs caused by contact with a
corrosive substance. They may also be called caustic burns.
Chemical Burn Causes and Risk Factors
Most chemicals that cause burns are either strong acids or bases. A glance at the medical information on
the labels of dangerous chemicals confirms the expected toxicity. Commonsense precautions and consumer
education can reduce your family's risk of injury. A variety of household products can cause chemical burns,
including:
 Ammonia
 Battery acid
 Bleach
 Concrete mix
 Drain or toilet bowl cleaners
 Metal cleaners
 Pool chlorinators
 Tooth-whitening products
- Infants and older people are most at risk for burns. Chemical burns tend to happen to:
 Young children exploring their environments who get their hands on something dangerous
 People whose jobs put them in contact with chemicals
 Signs and symptoms of chemical burns include the following:
 Redness, irritation, or burning at the site of contact
 Pain or numbness at the site of contact
 Formation of blisters or black dead skin at the contact site
 Vision changes if the chemical gets into your eyes
 Cough or shortness of breath
- Tissue damage from chemical burns depends on several things, including:
 The strength or concentration of the chemical
 The site of contact (eye, skin, mucous membrane)
 Whether it's swallowed or inhaled
 Whether or not skin is intact
 How much of the chemical you came into contact with duration of exposure
 How the chemical works
-In serious cases, the following can be developed:
 Low blood pressure
 Faintness, weakness, dizziness
 Shortness of breath
 Severe cough
 Headache
 Muscle twitching or seizures
 Irregular heartbeat

18
  Cardiac arrest
- Chemical burns can be very unpredictable. Death from a chemical injury, although rare, can happen.
Chemical Burn Complications
- Serious chemical burns can cause long-term complications:
 Many people have pain and scarring.
 Burns in the eye can lead to blindness.
 Swallowing harmful chemicals can lead to problems in your gastrointestinal tract, potentially leading to
permanent disability.
 Some acid burns can cause the loss of fingers or toes.
 Burns can cause emotional issues including anxiety, depression, and insomnia.
LESION - a region in an organ or tissue which has suffered damage through injury or disease, such as a wound,
ulcer, abscess, or tumor.

CHARACTERISTICS OF LESIONS:
a. Absence of vesication
b. Staining of the skin or clothing by the chemical
c. Presence of the chemical substance
d. Ulcerative patches of the skin
e. Inflammatory redness of the skin surface
f. Delayed healing

CHEMICAL BURNS THERMAL BURNS

BLISTER absent present

SKIN/CLOTHINGS Stained chemicals No staining

ANALYSIS OF SUBSTANCE Shows chemical corrosion absent

LESION Borders are distinct diffused

CHARACTERISTICS OF LESIONS BY DIFFERENT CHEMICALS:

a. Sulfuric Acid (Oil of Vitriol)
 most intense action, considerable destruction
 ulcerations where acid flowed, clothing destroyed
 blackish-brown sloughs
b. Nitric Acid
 Clothing is destroyed, brown
 yellow or yellowish-brown slough
c. Hydrochloric Acid
19
  not so destructive
 intense irritation, localized ulceration red or reddish-gray.
d. Caustic soda and Potash
 Corrosive action on the tissues with bleached appearance

4. ELECTRICAL BURNS - Contact burns, spark burns, Flash burns

5. RADIATION BURNS - x-ray, UV light burns

-also called Radiation Dermatitis, is a common side effect of radiation therapy. It is condition in
which the skin of the treated area becomes red and irritated and it occurs to some degree in most patients who
undergo radiation therapy. Radiation kills not only cancer cells, but also some of the healthy cells. This causes
the skin to peel. Damage to the skin can occur within 1 to 2 weeks of treatment and usually resolves itself over
time once the treatment period is complete.

SYMPTOMS OF RADIATION DERMATITIS

 hair loss, dry or wet peeling skin (desquamation)
 decreased sweating
 edema
 ulcerations
 bleeding
 skin cell death
 The extent of the symptoms depends on the total radiation dose, the size of the area treated, cellular
fractionation, and the type of radiation used. In severe radiation burn cases, the cancer treatment must be
discontinued until the skin heals. However, discontinuing therapy can compromise treatment.

AGE OF BURN
o immediately redness
o 2-3 hours, vesicaton
o 36-72 hrs, purculent inflammation
o 1-2 weeks sloughing
o after 2 weeks, granulation tissue formation
o end result, scar formulation
POSTMORTEM FINDINGS
 External appearances:
 skin blackening
 shortening of muscles
 pugilistic attitude
 skin splits
 presence of burnt material
 distribution of burns on clothes
 presence of smell
 burnt areas (blister)
 Internal appearances
20
  marked pallor of lover and kidney
 dry and cooked muscles
 dry and coagulated blood
 soot particles in air passages
 curling ulcers
 heat fractures, heat hematoma
DEATH FROM BURN
-Surface area involved is more than one third of total body surface
GENERAL EFFECT
o PRIMARY SHOCK due to fear or pain
o SECONDARY SHOCK due to hypovolemia
TOXEMIA
o SEPTICEMIA
o ASPHYXIA- due to inhalation of smoke, CO AND CO2
o CYANIDE INTOXICATION
o FAT EMBOLISM
MEDICOLEGAL IMPORTANCE
o mostly accidental
o suicidal occasionally
o homicidal
o concealment of crime
ANTEMORTEM BURN
o vital reaction
o soot particles

DEATH OR INJURY FROM COLD

Hypothermia is a medical emergency that occurs when your body loses heat faster than it can produce
heat, causing a dangerous low body temperature. Normal body temperature is around 96.8F(37 C). Hypothermia
occurs as your body temperature falls below 95 F (35 C).
The relatively constant temperature of the human body is maintained by both the thermoregulatory
system and adaptive behavior. Heat produced by the body must equal heat lost or illness due to thermal stress
will occur. Autopsy findings in heat -related and cold-related deaths frequently are not diagnostic. Determining
that a death was temperature- related requires information about the environment, the death scene, and the
victim's medical history.

 Not common in the Philippines

 Primary cause of death: Decrease dissociation of O2 from HGB in the RBC
 Diminished power of the tissue to utilize O2
 Cold damp air is more fatal than cold dry air.
 Women are more resistant to cold > greater deposits of SQ fats

Effects of cold
A. Local effect (Frostbite, Immersion foot, Trench foot)
21
 1st-blanching, paleness of skin due to vascular spasm.
2nd – erythema, edema, swelling due to vascular dilatation, paralysis and increased capillary
permeability
3rd – Blister formation
4th – Necrosis, vascular occlusion, thrombosis and gangrene.
Microscopically: Vacuolization, degeneration of epidermal cells
-Necrosis of the collage of the SQ 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 to cerebral anoxia, resulting to lethargy,
delirium, convulsions, coma or death.

PHYSICAL INJURIES OR DEATH BY LIGHTNING OR ELECTRICITY

 Lightning – it is an electrical charge from the atmosphere.
- 1 million volts / 200 amperes
 Elements of lightning that produces injury:
1. Direct effect from the electrical charge.
2. Surface flash burns from the discharge, electrical into heat energy.
3. Mechanical effect – expansion of air > laceration
4. Compression effect – Sledgehammer blow
 Spasmodic contraction of cerebral vessels, shock
 Electricity – main cause of death is shock.
-Above 300 volts are like the effect of lightning.
 Factors which influence the effect of electrical shock:
1. Personal idiosyncrasy – personal condition
2. Disease – cardiac disease is prone
3. Anticipation of shock – can withstand
4. Sleep – increases resistance
5. Amperage or intensity of the electrical current – principal factor.
- 70-80 in AC and 250 in DC
6. Resistance of the body
7. Nature of current, AC is more dangerous
8. Earthing – shock is enhanced
9. Duration of contract
10. Point of entry – left is more dangerous than the right
 Mechanism of death in electrical shock:
1. Ventricular fib – leads to rupture of muscle fibers
2. Respiratory failure due to bulbar paralysis.
3. Mechanical asphyxia due to violent and prolonged convulsion.
 Metallization: Specific feature of electrical injury particles of the metal are driven into the epidermis
causing darkening of the skin.
 Delayed effects of electrical injuries:
22
 o The metal of the conductor is volatilized, and necrosis of the area develops into gangrene.
o Damaged arteries become brittle, friable, and liable to rupture.
o Nervous injuries – retrograde amnesia, hemiplegia
o May enter the head, may cause cataract.

DEATH OR PHYSICAL INJURIES DUE TO CHANGE OF ATMOSPHERIC PRESSURE

(BAROTRAUMA)
As a general rule, when a person goes deeper in a body of water his atmospheric pressure increases and
as he ascends higher in the atmosphere it decreases.

INCREASE OF ATMOSPHERIC PRESSURE (Hyperbarism)

HENRY’S LAW
“At constant temperature, the amount of gas dissolved in a liquid is
directly proportional to the pressure.” This explains why as the diver goes deeper
his atmospheric pressure increases.
As he goes deeper there will be an increase in the amount of gas
dissolved in the blood and other body fluids.
The longer the diver remains under pressure the greater degree of gas
saturation of tissue which requires time for decompression. Which may cause
nitrogen narcosis preceded by a feeling of euphoria.
The diver may also suffer from the following:
1. Cerebral anoxia due to a prolonged stay under water
2. Muscular cramp;
3. Physical injuries in the process of diving and hitting hard objects;
4. Injuries caused by aquatic animals;
5. Effects of the changes of atmospheric pressure in a pre-existing disease like hypertension or
coronary affection.
If ascent is made rapidly, the diver will suffer from the effect of
sudden release of the gasses from the body fluids. Causing interstitial emphysema
in the chest, neck, and face and also pneumothorax and pulmonary air embolism.
Release of air bubbles in the circulation and act as emboli in different parts of the body causing
interstitial emphysema, pulmonary embolism, in big joint called bends. The affected areas cause ischemia,
pruritus and can even be fatal if it lodges in the vital of liver.

Post-Mortem Findings:
1. If death has been immediate
- Subcutaneous emphysema, generalized visceral congestion and the presence of gas bubbles
- Extra-vascular bubbles and hemorrhages in adipose tissues, like the
mesentery and tomentum
2. If death occurred after a lapse of several days
- Degeneration and softening of the white matter of the spinal cord
- Fat necrosis of the liver
- Osteonecrosis
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DECREASE OF ATMOSPHERIC PRESSURE (Decompression)
1. Hypobarism- at a higher altitude the atmospheric pressure becomes lower and more gas will be
liberated by the body fluid. The release of gases from the body fluid will cause:
a. Bends – joint and muscular pain due to the presence of air bubbles
b. Chokes – substernal distress, a non-productive coughing and
respiratory distress which is a result of bubble formation in the
pulmonary capillaries or effects of extravascular mediastinal bubbles
exerting pressure on the mediastinal contents and adjacent
pulmonary tissue
c. Substernal emphysema – accumulation of bubbles underneath the
skin and is observed as a crepitation on palpation of the skin
d. Trapped gas – may result in the doubling of the size of hollow viscus,
like the stomach and intestine at 18,000 feet level. Expansion of the
size of the stomach may cause diaphragmatic herniation.
2. Anoxia- at higher altitude the oxygen content of the atmosphere becomes lesser and lesser. Hypoxia
will be felt between 8,000 to 15,000 ft. level and flying beyond 34,000 ft. level must be provided with oxygen.

AIRCRAFT INJURIES AND FATALITIES

1. During Flight
a) Altitude: Hypobarism (Decompression)
b) Speed- spatial disorientation; sudden change of direction from speeds of 500 miles per hour
drains the blood from the brain which eventually causes unconsciousness in prolonged periods of time
c) Toxins like CO, CO2 saturates the cabin resulting or leading to asphyxia
d) As for Temperature, at about the altitude of 25,000 feet, expect that it is fairly freezing at 40
degrees Celsius below zero which can give you frostbite, at any normal day that is.
e) Pre-existing ailments which endangers the chances of you taking off in an aircraft or may even
cause your own life, such examples are COPD (Chronic Obstructive Pulmonary Disease), high blood
pressure or the history you have on strokes. Ailments like these can change or worsen given the right
circumstances like the changes in the environment etc.
2). During Crash: Fatalities that occur during take-off and landing
-Examples such as rupture of the heart due to compression, stroke, unconsciousness leading to a more
fatal outcome, and severe blows like fractures, or maybe even detached limbs in some freak happening.

ASPHYXIA
 It is the failure or disturbance of the respiratory process brought about by the lack or insufficiency of
oxygen in the brain. The unconsciousness that results sometimes leads to death.
 It is a term literally meaning absence of the pulse in Greek, has come to be used in forensic medicine for
events, and particularly deaths, where there has been deprivation of oxygen.
 It may occur where an environment is deprived of oxygen, when the term suffocation is best used, by
mechanical asphyxiation and chemical asphyxiation.
Asphyxia and its types
Effective Respiration depends on the combination of three critical elements:

24
 1. An open and patent airway
2. A functional muscular pump or bellows system to achieve airflow in and out of lungs
3. An adequate gas exchange between the alveoli of the lungs and the pulmonary vascular system

1. Mechanical Asphyxia
a. Smothering
A form of asphyxia caused by mechanical occlusion of external air passages, which include the
nose or mouth by hand, cloth, plastic bag or any other material.
b. Choking
A form of asphyxia caused by mechanical occlusion of the lumina of the air passages by a solid
object. (Café coronary)
c. Throttling
Throttling is the manual strangulation
d. Strangulation
 By hands (throttling)
 By ligature
 By hanging

General Causes of Hypoxia

1. Absence/reduction of oxygen in general atmosphere (suffocation) e.g. plastic bags, well, gutter, tank, etc.
2. Closure of external respiratory orifices i.e. mouth and nose (smothering, gagging)
3. Obstruction of internal respiratory passages at:
1. Pharynx –choking due to foreign body, laryngeal edema, food bolus, hemorrhages, dentures
2. Trachea –throttling, strangulation, mugging
3. Bronchi –aspiration, drowning
4. Restriction of respiratory movements
5. Trauma
6. Paralysis
7. Drugs
8. Diseases of lungs
9. Cardiac failure
10. Blood disorders –anemia
11. Carbon monoxide poisoning
12. Cyanide poisoning

Classical Signs of Asphyxia

1. Petechial hemorrhages on the face and neck, due to rupture of small venules on application of
pressure. Pressure may be severe enough in strangulation to rupture larger plexus of venules producing larger
ecchymosis.
Second most common place for petechial hemorrhages is chest especially visceral and parietal pleura, due to
negative pressure developed in an increased effort to inspire.

25
 2. In manual strangulation, arterial supply is not hampered while venous drainage of head and neck is
obstructed, leading to more leakage of fluid from veins. This results in bulging of eyes, protrusion of tongue,
edema and congestion
3. Cyanosis is most commonly seen on the face, i.e. bluish discoloration of face due to reduced
oxygenated hemoglobin.
4. Increased fluidity of blood and enlargement and engorgement of right heart is also found, but these
findings are not included in the classical signs of asphyxia.
 Petechial hemorrhages are seldom seen in hanging and not seen at all in drowning. They might be seen
in some bleeding disorders as well.
 Petechial Hemorrhages (Tardieu’s Spots)
 Petechial hemorrhages are the pinpoint (1-2 mm) collections of blood in serosal and skin surfaces due to
rupture of small venules under pressure.
 Externally
 Most often seen on face and conjunctiva
 Bleeding from nasal mucosa and external auditory meatus
 Internally
 Most often seen on serosal membranes of thorax. Mostly on visceral pleura and rarely on parietal
pleura
 Commonly seen on the heart surfaces
 It also may be found on the thymus in infants
 Never seen on peritoneal serosa
Significance of Petechial Hemorrhages
1. Generally petechial hemorrhages are highly unreliable signs of asphyxia.
2. Only the facial and ocular petechiae may have significance as indicator of asphyxia.
3. Normally they are present in areas of hypostasis.
4. Post-mortem petechiae can appear especially in dependent parts.
5. In drowning and suffocation, petechiae are seldom visible.

2. Positional Asphyxia
Positional asphyxia occurs when the position of a person’s body interferes with respiration, resulting in
death from asphyxia or suffocation. At death, the victim must be found in a position that interferes with
pulmonary gas exchange (breathing). Such a position may range from one that causes obstruction of the mouth
and nares, to one that causes restriction of the chest and diaphragm.
In inability of the victim to escape this position must be explained. In positional asphyxia death unrelated to
restraints, unconsciousness due to acute alcohol intoxication is the most frequent explanation of the victim’s
inability to escape from asphyxiating posture.
All other causes of death –natural or unnatural, medical or traumatic, must be explored by autopsy and
excluded to a reasonable degree of medical certainty.

3. Restraint Asphyxia
This includes:
1. Mugging
26
 2. Arm lock

Mugging/’Arm lock’ (Carotid sleeper or Bar arm)

When strangulation is affected by compressing victim’s neck against the forearm, it is known as
mugging (choke-hold). It may leave no external or internal mark of injury.
4. Sexual Asphyxia or autoerotic asphyxia
5. Traumatic asphyxia
 Homicidal traumatic
 Burking
 Bansdola
 Penetrating trauma
 Pressure on chest
 Pneumothorax
 Accidental trauma
Chemical Asphyxia
Another type of asphyxia is called "chemical." In this type, a chemical keeps oxygen from reaching your
cells. Chemicals that can cause asphyxia include:
 Carbon monoxide. This is a colorless, odorless gas that comes from burning different
types of fuel. If you breathe in too much of it, the gas builds up in your body and replaces
the oxygen in your blood.
 Cyanide. It keeps cells from taking oxygen in. You're at risk of cyanide poisoning if you
breathe smoke during a fire, have contact with certain industrial chemicals, or work in
jobs like mining or metalworking.
 Hydrogen sulfide. This gas smells like a rotten egg. It can come from sewage, liquid
manure, sulfur hot springs, and natural gas. If you breathe in too much, it can prevent
oxygen from entering your cells, much like cyanide does.
DEATH BY ASPHYXIA
Asphyxia - Applied to all forms of violent death due to interference with process of respiration
- Conditions in which the supply of O2 to the blood or tissues or both has been reduced below
normal level.
Types of asphyxia death:
1. Anoxic death
- Failure of arterial blood to be normally saturated with O2 due to:
a) Breathing in an atmosphere with insufficient O2- High altitude
b) External obstruction of the air passage -traumatic crush asphyxia
c) Paralysis of the respiratory center -poisoning, injury, anesthesia
d) Mechanical interference of the passage of air- drowning, asthma
e) Shunting of blood
2. Anemic anoxic death
-Decrease capacity of the blood to carry O2 due to Hge, CO poisoning, Low Hgb
3. Stagnant anoxic death
-Failure of circulation due to Heart failure, shock, arterial venous obstruction
4. Histotoxic anoxic death
27
 -Failure of the cellular oxidative process cannot be utilized in the tissues. Cyanide Phases of asphyxia
death:
1. Dyspneic phase - Breathing is rapid and deep, PR inc., Rise of BP
- Due to lack of O2 and retention of CO2
2. Convulsive phase-Cyanosis more pronounced, pupils dilated, unconscious
- Tardieu spots = petechia/hges in the visceral organs
-due to stimulation of CNS by CO2
3. Apneic phase - Breathing is shallow, gasping
- Due to paralysis of respiratory center
Classification of Asphyxia:
1. Hanging
2. Strangulations: by ligature, manual strangulation
3. Suffocation: choking
4. Asphyxia by drowning
5. Asphyxia by pressure on the chest
6. Asphyxia by irrespirable gasses
Hanging is ante-mortem:
Vital reaction= principal criterion
1. Redness or ecchymosis at the site of ligature.
2. Ecchymosis of the pharynx and epiglottis.
3. Line of redness or rupture of the intima of the carotid artery
B. ASPHYXIA BY STRANGULATION - Tightened by force not the weight

HANGING STRANGULATION

HYOID BONE FREQUENTLY INJURED FREQUENTLY SPARED

DIRECTION OF INVERTED V-SHAPE USUALLY HORIZONTAL

LIGATURE MARK

LIGATURE LOCATION AT LEVEL OF HYOID BONE BELOW LARYNX

LIGATURE LOCATION DEEPEST OPPOSITE THE KNOT UNIFORM DEPTH

28
 VERTEBRAL INJURY FREQUENTLY OBSERVED NOT OBSERVED

Manual strangulation or throttling:

- Form of asphyxial death where the constricting force is the hand.

C. ASPHYXIA BY SUFFOCATION
- Occlusion of air from the lungs by closure of air openings or 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.
- Overlaying - most common in children: pressure of pillows
- Gagging - application of materials to prevent air to have access to mouth and nostrils.

Plastic bag suffocation

Choking- Form of suffocation by the impaction 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 ½ minutes considered fatal.
- Average time required for death in drowning is 2 to 5 minutes.
Emergency treatment in Drowning
1. Schaefer’s method - Face down, prone position:operator exerts pressure in ribs
2. Sylveste’ s method- Lying on his back, astride over body, swinging arms

Post-mortem findings:
1. External findings
a) Wet clothes, pale face, F.B. clinging on skin surface
b) “Cutis anserine” or “goose flesh” -skin is pale, contracted NOT Dxtic
c) Washerwoman’s hands and feet - skin of hands & feet: bleached NOT Dxtic
d) Post-mortem lividity - marked in the head, neck and chest.
e) Presence of firmly clenched hands with objects - Person was alive at first
f) Physical injuries for struggle
g) Suicidal drowning - Pieces 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.
29
 2. “Edema aquosum”- Due: Entrance of water into air sacs, Lungs are doughy
3. “Champignon d’ocume” - whitish foam accumulates in the mouth/nostrils
= Due: abundance of mucous secretion
= One of the indications that death was due to drowning.
4. Tracheo-bronchial lumen ± congested, filled with froth
5. Blood stained fluid found inside chest cavity.
6. Section lungs shows fluid with bloody froth.

B. HEART
1. Both sides of heart may be filled or emptied with blood.
2. Salt water drowning - Blood chloride content is greater than left side.
Fresh water- Blood chloride is more on the right side.
Gettler’s Test:
- Quantitative determination of the chloride content of the blood in the right and left ventricle of the
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 after death.

FINDINGS CONCLUSIVE THAT THE PERSON DIED OF DROWNING

1. The presence of foreign bodies in the hands of the victim. The clenching of the hands is a
manifestation of cadaveric spasm in the effort of the victim to save himself from 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 air 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 because of the dominance of the flexor muscles
-”tete de negri” - bronze colour 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, mentality, Hx of previous attempt

Accidental = Absence of violence in the body. Exclusion of suicide, witnesses

E. COMPRESSION ASPHYXIA
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(TRAUMATIC CRUSH ASPHYXIA)
- Form of asphyxia where the free exchange of air in the lungs is prevented by the immobility of the chest
and abdomen due to external pressure or crush injury.

- Homicidal =offender kneels on the chest

- Accidental = pinned between two big objects

Burking - invented by Burke and Hare= murder for the sale to medical schools
- Kneels or sits on the chest and the hands close the mouth and nostrils

Death by crucifixion- alternative raising and lowering of the body leads to exhaustion, unconsciousness and
death from asphyxia = IC mm are stretched

F. ASPHYXIA BY BREATHING IIRESPIRABLE GASES

1. Carbon monoxide “silent killer”, colourless, insoluble in water and alcohol.
- Formed by the incomplete combustion of carbon fuel.

Qualitative test for CO in the blood

a) Kunkel’s test ± 4 volume of water + 3x its volume of 1% tannic acid
- crimson red if positive
b) Potassium Ferrocyanide test -bright red
c) Spectroscope exam
d) Gas chromatograph
e) Infra-red analysis
2. Carbon dioxide ± CO2, Carbonic acid gas
- Blown out of the lungs during respiration
- Product of complete combustion of carbon containing compounds
- End result of fermentation & decomposition of organic matters. - Septic tank
= The inhalation of pure CO2 may cause immediate vagal inhibition with spasm of the glottis and
death. = manhole, poorly ventilated rooms
Tests for the presence of CO2
1. Barium nitrate - white precipitate of Barium carbonate with carbonic acid
2. silver nitrate - white ppt. of silver carbonate when carbonic acid is added.
3. Hydrogen sulphide
( H2S, Sulphuretted hydrogen ) = rotten egg 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 gases
- Formed by the addition of acid to potassium or sodium salt of cyanide
- Found in plants; leaves of cherry laurel, bitter almond, kernels of common cherry, plum, peaches,
ordinary bamboo shoots, certain oil seed and beans.
- Contains AMYGDALIN which in the presence of water and natural enzyme
EMULSIN is readily decomposed to HYDROCYANIC ACID, glucose and benzaldehyde.
= 60-90 mg of Hydrogen cyanide is fatal, death in 2 to 10 min

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5. Sulfur dioxide - Heavier than air, pungent odor
- employed as disinfectant, bleaching agent,

- found in eruption of volcano

WAR GASES
Classification based on the physiological action
1. Lacrimator or Tear gas - causes irritation with copious flow of tears
a) Chloracetphene (C.A.P.)
b) Bromobenzyl cyanide (B.B.C.)
c) Ethyl Iodoacetate (K.S.K.)
High concentration- irritation of respiratory passages, lungs, V, N
2. Vesicant of Blistering Gas - contact with skin cause bleb or blister formation
a) Mustard gas (Dichloride sulphide, yellow cross, Yperite)
b) Lewisite ( Chlorovinyl-dichlorarsine)
3. Lung irritants (Asphyxiant or choking gas)
- Dysnea, tightness of the chest, coughing, coma, death
a) Chlorine (Cl2) - yellowish green gas
b) Phosgene (COCl2)
c) Chloropicrin
d) Diphosgene
4. Sternutator - nasal irritants of vomiting gases
5. Paralysants –Nerve gas - like organophosphates
6. Blood poisons -CO, H2S, and Hydrogen cyanide

DEATH OR PHYSICAL INJURIES DUE TO AUTOMOTIVE CRASH OR ACCIDENT

 Factors responsible to an Automotive Crash
1) HUMAN FACTOR (DRIVER)
a. Mental attitude: reckless driving, fatigue, inexperience
b. Perceptive defect: defective vision
c. Delayed reaction time - the time interval must be counted from the instant the brain, having
perceived the potential danger, decides that an accident is imminent.
d. Disease - the primary symptoms of Parkinson's disease can seriously interfere with the
complex task of driving a car.
e. Chemical factor- alcoholism, drug abuse
2) ENVIRONMENTAL FACTOR
-Poor visibility, poorly maintained roads, rain, blind intersection
3) MECHANICAL FACTOR: Poor brake, worn out tires
4) SOCIAL FACTOR: Speed, insurance
5) PEDESTRIAN - Improper Use of Lane, Unmarked Crosswalks

INJURIES AND DEATH ON DRIVERS AND PASSENGERS

1. First collision: the impact of the moving vehicle with another or
fixed object
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 The moving vehicle -rapidly decelerates and stops after impact.
The degree of damage depends:
a. Speed
b. Part of vehicle involved
2. Second collision: Impact of unrestrained occupants with the
vehicle interior
1st collision ,occupants move same direction/velocity towards point of
Impact.
a. Front impact > occupants move forward.
b. Side impact (severe)> moves to the side that was involved
in the 1st collision
*the passenger nearest to it will suffer the most.
c. Rear impact crash -acceleration-deceleration injury
whiplash
d. Roll over crash (Turn turtle impact)
-If vehicle is not put into stop after the 1st collision
-the unrestrained occupants will continue to strike to some parts of the
vehicle interior.
Pedestrian-vehicle Collision
Death or Physical Injuries to pedestrian
1. Primary impact -contact with vehicle
2. Secondary impact -subsequent impact of the
pedestrian to the ground
-accounts for the multiple injuries
3. Run over injuries

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