RAHEL (2014510015)

KERALA, INDIA
FORENSIC MEDICINE
2017-2018
Explain the term

BRAIN DEATH - 2019

Conception:

 irreversible cessation of all function of the brain

 the irreversible end of all brain activity (including involuntary activity necessary to sustain life)
due to total necrosis of the cerebral neurons following loss of blood flow and oxygenation

Prerequisites:

 proximate cause is known and demonstrably irreversible

 metabolic derangements corrected to extent possible
 no drug intoxication
 core temperature greater than 32℃

APARENT DEATH - 2019

# Appear to be dead #Drowning #Electrocution #Poisoning #Brain trauma #Thermal injury, etc.

AUTOPSY – 2019

“…..a post mortem examination of the body of the deceased for the purpose of scientific interest in
determining the cause of death and other information that may be obtained that might aid medical
science.”

 Complete - in which all body cavities are examined (including the head )
  Limited - which may exclude the head
 Selective- where specific organs only are examined.

EUTHANSIA - 2019

 PAINLESS killing of people who are incurably ill or very old.

 Euthanasia is illegal in most countries.
 Those who have incurable diseases , extreme pain and want comfortable death request for
euthanasia.

---positive euthanasia(apply medicine to accelerate patient death)
---negative euthanasia(to stop medicines/saving measurements and not to prolong patients life
by medical help)

MANNER OF DEATH (how the cause of death came about)

# Non- Violent death or natural death

# Violent death or non-natural death

 Homicide  Disease
 Suicide  Senility
 accident # Social death
 Undetermined
 capital punishment
 death due to war
 Euthanasia

NATURAL DEATH

# Non- Violent death or natural death : death due to natural diseased or pathological condition, old age,
debility(physical weakness),devitalization. In which death is not intended or attempted and also does not
occur accidently.

 Disease
 Senility
 Forensic pathology

 investigation of sudden, unnatural

unexplained or violent death
 autopsy performed to establish the cause
Forensic Psychiatry
of death
 determined
 Conception the manner of death it
(The code of ethics of the AAPL,1995 ):
classified as natural , homicide, suicide,
 Forensic psychiatry is a subspecialty of psychiatry in which scientific and clinical expertise is
accident or undetermined
applied to legal issues in legal context embracing civil, criminal, and correctional or legislative
 determine the mechanism of death
matters.
 determine
 Purpose: the time of death which is
to evaluate/assess the mental status, to judge the capacity/competency of exercise
determine by rigor mortis , liver mortis,
one’s privilege and duty/obligation.
and algor mortis . eg
 estimation of the weapon

LONG QUESTIONS

Answer the difference between the forensic

pathology and the general and systemic

pathology?2019

General and systemic pathology

 general and systemic pathology are

deal with the functional and
structural changes in diseased
tissues from the molecular level to
the effects on the individual
 the ultimate goal of pathology is
identification of the cause of
disease, a fundamental objective
that leads to disease prevention
 1) The difference between a incised wound and a laceration?

Laceration 2019

# A splitting wound

# Full thickness

# margin (edges of the skin which are on either side of the central disruption)

Incised wounds2019

# produced by sharp – edged weapons or instruments

# two types: slashed wounds and stb wounds

# slashed wounds : wound length is greater than its depth

# stab wounds : depth>length

Forensic biologic evidence include? 2019

Biological samples

# Blood/ Blood stain

# Semen/ semen stain

# Hair

# Bone

# Other: urine, saliva

2) Forensic investigation of blood stain?

 Inspection of the scene: location, area, spattering pattern, record/photograph, collection
 Tests for blood : Is the stain blood? luminol
 Species specificity: Is it human?

#Individuality

 Blood group: ABO? MNs? Rh? HLA?

 Identification by DNA profiling: DNA fingerprint, PCR-Mullis

Disputed paternity

# Mendelian laws: # alleles Blood group # DNA

Children born out of wedlock #Pregnancy after being raped

#Deceased alleged father #Missing alleged father

3) What is current mark?

Current mark or crater formation in the shape of the conductor causing the contact:

 Tough on palpation
 Raised margin
 Depressed floor
 White or black

4) Describe the external and internal findings of bodies died in fire?

 A. External findings
a. Burnt remains of dress
Clothing can offer some protection from burns.
The dead body may still bear burnt remains of
dress, particularly the portions which were tightly
in contact with the body. Smell of kerosene or
any such fuel which might have been used to set
fire on the body.
b. pugilistic (boxer’s or fencer’s) attitude
Due to coagulation of the muscle protein
resulting in contraction of the muscle fibers.
Flexor muscles are stronger than extensor’, the
whole body may assume a flexion attitude.
Pugilistic attitude do not indicate anything in
specific about the nature of burning, whether
antemortem or postmortem.
c. Heat rupture
The coagulated and contracted muscles tear
easily. These heat ruptures may be confused with
antemortem lacerations, or they may even be
confused with incised wounds.
d. Charring
*Sustained burning result in Charring of the
tissue Like singeing, blackening and heat
rupture, charring does not show anything specific
whether antemortem or postmortem.
*Extensive charring at times may obliterate the
antemortem features of burning.
B. Internally findings
a. Carbon soot
Carbon soot in the nasal and the mouth
cavities, mixed with mucus, adhered on
the wall of the respiratory tract and the
bronchioles. Congestion and edema of
respiratory tract and lungs.
b. Respiratory complex caused by heat
hyperemia and necrosis of larynx, trachea
and bronchus after inhaling thermal gas
and flame.
c. Circulatory system
The blood in the vessels is fluid, bright red
and thick. Muscles and the organs are
congested and bright red in color. The
chambers of the heart.may be full. CO in
the blood reach 50-70%.
d. Heat haematoma in the extradural level
*Heat haematoma show firm, friable,
cherry red or chocolate red, honeycomb in
sectioning due to
*vaporization of liquid in blood.
What are the differences between brain

death ,persistent vegetative state and apparent

death?2019

BRAIN DEATH -

conception :

 irreversible cessation of all function of the brain

 the irreversible end of all brain activity (including involuntary activity necessary to sustain life)
due to total necrosis of the cerebral neurons following loss of blood flow and oxygenation

Prerequisites:

 proximate cause is known and demonstrably irreversible

 metabolic derangements corrected to extent possible
 no drug intoxication
 core temperature greater than 32℃

APARENT DEATH -

# Appear to be dead #Drowning #Electrocution #Poisoning #Brain trauma #Thermal injury, etc.

Persistent vegetative state

 A wakeful unconscious state that lasts longer than a few weeks is referred to as a persistent
vegetative state.
 Test to discriminate apparent death or true death:
 Feather test
 Mirror test
 ECG test
 Shape of the pupils

5) Why is an autopsy important?

 Investigation of the cause of death
  Investigation of unnatural death
 Assessment of effectiveness of treatment
 Research into disease, collection of tissue for research
 Medical education
 Conclusion:
 Complete - in which all body cavities are examined (including the head )
 Limited - which may exclude the head
 Selective- where specific organs only are examined.

6) Why should students majored in clinical medicine study forensic medicine?

 To reveal a crime
 To be a witness (esp. Professional or expert)
 To avoid malpractice (or negligence)

Mission :

--To provide medical evidences for the investigation of a crime: clues, evidences

--To provide medical evidences for handling domestic cases: work-related injuries, disability rating

--To provide scientific research proof and expert opinion for the practice and legislation of medical
science

--To promote the development of medicine by forensic medicine research

7) Why are postmortem changes important for the forensic pathologist?

 8) Define rape?
 Rape is a sexual crime.RAPE is a forced sexual intercourse, without agreement the victim.
 This definition includes attempted rapes.

Condition

 Sexual intercourse: #Vaginal #Anal #Oral penetration

 Illegal: against victim’s free will
 Forced :psychological coercion and physical force, etc
 Victims: #Male and female #Heterosexual and homosexual

9) Signs of rape in victim ?

#Local signs of the female organs

#General signs are due to resistance of the act.

 Mechanical injury
 Psychic trauma
 Pregnancy
 Sexually transmitted diseases

#They are clues (evidences) of resistance the sexual intercourse.

  There are Bruises, and scratch abrasions on different regions of the body of victim,
particularly breast, face, genital region, neck, hands, arms, and thighs.
 In children victims general signs of rape are absent.

10) What is sudden death? Factors of sudden death?

 Conception: death due to potential disease or functional disorder.

 Factors : #sex # age # occupation/profession # climates
 Sex :males live are far more than females
 Age : any time of life . During to peroids of life the rates of sudden death are high : born—6
month; 30-50 yrs old.
 Occupation /profession : Workers,farmers ,officers ,intelligentsia ,the soldiers and students are
rare.
 Climate : Cold weather in north – cardiac disease .Hot weather in south—Sun stroke.

11) Cause of death in a sudden ? which disease has highest death rate in sudden death?

 Almost all kind of disease .

 According to the stastic data (adults)

# Cardiovascular disease

# Respiratory system

# Neural system

# Digestivesystem

# Urinary and genital system

12) Sharp forced injury vs blunt force injury?

Sharp force injury Blunt force injury

Causation Sharp implements Blunt force
Margins Sharp, distinct Irregular, jagged, discontinuous

Tissue bridging Absent or only rare Present

Abrasions Absent or rare Present
Contusions Absent or rare Present
Undermining Absent or rare Present

13) Criteria for brain stem death?

 deep coma
 mechanical ventilation
 A firm diagnosis of the basic pathology must be available and must be known to be due to
irremediable brain damage.
 Diagnostic tests for brain-stem death must be unequivocally positive.

Clinical testing

 All brain-stem reflexes are absent

 Vestibulo-ocular reflex negative
 No motor responses in any cranial nerves
 No gag reflex
 No respiratory movements
 Testing must be carried out with a body temperature not less than 35°C

Introduction to forensic medicine

• Conception
• Mission and objective
• Research field
• Branches of the forensic medicine
• History & system
• Doctor and law

Why do we study forensic medicine?2019

• To reveal a crime
• To be a witness (esp. Professional or expert)
• To avoid malpractice (or negligence)

 Forensic medicine is applying the scientific knowledge and expertise of the doctor to resolve the
legal issues.
 The application of medical science to legal problems.
Mission

• To provide medical evidences for the investigation of a crime: clues, evidences

• To provide medical evidences for handling domestic cases: work-related injuries, disability rating
• To provide scientific research proof and expert opinion for the practice and legislation of
medicine
• To promote the development of medicine by forensic medicine research
Objectives

• Living body
• Dead body
• Biological material/evidence
Living body

– Injured
– Disable
– Mental state
– Sex offence
– Child abuse
Dead body
Medical evidence:

– C.O.D., M.O.D., T.S.D., etc.

Autopsy:

– Violent death, Disaster & accident, Suicide

– Sudden death or unknown, Anonymous
– Death in custody or prison
– Death due to electricity, hot, cold
– criminal abortion, Dismembered body
– Poison, professional disease, drug abuse
– Highly infectious diseases
– Malpractice

Biological material/evidence

– Biological: urine, blood, bile, hairs, etc.

– Focus on: identification
Research field

– Each country differs

– In china:
– Death and death theory
– Post mortem phenomena
– Violent factor and death
– Sudden death and mechanism
– Mental state
– Disabled rating
– others

Forensic medicine

Forensic pathology

Forensic odontology

Forensic clinical medicine

Forensic psychiatry

Forensic biology

Forensic toxicological analysis

Forensic anthropology

Forensic Pathology

– Investigation of sudden, unnatural, unexplained or violent deaths

– Autopsy performed to establish the Cause of death
– Determined the Manner of death it classified as natural, homicide, suicide, accident
or undetermined
– Determined the mechanism of death
– Determined the Time of death it determined by rigor mortis, livor mortis and algor
mortis .e.g.
– Estimation of the weapon

The difference between forensic pathology and the general and systematic pathology

General and systematic pathology are deal with the functional and structural changes in diseased tissues
from the molecular level to the effects on the individual.
The ultimate goal of pathology is identification of the cause of disease, a fundamental objective that
leads to disease prevention.

Forensic Biology2019

Application of the biological genetics knowledge and technology to detect biological sample for
persons identification.

That involved forensic genetics, forensic hematogenetic, forensic serology, Forensic entomology .

Forensic Clinical Medicine

Forensic clinical medicine includes all medical (health care) fields which may related to legal,
judicial and police systems .

deal with the all aspects of living injured body, involved it’s functional and structural changes, the
gradated evaluation of trauma, the assessment of impairment and deal with the interaction between
disease and injury.

deal with the compensation of human trauma

Forensic Anthropology

– Identification and examination of skeletal remains

– Bones can reveal species, sex, approximate age, race and skeletal injury
– Facial reconstruction can help identify “John or Jane Doe”
Forensic Odontology

– Study of teeth characteristics, alignment and the overall structure of the mouth to
identify a person
– Bite mark analysis compares marks on a victim to the teeth of the suspect
Forensic Psychiatry

– Study of human behavior

– Determine if persons are competent to stand trial
– Develop a suspect’s behavioral profile based on previous patterns of other criminals
– Determine the civil and crime capacity of individual
Forensic Toxicological Analysis
 to detected the poison and derivative of poison from sample that came from the suspected
poisoned body to establish the Cause of death

Forensic Entomology

– Study of insects in crime scene to estimate the time of death.

– The Stages from Insects lay eggs to it hatch into larva should tell how long ago the
eggs were laid.
– Temperature and other weather conditions affect the development.

History & system (self-teaching)

Education

– U.S.A
– China

Coroners and Medical Examiners

• Duty: death investigation

The difference :

• Coroners-elected
Medical examiners -assigned

• Coroners-no special background or training Medical examiners -qualified medical doctors with
advanced training in forensic pathology
Doctor and Law

• Conform to law
• Defendant
• Witness
– ordinary witness
– professional witness
– Expert witness

Expert witness Doctor entrusted or appointed to make an expert evaluation of a problem or a technical
nature .

Questions:

What’s the differences between general pathology and forensic pathology?

Why should students majored in clinical medicine study forensic medicine?

 DEATH

 Conception, definition
 Criterion
 Mechanism
 Apparent death
 Nature of death
 Cause of death

Life

The origination of human life

 human being’s biology life and human life have difference.

The essence characteristic

 Brain wave?
 Heart beating?

 self-awareness

In china ,the human life beings since when baby births with respiration

Sleeping , dreaming and death

Meaning of death

Death2019

Death was defined as the permanent cessation of cardiac and /or respiratory function.

Standards

 Blood circulation totally stop, respiration and pulse stop.

----American Black law dictionary (<Black code>) , 1951 .
Death process

Types of death

 Somatic Death

 Cellular Death

Criterion of death

 signs of death ?
 heart death/ circulatory death
 lung death/ respiratory death
 brain death
Circulatory death & respiratory death

 heart beating stop first?

 respiratory stop first?
Brain death

conception :

 irreversible cessation of all function of the brain

 the irreversible end of all brain activity (including involuntary activity necessary to sustain life)
due to total necrosis of the cerebral neurons following loss of blood flow and oxygenation.
Brain death

Criteria for diagnosing

brain-stem death

 deep coma
 mechanical ventilation
 A firm diagnosis of the basic pathology must be available and must be known to be due to
irremediable brain damage.
 Diagnostic tests for brain-stem death must be unequivocally positive.
Clinical testing

 All brain-stem reflexes are absent

 Vestibulo-ocular reflex negative
 No motor responses in any cranial nerves
 No gag reflex
 No respiratory movements
 Testing must be carried out with a body temperature not less than 35°C
Brain death

Brain death

Persistent vegetative state

 A wakeful unconscious state that lasts longer than a few weeks is referred to as a persistent
vegetative state.
Apparent death

Appear to be dead

 Drowning
 Electrocution
 Poisoning
 Brain trauma
 Thermal injury, etc.

Apparent death

Test to discriminate apparent death or true death:

 Feather test
 Mirror test
 ECG test
 Shape of the pupils

Manner of death

 Violent death or non-natural death

 Homicide
 Suicide
 accident
 Undetermined

 Non- Violent death or natural death

 Disease
 Senility
 Social death
 capital punishment
 death due to war
 Euthanasia
Social death

 capital punishment
 death due to war
 Euthanasia

Violent death

 Homicide
 Suicide
 accident

Non- Violent death

 Disease
 Senility

Euthanasia2019

 Painless killing of people who are incurably ill or very old .

 Euthanasia is illegal in most countries.
 positive euthanasia
 negative euthanasia

Cause of death

 Immediate cause of death

 Underlying cause of death
 Contributory cause of death
 Inductive cause of death
 Conjunctive cause of death

Immediate cause of death

 Disease or injury result in death immediately ;

Underlying cause of death (major cause of death)

 The original cause of death ;

 Disease 、injury and violent incident that result in immediate cause of death .
 Be original disease or original injury result in death.

Death Certification

 provided by the doctor

 the death is known
 believed to be due to natural disease and no suspicious or unusual circumstances.
Medical cause of death

 (a) Myocardial infarction

 (b) Coronary thrombosis
 (c) Coronary atherosclerosis
II

Lung cancer

Not good!

Mode of death

 I (a) Heart failure

 (b) Coronary atheroma
or

 I (a) Coma
 (b) Cerebral haemorrhage
 (c) Hypertension
disease process

 I (a) Pulmonary oedema

 (b) Cardiac failure
Reference

 International Classification of Disease (ICD). -----W.H.O.

MEDICO-LEGAL INVESTIGATION OF DEATH

 Inquire the witness

 Investigate the scene
 History
 Autopsy
 Lab. Test
 Verdict

Verdict

1 unlawful killing (murder, manslaughter, infan-ticide, reckless driving)

2 accident

3 suicide

4 natural causes

5 industrial disease

6 dependence on drugs

7 open verdict (where the evidence is insufficient

to arrive at any more definite conclusion).

Autopsy

What is an autopsy?

“…..a post mortem examination of the body of the deceased for the purpose of scientific interest in
determining the cause of death and other information that may be obtained that might aid medical
science.”

Australian Law Reform Commission Report No. 7 1977

When?

 within 48 hours
Who ?

 The Pathologist
 Anatomical Pathology Technician
 Pathologist’s assistant (new job in USA)
Why do Autopsies?

 Investigation of the cause of death

 Investigation of unnatural death
 Assessment of effectiveness of treatment
 Research into disease, collection of tissue for research
 Medical education
Autopsy

 Complete - in which all body cavities are examined (including the head )
 Limited - which may exclude the head
 Selective- where specific organs only are examined.

Questions:

1 what is death? Somatic death? Cellular death?

2 how to diagnose brain death? Compare brain death with PVS?

Postmortem phenomena 2019

• Early postmortem phenomena

• Postmortem decomposition

Early postmortem phenomena：The early changes which occur within 24 hours after death names
early postmortem phenomena.

 muscular flaccidity
 rigor mortis*
 cadaveric spasm
 postmortem turbidity of cornea
 parchment-like transformation
 postmortem staining/ hypostasis*
 algor mortis *
 Autolysis
Rigor mortis is that state of the muscles of dead body when they become stiff or rigid. This rigidity of
the muscles after death indicates molecular death of the concerned muscles. The phase of primary
relaxation of the muscles continues for an hour or more after death.

Influence Factors:

 Age of the subject

 Physique of the subject
 Atmospheric temperature
 The cause of death
exhaustive disease

wasting diseases

strychnine and HCN poisoning

Estimation of the time of death：

1. feels warm and is flaccid - it has been dead less than 3 hours
2. feels warm and is stiff - it has been dead 3-8 hours
3. feels cold and stiff - it has been dead 8-36 hours
4. feels cold and flaccid - it has been dead more than 36 hours
Cadaveric Spasm
It is a condition in a dead body in which the muscles of the body which were in a state of strong
contraction immediately before death, continues to be so contracted at the moment of death and
after death, without passing through the stage of primary relaxation.

The spasmodic contraction of the muscles reflect ante-mortem state of excitement of mind, fatigue,
nervous exhaustion etc.

Medicolegal importance:

 Estimation the cause of death

 Estimation the nature of death
Postmortem Turbidity of Cornea

When the eyes are open, within about 15 minutes the corneas become hazy due to drying or
dessication and deposition of dust and debris over them. This haziness is transient and passes off.

The cornea becomes permanently hazy after about 10-12 hours of death.

Parchment-like Transformation

In the local surface of the body, especially in the wounded surface and mucus membrane surface, the
local skin turns to brown yellow like the parchment, due to moisture evaporating very quickly.

Hypostasis is bluish or reddish-purple discoloration due to capillary vessel distention with blood, at
the undersurface of skin of the dependant parts of the body, due to settling of the blood in those
areas due to the pull of the gravity, when circulation to keep the blood in motion ceases.

Influence Factors:

 Fixed positioning of the dead body

 Excessive loss of blood
 Severely anaemia subjects
 The complexioned of persons
 Other: asphyxia
Medicolegal importance:

 A sign of death
 The cause of death HCN or CO poisoning
 ØEstimation of the time of death-The time of onset is very variable, but is usually visible 2-3
hours after death, persisting until decomposition.From the distribution of the postmortem
staining the position in which the body was left for some hours after death can be known.

Algor Mortis

After death the body temperature of the cadaver falls, it tends to be equal to the temperature of its
immediate environment.

Influence Factors:

 atmospheric temperature
 media of disposal of the dead body
 wind, draught, rain and humidity
 clothing or coverings of the body
 the mass/surface area ratio, obesity or emaciation
 the posture of the body
 age, sex and the conditions before death
Medicolegal importance:

 Estimation of the time of death

1.Time since death

=37℃-rectal temperature(c)+3

2.Time since death

=[98.6℉-rectal temperature(F)] ÷1.5

Postmortem decomposition

The later changes which occur after 24 hours after death

 Putrefaction
 Mummification
 Adipocere
  Postmortem injuries
This is the usual course of decomposition, being a moist degeneration leading to liquefaction of the
soft tissues.

The speed of putrefaction depends on the climate and predators, etc.

Mummification

In warm conditions, either climatic or local environmental, a body may desiccate instead of
undergoing moist putrefaction. This was common in desert conditions in ancient times and led to
natural mummification in Egypt. Mummification is often partial, the rest of the body being
decomposed, skeletallized or converted to adipocere.

Adipocere

This is a chemical change of body fat which converts it by hydrolysis to a waxy compound similar to
soaps. Adipocere is often patchy and partial, the rest of the body being decomposed or even partially
mummified in dry graves.

Postmortem Injuries

Dead bodies can suffer a wide range of injuries which are inflicted after death. Animal predators are a
common cause, mammals, reptiles and birds may inflict any grade of injury upon a body. Apart from
animals, all kinds of mechanical trauma may cause postmortem injuries.

Postmortem injuries may be difficult to identify.

Questions:

1. In which condition will a body decompose fastest, in air, in water, or buried in ground?
2. why are postmortem changes important for the forensic pathologist?

MECHANICAL INJURY

Overview

Injury (Wounding, Trauma)

the structure or functional abnormality of human cells, tissues or organs which is caused by any kinds
of factors.

MECHANICAL INJURY : Injury caused by mechanical forces.

 Blunt force (instrument) injury

 Sharp instrument injury
 Gunshot (firearm) wound
 Explosion injury
 Injury caused by motor vehicle accident
Morphology changes
Injury to the skin:

 Abrasion
 Contusion (bruise)
 Lacerations
 Incised wound
OTHERS:

 Fracture
 Rupture of organs
 Dismemberment
To Form a Mechanical Injury

 Instrument
 Force
 Tissue

Abrasions

Conception:

an abrasion is an injury to the skin in which there is removal of the superficial epithelial layer of the
skin (the epidermis) by friction against a rough surface, or destruction of the superficial layers by
compression.

Significance

 To indicate where a blunt force or a blunt instrument has interacted with the body.
 Time since injury
 To provide clues of the direction of force, the type and shape of instrument.
 To suggest the purpose of a crime suspect

Ante V.S. Postmortem Abrasions: vital

reaction2019

 Antemortem abrasions have a reddish-brown appearance and heal without scarring.

 Abrasions produced after death are yellow and translucent with a parchment-like appearance.
Contusions
 an area of hemorrhage into soft tissue due to rupture of blood vessels caused by blunt trauma.
It can present in skin and the internal organs.

Significance

 To reflect the configuration of the object used to produce the contusion, they might be
patterned.
 To indicate that blunt force has been applied to a particular area, a sign of ante-mortem injury.
 Absence of a bruise does not indicate that there was no blunt force to that area .
 Time since injury.
Spectrum of Color Change

 FRESH: dark-blue or purple

 BLUE
 BROWN
 GREEN
 YELLOW
 NORMAL

LACERATIONS2019

 A SPLITTING WOUND
 FULL THICKNESS

Incised wounds2019

 produced by sharp-edged weapons or instruments.

 Two types: slashed wounds & stab wounds
 Slashed wounds :wound length is greater than its depth
 Stab wounds: depth > length

Fracture

 The destruction of the integrity and succession of the bone tissue.

Rupture of organs

Dismemberment

Injury due to functional disorder

 Neuro-genic shook
 Concussive injury
Complications

 Bleeding
 Embolism
 Infection
 Adrenal glands hemorrhage
 Adult respiratory distress syndrome, ARDS
 Multiple organ disfunction syndrome, MODS
MECHANICAL INJURY (II)
1. Blunt instrument injury & sharp instrument injury

Blunt instrument injury

 Blunt force injury

 Blunt instrument injury
Common types

1 Bare-hands injury: caused by any part of the body

 Body: foot, hand

 Abrasions, contusions, lacerations, factures, shock, etc.
2 Bite mark: caused by teeth

3 Stick injury: caused by stick or rode shaped instruments

Typical stick injury

 defined haematomas consisting of 2 parallel streaky bruises

Stab wound due to stick

4 Brick and stone injury

5 Crush injury: Caused by heavy and huge objects.

Complications: Crush syndrome

  Massive contusions--Circulation volume ↓-Muscle hemoglobin--Urinary cast -Toxic
metabolite-Acute renal failure, Traumatic shock
6 Falling injury: Injuries due to falling

Injuries due to falling

 Extensive and multiple injuries

 The external injuries are less serious than the internal.
 Injuries focus in one side of the body
 All injuries are caused by one single violent force.

Sharp instrument injury

 Sharp force injury

 Sharp instrument injury
Common types

1 Incised wound

2 Stab (punctured) wounds

3 Slash wound

4 Scissoring injury

Scissoring & stabbing

Scissoring & incising

Scissoring & cutting

Note: Defense wounds

 The wounds of the extremities incurred when an individual attempts to ward off a pointed of
sharp-edged weapon.
 Most commonly found on the palms of the hands, due to attempts to grasp or ward off the knife.
Hesitation Marks

 A sign of suicidal incised wounds

 Superficial incised wounds adjacent to , a continuation of , or overlying the fatal incised wound.
 Usually very superficial and often do not through the skin.

2 FIREARM WOUNDS

RIFLING
 A rifle gets its name from the presence of spiral grooves in the bore called "rifling." These grooves
spin the bullet, thereby increasing the rifle's range and accuracy.
GUNSHOT RESIDUE TESTS

 Analyzing residue
 Determine if an individual has fired a weapon
 Note: the pattern & distribution of gunshot residue deposition----important
FIREARMS

SMALL ARMS

 HANDGUNS
 RIFLES
 SHOTGUNS
 SUBMACHINE GUNS
 MACHINE GUNS

FIREARM WOUND

Wound from rifled weapon:

 Entrance wound
 Exit wound
NOTE: sometimes there will be no exit wound

CATEGORIES:

 Contact gunshot wound

 Close range gunshot wound
 Distant gunshot wound

 the basic differences between the skin appearance of a contact, close (intermediate), and
distant range gunshot wound.

ENTRANCE WOUND
 Contact wound:

 Burning
 Circular/Stellate
 Muzzle mark/Pattern
 Abrasion collar/ring
 Surrounding bruising
 Redness of monoxide staining
DISTANT GUNSHOT WOUNDS

Characterized by:

 Absence of soot, powder tattooing, searing

 Bullet hole/defect
NOTE: depends on the type of weapon, gunpowder (i.e. flake, ball powder)

Forensic investigation

 Gunshot wound?
 Shooting range?
 Direction?
 Suicide? Homicide? Accident?

3 Blast injury

 Direct injury
 Projectile injury
 Shock wave injury
 Burn injury
 Others
Forensic investigation

 Where is the centre of explosion

 Number of casualty, personal identification
 C.O.D?
 Material for lab. test
MECHANICAL INJURY (III)

1 Cranio-cerebral trauma

Types of Cranio-cerebral trauma: Scalp injury, Skull fractures, Intracranial Hemorrhages

1 Scalp injury

• Abrasion
• Contusion
 • Laceration
• Undermining
2 Skull fractures

Linear fractures

Depressed fractures

Hole shape fractures

Comminuted fractures

3 Intracranial Hemorrhages

• Epidural
• Subdural
• Subarachnoid
• Intracerebral
• Intraventricular

Epidural Hemorrhages: Location?

• violent force direct impact site or around

Blood come from:

• Bridging vein
• Sinus venosus
• Piamater vessels
Subdural Hemorrhages：Location：dura mater----arachnoid

• violent force direct impact site or opposite side

Intracerebral Hemorrhages: Coup contusions，Contre-coup contusions

Coup contusions

• By an impact to the stationary head that deforms but doesn’t fracture the skull & imparts
energy to the underlying brain
Contre-coup contusions

• The moving head strikes a surface that imparts a massive force to the head
• Falling backward
• Jumping from a moving vehicle
• Falling down the stairs

Injury due to Cranio-cerebral trauma

• Immediate impact injuries

 • Primary complications
• Secondary complications
A : Immediate impact injuries

• Contusions & lacerations

• Diffuse axonal injury
• Penetrating injuries

B: Primary complications

 Epidural Hemorrhages
 Subdural Hemorrhages
 Subarachnoid Hemorrhages
 Intracerebral Hemorrhages
 Intraventricular Hemorrhages
 Brain swelling

C: Secondary complications

• Increased intracranial pressure

• Hypoxic brain damage

Forensic investigation

• Examining & documenting the injury: nature? Location? Size? Color?...

• Times since injury: ante- or post-mortem? Surviving time since injury?
• Fatal trauma or nonfatal trauma?
• Tools?
• Suicide? Homicide? Accident?

SHARP FORCE INJURY V.S. BLUNT FORCE INJURY

Sharp force injury Blunt force injury

Causation Sharp implements Blunt force

Margins Sharp, distinct Irregular, jagged,

discontinuous

Tissue bridging Absent or only rare Present

Abrasions Absent or rare Present

 Contusions Absent or rare Present

Undermining Absent or rare Present

ANTE V.S. POSTMORTEM INJURIES

 How can we tell ante- from postmortem injuries?

 Vital (tissue) reaction: characterized by hemorrhagic red discoloration of the skin and
subcutaneous tissue.
Ante mortem injuries

 vital reaction: bleeding, inflammatory response

POSTMORTEM INJURIES

 Lack of vital reaction

 Dry, yellow appearance

Artifacts:

 Lividity
 Another fatal injury
 Immersed in water
 Animal activities
 Decomposition

Injury

• Fatal injury
– Absolute
– Relative
• Non-fatal injury
– Grave
– Flesh

Sudden death

History

The first recorded sudden death :

 In 490 BC, Phidippides, ran 26.2 miles from Marathon to Athens, and then he collapsed and
died.
Victims of Sudden Death

some well-known athletes :

 marathon runner Jim Fixx (1984)

 Olympic volleyball star Flo Hyman (1986)
 NBA basketball star Hank Gathers (1990)
 Olympic figure skater Sergei Grinkov (1995)
Conception

Death due to potential disease or functional disorder.

Traits:

 Sudden
 Unexpected
 Natural and non-violence
Sudden

 The maximum time interval varies from 1-24h

 Most individual falls down dead
 Die within in 1h of the onsets of symptoms
Unexpected

 The deceased seems to be healthy before sudden death.

Natural and Non-violence

 To identify a sudden death, one must wipe out the possibility of violent death.
Inducement

 Psychological or mental factor

 Too cold/too hot
 Excise
 Others
psychological or mental factor

 Angry
 Exultation
 Sorriness/teen
 Frighten/scare
 Brawl/wrangle

Too cold/too hot

 low temperature tend to induce the onset of cardiac disease.

Excise
  strenuous activity.
Others

 Eaten/drink too much: pancreatic inflammation.

 Smoking.
Factors of sudden death

 Sex
 Age
 Occupation/profession
 Climates
Sex

 Males are far more than females.

Age

 Any time of life

 During to periods of life the rates of sudden death are high: born --6 mon, 30-50years old.
Occupation/profession

 Workers
 Farmers
 Officers
 Intelligentsia
 The soldiers and students are rare.
Climates

 Cold weather in north-----cardiac disease

 Hot weather in south---sunstroke
Cause of death

Almost all kinds of disease

According to the statistic data( adults)

 Cardiovascular disease
 Respiratory system
 Neural system
 Digestive system
 Urinary and genital system
Note

 In some occasions it’s unable to find out any kind of disease responsible for death. Such death
usually caused by functional disorder.
Forensic investigation

 Scene investigation
 Autopsy and laboratory examine
  Analysis and making conclusions
Scene investigation

Task

 To find out the reason of nature death.

 Find and gather blood drop traces, food , drug , medicine, drink/ BEVERAGE
 Investigate the deceased: history and symptoms
Autopsy and lab. Examine

 Autopsy: key step to identify the cause.

 Histological examine
 Poison test and material evidence examination
Why autopsy?

 Sudden onset, dead, Unknown reason of death

 Doubt of suicide or homicide
 No signs/symptoms of disease and died suddenly
 Doubt of violent death: a quarrel/struggle previously
 Died in hospital: is there a mistake during treatment?

Sudden Death Due to Natural Disease

Sudden cardiac death

 300,000---400,000 deaths/year in U.S.

 The leading cause of death in men between 20—65 years of age
 The most common cause (U.S.)
Coronary atherosclerosis

 The most common cause of death from cardiovascular disease

 Half of the patients die suddenly
A.S.

Coronary atherosclerosis

 embolism

 Infarction
 Aneurysmal dilatation

Rupture of the heart

Other kinds of cardiovascular disease

 Hypertensive cardiovascular disease

  Cardiomyopathy
 Valvular disease
 myocarditis
 others…….
Valvular disease

Aortic dissection

 Blood dissects between the middle and outer two thirds of the aortic media,creating a blood
filled channel within the aortic wall.
 Marfan’s sysdrome affects fibrillin, a glycolprotein that sees to the adhesion and alignment of
the sheets of collagen in the aorta.

Aortic aneurysm

Death due to intracranial lesions

Less common than cardiac disease

The most common cause:

 Epilepsy
 Nontraumatic subarachmoid hemorrhage
 Intracerebral hemorrhage
 Meningitiss
 Tumors
 Cysticercosis(rare)
Epilepsy

 the most common cause: 3-4% of all natural deaths coming to autopsy in a medical examiner’s
office (U.S.).
epilepsy

 Stool and urine-soiled underpant

epilepsy

 Bite mark
epilepsy

 Bite mark in tongue

Mechanism of death in epilepsy

 A. cardiac arrhythmia precipitated by an autonomic discharge

 B. asphyxia
 C. accident fatal injury during the seizure
Intracerebral hemorrhage

 Cause: hypertension and A.S.:>2/3

  Cerebral anisotrophy/cacogenesis and berry aneurysms
 Other diseases intend to bleed

 apoplectic
 Intracerebral hemorrhage

 apoplectic
 Hemorrhage in basal ganglia
Meningitis

Respiratory System Disease

 Pulmonary thromboembolus
 Asthma
 Pneumonia
Pulmonary embolism

Gastrointestinal Tract Disease

Ulcus hemorrhage

Ulcus hemorrhage

Genital System

 Tubal pregnancy

 Tubal pregnancy with perforation of the fallopian tube

Questions:

1 what is sudden death?

2 Factors of sudden death?

3 Cause of death in sudden death? Which disease has highest death rate in sudden death?

Burn injury
1.Introduce
thermal injury mainly include burn injury and hypothermia .
2.Burn injury

Burn injury is caused due to contact with hot metal , any other hot solid or flame. The effects mainly
depend on the degree of heat and duration of contact.

2.1 Epidemiology

Tissue injury caused by thermal, electrical, or chemical agents

Can be fatal, disfiguring, or incapacitating

~ 1.25 million burn injuries per year

45,000 hospitalized per year

4500 die per year (3750 from housefires)

3rd largest cause of accidental death

2.2 Skin

Largest body organ.

Protects underlying tissues from injury

Temperature regulation

Acts as water tight seal, keeping body fluids

Sensory organ

Layers

– Epidermis
– Dermis
– Subcutaneos
– Underlying
Structures

• Fascia
• Nerves
• Tendons
• Ligaments
• Muscles
• Organs
2.3.1 Epidermis

Deeper layers divide to produce the stratum

corneum and also contain pigment to protect against UV radiation

2.3.2 Dermis

Consists of tough, elastic connective tissue which contains specialized structures

Dermis - Specialized Structures

Nerve endings

Blood vessels

Sweat glands

Oil glands - keep skin waterproof, usually discharges around hair shafts

Hair follicles - produce hair from hair root or papilla

Each follicle has a small muscle (arrectus pillorum) which can pull the hair upright and cause goose
flesh

Superficial Burn:
1st Degree Burn

Signs & Symptoms

Reddened skin

Pain at burn site

Involves only epidermis

1st degree(erythema information )

When contact occurs with comparatively degree heat for a very short period, there is erythema over the
area of contact. It is painful for some time. The erythema passes off in a few hours or a day.
Occasionally, the covering epidermis may get devitalized and may be shedded off after a few days.

2nd degree

Damage extends through the epidermis and involves the dermis.

Not enough to interfere with regeneration of the epithelium

Moist, shiny appearance

Salmon pink to red color

Painful
Does not have to blister to be 2nd degree

Usually heal in ~7-21 days

2nd degree(blister formation )

The effect is limited within the superficial layer of the skin, the epidermis. There is blister formation
which is surrounded by a red line (hyperemia). This is also painful. The blisters may rupture and may get
infected. Extensive blisters, in addition to shock due to pain, may also cause hypovolemic shock.

• Can be described as “superficial” or “deep”.

• Painful due to injured and exposed nerve endings. Able to heal, not completely destroyed.
• Intact blisters indicate superficial partial thickness burns.
• Deep partial thickness burns may become full thickness burns as a result of infection, trauma,
and decreased blood supply.
3rd degree

Full of the thickness of the skin is involved. There is singeing of hair and blackening due to deposition of
soot. The tissue involved is also charred to some extent. There will be a red lining and there may be
blister formation around the wound. These wounds ulcerate and may get infected. They heal by scar
formation, and the wounds are less painful due to total damage of the sensitive nerve endings.

4th degree

The lesion extends deeper to the subcutaneous tissue, involving the muscles and bones. These lesions
are less painful. They also heal with contracture limiting the function, when near to a joint. These lesions
obviously heal with great difficulty.

2.5 Postmortem findings

A.External findings
a. burnt remains of dress
Externally, the dead body may still bear burnt remains of dress, particularly the portions which were
tightly in contact with the body and which during the process of burning got pressed on the skin.
Smell of kerosene or any such fuel which might have been used to set fire on the body, may be
detectable.

b. pugilistic (boxer’s or fencer’s) attitude

Due to coagulation of the muscle protein resulting in contraction of the muscle fibers, in which flexor
muscles take upper hand, the whole body may assume a flexion attitude. The flexion attitude of the
body is popularly termed as pugilistic or boxer’s or fencer’s attitude which is nearly similar to an boxing
or fist-fighting. However, pugilistic attitude do not indicate anything in specific about the nature of
burning, whether antemortem or postmortem.
c. Heat rupture
Heat rupture may be present at places which may ocour due to severe contraction of the coagulated
muscle fibers when the coagulated and contracted muscles tear easily. These heat ruptures may be
confused with antemortem lacerations, or they may even be confused with incised wounds. But
carefully examined, there is no scope of confusion of a heat rupture. As for laceration, there is no
marginal abrasion and swelling. there may be marginal blister formation with zone of red line
surrounding the rupture, if the process of burning before the moment of death. The floor of a heat
rupture will show intact vessels and nerves running across the floor.

d. Charring
Charring of the tissue may occur due to sustained burning, which is common with deep burns. Charring
may involve even the bone. Like singeing, blackening and heat rupture, charring does not show anything
specific whether antemortem or postmortem. It should be cautioned that extensive charring at times
may obliterate the antemortem features of burning.

In some cases, there may be outflow of blood mixed fluid through the nose. This is due to excessive
secretion in the lung because of inhalation of smoke and rupture of capillaries

B.Internally findings

a.carbon soot

The nasal and the mouth cavities may show presence of carbon soot. Soot may also be present, mixed
with mucus, adhered on the wall of the lumen of the respiratory tract, as below as the lumen of the
bronchioles. The mucus membrane of the respiratory tract is congested. The lungs are congested and
may also be oedematous.

b.respiratory complex caused by heat

hyperemia and necrosis of larynx, trachea and bronchus after inhaling thermal gas and flame.

c.circulatory system
The blood in the vessels is fluid, bright red and thick. Muscles and the organs are congested and bright
red in color. The chambers of the heart may be full. CO in the blood reach 50-70%.

d. Heat haematoma in the extradural level

Heat haematoma in the form of firm, friable, cherry red or chocolate red clot of blood present in the
extradural level, which on sectioning has honeycomb appearance due to vaporization of liquid part of
blood, direct effect of heat. This haemorrhage appears to heat rupture of vessels at the extradural
level.

2.6Cause of death
a. Shock:

including neurogenic shock and hypovolemic shock

b. Toxins

Systemic absorption of the toxins from the ulcerated burn injuries.

c. mechanical asphyxiation

traumatic asphyxia in case of collapse of a house resulting from out-break of fire in a house.
d. fatal mechanical injuries
e.g. collapse of wall or house.
e. Infection and sepsis

f. inhaling asphyxiant gases like CO and CO2 during conflagration

g. Renal failure(oliguria)

2.7Medicolegal aspects
a. We need to identify whether cause of death is due to burn injury.

The most important findings of antemortem burning are the presence of soot in the larynx, trachea and
bronchus, CO concentration in the blood reachs 50-70%.

b.Whether burning is accidental, suicidal or homicidal. Burning incident is mostly accidental, next to
suicidal . Homicidal burning is not a common occurrence.

c.identification of the victim

when deep burn injuries obliterate the facial contour and different body parts get charred.

electrical injury

1. INTRODUCE

The electrical energy is converted to some other form of energy, e.g. light, heat or mechanical
energy.

More than 10,000 person were died due to

electrocution every year.

1.Factors influencing the fatality of an electric current

a. Current property
 Including alternating current(AC) and direct

Current(DC).

When Voltage equal to 500V, the worse is correspond, if under 500V, AC is more dangerous than DC.

but more 500V, DC is more dangerous.

b. Current intensity
Amperage, or the amount of current flow, is the most important factor in electrocution. It is
Directly

related to the voltage and inversely related to the

resistance.

Voltage is a measure of the electromotive force

and ohms are the resistance to the conduction of

electricity.

This is expressed in the formula: A=V/R

With 120 V, dry skin may have a resistance of 100,000 ohms; dry and calloused skin up to a million
ohms;

moist skin 1,000 ohms or less, and moist, thin skin as

low as 100 ohms.

With high-voltage currents, skin condition plays no significant role in resistance to electrocution.

Amperage is the most important factor in electrocution. Since voltage is usually constant, the main
factor in determining the amount of amperage that enters the body is the resistance, as expressed in
ohms. The minimal amount of amperage perceptible to a human is 1 mA(0.001A).A current of 5 mA
will produce tremors of the musculature while 15-17 mA will cause contracture of the muscles, which
prevents release of the electrical source. This latter current is the “no-let-go” threshold. At 50 mA,
there is contracture of all muscles, respiratory paralysis and death if the current is sustained.
Ventricular fibrillation occurs at currents between 75 and 100 mA. Extremely high currents,～1 A and
higher, do not cause ventricular fibrillation, but rather ventricular arrest.

c. The duration of the contact

The more is the duration of contact, the worse is the outcome.
d. Passage of current through the body
If the current pass through the heat or brain, there is more dangerous.
e. Other factors
Diseased heart(coronary insufficiency) , fatigue ,old man and children is more likely to suffer cardiac
arrest or fibrillation.

2. Causes of death duo toelectrocution

a. ventricular fibrillation
Very low current intensity(amperage) may initiate ventricular fibrillation and cause death. This may
occur most frequently when the current enters through the left upper limb and exits through the right
upper limb or right lower limb.

b. Paralysis of the respiratory center

When the current passes through the brain affecting the basal part. Paralysis of respiratory center
causes stoppage of respiration but the heart continues to beat. Death in many of these cases may be
prevented by artificial respiration for over a prolonged period.

3.Features of electrocution
a.Lesion at the site of the entrance of the current, including:

current mark(crater formation )

At the entrance of the electric current, due to the resistance offered by the skin, there will be a crater
formation or current mark, which is tough on palpation and the margin of which is raised and the floor is
depressed in the shape of the conductor causing the contact. If the skin is dry and tough, as in case of
the skin of the palm then, due to greater resistance offered by the skin, there may be some cracking of
the skin at the margin of the crater.

metallic dust of skin

The heat thus generated, may also cause atomization of the metallic electric wire. Thus the site of
entrance may have a metallic luster. We can observe it by scanning microscope and energy spectrum.

burning of the tissue

With high voltage electrocution, these two features may get totally obliterated due to gross damage of
the tissue locally, due to the effect of heat , fire or electric arc.

Lesion at the site of exit of the current

4.Medicolegal aspects
Most deaths caused by electrocution are accidental in manner.
Suicides are rare
Drug abuse can lead to drug dependence or addiction. (T)

Long bone length(femur, tibia, humerus) is

proportional to height. (T)2019

DNA polymorphism is unique to every individual. DNA comparisons allow for definitive identification
of an individual.(T)
For each individual there is a fixed dose of

drug/poison which will cause symptoms and

disability and a larger one which will kill.(F)2019

The Defloration is necessary to identify rape.(F)

We usually find hesitation mark on a suicide case. (T)

When the bitemark is very fresh, one should

collect trace salivary evidence for later DNA

profiling and matching. (T)2019

Defense wound usually located on the back of the body.(F-)

There are gun powder residues on the the entrance

wound of a contact gunshot (T)2019

Alternating current(60Hz) is much more dangerous than direct current ir electrocution(T)

Abrasions are always present in areas of blunt force injury.(F)

Abrasions produced after death are yellow and translucent with a parchment-like appearance.(T)

In a incised wound, the wound length is usually greater than its depth.(T)

A hesitation mark is usually very supericial and often do not through the skin.( T)

Sudden death is death due to potential disease or functional disorder.( T)

According to W.H.O, in Sudden Death, the maximum time interval varies from 1-25h.(F)

Sudden Death can happen at any age.( T)

Almost all kinds of disease can cause Sudden Death.(T)

Incised wounds are produced by sharp-edged weapons or instruments.( T)

Only the structure abnormality of human cells, tissues or organs which is caused by any kinds of
factors can be called as"Injury".(F)