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MEDICO-LEGAL ASPECTS

OF PHYSICAL INJURIES
REPORTERS:
LUISITO CORPIN
JERRY TONGZON


Physical injury : is the effect of some of
stimulus on the body.
Stab wound the effect is immediate but
a blunt object is delayed production on
the contusion.

Causes

1.
2.
3.
4.
5.
6.
7.

of Physical Injuries

Physical violence
Heat or cold
Electrical energy
Chemical energy
Radiation by radioactive substances
Change of atmospheric pressure
Infection

1. PHYSICAL INJURIES BROUGHT


ABOUT BY PHYSICAL VIOLENCE

The effect of the application of


physical injury on person is the
production of wound.
A disruption of the anatomic integrity
of the tissues of the body.
However, not all physical violence
will result in the production of wound.

Physics of wound production:


MV2

a. Kinetic energy

= __________
2
`Velocity component is the important
factor:
M16 rifle with a velocity of 3200 ft/ sec
causes damage more
than a heavier .38 caliber.

b. Time
= The shorter the period of time needed for the
transfer of energy,the greater the likelihood of
producing damage.
= If a person is hit on the body and the body
moves towards the direction of the force
applied, the injury is less as when the body is
stationary.
= The longer the time of contact between the
object or instrument causing the injury, the
greater will be the dissipation of energy

c. Area of transfer
= The larger the area of contact
between the force applied on the body,
the lesser the damage to the body.
= By applying an equal force, the
damage caused by stabbing is greater
compared to a blunt instrument.

d. Other factors
= The less elastic and plastic the tissue , the
greater that a laceration will result.
= Elasticity :
Ability of the tissue to return to its normal sizes
and shape after being deformed by a pressure.
= A force transmitted through a tissue
containing fluid will force the fluid away from
the area of contact in all directions equally,
frequently causing the tissue to lacerate.

VITAL REACTION
= It is the sum total of all reactions of tissue or
organ to trauma, either observed micro or
macroscopically.
a. RUBOR - redness or congestion of the area due to an
increase of blood supply as a part of the reparative
mechanism.
b. CALOR - Sensation of heat or increase in temperature.
c. DOLOR - pain due to involvement of the sensory nerve.
d. LOSS OF FUNCTION - due to trauma, the tissue may
not function.

The presence of vital reaction


differentiates an ante-mortem from a
post-mortem injury.

EXCEPT: vital reactions not seen even if


injury inflicted during life:
1.During agonal state of a living person
were cells dont react to the trauma.
2. Sudden death as in sudden coronary
occlusion.

CLASSIFICATION OF WOUNDS:
1. AS TO SEVERITY
a. Mortal wound - caused immediately after
infliction that is capable of death.
Parts of body that are mortal - heart,
vessels, CNS, lungs, other organs.
b. Non-mortal wound - Not capable of
producing death after infliction.

2. AS TO KIND OF INSTRUMENT USED


a. Blunt instrument - contusion, hematoma,
lacerated
wound.
b. Sharp instrument
= Sharp-edge instrument> incised wound
= Sharp pointed> punctured wound
= Sharp edge and sharp-pointed > stab
c. Wounds brought about by tearing force lacerated wound

d. By change in atmospheric pressure barotraumas.


e. Wounds brought about by heat or
cold - frostbite, scald, burns.
f. Wounds brought about by chemical
explosion - GSW, shrapnel wound
g. Wounds brought about by infection.

3. AS TO THE MANNER OF INFLICTION


a) HIT - means of bolo, blunt instrument,
axe.
b) TRUST or STAB - bayonet dagger
c) GUN POWDER EXPLOSION - Projectile
or shrapnel wound.
d) SLIDING or RUBBING or ABRASION

4. AS REGARDS TO THE
DEPTH OF THE WOUND
a)

Superficial - wound involves only


the layers of the skin.

b)

Deep - inner structures beyond the


layers of the skin.

PENETRATING WOUND - Wounding agent


did not come out or Piercing a solid organ.
PERFORATING WOUND - Wounding agent
produces communication between the
inner and outer portion of the hollow
organs.
OR piercing or traversing completely a
particular part of the body causing
communication between the points of entry
and exit of the instrument or substance
producing it.

5. AS REGARDS TO THE RELATION OF


THE SITE OF APPLICATION OF FORCE
AND THE LOCATION OF INJURY
a. Coup Injury - Physical injury which is
located at the site of the application of
force.
b. Contre-coup injury - opposite the site of
the application of force.
c. Coup contre-coup injury - site and also
opposite of application of force.

d. Locus minoris resistencia - Physical injury


not located at the site nor opposite the
site of theapplication of force but in some
areas offering the least resistance to the force
applied.
Example: Blow in fore head > contusion on the
region of the eyeball.
e.Extensive injury - Physical injury involving a
greater area of the body beyond the site of the
application of force.
Example : Fall or MVA

6. AS TO REGIONS OR ORGANS OF
THE BODY INVOLVED
Injuries in various parts of the body

7. SPECIAL TYPES OF WOUNDS


a) DEFENSE WOUNDS
- Instinctive reaction of self-preservation.
- hands/fractures
b)PATTERNED WOUND
- Wound in the nature and shape of the
instrument.
Wheels, abrasions from rope.
c)SELF-INFLICTED WOUNDS - Wound produced
on oneself but no intention to end his life.

Motive of producing self-inflicted


wounds:
1. To create or deliberately magnify
an existing injury or disease for
pension or workmans compensation.
2. To escape certain obligations or
punishment.
3. To create a new identity.
4. Gain attention or sympathy.
5. Psychotic behaviour.

Some ways of selfmutilation:


1. Head banging or bumping
2. Exposure of body to heat radiation
from open fires, radiators
3. Penetrating nail to chest wall
4. Castration by amputation of the
penis
5. Trichotillomania- pulling of body hair

LEGAL CLASSIFICATION OF PHYSICAL INJURIES


1. MUTILATION - Art. 262 RPC
Kinds of mutilation:
a.Intentionally depriving a person, totally or partially
of some of the essential organs for reproduction.
b. Intentionally depriving a person of any part or
parts of the human body other than the
organs for reproduction.
Mutilation to be punishable it must be intentional or
not physical injury.

MAYHEM - is the unlawful and violent


deprival of another of the use of a part
of the body so as to render him less
able in fighting, either to defend
himself or to annoy his adversary.
Vasectomy/Tubal ligation - not
mutilation and a legitimate method of
contraception despite the fact that it is
done intentionally and deprives a
person of his power of reproduction.

SERIOUS PHYSICAL INJURIES


Any person who shall wound, beat or
assault another (Art. 263, RPC) and
administering injurious substance,
without intent to kill (Art. 264, RPC).

The main purpose of dividing the


provision into four paragraphs
a) Is to graduate the penalties
depending upon the nature and
character of
the wound inflicted
b) Their consequences on the person
of the victim.

The main purpose of dividing the


provision into four paragraphs
a) Is to graduate the penalties
depending upon the nature and
character of
the wound inflicted
b) Their consequences on the person
of the victim.

1. Prison mayor - because of the physical


injuries inflicted, the injured person
becomes insane, imbecile, impotent or blind.
2. Prision correctional in its medium and
maximum periods
- loss of speech, hear or smell
- loss of eye, hand, foot, arm, leg
= loss of the use or incapacitated for the
habitual work he used to do.

3. Prision correctional in its minimum and


medium periods.
- person injured shall be deformed.
lost any other part of the body,
incapacitated for more than 90 days.
4. Arresto mayor in its maximum period to
prision correctional
- If the physical injuries shall have cause the
illness or incapacity for
labor for more than 30 days.

Is the offense shall be committed against


any of the persons enumerated inArt. 246 Or
with attendance of any of the circumstances
mentioned in Art. 248
= The case covered by subdivision number
1 of this article will be punished by
reclusion temporal in its medium and
maximum periods.
= Subdivision number 2 by Prision
correctional in its maximum period to
prision mayor in its minimum period.

= Subdivision number 3 by prision


correctional in its medium and maximum
= Subdivision number 4 prision correctional
in its minimum and medium periods.
The provisions of the preceding paragraph
shall not be applicable to a parent who shall
inflict physical injuries upon his child by
excessive chastisement. RA 7610.
It may be committed through a simple
negligence or imprudence.

ADMINISTERING INJURIOUS SUBSTANCE OR


BEVERAGES Art 264 RPC
Elements:
1. The offender inflicted upon another any serious
physical injury,
2. There is knowledge that the substance or
beverage administered is injurious Or took
advantage ofthe victims weakness of credulity.
3. There is no intent to kill in the part of the offender.
If intentional so> frustrated murder. Treachery is
inherent in Art. 264 RPC

LESS SERIOUS PHYSICAL INJURIES


Art. 265 RPC
Any person who shall inflict upon another
physical injuries not described in the preceding
articles,
= But which shall incapacitate the offended
party for labor 10 days or more
= Or shall require medical attendance for the
same period
Both of which is 10 days but not more than 30
days and there must be proof to it..

The crime of less serious physical injuries may be


qualified and a fine of a higher penalty is
imposed when:
1. There is a manifest intent to insult or offend the
injured person.
2. There are circumstances adding ignominy to the
offense.
3. The victims is the offenders parents,
ascendants, guardian, curators,teachers.
4. The victim is is a person of rank or person of
authority, provided the crime is not direct assault.

P.D. 169 Obligation imposed on


Physicians treating persons suffering
serious and less serious physical
injuries required to report to law
enforcement agencies.

SLIGHT PHYSICAL INJURIES AND


MALTREATMENT - Art 266 RPC
1. Arresto menor- when the offender has inflicted
physical injuries which shall incapacitate the offended
party for labor form 1 to 9 days or shall require medical
attendance of the same period
2. Aresto menor or fine not exceeding P200 and
censure when the offender has cause physical injuries
which do not prevent the offended party from engaging in
his habitual work nor require medical attendance.
3. Arresto menor in its minimum period or a fine not
exceeding P50 when theoffender shall ill treat another by
deed without causing any injury.

If there is no evidence to show actual


injury or incapacity for labor or period
of medicalattendance, the accused can
only be guilty of slight physical injuries.
So a tender slap on the face, holding the
arm tightly, application of pressure in
some parts ofthe body or mild blow
which show no sign of physical violence
may still be considered slight physical
injuries or maltreatment.

PHYSICAL INJURIES INFLICTED IN A


TUMULTOUS AFFRAY Art 252 RPC
Elements:
1. There is a tumultuous affray.
2. Participants suffered from serious
physical injuries.
3. The person who inflicted serious
physical injuries cannot be identified.
4. All those who appear to have used
violence upon the person of the offended
party shall be penalized
by arrest from 5 to 15 days.

TYPES OF WOUNDS
( MEDICAL CLASSIFICATION)

1. CLOSED WOUND - no breach of continuity of


the skin or mucous membrane.
a.Superficial - When the wound is just
underneath the layers of the skin or mucous
membrane.
a.1 PETECHIAE - is a circumscribed
extravasation of blood in the
subcutaneous
tissue or underneath the mucous membrane.
Example : mosquito bite, blood disease, hanging

a.2 CONTUSSION - is the effusion of


blood into the tissues underneath the
skin on
account of the rupture of the blood
vessels as a result of the application of
blunt force or violence.
= size of contusion greater than the size
of the object.
= Location of the contusion is not
always the site ofapplication of the
force. Example: Black eye> Forehead

Medico-legal point of view:


A contusion as indicated by its external
pattern may correspond to the shape of the
object or weapon used.
Extent -the possible degree of violence
applied.
Distribution- indicates the character and
manner of injury as in manual strangulation
around the neck.

Age of Contusion: appreciated from its color change


The size tends to become smaller from the periphery to
the centerand passes through a series of color changes
as a result of the disintegration of the RBC and
liberation of hemoglobin.
The contusion is red, purple soon after its complete
development.
= 4 to 5 days > green
=7 to 10 days > yellow and gradually disappears on
the 14 or 15 day.
The ultimate disappearance of color varies from 1 to 4
weeks
depending upon the severity and constitution of the
body.
The color changes starts at the periphery.

CONTUSION VS. POST-MORTEM


HYPOSTASIS
Contusion
Below the epidermis in the true skin in small
bruises or extravasations,below this in larger ones
and often much deeper still.
The epidermis has no blood vessels to be ruptured.
Post mortem Hypostasis
In the epidermis or in the cutis as a simple stain or
a showing through the
epidermis of the underlying engorged capillaries.

Contusion
Cuticle was probably abraded by the
same violence that produced the
bruise. In small punctures such as fleas
bites, this is not observed.
Post-mortem hypostasis
Cuticle unabraded, because the
hypostasis is a mere sinking of the
blood,there is no trauma.

Contusion
A bruise appears at the seat of and
surrounding the injury. This may or
may not be a dependent part.
Post-mortem hypostasis
Always in a part which for the time of
information is dependent.

Contusion
Often elevated because elevated blood
and subsequent inflammation swell
the tissues.
Post-mortem hypostasis
Not elevated, because either the blood
is still in the vessels or at most has
simply soaked into and stained the
tissues.

Contusion
Incision shows blood outside the
vessels. This is the most certain test of
difference and can be observed even in
very small bruises.
Post-mortem hypostasis
Incision shows the blood is still in its
vessels and if any oozing occurs drops
can be seen issuing from the cut mouths
of the vessels.

Contusion
Color variegated. This is only true of
bruises that are the same days old due to
the changes in the hemoglobin produced
during life.
Post-mortem hypostasis
Color is uniform. The well known change
in color produced in blood . Extravasated
Into living tissues does not occur in dead
tissues with the same regularity.

Contusion
If the body happens to be constricted at or supported
on a bruised place, the actual surface of
contact may be a little lighter than the rest of the bruise
but will not be white.
Post-mortem hypostasis
In a place which would otherwise be the seat of
hypostasis pressure of any kind even simple
support is sufficient to obliterate the lumen of the venules
and capillaries and so to prevent their filling
with blood.
White lines or patches of pressure bordered by the dark
color of hypostasis are produced and marks
of floggings, strangulation, etc. are thus sometimes
simulated

Contusion
If the body happens to be constricted at or supported
on a bruised place, the actual surface of
contact may be a little lighter than the rest of the bruise
but will not be white.
Post-mortem hypostasis
In a place which would otherwise be the seat of
hypostasis pressure of any kind even simple
support is sufficient to obliterate the lumen of the venules
and capillaries and so to prevent their filling
with blood.
White lines or patches of pressure bordered by the dark
color of hypostasis are produced and marks
of floggings, strangulation, etc. are thus sometimes
simulated

FACTORS INFLUENCING THE DEGREE


AND EXTENT OF CONTUSSION
1. General condition of the patient.
2. Part of the body affected.
Fatty tissues, bloody parts > contused easily
Fibrous areas, muscle> less
3. Amount of force applied The greater the
force, the more effusion of blood.

4. Disease - Contusion may develop with or


without application of force.
Example: Aplastic anemia, whooping cough
5. Age - Children and old age tend to
bruise easily.
6. Sex - women, obese easily develops
unlike boxers.
7. Application of heat and cold

The distinction between ante-mortem


and post-mortem contusions in an
undecomposed body is that in ;
1. Ante-mortem bruising: there is
swelling, damage to epithelium,
extravasation, coagulation and
infiltration of the tissues with blood
2. Post-mortem bruising there are no
such findings.

a.3 HEMATOMA
-is the extravasation or effusion of
blood in a newly formed cavity
underneath the skin. When theblunt
instrument hit a hard part of the body
like a bony part which is superficially
located.
Force causes the subcutaneous tissue
to rupture on account of the presence
of a hard structure

DISTINCTION BETWEEN CONTUSION AND


HEMATOMA
1. In contusion- the effused blood are
accumulated in the interstices of the
tissues underneath the skin
In hematoma blood accumulates in a newly
formed cavity underneath the skin.
2. In contusion, the skin shows no
elevation and is ever elevated, the
elevation is slight and is on account of
inflammatory changes
In hematoma - the skin is always elevated.

3. In contusion, puncture or aspiration


with syringe of the lesion, no blood can
be obtained.
In hematoma - shows presence of blood
and subsequent depression of the
elevated lesion.
Abscess, gangrene, hypertrophy, fibroid
thickening and even malignancy are
potential complications of
hematoma.

MUSCULO-SKELETAL INJURIES
1. Sprain - partial or complete
disruption in the continuity os a
muscular or ligamentous support of a
joint, due to a blow, kick or torsion
force.
2. Dislocation - displacement of the
articular surface of bones entering into
the formation of a joint.

3. Fracture - solution of continuity of bone


resulting from violence or some existing
pathology.
a. Close or Simple Fx - no break in continuity of
the overlying skin.
b. Open or Compound Fx - Fx is complicated by
an open wound caused by the broken bone
which protruded with other tissues of the
broken skin.
c. Comminuted Fx - Fractured bone is
fragmented into several pieces.

d. Greenstick Fx - Fx wherein only one side


of the bone is broken while the other is
merely bent.
e. Linear Fx - when the Fx forms a crack
usually in flat bones.
f. Spiral Fx - break in the bones forms a
spiral manner as seen in long
bones.
g. Pathologic Fx - Fx caused by weakness of
the bone due to disease.

4. Strain - the over-stretching instead


of an actual tearing or the rupture of
a muscle or ligament
which may not be associated with the
joint.
5. Sublaxation - Incomplete or partial
dislocation.

INTERNAL HEMORRHAGE
-rupture of blood vessels which may
cause hemorrhage due to the
following:
a. Traumatic intracranial hemorrhage.
b. Rupture of parenchymatous organs.
c. Laceration of other part of the body.

CEREBRAL CONCUSSION
( COMMOTIO CEREBRI )
- THE JARRING OR STUNNING OF THE BRAIN
CHARACTERIZED BY MORE OR LESS
COMPLETESUSPENSION OF ITS FUNCTIONS AS
A RESULT OF INJURY TO THE HEAD WHICH
LEADS TO SOME COMMOTION OF THE
CEREBRAL SUBSTANCE.
- is more severe when the moving or mobile
head struck a fixed hard object as compared
when the
head is fixed and struck by a hard moving object

Signs and Symptoms


1. unconsciousness which is more or
less complete.
2. muscles are relax and flaccid.
3. eyelids are closed and the
conjunctivae are insensitive.
4. surface of the body is pale, cold and
clammy.
5. respiration is slow and sighing.

6. pulse is rapid, weak, faltering and


scarcely perceptible to the fingers.
7. temperature is subnormal.
8. sphincters are relaxed with unconscious
evacuation of the bowel and bladder.
9. reflexes are present but sluggish and in
severe cases may be absent.
Loss of memory for events just before the
injury is a constant effect of cerebral
concussion and is of medico-legal
importance.

2.OPEN WOUNDS
a. Abrasion ( Scratch, graze, impression mark,
friction mark )
- it is an injury characterized by the removal of the
superficial epithelial layer of the skin caused by
a rub r friction against a hard rough object.

Contussion with abrasion = forcible contact before


friction occurs.

- the shape varies and the raw surface exudes


blood and lymph which later dries and forms a
protective covering as SCAB or CRUST.

Characteristics of abrasion:
1. It develops at the precise point of the
force causing it.
2. Grossly or with the aid of a hand
lens the injury consists of parallel linear
injuries which
are in line with the direction of rub or
friction causing it.
3. It may exhibit the pattern of the
wounding material.
4. Usually ignored by attending
physician.

Medico-legal viewpoint
= abrasions caused by fingernails may indicate
struggle or assault and are usually located
in the face, neck, forearms and hands.
= abrasions resulting from friction on rough
surfaces are located in bony parts and are
usually associated with contusion or laceration.
= nature of the abrasion may infer degree of
pressure, nature of the rubbing object and
the direction of movement.
5. Abrasion heals in a short time and leaves no scar
unless if not
infected or if the whole thickness of the skin is
involved.

Forms of abrasion
1. Linear abrasion - appears as a single line,
straight or curve.
= pinching with fingernails = curve a.
= sliding the point of a needle = straight
linear ab.
2. Multi-linear - develops when the skin is
rubbed on a hard rough object producing
several
linear marks parallel to one another.
Example: MVA

3. Confluent - linear marks in the skin


are almost indistinguishable on
account of the severity of friction and
roughness of the object.
4. Multiple - several abrasions of
varying sizes and shapes may be
found in different parts of the body

Types of abrasion
1. Scratch - caused by sharp pointed object which
slides across the skin, like pin, thorn or fingernail.
Injury usually parallel to the direction of slide.
= Fingernail scratch > broad at point of
commencement with tailing at the end.
2. Graze - usually caused by forcible contact with
rough, hard objects resulting to irregular removal
of the skin surface.
= course indicated by a clean commencement and
tags on the end.

3. Impact or imprint abrasion ( patterned abrasion,


stamping abrasion,abrasion a la signature)
- those whose pattern and location provides
objective evidence to
show cause, nature of the wounding instrument
and the manner of assault or death.
= marks of grid of radiator, thread marks of wheel,
teeth marks.
4. Pressure or friction abrasion - caused by
pressure accompanied by movement usually
observed in hanging or strangulation.
= spiral strands of the rope as seen in the skin in
hanging.

Differential diagnosis:
1. Dermal erosion - gradual breakdown
or very shallow ulceration of the skin
which involves only the epidermis and
heals without scarring.
2. Marks of insects and fishes bites skin injury is irregular with no vital
reaction and usually found on angles of
the mouth, margins of nose, eyelids and
forehead.

3. Excoriation of the skin by excreta found in infants and the skin lesions
heals when the cause is removed.
No apparent history of rubbing trauma
on the affected area.
4. Pressure sore - usually found at the
back at the region of bony prominence.
History of longstanding illness, bed
ridden.

ANTEMORTEM POSTMORTEM
ABRASION
ABRASION
COLOR

reddish-bronze due
to slight
exudation of blood

yellowish and transparent

LOCATION

any area

over bony prominence


Rough handling of the cadaver

VITAL

with intravital
reaction
may show remains
of damaged
Epithelium

shows not vital reaction and is


characterized by a separation
of the epidermis from
Complete loss of the former

b. Incised wound ( cut, slash, slice)


-produced by a sharp-edged ( cutting)
-or sharp-linear edge of the instrument like a knife,
razor, bolo, glass etc.
-Impact cut > when there is forcible contact of the
cutting instrument with the body surface.
-Slice cut > when cutting injury is due to the pressure
accompanied with movement of the instrument
- Chopped or Hacked wound > when the wounding
instrument is a heavy cutting instrument like
Saber - injury is severe

Characteristics of incised wound:


1. Edges are clean cut.
2. The wound is straight
3. Usually the wound is shallow near the extremities
and deep at the middle portion.
4. Profuse hemorrhage because of the clean cut on
the vessels.
5. Gaping is usually present due to the retraction of
the edges.
6. Clothes will also show a clean cut if cut by the
instrument.
7. Faster healing if without complications.
8. Incised wound made by broken glasses

Changes that occur in an incised wound:


1. After 12 hours - edges are swollen, adherent with
blood and with leukocyte infiltration.
2. After 24 hours - proliferation of the vascular
endothelium and connective tissue cells.
3. After 36 to 48 hours - capillary network
complete, fibroblasts running at right angles to
the vessels.
4. After 3 to 5 days - vessels show thickening and
obliteration

Why a person suffers from incised


wound:
1. As a therapeutic procedure.
2. As a consequence of self-defense
3. Masochist may self-inflict incised
wounds for self-gratification.
4. Addicts and mental patients

Suicidal wounds
- usually located in peculiar parts of the
body, accessible to the hand.
- the most common site is the wrist,
radial artery and the neck.

Homicidal wounds
-usually deep, multiple and involve
both accessible and non-accessible
parts.
-clothings are usually involved
-defense and other forms of wounds are
present

Accidental wounds

multiple incised wounds observed on


the passenger and driver of MVA due to
broken windshields.

- kitchen knives in the preparation of


food.

SUICIDAL
WOUNDS

HOMICIDAL
WOUNDS

DIRECTION

Oblique from below left


ear,
downwards across front
neck
just above Adams apple

Usually horizontal below


the adams apple

SEVERITY

Usually not so deep and


Usually deep and may cause
may only involve trachea, involvement of the cartilage
carotid and esophagus
and bones.

SUPERFL
CUT

Usually present before


Practically absent but may
the
rarely be present when the
commencement of deeper victim struggled when attacked
wound.

POSITION
OF THE

May be sitting or facing


a

Usually victim lying on bed


or in other place.

WOUNDING
WEAPON

SUICIDAL
WOUNDS

HOMICIDAL
WOUNDS

Firmly grasp (cadaveric


spasm) or found lying
beside the victim

Weapon is absent

BLOOD

Bld found in front part of Bld found at the back of neck.


DISTRIBUTION body
Hands are clean.
Hand smeared with blood.
MOTIVE

History of mental
depression,
Financial, social
problems, alcoholism

Absence of such history

PREVIOUS
HISTORY
of SELF-

May be present

Always absent

DESTRUCTION

3. STAB WOUNDS - produced by the penetration of


a sharp and a sharp edged instrument like a knife,
scissors.
-if the sharp edge is the one that comes in contact
with the skin then it is an incised wound.
If the sharp pointed portion first come in contact, it
is a stab wound.
- surface length may reflect the width of the
wounding instrument.

-smaller when the wound is not so deep.


-wider if upon withdrawal is not in the
same direction as seen in slashing
movement.
- The presence of an abrasion from the
extremity of the skin defect is in line with
direction of the slashing
movement.

The extremities of stab wound may show the nature of


the instrument used.
-a doubled bladed weapon shows both extremities to be
sharp.
A single bladed weapon - one of its extremities as
rounded and contused, not seen if instrument is
quite thin.
-The direction of the surface defect may be useful in
the determination of the possible relative position of
the offender and the victim when the wound was
inflicted.

As to whether the wound is slit-like or gaping


depends on the direction of the wound to the Langers
line.
The depth of the wound may be influence by:
1. size and sharpness of the instrument.
2. area of the body involved
3. the degree of force applied
Hemorrhage is always the most serious
consequence of stab wound due to the severance
of blood
vessels or involvement of bloody organs.

How to describe stab wound:


1. length of the skin defect - edges must be
coaptated first
Tailing - the direction of withdrawal of the
wounding weapon.
2. condition of the extremities
= sharp extremity > sharpness of the instrument
used.
= If Both extremity are sharp > double bladed
weapon is used.

How to describe stab wound:


1. length of the skin defect - edges must be
coaptated first
Tailing - the direction of withdrawal of the
wounding weapon.
2. condition of the extremities
= sharp extremity > sharpness of the instrument
used.
= If Both extremity are sharp > double bladed
weapon is used.

3. condition of the edges.


= edges are regular and clean cut> due to one
stabbing act.
= serrated or zigzag in appearance > several
stabbing wounds ( series of thrust and
withdrawal.)
4. linear direction of the wound - it may
be running vertically, horizontally, or
upward medially or laterally

5. location of the stab wound - to include


exact measurement from anatomical
landmarks.
6. direction of the penetration - must be
tridimentional
7. depth of the penetration
8. tissue and organs involved

Stab wounds may be:


A.Suicidal
1. Located over vital parts of the body.
2. Usually solitary
3. Located over covered parts of the body,
the clothing is not involved
4. Stab wound is accessible to the hand of
the victim

6. Wounding weapon is firmly grasp by the


hand of the victim.
7. If stabbing is accompanied with slashing
movement
> the wound tailing abrasion is seen towards
the hand inflicting the injury.
8. Suicide not may be present
9. Presence of a motive for self destruction.
10. No disturbance in the death scene with
wounding instrument found near the victim.

B. Homicidal -stabbing with homicidal intent is


the most common
Characteristics:
1. Injuries other than stab wound may be
present .
2. Stab wound may be located in any part of the
body.
3. Usually more than one stab wound
4. A motive for stabbing, if none then the
offender either
insane/drugs
5. Disturbance in the crime scene

Medical evidence showing the intent of


the offender to kill the victim:
1. there are more than one stab wounds
2. stab wounds located in different parts of the
body
3. stab wounds are deep
4. serrated stab wounds means thrust and
withdrawal of the wounding weapon to increase
internal damages.
5. irregular or stellate shape skin defects> due to
changing direction of the weapon with the portion of
the instrument at the level of the skin as the lever.

4. PUNCTURED WOUND is the result of a thrust of a sharp


pointed instrument.
= External injury is quite small but the depth is to a certain
degree.; ice-pick, nail
- Nature of the external injury depends on the sharpness of
the end of the wounding instrument:
= contusion of the edges> if end is not sharp
= opening may be> round, elliptical, diamond shaped or
cruciate.
- External hemorrhage is limited although internal injuries
may be severe.> blood vessels and bloody
organs is fatal if no intervention applied.
- Site of external wound can be easily sealed by dried bld,
serum, or clotted bld.
- Punctured wounds are usually accidental

Characteristics:
1. The opening of the skin is very small,
wound is much deeper than it is wide.
2. External hemorrhage is limited than
internally may be severe.
3. Sealing of external opening is
favorable for the growth and multiplication
of anaerobic organism like bacillus tetani.

Homicidal
1. multiple and usually located in different
parts of the body.
2. wound are deep
3. there are defense wounds on the victim.
4. signs of struggle in the crime scene.

Suicidal
1. located in areas of the body where the vital organs
are located.
2. usually singular, if multiple located in one area.
3. parts of body involved is accessible by the hand of
the victim.
4. clothing usually not involved.
5. wounding is made while the victim is in sitting or
standing position , bleeding is towards the
lower part of the body or clothing.
6. no disturbance in the crime scene.
7. wounding instrument found near the body.

Puncturing wound with puncturing


instrument loaded with poison:
1. poison dart cyanide or nicotine
2. fish spines
3. dog bites with hydrophobia virus
4. injection of air and poison as a way of
euthanasia.

5.LACERATED WOUNDS ( TEAR, RUPTURE,


STRETCH PUTOK)
- a tear of the skin and the underlying
tissues due to forcible contact with a blunt
instrument.
- May be produced by a hit with a piece of
wood, iron bar, fist, stone, butt.
- If the force is applied to a tissue is
greater than its cohesive force and
elasticity> the tissue tearsand a laceration
is produced.

Characteristic:
1. shape and size of the injury does not correspond to the
wounding instrument
2. tear on the skin is rugged with extremities irregular, illdefined.
3. injury developed where the blunt force is applied.
4. borders of the wound are contused and swollen.
5. developed in areas where the bone is superficially
located.like scalp.
6. examination with the aid of hand lens shows bridging
tissue joining the edges and hairs bulbs
are intact.
7. bleeding is not extensive due to blood vessels are not
severed evenly.
8. healing process is delayed and has a tendency to develop
a scar.

Classification of lacerated wounds:


1. Splitting caused by crushing of the skin
between two hard objects.
Ex: laceration of scalp hit by a bunt instrument,
cut eyebrow of a boxer.
2. Overstretching of the skin
-When pressure is applied on one side of the
bone> the skin over the area will be stretched
up to a
breaking point to cause laceration and exposure
of the fractured bone.
-In avulsion: the edges of the remaining tissue is
that of laceration.

3. Grinding compression
-the weight and the grinding movement may
cause separation of the skin with the
underlying tissues.
4. Tearing
-this may be produced by a semi-sharped edged
instrument which causes irregular edges on the
wound like hatchet and choppers.
Lacerated wounds are rarely suicidal.

INCISED
WOUNDS

LACERATED
WOUNDS

Edges are clean cut,


regular, well defined

edges are roughly cut,


irregular, ill-defined

No contusion or swelling
around the
Incised wounds

swelling and contusion


around the
lacerated wounds

Extremities of the wound


are sharp, may be
Round, or contused

extremities are ill-defined


and irregular

INCISED
WOUNDS

LACERATED
WOUNDS

Examination by means of a hair bulbs are preserved


hand lens
Shows that hair bulbs are
cut
Healing is faster

healing is delayed

Caused by sharp edged


instrument

caused by a blunt
instrument

GAPING OF WOUND
Separation of the edges especially in deep
wound may be due to the following:
1. mechanical stretching or dilatation
the presence of a mechanical device on
the edges to prevent coaptation will cause
separation.
Example: drain in an abscess, retractor
during operation.

2. loss of tissue due to:


a. Destruction due to pressure, inftion, cell
lysis, burning, chemical reaction.
b. Avulsion or physical or mechanical stretching
resulting to separation of a portion of the tissue.
c. Trimming of the edges - debridement of the
skin which come in contact with the bullet at
theentrance and exit of GSW and removal of
necrotic materials.

3. retraction of the edges


-underneath the skin are dense networks of
fibrous and elastic connective tissue fibers
running on the same direction and forming a
pattern more or less present in all persons.
- This pattern of fiber arrangement is called
cleavage direction or lines of cleavage of
the skin and their linear representation on
the skin is called Langers line.

Practical ways of determining how much of


the skin surface is involved in an injury or
disease:
-skin functions as a mechanical protection of
the body, storage of water.
Determination of how much skin is involved
is important in the mode of treatment and
prognosisespecially in burns, contusion..
- burns of 70% in children and older age group
are fatal.

= rule of nine is used.


Head and neck
one upper extremity
front chest and abdomen
posterior chest and abdo
one lower extremity front
one lower ext(back)
pudendum

9%
9%
18%
18%
9%
9%
1%

9%
18%
18%
18%
18%
18%
1%

Factors responsible for the severity of the


wound:
1. Hemorrhage may influence the severity of
wound by:
a. loss of blood incompatible with life
- blood constitutes 1/20 of the body weight
of an adult.
- 5 to 6 quarts of blood ( one quart is 946 cc)
- loss of 1/10 of its volume will cause no
significant change.

- loss of one quart> fainting


- loss of 1/3 to 2/5 > irreversible shock
- males can withstand more loss of blood
than females.
- hypertension causes more excessive and
rapid bleeding.

b. Hemorrhage may result in an increase in


pressure in or on the vital
organs to affect the normal function.
- intracranial hemorrhage cause compression
of the vital centers of
the brain.
- hemopericardium > pericardial tamp
- hemorrhage to the chest> diminution of the
respiratory output>anoxia.

c.. Hemorrhage may cause mechanical


barriers to the function of organs.
- into tracheo-bronchial lumina> asphyxia
- into muscles > disturbance in their
contractility.

Causes of hemorrhage:
a. trauma - destruction of its blood vessel
wall
b. natural causes
- intracerebral hemorrhage(apoplexy)>
lenticulostraite br. MCA
- Spontaneous subarachnoid hemorrhage >
saccular berry aneurysm
- rupture of arteriosclerotic aneurysm

- rupture of esophageal varices


- pulmonary hemorrhage due to PTB, lung abscess,
bronchiectasis
ruptured ectopic pregnancy
2. Size of injury - burns greater than 1/3 of the
body are fatal
3. Organs involved usually fatal to heart, brain,
lungs.
4. Shock blow to genitalia, slight burns to young
and old.
5. Foreign body or substance introduced into the
body - bacterial, viral, foreign body, chemical,

TOXIN.
1. snake bites> 2 punctured wds at the
center of the reddened affected area. The
venom is injectedthrough its fangs which is
connected to the poison gland.

Snake venom toxicity will depend on:


1. potency of venom injected
2. amount of venom injected by the fang
will depend on
- season of the year
- the length of time the snake has eaten.
- if a snake has just killed its prey> toxic
content is smaller.
3. size of the patient
4. immediate treatment instituted.

Snake venoms are two principal classes:


1. Neurotoxic - primarily paralysis the
respiratory and cardiac center of the brain.
may cause N,V, ascending paralysis, coma,
convulsion, c/p arrest
2. Hematoxic - affects particularly the blood
- manifestations are pain, swelling on the
affected area, IV hemolysis, N,V, pulmonary
and cardiac
edema

Emergency treatment may be:


1. incision of the wound to promote more
external hemorrhage to drain the venom.
2. tourniquette above the site of the wound
3. placing ice on the bite site
4. sucking the wound to drain venom with
the mouth
5. administration of anti-snake venom
serum.

2. Scorpion venom
- venom has toxic, hemolytic, hemorrhagic
- one punctured wound on the center of a reddened
area
pain, edema and reddening
3. Coelenterate sting ( jellyfish )
- tentacles penetrate into the skin and cause
explosion of the nematocyst and liberation of the
venom.
- extreme pain. Urticarial rash, dilated pupils,
paleness, labored breathing

Absence of medical or surgical intervention


- wound may not be fatal but due to neglect
or ignorance of its management, may be serious
and fatal.

FATAL EFFECT OF WOUNDS:


1. Wounds may be directly fatal by reason of:
a. Hemorrhage - neck due to carotid bleed.
b. Mechanical injuries on vital organs
c. shock

2. Wounds may be indirectly fatal by reason


of:
a.
b.
c.
d.

secondary hemorrhage following sepsis


specific infection
scarring effect
secondary shock

NATURE OF DEATH DUE TO SECONDARY


CAUSES
1. Changes whose natural sequence are
direct & obvious sepsis, tetanus
2. Changes producing separate pathological
lesions which in turn proves to be fatal
Ex: operation to ligate vessel but died of
peritonitis despite diligence/skill

3. Changes where a definite pathological


condition was present before the injury.
Ex. Person with tumor and stabbed , stab is
not capable of death but accused is
responsible for his death.
4. Changes where a definite pathological
condition of totally different nature
arises after the wounding and the
consequential sequence is doubtful.
Ex. TB meningitis ffg blow to the head

COMPLICATIONS OF TRAUMA OR INJURY


1. Shock due to injury to nervous system,
anoxemia, endothelial damage
2. Hemorrhage
3. Infection
a. from the instrument
b. from the organs involved in trauma ex.
Bowels injured
c. injury may depress general vitality
d. deliberate intro of micro-organism
4. Embolism

HEALING OF WOUNDS
1. Power of the human tissue to regenerate
-replaced the destroyed tissue by newly
formed similar tissue.
Regenerates rapidly : C.T., blood forming
tissues,surface epith. Skin
Slow to regenrate:sm. Muscles, neurons of
CNS, highly specialized glandular tiss.

Time of healing is dependent on:


a. vascularity
b. age of person
c. degree of rest or immobilization
d. nature of the injury

2. Aberrated healing process:


a. formation of exuberant granulation or
proud flesh
b. keloid formation
c. stricture
d. fistula or sinus formation

MEDICO-LEGAL INVESTIGATION OF WOUNDS


Rule to follow by a physician:
1. all injuries must be described
2. description of wound must be
comprehensive, sketch/photograph
3. examination must be influenced be any
other information obtained from others in
making a report
or a conclusion.

MEDICO-LEGAL INVESTIGATION OF WOUNDS


Rule to follow by a physician:
1. all injuries must be described
2. description of wound must be
comprehensive, sketch/photograph
3. examination must be influenced be any
other information obtained from others in
making a report
or a conclusion.

Outline of the medico-legal investigation of


physical injuries:
1. General investigation of the surroundings:
a. examination of place where crime is
committed.
b. Examination of clothing, stains, cuts, hair,
f.b. in the crime scene
c. Investigations on possible witnesses to
the incident
d. Examination of the wounding instrument
e. Photography, sketching, accurate
description of the crime scene.

2. Examination of the wounded body


a. examinations applicable to living or the
dead
- age of the wound from the degree of
healing
- determination of the weapon used
- reasons for the multiplicity of wounds
- determination if the wound is accidental,
suicidal or homicidal

b. examination applicable only to the living


- determination if injury is fatal
- determination if injury will produce
permanent deformity
- determination if wound produces shock
- determination if wound produces
complications

c. examination applicable to a dead victim


only
- determination if wound is pre-mortem or
post-mortem
- determination whether wound is mortal or
not
- determination whether death is
accelerated by a disease present at time of
injury.
- determination whether wound cause by A,S,
H

3. Examinations of wound
- character of wound : abrasion, hematoma,
laceration etc
- location of wound : from some fixed area
> to determine trajectory/course
- depth of wound : not in the living , only if
the outer and inner are fixed

conditions of the surroundings of the


wound

= near GSW burning, tattooing


= suicidal cuts superficial tentative cuts or
hesitation cuts
= lacerated wounds contusion on
neighboring skin

Extent of the wound


= extensive injury - marked degree of force
applied in the production of the wound.
= homicidal cutthroats are deeper,
extensive, numerous than suicide
direction of the wound > impt. in the
position of the victim to the offender
- number of wounds several> homicidal

- conditions of locality
a. degree of hemorrhage
b. evidence of struggle
c. information as to the position of the
body
d. presence of suicide note
e. condition of the weapon

HEMORRHAGE

SIGNS OF
INFLAMMATION

ANTE-MORTEM
WOUNDS

POST-MORTEM
WOUNDS

More profuse, arterial


due to loss of tone of
vessels,
Absence of heart action
Post-mortem clotting of
blood inside b.v.

Slight or none, venous

Marks of spouting of blood


from arteries

No spouting of blood

Clotted blood

Bld not clotted,or soft clot

Inflammation & reparative


process
Swelling in the area,
Effusion of lymph, pus
Adhesion of the edges
Unless if victim is weakened

None

ANTE-MORTEM
WOUNDS

POST-MORTEM
WOUNDS

SIGNS OF
REPAIR

Fibrin formation
No time of repair
growth of epithelium
Scab or scar formation

No time of repair

RETRACTION
OF THE EDGES

Deep staining of the edges and


cellular tissues
can be removed by washing

Not deeply stained


can be removed by washing

Edges gape owing to the


reaction
of the skin and muscle fibers

Edges do not gape, but are


closely approximated to
Each other unless if the
wound is 1 to 2 hrs
after death

DETERMINATIONS IF WOUND IS:

HOMICIDAL
ABRASIONS

CONTUSION

INCISED

SUICIDAL

Not common unless Rarely observed


If dragged
Or if victim resisted
Rare except when
jumping from a
height

ACCIDENTAL
Extensive
abrasions MVA

Found in any portion


of the body - Fall

Commonly observed Commonly observed Frequent but rarely


depth, location and cause of death
WOUNDS
surroundings

Points to consider in the determination as


to whether the wounds is A, S, H.
1. external signs and circumstances related
to the position and attitude of the body
when found.
2. location of the weapon or the manner in
which it was held
3. the motive in the commission of the
crime
4. the personal character of the deceased

5. the possibility for the offender to have


purposely changed the truth of the
condition.
6. other information
a. signs of struggle
b. number and direction of wounds
c. direction of wound
d. nature and extent of the wound
e. state of clothing

LENGTH OF TIME OF SURVIVAL OF THE


VICTIM AFTER INFLICTION OF THE WOUND
1. degree of healing> signs of repair of
wound appear in less than a day after the
infliction of injury.
2. changes in the body in relation to the
time of death >systematic changes in the
body = wasting,
anemia, bed sore.
3. age of blood stain not reliable
4. testimony of witness when the wound
was inflicted.

POSSIBLE INSTRUMENTS WHEN USED BY THE


ASSAILANT IN INFLICTING THE INJURIES
1. contusion blunt
2. incised wound sharp-edged instrument
3. lacerated wounds- blunt
4. punctured wounds sharp pointed
5. abrasion body surface is rubbed on a
hard surface
6. GSW the diameter of the wound of
entrance may approximate the caliber of
the wounding
instrument.

Could the injury have been inflicted by a


special weapon?

A physician cant determine that a specific


weapon was used in inflicting a wound.
It is possible that it is caused by a certain
instrument presented.
He must be cautious in giving categoric
statements

Which of the injuries sustained by the


victim caused death?

If with conspiracy - no need coz the act of


one is the act of all.
If none- offenders are only responsible for
their individual acts.
If multiple injuries: which of the wound
injured a vital organ. Or if same organ
which caused the degree
of damage.

Which of the wounds was inflicted first?


If multiple for the qualification of the
offense committed.
First - treachery , murder
Last homicide
Consider:
1. relative position of the assailant and the
victim when the first injury was inflicted on
the latter.

2. trajectory/course of the wound inside


the body of the victim

3. organs involved and the degree of injury

4. testimony of witness

5. presence of defense wounds inflicte

Effect of medical and surgical intervention on


the death:
If death followed after operation> offender is
responsible if death was inevitable and that
even withoperation death is normal and
direct consequence of the injury, and the
physician is competent and inspite of exercise
of degree of diligence still death is the
outcome.
If death ensued even the wounds are minor,
and death due to the negligence or
incompetence of thephysician then the
offender cant be responsible.

Effect of negligence of the injured person on


the death
If death occurred from complications arising
from a simple injury owing to the
negligence of the injured person in its proper
care and treatment
= the offender is responsible for the death
= a person is not bound to submit himself to
medical tx for the injuries received during the
assault.
= unless if it is proven that the negligence of
the victim is deliberate sooffender is not
responsible but only for physical injuries.

Power of volitional acts of the victim after


receiving a fatal injury:
= dying declaration, attempt to kill the
offender after the first blow of the offender
Relative position of the victim and assailant
when injury was inflicted:
1. location of the wound
2. direction of the wound
3. nature of instrument used in inflicting the
injury
4. testimony of the witness

EXTRINSIC EVIDENCES OF THE WOUNDS


1. evidences from the wounding weapon
= position of the weapon - near or grasp by
victim
= blood on weapon - may be stained with
blood
= hair and other substance on weapon
2. evidences in the clothing of the victim
= soaked with blood - hemorrhage
= gunpowder - distance

3. evidences derived from the examination of


the assailant
= paraffin test, tears in clothing, blood stains,
intoxication etc.
4. evidences derived from the crime scene
= amount of hemorrhage, wounding instrument
etc.

PHYSICAL INJURIES IN THE DIFFERENT PARTS OF


THE BODY

1. HEAD AND NECK


= not be underestimated
= bleeding from ears, nose, mouth > basal
fractures
= may have normal x-rays yet with severe head
injury

Factors influencing the degree and extent of


head injuries :
a. nature of the wounding weapon> degree of
violence applied depends on the thickness of
the scalp and the weight of the weapon.
b. Intensity if the force > intensity and heavy
agent
c. point of impact >extensive in fx of vaults at
side or back
d. mobility of the skull at the application of
force

if head is mobile, free> effect on the brain is


due to the shearing
movement imparted to the brain.
> may produce contusion, laceration without
fx.
If head is fixed and unsupported> jarring
movement of the brain is absent but the
fracture is
extensive.

Head injuries are classified as to the site of


the application of force:
1. Direct or Coup injuries
2. Indirect injuries
a. contr-coup injuries
b. remote injuries fall hitting buttocks>
basal fx
c. locus minoris resistencia - injury in areas
with less resistance
3. Coup-contre-coup injuries ( direct and
indirect injuries)

Wounds in the Scalp:

1. it is difficult to prevent the spread of


infection
2. there is proximity of the scalp to the brain
3. there are free vascular connection between
the structures inside and outside the brain
4. it is frequently difficult to determine the
extent of damage of the skull.

GUNSHOT WOUNDS
Death or physical injuries brought about by
powdered propelled substances:
1. Firearm shot
= the injury is caused by the missile propelled
by the explosion of the
gunpowder located in the cartridge shell and
the rear of the missile.
2. detonation of high explosives - grenades
= explosion inside the metallic container will
cause fragmentation of the container.

I. FIREARM WOUND
= Firearm : is an instrument used for the
propulsion of a projectile by the expansive
force of gassescoming from the burning of
gunpowder. (technical definition)
= includes rifles, muskets, shotguns, revolvers,
pistols, other deadly weapons which a bullet,
ball, shell or other missile may be discharged by
means of gunpowder or other explosives.
= includes air rifle except of small calibers and
limited range.
= the barrel of any firearm shall be considered
as a complete firearm for all purposes thereof.

Penal provisions of laws relative to firearm:


a. Sec. 2692 RAC unlawful manufacture,
dealing in acquisition, disposition or possession
of firearms or ammunitions therefore or
instrument used or intended to be used in
the manufacture of firearms or ammunition.
b. Sec. 2690 RAC selling of firearms to
unlicensed purchaser.
c. Sec. 2691 RAC - failure of personal
representative of deceased licensee to
surrender firearm.
d. Art. 155 RPC - Alarms and Scandals
e.Art. 254 RPC Discharge of firearms

CLASSIFICATION OF SMALL FIREARMS:


Small firearms - are those which propel
projectile of less than 1 inch in diameter.
1. as to wounding power:
= low velocity firearm >muzzle velocity of not
more than 1400 ft per sec.
Ex. Revolver
= high power firearm > muzzle velocity more
than 1400 ft. per second
> usual is 2200 to 2500 ft per second or more.

2.as to nature of the bore:


= smooth bore weapon >inside portion of the
barrel that is perfectly smooth
from the firing chamber to the muzzle. Ex.
shotgun
= rifled bore firearm > the bore of the barrel
with a number of spiral lands
and grooves which run parallel with one
another but twisted spirally from breech to
muzzle.
Ex. Military rifle

3. as to manner of firing
= pistol fired with a single shot
Ex. Revolver
= rifle may be fired from the shoulder Ex.
Shotgun

4. As to the nature of the magazine


= cylindrical revolving magazine the cartridge
is located in a cylindrical
magazine which rotates at the rear portion of
the barrel
Ex. Revolver
= vertical or horizontal magazine the cartridge
is held one after another
vertically or horizontally and also held in place
by a spring side to
side or end to end.
Ex. Automatic pistol

Types of small firearms which are of medicolegal interest:

1. revolver usual muzzle velocity is 600 feet


per second
2. automatic pistol self-loading firearm,
muzzle velocity of 1200 feet per second
3. rifle - muzzle velocity of 2500 feet per
second and a range of 3000 feet.
4. shotgun - projectile is a collection of pellets

A weapon in order to cause injury must have


two principal component parts:

1. the cartridge or ammunition - bullet primer,


cartridge case, powder charge
2. firearm instrument for the propulsion of a
projectile force of gases from a burning powder.

ENTRANCE WOUND

EXIT WOUND

Appears to be smaller than the missile


Owing to the elasticity of the tissue

Always bigger than the missile

Edges are inverted

Edges are everted

Usually oval or round depending upon


the bullet shape

Does not manifest any definite the angle


of approach of

Contusion collar or contact ring is present


due to invagination of the skin
and spinning of the missile

Absent

Tattooing or smudging may be present


when
when firing is near

Absent

Underlying tissues are not protruding

Underlying tissues may be seen


Protruding from the wound

INSTANCES WHEN THE SIZE OF THE WOUND


OF ENTRANCE DO NOT APPROXIMATE THE
CALIBER OF THE FIREARM
In distant fire, the rule is that the diameter of
the GSW of entrance is almost the same as the
caliber of the wounding firearm except:
1. Factors which make the wound of entrance
bigger than the caliber:
a. in contact or near fire
b. deformity of the bullet which entered
c. bullet might have entered the skin sidewise
d. acute angular approach of the bullet

2. Factors which make the wound of entrance


smaller than the caliber

a. fragmentation of the bullet before


penetrating the skin
b. contraction of the elastic tissues of the skin

Other evidences or findings used to determine


entrance of GSW
1. examination of the clothing, if involved in the
course of the bullet
a. fabric shows punch in destruction
b. particle of gunpowder
2. examination of the internal injuries caused by
the bullet
a. bone fragments, cartilage, soft tissues are
driven away from entrance wound
b. destruction of the bone is oval, with sharp
edges at the exit it is irregular, bigger and
bevelled

Determination of the trajectory of the bullet


inside the body of the victim
1. external examination
a. shape of wound of entrance
= when bullet is fired at right angle with the
skin> the wound of entrance is circular except
in case of near fire.
= if fired at another angle , it is oval
= when the bullet is deformed no such
characteristics findings will be observed.

b. shape and distribution of the contusion collar


= contusion collar is widest at the side of the
acute angle of approach of the bullet.
= if the bullet hits the skin perpendicularly>
collar will have a uniform
width around the GSW except when bullet is
deformed or in near fire.
c. difference in level between the entrance and
exit wounds
d. by probing the wound of entrance not with
too much force

2. internal examination
a. actual dissection and tracing the course of
the wound at autopsy
b. fracture of bones and course in visceral
organs
c. location of bone fragments and lead particle

3. other evidences to show trajectory


a. relative difference in the vertical location of
entrance and exit in the clothing
b. relative position and distance of the
assailant from the victim in the reconstruction
of re-enactment
of the crime.
c. testimony of witness

EXIT WOUNDS OR OFFSHOOT WOUND


Does not show characteristic shape unlike the
entrance wound due to the absence of
external support
beyond the skin so the bullet tends to tear or
shatter the skin.
Shored GSW of exit: if pressed on a hard object
like when victim is lying:
Wound of exit is circular or nearly circular with
abrasion

ODD AND EVEN RULE IN GSW


= If the number of entrance and exit wound is
even so presumption that no
bullet is lodge in the body
How to determine the number of fires made by
the offender:
1. determination of the number of spent shells
2. determination of entrance wounds in the
body of the victim number of entrance
wounds may not show the exact number of fire:

a. not all fire made may hit the body of the


victim
b. the bullet may in the course of its flight
hit a hard object thereby splitting it and
each
fragment may produce separate wounds of
entrance.
c. Bullet may have perforated a part of the
body and then made another wound in some
other
parts of the body.
3. number of shots heard by the witness

Instances when the number of GSW of entrance


is less than the number of GSW of exit in the
body of the victim:
1. a bullet might have entered the body but split into
several fragments, each of which made separateexit.
2. one of the bullets might have entered a natural
orifice of the body. Ex. Nose
3. there might be two or more bullets which
entered the body through a common entrance and
later making individual exit wounds .
4. in near shot with a shotgun, the pellets might
have entered in a common wound and later
dispersed while inside the body and making separate
wounds of exit.

Instances when the number of GSW of entrance is


more than the number of GSW of exit in the
body of the victim:
1. when one or more of the bullet is not through
and through and the bullet is lodged in the body.
2.when all of the bullets produce through and
through wounds but one or more made an exit in
the
natural orifices of the body.
3. when different shots produced different
wounds of entrance but two or more shots
produced a
common exit wound.

Instances when there is no GSW of exit but the


bullet is not found in the body of the victim:
1. when the bullet is lodged in the GIT and
expelled through the bowel or lodged in the
pharynx and
expelled through the mouth.
2. near fire with a blank cartridge produced a
wound of entrance but no slug may be recovered.
3. the bullet may enter the wound of entrance
and upon hitting the bone the course is deflected
to
have the wound of entrance as the wound of exit.

Antemortem GSW hemorrhage, swelling, vital


reaction.
- microscopically: congestion and leucocytic
infiltration.
Problems confronting Forensic Physician in the
identification of GSW:
1. alteration of the lesion due to natural
process:drying of wound, infn, healing proc..
2. medical and surgical intervention: refer to
clinical record of patient
3. embalming
4. problems inherent to the injury itself.
5. x-ray exam migratory, external souvenirs

Examination of the external wearing apparel of


the victim of GSW may be significant in
investigation because:
1. it may establish the possible range of the fire:
a.contact fire
=tear in the clothing covering the skin, fibers turn
outward away from body
= soot deposit, gunpowder tattooing, burning of
fibers around the turned fiber
= muzzle imprint
= dirt and greasy deposit may be wipe out and
visible in the torn clothing

b.not contact but near shot


= same with (a) except for absence of muzzle
imprint and beyond flame range
c. far fire
= there is a hole tear with inward direction of the
thread
2. it may be useful in the determination as to which
is the point of entry and of exit of the bullet.
Entrythe fiber are inverted.
3. it may be useful in locating the bullet

b.not contact but near shot


= same with (a) except for absence of muzzle
imprint and beyond flame range
c. far fire
= there is a hole tear with inward direction of the
thread
2. it may be useful in the determination as to which
is the point of entry and of exit of the bullet.
Entrythe fiber are inverted.
3. it may be useful in locating the bullet

Special consideration on bullets


1. souvenir bullet
2. bullet migration
3. tandem bullet

EVIDENCES SHOWING THAT THE GUNSHOT WOUNDS


MAY BE SUICIDAL
1. shot fired in a closed locked room, or open
uninhabited place.
2. death open near the place victim was found
3. shot fired with the muzzle of the gun in contact
with the part of body involved
4. location of entrance wound accessible part of
body
5. shot usually solitary
6. direction of fire is compatible with the
trajectory of bullet

7. personal history may reveal social, economic,


business or marital problem which cannot be solve.
8. gunpowder presence in the hand of the victim
9. entrance wound usually does not contain
clothing
10.fingerprints of victim on the butt
11.suicide note at the vicinity
12.no disturbance in the place of death

Russian roulette = unfortunate victim has no


predetermined desire of self-destruction

EVIDENCES THAT GSW IS HOMICIDAL


1. site of wound of entrance has no point of
election
2. fire is made when the victim is at some distance
3. signs of struggle or defense wounds
4. disturbance in the surroundings
5. wounding firearm usually not found in the scene
of the crime
6. testimony of witness

EVIDENCES TO SHOW THAT GSW IS ACCIDENTAL


1. usually one shot
2. no special area of body involved
3. consideration on the testimony of the assailant
and determination as to whether it is possible by
knowing the relative position of the victim
4. testimony of the witness

POINTS TO BE CONSIDERED AND INCLUDED IN THE


REPORT OF THE PHYSICIAN
1. complete description of the wound of entrance
and exit
2. location of the wound; part of body involved,
distance of wound from midline, distance of
wound
from heel or buttock.
3. direction and length of the bullet track
4. organs or tissues involved in its course
5. location of the missile, if lodged in the body
6. diagram. Photograph, sketch or drawing showing
the location and number of wounds

QUESTIONS THAT A PHYSICIAN IS EXPECTED TO


ANSWER IN COURT;
1. COULD WOUND THE WOUND BE INFLICTED BY
THE WEAPON PRESENTED TO HIM?
2. AT WHAT RANGE WAS IT FIRED?
3. WHAT WAS THE DIRECTION OF THE FIRE?
4. IS IT SELF-INFLICTED?
5. ARE THERE SIGNS OF STRUGGLE?
6. DID THE VICTIM DIE INSTANTANEOUSLY?
7. IS IT POSSIBLE FOR THE VICTIM TO FIRE OR
RESIST THE ATTACK AFTE THE INJURY WAS
SUSTAINED?
8. WHERE WAS THE POSTION OF THE ASSAILANT
AND THE VICTIM WHEN THE SHOT WAS FIRED?

The caliber may be inferred from the diameter of the


wound of entrance.

Determination of the length of survival of the victim:


1. nature of the GSW
2. organs involved
3. presence or absence of infection
4. amount of blood loss
5. physical condition of the patient
Capacity of a victim to perform volitional acts
depends upon the area of the body involved,
involvement of vital organs and the resistance of the
victim.

DETERMINATION AS TO THE LENGTH OF TIME A


FIREARM HAD BEEN FIRED
1. odor of the gas inside the barrel
2. chemical changes inside the barrel
3. evidences that may be deduced from the wound
DETERMINING WHETHER THE WOUNDING WEAPON IS
AN AUTOMATIC PISTOL OR A REVOLVER
1. location of the empty shells revolver the
empty shells are found in the cylindrical magazine
chamber after the fire
2. nature of the spent shell automatic firearm =
bullet is copper jacketed

3. nature of the base of the cartridge or spent


shell = base of a revolver has a wider diameter
than that of the cylindrical body to keep the cartridge
stay in the magazine chamber.
It may be possible for a person who is accustomed
to the sounds of firearms of different calibers to
identify the firearm by the sound produced.
It is not possible to determine the direction of the
shot by determining the direction of the sound
except
when the flash or the person firing the shot is seen at
the time the shot was fired

GSW may not be a near fire or may not appear to be


near fire:
1. when a device is set up to hold the firearm and to
enable it to be discharged at a long range by the
victim.
2. when the GSW of entrance does not show
characteristics of a near shot because the clothing
are
interposed between the victim and the firearm.
3. when the examining physician failed to distinguish
between a near or far shot wound
4. when the product of a near shot has been washed
out of the wound.

X-ray

1. facilitate the location and extraction of the wound


2. reveals fragmentation and its location
3. shows bone involvement like fracture
4. reveal trajectory of the bullet
5. shows effect of the bullet wound, like
hemorrhage, escape of air, laceration

SHOTGUN WOUNDS
Is a shoulder fired firearm having a barrel that is
smooth-bored and is intended for the firing of a
changed
compound of one or more balls or pellets.
Measure the distance between the two farthest
shot(pellets) in inches and subtract one, the
number obtained will give the muzzle-target distance
in yards.

Determination of the presence of gunpowder and


primer components:

Importance:

1. Determination of the distance of the gun muzzle


from the victims body when fired. Usually not
more than 24 inches when fired.
2. Determining whether a person has fired a firearm.
dorsum of the hand
= metallic residues, burning and unburned gunpowder
= in suicide found in the palm

Procedures in determining the presence of


gunpowder:
1. Gross examination use of hand lens Fine black
powder not conclusive
2. Microscopic examination
3. Chemincal Test

Tests for the Presence of Powder residues


1. On the skin - Dorsum of the hand or Wound of
entrance
Dermal nitrate test ( Paraffin test, Diphenylamine
test, Lungs test , Gonzales test)
= melted paraffin heated at 150 degrees fahrenheitLungs reagent
= small particles with nitrate or nitrite > blue reaction
= not conclusive: fertilizers, cosmetics, cigarettes,
urine
= Negative is not conclusive: thorough washing

2. On clothings
Walkers test ( C-acid test, H-acid test)
= glossy photographic paper fixed in hyposolution for
20 min to
remove the silver salts and washed for 45 min. and
dries.

Tests for the presence of Primer Components


metallic primer residues like barium, antimony, and
lead.
1. Harrison and Gilroy test :Cotton swab moistened
with 0.1 molar HCl to gather the primer component.
= Reagent sodium rhodisonate yields red color with
the primer components.
= Add 1.5 HCl to the red area> blue-violet or pink in
lead or barium
= lacks specificity, sensitivity

2. Neutron Activation Analysis (NAA)


= Sample obtained by paraffin or by washing with
dilute acid
= Extremely sensitive, even with small quantity
3. Flameless Atomic Absorption Spectroscopy (FAAS)
4. Use of Scanning electron microscope with a Linked Xray analyzer

THERMAL INJURIES OR DEATHS


- are those caused by deviation from normal
temperature, capable of producing
cellular or tissue changes in the body.
- Exposure to severe cold
= Frost bite
- exposure to high temperature = burning scalding

1. DEATH OR INJURY FROM COLD


- not common in the Philippines
- Primary cause of death: Decrease dissociation of O2
from Hgb in the RBC
: Diminished power of the tissue to utilize O2
- Cold damp air is more fatal than cold dry air.
- Women are more resistant to cold > greater deposits
of SQ fats.

Effects of COLD:
A. Local effect ( Frostbite, Immersion foot, Trench
foot )
1st- Blanching , paleness of the skin due to vascular
spasm.
2 nd - Erthyma, edema, swelling due to vascular
dilatation, paralysis and
increased capillary permeability.
3rd - Blister formation
4 th - Necrosis, vascular occlusion, thrombosis and
gangrene.
Microscopically: Vacuolization, degeneration of
epidermal cells
: Necrosis of the collage of the SQ tissue
: Occlusion of the vessels due to clumping of RBC

Effects of COLD:
A. Local effect ( Frostbite, Immersion foot, Trench
foot )
1st- Blanching , paleness of the skin due to vascular
spasm.
2 nd - Erthyma, edema, swelling due to vascular
dilatation, paralysis and
increased capillary permeability.
3rd - Blister formation
4 th - Necrosis, vascular occlusion, thrombosis and
gangrene.
Microscopically: Vacuolization, degeneration of
epidermal cells
: Necrosis of the collage of the SQ tissue
: Occlusion of the vessels due to clumping of RBC

B. Systemic effects:
- Reflex in nature due to the stimulation and paralysis
of the nerves
- Pulmonary ,Cardiac action is slowed down due to
cerebral anoxia>
resulting to lethargy, delirium, convulsions, coma or
death.

2. DEATH OR INJURY FROM HEAT - effect may be local


or general

Classifications of Heat Injury:

a) General or Systemic effects:


a.1 Heat cramps
a.2 Heat exhaustion
a.3 Heat stroke

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

GENERAL OR SYSTEMIC EFFECT: death usually


accidental
1. Heat cramps( Miners Camp, Firemans Camp,
Stroker s camp)
- Involuntary spasmodic painful contraction of
muscles due to dehydration and excessive loss of
chlorides by sweating
Ex. Fluids with chlorides
2. Heat Exhaustion ( Heat collapse, Syncopal Fever,
Heat syncope,Heat prostration)
- Due to heart failure, cause:Heat precipitated by
exertion/warm clothes
= Sudden syncope, face turns pale, dim vision
Ex. Removal of heated area

. Heat stroke(Sunstroke,Heat Hyperpyrexia,Comatous


form,Thermic Fever)
- Working in ill-ventilated places with dry
temperature or exposure to the sun
LOCAL EFFECTS OF HEAT
1. Scald:
Caused by hot liquid
The injury by scalding is not severe as burns:
a. Scalding liquid runs on the body surface
distributing the heat
b. Easily cools off
c. Temperature not as high except : oils and molten
metals

2. Thermal burns: Caused by heat or chemical


substances like fire, radiant heat,friction, solid
substances, electricity.
: Classification of burns/ DUPUYTRENS
CLASSIFICATION
1st degree

ERYTHEMA

2nd degree

VESICLE FORMATION

3rd degree

Destruction of the
cuticle,part of
skin,painful

4th degree

Whole skin is destroyed,


ulceration,not painful

5th degree

Deep facia, muscles

6th degree

Charring of the limbs

BURNS

SCALDS

CAUSE

DRY HEAT FLAME,


HEATED
SOLD RADIANT HEAT

MOIST HEAT- LIUID,


STEAM

LOCATION

AT OR ABOVE TE SITE
OF CONTACT

OCCURS AT OR BELOW

SINGEING

OF HAIR IS PRESENT

ABSENT

BOUNDARY OF
NORMAL

NOT CLEAR

DISTINCT

INJURY

SEVERE

LIMITED

CLOTHINGS

INVOLVED

NOT BURNED

Proofs that the victim was ALIVE BEFORE burned to


DEATH:

1.
2.
3.
4.

Presence of carbon particles in the air passage.


Increase carboxy-hemoglobin blood level.
Dermal erythema, edema and vesicle formation.
Subendocardial left ventricular hemorrhage.

BURNS

ANTE-MORTEM
BURNS

POST MORTEM
BURNS

BLISTER

ABUNDANT ALBUMIN /
CHLORIDES

SCANTYALBUMIN/
CHLORIDES

AREA OF
INFLAMMATIO
N
BASE OF THE
VESICLE

AROUND THE
ANTEMORTEM BURN

ABSENT

RED

NOT MUCH CHANGE IN


COLOR

TRACHEOBROCHIAL
LUMEN
BLOOD

PARTICLES OF SOOT OR NO FINDINGS


CARBON
ABUNDANCE OF
CARBOXY-HGB

ABSENT

Differential diagnosis of blisters:

1. Due to putrefaction fluid content is blood stained


watery fluid
- asso. with putrefactive changes in other parts of
body.
2. Due to disease- heat by the size, distribution

3. Due to friction- Hx of application of heat

3. Chemical burns
- heat by the size, distribution
- Hx of application of heat
Characteristics of lesions:
a. Absence of vesication
b. Staining of the skin or clothing by the chemical
c. Presence of the chemical substance
d. Ulcerative patches of the skin
e. Inflammatory redness of the skin surface
f. Delayed healing

CHEMICAL
BURNS

THERMAL
BURNS

BLISTER

ABSENT

PRESENT

SKIN /
CLOTHINGS

STAINED
CHEMICALS

NO STAINING

ANALYSIS OF
SUBSTANCE

SHOWS
CHEMICAL
CORROSION
BORDERS ARE
DISTINCT

ABSENT

LESION

DIFFUSED

Characteristic lesions by different chemicals:

a. Sulphuric acid ( Oil of Vitriol)


= most intense action, considerable destruction
= ulcerations where acid flowed, clothings destroyed
= blackish-brown sloughs

b. Nitric acid
= Clothing is destroyed, brown
= yellow or yellowish brown slough

c. Hydrocloric acid
= not so destructive
= intense irritation, localized ulceration red or
reddish-gray.
d. Caustic soda and Potash
= Corrosive action on the tissues with bleached
appearance

4. Electrical burns - Contact burns, spark burns, Flash


burns

5. Radiation burns - x-ray, UV light burns

PHYSICAL INJURIES OR DEATH BY


LIGHTNING AND ELECTRICITY
Lightning - is an electrical charge from the
atmosphere.
- 1 million volts/ 2000 amperes
Elements of lightning that produces injury:
1. Direct effect from the electrical charge.
2. Surface flash burns from the discharge - electrical
into heat energy.
3. Mechanical effect - expansion of air > laceration
4. Compression effect - sledgehammer blow

Spasmodic contraction of cerebral vessels > shock

Electricity - main cause of death is shock


- Above 300 volts are like the effect of lightning,

Factors which influence the


effect of electrical shock:

1. Personal idiosyncracy personal condition


2. Disease cardiac dis. Is prone
3. Anticipation of shock Can withstand
4. Sleep increases resistance
5. Amperage or intensity of the electrical current
principal factor
= 70-80 in AC and 250 in DC.

Factors which influence the effect of


electrical shock:

1. Personal idiosyncracy personal condition


2. Disease cardiac dis. Is prone
3. Anticipation of shock Can withstand
4. Sleep increases resistance
5. Amperage or intensity of the electrical current
principal factor
= 70-80 in AC and 250 in DC.
6. Resistance of the body
7. Nature of current AC is more dangerous
8. Earthing- shock is enhanced
9. Duration of contact
10.Point of entry left more dangerous than the right

Mechanism of death in electrical shock:

1.Ventricular fib leads to rupture of muscle fibers


2. Respiratory failure due to bulbar paralysis
3. Mechanical asphyxia due to violent and prolonged
convulsion.

Metallization: - specific feature of electrical


injury particles of the metal are driven into the
epidermis causing darkening of the skin

Delayed effects of electrical injuries:


= the metal of the conductor is volatilized
and
= necrosis of the area develops into gangrene
= Damaged arteries becomes brittle, friable and
liable to rupture
= Nervous injuries retrograde amnesia,
hemiplegia
= May enter the head > cataract

DEATH OR PHYSICAL INJURIES DUE TO CHANGE


AF ATMOSPHERIC PRESSURE ( BAROTRAUMA)

Increase of atmospheric pressure ( Hyperbarism)


-Normal atmospheric pressure at sea level is 760
millimeters of Hg.

- Henrys Law
- At constant temperature, the amount of gas
dissolved in a liquid is directly proportional to
the pressure

= As he goes deeper there will be an increase in the


amount of gas dissolved in the blood and other body
fluids.

= If ascent is made rapidly, the diver will suffer from


the effects of the sudden release of the gasses from
the body fluids.

= released of air bubbles in the circulation and act as


emboli in different parts of the body causing
interstitial emphysema, pulmonary embolism, in big
joints called bends.

Decrease of atmospheric pressure


(Decompression)
1. Hypobarism - at high altitudes the
atmospheric pressure is lower and more gas will
be liberated by the body fluid.
= release of gasses results to:
a) Bends joint and muscular pain
b) Chokes Substernal distress, non-productive
coughing
c) Substernal emphysema
d) Trapped gas
2. Anoxia- Hypoxia felt at 8000-15,000 feet
level
- Aircrafts greater than 34,000 feet be provided
with O2.

AIRCRAFT INJURIES AND FATALITIES


1. During the flight
a) Altitude: Hypobarism ( Decompression)
b) Speed - spatial disorientation ; sudden change
of direction at a speed of 500 miles drains brain
from blood to the lower parts> unconsciousness
c) Toxins - CO, CO2 saturates cabin resulting to
asphyxia
d) Temperature - At 25,000 feet 40 degree below
zero: frost bite , freezing
e) Pre-existing disease - Coronary dis./Hpn fatal
due to sudden change env.
2. During crash fatalities occur us. during
take-off and landing.
- Fx, Rupture of the heart due to cmpression.

DEATH BY ASPHYXIA
Asphyxia - Applied to all forms of violent death
due to interference with process of respiration
- Conditions in which the supply of O2 to the
blood or tissues or both has been reduced
below normal
level.
Types of asphyxial death:
1. Anoxic death
- Failure of arterial blood to be normally
saturated with O2 due to:
a) Breathing in an atmosphere with insufficient
O2- High altitude

b) External obstruction of the air passage


-traumatic crush asphyxia

c) Paralysis of the respiratory center


-poisoning, injury, anesthesia

d) Mechanical interference of the passage of


air- drowning, asthma

e) Shunting of blood

2. Anemic anoxic death


Decrease capacity of the blood to carry O2 due
to Hge, CO poisoning, Low Hgb
3. Stagnant anoxic death
Failure of circulation due to Heart failure, shock,
arterial venous obstruction
4.Histotoxic anoxic death
Failure of the cellular oxidative process, cannot
be utilized in the tissues. Cyanide

Phases of asphyxial death:


1.Dyspneic phase - Breathing is rapid and deep,
PR inc., Rise of BP
due to lack of O2 and retention of CO2
2. Convulsive phase - Cyanosis more pronounced,
pupils dilated, unconscious
- Tardieu spots =petechia /hges in the visceral
organs
due to stimulation of CNS by CO2
3. Apneic phase - Breathing is shallow, gasping
- Due to paralysis of respiratory center

Classification of Asphyxia:
1. Hanging
2. Strangulations: by ligature, manual
strangulation, spl forms -palmar
3. Suffocation: choking
4. Asphyxia by drowning
5. Asphyxia by pressure on the chest
6. Asphyxia by irrespirable gasses

Hanging is ante-mortem:
Vital reaction= principal criterion
1. Redness or ecchymosis at the site of ligature.
2. Ecchymosis of the pharynx and epiglottis.
3. Line of redness or rupture of the intima of the
carotid artery
4. Subpleural hges.

B.ASPHYXIA BY STRANGULATION - Tightened by


force not the weight
HANGING

STRANGULATION

HYOID BONE

FREQUENTLY INJURED

FREQUENTLY SPARED

DIRECTION OF
LIGATURE MARK

INVERTED V-SHAPE

USUALLY HORIZONTAL

LIGATURE LOCATION

AT LEVEL OF HYOID BONE

BELOW LARYNX

LIGATURE LOCATION

DEEPEST OPPOSITE THE


KNOT

UNIFORM DEPTH

VERTEBRAL INJURY

FREQUENTLY OBSERVED

NOT OBSERVED

Manual strangulation or throttling:


- form of asphyxial death where the constricting
force is the hand.
C. ASPHYXIA BY SUFFOCATION
- Occlusion of air from the lungs by closure of air
openings or obstruction of the air passageway
from the external openings to the air sacs.
Smothering:
- A form of asphyxial death cause by closing the
external respiratory orifices.
Overlaying - most common in children : pressure
of pillows
Gagging - application of materials to prevent air
to have access to mouth and nostrils.

Plastic bag suffocation


Choking- Form of suffocation by the impaction of
F.B. in the respiratory passage.
D. ASPHYXIA BY SUBMERSION OR DROWINING
- Form of asphyxia where the nostrils and mouth
has submerged in watery fluid.
Time required for death in drowning:
- Submersion for 1 minutes considered fatal.
- Average time required for death in drowning is 2
to 5 minutes.

Emergency treatment in Drowning


1. Schaefers method - Face down, prone
position:operator exerts pressure in ribs
2. Sylveste s method- Lying on his back, astride
over body, swinging arms

Post-mortem findings:
1. External findings
a) Wet clothes, pale face, F.B. clinging on skin
surface
b) Cutis anserine or goose flesh -skin is pale ,
contracted
NOT Dxtic
c) Washerwomans hands and feet - skin of hands &
feet:bleached NOT Dxtic
d) Postmortem lividity - marked in the head, neck
and chest.
e) Presence of firmly-clenched hands with objects Person was alive at first
f) Physical injuries for struggle

2. Internal findings
A. RESPIRATORY SYSTEM
1. Emphysema aquosum - Lungs are distended
overlapping the heart
= Due to irritation made by the inhaled water on
the mucous membrane of
the air passage which stimulate the secretion of
mucous.
2. Edema aquosum- Due:Entrance of water into
air sacs, Lungs are doughy
3. Champignon docume - whitish foam
accumulates in the mouth/nostrils
= Due: abundance of mucous secretion
= One of the indications that death was due to
drowning.

4. Tracheo-bronchial lumen congested, filled


with froth
5. Blood stained fluid found inside chest cavity.
6. Section lungs shows fluid with bloody froth.
B. HEART
1. Both sides of heart may be filled or emptied
with blood.
2. Salt water drowning - Blood chloride content is
greater than left side.
Fresh water- Blood chloride is more I the right
side. FRESH- RIGHT

Gettlers Test:
- Quantitative determination of the chloride
content of the blood in the right and left
ventricle of the heart.
:Difference of at least 25 mg.
C. STOMACH
Presence food in the stomach but absence of
water.
> Death is rapid or submersion made after
death.
Impossible for water to get into the stomach if
body is submerged afterdeath.

FINDINGS CONCLUSIVE THAT THE PERSON DIED OF


DROWNING
1. The presence of F.B. in the hands of the
victim.
The clenching of the hands is a manifestation of
cadaveric spasm in the effort of the victim to
save himself from drowning.
2. Increase in volume (emphysema aquosum)
edema of the lungs ( edema aquosum)

3.Presence of water in the stomach


4. Presence of froth, foam, F.B. in the air passage
found in the medium where the victim was found.
5. Presence of water in the middle ear due to
violent inspiration when the mouth is full of water.
Floating of the body in drowning:
-Within 24 H due to the decomposition which
causes the accumulation of gas in the body, the
body floats.
- Body is flexed because of the dominance of the
flexor muscles
-tete de negri - bronze color of head and neck;
face as the most dependent portion of the body.

Homicidal D. = struggle, motive, articles found


near the place, phys. Injuries
Suicidal D.= note, heavy objects, mentality, Hx of
previous attempt
Accidental = Absence of violence in the body.,
exclusion of suicide, witnesses

E.COMPRESSION ASPHYXIA
( TRAUMATIC CRUSH ASPHYXIA )

Form of asphyxia where the free exchange of air


in the lungs is prevented by the immobility of
the chest and abdomen due to external pressure
or crush injury.

Homicidal =offender kneels on the chest

- Accidental = pinned between two big objects

Burking - invented by Burke and Hare= murder for


the sale to medical schools
Kneels or sits on the chest and the hands close
the mouth and nostrils
Death by crucifixion- alternative raising and
lowering of the body leads to exhaustion,
unconsciousness and death from asphyxia = IC mm
are stretched

F. ASPHYXIA BY BREATHING
IIRESPIRABLE GASES
1. Carbon monoxide silent
killer, colorless, insoluble in
water and alcohol.
- formed by the incomplete combustion of carbon
fuel.

Qualitative test for CO in the


blood
a) Kunkels test 4 volume of water + 3x its
volume of 1% tannic acid
- crimson red if positive
b) Potassium Ferrocyanide test -bright red
c) Spectroscope exam
d) Gas chromatograph
e) Infra-red analysis

2. Carbon dioxide CO2,


Carbonic acid gas
- Blown out of the lungs during respiration
- Product of complete combustion of carbon
containing compounds
- End result of fermentation & decomposition of
organic matters.- septic tank
= The inhalation of pure CO2 may cause
immediate vagal inhibition with spasm of the
glottis and
death. = manhole, poorly ventilated rooms

Tests for the presence of CO2


1. Barium nitrate - white precipitate of Barium
carbonate with carbonic acid
2. silver nitrate - white ppt. of silver carbonate
when carbonic acid is added.
3. Hydrogen sulfide
( H2S, Sulphuretted hydrogen ) = rotten egg odor
- Formed during decomposition process of organic
substances containing sulphur
- Causes titanic convulsion, delirium, coma, death

4. Hydrogen cyanide - one of the most toxic,


rapid acting gas
- Formed by the addition of acid to potassium
or sodium salt of cyanide
- Found in plants; leaves of cherry laurel,
bitter almond, kernels of common
cherry, plum, peaches, ordinary bamboo
shoots, certain oil seed and beans
- Contains AMYGDALIN which in the presence
of water and natural enyzme
EMULSIN is readily decomposed to
HYDROCYANIC ACID, glucose and
benzaldehyde.
= 60-90 mg of Hydrogen cyanide is fatal,
death in 2 to 10 min

5. Sulfur dioxide - Heavier than air, pungent


odor
- employed as disinfectant, bleaching agent,
found in eruption of volcano
WAR GASES
Classification based on the physiological action
1. Lacrimator or Tear gas - causes irritation with
copious flow of tears
a) Chloracetphene (C.A.P.)
b) Bromobenzyl cyanide (B.B.C.)
c) Ethyl Iodoacetate ( K.S.K.)
High concentration- irritation of respiratory
passages, lungs, V,N

2. Vesicant of Blistering Gas - contact with skin


cause bleb or blister formation
a) Mustard gas ( Dichlordiethyl sulfide, yellow
cross, Yperite)
b) Lewisite ( Chlorovinyl-dichlorarsine)
3. Lung irritants ( Asphyxiant or choking gas)
- Dysnea, tightness of the chest, coughing, coma ,
death
a) Chlorine ( Cl2) - yellowish green gas
b) Phosgene (COCl2)
c) Chloropicrin
d) Diphosgene

4. Sternutator - nasal irritants of vomiting gases


5. Paralysants Nerve gas - like organophosphates
6. Blood poisons -CO, H2S, Hydrogen cyanide

DEATH OR PHYSICAL INJURIES DUE TO


AUTOMOTIVE CRASH OR ACCIDENT
Factors responsible to an Automotive Crash
HUMAN FACTOR ( DRIVER)
1. Mental attitude: reckless driving, fatigue,
inexperience
2. Perceptive defect
3. Delayed reaction time
4. Disease
5. Chemical factor

2. ENVIRONMENTAL FACTOR
Poor visibility, poorly maintained roads, rain,
blind intersection
3. MECHANICAL FACTOR: Poor brake, worn out
tires
4. SOCIAL FACTOR: Speed, insurance
5. PEDESTRIAN

Injuries and Death on the


Driver and Passengers:
1. First collision: the impact of the moving
vehicle with another or fixed object
= The MOVING VEHICLE - rapidly decelerates and
stops after impact.
= The degree of damage depends:
a) speed
b) part of vehicle involved

2. Second collision: Impact of unrestrained


occupants with the vehicle interior
= 1st Col., Occupants move same direction/velocity
towards point of impact
a) Front impact> Occupants move forward.
b) Side impact ( severe) > moves to the side that
was involved in the 1st Col.
>The passenger nearest to it will suffer the most.
c) Rear impact crash - Acceleration-deceleration
injury or whiplash
d) Roll over crash ( Turn turtle impact )
= If vehicle is not put into a stop after the 1st Col.
> the unrestrained occupants will continue to
strike to some parts of the vehicle interior.

Pedestrian-Vehicle Collision:
Death or Physical Injuries to pedestrian
1.Primary impact - Contact with vehicle
2. Secondary impact - Subsequent impact of the
pedestrian to the ground
- Accounts for the multiple injuries
3. Run over Injuries

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