Contusion- the medical term for a bruise.
It happens when an injured capillary
__CHAPTER 11 : PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE
BODY
DEFINE | TERMS
Coup injury - these are injuries which occur at the site of the application of force
and will develop as a natural consequence of the force applied. It may result to in
the compression of the head by the wheel of a vehicle, when the head strikes an
object in motion, as bullets, and when the head is in motion and strikes an object,
as in vehicular accidents.
Contre Coup Injuries - these are injuries which develop opposite the site of the
application of force. A blow on the occiput may produce laceration or contusion of
the frontal lobe of the brain. This is observed when the head is free and mobile.
Coup-contre-coup Injuries (Direct and Indirect Injuries) - these are injuries may
be at the site of impact and at the same time found in some other parts of the
head which may be opposite the site of application of force, or elsewhere.
Locus Minoris Resistencia - the injury sustained in the head which may not be
at or opposite the application of force but may be found in some areas of the
skull offering the least resistance. A blow on the head may cause a linear fracture
of the roof of the orbit on account of the papyraceous nature of the bone.
Hemorrhage - an escape of blood from a ruptured blood vessel, especially when
profuse.
Concussion - type of traumatic brain injury—or TBI—caused by a bump, blow,
or jolt to the head or by a hit to the body that causes the head and brain to move
rapidly back and forth.
or blood vessel leaks blood into the surrounding area. Contusions are a type of
hematoma, which refers to any collection of blood outside of a blood vessel.
Fracture - complete or incomplete break in a bone resulting from the application
of excessive force.
Crushing injuries - an injury that occurs when force or pressure is put on a body
part. This type of injury most often happens when part of the body is squeezed
between two heavy objects. Damage related to crush injuries include: Bleeding
and Bruising.
Skull- is a bony structure that forms the head in vertebrates. It supports the
structures of the face and provides a protective cavity for the brain. The skull is
composed of two parts: the cranium and the mandible.
Cerebrum - is the uppermost part of the brain. It contains two hemispheres split
by a central fissure. The cerebrum itself contains the major lobes of the brain and
is responsible for receiving and giving meaning to information from the sense
organs, as well as controlling the body.
Cerebral vertebrae​ - the vertebrae of the neck, immediately below the skull.
Lungs - are a pair of spongy, air-filled organs located on either side of the chest
(thorax).
Heart - a muscular organ about the size of a fist, located just behind and slightly
left of the breastbone. The heart pumps blood through the network of arteries
and veins called the cardiovascular system.
Diaphragm - a thin skeletal muscle that sits at the base of the chest and
separates the abdomen from the chest. It contracts and flattens when you inhale.
Abdomen​ - is the body space between the thorax (chest) and pelvis.
Pelvis - is either the lower part of the trunk of the human body between the
abdomen and the thighs (sometimes also called pelvic region of the trunk) or the
skeleton embedded in it (sometimes also called bony pelvis, or pelvic skeleton).
Extremities​ - An uttermost part of the body, such as a hand or a foot.
KNOW
· Head and Neck Injuries (p299 & p313)
Injuries of the ​head must not be underestimated. They must be treated with
extreme care. The absence of an external wound on the head does not itself
permit a conclusion that there is no internal damage. Contusion and hematoma
of the scalp may only be appreciated during the post-mortem examination. The
presence of hair further augments the difficulty of appreciating head injuries.
The presence of bleeding from the ear, nostrils and mouth may be associated
with basal fracture. Fracture of the vault and other portions of the cranial box may
cause unconsciousness and this may be mistaken for simple intoxication. It is
preferable to have the patient under careful, intelligent and continuous
observation for at least twelve to twenty-four hours to avoid risk to the life of the
patient. X-ray examinations may be useful in order to determine the presence of
fracture. However, it is not uncommon that no fracture is observed, and yet the
intracranial injury is quite severe.
Abrasions of the ​neck may be present in cases of manual strangulation. Ligature
marks are present in death by hanging or strangulation by ligature. Incised
wounds may be homicidal or suicidal. Suicidal cut-throat wounds are usually
diagonal while homicidal wounds are usually horizontal. Incised and stab wounds
of the neck may involve the trachea and the big blood vessels and nerves and in
most cases, end fatally. Asphyxia, pneumonia, hemorrhage and shock are the
common causes of death from neck injuries.
Wounds of the esophagus are not common. They are usually accompanied by
wounds of the trachea and large blood vessels of the neck. Severance of the
recurrent laryngeal nerve causes aphonia.
Contusion or rupture of the muscles, severance of the nerves are sometimes
observed in severe trauma applied to the neck. Forcible blow in the anterior
portion of the neck may cause unconsciousness or even death due to reflexed
inhibitory action on the vagus nerve.
· Injuries in the Chest (p314)
Injuries in the chest are important because vital organs are inside the chest
cavity, namely: the heart, lungs and the principal blood vessels.
The ​chest wall is easily contused by the application of moderate force on account
of the superficial location of the ribs. Lacerated wounds are rarely observed as a
direct effect of violence, but are observed when the fractured ends of the ribs
pierce the skin in severe crush injuries due to motor vehicle accidents.
Stab wounds on the chest are quite common on account of its accessibility when
both the assailant and the victim are in a standing position. The intercostal
vessels may be involved, causing considerable hemorrhage. Stab wounds of the
chest, as a general rule, involve the lungs, heart and the big blood vessels in the
chest cavity.
Bullet wounds of the chest may be superficial or may involve the pleural viscera.
Hemorrhage, collapse of the lungs due to the removal of the negative
intrathoractic pressure and pneumonia may develop if the victim does not die
immediately.
Fracture of the ribs causes severe pain during each phase of respiration and if
complete, it may be associated with laceration of the parietal pleura or of the
skin. The lungs and the heart may also be lacerated when there is an inward
displacement of the fractured ends.
Hemorrhage in the pleural cavity coming either from the intercostal vessels or
from the lung tissue itself may cause compression and collapse of the lungs and
the patient may die of respiratory embarrassment or anemia.
Contusion of the lungs may be caused by a blunt instrument with or without
fracture of the ribs, or by compression of the chest. The lungs may be injured by
a sharp-pointed instrument or by a bullet. Injury of the lungs may cause bloody
froth coming out of the mouth.
Severe traction exerted at the region of the hilus may tear the lungs at the point
of attachment. Death is usually due to a severe shock or a rapid hemorrhage.
Application of a severe crushing or grinding force in the chest wall causes
extensive fracture of the ribs and may results to contusion and crushing injury to
the lungs. The laceration may not be so severe but later the victim succumbs to
lobar pneumonia.
The ​heart may fail and causes death due to an existing natural disease
independent of trauma. Coronary insufficiency, myocardial fibrosis, valvular
lesion or tamponade due to the rupture of the ventricle are common lesions.
Wounds of the heart are produced by sharp instruments, bullets or the sharp
ends of the fractured ribs. Contusion of the heart is easily produced on slight
trauma on account of its vascularity. Wounds of the ventricle if small and oblique
are less dangerous than those of the auricle because of the thickness of its wall.
The right ventricle is the most common site of the wounds due to external
violence, because it is the most exposed part of the heart.
Foreign bodies like bullets, shrapnels, fragments of a shell may be embedded in
the myocardium without any cardiac embarrassment. The person may live for a
long time and may die of some other causes.
Tearing of the heart from its attachments may be due to violent compression of
the chest with the pressure forcing the organ downward and away from the neck.
The severe traction may cause the laceration of the aorta.
Rupture of the heart is usually produced by a blunt instrument or by a crushing
injury due to vehicular accidents. The heart is commonly ruptured at the right
side towards the base. Death is due to severe hemorrhage, cardiac tamponade
or shock.
Crushing injuries of the heart are due to compression of the chest with the
fractured fragments injuring the heart as in vehicular accidents, violent dynamite
blast, or crushing of the chest between hard object.
Wounds of the aorta and pulmonary vessels are rapidly fatal. Rupture of the
aorta may be traumatic or spontaneous. Spontaneous rupture may be due to
aneurysm. The cause of death is either the profuse hemorrhage or cardiac
tamponade.
Wounds of the ​ diaphragm due to a sharp instrument and bullets are caused by
injuries either of the chest or abdomen. Their fatal effect is not on the injury to the
diaphragm but on the accompanying injuries to the other organs. Any penetrating
wound in the diaphragm may cause a potent rent for diaphragmatic herniation.
Rupture of the diaphragm is due to a sudden increase of intra-abdominal
pressure crushing injuries caused by vehicular accidents or traumatic
compression of the chest.
Death in diaphragmatic injuries may be due to shock, hemorrhage, intestinal
obstruction caused by herniation, or the accompanying injuries.
· Abdominal Injuries
Abdominal Wall: The skin may remain unmarked inspite of extensive internal
injuries with bleeding and disruption of the internal organs. The areas most
vulnerable are the point of attachment of internal organs, especially at the source
of its blood supply and at the point where blood vessels change direction.
The area in the middle superior half of the abdomen, forming a triangle bounded
by the ribs on the two sides and a line drawn horizontally through the umbilicus
forming its base, is vulnerable to trauma applied from any direction. In this
triangle are found several blood vessels changing direction, particularly the celiac
trunk, its branches (the hepatic, splenic and gastric arteries) as well as the
accompanying veins. The loop of the duodenum, the ligament of Treitz and the
pancreas are in the retroperitoneal space, and the stomach and transverse colon
are in the triangle, located in the peritoneal cavity. Compression or blow on the
area may cause detachment, laceration, stretch-stress, contusion of the organs
(Legal Medicine 1980, Cyril H. Wecht ed., p. 41).
Stomach: Spontaneous rupture of the ​ stomach may be observed in cases of
gastric ulcer or new growth. A blunt force applied at the upper portion of the
abdomen may cause bruising or even rupture. The pyloric end and the greater
curvature are the most frequent sites of a rupture.
Penetrating stab wounds of the stomach are dangerous to life on account of a
hemorrhage, infection and injury to the adjacent organs like the liver. Tearing of
the stomach is common when the person is run over by a motor vehicle at the
region of the abdomen.
Intestine: ​
Ulcer at the duodenum may rupture spontaneously. The same is true in
cases of tuberculous, amoebic, cancerous or typhoid ulcerations. Peritonitis and
hemorrhage are the common causes of death.
Traumatic rupture may be due to a blow, kick, fall or vehicular accident. When
force is applied to the front portion of the abdominal wall, the intestine may be
pressed between the vertebral column and the force applied, producing either
partial or complete severance or laceration. Its septic contents will scatter in the
abdominal cavity and cause generalized peritonitis.
Injuries caused by sharp instruments or by gunshots usually cause multiple
lesions in the intestine and may also involve other visceral organs. The intestine
may be involved in vehicular accidents and on account of the grinding force of
the wheel, severe hemorrhage, laceration and herniation in the abdominal wall
are usually observed.
The mesentery may be contused, lacerated or crushed but in most cases its
involvement is secondary to lesion in the intestine.
Liver: The liver is one of the most vulnerable organs in the abdominal cavity
because of its size, weight, location, friability, and fixed position. Injuries are
frequently met in cases of blow, kick, crush, fall or sometimes in sudden
contraction of the abdominal wall. The right lobe is more frequently involved than
the left owing to its size and exposed location. Rupture is usually transversely or
anteroposteriorly. On account of its extreme vascularity, the victim usually dies of
severe hemorrhage, shock and very rarely of supervening infection. Sometimes
recovery occurs after slight laceration but occasionally, abscess develops.
Stab and gunshot wounds of the abdomen may involve the liver. Severe
hemorrhage or shock usually causes the death. It may be lacerated by the
fractured ends of the lower ribs in crush injuries.
The gall bladder may be ruptured as a result of a kick, blow or crush injury. It
may be inju*ed-by penetrating weapons. Death is due to hemorrhage and the
effusion of bile into the peritoneal cavity.
Spleen: The spleen usually suffers traumatic rupture resulting from the impact of
a fall or blow and from the crushing and grinding effects of wheels of motor
vehicles. Although the organ is protected at its upper portion by the ribs and also
by the air-containing visceral organs, yet on account of its superficiality and
fragility, it is usually affected by trauma. Congestion and diseased condition of
the spleen, as in malaria, typhoid, kala-zar, make it more easily susceptible to
slight trauma.
Laceration of the spleen is more common at the region of the hilus and the lesion
may be longitudinal or transverse. Lesion on the convex surface is also common
especially when the force is applied to the left flank. On account of the vascular
nature of the organ and its proximity to the plexuses of nerves, the victim usually
dies of severe shock or hemorrhage.
Penetrating stab wounds of the spleen are common but most often other visceral
organs are also involved. Death is due to hemorrhage.
Kidney: ​Traumatic injury of the kidney may be due to a blow at the lumbar region
somewhere at the region of the 12th rib. It may be ruptured at the slightest
violence when it is diseased as in cases of hydronephrosis, pyelonephritis,
tuberculosis, abscess or tumor. The kidney may also be ruptured when the
individual is run over by a vehicle or severely crushed from a fall.
Injury of the kidney is accompanied by peri-renal hematoma which consists of
blood and urine. Death is due to a severe hemorrhage, loss of kidney functions
and shock. Abdominal hemorrhage is present only if there is injury to the
peritoneum concomitant to the lesions in the kidney.
The adrenals may be contused, crushed or lacerated by severe violence. The
right is more prone to injury of its vulnerable location.
Pancreas: The pancreas may be injured by a violent blow at the epigastric
region. Death may be due to hemorrhage, shock, or insulin insufficiency. If death
does not occur immediately, fat necrosis is observed in the abdominal cavity on
account of the leakage of the lipolytic enzyme.
Spontaneous hemorrhage of the pancreas is frequently observed in the tropics.
Its exact cause is still a matter of medical research.
· Pelvic Injuries
Fracture of the pelvic bones, especially of the pubis, is common in vehicular
accidents and crush injuries. Separation of the symphysis may be observed
without any external sign of injury. The patient may show difficulty of locomotion,
and to a certain degree, damage to the urinary bladder.
Urinary Bladder: The bladder may be involved in a blow, crush, or kick at the
hypogastrium especially when distended with urine. Among parturient women,
the bladder may rupture in the course of delivery. It may also be involved in
fractures of the pubic bones. Spontaneous rupture is rare when it is
over-distended due to urethal stricture, enlargement of the prostate, or tumor.
Symptoms of rupture of the bladder are pain, tenderness at the lower portion of
the abdomen, bloody urine, difficulty in urination and rigidity of the abdominal
muscles. Death may be due to shock or super-imposed infection.
Uterus: A non-gravid uterus is rarely involved in pelvic injuries, but a gravid
uterus is likely to be ruptured in a blow, kick, or crush injuries. Spontaneous
rupture of the uterus is commonly observed among pregnant women due to the
injudicious use of drugs or abnormal presentation. Partial separation of the
placenta may be spontaneous or due to trauma. Death is due to shock,
hemorrhage, peritonitis or septicemia.
Vagina: ​Laceration of the vagina may be due to a sexual act or a faulty
instrumentation to induce a criminal abortion. The vaginal wall
· Extremities
Physical injuries on both upper and lower extremities are usually due to direct
violence, crushing or some indirect force.
Contusions and abrasions are frequent lesions of the extremities. Lacerated
wounds are commonly observed in portion where the bones are superficially
located as in the anterior aspect of the leg. Incised and punctured wounds of the
hand are quite common on account of its utility and movability.
Crushing injury of the extremities may cause laceration of the blood vessels and
nerves. Injury of the intima of the blood vessels causes thrombus formation and
in severe cases aneurysm may develop. Extravasation of the blood into the
muscles causes swelling and pain.
Fracture of the bones may be due to a direct violence, an indirect violence or a
muscular action.
Injury of the extremities may cause shock, hemorrhage and infection. The shock
is principally due to the injury on the nerve, hemorrhage and fracture of the
bones. Infection may be severe and may require amputation of the extremities.
DIFFERENTIATE
· Direct head injury | Indirect head injury (p300)
Direct head injuries are injuries which occur at the site of the application of force
and will develop as a natural consequence of the force applied. Direct injuries
may result:
1. In compression of the head by the wheel of a vehicle.
2. When the head strikes an object in motion, as bullets.
3. When the head is in motion and strikes an object, as in vehicular
accidents.
Indirect head injuries are injuries in the head which are not found at the site of
the application of force. The injury may be at the opposite, or in some areas
offering the least resistance, or in areas which have no relation with the site of
the impact.
1. Contre Coup Injuries: These are injuries which develop opposite the
site of the application of force. A blow on the occiput may produce
laceration or contusion of the frontal lobe of the brain. This is
observed when the head is free and mobile.
2. Remote Injuries: Remote injuries are produced in cases where the
force is applied in some areas of the body which have no relation to
the head. A fall on the feet or buttocks may cause basal fracture of
the skull.
3. "Locus Minoris Resistencia": The injury sustained in the head may not
be at or opposite the application of force but may be found in some
areas of the skull offering the least resistance. A blow on the head
may cause a linear fracture of the roof of the orbit on account of the
papyraceous nature of the bone.
· Extradural or Epidural Hemorrhage | Subdural Hemorrhage
|Subarachnoidal Hemorrhage | Cerebral Hemorrhage (p303)
Intracranial hemorrhages may occur even in the absence of a fracture.
Hemorrhage may be present without trauma. The blood vessels of the brain may
be diseased and may rupture spontaneously.
a. Extradural or Epidural Hemorrhage (almost exclusively due to trauma):
Extradural hemorrhage is caused by a fracture of the skull. The fracture will
cause laceration of the blood vessels which are grooved at the inner table of the
skull. The branches of the meningeal vessels are usually involved, the most
frequent of which are the branches of the middle meningeal vessels. The
laceration is commonly unilateral except when the fracture extends to the
opposite side.
Hemorrhage at the region of the vault produces a discus-shaped clot with
compression of the brain substance and this may cause neurologic disturbance.
If the patient lives for sometime, there will be an organization of the clot and a
fibrous thickening of the dura.
A person suffering from extradural hemorrhage may complain of headache,
vomiting and drowsiness. The pupils may be dilated on the side of the
hemorrhage. Examination of the cerebro-spinal fluid shows absence of blood,
unless it is complicated with hemorrhage in other regions in the cranial cavity.
b. Subdural Hemorrhage: Unlike extradural hemorrhage, subdural bleeding is
essentially venous or capillary. It is the most common cause of cerebral
compression. It may be a consequence of fracture of the skull, laceration of the
brain, spontaneous rupture of the blood vessels on the surface of the brain or
laceration of the dura and meningeal vessels. It usually comes from the small blood
vessels which cross the subdural space to the subarachnoidal area.
Majority of subdural hemorrhages are traumatic in origin although a few may be due
to a natural disease of the blood vessels of the brain. There are difficulties in
ascertaining the cause and source of such hemorrhage.
c. Subarachnoidal Hemorrhage: Subarachnoidal hemorrhage may be due to trauma
or to spontaneous rupture of blood vessels. Its causes may be summarized as
follows:
1. It may be produced by severe head injury especially in contre coup kind.
2. It may be due to ruptured cerebral aneurysm and is commonly seen at the
base of the brain.
3. It may be an extension of the spontaneous hemorrhage of the brain which
extends to the subarachnoid space.
4. In asphyxia there may be subarachnoidal hemorrhage in the form of petechial
hemorrhage.
d. Cerebral Hemorrhage: Cerebral hemorrhage may be traumatic or spontaneous in
origin. If a person develops rupture of a blood vessel and suddenly collapses and
falls on the ground producing a certain degree of head injury, it is quite difficult to
ascertain the exact origin of the hemorrhage. A careful dissection of the brain tissue
involved is necessary to determine the presence of pathology of the blood vessel.
Traumatic cerebral hemorrhage is usually due to laceration or contusion of the brain
in contre-coup injuries. Severe crushing of the skull in vehicular accident cases may
cause the sharp fractured edges of the bone to lacerate the brain and produces
severe cerebral hemorrhage. It may involve the gray matter only but in severe cases
the hemorrhage extends up to the white matter.
EXPLAIN | DISCUSS
· Medico-legal questions in Intracranial Injuries (p.310)
a. Is the origin of the intracranial hemorrhage due to trauma or disease?
Extradural or epidural hemorrhage is always caused by trauma. Subdural
hemorrhage is, as a rule, traumatic in origin but it may also be caused by some
diseased condition of the blood vessels or by a local inflammatory process.
Subarachnoidal hemorrhages are usually spontaneous and are usually caused
by ruptured aneurysm or sclerotic vessels at the circle of the Willis.
b. In cases of cerebral concussion, can the victim remember the incidents before,
during or after the accidents?
In mild form of cerebral concussion or after a psychological treatment, 'the victim
may be able to recall the incident. In severe form of concussion, the victim may
totally lose the recollection of past events.
c. Can the victim of head injuries still retain voluntary movement and speech?
In severe head injuries with comminuted fracture of the skull there is immediate
loss of consciousness such that voluntary movement and speech are no longer
possible. The capacity of the victim to retain voluntary movements and speech
depends upon the loss of consciousness and the area of the brain involved.
d. Post-traumatic Automatism:
A person while under the state of post-traumatic automatism may commit a crime
while in an unconscious state. He is considered to be exempted from criminal
liability.
e. In gunshot wounds of the head, how can the point of entrance be determined?
At the point of entrance, the injury at the outer table is oval or round while there is
bevelling fracture at the inner table.
f. Post-traumatic Irritability:
The victim of a head injury may suffer post-traumatic irritability and may lead to
do acts of impulsive violence. If irritability develops after a head injury, it is
doubtful if it will be a valid defense following the doctrine of acting under an
irresistible impulse.
· Injuries to the lungs (p. 315)
The lungs may be injured by a sharp-pointed instrument or by a bullet.
Hemorrhage in the pleural cavity may cause compression and collapse of the
lungs and the patient may die of respiratory embarrassment or anemia.
Contusion of the lungs may be caused by a blunt instrument with or without
fracture of the ribs, or by compression of the chest. Application of a severe
crushing or grinding force in the chest wall causes extensive fracture of the ribs
and may result in contusion and crushing injury to the lungs.
· Injuries to the heart
The heart may fail and causes death due to an existing natural disease
independent of trauma. Wounds of the heart are produced by sharp instruments,
bullets or the sharp ends of the fractured ribs. Rupture of the heart is usually
produced by a blunt instrument or by a crushing injury due to vehicular accidents.
The heart is commonly ruptured at the right side towards the base. Death is due
to severe hemorrhage, cardiac tamponade or shock.
· Injuries to the diaphragm
Wounds of the diaphragm due to a sharp instrument and bullets are caused by
injuries either of the chest or abdomen. Their fatal effect is not on the injury to the
diaphragm but on the accompanying injuries to the other organs. Any penetrating
wound in the diaphragm may cause a potent rent for diaphragmatic herniation.
Death in diaphragmatic injuries may be due to shock, hemorrhage, intestinal
obstruction caused by herniation, or the accompanying injuries.
 b. Intensity of the Force:
c. Point of Impact:
· Abdominal Injuries d. Mobility of the Skull at the Time of the Application of Force:

Liver: · Classification of head injuries (p.300)

Injuries are frequently met in cases of blow, kick, crush, fall or sometimes in
sudden contraction of the abdominal wall. victim usually dies of severe
hemorrhage, shock and very rarely of supervening infection.
Spleen:
The spleen usually suffers traumatic rupture resulting from the impact of a fall or
blow and from the crushing and grinding effects of wheels of motor vehicles.
Kidney:
a. Direct or Coup Injuries:
These are injuries which occur at the site of the application of force and will
develop as a natural consequence of the forceapplied.
Direct Injuries may Result to:
(1) In compression of the head by the wheel of a vehicle.
(2) When the head strikes an object in motion, as bullets.
(3) When the head is in motion and strikes an object, as in vehicular accidents.

Traumatic injury of the kidney may be due to a blow at the lumbar region b. Indirect Injuries:
somewhere at the region of the 12th rib. It may be ruptured at the slightest
These are injuries in the head which are not found at the site of the application of
violence when it is diseased Injury of the kidney is accompanied by peri-renal
force. The injury may be at the opposite, or in some areas offering the least
hematoma which consists of blood and urine. Death is due to a severe
resistance, or in areas which have no relation with the site of the impact.
hemorrhage, loss of kidney functions and shock.
(1) Contre Coup Injuries:
Pancreas:
These are injuries which develop opposite the site of the application of force. A
The pancreas may be injured by a violent blow at the epigastric region. Death
blow on the occiput may produce laceration or contusion of the frontal lobe of the
may be due to hemorrhage, shock, or insulin insufficiency.
brain. This is observed when the head is free and mobile.
ENUMERATE
(2) Remote Injuries:
· Factors influencing the degree and extent of head injuries (p299)

a. Nature of the Wounding Agent:

Remote injuries are produced in cases where the force is applied in some areas
of the body which have no relation to the head. A fall on the feet or buttocks may
cause basal fracture of the skull.
(3) "Locus Minoris Resistencia":
d. Comminuted Fractures:
Comminution of the skull may develop as a result of a fissure or a depressed
fracture. The presence of comminuted fracture is an indication of the severity of
force applied or the use of a heavy weapon.

The injury sustained in the head may not be at or opposite the application of
force but may be found in some areas of the skull offering the least resistance. A
blow on the head may cause a linear fracture of the roof of the orbit on account
of the papyraceous nature of the bone.
c. Coup-contre-coup Injuries (Direct and Indirect Injuries):
The injuries may be at the site of impact and at the same time found in some
other parts of the head which may be opposite the site of application of force, or
elsewhere.
e. Pond or Indented Fracture:
In the skull of infants wherein there is undue elasticity, the production of a pond
or indented fracture is common. It may be a result of a simple compression of the
skull, as in a pingpong ball.
f. Gutter Fractures:
A tangential or glancing approach of a bullet may cause the production of a
furrow in the cranium. It may involve both the outer and inner tables.

· Types of Skull Fractures (p.302) g. Bursting Fractures:

a. Fissure Fractures: It is an extensive fracture running parallel to the two points of contact, if
mechanical force is applied on one side of the head, while it is pressed on the
Fissure or linear fracture involves the inner and outer table. It is usually caused other side against a hard substance,such as a wall, while the individual is
by the impact of a blunt object and may appear as a radiating crack from the site standing, or against the hard ground or floor, when he is in a lying posture.
of the application of force and may involve the base of the cranial fossae.
· Complications of lung injuries (p315)
b. Localized Depressed Fracture:
a. Hemorrhage
It invariably shows the nature of the instrument that causes the fracture. b. Compression of the lungs
c. Severe Pneumothorax
c. Penetrating Injuries of the Skull: d. Cerebral air embolism
e. Hemoptysis
Sharp-edged instrument produces a clean-cut fracture of the skull. The size and f. Subcutaneous emphysema
shape of the fracture may correspond to the shape of the wounding instrument.
· Injuries of the limbs (p. 321)

a. Direct violence will result in a contusion and when the force applied is severe it
may cause interstitial muscular hemorrhage and fractures of the underlying bone.

b. Indirect violence, such as twisting or pathological fracture of the bone

underneath, causes laceration of the muscles around with marked hemorrhage.

c. Crushing injuries of the limb can result in severe soft tissue trauma and are
most commonly caused by vehicular accidents or fall of heavy materials. These
are usually accompanied by marked swelling, comminution of the bone and
extravasation of the blood.
Chapter 12 metallic container will cause fragmentation of the container.
Each fragment or shrapnel is moving with certain velocity
DEATH OR PHYSICAL INJURIES without any predetermined direction.

CAUSED BY EXPLOSION 2. Factors affecting radiation (based on sir outline)

Factors Responsible for the Effect of Radiation: (nearest

topic based kan sir outline)
DEFINE
a. Age — Children and old persons are more susceptible to
1. Explosion - is the sudden release of potential energy
radiation.
producing a localized increase in pressure.
b. Dosage — Bigger dose of radiation will cause more
2. Detonation is a chemical process which results in the
damaging effects on the body tissues.
extremely rapid decomposition of nitrogenous compounds.
Releasing heat and gas is its reaction by-product. It is the c. Kind of Radiation — The biological damage is not
shock wave spreading out of the explosion that causes the always proportional to the energy absorbed, but it depends
destructive effect of high explosive. on the kind of energy emitted. Gamma and neutron
radiations are most destructive.
3. Blast wave - A pressure front generated by a
high-grade explosive. d. Fractional Doses — A single dose may be lethal when
administered fractionally over a long interval of time.

e. Sensitivity — Muscles and connective tissue are

KNOW
radioresistant while actively dividing tissues like blood
1. Death or physical injuries noted in high detonative forming organs, intestinal epithelium are quite
explosions radiosensitive.

• Detonation of high explosives, as in grenades, bombs

and mine explosion. Explosion of the gunpowder inside the
Differentiate
1. Diffused Reactant Explosion and Condensed Reactant
Explosion ​(page 323)
a. Diffused Reactant Explosion — This is caused by the
mixture of gas and air. If the gas and air are mixed in
correct proportion, product of heat and subsequent pressure is
produced. Explosion of diffused reactants must be initiated by
flame, spark or sometimes heat. Mixture of gases with other
materials may cause production of flame. The most common
example of dispersed gas explosion is in the internal
combustion engine.
b. Condensed Reactant Explosion — This chemical explosion
occurs when large quantity of heat and gas is produced as a
result of rapid chemical reaction in a solid or liquid material.
It has a point of origin so that the most severe damage is
closest to the source and the effects diminish as the distance
from the center increases. There is no need of atmospheric
oxygen and if oxygen is required in the reaction it is
incorporated into the explosive
Explain / Discuss
1. Effects of Atomic Explosion to the Human Body (page
328)​ :
The effects of atomic explosion of the human body are
inversely proportional to the distance. One megaton of atomic
bomb exploded in air can cause fire of up to a 10 miles
radius. The pressure front of the blast can be felt one mile
away in 2 seconds time. The blast wave is of sufficiently long
duration which is accompanied by transient blast winds causing
damages to the people and the surrounding structures.
Other effects of atomic explosion are the same as that of
ordinary chemical bomb explosion but of a much more severe
intensity.
Aside from the immediate traumatic effects, the radiation
emitted by the radio-active substances can also have an effect
which may be local or general.
1. General Effects:
Massive dose causes generalized erythema, disorientation
followed by coma and death.
Lesser dose may-cause nausea, vomiting followed by prostration
and rapidly developing and persistent leukemia.
Later symptoms may develop in the form of rise of
temperature, ulceration of lymphoid, easy fatigability,
oro-pharyngeal ulceration and severe leukopenia.
2. Local Effects:
a. Individual Cells — It causes retardation of cell division, 2. What caused it to explode?
structural changes in the chromosomes and cytoplasm,
3. How it produced the injury?
vacuolization, and with evidence of maturation. There is loss
of the supporting mesenchymal cells. 4. How was it initiated?

b. Skin — Epilation of the hair with the follicles remaining · Classification of explosion as to source of energy ​p322
intact, sweat glands lose their function, erector pili muscles not
much affected. The skin become edematous and later 1. Mechanical (Hydraulic) Explosion
desquamated and ulcerated. Radiation dermatitis is persistent,
2. Electrical Explosion
usually painful with patchy keratitis and foci of ulceration.
Hyperpigmentation or depigmentation may later develop. 3. Nuclear Explosion

c. Blood Vessels — There is endothelial necrosis and localized 4. Atomic Explosion

thrombosis. The blood vessels thicken because of the
5. Chemical Explosion
hyalinization of the collagen. Some blood vessels are occluded
with the loss of the muscular layer. · Place of Atomic Explosions ​p328

d. Eye — Cataract develops. 1. Aerial Explosion

e. Genital Organ — In female it causes sterility, abortion or 2. Ground Explosion

stillbirth. In men, it also causes sterility without loss of
3. Submarine Explosion
sexual potency.
· Rays emitted by radioactive substances during explosion
p328
ENUMERATE
1. Alpha Rays
· Concerns in determining Explosions ​p322
2. Beta Rays
1. What exploded?
3. Gamma Rays
4. Neutron Rays

· Sources of Radiation

1. Natural sources

2. Man-made sources

· Natural sources of radiation ​p​330

1. Cosmic Origin

2. Terrestial Origin

· Man-made sources of radiation ​p330

1. Diagnostic X-ray Equipment

2. Clinical nuclear pharmaceutical agents.

3. Therapeutic radiation apparatus.

4. Radiation sources used in industry, like nuclear power plant

 CHAPTER 13
GUNSHOT WOUNDS
DEFINE | TERMS
● Firearm
● A firearm is an instrument used for the propulsion of a projectile
by the expansive force of gases coming from the burning of
gunpowder.
● Detonation
● Detonation is a chemical process which results in the extremely
rapid decomposition of nitrogenous compounds
● Revolver | Pistol | Rifle | Shotgun
● A revolver is a firearm which has a cylindrical magazine situated at
the rear of the barrel, capable or revolving motion and which can
accommodate five or six cartridges
● This is a firing weapon in which the empty shell is ejected when
the cartridge is fired and a new cartridge is slipped into the breech
automatically as a result of the recoil.
● A rifle is a firearm with a long barrel and butt.
● A shotgun is a firearm whose projectile is a collection of lead
pellets which varies in sizes with the type of the cartridge applied.
● Cartridge
● The cartridge case or shell is a cylindrical structure with a base
which houses the powder
● Ammunition
● It is a complete unfired unit consisting of bullet, primer, cartridge
case, and powder charge.
● Primer | Case shell | Powder or Propellant | Projectile or Bullet
● The primer compound is located and sealed at the cartridge base
covered by a small disc of soft metal, which is usually a lead-tin
alloy known as percussion cap or primer cap.
● It is a structure with a base which houses the powder
● The propellant is the primary propulsive force in a cartridge which
when exploded will cause the bullet to be driven forward towards
the gun muzzle.
● It is the metallic object attached to the free end of the cylindrical
tip of the cartridge case, propelled by the expansive force of the
propellant, and responsible in the production of damages in the
target.
● Bullet’s Kinetic energy
● It is the energy associated with motion. In the English system it is
express in foot pound or the work of a force resulting when a
weight of one pound is brought to a height of one foot.
● Bullet efficiency
● It refers to that where the cartridge powder charge can be burned
in approximately 0.00001 second.
● Ballistics coefficient
● This describes the ability of a bullet to maintain its velocity against
air resistance.
● Soot | Smudging | Fouling | Smoke Blackening
● These are among the byproducts of complete combustion of the
gunpowder and other elements with the propellant. It is light,
almost black, and lack sufficient force to penetrate the skin.
5
● Powder grains
● This consists of the unburned, burning and partially burned
powder, together with graphite which comes out of the muzzle.
● Powder burns
● Powder burns is a term commonly used by physicians whenever
there is blackening of the margin of the gunshot wound of
entrance.
● Abrasion collar or Contusion collar
● This refers to that where the pressure of the bullet on the skin will
cause the skin to be depressed and as the bullet lacerates the skin,
the depressed portion will be rubbed with the rough surface of the
bullet.
● Contact fire | Muzzle imprint
● It refers to that when the gun muzzle is pressed on the skin when
fired, all of the products of combustion primarily the muzzle blast
will penetrate the tissues causing severe mechanical destruction
on account of pressure.
● Entry wound
● A wound made by a bullet or other object as it enters the body.
● Exit wound
● A perforation of the skin caused by a projectile (such as a bullet)
leaving the body.
● Russian Roulette
● A group of persons may agree to load a revolver with a single live
cartridge and each member of the group will cock and pull the
trigger with the muzzle pressed or directed to the temple or
towards other vital parts of the body.
KNOW
FIREARM AND PROJECTILE
A firearm is an instrument used for the propulsion of a projectile by the expansive
force of gases coming from the burning of gunpowder.
Section 877, Revised Administrative Code — "Firearm" defined: "Firearm" or "arm",
as herein used, includes. riffles,muskets, shotguns,revolvers,pistols, and all other
deadly weapons from "which a bullet, all, shot, shell, or pfher missile may be
discharged by means of gunpowder or other explosives. The term also includes air
rifles except such as being of small caliber and limited range are used as toys. The
barrel of any firearm shall be considered as a complete firearm for all purposes
thereof.

How to Determine the Number of Fires Made by the Offender​ (363-364)
1. Determination of the Number of Spent Shells:
Search must be made at the scene of the crime or at the place where the offender
made the fire, for spent shells, if the weapon used is an automatic pistol or rifle. In
case of revolver fire, the empty shells may be found still inside the cylindrical
magazine. In machine gun fire, the spent shells may still be attached to the cartridge
belt.
2. Determination of Entrance Wounds in the Body of the Victim:
Although most often erroneous, the investigator may be given an idea as to the
minimum number of shots made. The number of wounds of entrance may not show
the exact number of fire because:
a. Not all the 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. The bullet may have perforated a part of the body and then made another
wound of entrance in some other parts of the body; thus a single shot may
produce two wounds of entrance.
3. Number of Shots Heard by Witnesses:
The witnesses might be able to count the number of shots heard especially if the shots
were made at sufficient intervals of succession. However in cases of machine gun
fire, there is difficulty in ascertaining the number heard and the testimony of witness
as to the number of shots heard must be admitted with caution.
Clothings:​ (367-368)
The effects of the garments on the movement of the bullet depend upon:
1. The number of layers of fabric between the muzzle and subjacent skin;
2. Nature of the fabric which may be closely woven or loose mesh, light or heavy,
cotton or synthetic fibers.
3. Muzzle-clothings distance.
Examination of the External Wearing Apparel of the Victim of Gunshot maybe
Significant in Investigation because:
1. ​It may establish the possible range of the fire:
a. Contact Fire:
(1) There is a tear of the clothings covering the skin at the site of the gunshot wound
with fusion of its fibers in case of artificial fabric. Fibers are turned outward away
from the body.
(2) Soot deposit and gunpowder tattooing around the torn fabric. Burning of the fibers
are visible.
(3) Muzzle imprint (profile of the muzzle) especially in artificial fabric may be
present.
(4) Dirt and greasy deposit is carried by the bullet and may be wiped out and be
visible on the torn clothing.
b. Not Contact but Near Shot: The same findings as in contact shot except when it is
beyond the flame range and absence of muzzle imprint.
c. Far Fire: There is a hole 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:
The direction of the fibers will be inward or inverted at the point of entry, while it is
outward or everted at the point of exit. Care must be exercised in making the
inference inasmuch as improper handling may change the direction of the fibers.
3. It may be useful in locating the bullet:
The clothings, like skin and bone are not easily perforated. It is frequently observed
that the bullet is recovered just underneath the clothings of a dead victim at the crime
scene.
Special Consideration on Bullets:​ (p 368)
1. Souvenir Bullet:
Bullet has been lodged and has remained in the body. Its long presence causes the
development of a dense fibrous tissue capsule around the bullet causing no untoward
effect. It may be located just underneath the skin to be easily palpated and may cause
inconvenience and irritation. Deep seated location may not cause any problem to
warrant its immediate removal.
2. Bullet Migration:
Bullet that is not lodged in a place where it was previously located. A bullet which
strikes the neck may enter the air passage, and it may be coughed out or swallowed
and recovered in the stomach or intestine.
Bullets Embolism — a special form of bullet migration when the bullet loses its
momentum while inside the chamber of the heart or inside the big blood vessels and
carried by the circulating blood to some parts of the body where it may be lodged. It
may cause sudden loss of function of the area supplied or death if vital organs are
involved.
3. ​Tandem Bullet:
Two or more bullets leaving the barrel one after another. In cases of misfire or a
defect in the cartridge, the bullet may be lodged in the barrel and a succeeding shot
may cause the initial and the succeeding bullet to travel in tandem. There is a strong
possibility for them to enter the target in a common hole. This might create doubt to
the statement made by the firer that he made only a single shot, but ballistic
examination can show as to whether the bullet travelled in tandem.
Capacity of the Victim to Perform Volitional Acts:
The power of the victim to perform voluntary acts depends upon the area of the body
involved, involvement of vital organs, and the resistance of the victim. Injuries which
will cause incapacity to do voluntary acts as those involving the brain and the spinal
cord definitely inhibits volitional acts.
Importance X-ray Examination in GSW
The use of an X-ray is almost indispensable in the examination of gunshot injuries.
The use of the apparatus will facilitate recovery of the lodged bullet together with the
location of its fragments.
The body might have been X-rayed with unspent and spent ammunition clinging on
the clothings and may be mistaken to be inside the body; teeth fillings or crown may
resemble bullet on X-ray examination of the skull. "Migratory" bullets may be found
in some parts of the body away from the bullet tract. Victim may have "bullet
souvenir" on account of a previous gunshot injury and may confuse the examiner as
to be an effect of recent shot.
X-ray: The use of the x-ray must not be overlooked in a gunshot wound investigation.
Several exposures at different angles must be made to determine the precise location
of the bullet, trajectory, position of the slug, and other injuries.
X-ray Examinations may:
a. Facilitate location and extraction of the bullet lodged.
b. It will reveal fragmentation and their location.
c. It will show bone involvement like fracture.
d. It will reveal trajectory of the bullet.
e. It will show the effects of the bullet wound, like hemorrhage, escape of air,
laceration and other injuries.
SHOTGUN WOUNDS
The character of the wound and the degree of dispersal is influenced by the
muzzle-target distance, gauge of the shotgun, degree of choke and the type of
ammunition. However, it is highly recommended to have an experimental shot with
the firearm using similar cartridge and under the same environmental conditions.
A close shot produces more serious injuries because the shots are concentrated on a
specific target and because of greater kinetic energy of the pellets.
Tests for the Presence of Primer Components: ​(p. 381-382)
1. ​Harrison and Gilroy Test:
A cotton swab moistened with 0.1 molar hydrochloric acid is used to gather
antimony, barium and lead.
2. ​Neutron Activation Analysis (NAA):
A sample is obtained from the hands by the use of paraffin or by washing the hand
with dilute acid. It is then exposed to radiation from a nuclear reactor emitting
neutrons. Secondary radioactivity is induced in the materials removed from the hand.
By making an appropriate counts at different energy levels, the elemental
composition of the residues can be determined with precision and accuracy. MARKINGS AND STRIATIONS

The technique is extremely sensitive and a very small quantity can be detected, but
only few laboratories can afford to undertake the procedure because it is very
expensive and the test is unable to detect the presence of lead. The test requires access
to a nuclear reactor. Principle: Barium and antimony are converted into isotopes by
means of neutron bombardment, afterwards their quantity is measured.
3. Flameless Atomic Absorption Spectroscopy (FAAS):
The sample of handwashing is subjected to a high temperature to vaporize the
metallic elements of the primer residue. This in turn is detected and quantitated by
absorption spectrophotometry. This method is quick, sensitive and employs
equipment within the economic means of a modern-size crime laboratory. It can
detect the presence of barium, antimony and lead.
4. Use of Scanning Electron Microscope with a Linked X-ray Analyzer:
Adhesive material is used to remove any residue particles from the hand. The material
is then examined under the scanning electron microscope with a linked X-ray
analyzer. Particles of the primer residue have the characteristic size and shape which
can easily be distinguished from other materials. Analysis of the particles with X-ray
analyzer will confirm their identification.
While this method appears to be more specific than the-previously mentioned
methods, it is seldom used because the initial equipment is expensive and it requires a
longer period of time to analyze a case.
1. ​Impression Type Mark (Stamp Mark) —This is the forcible application of a
hard surface against a softer one leaving an impression on the harder surface.
Example: a. The striking of the firing pin on the percussion cap.
b. The impact of the base of the cartridge on the breach block of the
gun.
2. ​Striation or Serration Mark — These are produced by a harder surface scraping,
dragging, sliding or slipping across a softer one leaving a series of abrasions,
serrations and scrapes.
Example: a. The bullet surface may show rifling marks on its surface as it
passes the spiral landings and groovings of the inner surface of the barrel.
b. The extractor produces striations as it slips over the cartridge groove.
c. The ejector may cause striation markings on the cartridge case in the
process of ejection of the spent shell.
When a cartridge is fired from a firearm, the following marks may be found in the
shell and from the bullet,
a. ​Marks Found in the Shell:
(1) Marks of the Firing Pin: The firing pin leaves impressions in the percussion cap.
The depth, location and the size may be the individual characteristic of a firearm,
although the hardness of the metal in the cap may cause certain degree of variation of
the impression.
(2) Marks from the Extractor: The extractor mark is found in front of the rim of the
shell. The scratch impressed by the extractor is a characteristic in a particular firearm.
(3) ​Marks of the Ejector: This mark is found at the head of the shell. Generally the
ejector mark has a position opposite the extractor mark, although it is not always the
case.
(4) ​Marks from the Breechblock​: The impact of the shell to the breechblock in the
recoil impresses the ridges of the breechblock and often gives identification marks
characteristic of a firearm
(5) ​Marks on the Cylindrical Surface of the Shell​: The marks are brought about by
the surface of the firing chamber or by the magazine, b. Marks Found in the Bullet:
(1) Number of Lands and Grooves: The number of grooves, depth, and width depend
upon the manufacturer of the firearm. (2) Direction of the Twist of the Rifling Marks:
The direction of the spiral lands and grooves may be a twist to the right or to the left.
GUNSHOT WOUNDS IN DIFFERENT PARTS OF THE BODY
Head and Neck:
1. Cranium: Close or near contact fire in the head may produce marked laceration of
the skin, burning and tattooing of the surrounding skin. The skull is fractured without
any definite shape with linear extensions to almost all of the bones comprising the
cranial box.
Fire from a distance with the bullet having a right angle of approach to the skull, the
fracture is oval at the outer table. There will be radiating linear fractures from the
point of entrance. The wound of exit will be clean-cut oval or round opening at the
inner table with a bevelled fracture at the outer table.
Grazing approach of the bullet may produce an elongated gutter-like depressed
fracture of the cranium. The tangential impact of the bullet may cause it to split and it
is not uncommon to see a fragment lodging in the brain substance while the other
ricochette outside hitting other objects nearby:
: Bullet wound in the brain substance is usually a rugged tunnel
2. Brain Substance​
with a diameter larger than that of the caliber of the bullet, with marked ecchymosis
of the surrounding area and filled with fresh and clotted blood. Fragments of bones
may be felt in the tunnelled bullet tract. In most cases, injury of the brain causes
sudden loss of consciousness and incapable of voluntary movement.
Injury of the cerebral hemispheres is as a rule not immediately fatal and the victim
may survive the injury, however, a bullet course which includes the medulla, pons
and other vital centers causes immediate death. Some victims may live for sometime
but may develop epileptiform convulsions as a sequela.
3. Face: Firearm wound on the face may not cause serious trouble except that it
becomes a potential avenue of infection and may cause marked deformity.
In suicidal shot, the muzzle of the firearm may be placed inside the mouth or nostrils
that no visible wound of entrance is appreciable. The course of the bullet is usually
upwards and in most cases the brain is involved.
4. Neck:
The bullet may pierce the front portion of the neck and may involve the cervical
portion of the spinal cord; thus causing instantaneous death if the upper portion is
involved. The course of the bullet may involve the carotid or jugular vessels and
death may be due to profused hemorrhage. The anterior wall of the esophagus may be
perforated and the bullet may enter into the gastrointestinal tract and expelled through
the bowel. Injury to the trachea and upper bronchi may cause asphyxia or aspiration
pneumonia.
Chest: 1. Chest Wall:
The bullet wound on the chest wall usually has an upward course and may involve
both sides. The bullet may strike the rib, sternum or the body of the vertebra and may
cause deformity or deflection of its course. When the intercostal or mammary vessels
are injured, there will be profused hemorrhage. Hemothorax of more than a liter is
observed in fatal cases.
2. Lungs:
The passage of a bullet in the lungs produces a cylindrical tunnel much larger than the
diameter of the projectile with bloody contents and ecchymotic borders. When the
pulmonary vessels are involved, profused hemorrhage is observed which produces
death before medical or surgical intervention can be instituted. If only one lung is
involved, the profuse hemorrhage may cause collapse of the lung, displacement of the
heart, and mediastinum towards the uninjured side. Emphysema is present when there
is marked injury to the air sacs. Involvement of the bigger bronchi may cause
asphyxia with the lung partially atelectatic and emphysematous. The victim may not
die immediately but later may develop aspiration pneumonia or cerebral embolism. 3.
Heart: Bullet wound of the heart may be circular or stellate witn subepicardial
hemorrhage in the surrounding tissue. The course may be of any direction but the
right ventricle is often involved because of the large surface area of exposure in front.
Gunshot wound of the heart as a general rule does not prevent the victim from
running, walking, climbing stairs, or do other forms of volitional acts for death-is not
usually instantaneous. Wound of the auricle is more rapidly fatal as compared with
the wound of the ventricle on account of the thickness of the musculature of the latter
which produces temporary closure of the wound. Bullet may lodge in the musculature
of the ventricle and
becomes encapsulated by fibrous tissue. Death in firearm wound of the heart may be
due to the loss of blood or tamponade.
Abdomen​: Abdominal gunshot wounds are quite frequent but not as serious as those
of the chest and head because of its amenability to surgical operation. In most cases
injuries are not only limited to one organ but to several organs. Injuries to the visceral
organs may not be found along the course of the bullet on account of their mobility
and their capacity to change their forms. Involvement of the vertebral column may
cause injury to the spinal cord. The mesenteric vessels, aorta, vena cava, and other big
abdominal blood vessels may be lacerated and cause severe hemorrhage.
Bullet wound of the liver and other parenchymatous abdominal organs may cause
stellate perforations which are usually larger than the caliber of the bullets that cause
them. The tunnel which is also wide may contain fragmented tissue, fresh and clotted
blood. On account of the richness of the blood supply of the parenchymatous organs,
profuse hemorrhage is the natural sequela. Loss of function, especially of the kidneys,
pancreas, etc. may lead to fatal results.
Bullet wounds of the stomach and other hollow organs are usually small on account
of the contractility of the walls. The wound of entrance is smaller than the wound of
exit. Grazing injury may simulate a lacerated wound. Injury of the viscus is usually
multiple and with less hemorrhage except when it involves the mesenteric vessels.
Timely surgical intervention may prevent untoward complications. However, death
due to peritonitis is not rare on account of the spilling of its contents into the
abdominal cavity.
Spine and Spinal Cord:
Injury of the spine may not involve the spinal cord, but injury of the spinal cord may
be due to:
1. The bullet may directly affect the canal and the spinal cord causing either partial or
complete severance.
2. The bullet may not hit directly the spinal cord but may cause injury in the body or
other parts of the vertebra and contusion, concussion or compression on account of
the impact. Injury of the upper cervical spinal cord may cause immediate death
because the vital nerve tracts may be involved. Lower spinal cord injury may cause
motor or sensory paralysis and may later succumb to hypostatic pneumonia,
suppuration or other complications.
Penal Provisions of Laws Relative to Firearm:
· ​Section 2692, Revised Administrative Code: Unlawful manufacture, dealing in
acquisition, disposition, or possession of firearms, or ammunitions therefor, or
instrument used or intended to be used in the manufacture of firearms or ammunition
Any person who manufactures, deals in, acquires, disposes, or .possesses any firearm,
parts of firearms, or ammunition therefor, or instrument or implement used or
intended to be used in the manufacture of ammunition in violation of any provision of
section 870-906, inclusive, of the code, as amended, .shall, upon conviction, be
punished by imprisonment for a period of not less than pjie year and one day nor
more than five years, or both such imprisonment and a fine of not lessthan one
thousand pesos nor more than five thousand pesos, in the discretion of the court. If
the article illegally possessed is a rifle, carbine, grease gun, bazooka, machine gun,
submachine gun, hand grenade, bomb, artillery of any kind or ammunition
exclusively intended for such weapons, such period of imprisonment shall be not less
than five years nor more than ten years. A conviction under this section shall carry
with it the forfeiture of the prohibited article or articles by the Philippine
Government.
· ​Section 2690, Revised Administrative Code: Selling of firearms to unlicensed
purchaser
It shall be unlawful for any dealer in firearms or ammunition to sell or_deliver any
firearms or ammunition or any part of a firearm to a purchaser or other person until
such purchaser or other person shall have obtained the necessary license therefor.
Any person violating the provisions of this section, upon conviction in a court of
competent jurisdiction, shall be punished by a fine not exceeding two thousand pesos,
or by imprisonment not exceeding two years, or both.
· ​Section 2691, Revised Administrative Code: Failure of personal representative
of deceased to surrender firearm
When a holder of any firearm license shall .dfc or become subject to legal disability
and any of his relatives, or his legal representative, or any other person shall
knowingly come into possession of any firearm or ammunition covered by such
license, such person, upon failure to deliver the same to the Chief of .Constabulary in
Manila or to the senior officers of Constabulary in the province, shall be punished by
a fine not exceeding five hundred pesos or by imprisonment not exceeding six
months, or both.
·​ ​Art. 155, Revised Penal Code: Alarms and Scandals
The penalty of arresto menor or fine not exceeding 200 pesos shall be imposed upon:
1. Any person who within any town or public place, shall discharge any firearm,
rocket, firecracker, or other explosive calculated to cause alarm or danger;
2 horizontally and also held in place by a spring side to side
Art. 254, Revised Penal Code:
Discharge of firearms: Any person who shall shoot at another with any firearm shall
suffer the penalty of prision correccional in its minimum and medium periods, unless
the facts of the case are such that the act can be held to constitute frustrated or
attempted parricide, murder, homicide or any other crime for which a higher penalty
is prescribed by any of the articles of the code
DIFFERENTIATE
● Firearms (Low Velocity | High Velocity) [p. 334-335]
● As to wounding power
● Low velocity: These are firearms with muzzle velocity of not
more than 1,400 feet per second.
● High velocity: These are firearms with muzzle velocity of
more than 1,400 feet per second. The usual muzzle velocity
is 2,200 to 2,500 feet per second or more.
● As to nature of the bore
● This firearm has the inside portion of the barrel that is
perfectly smooth from the firing chamber to the muzzle.
● This is a firearm with the bore of the barrel with a number
of spiral lands and grooves which run parallel with one
another, but twisted spirally from breech to muzzle.
● As to manner of firing
● Firearm which may be fired only by a single hand.
● Firearm which may be fired from the shoulder.
● As to nature of magazine
● The cartridge is located in a cylindrical magazine which
rotates at the rear portion of the barrel.
● The cartridge is held one after another vertically or
or end to end.
● Contact fire | Loose contact or near fire | Short range | Medium range |
Long range or Distant Fire [p. 354-358]
● In contact fire the nature and extent of the injury is caused not
only by the force of the bullet but also by the gas of the muzzle
blast and part of the body involved.
● In loose contact or near fire the (1)entrance wound may be large
circular or oval depending upon the angle of approach of the
bullet; (2) Abrasion collar or ring is distinct; (3) Smudging,
burning and tattooing are prominent with singeing of the hair; (4)
Muzzle imprint may be seen depending upon the degree of
slapping of the skin of the gun muzzle; (5) There is blackening of
the bullet tract to a certain depth; (6) Carboxyhemoglobin is
present in the wound" and surrounding areas.
● In short range the (1) edges of the entrance wound is inverted;
(2) if within the flame reach (about 6 inches in rifle and high
powered firearms and less than 3 inches from an ordinary
handgun), there is an area of burning; (3) smudging is present due
to smoke; (4) "Powder tattooing” is present (dense and limited
 dimension of spread); (5) Abrasion ring or collar is present
(contact ring).
● In medium range the (1) gunshot wound with* inverted edges'and
with abrasion collar is present; (2) burning effects (skin bum and
hair singeing) is absent.; (3) smudging may be present if less than
30 cm. distance; (4) gunpowder tattooing" is present but of lesser
density and has a wider area of distribution; (5) contact ring is
present.
● In long range or distant fire the (1) gunshot wound is'circular or
ovaf depending on the angle of approach with abrasion collar; (2)
wound of entrance has no burning, smudging or tattooing; (3)
contact ring is present.
● Gunshot wound entry | Gunshot wound exit
Entry:
● Appears to be smaller than the missile owing to the elasticity of
the 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 missile.
● Tattooing or smudging may be present when firing is near.
● Underlying tissues are not protruding
● Always present after fire.
● Paraffin test may be positive.
Exit:
● Always bigger than the missile
● Edges are everted
● It does not manifest any definite shape
● “Contusion collar” is absent
● Tattooing or smudging is absent
● Underlying tissues may be seen protruding from the wound
● May be absent , if missile is lodged in the body.
● Paraffin test always negative.
● Suicidal GSW | Homicidal GSW | Accidental GSW
● Suicidal: The shot was fired in a closed or locked room, usually in
the office or bedroom. he death weapon is almost always found
near the place where the victim was found. The shot was fired with
the muzzle of the gun in contact with the part of the body involved
or at close range. The direction of the fire is compatible with the
usual trajectory of the bullet considering the hand used and the
part of the body involved.
● Homicidal: The site or sites of wound of entrance has no point of
election. The fire is made when the victim is usually at some
distance from assailant. Signs of struggle (defense wounds) may
be present in the victim. There may be a disturbance of the
surroundings on account of previous struggle. Wounding firearm
usually is not found at the scene of the crime.
● Accidental: Usually there is but one shot. There is no special area
of the body involved. Consideration of the testimony of the
assailant and determination as to whether it is possible to be
accidental by knowing the relative position of thevictim and the
assailant.
● Common to all: Testimony of witnesses.
● (Ballistics) Interior | Exterior |Terminal | Medical
● Interior Ballistics (Internal Ballistics) — It is a branch of the
science of Ballistics which deals with what happened to the
cartridge and its bullet from the time the trigger of the gun is
pulled until the bullet exits from the barrel. It deals with the study
 of what happened in the chamber and gun barrel after the pull of
the trigger.
● Exterior Ballistics (External Ballistics) — It deals with what
happened to the bullet or projectile from the moment it leaves the
gun barrel to the moment of impact on the target or object. It is
concerned with the flight of the bullet and the influence of all
factors in its flight.
● Terminal Ballistics — This concerns with the effect of the bullet on
the target or until it comes to rest.
● Medical Ballistics — A form of terminal ballistics wherein the target
is a person. It is concerned with the penetration, severity and
appearance of the wound due to bullet or missile.
● Determination of Trajectory of bullet inside the body
● 1. External Examination:
EXPLAIN | DISCUSS
● Parts of a FIREARM
● Handle or Butt — The portion of the firearm used for handling it. It
may house the magazine.
● Firing Chamber — The place where the cartridge is held in position
before the fire mechanism starts.
● Breechblock — The steel block which closes the rear of the bore
against the force of the charge. The face of this block which comes
in contact with the base of the cartridge is known as the
breech-face.
● Trigger Guard.
● Front and Rear Sight.
● Safety Device like safety lock.
● Sling.
● Mechanism of Firearm Action
● When the firearm is cocked and ready to fire, a pull on the trigger
will cause the firing pin of the hammer to hit the percussion cap of
the cartridge in the firing chamber which is aligned with rear
portion of the barrel. The hit by the firing pin on the percussion cap
will cause generation of a sufficient heat capable of igniting the
primer. The primer will in turn ignite the gunpowder or propellant
which will cause evolution of gases under pressure and
temperature. The marked expansion of the gases will force the
projectile forward with certain velocity. Owing to the presence of
the rifling at the inner wall of the bore, the barrel offers some
degree of resistance to the projectile. Inasmuch as the rifling
marks are arranged in a spiral manner, the projectile will produce
a spinning movement as it comes out of the muzzle.
● a. Shape of the Wound of Entrance — When the bullet is
fired at right angle with the skin the wound of entrance is
circular except in cases of near fire. If fired at another
angle, the wound of entrance is usually oval in shape. When
the bullet is deformed, no such characteristic findings will
be observed.
● b. Shape and Distribution of the Contusion or Abrasion
Collar — As a general rule, the contusion (abrasion) collar is
widest at the side of the acute angle of approach of the
bullet. If the bullet hits the skin perpendicularly, then the
collar will have a uniform width around the gunshot wound,
except when the bullet is deformed or in near fire.
● c. Difference in Level Between the Entrance and Exit
Wounds — The difference in height between the gunshot
wound of entrance and exit may be determined by
measuring those wounds from the fixed references in the
body, e.g. sole of the foot, or by drawing a horizontal line
across the body and using it as a reference point.
● d. By Probing the Wound of Entrance — The probe must be
applied without too much force so as not to create a new
course in the soft tissues. Care must be observed in cases
of deflection of the course due to some hard objects that
might have been involved.
 ● 2. Internal Examination:
● a. Actual Dissection and Tracing the Course of the Wound at
Autopsy: The tissues involved are hemorrhagic and bone
spicules and lead particles may be seen or felt.
● b. Fracture of Bones and Course in Visceral Organs:
Occasionally, the nature of the bone fracture may show the
direction, especially when the bullet is not deformed before
causing the fracture. Injuries in solid visceral organs may
clearly manifest the course because of the absence of
contractility.
● c. Location of Bone Fragments and Lead Particles: The bone
spicules and lead fragments go with the flight of the bullet
and may be utilized in the determination of the trajectory.
● d. X-ray Examination: Bone spicules and lead fragments
may be observed and their exact location determined in
relation with the wound of entrance.
● 3. Other Evidences to Show Trajectory:
● a. Relative difference in the vertical location of the entrance
from the exit in the clothings.
● b. Relative position and distance of the assailant from the
victim in the reconstruction or reenactment of the crime.
● Odd and Even Rule in GSW [p. 363]
● If the number of gunshot wounds of entrance and exit found in the
body of the victim is even, the presumption is that no bullet is
lodged in the body, but if the number of the gunshot wounds of
entrance and exit is odd, the presumption is that one or more
bullets might have been lodged in the body.
● The rule is merely presumptive and actual inspection and autopsy
will verify the truth of the presumption. It may be possible that all
of those wounds or a majority of them are entrance wounds with
some bullets lodged, yet the number may still be even. Sometimes
it is difficult to locate the lodged bullet but with the help of a
portable X-ray, its location and extraction can be facilitated.
● Instances when there is no GSW exit but the bullet is not found in the
body
● When the bullet is lodged in the gastro-intestinal tract and
expelled through the bowel", or lodged in the pharynx and
expelled through the mouth by coughing.
● Near fire with a blank cartridge produced a wound of entrance but
no slug may be recovered.
● 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
● Gunshot wounds as suicidal
● The shot was fired in a closed or locked room, usually in the office
or bedroom. If in the bedroom, the shot was fired while the victim
was lying in bed and the weapon covered with pillow or bedding to
muffle the sound. It may be committed in an open isolated or
uninhabited place.
● The death weapon is almost always found near the place where the
victim was found. When a light, low caliber hand firearm was used
and the shot was made in parts of the body where death may
develop almost instantaneously, the victim may be seen with the
grip of the firearm firmly held in the palm of the wounding
(cadaveric spasm).
● The shot was fired with the muzzle of the gun in contact with the
part of the body involved or at close range. The wound of entrance
may show signs of muzzle impression, burning, smudging and
tattooing.
● The location of the gunshot wound of entrance is in an accessible
part of the body to the wounding hand. It may be at the temple,
roof of the mouth, precordial or epigastric region. A person
committing suicide will do the act in his most convenient way,
unless he has the intention of deceiving the investigator.
 ● The shot is usually solitary. If the shot is made on the head
involving the brain, the shocking effect of the injury will not make
him capable of firing another shot. However, shots in some parts of
the body which may not produce immediate death or sudden loss
of consciousness, the possibility of additional shots is not remote.
The victim may be determined to die and had fired additional shots
to insure realization of his intention.
● The direction of the fire is compatible with the usual trajectory of
the bullet considering the hand used and the part of the body
involved. A shot on the temple is usually directed towards the
opposite temple and upwards, while a shot in the precordium and
epigastrium is usually backwards and downwards.
● Personal history may reveal social, economic, business or marital
problem which the victim cannot solve. He may have history of
mental disease, depression, severe frustration or previous attempt
of self-destruction.
● Examination of the hand of the victim may show presence of
gunpowder.
● Entrance wound do not usually involve clothings.
● Fingerprints of victim on the butt.
● Search of the place where the shot took place may reveal a suicide
note which usually mentions among other things the reason why
the victim committed suicide.
● No disturbance in the place of death.
● Gunshot wounds as homicidal
● The site or sites of wound of entrance has no point of election.
● The fire is made when the victim is usually at some distance from
assailant.
● Signs of struggle (defense wounds) may be present in the victim.
● There may be a disturbance of the surroundings on account of
previous struggle.
● Wounding firearm usually is not found at the scene of the crime.
● Testimony of witnesses.
● Gunshot wounds as Accidental
● Usually there is but one shot.
● There is no special area of the body involved.
● Consideration of the testimony of the assailant and determination
as to whether it is possible to be accidental by knowing the
relative position of the victim and the assailant.
● Testimony of witnesses.
● Basic Principles involve in Firearm ID
● The quality of metal in the manufacture of the firearm is very much
harder and resistant to deformity as compared with the quality of
metal used in the manufacture of the cartridge, so that in the
process of contact between the part of the gun involved and the
cartridge, the surface condition of the part of the gun can easily be
impressed on the shell or bullet.
● For reasons known only to the manufacturer, firearms have certain
physical characteristics of certain type of caliber which
differentiate it from others. This includes the number of lands and
grooves, the direction of the twist, width of the individual land or
groove, style of the cannelure, etc., which become the basis of
class characteristics in firearm identification.
● No two firearms can be manufactured with identical surface
characteristics. Each firearm on close examination will show the
differences. Marks on the different bullets or shells fired from one
firearm have similar characteristics when viewed in the
comparison microscope. Marks on different bullets or shells fired
from different firearms will show variation in the findings. This is
referred to as individual characteristics.
ENUMERATE
● Death or physical injuries caused by powder propelled substances are due
to?
● Firearm shot ● Movements of bullet on trajectory
● Detonation of high explosives ● Forward Movement
● Spinning Movement
● Tumbling Movement (End-over-end flotation)
● Wabbling Movement (Tailwag)
● Classification of firearms ● Pull of Gravity
● As to Wounding Power
● Low Velocity Firearm
● High Power Firearm
● As to the Nature of the Bore: ● Destructive mechanism of gunshot is due to?
● Smooth Bore Weapon ● Laceration and Permanent Cavity in the Bullet Trajectory
● Rifled Bore Firearm ● Temporary Cavity
● As to the Manner of Firing ● Hydrostatic Force
● Pistol ● Shock Wave
● Rifle ● Fragmentation or Disintegration of the Bullet
● As to the Nature of the Magazine ● Fragmentation of Hard Brittle Object in the Trajectory
● Cylindrical Revolving Magazine Firearm ● Muzzle Blast in Contact Fire
● Vertical or Horizontal Magazine ● Other Consequential Effects on the Body of the Victim

● Types of Small firearm which are of medico-legal interest ● GSW entrance appearance is due to?
● Revolver ● Caliber of the Wounding Weapon
● Automatic Pistol ● Characteristics Inherent to the Wound of Entrance
● Rifle ● Direction of the Fire
● Shotgun ● Shape and Composition of the Missile
● Range
● Kind of Weapon

● Principal Parts of a cartridge or ammunition

● The cartridge case or shell. ● Instances when the number of GSW entry is less than GSW exit
● Primer. ● A bullet might have entered the body but split into several
● Powder or propellant. fragments, each of which made a separate exit.
● Bullet or projectile
 ● One of the bullets might have entered a natural orifice of the body, ● Determination of the distance of the gun muzzle from the victim's
e.g. mouth, nostrils, thereby making it not visible and then body when fired
producing a wound of exit. ● Determining whether a person has fired a firearm
● There might be two or more bullets which entered the body
through a common entrance and later making individual exit
wounds.
● 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.

● Problems confronting Forensic

● Alteration of the Lesion Due to Natural Process
● Medical and Surgical Intervention
● Embalming
● Problem Inherent to the Injury Itself
● X-ray Examination

● Questions expected to be answered in court

● Could the wound or wounds be inflicted by the weapon presented
to him?
● At what range was it fired?
● What was the direction of the fire?
● May it be possible that those gunshot wounds are self-inflicted?
● Are there signs of struggle in the victim?
● May it be possible for the victim to fire or resist the attack after the
injury was sustained by him?
● Did the victim die instantaneously?
● Where was the relative position of the assailant and the victim
when the shot was fired?

● Importance in determining the gunpowder on the skin of the victim


CHAPTER 14. THERMAL INJURIES OR DEATHS (p. 394-413)
(GAB., MENG., VIL.)
DEFINE | TERMS
·​THERMAL INJURIES (p. 394) – They are those caused by an
appreciable deviation from normal temperature, capable of
producing cellular or tissue changes in the body.
·​THERMAL DEATH (p. 394) – This is death primarily caused by
thermal injuries.
·​GIDDINESS – It is a sensation of whirling and tendency to fall or
stagger (Dizziness).
·​SYNCOPE (p. 199) – This is death due to sudden and fatal
cessation of heart action with circulation included.
·​LETHARGY – It is a pathological state of sleepiness or deep
unresponsiveness and inactivity.
·​DELUSION (p. 630) – It is a false or erroneous belief in something
which is not a fact.
and associated especially with brain disorders such as epilepsy,
presence of certain toxins or other agents in the blood, or fever in
children.
·​DELIRIUM (p. 653) – It is a state of confusion of the mind,
characterized by incoherent speech, hallucination, illusions,
delusions, restlessness and purposeless motions.
·​SEPSIS - It is the presence of bacteria, infectious organisms, or
toxins created by infectious organisms in the bloodstream which
spread throughout the body.
·​HEAT RUPTURE (p. 407) - It is the splitting of the soft tissues of
the body due to exposure before or after death of the body to
considerable heat.
·​HEAT STIFFENING (p. 407) – This is a condition found in dead
bodies which have been subjected to heat.
·​CHEMICAL BURNS (p. 410) – Also known as Corrosive Burns. They
are the action of strong acids and alkalies and other irritant
chemicals which cause extensive destruction of the tissue.
·​RADIATION BURNS (p. 413) - These are burns that may be caused
by: (a) intense exposure to X-ray; or (b) an overdose of ultraviolet
light.

·​CONVULSION – It is a sudden, violent, or irregular movement of a

limb or of the body, caused by involuntary contraction of muscles
KNOW
·​Death or Injury due to COLD (p.394)
Death or injury due to a cold is not common in tropical countries.
The primary cause of death is attributed to the decreased
dissociation of oxygen from hemoglobin in the red blood cells and
diminished power of the tissue to utilize oxygen. Cold produces a
vascular spasm which results to anemia of the skin surface followed
by vascular dilatation with paralysis and increased capillary
permeability. Prolonged exposure may cause necrosis and
gangrene.
·​Death or Injury from HEAT (pp. 396-398)
The effects of heat in the body may be local at the application, or
general when the whole body is affected. There are two
classifications of heat injury which includes General or Systematic
Effects and Local Effects. The former consist of heat cramps, heat
exhaustion and heat stroke while the latter consist of scald and
burns.
·​Medico-legal importance of Heat Injury (p. 398)
If ever death occurs, it is most often accidental. Laborers who are
working under the sunshine, in a heated room, or in a poorly
ventilated place may suffer from any of the conditions. Alcoholism,
ill-health, disease and fatigue may be some of the predisposing
factors. Although mostly accidental, physician must perform the
necessary post-mortem examination in the bodies to eliminate the
possibility of foul play. However, it may be homicidal or suicidal in
rare instances. Children may be victims of infanticidal acts when
subjected to conditions promoting their development.
·​Medico-legal aspects of burns and scalds (p. 409-410)
During the ancient and medieval times, branding is a means to
secure identity. Red-hot metals shaped in letters or figures are
pressed in the arm and thigh. With the improvement of the present
method of identification, branding is now only made on domestic
animals. Extraction of confession by burning the fingers, application
of heated metals on the skin, or pouring boiling water on the body
is now punishable.
·​Time required to completely burn a human body (pp. 404-405)
The time required to transform the human body to ashes is
dependent upon several factors, namely:
a. Degree or intensity of heat applied.
b. Duration of the application of heat.
c. Physical condition of the body.
d. Presence of clothings and other protective materials.
About 72% of the human body weight is. water and this is
responsible for the delay in its combustion, however, there is about
5% fat which may enhance combustion on account of its
combustibility. In a gas furnace incinerator, it requires about four
hours of continuous application of heat to transform the body into
ashes.
·​Age of burns (pp. 405)
A very recent burn will show no pus, or much healing, or edema.
When the pus is already present and the red inflammatory zone has
disappeared, it is about 36 hours or a few days old. There is a
superficial sloughing in a third degree burn in about a week. The
deeper sloughs are thrown off in two weeks and are attended with
suppuration. When the red granulation tissue is present, it is about
two weeks old. The age of older burns is estimated by the amount
of granulation tissue present, by its depth, and by the extent of the
growth of epidermis from circumference.
·​Investigation of death in a conflagration (p. 408)
Examination of the burnt body should be directed to obtain the
following informations:
a. Identity, which may be established from: Clothing. Careful
handling must be stressed, as charred materials can yield
considerable information in expert hands, but can also be easily
destroyed. The size of footwear may be of importance. Property in
the pockets such as key, money, papers and the like. Height — Sex
— Age — Color of eyes — Color of hair. Natural disease or stigmata
such as scars, old deformities or injuries and dentition.
b. Whether the person was alive in the fire, which can be decided
from the presence of carbon particles in the air passages, and the
estimation quantitatively of carbon monoxide in the blood.
c. Cause of death.
d. Information indicating a possible cause of the fire, as shown by
examination of the deceased. Evidences of the following should be
noted. Alcoholic intoxication (Blood and urine estimation for
alcohol). Natural disease which might have caused collapse, such as
epilepsy, hypertension, myocardial fibrosis. Site of origin of the fire,
as shown by maximal effects in relation to position of the body.
Demonstration of injuries which could have been sustained before
the fire commenced.
·​Treatment of Corrosive Substances Injury (p. 412)
a. Neutralization of the corrosive substances.
b. Protection of the eye from involvement.
c. Prevention of infection of the lesion.
d. Other supportive or symptomic treatments.
Burns from corrosive fluids are quite rare and are usually due to
accidents in chemical laboratories. Vitriol throwing is common in
England. Intentional spilling or throwing of corrosive fluid causes
physical injury and on account of the deforming scar it produces, it
becomes a serious physical injury. Corrosive burns are commonly
observed in suicidal ingestion with spilling of the chemical around can  encompass  intentionally  ignited  fires,  such  as  brush  or  trash  fires,  which 
the mouth and neck. spread uncontrollably. 

·​Laws involved in: ·​Burns | Scalds (p. 402)

o​ A
​ rson (pp 410)
The Revised Penal Code considers the killing of a person
by means of fire as murder. The setting of a building on
fire must be an intentional means to kill the person
inside the building to make it a murder (Art. 248).
There should be the actual design to kill and that the
use of fire should be purposely adopted as a means to
that end (People v. Burns 41 Phil. 418).
Burns are caused by dry heat and occurs at or above the site of
contact of the flame. Because of the flame or radiant heat, singeing
of hair is present and the boundary of the affected and unaffected
area is not clear. Depending on the factors that influence the effect
of burns in the body, the injury sustained may be severe.
Scalds, on the other hand, are caused by the application of moist
heat. Because of the heat being moist, singeing of hair is absent
and clothes are not usually burned.

DIFFERENTIATE ·​Ante-mortem Burns | Post-mortem Burns (p. 406)

·​Intentional Fire | Accidental Fire The principal basis of the distinction is the presence or absence of
vital reaction, like inflammation, vesicle formation, congestion and
Intentional  fires  are  those  fires  that  are  deliberately  set  and  include  fires that  granulation tissue.
result  from  deliberate  misuse  of  a  heat  source,  fires  of  an  incendiary  nature 
(arson), as well as controlled burn fires, such as crop clearing.  The blister formed in ante-mortem burns contains abundant
albumen and chlorides, while in post-mortem burns, the blister
In  contrast,  accidental  fires  are  those  in  which  the  proven  cause  does  not  contains scanty albumen and chlorides. There is an area of
involve  any  deliberate  human  act  to  ignite  or  spread  the  fire.  While  in  most  inflammation around an ante-mortem burn which is not present in
instances,  this  classification  is  clear,  some  deliberately  set  fires  can  be  the case of post-mortem bums.
accidental. 
The base of the vesicle is red in ante-mortem bums while there is
Though  both  are  similar  in  the  sense  that  there  is  misuse  of  a  heat  source,  not much change in color in the case of post-mortem burns.
accidental  fires  are  not  the  result  of  deliberate or intentional actions, but also 
Blood will show presence and abundance of carboxyhemoglobin in
cases of ante-mortem burns, but not in cases of post-mortem
burns.
·​Spontaneous | Preternatural Combustibility (p. 410)
Some authorities claim that the human body can ignite itself
spontaneously and burn itself to death. This is hardly possible
because of the high percentage of water in the human body.
Spontaneous combustibility may be utilized as a defense in cases of
homicidal burns if it is really probable.
In Preternatural Combustibility, it states that the human body is
inflammable on account of the presence of gases which easily
ignite. The gases are said to be the products of the action of
microorganisms in the body. This explains the presence of
phosphorescent light in the graveyard during night time. If ever the
theory is true, then there can only be a partial combustion of the
human body.
·​Thermal Burns | Chemical Burns (pp.410-411)
Blisters may be found in thermal burns, however, these are absent
in cases of chemical burns. There may be chemical stains in case of
chemical burns, while in thermal burns these are absent. In thermal
burns, the lesion is diffused while in chemical burns the borders are
distinct and simulates a geographical appearance.
·​Contact Burn | Spark Burn | Flash Burn (P. 413)
Contact Burns are due to close contact with an electrically live
object. The degree of injury will vary depending on how long
contact is maintained.
Spark Burns are due to poor contact and the resistance of dry skin
and show a pricked appearance with a central white zone and
surrounding hyperemia. This burn, which may be essential to the
proof of electrical contact, can be very hard to identify.
Flash Burns is  ​any burn injury caused by intense flashes of light,
high voltage electric current, or strong thermal radiation. The
appearance varies from the arborescent pattern of lightning burns
to the “crocodile skin” appearance of a high voltage flash.
EXPLAIN | DISCUSS
·​Primary Cause of Death in Cold Injury (pp 394)
The primary cause of death in cold injury is attributed to the
decreased dissociation of oxygen from hemoglobin in the red blood
cells and diminished power of the tissue to utilize oxygen. Cold
produces a vascular spasm which results to anemia of the skin
surface followed by vascular dilatation with paralysis and increased
capillary permeability. Prolonged exposure may cause necrosis and
gangrene.
·​Local Effects of Heat (Scald, Thermal Burns, Chemical Burns,
Electrical Burns)
 1. Scalds - Scalds are injuries produced by the application to the
body, liquids at or near boiling point, or in its gaseous state.
The term applies to tissue destruction by moist heat.
2. Thermal Burns - Burns are lesions which are caused by the
application of heat or chemical substances to the external or
internal surfaces of the body, the effect of which is
destruction of the tissue of the body.
3. Chemical Burns - Chemical burns are the action of strong
acids and alkalies and other irritant chemicals which cause
extensive destruction of the tissue. Healing is quite slow and
may require plastic surgery. The most common of the
chemicals are concentrated sulfuric acid, nitric acid,
hydrochloric acid, caustic soda and potash, lysol, etc.
Chemical burns may be followed by keloid scars.
4. Electrical Burns - There are three kinds of electrical burns,
namely: — contact burns, spark burns, and flash burns. The
characteristic feature of all of them is that their depth is
greater than the surface appearance this would suggest that
severe sloughing of the tissues may occur later.
·​Characteristics of scalds (pp. 398-399)
a) They have a distribution called a “geographical lesion.” It
follows the portion involved in the splashing of the scalding
fluid together with the rule of gravity.
b) The skin lesion may be located in covered portions of the
body without affecting the clothings.
c) There is neither burning of the hair nor deposit of
carbonaceous material on the skin surface.
d) The lesion is usually first, second or third degree, except in
cases of heated oil or molten metals.
e) Inhalation of heated vapor may lead to inflammatory reaction
in the air passage which may lead to respiratory obstruction
due to edema of glottis.
f) Usually, there is redness of skin immediately after the
application, later a blister is formed.
g) Sepsis with development of pus may appear in one or two
days. Healing may be accompanied by formation of scars,
which may result in contracture or keloid formation.
·​Characteristics of burns (pp. 400-401)
a) The lesion varies from simple erythema to complete
carbonization of the body.
b) Usually, there is singeing of the hair and carbon deposits on
the area affected.
c) The area involved is general and usually without any
demarcation line of the affected and unaffected parts.
ENUMERATE
·​ ​GENERAL EFFECT OF HEAT INJURY (pp. 396-398)
a)​ H
​ eat Cramps
b)​ H
​ eat Exhaustion c.​ C
​ omatous​ Form

c)​ H
​ eat Stroke d.​ T
​ hermic Fever

·​OTHER NAMES FOR: HEAT CRAMPS|HEAT EXHAUSTION|HEAT ·​DUPUYTREN’S CLASSIFICATION OF BURNS IN THE BODY (pp.
STROKE (pp. 396-398) 401-402)

1.​ H
​ eat Cramps o ​First Degree – There is simple redness of the skin
associated with superficial inflammation and slight
a.​ M
​ iner’s Cramp
swelling which may subside after a few hours or may
b.​ F
​ ireman’s Cramp
last for several days.

c.​ S
​ toker’s Cramp
o ​Second Degree – There is vesicle formation with
acute inflammation.
2.​ H
​ eat Exhaustion
o T
​ hird Degree – There is destruction of the cuticle and

a.​ H
​ eat Collapse part of the true skin.

b.​ S
​ yncopal Fever o ​Fourth Degree – The whole skin is destroyed with
formation of slough which is yellowish-brown or
c.​ H
​ eat Syncope
parchment-like.
d.​ H
​ eat Prostration
o ​Fifth Degree – There is involvement of the deep fascia
3.​ H
​ eat Stroke and muscles.

a.​ S
​ unstroke
o ​Sixth Degree – There is charring of the limb involving
subjacent tissues, organs and bone.
b.​ H
​ eat Hyperpyrexia
 ·​KINDS OF ELECTRICAL BURNS (pp. 412-413) [3 Kinds]

·​PROOFS THAT VICTIM WAS ALIVE BEFORE GETTING BURNED TO o​ C

​ ontact Burns

DEATH (p. 405)

o​ S
​ park bruns

o​ P
​ resence of Smoke in the air passage.

o​ F
​ lash Burns

o​ I​ ncrease of carboxy-hemoglobin blood level.

o​ D
​ ermal erythema, edema, and vesicle formation.

o​ S
​ ubendocardial left ventricular hemorrhage.

·​FINDINGS THAT PROVE THAT DEATH WAS DUE TO BURNING (pp.
405-406)
o T
​ he following findings may prove that death is due to
burning:
a) Presence of vital reaction at the heated
areas.
b) Presence of carboxyhemoglobin in the
blood.
c) Presence of carbon particles in the
trachea-bronchial lumina.
CHAPTER 15
PHYSICAL INJURIES OR DEATH BY
LIGHTNING AND ELECTRICITY
DEFINE | TERMS
·​Lightning-​​is an occurrence electrical charge in the atmosphere. Its place of and
intensity are unpredictable. (P. 413)
·​
Sledge Hammerblow-​​ this is the effect when a compressed air pushed before the
current with superheated atmosphere may produce a backward wave. This produce
concussion, shock, or unconsciousness to the victim. (P. 413)
KNOW
· Elements of lightning that produces injury (p. 413)
1. Direct effect from the electrical charge: ​
The electrical charge of lightning may
pass to the body producing electrocution. The human body especially its nerves, is a
good conductor of electric current.

2. Surface "flash" burns from the discharge: ​Some of the electrical energy in a
lightning is transformed to heat energy. The superheated air may cause burning of
the skin of the victim. The flash burn may produce arborescent marking but are by no
means typical.
3. Mechanical effect: ​The expansion of the air on account of the superheated
atmosphere may bring about mechanical injury. It may result to laceration of the
body surface, severe tearing of the clothings and displacement of parts of the body.
4. Compression effect: ​The compressed air pushed before the current with
superheated atmosphere may produce a backward wave. This causes the "sledge
hammerblow" on the body of the victim, thereby producing concussion, shock, or
unconsciousness to the victim.
· ​Points to be considered in making a diagnosis of death due to lightning (p.
414)
1. History of a thunderstorm that took place in the locality.
2. Evidences of the effects of lightning are found in the vicinity, like damages to
houses, trees, and other objects; death of other person and animals nearby.
3. Metallic articles are fused and magnetized.
4. Fusion of glass materials on account of severe heat.
5. Absence of wound and other injuries indicating suicidal or homicidal death.
6. Skin often shows arborescent markings due to superficial erythema which
disappear in a day or two if the person lives.
7. Burns may be present, but may be limited to the part under the pieces of metals
such as watch, knife or bunch of keys. The burns are superficial or may be very
deep.
·​
Death or physical injuries from electricity (p. 416)
The main cause of death in electricity is shock. Ordinary domestic line is from 100 to
250 volts and it is sufficient to produce death. The effect of 300 volts and above may
be similar to lightning stroke. Voltage is not only the factor causing the injury. As a
matter of fact, amperage or intensity of the electrical current is the principal factor.
The damage to the body by an electrical discharge depends upon several factors
which may increase or decrease the electrical conductivity of the body. The presence
of moist skin, wet floor, barefoot and proximity of metals, increase the conductivity of
the body to electricity. Dryness of the skin, presence of rubber boots or shoes,
dryness of the floor and better insulation of the metallic conductor increase the
resistance. An increase in the conductivity of the body will promote more injury.
·​
Mechanism of death in Electrical Shock (p. 417)
1. Ventricular fibrillation which may lead to the rupture of some of the muscle fibers
and focal hemorrhages in low voltage.
2. Respiratory failure due to bulbar paralysis in high voltage.
3. Mechanical asphyxia due to violent and prolonged convulsion.
·​
Treatment or management when electrocuted (p. 419)
1. Remove the victim from live wire installations. Close the switch and remove the
victim and in which case, care must be exercised by the rescuer.
2. Artificial respiraton which must continue for about an hour until positive proof of
death is present.
3. Treatment of shock or coma. As soon as spontaneous respiration is established,
raise the temperature of the patient by the application of hot water in bottles and
blankets. Cerebral edema may be treated by lumbar puncture. Stimulant may be
given to improve the health .
Treatment: (p. 415)
1. Artificial respiration.
2. Air passage must be kept free.
3. Lumbar puncture to release the tension in the cerebrospinal fluid.
4. Rectal hypnotic to combat delirium.
5. Treatment to combat shock.
6. Treatment to build resistance of the victim.
· ​Laws involved in:
o Death Penalty by Electrocution
Art. 81, Revised Penal Code — When and how the death penalty is to be
executed. — The death sentence shall be executed with preference to any
other and shall consist in putting the person under sentence to death by
electrocution. The death sentence shall be executed under the authority of the
Director of Prisons, endeavoring so far as possible to mitigate the sufferings
of the person under sentence during electrocution as well as during the
proceedings prior to the execution. If the person under sentence so desire, he
shall be anesthesized at the moment of the electrocution.
Art. 82, Revised Penal Code​ — Notification and execution of the sentence
and assistance to the culprit. — The court shall designate a working day for
the execution, but not the hour thereof, and such designation shall not be
communicated to the offender before sunrise of said day, and the execution
shall not take place until after the expiration of at least eight hours following
the notification, but before sunset. During the interval between notification and
the execution, the culprit shall, in so far as possible, be furnished with
assistance as he may request in order to be attended in his last moments by
priests or ministers of the religion he professes and to consult lawyers, as
well as in order to make a will and confer with members of his family or
persons in charge of the management of his business, of the administration of
his property, or of the care of his descendants.
DIFFERENTIATE
· Alternate Current | Direct Current (​based ha interner)
Direct current (DC) ​is the flow of electric charge in only one direction. It is the
steady state of a constant-voltage circuit.
Alternating current (AC) ​
is the flow of electric charge that periodically reverses
direction.
EXPLAIN | DISCUSS
· Effects of lightning in the human body (p. 414)
Death is usually the immediate effect due to the involvement of the central nervous
system. The shock is produced by the instantaneous anemia of the brain brought
about by the spasmodic contraction of the cerebral vessels. The lightning may cause
immediate loss of consciousness and because of the intense disturbance of the air,
the clothings may be removed from the body or severely torn. Occasionally, a person
may recover from the effect of the lightning stroke but in most cases suffer from
certain degree of neurological disturbances.
ENUMERATE
· Classes of burns due to lightning (p. 414)
1. Surface burns — ​ These are superficial burns usually seen under metallic objects
worn or carried by the victim.
2. Linear burns — ​ These are found where areas of the skin offer less resistance,
notably in the moist creases and folds of the skin and may vary in length from one to
twelve inches.
3. Arborescent or filigree burns — ​
These are radiating burns from a point, similar
to electrocution.
·​
Factors which Influence the Effect of Electrical Shock (p. 416- 417)
1. Personal idiosyncracy — ​ Individual personality, physical condition, and the
existence of mental or bodily distress at the time, influence the effect of a shock.
2. Disease — ​A person suffering from cardiac disease is predisposed to death from
electrical shock.
3. Anticipation of a shock — ​When a person is aware of the possibility of a shock,
the victim can withstand one which might otherwise be dangerous.
4. Sleep — ​Sleep increases the resistance to an electrical current.
5. Electrical voltage or tension — ​Most fatalities are followed by a shock from a
current at a tension of 220 — 250 volts, although 50 volts which are used for
therapeutic purpose also show fatality.
6. Amperage or intensity of electric current — ​This is the principal factor. This is
determined by dividing the voltage with the resistance of the conductor. Amperage of
70-80 in alternating current or 250 in direct current is dangerous to man.
7. Density of the current.
8. Resistance of the body — ​Factors that will reduce the resistance of the body to
electrical flow will promote more injury.
9. Nature of the current — ​It is claimed that the alternating current is more
dangerous than direct current.
10. Earthing— ​The development of shock is enhanced, if the victim is grounded or
earthed. Earthing will promote continuous flow of electric current.
11. Duration of contact — ​Low tension may kill when contact is maintained for
several minutes. A shorter duration of contact is enough for high tension to produce
death.
12. Kind of electrodes — ​Some electrodes conduct a free flow of electric current
while others do not.
13. Point of entry — ​Contact of the left side of the body is claimed to be more
dangerous than that of the right side.
CHAPTER 16
DEATH OR PHYSICAL INJURIES DUE TO CHANGE OF ATMOSPHERIC
PRESSURE (BAROTRAUMA)
DEFINE | TERMS
· Atmospheric Pressure - ​ The normal atmospheric pressure at sea level is
760 millimeters of mercury. A person is subjected to an increase of
atmospheric pressure as he goes deeper in a body of water and a decrease as
he ascends higher in the atmosphere. (p.421)
· Bends - ​Air emboli during decompression may lodge in the capillaries of
the big joints causing it to adopt a semi-flex position (p.422); Joint and
muscular pain due to the presence of air bubbles (p.423)
· Chokes - ​Substernal distress, a non-productive coughing and respiratory
distress. This is the result of bubble formation in the pulmonary capillaries or
from the effects of extravascular mediastinal bubbles exerting pressure on the
mediastinal contents and adjacent pulmonary tissue. (p.423)
· Hypoxia - ​
It will be felt between 8,000 to 15,000 feet level. (p.423)
· Anoxia - ​
At higher altitude the oxygen content of the atmosphere
becomes lesser and lesser. (p.423)
· Paper Bag Pressure
KNOW
· Nitrogen Narcosis ​It is when nitrogen, an inert gas which constitute
approximately 80% of the air in the lungs is also dissolved in the body fluid.
This condition is preceded by a feeling of euphoria. (p.421)
· Aircraft injuries and fatalities
Causes of Injuries and Fatalities in Aircraft are:
1. During the Flight:
a. Altitude: Hypobarism (Decompression).
b. Speed — Passengers and crew may suffer from spatial disorientation and
windblast. The sudden change of direction at a speed of 500 miles tends to
drain blood from the brain to the lower parts of the body resulting to a
momentary black-out or unconsciousness.
c. Toxins — Carbon dioxide, carbon monoxide, and other irrespirable gases
may saturate the cabin compartment and cause asphyxia.
d. Temperature — At high altitude, the temperature falls and at the height of
25,000 feet, it is 40° below zero. Death may be due to frostbite or freezing of the
body.
e. Pre-existing disease — Coronary disease or hypertension may cause fatality
due to the sudden change of environment.
2. During the Crash:
Most of the aircraft fatalities occur during the take-off and landing. During the
crash, the whole plane bursts into flame due to its high octane fuel content. If a
passenger or crew survives
the crash, he will suffer from severe thermal injuries. Modern high speed
turbojet or jet aircraft have a velocity of not less than 500 miles per hour as
much as that of the terminal
velocity at the time of the impact which causes widespread destruction of the
aircraft and also of the ground. Potential survivor may be those who were
trapped within the cabin but are rescued before a fire develops or those who
are fortuitously thrown from the aircraft.
a. Fracture of the tibia and fibula is due to the presence of the horizontal bar at
the rear of the front seat;
b. Fracture of the femur is due to the high vertical force and the
front bar of the seat;
c. In the chest, the common site is the upper half and is frequently associated
with sternal injuries indicating that it is of a flexion type;
d. Cranio-facial injuries is due to the impact of the head to the seat in front
when subjected to a vertical hit. There may be a fracture of the classical ring
type surrounding the foramen magnum due to the vertical force.
e. Rupture of the heart or aorta is quite common as this is due to compression
of the heart between the sternum and spine during the flexion or the mobile
heart is torn from the static aorta during deceleration of the body in the vertical
fall of the
body.
DIFFERENTIATE
· Hyperbarism | Hypobarism
Hyperbarism or the increase of atmospheric pressure is a condition
observed underwater by scuba divers, pearl divers, salvage divers, treasure
hunters, pleasure swimmers, etc. As the diver goes deeper into the body of
water, the atmospheric pressure he is subjected to increases. The
atmospheric pressure is doubled at 10 meters and this increases further as
he goes deeper. As a consequence of this, there is an increase in the amount
of gas dissolved in the blood and other body fluids.
Hypobarism or the decrease of atmospheric pressure states that at a
higher altitude, the atmospheric becomes lower and more gas will be
liberated by the body fluid.
EXPLAIN | DISCUSS
· Henry’s Law
Henry's law provides that "at constant temperature, the amount of gas
dissolved in a liquid is directly proportional to the pressure.​
"
· Effects of High atmospheric pressure (p. 421)
 - There is an increase in the amount of gas dissolved in the blood and other - In the chest, it may cause interstitial emphysema at its wall and also
body fluids. at the neck and face. Pneumothorax and pulmonary air embolism may
- an inert gas which constitute approximately 80% of the air in the lungs is also also be present.
dissolved in the body fluid and this causes the so-called "nitrogen narcosis" - Air emboli during decompression may lodge in the capillaries of the
(rupture or drunkenness of the deep). This condition is preceded by a feeling big joints causing it to adopt a semi-flex position
of euphoria
- the absorption of gas in the lungs will cause decrease pressure on the - The release of gases from the body fluid will cause:
pulmonary tissue a. "Bends"
- A rapid descent may cause rupture of the blood vessels and hemorrhage. b. "Chokes"
c. Substernal emphysema
d. Trapped gas
· Effects of Low atmospheric pressure (p. 423)
- 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. This is the result of bubble formation in the pulmonary
capillaries or from the 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

CHAPTER 17
viscus, like the stomach and intestine at 18,000 feet level. The size
quadruples at 33,000 feet. Expansion of the size of the stomach may cause
diaphragmatic herniation.

ENUMERATE DEFINE | TERMS

· Body effects during release of gas from the body fluid in decreasing
atmospheric pressure or ascent. (p. 422 and 423)
- Effects of ascent from a high atmospheric pressure
- Released air bubbles may be present in the circulation and become
potent emboli in different parts of the body.
Asphyxia - the general term applied to all forms of violent death which results
primarily from the interference with the process of respiration or the condition in
which the supply of oxygen to the blood or to the tissues or both has been reduced
below normal level.
Dyspnea - due to the lack of oxygen and the retention of carbon dioxide in the body
tissue, the breathing becomes rapid and deep, the pulse rate increases, and there is
a rise in the blood pressure. The face, hands and fingernails become bluish,
especially in the case of infants.
Apnea - due to the paralysis of the respiratory center of the brain, the breathing
becomes shallow and gasping and the rate becomes slower till death. The heart later
fails.
Tardieu Spots - small petechial hemorrhages caused by the hemorrhage produced
by the rupture of the capillaries on account of the increase of intra-capillary pressure
Strangulation - compression of the neck by means of a ligature which is tightened by
a force other than the weight of the body
Lynching - form of homicidal hanging usually found in southern states of the United
States. It is usually practiced by Americans against the Negroes who commit crime
against the white-American. Whenever, the colored offenders are apprehended, they
are hanged by means of a rope on a tree or some similar objects. The Negroes are
executed without due process of the law.
Throttling - This is a form of asphyxial death whereby the constricting force applied in
the neck is the hand.
Smothering - This is a form of asphyxial death caused by the closing of the external
respiratory orifices, either by the use of the hand or by some other means. The
nostrils and mouth may be blocked by the introduction of foreign substances, like
mud, paper, cloth, etc.
Choking - This is a form of suffocation brought about by the impaction of foreign
body in the respiratory passage.
Burking - This is a form of traumatic asphyxial death invented by Burke and Hare for
the purpose of murdering people to be sold to medical schools for dissection. The
murderer kneels or sit on the chest and with his hands close the nostrils and mouth
of the victim. By this method, there will be no external marks to indicate how
respiration has been obstructed. Internal examination may show signs of asphyxia.
Café Coronary - A restaurant patron apparently has a sudden heart attack in the
middle of his dinner and dies without much untoward symptoms. Autopsy may reveal
a large mass of food lodged in his throat and the cause of death is in fact asphyxia
by choking. This usually happens when the person has a high blood alcohol level
which apparently anesthetized his gag reflex. It is an accidental rather than a natural
death.
Emphysema Aquosum - The lungs are distended like balloons, overlapping the
heart, with rib markings on the surface and protruded out of the chest upon removal
of the sternum. This is due to the irritation made by the inhaled water on the mucous
membrane of the air passage which stimulate the secretion of mucous. The lungs
are progressively distended and the emphysema is due to the fact that the air is
driven by the fluid on the lung surface.
Edema Aquosum - This is due to the entrance of water into the air sacs which makes
the lung doughy, readily pits on pressure, and exudes water and froth on section.
Champignon d’ocume - This is the whitish foam which accumulates in the mouth and
nostrils. It is due to the abundant mucous secretion of the respiratory passage which
by respiratory movement whips up the substance into foam. Removal of the foam
and followed by pressure on the chest will produce further foam in the mouth and
nostrils. This finding is considered to be one of the indications that death was due to
drowning.
KNOW
Mechanism of death by hanging
There is a ligature around the neck with a knot or with a sliding noose, and the other
end is fastened to an elevated object like peg, nail, window casing, door knob, tree,
etc.. Upon suspension of the body, the weight causes the noose or band to tighten,
producing pressure at the region of the neck. The pressure of the band will cause the
air passage to constrict, the larynx is pushed backwards and its opening is closed by
the contact of the anterior to the posterior laryngeal wall producing asphyxia. The
pressure of the ligature may also cause compression of the superior laryngeal nerve,
carotid arteries and jugular veins producing cerebral anoxia. The form of furrow that
develops in the neck depends upon the type of ligature, the number of loops around
the neck and the point of suspension. Protrusion of the tongue depends upon how
pressure is applied around the neck. If above the larynx and in an upward direction,
the tongue will be pushed outward and will protrude from the mouth, but if the
pressure is below the larynx, the tongue is kept inside the buccal cavity.
Asphyxia by Strangulation
Strangulation by ligature is produced by compression of the neck by means of a
ligature which is tightened by a force other than the weight of the body. Usually, the
ligature is drawn tight by pulling the ends after crossing at the back or front of the
neck, or several folds of the ligature may be around the neck tightly placed and the
ends are knotted, or a loop is thrown over the head and a stick inserted beneath it
and twisted till the noose is drawn tight​.
Asphyxia by Suffocation
Asphyxia by suffocation is exclusion of air from the lungs by closure of air openings
or obstruction of the air passageway from the external openings to the air sacs.
Foreign bodies usually seen in Choking
The most common foreign bodies impacted are: a. Vomitus, especially when the
person is under the influence of alcohol; b. Regurgitation of food from the stomach,
as coagulated milk in children; c. Bolus of food; d. Detached membrane in diphtheria;
e. False set of teeth; f. Blood in tonsillectomy operation; and g. Respiratory
hemorrhage as in tuberculosis.
Asphyxia by Submersion or Drowning
This is a form of asphyxia wherein the nostrils and mouth has been submerged in
any watery, viscid or pultaceous fluid for a time to prevent the free entrance of air
into the air passage and lungs. It is not necessary for the whole body to be
submerged in fluid. It is sufficient for the nostrils and mouth to be under the fluid.
Time required for death in drowning
Submersion for 1-1/2 minutes is considered fatal, if ordinary efforts for respiration is
made, however, a person may survive even after 4 minutes of submersion. The
average time required for death in drowning is 2 to 5 minutes. It has been claimed
that the length of survival in drowning is proportional to the amount of froth in the
respiratory tract.
Medico-legal aspects in drowning
Post-mortem Findings:
1. ​
External Findings​
:
a. Clothes are wet, face is pale and with foreign bodies clinging on the skin surface.;
b. Skin is puckered, pale, contracted in the form of "cutis anserina," or "goose-skin,"
or "gooseflesh" particularly those of the extremities and when the body is submerged
in cold water.
c. Penis and scrotum may be contracted and retracted especially when the body is
found in cold water;
d. Washerwoman's hand and feet. The skin of the hands and feet, is bleached,
corrugated and sodden in appearance. This is not diagnostic of drowning but proves
only that the body has remained in water for some time without reference as to the
cause of death;
e. Eyes are half-opened or closed, with eyelids livid, conjunctivae injected and pupils
dilated;
f. The mouth may be closed or half-opened with the tongue protruding;
g. Post-mortem lividity is mostly marked in the head, neck and chest;
h. Presence of firmly-clenched hands with objects as weeds, stones, sand, etc.,
indicative that the person was alive when placed in the water (cadaveric spasm).
This is also indicative that there
was struggle of the victim for life.
i. Physical injuries may be present on the body surface which may be indicative of
previous struggle with an offender, effort of the victim to save himself, hitting on hard
and rough objects while in water by the force of the current, or some other causes.
j. In suicidal drowning, pieces of stone or other heavy objects may be recovered in
pockets or clothings to facilitate submersion.
Internal Findings:
a. ​Respiratory System:
(1) ​"Emphysema aquosum" — ​The lungs are distended like balloons, overlapping the
heart, with rib markings on the surface and protruded out of the chest upon removal
of the sternum.
(2) ​"Edema aquosum" —
​ This is due to the entrance of water into the air sacs which
makes the lung doughy, readily pits on pressure, and exudes water and froth on
section.
(3) ​"Champignon d'ocume" — ​This is the whitish foam which accumulates in the
mouth and nostrils.
(4) Tracheo-bronchial lumina is markedly congested and filled with fine froth with
foreign bodies that are also found in the fluid medium where the body is recovered.
(5) Blood-stained fluid may be found inside the chest cavity and this is due to the
permeation of water trapped inside the air sacs.
(6) The whole lung field may be congested but if there is an abundance of water in
the air sacs, it may appear pale.
(7) Section of the lungs shows the presence of fluid with bloody froth.
b. ​
Heart:
(1) Both sides of the heart may be emptied or filled with blood. The right side may be
distended with blood while the left may be emptied on the account of the distention of
the air sacs, thereby limiting the capillary flow.
(2) If drowning took place in salty water, the blood chloride content is greater in the
left side of the heart than in the right, but if drowning took place in fresh water, the
blood chloride is more in the right than in the left. This is one way to determine the
place where a victim was drowned.
Gettler’s Test
This is a quantitative determination of the chloride content of the blood in the right
and left ventricle of the heart. The demonstration of the difference of at least 25 mg.
proves that death occurred in a fresh or salt water pool and drowning is the cause of
death.
Compression Asphyxia
This is a form of asphyxia whereby 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.
In homicidal cases, the assailant may kneel on the chest of the victim or squeeze the
victim between the arms and legs as in wrestling. In accidental cases, the body may
be pinned between two big objects or collapsing buildings on the ground.
Death by Crucifixion
When a person is nailed on a cross the weight is supported by the nailed feet. In
order to breathe, the person had to raise his body and then throw his weight on his
feet. When on the cross, the intercostal muscles are stretched and the chest cage is
fixed. The alternative raising and lowering of the body lead to exhaustion,
unconsciousness and death from asphyxia. Because of the difficulty of the chest
movement, this type of death may be classified as ​
traumatic asphyxia​.
Asphyxia by breathing Irrespirable Gases [Carbon Monoxide, Carbon Dioxide,
Hydrogen Sulfide, Hydrogen Cyanide, Sulfur Dioxide]
Carbon monoxide is formed from the incomplete combustion of carbon fuel. The
fatal carbon monoxide poisoning usually involves burning of wood, oil, coal,
kerosene and charcoal used in heating or cooking, or gasoline engines in cars.
Carbon monoxide is sometimes called the "silent killer", it is a colorless gas,
insoluble in water and alcohol.
Carbon dioxide is a colorless, heavy gas often mixed with caebon monoxide and
hydrogen sulfide and is often found in drainage pipes, deep wells, sewage tanks and
other places where decomposing organic matters are present. A small amount of gas
which is mixed with air (2%) is a potent stimulant to increase rate and depths of
breathing, however, stronger concentration (10% or more) may cause ataxia, fall of
blood pressure, loss of reflexes, anesthesia, diminished respiration, dyspnea,
discomfort and muscular weakness. Greater concentration (60%) may cause
immediate loss of consciousness, with or without convulsion and death. The
inhalation of pure carbon dioxide may cause immediate vagal inhibition with spasm
of the glottis and death. Ordinarily, the cause of death is asphyxia due to deficiency
of oxygen supply to the brain (anoxia).
Hydrogen sulfide is a colorless, transparent gas, sweetish taste and emiting an
odor similar to a rotten egg. The gas is soluble in water to form carbonic acid and it
burns in the air with a pale blue flame. A dilute solution produces irritation of the
eyes, nose, throat and air passages, followed by dizziness, headache, nausea,
vomiting, abdominal pain, cyanosis, dilated pupils, cold extremities and labored
breathing. Prolonged exposure to a diluted atmosphere may cause tetanic
convulsion, delirium, stupor, coma and death.
Hydrogen cyanide ​is one of the most toxic and rapid acting gases. Orally, the
equivalent of 60 — 90 mg. of hydrogen cyanide is fatal. A vapor cyanide produces
the symptoms at different levels. The average span of life after partaking in the drug
is two to ten minutes. It is possible that life may be prolonged for two to three hours,
but in most cases the patient will recover, if death does not occur within an hour.
Sulfur dioxide ​produces irritation of the respiratory passage, thus causes sneezing,
coughing, spasm of the glottis and suffocation. It also irritates the eyes and causes
congestion and lacrimation. Post-mortem findings are not characteristic. There may
be cyanosis, with signs of asphyxia​
.
War Gases
Although the term signifies its use in time of war, it may be also used in riots, mobs
or in any other situation where control or suppression of the activities of the people in
a specific area is desired. Some of the agents included may cause death, however,
when applied in a lesser concentration it may only cause irritation, inconvenience,
weakening of resistance of defense and physical damages on the victims. These are
classified into: a.) lacrimator or tear gas; b) vesicant or blistering gas; c) lung irritants;
d.) sternutator; e) paralysants; and f.) blood poison.
DIFFERENTIATE
· Anoxic death | Anemic Anoxic death | Stagnant Anoxic death | Histotoxic
Anoxic death (p. 426)
Anoxic death​- this is associated with the failure of the arterial blood become normally
saturated with oxygen, as in high altitude.
Anemic Anoxic death​ - this is due to the decreased in the capacity of the blood to
carry oxygen. Which condition may be due to the following; sever hemorrhage,
poisoning like carbon monoxide, and; low hemoglobin level in the blood.
Stagnant Anoxic death​ - this is brought about by the failure of circulation. the failure of
Circulation may be due to the following: Hearth Failure; Shock; Arterial and venous
obstruction incident to embolism, vascular spasm, varicose veins, or the use of
tourniquet
Histotoxic Anoxic death- ​this is due to the failure of the cellular oxidative process, e.​ L
​ ips lipid or blue
although the oxygen is delivered to the tissue, it cannot be utilized properly. Cyanide
and alcohol are common agents responsible for Histotoxic Anoxic Death f.​ S
​ aliva dribbled from the mouth with froth.

· Ante-mortem Hanging | Post-mortem Hanging g.​ ​State of erection or semi- erection of the penis with seminal fluid in
the urethral meatus.
Ante-mortem Hanging (p.435) ​The following findings Shows that hanging is Ante-
Mortem: h.​ P
​ ost- mortem lividity with ecchymosis are mostly marked at the legs.

a.​ ​ Redness or ecchymosis at the site of ligature i.​ ​Urination or defecation due to the loss of power of the sphincter
muscles
b.​ E
​ cchymosis of the pharynx and epiglottis.
2.​ I​ nternal Findings
c.​ L
​ ine of redness or rupture of the intima of the carotid artery.
a.​ E
​ ngorgement of the lungs
d.​ S
​ ub- pleural, subepicardial punctiform hemorrhages.
b.​ V
​ enous system contains dark- colored fluid blood

c.​ ​Right side of the heart and the big blood vessels connected with it
It is advised to look for other injuries which are capable of producing are distended with blood.
death to eliminate the possibility of hanging is the cause of death.
d.​ B
​ lood vessel of the brain are generally congested.
Post-mortem Hanging 433
e.​ ​ Kidneys are congested.
1.​ G
​ eneral External Appearance
f.​ ​ Sub-pleural, sub-pericardial punctiform hemorrhage
a.​ ​Neck elongated and stretched with the head inclined on the side
opposite the knot or nose. 3.​ F
​ indings in the neck

b.​ ​Eyes closed or partly opened with pupils usually dilated on one side a.​ N
​ eck is flexed opposite the side where the neck is located
and small on the other side.
b.​ ​Ligature mark which forms a groove and deepest mark opposite the
c.​ ​Lividity or pallor of the face with swelling and protrusion of the knot. The width of the groove is pale or parchment-like.
tongue.
c.​ ​The course of the ligature in inverted V- Shape with the apex of the V
d.​ H
​ ands are clenched firmly and purple colored fingernails. at the site of the knot.
 d.​ ​The skin at the site of the ligature is hard with red line of congestion
and hemorrhage in some points.
e.​ ​Ecchymosis of the neck depends upon the width and softness of the
ligature.
f.​ ​There may be rapture of the underlying blood vessels, muscles and
other soft tissues.
g.​ ​ The lining membrane of the blood vessel may be lacerated.
h.​ ​The fracture of the upper cervical vertebrate ang the injury of the
spinal coed is due to long drop hanging or to judicial hangin.
i.​ ​Fracture of the hyoid bone or the tracheal rings.
j.​ ​Contusion of the inner wall of the trachea.
· Hanging | Strangulation by Ligature. 437
Hanging- ​is a form of violent death brought about by the suspension of the
body​ ​by a ligature which encircles the neck and the constricting force in the weight
of the body. It is not necessary that the whole body will be left suspended. The
victim may be sitting or lying with the face downward provided that the pressure is
present in front or in the side of the neck.
Strangulation by Ligature ​(p.436). Strangulation by ligature is produced by
compression of the neck by means of a ligature which tightened by a force other than
the weight of the body. Usually, ligature is drawn tight by pulling the ends after
crossing at the back or front of the neck, or several folds of the ligature may be
around the neck tightly placed and the ends are knotted, or a loop is thrown over the
head and a stick inserted beneath it and twisted till the noose is drawn tight.
· Accidental | Homicidal | Suicidal [Hanging] (p.435)
Accidental – ​very rare and does not show any of the manifestation presented below
Homicidal (p.435) ​
the evidence for support of homicidal hanging:
a.​ ​are Nature of te windows and doors- See whether the entrance was forcibly
opened or have been used as an escaped by the offender in homicidal case.
b.​ ​Presence of signs of struggles in the clothing, furniture, and beddings- the
furnitures are disturbed whenever there was previous struggle before hanging
c.​ ​Presence of stains, bodily injuries in the body of the victim
d.​ P
​ resence of defense wounds inn the body of the victim
Suicidal (p.436)- ​
Evidence in support of suicidal hanging:
a.​ ​Findings at the place where the dead body was found is compatible with the
self -suspension.
A chair may be found where he can stand to tie the rope at a higher level. The chair
or stool may be kicked away and the body becomes suspended on a rope. A
hammer to fix the nail may be found near the place where the body was found.
b.​ ​ Unusual position of the body when found:
The feet or the knee may be found partially touching the floor if the body was found
in a reclining position to make part of the body weight as the constricting force on the
neck.the clenching of the hand and absence of signs of struggle to free himself from
the effect of ligature mat be infer the desire of self destruction.
c.​ ​Absence of signs of struggle: there are no marks on the body that may cause
unconsciuoness to infer homicidal hanging.
d.​ S
​ igns of Vital reactions in the ligature marks around the neck:
The forrow may be deep, congested and papraceous with the abrasion on the
account of the side of the ligature as pressure on the neck is produced by the weight
of the body.
e.​ S
​ igns of previous ineffective suicide attempt.
·​
Accidental | Homicidal | Suicidal [Smothering] p.441
Accidental Smothering ​ may occur when a person is under the influence of alcohol,
epilepsy or in any other helpless state. Accident smothering is common among
children

f.​ P
​ resence of a suicide note written by the victim, Homicidal- ​
the application of materials, usually handkerchief, linen or other clothing
matters to prevent air to have access through the mouth or nostrils. The pressure
g.​ ​The material used are those which are easily accessible, like handkerchief , net, might be so severe that it may cause injury to the buccal mucosa and teeth​ .
bedding , etc.
Suicidal – ​
the nostril and mouth may be blocked by the introduction of foreign
h.​ ​The history of reverses in life, like financial loss, love, studies, etc., his mental substances, like mud, paper, cloth, etc. Suicidal smothering by means of his own
condition. hand is not possible. The moment that the victim becomes unconscious, the intrinsic
release of the pressure will save him​
.
i.​ ​The presence of suicidal note infer that hangin is suicidal.
·​
Accidental | Homicidal | Suicidal [Drowning]. p.449
j.​ ​No disturbance in the place where the death took place
Accidental
k.​ T
​ he rule is that hangin is suicidal unless there are evidence to show that it is not.
a.)​ A
​ bsent of marks of violence on the body surface.
· ​Accidental | Homicidal | Suicidal [Strangulation by Ligature] (p.438)
b.)​ ​ Condition and situation of the victim immediately before death which may
Accidental- ​there are few instances of strangulation which are accidental and most of make one inclid to believe that it is accidental.
the victims are children or epileptics who are helpless and incapable of extricating
themselves. (p. 439) c.)​ E
​ xclusion of suicidal or homicidal nature of the drowning.

Homicidal ​is the most common of the three forms of Strangulation by Ligature. Aside d.)​ T
​ estimony of a witness or witnesses who saw the incident happened​
.
from from the ligature mark in the neck, there is evidences of struggle of marks of
violence in other parts of the body. The ligature may be passed around the neck and Homicidal-
then the feet and hands are bound together. Smothering may be done by placing a
handkerchief gag in the mouth. (P. 438) a.​ ​Thre are evidences of struggle like physical injuries and destruction of the
clothing of the victim
Suicidal- ​Suicidal strangulation by ligature is a rare case. It may may be done by
placing ligature around the neck and tightened by means of twisting a piece of stick. b.​ ​Articles belonging to the assailant may be found near the place where the
(P. 439) deceased was recovered.

c.​ ​Presence of a motive for killing.

d.​ ​Presence of ligature on the hands or legs which could not possibly be applied by EXPLAIN
the victim himself.
CLASSIFICATION OF ASPHYXIA BY HANGING
e.​ ​Presence of physical injuries which could not have been self-inflicted, like
gunshot wound at the back, severe injuries in the head, etc. 1.​ A
​ s to the location of the Ligature and Knot:

f.​ T
​ estimony of witnesses.
a.​ ​Typical — ​When the ligature runs from the midline above the
thyroid cartilage symmetrically encircling the neck on both sides to the
Suicidal
occipital region.
a.​ H
​ eavy articles or weight may be found in the pocket or clothing
b.​ ​Atypical — ​When the ligature is tied or noosed and present on one
b.​ ​ Presence of a suicidal note side of the neck, in front or behind the ear, or on the chin.

c.​ D
​ etermination of the strong reason for him to commit suicide 2.​ A
​ s to the Amount of Constricting Force:

d.​ M
​ entality of the person a.​ ​Complete — ​When the body is completely suspended and the
constricting force is the whole weight.
e.​ ​Study of the character and manner of the person previous to the commission of
suicide b.​ ​Partial ​— ​When the body is partially suspended as when the
victim is sitting, kneeling, reclining, prone or in any other positions.
· Schaefer’s method | Sylvester’s method (p.445)

​ chaefer’s Method​. With the face down, the patient must be in a prone position. The
S 3.​ A
​ s to Symmetry:

operator kneels astride the body and exerts pressure on the lower ribs at the rate of
12 to 15 times a minute.
Sylvester’s method​- with the patients lying on his back, and the operator striding
over the body, swinging the arms, forward up and then pressing the chest wall. This
is repeated every 3 to 5 seconds.
a.​ ​Symmetrical — ​When the knot or noose is at the midline of the
body either at the occiput or just below the chin.
b.​ ​Asymmetrical — ​When the knot or noose is not in the midline but
on one side, with the head tilted to the side opposite the location of the
noose or knot.

MECHANISM OF DROWNING
When a person does not know how to swim and falls into a deep body of water, his
body will sink on account of the momentum of the fail and because the specific
gravity of the human body is slightly more than that of the water. Later, the body will
be buoyed because of the instinctive movement of the individual, coupled with the
presence of air underneath his clothings. While under water, the breath is held but
upon reaching the surface there i6 an attempt to breathe. Air and water then gets into
the mouth and nostrils. Then, he will endeavor to raise his hand which will cause him
to sink under water. He then alternately appears and disappears on the surface and
everytime he attempts to breathe, water will get in. Because of the entrance of the
fluid, there will be violent coughing which will expel the air in the lungs and creates
an imperative desire to breathe, during which more water is drawn in. The drawn-in
water may go to the lungs or to the stomach. The water fills the bronchioles forcing
the residual air to be in the lung surface and causing the lungs to balloon and become
soggy and edematous. Death usually occurs 2 to 5 minutes later.
Phases of Drowning
The body may not immediately be recovered after drowning because it is under the
water. The specific gravity of the human body is slightly more than that of the water.
Within 24 hours, on account of the decomposition which causes the accumulation of
gas in the body, the body floats. The floating of the body is markedly influenced by
the weather, condition of the fluid medium where drowning took place, presence of
wearing apparel, age, sex and body built. The body when recovered, floats usually
with flexed extremities. This is due to the dominance of the flexor muscles over the
extensors in the process of rigor mortis. The head is submerged because it has a
higher specific gravity than the rest of the body. And because the head is now the
most dependent portion of the body, more blood accumulates in the face. This
explains the dark bloated condition of the face during the early stage of
decomposition, otherwise known as "fete ​de negri" ​or the bronze color of the head
and neck of a person who died in water during the process of decomposition.
​TYPES OF ASPHYXIAL DEATH

1.​ ​"Respiration de surprise" occurring at the moment when the mouth and nose are
covered with fluid consisting of one deep inspiration. 1.​ Anoxic Death
​

2.​ ​Phase of resistance which consists* of a short period of apnea due to the irritation 2.​ Anemic Anoxic Death
​

of the sensory laryngeal nerve endings by the cold water.

3.​ Stagnant Anoxic Death
​

3.​ D
​ yspneic phase with a forceful respiratory movement.
4.​ Histotoxic Anoxic Death
​

4.​ A
​ nother apneic phase.

5.​ T
​ erminal respiration, after which the breathing stops permanently.
CAUSES OF ANOXIC DEATH

a)​ ​Breathing in an atmosphere without or with insufficient oxygen, as in

MECHANISM OF FLOATING OF THE BODY IN DROWNING high altitude.
 b)​ ​Obstruction of the air passage due to pressure from outside, as in 1.​ Hanging
​

traumatic crush asphyxia.

2.​ Strangulation
​
c)​ P​ aralysis of the respiratory center due to poisoning, injury or anesthesia,

etc. a. Strangulation by ligature

d)​ ​Mechanical interference with the passage of air into or down the b. Manual strangulation or throttling
respiratory tract due to:
c. Special forms of strangulation
1) Closure of the external respiratory orifice, like in smothering
and overlaying. i.​ P
​ ​ almar strangulation

2) Obstruction of the air passage, as in drowning, choking with ii.​ G

​ ​ arroting

foreign body impact, etc.

iii.​ M
​ ​ ugging or yoking
3) Respiratory abnormalities, like pneumonia, asthma,
emphysema and pulmonary edema. iv.​ C
​ ​ ompression of the neck with stick

e)​ ​Shutting of blood from the right side of the heart to the left without 3.​ Suffocation
​

passage through the lungs as in congenital anomalies like potent foramen a. Smothering or closing of the mouth and nostrils by solid
ovale.
objects

b. Chocking or closing of the air passage by obstruction of its

PHASES OF ASPHYXIAL DEATH lumen

1.​ Dyspneic Phase

​
4.​ Asphyxia by submersion or drowning
​

2.​ Convulsive Phase

​
5.​ Asphyxia by pressure on the chest (Traumatic crush asphyxia)
​

3.​ Apneic Phase

​
6.​ Asphyxia by irrespirable gases
​

CLASSIFICATION OF ASPHYXIA MANNERS O DEATH IN MANUAL STRANGULATION

 1.​ The air passage may be blocked and death is due to asphyxia
​ c. Submersion when unconscious

2.​ ​The pressure on the neck may cause compression of the blood vessels and 3.​ Other conditions associated with drowning:
​
disturb the blood supply of the brain
a. The person might have fallen into the water and his body
3.​ ​The nerves of the neck may be traumatized especially the superior strikes on a solid hard object which is capable of producing death by
laryngeal branch of the glossopharyngeal, hypoglossal nerves and the plexus itself.
surrounding the bifurcation of the common carotid artery or of the vagus
producing shock. b. The person might be under the influence of alcohol or other
depressants and incapable of helping himself.

c. Cramps might have prevented him from saving himself.

SPECIAL FORMS OF STRANGULATION
d. Shock due to fright or sudden exposure to cold might have
1.​ Palmar strangulation
​ caused sudden heart failure.

2.​ Garroting
​ e. The person might have died of some other causes independent
of drowning, like apoplexy, cardiac failure, etc..
3.​ Mugging or yoking
​
f.​ The person might have been dead and thrown into the water.
​
4.​ Compression of the neck with stick
​

CONCLUSIVE FINDINGS THAT COD IS DROWNING

CAUSE OF DEATH IN DROWNING
1.​ ​The presence of materials or foreign bodies in the hands of the victim.
1.​ Typical drowning
​ The clenching of the hands is a manifestation of cadaveric spasm in the effort
of the victim to save himself from drowning.
2.​ Atypical drowning
​

2.​ ​Increase in volume (emphysema aquosum) and edema of the lungs

a. Cardiac inhibition following submersion due to the stimulation (edema aquosum).
of the vagus nerve
3.​ ​Presence of water and fluid in the stomach contents corresponding to the
b. Laryngeal spasm due to submersion medium where the body was recovered.
 4.​ ​Presence of froth, foam or foreign bodies in the air passage found in the b. Diphenylamine chlororsine (D.M.)
medium where the victim was found.
c. Diphenyl (cyanarsine (D.C.)
5.​ Presence of water in the middle ear.
​
5.​ Paralysants (Nerve Gas)
​

6.​ Blood Poisons

​
CLASSIFICATION OF WAR GASES
a. Hydrocyanic Acid (Hydrogen Cyanide or Prussic Acid)
1.​ Lacrimator or Tear Gas
​
b. Hydrogen Sulfide (Sulphurated hydrogen)
a. Chloracetophenone (C.A.P.)
c. Carbon Monoxide (Carbon Oxide, CO)
b. Bromobenzyl Cyanide (B.B.C.)

c. Ethyl Iodacetate (K.S.K.)

2.​ Vesicant or Blistering Gas

​

a. Mustard Gas (Dichlordiethyl Sulfide, Yellow Corss, “Yperite”)

b. Lweiste (Chlorovinyl-dichlorarsine)

3.​ Lung Irritants (Asphyxiant or Choking Gas)

​

a. Chlorine (Cl​2​)

b. Phosgene (COCl​2​)

c. Chloropicrin

d. Diphosgene

4.​ Sternutator (Nasal Irritants or Vomiting Gases)

​

a. Dihenyl chlorarsine (D.A.)