FORENSIC MEDICINE

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FORENSIC MEDICINE By: WILFREDO R. BERALDE

Death defined:
Death defined DEATH is defined as the state of complete persistent cessation of respiration, circulation and other vital function of the body. It is the return of the body to a stable equilibrium, chemically and physically. Note: It is hardly possible to determine the exact time of death. SOMATIC DEATH (or Clinical Death) ± Occurs when a physician declares a person has expired due to complete, persistent and continuous cessation of the vital function of the brain, heart and lungs. But there is still animal life among individual cells as evidenced by presence of excitability of muscles and ciliary movement of individual cells. EARLY SIGNS OF DEATH a. Face and lips become pale b. Muscles become flaccid. Out of condition; not strong or robust; incapable of exertion or endurance c. Sphincters are relaxed d. Lower jaw tends to drop e. Eyelids open and pupils dilate f. Skin loses its elasticity g. Body fluids tend to gravitate to dependent portion h. Body heat gradually assumes the temperature of the surroundings EARLY SIGNS OF DEATH: a.²Face and lips become pale b.²Muscles become flaccid.²Flaccid means out of condition; not strong or robust; incapable of exertion or endurance c.²Sphincters are relaxed.²Sphincter means a ring of muscle that contracts to close an opening d.²Lower jaw tends to drop e.²Eyelids open and pupils dilate.²Dilate means become wider f.²Skin loses its elasticity.²Elasticity means the tendency of a body to return to its original shape after it has been stretched or compressed. g.²Body fluids tend to gravitate to dependent portion.²Gravitate means move due to the pull of gravitation h.²Body heat gradually assumes the temperature of the surroundings

which does not survive is dismissed upon the death of the defendants.²Catalepsy means a trancelike state with loss of voluntary motion and failure to react to stimuli. APPARENT DEATH (or State of Suspended Animation) ± This condition is not really death but a mere transient loss of consciousness or temporary cessation of the body. As a general rule. Hysteria Uremia Catalepsy Electric Shock Drowning MEDICO-LEGAL IMPORTANCE ± to prevent premature burial. that are usually excreted in the urine. Catalepsy. hence called ³ULTIMEN MARIENS´. The auricle is the last to stop. the beating is present for an hour after decapitation. urea.MOLECULAR OR CELLULAR DEATH ± Occurs 3-6 hours after death. Apparent means appearing as such but not necessarily so. if there is no heart action for a period of five minutes. Cessation of Heart Action and Circulation. Civil case for claim. The following condition may produce Apparent Death. In judicial hanging.²Hysteria means excessive or uncontrollable fear. There is death to individual cells. Hysteria.²Uremia means accumulation in the blood of nitrogenous waste products. Uremia. (Execution by cutting off the victim's head . In decapitation. Property of a person transmitted to his heirs at the time of his death. death is regarded as certain. Transient means lasting a very short time. Criminal Liability of a person is extinguished by death. Legal Importance of Determining Death Signs of Death: 1. Legal Importance of Determining Death: y y y y Civil personality of a natural person is extinguished by death. the heart beats for 20-30 minutes after the individual has been executed.

In a living person there appears a bloodless zone at the site of the application of the ligature and a livid area distal to the ligature. . the blood vessel is white and there is no jerking escape of blood but may only ooze towards the nearby skin. blood may flow without pressure continuously. Palpation of pulse Magnus test. there is no such change in color. In a dead man. Use of electrocardiograph. 2. y y y Methods of Examining Peripheral Circulation Magnus test Opening of small artery Icard¶s test Diaphanous test Application of heat on skin 1. There may be no appreciable change of color if a living person is markedly anemic. Occasionally the pulsation is very imperceptible and irregular that the examiner experience much difficulty. The shadow may be enlarged and the excursion made less visible due to pericardial effusion. If such ligature is applied to the finger of a dead man.²Fluoroscopic examination of the chest will reveal the shadow of the heart in its rhythmic contraction and relaxation.Use of electrocardiograph y Palpation of pulse²Pulsation of the peripheral blood vessels may be made at the region of the wrist or at the neck.²A ligature (Thread used by surgeons to bind a vessel as to constrict the flow of blood) is applied around the base of a finger with moderate tightness. The color of the area where the ligature is applied will be the same as that one distal to it.Signs of Death Auricle is a small conical pouch projecting from the upper anterior part of each atrium of the heart. The electrocardiograph will record the heart beat even if it is too weak to be heard by auscultation. When bigger arteries are cut. heart sound can be audible during life even without the aid of stethoscope by placing the ear at the precordial area.²In the living.²The heart beat is accompanied by the passage of electrical charge through the impulse conducting system of the heart which may be recorded in an electrocardiograph machine. Opening of small artery. Fluoroscopic examination. Auscultation of heart sound. the blood escapes in jerk and at a distance. This is the best method of determining heart action but quite impractical. Methods of Detecting Cessation of Heart Action Palpation of pulse Auscultation of heart sound Fluoroscopic examination. The pulsation of the vessels is synchronous with the heart beat.²The rhythmic contraction and relaxation of the heart is audible through the stethoscope.

The finger webs may appear yellow in a strong light even if living in cases of anemia or carbon monoxide poisoning. and other vital reactions of the injured area will be observed. Peculiar conditions like Cheyne-Strokes Respiration (apneic interval not longer than 1520 seconds) y Apparent drowning Newly born infants y y Methods of Detecting Cessation of Respiration Observation of the chest movement during inspiration and expiration. Palpation of the radial artery with the fingers. 2. Auscultation Use of mirror ± dimming of mirror if there is respiration due to moist air. . In the living. No such pulsation will be observed in a dead man. congestion. blister formation. Application of heat on skin. respiration may cease for sometime but may be restored by continuous artificial respiration. Icard¶s test.Winslow test y In feather or cotton fibers: A fine feather or a strip of cotton is placed in front of the lips and nostrils. But if applied to a living person. Diaphanous test. etc.²The fingers are spread wide and the finger webs are viewed through a strong light. or other vital reactions. respiration is present. If circulation is still present.3. 5. Conditions in which suspension of respiration is present without death ensuing: Purely voluntary act. the dye will spread all over the body and the whole skin will have a greenish-yellow discoloration due to fluorescein. Cessation of Respiration ± A person can hold his breath no longer than 3 ½ minutes. This is not a reliable test as the slightest movement of outside air or nervousness of the observer will move the feather or cotton fibers. Examination with a feather or cotton fibers or glass of water. swimmers. it will not produce true blister.²If heated material is applied on the skin of a dead man. This test should be applied only with the use of the daylight as the color is difficult to be appreciated with the use of artificial light.² 6. the solution will just remain at the site of the injection. There is no sign of congestion.²This consists of the injection of a solution of fluorescein subcutaneously. Palpation of pulse. In a dead man. example divers. the finger webs appear red but yellow in the dead. The feather or cotton fibers will be blown away during expiration and towards the nose and mouth during inspiration. one will feel the rhythmic pulsation of the vessel due to the flow of blood. If there is movement of the feather or cotton not due to external air. 4. In electric shock.

symptoms include headache and stiff neck and fever and nausea Liver abscess Rheumatic fever²A severe disease chiefly of children and characterized by painful inflammation of the joints and frequently damage to the heart valves. This is not a good test because of the difficulty of preventing movement of the place where the body lies. then respiration is taking place. Insensibility of the Body and Loss of Power to Move After the whole body is insensible. Cholera Cerebrospinal fever Liver abscess Rheumatic fever Small fox Strychnine poisoning Yellow fever Conditions wherein there is rise of temperature immediately after death usually observed in the first two hours.Collapse Involving the lungs with progressive wasting of the body Conditions wherein there is rise of temperature immediately after death usually observed in the first two hours (post-mortem caloricity). Nux vomica is a medicine made from the seeds of an Asiatic tree. If the surface of the water is smooth and stable. formerly used as a stimulant. Heart valve is a valve to control one-way flow of blood Small fox Strychnine poisoning²Strychnine is an alkaloid plant toxin extracted chiefly from nux vomica. There is movement of the image formed by reflecting artificial or sun light on the water or mercury contained in a saucer and placed on the chest or abdomen if respiration is not taking place. Cooling of the Body ( ALGOR MORTIS) The progression fall of body temperature is due to the cessation of metabolic process. 3. No kind of stimulus is capable of letting the body voluntary movement. Apoplexy²A sudden loss of consciousness resulting when the rupture or occlusion of a blood vessel leads to oxygen lack in the brain Epilepsy Trance²A state of mind in which consciousness is fragile and voluntary action is poor or missing. contains strychnine and brucine. but if it waves or water movement is observed. formerly used as a stimulant Yellow fever²Caused by a flavivirus transmitted by a mosquito. Phthisis. Conditions in which the above is present in the living. a state resembling deep sleep have . Meningitis is Infectious disease characterized by inflammation of the meninges. the tissues that surround the brain or spinal cord. The reflection is utilized to magnify the movement of the surface of mercury water. one of the most prominent sign of death. 4. there is no respiration taking place. Conditions where fall of temperature occur before death are as follows: Cancer. Fall of temperature of 15oF to 20oF is considered a certain sign of death.y In glass of water: A glass half full of water is placed at the region of the chest. post-mortem caloricity. which is rapid during the first 2 hours after death. usually caused by a bacterial infection. Cholera Cerebrospinal fever²Meningitis caused by bacteria and often fatal.

4. sphincters relaxed so there is no incontinence or urination and defecation. Pale and waxy looking Loss of elasticity Opacity . CHANGES IN THE BODY FOLLOWING DEATH: CHANGES IN THE MUSCLES ± There are three stages after death: CHANGES IN THE BODY FOLLOWING DEATH Stage of Primary Flaccidity: Characteristics are as follows: Occurs 3 ± 6 hours after death.flaccidity Pupil is in the position of rest y Opthalmoscopic findings y Tache noir de la scleratique ± yellowish to black round triangular spot found in the sclera. 7. Change in and about the Eye y Loss of corneal reflex . the transparent dome-shaped anterior portion of the outer covering of the eye. Changes in the Skin Following Death 1. . blister contains fluid.Catalepsy²A trancelike state with loss of voluntary motion and failure to react to stimuli Cerebral concussion²Injury to the brain caused by a blow.the phenomenon of not permitting the passage of electromagnetic radiation Effect of the application of heat 6. Action of the Heat on the Skin ± Only dry blister is found on dead.Corneal relates to cornea. Muscles relaxed. In living. Sclera is the whitish fibrous membrane (albuginea) that with the cornea forms the outer covering and protection of the eyeball y y y Clouding of the cornea Flaccidity of the eyeball. 2. contracts when stimulated. usually resulting in loss of consciousness Hysteria 5. 3. pupils dilated. it covers the iris and pupil and is continuous with the sclera.

Characteristics include: Occurs 6 ± 24 hours and last to 36 hours after death. injury to the nervous system or injury to the chest. Exposure to warm conditions will make such stiffening disappear. The body assumes the ³pugilistic attitude.´ CONDITIONS SIMULATING RIGOR MORTIS COLD STIFFENING ± When dead body is frozen. high temperature. CADAVERIC SPASM ± Sometimes known as INSTANTANEOUS RIGOR. Aged. there is stiffening due to solidification of fat. Whole body becomes rigid (Unchanging and unmoving) due to muscular contraction. CONDITIONS SIMULATING RIGOR MORTIS: HEAT STIFFENING ± When the dead body is exposed to temperature above 75oC. Stage of Secondary Flaccidity ± There is the commencement of putrefaction. whereas Cadaveric spasm appears immediately after death In rigor mortis Muscles involved are: all muscles In cadaveric spasm only Certain group of muscles or asymmetrical are involved The Occurrence of rigor mortis is natural. Healthy muscles delay the onset. muscle proteins coagulates (Change from a liquid to a thickened or solid state) and causes the muscles to be rigid. which have been previously coagulated during the period of rigor mortis. there is an increase lactic acid and phosphoric content of muscles. newborn. DISTINCTION BETWEEN RIGOR MORTIS & CADAVERIC SPASM: DISTINCTION BETWEEN RIGOR MORTIS & CADAVERIC SPASM Rigor mortis occurs 6-24 hours after death. exhaustion. Chemically. moist air hastens onset. Muscles become flaccid and soft due to dissolution of muscle protein. whereas Cadaveric spasm May or may not appear .Stage of Post-Mortem Rigidity ± Cadavers rigidity or rigor mortis or death struggle of muscles. Instantaneous rigidity of muscles after death due to extreme nervous tension. The reaction becomes acidic.

whereas Post Mortem Clot Can be stripped off in layers Anti-Mortem Clot is Uniform in color Post mortem clot has distinct layer Slide30: wilfredor. Hydrocyanic acid is a solution of hydrogen cyanide in water. Kinds of Post Mortem Lividity: Hypostatic lividity Diffusion lividity Post mortem lividity or post mortem suggilation or post mortem hypostasis or liver mortis. caused by choking or drowning or electric shock or poison gas. whereas Post-mortem clot occurs Immediately after death In anti-mortem clot. Clotting is accelerated by infections and fevers. poisoning by opium. whereas Cadaveric spasm May determine nature of crime. hydrocyanic acid or carbon monoxide poisoning. Clotting is delayed in cases of asphyxia. weak solutions are used in fumigating and in the synthesis of organic compounds Distinctions:: Distinctions: Anti-mortem clot is Firm in consistency. This is the accumulation of blood in the most dependent portion of the body giving a dull red or purplish color. whereas Post mortem clot is Raw if clot is removed Anti-Mortem Clot is Homogenous in construction. Asphyxia is a condition in which insufficient or no oxygen and carbon dioxide are exchanged on a ventilatory basis.Medico-legal importance of rigor more-tis is that it can give approximate time of death. Slide28: CHANGES IN THE BLOOD COAGULATION OF BLOOD ± This occurs 6-8 hours after death due to the cessation of circulation. Surface of the blood vessel is smooth and healthy. This is the accumulation of blood in the most dependent portion of the body giving a dull red or purplish color. CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TROPICAL: CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TROPICAL Slide32: .beralde POST MORTEM LIVIDITY or post mortem suggilation or post mortem hypostasis or liver mortis.

Kinds of Mummification: Natural mummification Artificial mummification By exposure to heat By treatment with formalin.beralde SAPONIFICATION. Presence of live fleas in the clothing in drowning cases Amount of urine in the bladder State of clothing: If the victim is wearing street clothes. If the victim is wearing nightgown or pajamas. the likelihood is that death occurred at daytime.beralde Chemical changes in CSF (15 hours after death) Lactic Acid ± 15 mg to 200 mg% NPN ± 15 mg to 40 mg% Amino Acid Concentration ± 1 to 12% Post mortem clotting and coagulation ± 6 to 8 hours after death. Fatty tissues of the body are transformed to soft brownish substances known adipocere. Conditions of bones . Dehydration of the body resulting in shivering and preservation of the body when buried in hot. place with dry atmosphere and with free access of hot air.beralde SPECIAL MODIFICATION OF PUTREFACTION MUMMIFICATION.beralde SPECIAL MODIFICATION OF PUTREFACTION: wilfredor. arid. death occurred at nighttime. Onset of decomposition ± 24 to 48 hours after death Stage of decomposition Entomology of cadaver ± presence of maggots after more than 24 hours Slide36: wilfredor. Slide37: wilfredor. Slide34: wilfredor. arsenic. Slide35: wilfredor. like in Egypt.wilfredor. etc.beralde Stage of digestion of food in stomach ± it takes 3-4 hours for the stomach to evacuate its contents after each meal. Example is death in deserts.beralde DURATION OF DEATH DETERMINATION: Presence of rigor mortis ± 3-6 hours & may last from 18-36 hours Presence of post mortem rigidity ± 3-6 hours after death. Presence or absence of soft tissues in the skeletal remains.