Forensic notes

Mechanism: The metabolic rate is greatly •}}c1::Suspended Animation (Apparent Death){{

reduced •Seen in practitioners of yoga–Hypothermia–Sun stroke–Drowning–Drug overdose (e.g.
barbiturates or opiates, )–Head injury (heatstroke)–newborns
electrocution, cholera, postanesthesia,
.shock, cerebral concussion or insanity
The patient can be resuscitated by cardiac massage or electric stimulator and artificial
.respiration. The death certificate should not be issued without an ECG or EEG record
Death is not a moment its a continuous process*Medically and scientifically, death is * ]‫[ُأضيفت‬
{{c1::not an event , it is a process}}*process means not all cells death together (brain death first
.then gradually other tissues become dead)
DeathThe irreversible cessation of all integrated functioning of the human organism as ]‫[ُأضيفت‬
a whole, mental or physicallegally defined as the irreversible, complete cessation of function of
3 systems:{{c1::(1 ) CNS(2 ) RS(3 ) CVS}}
Somatic deathSomatic death is the death the permanent, irreversible death of an ]‫[ُأضيفت‬
organism as a whole. In humans it is {{c1::usually after brain death}} , as the other vital
organs are unable to function without the brain. With modern technology, though, one can be
brain dead but still have circulation and respiration artificially . In such a case one isn't
somatically dead because other organs are still alive. Once artificial support is removed somatic
death occurs , because the person is then entirely and completely inactive with regard to brain,
.circulation, and respiration
Somatic deathAlso called as {{c1::clinical death or systemic death}}• Somatic death ]‫[ُأضيفت‬
is characterized by complete loss of sensibility and the ability to move. There is complete and
irreversible cessation of the functions of {{c1::the circulatory, respiratory and central nervous
.system}} the so called tripod of life ’ that maintains life and health
Somatic death corresponds with physical stoppage offunctions of heart , lung and brain. ]‫[ُأضيفت‬
However,individual cells may not die and respond to chemical,thermal or electrical stimuliFor
example pupils muscle may contract onapplication of myotic drug.Somatic death indicates
demise of a person and it Somatic death indicates demise of a person and it entitles Registered
entitles Registered Medical Practitioner to certify Medical Practitioner to certify that death that
death has occurred.has occurred. 6 Thus legal {{c1::Thus legal defintion of death depends upon
the diagnosis of somatic death}}
Brain Death.is the complete and irreversible loss of brain function (including ]‫[ُأضيفت‬
involuntary activity necessary to sustain life A brain deprived of oxygen survives for {{c1::3 to
7 minutes}}, making it the first organ to die when circulation or respiration ceases or is impeded,
whatever the cause of trouble may be. this is brain death, and it's the reason why clinical death,
the period in which a person can be resuscitated, is so short. Once the brain goes, the heart
.doesn't know how to pump and the lungs don't know how to breath
Cortical Brain Death• Also called as {{c1::cerebral brain death or persistent vegetative ]‫[ُأضيفت‬
state}}• In this condition, clinically patient is in irreversible coma and shows sign of severe
brain dysfunction with loss of higher levels of cerebral activity resulted either from:{{c1::1.
Hypoxic insult2. Traumatic insult or3. Toxic insult}}
In this condition the person will exist in a vegetative state because brain stem is intact ]‫[ُأضيفت‬
maintaining respiration and cardiac activity.Such vegetative people are not considered dead but
because of irreversible loss of awareness, they are considered as {{c1::living cadavers}}
Here the survival of the brainstem ensures that spontaneous breathing will continue and ]‫[ُأضيفت‬
therefore cardiac function is not compromised. The victim can remain in deep coma almost …
but they are {{c1::not on life support machines}}
It is another matter when brain death spreads below {{c1::the tentorium}}. When the ]‫[ُأضيفت‬
brainstem (specifically the midbrain, pons and upper medulla) suffers neuronal damage, the
lossof the 'vital centres' that control respiration, and of the ascendmg reticular activating system
that sustains consciousness, cause the victim not only to be irreversibly comatose, but also to be
incapable of spontaneous breathing and the heart stops ……. Need life support machines This
then is the state of 'brainstem and almost all doctors and most jurisdictions now accept that, once
irreversible damage to the brainstem has been proved, the patient is 'dead' in the somatic sense
They are,however, not yet dead in the cellular sense and it is through this 'physiological window'
.that the spectacular advances in cadaver donor transplant surgery have been made
Brainstem deathAll brain stem reflexes must be absent..{{c1::Unconsciousness ]‫[ُأضيفت‬
(coma)Absence of spontaneous breathing No Respiratorymovements After disconnection of
ventilatorPupils should be fixed, dilated, no light reflexes.No Corneal reflexAbsent of the
oculo cephalic reflexAbsent vestibulo ocular reflexesNo Motor responsesNo Gag reflex}}
Cellular death•Cessation of respiration is soon followed byautolysis and decay, which, if ]‫[ُأضيفت‬
it affects the whole body, is {{c1::indisputable evidence of true death.}}
will remain metabolically active and thus ‘alive’ formany hours }}c1::Skin and bone{{ ]‫[ُأضيفت‬
and these cells can be successfully cultured days aftersomatic death.White blood cells are
capable of movement for up to {{c1::12 hours}} aftercardiac arrest a fact that makes the concept
of microscopicidentification of a ‘vital reaction’ to injury of doubtful reliability.•The cortical
neuron , on the other hand, will die after only 3 7minutes of complete oxygen
deprivation.•ORGAN SURVIVAL TIME Heart {{c1::60}} mins Liver {{c1::15}} mins Kidney
{{c2::45}} mins Blood {{c2::6}} hrs Bone marrow {{c2::6}} hrs•A body dies cell by cell and
.the complete process may takemany hours
{{c1::The mode of death}} : an abnormal physiological state that pertained atthe time ]‫[ُأضيفت‬
of death:1 {{c1::Coma}} death from failure of functioning of brain2 {{c1::Syncope}} death
from failure of functioning of heart3 {{c1::Asphyxia}} death from failure of functioning of
lungsThese offer no information as to the underlying pathological condition and should not be
used as the definitive cause of death unless further qualified by the more fundamental
.aetiologicalprocess
{{c1::The cause of death}} is any injury or disease that produces a physiological ]‫[ُأضيفت‬
derangement in the body that results in the death of the individual.. : Diseases natural
deathsTrauma or poisons unnatural deaths
The Manner of DeathThere are 4 ways a person could die,referred to as the manner of ]‫[ُأضيفت‬
death:{{c1::1. Natural2. Accidental3. Suicide4. Homicide}}A fifth manner of death should be
added:5. Undetermined or Unknown
Cause and Mechanism of DeathThe reason someone dies is called {{c1::thecause of ]‫[ُأضيفت‬
death}}Proximate cause of death refers to anunderlying cause of death as opposed tothe final
cause.Example: radiation cancer = radiation exposure{{c1::Mechanism of death}} describe
.thespecific change in the body that broughtabout the cessation of life
 Examples of {{c1::causes of death}}:heart attack, gunshot wound, skull fracture, ]‫[ُأضيفت‬
diseases orinjuries, stroke, burning, drowning, strangulation, hanging,suffocation, massive
trauma, bludgeoning Examples of {{c1::mechanisms of death}}:Exsanguination (bleeding to
death)Sepsis (infection in blood stream)Brain trauma (cerebral contusion)Brain bleeding
(intra cerebral bleed)Stop breathing (asphyxia)Pulmonary arrestCardiac arrest
Immediate Changes (Somatic Death)A Irreversible cessation of the function ofbrain ]‫[ُأضيفت‬
including {{c1::brainstem.}}B Irreversible cessation of {{c1::respiration.}}C Irreversible
cessation of {{c1::circulation.}}
Irreversible cessation of the function of brainincluding brainstemThis condition is ]‫[ُأضيفت‬
sometimes seen in:{{c1::1Prolonged fainting attack2Vagal inhibitory
phenomenon3Epilepsy,4Narcosis,5Electrocution}}
Irreversible cessation of respirationComplete stoppage of respiration for {{c1::> 4 ]‫[ُأضيفت‬
min}} usuallycauses death.i. Inspection: No visible respiratory movement.ii. Palpation: No
.respiratory movement can be felt.iii. Auscultation: Breath sounds cannot be heard
Respiration may stop briefly without death as in:{{c1::1• Voluntary breath ]‫[ُأضيفت‬
holding2• Drowning3• Cheyne Stokes respiration4• Newborns}}
Irreversible cessation of circulationStoppage of heart beat for {{c1::> 3-5 min}} results ]‫[ُأضيفت‬
in death.The following tests may be performed to test circulation:i. Radial, brachial, femoral
and carotid pulsations will beabsent,ii. Auscultation of heart: Absence of the heart beatiii.
.ECG: shows a flat line without any elevation ordepression
2Early changes{{c1::• Loss of elasticity of the skin, and facial pallor• Primary ]‫[ُأضيفت‬
relaxation of the muscles• Contact pallor and flattening• Changes in the eye• Algor mortis•
Livor mortis• Rigor mortis}}
Changes in the skin and facial pallorSkin becomes {{c1::pale and ash white}} due to ]‫[ُأضيفت‬
stoppage of circulation and drainage of blood from the capillaries and the small vessels. The
skin {{c1::loses its elasticity}} and the face looks younger due to loss of creases.The lip appear
.{{c1::brownish, dry and hard}} due to drying
Primary flaccidity of the muscles•The muscles rapidly become flaccid ( primary ]‫[ُأضيفت‬
flaccidity ), with complete loss of tone, but they may retain their reactivity and may respond to
touch and other forms of stimulation for some hours after cardiac arrest.• Discharges of the dying
motor neurons may stimulate small groups of muscle cells and lead to focal twitching, although
these decrease with time.• Loss of muscle tone in the sphincters may result in {{c1::voiding of
urine}} ; this issuch a common finding
Stomach•{{c1::Regurgitation}} is a very common feature of terminal collapse and it is a ]‫[ُأضيفت‬
common complication of resuscitation.• Gastric contents are identified in the mouth or airways
in up to 25 % of all autopsies.• The presence of this material cannot be used to indicate that
inhalation was the cause of death unless it is supported by eyewitness accounts or by the
.microscopic identification of food debris in the peripheral airways
The areas which remain in contact with the }}c1::Contact flattening and pallor{{ ]‫[ُأضيفت‬
ground,become flat and the blood from vessels of these areas is pressed out, this continues even
.after the formation of postmortem staining over the surrounding areas
Changes in the eye1{{c1::Loss of corneal and pupillary reflexes}} : not a reliablesign ]‫[ُأضيفت‬
of death. the pupils react for sometime to myoticand mydriatic agents.{{c1::Opacity of the
cornea}} : There is opacity and hazinessof the cornea due to drying and deposition of dustand
debris over it. This may be delayed, if the lids areclosed after death. If the lids are closed, the
cornearemains clear for about 2 h. This haziness istransient and passes off, if a drop of water is
pouredon the cornea. But the cornea becomes permanentlyhazy after about 10 12 h of death due
.todecomposition
Changes in the eye2{{c1::Tache noire}} (French, black line): If the eyelidsremain open ]‫[ُأضيفت‬
for 3 4 h after death, there is formationof two yellow triangles (base on the limbus, apex atthe
lateral or medial canthus and sides are formed bythe margins of the upper and lower eyelids) on
thesclera at each side of the iris, which become brownand then black.Cause: Drying/
dehydration and deposition ofcellular fragments, mucus and dust on the exposed conjunctiva and
the sclera underneath. paste-e9e72687d0a1bfcefba2e8849511f7c211cb4aca.jpg
Eye{{c1::1•Loss of corneal and light reflexes2-Mid dilated pupils.3•Irregular size and ]‫[ُأضيفت‬
shape of the pupils ( anisocoria ).}}•Eyelids usually closed incompletely•loss of intraocular
tension.•The retinal vessels show the break up orfragmentation of the columns of blood, which is
called trucking ’ or shunting (Kevorkian sign).Vitreous potassium and hypoxanthine: Steady
rise : Steady risein the values are seen after death. the values are seen after death.•Tache noire :
where the sclera remains exposed to air, two black triangular spots appear at each side of the
cornea (due to drying).The pressure in eye is 14 25 mmhg and it can be benefit in determine
the death time  after one hour the pressure decrease to half and after two hours it decreases to
.zero
Cooling of the Dead Body1Latin algor: {{c1::coolness}}, mortis: death)The most ]‫[ُأضيفت‬
useful indicator of time of deathduring the first 24 hours post mortem.*After death all metabolic
activity ceases rapidly(muscles, liver) & circulation stops SO heatproduction ceases soon after
death.• Loss of the body heat occurs by{{c1::1-conduction,2-convection,3- radiation and4-
.evaporation}} till it balanceswith the temperature of surroundings
Cooling of the Dead Body2*normal body temperature when takenorally 36 37.2 C = ]‫[ُأضيفت‬
96.7 99 F)Rectally 36.5 37.5 C)… when the rectal temperature falls below 75F{{c1::( 23.8
c )}}its indicative of deathand below 70{{c1::(21.1 C)}} it s a sure sign of death
Estimation of time passed after death, themeasurement of {{c1::the inner core • ]‫[ُأضيفت‬
temperature is}} important and is more reliable than the outer surface temperature.• Site of the
body used to record the inner core emperature:1 Rectum 8 10 cm above anus)2 External
auditory meatus3 Sub hepati c (inferior surface of liver)4 Nostrils upto cribriform plate5
Intracerebral (through the
How time passed since death can be estimated1{{c1::Glaister and Rantoul}} : time ]‫[ُأضيفت‬
interval after death in hours = ( 37.2 C rectal temperature )/(rate of fall oftemperature /hour )
Rate of temperature fall1 C/hr in summer 1.5 C/hr in winter
Rectal temperature is higher in case of 1-{{c1::struggle or exercise prior}} todeath.3- ]‫[ُأضيفت‬
{{c1::CO}} poisoning, 4-{{c1::coronary thrombosis, ruptured aortic aneurism}},5-{{c1::heat
stroke,infections,pontine hemorrhage ,and asphyxial death}}
• Low temperature is seen in{{c1::1- congestive cardiac failure, 2-cholera,3- ]‫[ُأضيفت‬
hypothermia , hemorrhage, 4-collapse and secondary shock }}
Is postmortem cooling ideal method of estimating death 2 Another factor to be ]‫[ُأضيفت‬
considered is that death may not occur immediately following an assault .Patientscould be
injured and lie in a coma for several hours.(patient who bleeds )So postmortem cooling is
{{c1::not the ideal method of estimating death}}
Factors affecting rate of cooling1-{{c1::Air movement}}: A body kept in a well ]‫[ُأضيفت‬
ventilated room will cool more rapidly than one in aclosed room.2-{{c1::Humidity}}:Cooling is
more rapid in a humid rather than in a dry atmosphere since moist air is better3-
{{c1::Age}} :rate of fall is rapid in extremes of age than adults 4-{{c1::Sex}}: Rate of fall is less
in female as compared to male because of more subcutaneous body fat.5-{{c1::Clothing or
coverings of the body:}}6-Emaciation(muscle wasting)lack of muscle bulk allows a body to cool
.faster
Cause of Death :In cases of death due to chromic wasting disease (sever bleeding, rate -7 ]‫[ُأضيفت‬
of cooling is {{c1::rapid}}In cases of death due to septicemia may be {{c1::rise}} in temperature
then the temperature fallDeath due to {{c1::CO and CO2 poisoning in cases of hangingand
.strangulation}} in the initial stage rate of fall will be less
8Site of reading of body temperaturePosture of the body extended or curled into afetal ]‫[ُأضيفت‬
position9-{{c1::Edema}}: slower cooling rate10-Environmental temperature.In water rate of
fall is 4 times more in water than in air , rate of fall will be more in flowing water than in in
stagnant water
What is {{c1::Postmortem Caloricity}}1Instead of cooling, the temperature of the dead ]‫[ُأضيفت‬
body remains high for the initial 1 2 hs or so. This is due to:i. Postmortem glycogenolysis:
Compulsoryphenomenon which occurs in all dead bodies andwhich starts soon after death
(produces upto 140calories).ii . Cause of death:• In deaths occurring due to infectious
diseasessepticemia or bacteremia, heat is produced by theaction of the infective
organisms.What is Postmortem Caloricity• • If death is preceded by a severe convulsion, as in
If death is preceded by a severe convulsion, as in tetanus and strychnine poisoning, it causes an
tetanus and strychnine poisoning, it causes an increase in the body temperature.increase in the
body temperature.• • In case of death due to heat stroke or pontine In case of death due to heat
stroke or pontine hemorrhage, the heat regulation is severelyhemorrhage, the heat regulation is
severelydisturbed before deathdisturbed before death. . iii. iii. High environmental
temperature:High environmental temperature:In tropical In tropical countries, countries, when
the environmental temperature is when the environmental temperature is higher than the body
temperature, the dead body higher than the body temperature, the dead body may absorb some
.heat.may absorb some heat
postmortem lividity(Latin: postmortem ——"after death", lividity ——"black andblue") ]‫[ُأضيفت‬
{{c1::Livor , Lividity, hypostasis , mortis, vibices, suggilation,postmortem or cadaveric lividity,
darkening of death]}}
lividity , postmortem hypostasisAfter death occurs, circulation of blood ceases & ]‫[ُأضيفت‬
subsequent movement of blood is by gravityBlood accumulates in the capillaries in the
dependent parts of the body … purple or reddish purple discoloration of the adjacent
skinWithin pressure areas such as the shoulder blades, buttock & calves discoloration will be
pale . (compressed blood vessels) starts {{c1::immediately}} after death. apparent after
{{c1::2 hrs}} and fixed after {{c1::8 hrs}}may not appear at all especially in {{c1::infants , old
and anemic or in those who have died from severe blood loss}}
Sites of hypostasisDepends on the position of the bodybefore death:shoulders, ]‫[ُأضيفت‬
buttocksheels pressing against s{{c1::urface givinga white color (pale).}}Supine
distally in legs & feet}}c1::Hanging Position{{ ]‫[ُأضيفت‬
drowning :site of hypostasis {{c1::chest, upper chest, and upper limbs.}}-
facing down as in epilepsy, drunken victimswhitening around nose & lips.The linear marks -
are formed by pressure from creases {{c1::in the blanket}}. The pale areas around the mouth and
nose are not necessarily signs of suffocation
internal lividityHeart : mistaken for MILungs : mistaken for pneumoniaIntestine : mistaken
for hemorrhagic infarction-once hypostasis is established it has ability to undergo subsequent
gravitational shift if the body is moved into a different posture.This is important because
changes in the position of a body after the initialdevelopment of hypostasis will result in
{{c1::redistribution of the hypostasis}} andexamination of the body may reveal two overlapping
patternsIt can also be used by forensicinvestigators to determine whether or nota body has been
moved (for instance, ifthe body is found lying face down but thepooling is present on the
.deceased's back,investigators can determine that the bodywas originally positioned face up)
Color of HypostasisThe color of hypostasis is variable and depends on the state of ]‫[ُأضيفت‬
oxygenation at death(on Hb concentration )The normal color of the postmortem staining is
either bluish or purplish red. It may be masked by {{c1::dark skin colours, by jaundice or by
some dermatological conditions }}
Deep bluish violet {{c1::Asphyxia}}-Brown {{c2::methahemoglobinemia}}-cherry - ]‫[ُأضيفت‬
pink {{c3::CO poisoning(carboxyhemoglobin) /cold temperatures/cyanide}}-Pale {{c4:: anemia,
hemorrhage (or normal in extremes of age).}}-Brown to black {{c4::Mummified bodies}}
Hypostasis Starts from 1 2 hr to many hrs after death.The time is so variable that it ]‫[ُأضيفت‬
has no significant role in determining thetime of deathin summer hypostasis remain {{c1::24-
36 hr.}}In winter it remains about {{c1::12 hrs more ( 48 hr).}}In snowing it remains much
.more
Medicolegal Importance of Hypostasis{{c1::Sure sign of deathCause of ]‫[ُأضيفت‬
deathPosition before/ after deathIndicate if the body was moved or not after death}}
paste-c79e7e3101a4b8f8221ae74fafecfb27d4d7d447.jpg {{c1::;;}} ]‫[ُأضيفت‬
Medico legal importance of {{c1::Hypostasis}}i. It is a sign of death ii. The time ]‫[ُأضيفت‬
since death can be roughly estimated from the formation, extension and fixation of the
postmortem staining.iii. It indicates the posture of the body at the time of death.iv. It may
indicate the moving of the body to another position sometime after death.v. Cause of death may
.be judged from the distribution and color of postmortem staining
refers to a {{c1::stiffening of the body resultingfrom lack of )"rigor " mortis "of death ( ]‫[ُأضيفت‬
oxygen pumped to the muscle cells after the heart stops beating}}Death  cessation of
respiration  depletion of oxygen  less ATP  secondary anoxicprocess  lactic acid cell
cytoplasm becomes increasingly acidic  with low ATP and highacidity, the actin and myosin
fibres bind together and form a gel  but Unlike normalmuscle contractions, the body is unable
to complete the cycle and release the couplingbetween the myosin and actin, creating a perpetual
state of muscular contraction, until thebreakdown of muscle tissue by digestive enzymes during
.decomposition
RM initiated when the ATP concentration falls to {{c1::85 % of normal}}It starts to ]‫[ُأضيفت‬
develop about {{c1::2-3 hrs after death}}Rigor develops uniformly throughout the body but it
is first detected in smaller musclegroups such as those around the eyes, mouth, jaw &
fingersPeaks in the next 6 12 hrsIt concludes around {{c1::36-48 hrs}} after deathIt resolves
in the same order in which it develops secondary flaccidity
Factors affecting timing of RMEnvironmental temperature :{{c1::Cold and wet}}  ]‫[ُأضيفت‬
onset slow, duration longer “ remain 36 48 hr”{{c1::Hot and dry}}  onset fast, duration shorter
“ remain 24 36 hrMuscular activity before death :muscles {{c1::healthy, at rest before death}}
 slow onset, duration longer{{c1::muscles exhausted/ fatigued}}  onset rapid, esp in those
limbs being used (eg insomeone running at time of death, lower limbs develop RM faster than
upper limbs){{c1::increase activity (convulsions, electrocution, lightning)}}  rapid onset &
shortdurationage :extremes of age  rapid onsetHealthOthers Rigor mortis may be delayed
or be very weak in emaciated individuals. Its onsetmay also be very rapid in infants. Poisons,
.such as strychnine, that produce convulsions can accelerate the development of rigor mortis
paste-fdebb27ba9e7232b21dcc64fd5c5423380a743fb.jpg {{c1::;;}} ]‫[ُأضيفت‬
Early onset of rigor{{c1::1-Exhaustive or wasting diseases, like cholera, ]‫[ُأضيفت‬
typhoid,tuberculosis, cancer2-Violent deaths, like cut throat, electrocution, firearmand
lightning injuries3-Poisoning with strychnine, organophosphate, insulin or HCN4-Fatigue or
exhaustion5-Heat stroke}}
Late onset of rigor{{c1::1• Asphyxia (CO, hanging)2Hemorrhage3Cold, ]‫[ُأضيفت‬
refrigerated bodies4Paralyzed muscles5Pneumonia}}
Effects of {{c1::rigor mortis}}• There is goose skin appearance of the body due ]‫[ُأضيفت‬
torigor mortis of the erector pilae muscles.• Rigor in the muscles of the seminal vesicles
maycause postmortem ejaculation of seminal fluid• Contraction of the heart muscle due to rigor
mortis should not be mistaken for myocardial hypertrophy • Rigor mortis in the uterine muscle
.cannot expel the fetus from the womb
Cadaveric SpasmAlso known a{{c1::s instantaneous rigor or rigidity , or cataleptic ]‫[ُأضيفت‬
rigidity.}}Rare form of muscular stiffening that occurs at the moment of death, persists into the
period of rigor mortis and can be mistaken for rigor mortis The cause is unknown, but usually
associated with violent deathshappening with intense emotion May affect all muscles in the
body, but typically {{c1::only groups}}, such as theforearms, or handsMaybe seen in cases of
drowning victims when grass, weeds, roots or other materials are clutched, and provides proof of
life at the time of entry into the water. Often demonstrates the last activity one did prior to
death and is therefore significant in forensic investigations, e.g. clinging on a knife tightly
Heat stiffness:Exposure of a body to intense heat at > 65 C(burning, high ]‫[ُأضيفت‬
voltageelectrocution, etc)  coagulation of muscular proteins  muscularshortening There will be
coagulation of the muscle protein in which theflexors are affected more , giving rise to {{c1::a
pugilistic attitude of the body }}
Cold stiffness:Exposure of the body to extreme cold {{c1::(< 5⁰C)}} - solidification ]‫[ُأضيفت‬
of subcutaneous fat and muscles, freezing of synovial fluid in jointsRigor mortis halted until
thawing occurs, after which it develops very rapidly
Medicolegal Importance of RM{{c1::May help in time estimationMay help in ]‫[ُأضيفت‬
finding the cause of deathMay help to know the positionSure sign of death}}
After some hours of stay, rigor mortis passes away and •}}c1::Secondary Flaccidity{{ ]‫[ُأضيفت‬
the body becomes relaxed or flaccid for the second time. This is secondary relaxation or
secondary flaccidity of the muscles. It occurs only with the onset of decomposition or
putrefaction of the dead body During this phase, other signs of putrefaction will be there. the
reaction of the muscles will again be alkaline due to breakdown of protein with liberation and
.accumulation of ammonia
DecompositionIn the cycle of life, dead bodies are usually returned,through reduction ]‫[ُأضيفت‬
into their various components, to the chemical pool that is the earth. Some components will do
this by entering the food chain at almost any level from ant to tiger whereas others will be
reduced to simplechemicals by the autolytic enzymic processes built into the lysosomes of each
cell.{{c1::PutrefactionMummificationAdipocereSkeletelization}}
is by far the commonest route ofdecomposition taken by any }}c1::Putrefaction{{ ]‫[ُأضيفت‬
.bodyafter death and this route will befollowed unless some unusualconditions apply
Environmental temperatureThe optimum temperature for decomposition is 21 38 C.• ]‫[ُأضيفت‬
Decomposition nearly stops at < 0 C and > 48 C• The rate of decomposition is about twice as
rapid in summer as inwinter.• Optimum temperature helps in:a. Chemical breakdown of the
tissuesb. Promoting the growth of microorganisms responsible for decomposition ii.
{{c1::Moisture}}: Presence of moisture promotes decomposition by promoting the growth of the
.organis ms. • If the body dries up quickly, putrefaction ceases and mummificationoccurs
Manner of burial:If the body is buried soon after death, putrefaction is {{c1::less.}} ]‫[ُأضيفت‬
• In surface burial, the rate of decomposition is more than in the deep burial, because of
abundance of bacteria in surface soil in comparison to deep soil. • Putrefaction is delayed if
body is buried in dry, sandy soil or the body is placed in a coffin, because there is exclusion of
.water, air and action of insects and animals
Internal factorsi. Age: In {{c1::stillborn fetuses or infants}} who are unfed or have ]‫[ُأضيفت‬
not breathed, the process of decomposition is slow, since it occurs from outside, as their bodies
are sterile. Bodies of children putrefy rapidly and of old people slowly.ii. Sex: lowest effect 
Sex does not have much to influence, but occurs faster in females, because of its abundant
subcutaneous fatty tissue thatcontains moisture and retains body heat for a longer period.iii.
Condition of the body:Emaciated body decomposes later than a well nourished bulky, fatty
body dueto more fluid content in the latter which promotes growth of microorganismsiv. Cause
of death: When death is due to {{c1::infection or septicemia,}} decomposition is rapid
Putrefaction is delayed in death due to 1-{{c1::wasting disease, anemia,}} 2-poisoning ]‫[ُأضيفت‬
by {{c1::carbolic acid, zincchloride, strychnine and heavy metal}} due to the preservative action
.of these substances on the tissues or their destructive/ inhibitive effects on microorganisms
External injury on the body:Dead body having external injuries (eitherantemortem or ]‫[ُأضيفت‬
postmortem) will decompose earlier, because the injured areas will {{c1::allow invasion of the
body by bacteria.}}
Decomposition of Submerged BodyCasper's dictum states that rate of decomposition in ]‫[ُأضيفت‬
air is {{c1::twice}} as rapidly as in water, and {{c1::eight}} times as rapidly in deeply buried
bodies, i.e. 1 week of putrefaction in air = {{c1::2}} weeks in water = {{c1::8}} weeks in soil at
similar temperature, but this dictum is not useful practically. The deeper a body is buried, the
.better its preservation during an elapsed period of time
 The process of decomposition in water is slow due to:{{c1::• Exclusion of air• ]‫[ُأضيفت‬
Protection by clothes• Early cooling of the body}}
E{{c1::arly putrefaction . Late putrefaction}}Larynx and trachea ` i. Heart, lungs, ]‫[ُأضيفت‬
kidneysii. Stomach, intestines ii. Esophagus, diaphragmiii. Spleen iii. Blood vesselsiv. Liver
iv. Bladderv. Brain Prostate, uterus (non gravid)vi. Gravid uterus vi. Skin, muscle, tendon
Putrefactionthe normal final sign of death.starts immediately after death at the cellular ]‫[ُأضيفت‬
levelbecomes visible in {{c1::48 72 hrs.}} The 1 st visible sign of putrefaction is green or
greenish red discoloration ofthe skin of the anterior abdominal wall.. normally starts in {{c1::the
)rightiliac fossa}}.. usually in the first 24 36 h ……. generalized bloating 60 72 h
PutrefactionTwo phenomena for putrefaction:{{c1::Autolysis}}: occurs by digestive ]‫[ُأضيفت‬
enzymes released from the cells afterdeath . Chemical process ” … Since it is a chemical
process, it is accelerated by heat, slowed by cold, and stopped by freezing or the inactivation of
enzymes by heat.Organs rich in enzymes will undergo autolysis faster than organs with
lesseramounts of enzyme. Thus, the pancreas autolyzes before the heart.{{c1::Bacterial
action}}: Bacterial action and fermentation (liquefaction of the soft tissues over a period of
time .. most of them come from the bowel and Clostridium predominates (same bacteria that
causes gas gangrene)
The blood vessels provide an excellent channel for bacterial spread throughout the ]‫[ُأضيفت‬
body decomposition of Hg (to{{c1::sulphmethemoglobin}} which, when present in the
superficial vessels, results in linear branching patterns ofbrown discoloration of the skin that is
called marbling as the superficial layers of the skin lose cohesions, blisters full of red or brown
fluid form in many areas. When the blisters burst, the skin sloughs off. Considerable gas
formation is common and the body begins to swell, with bloating of the face, abdomen, breasts
.and genitals
The increased internal pressure causes the eyes and tongue to protrude and forces ]‫[ُأضيفت‬
bloody fluid up from thelungs and it will often leak out of the mouth and nose as
{{c1::purge}}in general terms, within a week or so the body cavities will burst and the tissues
will liquefy and drain awayinto the underlying ground {{c1::Brain &epithelial tissues}} are the
1 st to be affected by putrefaction {{c1::Heart, uterus & prostate}} may survive for longer
.periods.As decomposition proceeds, the weight of the organs decreases
MummificationA body lying in {{c1::dry and warm or cold}} conditions, either ]‫[ُأضيفت‬
climatic or in the microenvironment, may desiccate instead of putrefying drying & shriveling of
the tissues brown in colorAlso seen in newborn infants (sterile) whose bodies are placed in
cool dry environmentsNo growth of micro organisms.Medicolegal Importance of
MummificationCause of DeathCan detect abnormal pathology inside deep organsThe time
required for complete mummification cant be precisely stated but it takes several weeks to
months,depending on the size of the body more likely in the thin individual) and atmospheric
conditionsOnce the changes are complete, the body will remain in that condition indefinitely.
Mummification is partial paste-48bc8fcdb62065b8f972738f147ed4c7b72a32cf.jpg
Adipocerechemical change in the body fat, which is hydrolysed to a waxy compound ]‫[ُأضيفت‬
not unlike soap{{c1::Moisture}} is necessary.The optimum conditions for the formation of
adipocere{{c1::wet, warm environment}} (sometimes original body water beingsufficient for
adipocere{{c1::bacterial activity (C. perfiringes}}It occurs in:subcutaneous fat of the
cheeks ,breast, buttocksmay occur in internal organs such as liver , kidney & heart.It needs
months to occur, and occurs partially
3 stagesIn early stages: adipocere is a pale ,,greasy semi fluid material with a ]‫[ُأضيفت‬
mostunpleasant smell .Later : becomes more brittle and whiterwhen fully formed , adipocere
is a{{c1::grey, firm , waxy}} compound whichmaintains the shape of the body paste-
4ccd00cfd7e11dc6cf9753f01500098ec4bff1de.jpg
Adipocereformation in aninfant buried for {{c1::3 years}}. Thebody fat has been ]‫[ُأضيفت‬
converted into brittle waxy material,which formsa shell around the skeleton. paste-
4ccd00cfd7e11dc6cf9753f01500098ec4bff1de.jpg
Medicolegal Importance of AdipocrerePreserve the body which can p{{c1::ermit ]‫[ُأضيفت‬
identification after death.}}It may give conclusions about {{c1::the cause of death.}}It
indicates that the time interval since death was {{c1::at least weeks to several months}}
The first change that affects the body in water is {{c1::the loss of epidermis}} . Gaseous• ]‫[ُأضيفت‬
decomposition progresses andthe bloated body is often lifted to the surface by these gases, most
commonly at about 1 week but this time is extremely variable
SkeletelizationThe environment is more important than the time in this process. ]‫[ُأضيفت‬
{{c1::12 18 months}}: soft tissues will be absent Tendons, ligaments, hair and nails will be
identifiable for some timeafter thatafter 3 yrs: the bones will be bare and disarticulatedIn
temperate zones the bones will remain solid & heavy with the preservation of bone marrow in
long bones for a number of years, that can sometimes be suitable for specialistDNA
analysisAfter {{c1::40 50 years}}:Bone surface becomes dry & brittlemarrow cavity will be
.empty
The {{c1::longer the postmortem interval}}, the less precise the estimate of the interval ]‫[ُأضيفت‬
Core body temperaturethe best and the most }}c1::Estimating the Time of Death{{ ]‫[ُأضيفت‬
commonly usedRigor mortisHypostasis:complete after 6 hrs.Chemical changes in
vitreousas time since death increases, so does the K conc.Eye pressure:eye balls become
softer, and less fluid pressure in the first 3hrsGastric emptyingGastric emptying: :depend on
type of meal and emotional status.depend on type of meal and emotional status.The
entomology of dead:The entomology of dead:Studying insectsStudying insects& their maggots
which infest the dead body & their maggots which infest the dead body for estimating the
probable time of death.for estimating the probable time of death.Different types of insects infest
the dead body at different Different types of insects infest the dead body at different
stagesstagesafter death occurs.after death occurs.Scene markersScene markersThough
unscientific, is often more accurate than Though unscientific, is often more accurate than
determinations made by scientific meansdeterminations made by scientific means
Classification of wounds{{c1::Acute Vs ChronicOpen Vs ClosedEtiological ]‫[ُأضيفت‬
classificationMedico legal classification}}
{{c1::Acute( traumatic and surgical )}} wounds are the result of injuries that disrupt the ]‫[ُأضيفت‬
.tissue
C hronic wounds results from:1.Relatively {{c1::slow process}} that leads to tissue ]‫[ُأضيفت‬
damage2.From {{c1::acute wounds that don t heal within 3 months}} and are characterized
. byprolongation of the inflammatory phase
Chronic wounds include {{c1::pressure, venous, and diabetic ulcers}} . Typically, ]‫[ُأضيفت‬
aninsufficiency in the circulation or other systemic support of the tissue causes itto fail and
disintegrate. Infection then takes hold of the site and becomes achronic abscess
Open woundscan be categorized into the following :{{c1::Incisions or incised ]‫[ُأضيفت‬
wounds}} , caused by a clean, sharp edged object such as a knife, or a glass
splinter.{{c1::Lacerations}} , irregular tear like wounds caused by some blunt
trauma.{{c1::Abrasions (grazes)}}, superficial wounds in which the topmost layer ofthe skin
.(the epidermis ) is scraped off. Abrasions are often caused by asliding fall onto a rough surface
Open wounds can be categorized into the following :{{c1::Puncture wounds}} , caused ]‫[ُأضيفت‬
by an object puncturing the skin, such as a nailor needle.{{c1::Penetrating wounds}} , caused
by an object such as a knife entering andcoming out from the skin .{{c1::Gunshot wounds}} ,
caused by a bullet or similar projectile driving into orthrough the body. There may be two
wounds, one at the site of entry and one at the site of exit , such is generally known as a through
.and through
Closed woundscan be categorized into the following :{{c1::Contusions}} , more ]‫[ُأضيفت‬
commonly known as bruises , caused by a blunt force traumathat damages tissue under the
skin.{{c1::Hematomas}} , caused by damage to a blood vessel that in turn causes blood
tocollect{{c1::Crush injury}} , caused by a great or extreme amount of force applied over a
.longperiod of time
paste-048aaa1ded171ec6caff40422462856b72521e4b.jpg {{c1::;;}} ]‫[ُأضيفت‬
a Wounds caused by blunt instruments:{{c1::Abrasions.BruisesLacerations.}} ]‫[ُأضيفت‬
bWounds caused by sharp instruments:{{c1::Incised wounds.Stab wounds.Puncture ]‫[ُأضيفت‬
wounds}}
c Wounds caused by firearm weapons:{{c1::Firearm wound.}} paste- ]‫[ُأضيفت‬
403ea9b09773aa5dded6370e8e3d9570d1bd28f9.jpg paste-
a8d17c004d36226bf1d09f3add648f38ba8c84a7.jpg
d--Wounds caused by physical and chemical agents:{{c1::.Burns..Corrosion. paste- ]‫[ُأضيفت‬
8a40db6a4908897ad276c11224bdc6b6552782b6.jpg .Radiation and electric burns. paste-
aa887dcc2e39ac48f81ec7aaa8c2d84b86f7aa27.jpg }}
Medico legal classification{{c1::Suicidal woundsHomicidal woundsAccidental ]‫[ُأضيفت‬
woundsDefense woundSelf inflicted wounds}}
AbrasionsAn abrasion is {{c1::the most superficial type of injury and affects only the ]‫[ُأضيفت‬
epidermis}} . As the epidermis does not contain blood vessels,abrasions should not bleed , but it
may be the superficial layers of the dermis that is associated with minimal bleeding. paste-
05dc0b69d21bdab285223b68727a865b0d7069ae.jpg
caused by linear movement of a pointed instrument on the : }}c1::Linear abrasions{{ 1 ]‫[ُأضيفت‬
skin. e.g. Scratches. image-9.jpg paste-aaea1fed3645e692d0453c33b2fb4a10e6b2221c.jpg
Most abrasions are caused by a lateral rubbing : }}c1::scrape or Brush abrasion{{ 2 ]‫[ُأضيفت‬
action rather than vertical pressure , the direction of the force can often be determined by tags of
epidermis dragged to the terminal end of the abrasion. paste-
90db03662db05df8022b55eb3b7098203e57f8b8.jpg Scrape like abrasion from sliding across
pavement paste-fe2c3a32c2cbf75f28a3e5c2189fbd5cef6d5276.jpg
the blunt force is directed perpendicular to the : }}c1::Crush (Impact) abrasion{{ 3 ]‫[ُأضيفت‬
skin ,crushing it. Such abrasions tend to be focal and are commonly seen overlying
bonyprominences where a thin layer of skin covers bone paste-
a315f3a5d3beda5ecc723797cafb55caba6d18e0.jpg
4 {{c1::Finger nail abrasion}} These are important because of their frequencyin ]‫[ُأضيفت‬
assaults especially child abuse, sexual attacks and strangulation.Often associated with focal
bruises , fingernail abrasions are mostoften seen on the neck, the face, the upper arms and the
forearms. paste-8b1ffebde5591da7f976944bcb9fa18d5333b95b.jpg
Determination of the direction of impact inan abrasion caused by a tangential force . ]‫[ُأضيفت‬
{{c1::The epidermal tag}} raised by the impact tendto pile up at the distal end paste-
da299ef77cdffe80a874b4052bb1d2c57be0a239.jpg
over the supraorbitalridge (eyebrow), zygomatic arch ( and the }}c1::Impact abrasions{{ ]‫[ُأضيفت‬
side of the nose are commonly seen in individuals who are unconscious when they collapse, and
strike their heads on the ground paste-e9ea80699d9e68855e006ae9c321b5ddc5c6a2b0.jpg
5 {{c1::patterned abrasions}} .is a variation of an impact abrasion .Here, the imprint ]‫[ُأضيفت‬
of either the offending object,such as a pipe, or intermediary material, such asclothing , is
imprinted or stamped on the skin by the crushing effect of the blunt object paste-
be2d281959d6e87c59e86052ed1ef22a65a31453.jpg paste-
4ca87dd1c58b58f9a3608f4686b8fb1a3e526287.jpg
are occasionally misinterpreted as }}c1::Postmortem insect bites and diaper rash{{ ]‫[ُأضيفت‬
abrasions by the inexperienced physicianAnother artifact that can be confused with an abrasion
is drying of the skin of the scrotum and, less commonly, of the vulva The skin inthese areas
seems to be very susceptible to drying , especially if exposed to the open air. It has a reddish
brown or yellow coloration and may be interpreted as an abrasion paste-
ccd8bf67b8f5faff33977d706584bef6d9e764e9.jpg paste-
59106b286b8635c79f4a2080e74993be5fcae1aa.jpg paste-
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83afe310c869b457f44d049b26be39649cb501ac.jpg
1It indicates violence2Its shape gives an idea about the }}c1::Medico legal Aspect{{ ]‫[ُأضيفت‬
causative instrumente.g. :fingernail abrasions-teeth abrasions in bites.-abrasions that take the
shape of the radiator in car accidents.3 Its site in the body may give an idea about the type ofthe
crime e.g.:-Fingernail abrasions on the neck suggest throttling-Fingernail abrasions on the inner
sides of the thighssuggest rape.Medico legal AspectMedico legal Aspect44--The The ageageof
the abrasion gives an idea of the abrasion gives an idea about the time of its infliction as about
the time of its infliction as follows:follows:--In the In the first first 2 2 daysdays, it is covered
with dry , it is covered with dry serum or a soft scab.serum or a soft scab.---The scab falls after
one week leaving a red colored area which disappears after after 3 weeks..5--An abrasion may
rarely cause death when it is infected by tetanus .tetanus .6-Abrasions differentiate cut wounds
from laceration in the areas in the areas where the skin is stretched over bone (e.g. the skull).7-
Abrasion differentiates hypostasis(livor mortis) from bruis
It is impossible to tell weather abrasion occurs i{{c1::mmediately before death or after}} ]‫[ُأضيفت‬
it if there was insuffient time for any inflammatoryreaction to occur
paste-bbfe2fe4560d372b05ae12750181f51782b76248.jpg {{c1::''}} ]‫[ُأضيفت‬
Bruise or Contusionleakage of blood from ruptured small vessels (veins , venules ]‫[ُأضيفت‬
andarterioles) into the surrounding tissues. Due to blunt force traumaOften associated with skin
abrasion or laceration{{c1::Bruise}} ” usually implies that the lesion is visible through the
skin{{c1::contusion}} “ can be anywhere in the body (spleen ,muscle)People with blood
.disorders and liver disease may develop more severe contusionsthan healthy individuals
The site of bruisingdoesn t necessarily reflect the site of trauma because blood tends to ]‫[ُأضيفت‬
spread out in diffused manner from the site of injury.for example:1.a deep bruise in the mid
thigh may later appear {{c1::at the knee}}2.a bruise at the forehead may sink down to {{c1::eye
lid giving a black eye.}}
SHAPE AND SIZEof bruises are very variable & poor indicator of causative object. ]‫[ُأضيفت‬
There is one exception, which is the verysuperficial bruise caused by a moderate forcewhere the
leakage of blood is confined to theepidermis and the upper strata of the dermis,sometimes
referred to {{c1::as intradermal ’ bruises }}In these bruises, the leakage of blood is small and
the blood is held where it has leaked As a result, these intradermal bruises can reproduce the
nature of the object that caused it. paste-f00e3e70236ef2664164b42a4eca58b2703f5c52.jpg
paste-16a8a664dc912096771e588f0ef0cfa3875ee146.jpg paste-
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on theforehead due toa fall onto ribbedceramic tiles. }}c1::Patternedintradermalbruise{{ ]‫[ُأضيفت‬
paste-c361578f876d4688ffb3fd153c46a397209e5d2d.jpg paste-
7654d59217d756630570eb686822c812a462c456.jpg
paste-2113b7c3ff3fb316e4a455f102c44b38376513c4.jpg paste- ]‫[ُأضيفت‬
43998982d42e48440d8814e32e2a9fdd78afd7be.jpg {{c1::[[}}
AGE AND COLOUR CHANGEIN BRUISESDark red: less than {{c1::24 hours}} ]‫[ُأضيفت‬
(oxygenatedDusky purple, blue (deoxygenatedblood)Brown: From {{c1::1 3 days}}Green:
{{c1::3 to 5 days}}( biliverdin)Yellow:{{c1::5 to 7 days}} ( bilirubinStraw then back to
normalcolour paste-15fedd4f604230434594cbab3cc71be872d51292.jpg when there are multiple
colorswithin the bruise , we depend on theperipheral color to {{c2::determine theage of the
wound}}
severity of bruising{{c1::1) Anatomical site}}overbony prominence (shin, cheeks), ]‫[ُأضيفت‬
vascular tissue(eyelid, orbit) fatty tissue (buttocks) will bruise easilyEscaped blood has room to
accumulate in lax tissues.Dense, tightly boundtissue, e.g. palms, soles, rarelybruises{{c1::(2 )
Age}}very young and very old tend to bruise easily({{c1::3 ) Obesity & Sex}} more in females
& more in{{c1::(4 ) Disease of clotting}}"spontaneous"bruising ( haemophilia , leukaemia and
platelet disorders), liver disease ( including alcoholism),vitamin C deficiency ( scurvey ), poor
.nutrition,{{c1::(5 ) Skin colour}} black skin may mask bruising
paste-1c8c0209dce4e1821c18b8b0b612db5443d44255.jpg paste- ]‫[ُأضيفت‬
6e47159962b68bbbabb0f08bad72860124a99c38.jpg paste-
0965f5439ce06f7df863e35468e47b53d3470c85.jpg paste-
88bb462745f7b20186d151ccbba38937bde1b8c3.jpg {{c1::nn}}
Bruises may be dangerous if :-They occur in a trigger zone . {{c1::1-epigastrium , 2- ]‫[ُأضيفت‬
testis, larynx, cervix and urethra,3- mastoid process, carotid area}}-They are {{c1::extensive}}-
They become {{c1::infected}}-They hide a more serious injury : e.g. {{c1::ruptured organ }}
Medicolegal importance :{{c1::•Age of injury.•Degree of violence•Different colors in ]‫[ُأضيفت‬
the same victim are important especially in child abuse .•Bruising usually due to Accident or
assault; it israrely self inflicted (too painful andunimpressive!)}}
paste-26a09a6e492c952b3c8344b7f1633b64d225804c.jpg {{c1::ll}} ]‫[ُأضيفت‬
paste- }}c1::Livormortis (hypostasis){{ ]‫[ُأضيفت‬
5dd1da219b6af6e4d5ce8b18d924e216a763ada1.jpg paste-
fb9b3e8339a5bf3faaf61c1cd76180a34dd621c0.jpg paste-
fa80f44246447e0a44af38464dad49ce81b443af.jpg paste-
bee68d9617c3524e33120977ec9b67104aa4885d.jpg
lacerationDefinition:{{c1::Full thickness tearing of the skin (or other tissue) due to ]‫[ُأضيفت‬
stretching, and crushing}} of tissues by blunt force trauma. (by moving object or fall)Typically
over bony prominence {{c1::(scalp, eyebrows, cheek, chin).}}A single blow may cause more
than one laceration
lacerationCharacteristics{{c1::•Ragged edges (torn apart)}}•Associated bruising and ]‫[ُأضيفت‬
abrasions of skin edges and adjacent tissues.• Heals with scaring. paste-
6fb10b703cca83c60dfad38fb28127308497a10f.jpg paste-
2b649e835029f421867a6e5e703be8bb952fa9c8.jpg paste-
e298bf4732ccef5e7d01478cc68295a606443f31.jpg
Shape and size not usually related to •}} c1::Medico legal importance of laceration{{ ]‫[ُأضيفت‬
causal agent.•Rarely self inflected.•Trace evidenced in wound ( dust or dirt
Incised woundsDefinition: Clean division of the full thickness of skin and underlaying ]‫[ُأضيفت‬
tissues so that the margins are almost free from any damage .Usually caused by a {{c1::sharp
edged instrument}} knives or broken glassAn incised wound is LONGER THAN IT IS DEEP
due to swipe actionTypes1. {{c2::Hesitation cuts}}: hollow cuts made by people considering a
suicide attempt. They are often non lethal, multiple parallel cuts2. {{c2::Chop wounds}} : The
presence of an incised wound of the skin,with an underlying comminuted fracture or deep groove
in the bone, indicates that one is dealing with a chopping weapon paste-
dcebc2769b6f300306665b35ec4dda0b134f3c21.jpg paste-
bfc78901c9ad09da5e72c7f3239507c9ee290223.jpg paste-
5bca8604862029e509457263843b5cad55007ade.jpg
Characteristics•They are caused by sharp edged weapons.•Shape of injury is linear ]‫[ُأضيفت‬
shaped.•Margins are slightly everted,clear cut, smooth& clean•Surrounding skin is clear.•Blood
vessels are cut hence bleeding isprofuse•Hair , hair bulb, muscles, bones are cut•Nerves are cut
hence paralysis may result.•Liability to sepsis is {{c1::minimal (anycontamination will be
washed by the profusebleeding).}}•Healing is usually by scarring paste-
bf316b383797508375076cf9598651b8e0ac30bc.jpg Incised wounds of the neck can be
. homicidal, suicidal , or rarely accidental
Homicidal incised neck woundsfrom beh{{c1::ind}}Present two different pictures, ]‫[ُأضيفت‬
depending on whether they are produced from the back or the front.Most commonly , a person s
throat is cut from behind Often, the victim is face down on the floor or ground at the time the
wound is inflicted.The knife is drawn across the neck, from left to right by a right handed
assailant and from right to left by a left handed individual.shallow ----> deep centrally ----
>shallow.The wound generally starts below the ear; runs downward and medially at an angle,
then straight across the midline of the neck, and then upward, ending on the opposite side of the
neck, lower than its point of initiation paste-afe6b980d56f42081ae735aa553f9f3975f92683.jpg
Homicidal incised neck woundsfrom {{c1::front}}Homicidal incised wounds of the neck ]‫[ُأضيفت‬
inflictedfrom the front tend to be short and angledA right handed individual typically inflicts
incised wounds on the left side of the victim s neck, with the slashes running downward and
medially at an oblique angle.If the wounds are inflicted on the right side, they tend to be fewer in
number.Horizontally incised wounds inflicted from the front of the neck are the least
common.Instead of the neck s being cut with one long, continuous motion , these wounds are
inflicted by swipes ” or slashes made while facing the individual paste-
c4a32fb1eada1f61111f1c71733fb9e49ce1084b.jpg
Suicidal cutThroat:In self inflicted wounds of the neck, the }}c1::SELF INFLICTED{{ ]‫[ُأضيفت‬
same general pattern holds as for a homicidal assault from the behind.The wound usually begins
higher on the neck on the side opposite to where it terminates.Suicidal incised wounds of the
neck are usually, but not always, accompanied by hesitation marksIncision is usually through
level of thyrohyoid ligament and may be down to spine!In rare instances, it may be accompanied
bycadaveric spasm with the knife found firmly clenched in the victim s hand unequivocal proof
of suicide. paste-bf316b383797508375076cf9598651b8e0ac30bc.jpg
Reflect sharp edge, not weapon type•No trace •}}c1::Medico legal aspect{{ ]‫[ُأضيفت‬
evidence•Profuse external haemorrhage and airembolism•Danger to life depends on site and
depth•Incised wounds are usually homicidal orsuicidal & rarely accidental in•Post mortem
.incised wounds may be causedby criminal to hide crime & identity
In homicidal incised wound,{{c1::defense incisions}} arepresent on dorsum of hand, ]‫[ُأضيفت‬
ulnar aspect, forearm or on palm. paste-06d6b7cb56821d4b77317f23e6ab6fab1bb97d46.jpg
paste-b224fd1b8a5b68e4b5fc18032fd4fb4a5922b3df.jpg
paste-c4fa9d7da498df8c0c065aabd90dc54817580a7d.jpg {{c1::mm}} ]‫[ُأضيفت‬
Stab &Puncture woundsA stab wound is deeper than it is long and it is the depth of the ]‫[ُأضيفت‬
injury that makes it so often fatal and hence of such forensic interest.Stabbing is the commonest
method of homicide in Britain and accounts for over 50 per cent of all murders, many of which
are domestic in type.Often appear trivial externally (short incision or laceration) BUT often
causes internal trauma and haemorrhage{{c1::PENETRATING}}passes into but not through
organ{{c1::PERFORATING OR TRANSFIXING}}passes through an organ
SHAPE OF WOUNDSHAPE OF WOUND May indicate:(1 Cross sectional shape of ]‫[ُأضيفت‬
knife bladee.g.-{{c1::Double edged blade}}  Slit with two sharp ends-{{c1::unibladed
weapon}}  wound with one acute angle while the other angle is rounded.closed-{{c1::scissor}}
 rhomboid wound. (both are rounded) paste-04e20cf9d6e728eb251af77d8bce31834a56659b.jpg
paste-0271e54d93a18438c6bed44465914b068bae5b79.jpg
2 ) Direction of insertion :N.B. The direction of the wound track through the tissues is ]‫[ُأضيفت‬
assessed at post mortem, with the body lying flat on its back. The position of the internal organs
isdifferent in life, when standing,sitting and breathing. 3 ) Movement of instrument on
withdrawal {{c1::Small change in angle}} ----> notch {{c1::Twisting}} ----> crescentic
wound paste-579ab706bf1627183062d800961dba52a81eb4bb.jpg
caused by knife s being twisted or }}c1::Irregular configuration of stab wounds{{ ]‫[ُأضيفت‬
movement of victim as blade is withdrawn paste-
f925340013554036b73a110a48e15e837843f280.jpg
paste-8644a4ebcea3d4c74a3aeb06cf3567e3e43f3f5d.jpg Fatal stab wound of the chest ]‫[ُأضيفت‬
and the knife that caused it. The wound does not reproduce the size of the knife, due to
{{c1::contraction of the elastic fibres in the skin}}
paste-d10464b5c5a647038bcb6d7887b7ed9c46676bb0.jpg paste- ]‫[ُأضيفت‬
1db57d23c0f0f01e18f680f04455b1ee4e7a109c.jpg Stab wounds with {{c1::Phillips
screwdriver}}
DEGREE OF FORCEWound depth is a poor indicator of force appliedBony damage ]‫[ُأضيفت‬
is useful indicator of depth and impliessignificant forceMost resistance offered by
{{c1::CLOTHES AND SKIN}}Once the skin has been penetrated, the blade slips easily
through theunderlying muscle, internal organs and uncalcified cartilage, without the need for
.furtherapplication of force
STAB WOUNDSAdequate description may provide{{c1::vital information}} about :1) ]‫[ُأضيفت‬
Type of weapon : usually a knife2) Dimensions of the weapon3) Taper of blade4) Movement of
knife in wound5) Direction of thrust6) Depth of thrust7) Amount of force used8) Likely effect on
victim
paste-49069374b6a6e5dfa59e7547853222f342e5c463.jpg {{c1:: paste- ]‫[ُأضيفت‬
fb5b01d07858a9ba7b62628a356abfbf29d1457d.jpg }}
Medico legal aspect Stab wounds are usually{{c1::homicidal , sometime suicidal & ]‫[ُأضيفت‬
rarely accidental}}
Suicide is usually done at calm, quite & lonely •}}c1::SUICIDAL INJURIES{{.1 ]‫[ُأضيفت‬
place•Surrounding are not disturbed•No signs of struggle , No defense wounds•Sometimes
hesitation wounds may be present.•Weaapon usually present on or near the body.•Injury is
usually single . Common injuries incised, firearmwound•Site & direction of injury is explainable
with handedness ofperson & with self infliction.•There may be evidence of other methods
attempted for suicide
May be caused at any place.•Surrounding usually •}}c1::2.HOMICIDAL INJURIES{{ ]‫[ُأضيفت‬
disturbed.•Signs of struggle usually present on clothes & body.•Defense wounds may be
present•There may be evidence of sexual assault on female victim•Weapon is usually
missing•Injuries are multiple & on any body part .Common injuries are lacerated, stab, firearm
ACCIDENTAL INJURIES•Injuries due to impact of the vehicle depends upon thepart .3 ]‫[ُأضيفت‬
of vehicle that hits (primary impact injuries•The victim may be thrown forward or on top of
thevehicle & may again impact the vehicle & may getinjured secondary impact injuries)•Due to
impact of vehicle, person may fall, henceinjuries received depends upon the surface on whichhe
falls (secondary injuries•Common injuries are {{c1::Abrasion, contusion, laceration}}
Cuts are usually superficial, multiple and }}c1::4 SELF INFLICTED INJURIES{{ ]‫[ُأضيفت‬
parallelIn right handed people most of injuries are on the leftside.Features :1 certain sites :
throats, wrists and the front of thechest2 they are often multiple3 suicidal injury of the chest are
almost always stabwounds4 stab wounds of the neck are uncommon in suicide
5 DEFENSE WOUNDSWhen punching, kicking or attack with a blunt instrument ]‫[ُأضيفت‬
takes place{{c1::, the outer side of the forearm, back of the hand}}may be abraded , bruised or
even lacerated . Finger may bebroken. paste-ea79d137a39d5fc631c420454c8f99b9bb9aa158.jpg
paste-7309c18bb29e4c08a22dd3510b0a3d17d56f8757.jpg
Complications of wounds:{{c1::Neurogenic (primaryTraumatic (secondary ]‫[ُأضيفت‬
shock).HemorrhageEmbolism (air, thrombus, fat)Injury to internal organs.Formation of
scar.InfectionCrush syndrome :Severe crushing of muscles liberation of myoglobin blocking
of renal tubulesacute renal failure}}
Primary/Immediatecauses{{c1::Neurogenic shockInjury to vital ]‫[ُأضيفت‬
organsHemorrhage.}}
Secondary/Remote causes{{c1::InfectionThromboembolismAcceleration of ]‫[ُأضيفت‬
preexisting diseaseProfessional medicalnegligence.Renal failure due tocrush syn.}}
Toxicology•Is the study of the adverse effects of chemicals on living organism including ]‫[ُأضيفت‬
{{c1::mechanisms of harmful effects, conditions under which theseharmful effects occur,}}•Is
the science of poison
are substance ( liquid or gaseous) which if introduced in the living body }}c1::Poisons{{ ]‫[ُأضيفت‬
in sufficient quantities (inhaled or ingested) or brought intocontact with any part will produce ill
health or death by it constitutional or local effects or both Thus, almost anything is a poison
All things are poison and nothing is without poison Solely {{c1::the dose}} ’‘• ]‫[ُأضيفت‬
determines that a thing is poison
Breathing too much pure oxygen, drinking excessive amounts of water, oringesting too • ]‫[ُأضيفت‬
much salt can kill•On the other hand, even the classical toxic chemical may be ingested in
subtoxic quantities and not cause symptoms of toxicity•All chemicals are potentially toxic under
the proper condition•An important principle is that any chemical may be poisonous {{c1::at a
givendose and route of administration}}
Classification of PoisonsAccording to their mode of action , poisons are classified ]‫[ُأضيفت‬
as{{c1::1-coorosive 2-irritant 3-neurotics 4-cardiac 5-asphyxiants }}
Corrosives: They produce inflammation and ulceration of the tissues;symptoms are ]‫[ُأضيفت‬
commonly manifested immediately.•It comprises both {{c1::strong acids (concentrated sulphuric
acid, hydrochloricacid) and strong alkalis}}
II. Irritants: A group of poisons which by their specific action causesinflammation of the ]‫[ُأضيفت‬
gastrointestinal tract (GIT ) and other symptoms ;symptoms are usually manifested slowly.•e.g.
{{c1::Metallic, e.g. arsenic, antimony, copper, lead , mercury, zinc.}}
III. Neurotics: They act mainly on the CNS, though some have localirritant • ]‫[ُأضيفت‬
actione.g.Cerebral Š . {{c1::opioids, alcohol , anaesthetics, ether, cannabis, cocaine.}}
IV. Cardiac: {{c1::Digitalis, oleander, aconite, nicotine, hydrocyanic acid}} ]‫[ُأضيفت‬
V. Asphyxiants: : {{c1::CO, CO2, H2S, war gases.}} ]‫[ُأضيفت‬
Miscellaneous: It includes poisons having widely different • ]‫[ُأضيفت‬
pharmacologicalactionsi.Agrochemicals:•Pesticides {{c1::( organophosphate)}}•Fumigants
{{c1::(Aluminium phosphide)}}•Rodenticides {{c1::( Thallium sulfate)}}•Herbicides {{c1::
( Paraquat}}
ii.Drugs of dependence: Tranquilizers, antidepressants hallucinogens.iii.Petroleum ]‫[ُأضيفت‬
products: {{c1::Kerosene, petrol, naphtha.}}iv. Food poisoning: Bacterial, chemical
(botulismv.Others: Analgesics and antipyretics
Classification based on physical form:{{c1::Solid, liquid, gas, vapour, aerosol}}Solid ]‫[ُأضيفت‬
poisons: e.g. lead, arsenic, mercury.Liquid poisons: can be absorbed by ingestion or by
inhalation or through theskin.(methanol, ethanol)Gaseous poison : carbon monoxideVapour:
{{c1::benzene vapour}}aerosol: {{c1::asbestose}}
ToxinsAre small poisonous molecules, peptides, or protein produced by plants , animals, ]‫[ُأضيفت‬
and other organisms like viruses, fungi, bacteria, or protozoa. They can cause diseases when
absorbed by body tissues and interact with thebody’s enzymes.Example{{c1::Venoms}} are
toxins that are injected by a bite (e.g. from a spider)
Forensic toxicology•It deals with {{c1::the medical and legal aspects of the harmful ]‫[ُأضيفت‬
effects ofchemicals on human beings}} It involves not only the identification and quantifying of
a drug, poison or substance inhuman tissue, but also the ability to interpret the results of one’s
finding• Aid in establishing the cause of death and determining its circumstances ina post
mortem investigation
Clinical toxicology :•Are physicians who receive specialized training in ]‫[ُأضيفت‬
e{{c1::mergency medicine and poison management}}•It deals with human diseases caused by or
associated with abnormal exposure to chemical substances.• Efforts are directed at treating
patients poisoned with drugs or other chemicals and at the development of new techniques to
treat those intoxications
Environmentaltoxicology•Focuses on the impact of {{c1::chemical pollutants in the ]‫[ُأضيفت‬
environment on biological organism•}}Although toxicologist concerned with the effects of
environmentalpollutants on human health fit in this definition, it is most commonlyassociated
with studies on the impacts of chemicals on non humansorganism such as fish, birds, and
terrestrial animal
Mechanistic toxicology Is concerned with the identifying and understanding {{c1::the • ]‫[ُأضيفت‬
cellular,biochemical, and molecular mechanisms}} by which chemicals exert toxic effects on
living organism.Useful in the design and production of safer alternative chemicals and in rational
.therapy for chemical poisoning and treatment of disease
Descriptive toxicologyConcerned directly with toxicity testing which provides • ]‫[ُأضيفت‬
Information for {{c1::safety evaluation and regulatory requirments}}
Regulatory toxicologistHas the responsibility for deciding on the basis of data provided • ]‫[ُأضيفت‬
by {{c1::descriptive and mechanistic toxicologist}} whether a drug o another chemical poses a
sufficiently low risk to be marked for astated purposeFDA ( FOOD AND DRUG
ADMINISTRATION )EPA( ENVIROMENTAL PROTECTION AGENCY)
also involved in the establishment of standards for the }}c1::Regulatorytoxicologists{{ ]‫[ُأضيفت‬
amount of chemicals permitted in ambient air, industrial atmospheres, and drinking water
Integrate scientific information from basic descriptive and mechanistic toxicology studies use it
for risk assessment
Central.-Paralytic--‫ بيئة‬c1::Ambient{{-TYPES OF ANOXIA (1 ) Anoxic anoxia ]‫[ُأضيفت‬
Anemic anoxia- ) 2(}}Mechanical (violent asphyxia).-Obstruction of the blood flow to the lungs
) 4(‫ راكد‬Chemically combined hemoglobin-Hemolysis-Hemorrhage(3 ) Stagnant anoxia
-Histotoxic anoxia ex HCN
Stages ofmechanical anoxia or violent asphyxia:Threestages:(1) {{c1::Stage of forced ]‫[ُأضيفت‬
respiration}}:-It is due to stimulation of the respiratory center.-Clinical picture : DYSPNEA(2)
{{c1::Stage of convulsion }}-It is due to cerebral irritation.-Clinical picture : CONVULSIONS,
CYANOSIS, HYPERTENSION , LOSS OFCONSCIOUSNESS, CONSTRICTED
PUPILS.(3) {{c1::Stage of paralysis}}-Clinical picture : LOSS OF CONSCIOuNESS,
FLACCID MUSCLES & LOST REFLEXES, DEEP CYANOSIS, DILATED PUPILS,
IRREGULAR BREATHING(Cheyne Stokes respiration).** Death occurs in about {{c1::5
minutes..}}
are found where the air passages are obstructed by pressure applied to theneck or to the ]‫[ُأضيفت‬
chest .The classical features of asphyxia ’ are:( although not diagnostic, are important.){{c1::1-
congestion of the face;2-oedema of the face;3-cyanosis (blueness) of the skin of the face4-
petechial haemorrhages in the skin of the face and the eyes}}A fifth feature increased fluidity of
the blood is now not accepted.Very non specific, very unreliableThe {{c1::slower}} the death,
the {{c1::more prominent}} asphyxial signs
are pinpoint hemorrhages produced by rupture of small vessels, }}c1::Petechiae{{ ]‫[ُأضيفت‬
predominantly small venules . Rupture appears to be mechanical in etiology and is caused by
sudden over distention following abrupt increases in intravascular pressure These are most
common in the visceral pleura and epicardium . also seen in the conjunctivae and sclerae
Cyanosiscaused by an increase in the amount of reduced hemoglobinIt does not ]‫[ُأضيفت‬
become observable until at least {{c1::5 g of reduced hemoglobin}} ispresent.Congestionis the
red appearance of the skin of the face and head It is due to the filling of the venous system when
compression of the neck orsome other obstruction prevents venous return to the heart.Oedemais
the swelling of the tissues due to transudation of fluid from the veins causedby the increased
venous pressure as a result of obstruction of venous return to the heart paste-
8acac76b9e2048894e2a2dd24ce24f05bcbfc1a6.jpg
The autopsy diagnosis of 'asphyxia'careful assessment of the history and circumstances ]‫[ُأضيفت‬
of the death + exclusion of other causes + cautious evaluation of the signs  {{c1::diagnosis}}.
.Most important cause for airway obstruction
Mechanism of deatha combination of these1) Compression of the neck(Occlusion of ]‫[ُأضيفت‬
neck vein Compression of the carotid arteries….Reflex vagal inhibition) {{c1::(hanging
andstrangulation}}2. Blockage of the airway {{c1::(suffocation, gagging)}}3. Compression of
the chest, neck, or face {{c1::(postural or positional asphyxia)}}4. Chemical and lack of
available oxygen in theatmosphere
Strangulation……. Pressure on the neck{{c1::HangingStrangulation with ]‫[ُأضيفت‬
LigatureThrottling (manual asphyxia)}}
Post mortem picture of hanging 1 ) General2 ) Special features{{c1::-Protrusion of ]‫[ُأضيفت‬
the tongue-Dribbling of saliva.-Hypostasis of the lower half of the body.}}-Neck
signs.Elongated and the head is tilted to the opposite side of suspension point.. Ligature marks
( {{c2::HIGH UP in the neck, OBLIQUE , INCOMPLETE , has an IMPRINT of the
ligature).}}** Homicidal , suicidal or accidental
It is the mechanical anoxic death due to suspension of the body ‫ شنق‬HangingDefinition ]‫[ُأضيفت‬
from the neck by a ligature.Causes of death{{c1::-Cerebral ischemia-Vagal cardiac inhibition.-
Mechanical anoxia-Transection of the spinal cord judicial hanging}}
paste-dca21c6d7729e91b70efa255c65fa64e827ccc66.jpg }}c1::Types of hanging{{ ]‫[ُأضيفت‬
Strangulation withwithLigatureLigatureDefinition::.It is the mechanical anoxic death ]‫[ُأضيفت‬
causedby by constriction of the neck by a ligature {{c1::occluding the air passages from
outside .}}Causes of deathdeath:.{{c2::-Mechanical anoxia.-Reflex cardiac inhibition.-Delayed
edema of the of th glottis and choking}}
Postmortempicture of strangulation:1 ) General2 ) Special featuresAll are neck ]‫[ُأضيفت‬
incomplete hanging.Low in the neck below the thyroid ‫ زي‬:c1::-Ligature marks{{signs
c2::. Transverse.. Complete..Deep all through. Abrasions and contusions taking the {{}}.cartilage
c2::- Inward fracture of the hyoid bone and the thyroid {{}}shape of the ligating material
Homicidal , **.}}cartilage may befractured-Contusions and lacerations of the neck muscles
suicidal or accidental
Throttling« Manual strangulation»DefinitionIt is the mechanical anoxic death caused ]‫[ُأضيفت‬
by constriction of the neck by the hand occluding the air passages from outsideCauses of
death{{c1::- Mechanical anoxia- Reflex cardiac inhibition.- Cerebral anoxia- Delayed glottic
edema and choking}}
Postmortem picture of throttling 1 ) General2 ) Special featuresAll are neck ]‫[ُأضيفت‬
signs{{c1::- Multiple contusions and fingernail abrasions- Inward fracture of the hyoid bone it is
the most common cause of hyoid bone fracture ) and fracture of the thyroid cartilage.-
Contusions of the deep tissues of the neck.}}**Homicidal , suicidal or accidental
Situations in which accumulations of irrespirable gases occur}}c1::SUFFOCATION{{ ]‫[ُأضيفت‬
are commonly industrial or agricultural they may be found in the deep tanks of ships where rust
formation has removedoxygen, in farm silos containing grain, or in deep wells in chalk where
carbon dioxide has accumulated. The individual entering these situations without protective
equipment will be rendered unconscious extremely quickly and willdie rapidly unless removed
from the hypoxic environment. In all these situations, asphyxial signs may be minimal as
collapse and death may be so rapid
Rapid deaths are also reported when a {{c1::plastic bag}} is placed over the head, ]‫[ُأضيفت‬
either as a deliberate suicidal act or accidentally by children. Typically, no classic signs ’ are
seen and the face is usually pale when the bag isremoved. The bag need not be tied around the
neck to be effective. paste-77757bcf44d1573930ee597a91666c01d80ace97.jpg
six general forms of suffocation:{{c1::1 . Entrapment/environmental suffocation2 . ]‫[ُأضيفت‬
Smothering3 . Choking4 . Mechanical asphyxia5 . Suffocating gases}}
environmental suffocation, an individual inadvertently enters an areawhere there is ]‫[ُأضيفت‬
{{c1::gross deficiency of oxygen.}}
SmotheringDefinitionIt is the mechanical anoxic death caused by occlusion of the ]‫[ُأضيفت‬
external respiratory openings by the hand or soft objects Causes of deathMechanical anoxia
c1::-Multiple contusions {{Postmortem picture of smothering( 1 ) General( 2 ) Special features
and fingernail abrasions.-Contusions in the buccal mucosa- Ventral hypostasis in cot death
** Homicidal , suicidal or accidental}}‫المهد‬
Smothering with a pillow or other object (including a hand) }}c1::SMOTHERING{{ ]‫[ُأضيفت‬
pressed over the nose and mouth will only very rarely cause any petechiae , any significant
cyanosis or congestion unless the victim struggles and fights for breath against the obstructed
airways.Smothering may be virtually impossible todiagnose if it is applied to those who cannot
there may be , ‫كفاح‬or do not resist the old, the infirm or the veryyoung. If the victim does struggle
bruises and abrasions to the face, on the lips or inside the mouth(where lips are pressed against
teeth). paste-1fca6e123e642de7a99f3e54a527dc4194ea60d6.jpg
Mechanical asphyxia is almost alwaysaccidental in manner. It can besubdivided into ]‫[ُأضيفت‬
three types:{{c1::Traumatic Asphyxia}}Traumatic asphyxia occurs when a heavy weight
presses down on an individualschest or upper abdomen, making respiration impossible. Causes
of death-Mechanical anoxia-Injury to vital organs{{c1::Positional asphyxia}}Positional
asphyxia is virtually always anaccident and is associated withalcohol or drug intoxication. In this
entity, individuals become trapped inrestricted spaces, where, because of the position of their
bodies, they cannotmove out of that area or position.{{c1::Riot crush}}Riot crush, as the name
implies, occurs in riots, when the chest is compressedby stampeding people piling on top of each
other. Respiratory movementsare, thus, prohibited by this human pile
Postmortempicture of traumatic asphyxia1 ) General2 ) Special features{{c1::- ]‫[ُأضيفت‬
Contusions and abrasions of the chest and abdomen.-Fracture ribs-Rupture of internal organs-
Line of demarcation between the discolored upper part of the body and the lower part.}}**
Homicidal , suicidal or accidental
GAGGINGThe air passages may be obstructed when a {{c1::cloth or soft object is ]‫[ُأضيفت‬
pushed into the mouth, or placed across themouth}}, often during a robbery when the victim is
tied upand the cloth is used to ensuretheir silence . At first, breathing can take place via the nose,
but as time goes on, nasal mucus and edema close the posterior nares andprogressive asphyxia
develops paste-fd834f12c3a319adf8f9b20e74ad7664eeaca9a5.jpg
ChokingDefinitionIt is the mechanical anoxic death caused by {{c1::occlusion of the ]‫[ُأضيفت‬
respiratory passages from inside}}Causes of death-Reflex cardiac inhibition-Mechanical
anoxiaTypes:-Pathological-Non pathologicalHomicidal , suicidal or accidental
DrowningDefinitionIt is the mechanical anoxic death due to {{c1::submersion of the ]‫[ُأضيفت‬
espiratory openings under water.}}Causes of death-Direct causes: mechanical anoxia-Indirect
.causes:. Reflex cardiac inhibition due to vagal stimulation .-Head injury or other fatal injuries
Posrmortempicture of drowningSure external signs{{c1::.Froth.Cadaveric ]‫[ُأضيفت‬
spasm}}Probable external signs.Related to anoxic anoxia : cyanosis.Related to presence of the
Washerwoman skinPostmortem ‫اوزة‬c1::skin is pale& wetGoose skinskin{{:body in water
Affection of postmortem changes due to presence in water:{{c1::Cooling , .}}injuries
hypostasis , adipocere , putrefaction}}**Homicidal , suicidal or accidental
[‫ ]ُأضيفت‬Chemical AsphyxiantsIn chemical asphyxia, inhalation of a gaseous compound prevents
utilization of oxygen at the cellular level. The most common chemicalasphyxiant encountered by
a medical examiner is carbon monoxide. Hydrogen cyanide Hydrgen florid Sexual
Asphyxia {{c1::(Autoerotic Asphyxia, Autoerotic Deaths)}}These are asphyxial deaths,
principally caused by hanging, in which transitory anoxia is intentionally induced to enhance
sexualarousement produced by masturbation