MEDICO LEGAL

ASPECT OF PHYSICAL
INJURIES
Physical injuries . . . .

- are the effects of the application of

stimulus to the body. These effects may only
be apparent when the stimulus applied is
small and the body resistance is great, or real
when the effects are visible. Their
appearance may be immediately after the
application of the stimulus, or delayed as
physical injuries brought about infection.
Causes of Physical Injuries:

1. Physical Violence
2. Heat or Cold
3. Electrical Energy
4. Chemical Energy
5. Radiation by radio-active substance
6. Change in the Atmospheric Pressure
 Physical injuries brought about by
physical violence
Wound
is the solution of the natural continuity of any
tissue of the living body. In several occasions,
the word physical injury is use interchangeably
with wound. However, the effect of physical
violence may not always result to the production
of wound, but wounds are always the effect of
physical violence.
Vital Reaction:

It is the some total of all reactions of

tissues and organs for which activities of
living cells are necessary. It is the response
of living tissue to an existing stimulus. The
tissue reaction maybe observed
macroscopically but it is better observed
with precision through the microscope.
Defense Wound
are the results of a person’s
instinctive reaction of self-protection.
It maybe found in the hand, in the
effort to grasp the wounding weapon
or by raising the hands to protect the
vital parts of the body..
EXAMPLE OF DEFENSE WOUND
 Classification of Wounds:
1. As to Severity:
A. Mortal Wounds:
Wounds which are immediately after infliction or
shortly afterwards is followed by death.
Wounds involving the following parts of the body
produce death within a short time:

1. The heart and large blood vessels

2. The brain and upper part of the spinal cord
3. The lungs
4. The stomach, liver, spleen and intestine
B. Non-mortal wounds:

Wounds which by themselves are not

capable of producing death immediately after
infliction or shortly afterward.
2. As to Kinds of Instrument Used:
(1)Sharp-edged instrument

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(2) Sharp-pointed instrument

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(3) Sharp-edged and pointed instrument
C. Wound brought about by tearing force
D. Wound brought about by change of
atmospheric pressure

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E. Wound brought about by heat and cold
F. Wound brought about by infection

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3. As to the Manners of Infliction:
a. Hit by means of a bolo, blunt instrument, axe.

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b. Thrust or stab-by dagger, knife, saber,
bayonet.

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c. Tearing or stretching.

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d. Gunpowder explosion,- projectile or shrapnels.

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e.. Sliding or rubbing.
4. As regards the Depth of Wound:
a. Superficial - When the wound involved
only the layers of the skin.
b. Deep - When the wound involved the inner
structures of body.
 It may be:
(1). Penetrating – When it has
pierced a solid organ or tissue.
(2). Perforating – When there
is a communication between the inner
and outer portions of the hollow
organs.
5. As regards the Relation of the Site of the
Application of Force and the Location of the
Injury:
a. Coup Injury- Physical injury which is found
at the site of the application of force.
b. Contre Coup Injury - Physical injury found
on opposite the site of the application of
force.
c. Coup contre coup injury - Physical injury
which is found at the site and also opposite the
site of application of force.
d. Locus Minoris Resistencia - Physical injury
found not at the site or opposite the site of
the application of force but in some areas
offering the least resistance to the force
applied.
• e. Extensive Injury – Physical injury
involving a greater area beyond the site
of the application of force with manifest
marks of extensions from the location of
the place where the force is applied.
6. As to the Regions or Organs of the
Body Involved:
The wound on different organs and
regions of the body will be
discussed separately under
“Injuries in Various Parts of the
Body”.
7. Legal Classifications:

a. Mutilation: Art. 262, Revised Penal Code

b. Serious Physical Injuries: Art. 263, Revised
Penal Code
c. Administering Injurious Substances or
Beverages: Art. 264, RPC
d. Less Serious Physical Injuries: Art. 265, RPC
e. Slight Physical Injuries and Maltreatment: Art.
266, RPC
Abrasion in the form of tire marks in a victim of vehicular accident
PICS
Abrasion
 PICS
Contusion of the right eyelids
PICS
Multiple stab wounds
8. As to the types of the Wounds:
A. Close wounds:
When there is no breach of continuity of the skin or mucous membrane.
1. Superficial:
(a) Petechia
(b) Contusion or bruise
 INSERT PICS

(c) Hematoma or blood cyst

2. Deep:
(a) Sprain
(b) Dislocation
(c) Simple fracture
(d) Rupture of organs
(e) Concussion
(f) Internal hemorrhage
b. Open wounds:
When there is communication with the outside or break in the
skin or mucous membrane
1. Abrasion or scratch

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2. Incised wound
3. Lacerated wound

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4. Punctured wound

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5. Wound produced by powder explosion
6. Mutilation

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7. Avulsion
TYPES OF WOUNDS
CLOSE WOUNDS:
A. SUPERFICIAL CLOSE WOUNDS:
1. PETECHIAE:
These are circumscribed extravasations of
blood in the subcutaneous tissue or underneath
the mucous membrane. It may or may not be
brought about by trauma. Several petechiae may
coalesce with one another forming bigger
hemorrhagic area.
2. CONTUSION:

A contusion or bruise is a wound not on

the surface of the skin but in the substances
cellular tissue. The extent depends upon the
severity of the force applied, part injured,
delicacy of the tissue and the condition of the
blood vessels. There is swelling and
discoloration of the tissue and extravasation
of blood.
Changes in color of contusion:

The contusion is red and sometimes purple

soon after the injury.
In 4 to 5 days, the color is change to green.
In 7 to 10 days, in becomes yellow and
gradually disappears on the 14th or 15th day.
The ultimate disappearance of color varies
from 1 to 4 weeks, depending upon the severity
and constitution of the body.
Example:

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A blow on the head may produce contusion on the eye
lids
The position of the bruise may indicate the manner of assault
Example:

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Contusion produced with a branch of tree will show the markings of the branch.
The determination of the age of the contusion is based on the color changes.
 Factors Influencing the Degree and Extend of Contusions;

a. General condition of the victim:

Some healthy persons are easily bruised.

b. Part of the body affected:

Bloody portion of the body produces larger contusions,
more specially when the subcutaneous tissue is loose.
Area of the body where there is excessive fat, contusion
easily develops, while parts of the body with abundant
fibrous tissue and good muscle tone, bruising is less.
c. Amount of force applied:
This depends upon the amount or degree of
injuries produced by the force.

d. Diseases:
May or may not require force to produce
contusion:
Example:
1. Purpura;
2. Hemophilia;

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3. Aplastic anemia;

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4. Whooping Cough;

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E. Age:
Children and old people tend to bruise
more easily. Children have loose and
delicates skin. Old people have less flesh
and there are vascular changes.
F.Sex:
Women, specially if obese,
easily develop contusion.
Athletes, like boxers do not
develop contusion easily.
3. HEMATOMA:

This is the extravasation of blood in a

newly formed cavity. It is sometimes called
blood tumor. There is extreme destruction of
the tissues underneath the skin, thereby
allowing the blood to accumulate. Puncture of
aspiration of the area, blood will be obtained.
Complications of hematoma:
If conditions become favorable, the hematoma
may develop into:
a. Abscess
b. Gangrene

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c. Hypertrophy

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d. Fibroid thickening

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e. Malignancy

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B. DEEP CLOSE WOUNDS:
1. FRACTURE:
Fracture is the sudden
solution of continuity of a bone,
resulting from violence of from
some existing pathology.
 Classifications of fracture:

a. Close or simple fracture:

Fracture wherein there is no break in the
continuity of the overlying skin or where the external air has no
point of admission to the site of injury.

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b. Open or compound fracture:
Fracture wherein the skin or mucous membrane has direct
or indirect communication between the fracture and the external
air.

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2. Sprain:
A sprain is a subcutaneous separation or tearing of the
articular tendons, ligaments or muscles.

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3.DISLOCATION:
It is displacement from each other of the articular surfaces
of bones entering into the formation of a joint.

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 Classifications of dislocation:
a. Simple or close dislocation:
A dislocation wherein there is no break in the skin.

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b. Compound or open dislocation:
Dislocation associated with an external wound.

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4. CEREBRAL CONCUSION:

The jarring or stunning of the brain

characterized by more or less complete
suspension of its functions, as a result of injury to
the head, which leads to some commotion of the
cerebral substance.
5. INTERNAL HEMORRHAGES:
a. Intracranial hemorrhages
b. Ruptures or parenchymatous organs.
c. Laceration of other organs.
OPEN WOUNDS:
1. Abrasion:
It is an injury characterized by the
removal of the superficial epithelial layer of the
skin brought about by friction against a hard
rough surface. It may or may not be associated
with bruise. The raw area exudes blood and
lymph which later cries and forms a protective
covering known as crust or scab.
Forms of Abrasions:
a. Linear:
The abrasion which appears as single line. It may
curved or straight.

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b. Multi- Linear:
This is a seen when the body surface is rubbed on a rough hard object
thereby producing several linear marks parallel to one another:

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c. Confluent:
Abrasion where he linear marks on the skin surface are almost
indistinguishable on account of the severity of friction and roughness of
the object.

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d. Multiple:
Several abrasions are noted on the body surfaces of a person.

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Types of Abrasions:
1. Scratches – These are caused by a sharp- pointed
objects slide across the skin, like pin, thorn, or finger nail. The injury
is always parallel to the direction of the slide.

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2. Grazes – These are usually caused by forcible contact with
rough, hard objects resulting to irregular removal of the skin
surface.

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3. Impact or imprint abrasion - This is brought about by
sudden impact of hard rough object on the skin there by producing
an impression on the surface.

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4. Pressure of friction abrasion – These are abrasion whereby
pressure is applied accompanied by movement and is commonly
seen in hanging or strangulation.

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 Distinctions between erosion and
abrasion:
In abrasion, there is scraping off of
the outer layer of the skin brought
about by friction of sliding, while in
erosion there is superficial loss or
eating away of the tissues by any
cause other than friction or sliding.
Differential diagnosis of abrasion:

1. Mark produced by insects and fishes:

Injury brought about by insects and fishes in bodies
shows no vital reaction and are usually found in the angles of the
mouth, margin of nose, eyelids and forehead.

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2. Excoriation of the skin by excreta:
It is only found in infants and may be removed when the
cause is removed.

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3. Pressure sore:
Usually found at the back at the region of bony prominence.
History of long standing illness and bedridden differentiate it from
simple abrasion although the sore may start as an area of abrasion.

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 Distinctions Between Ante-mortem and Post- mortem
Abrasion:
Ante-mortem abrasion
1. Color Reddish- brown in
appearance due to slight
exudation of blood.
2. Location Any area.
3. Vital reaction With intravital reaction and
may show remains of
damaged epithelium.
Post-mortem abrasion
Yellowish and translucent in
appearance.
Generally occur over bony
prominence, such as elbow,
and attributed to the rough
handling of the cadaver.
Show no vital reaction and
is characterized by a
separation of the epidermis
from complete loss of the
former.
POST MORTEM ABRASION
ANTE-MORTEM ABRASION
2. INCISED WOUND:

This is produced by forcible contact of the

body with sharp-edged instrument. There is no
loss of substance and the wound usually gapes.
The retraction is most marked at the center of the
wound, and the degree of retraction depends
upon the amount of elastic tissues severed and
the direction of the wound. The edges of the
wound are clean-cut, well-defined and regular.
The extremities are sharp.
 Wounds brought about by glasses:
Sometimes it is difficult to determine the type of
wound brought about by glasses. It may be lacerated,
incised, stab or punctured depending upon the
characteristic of the wound produced.
If the sharp point of the broken glasses causes the
injury it may be a punctured wound. The wound may
simulate an incised wound when the sharp edge of the
glass forcibly come in contact with the skin, although
minute examination of the edges may show contusion.
Examination with the aid of the hand lens is
necessary to determine the presence of particles or flakes
of glasses in the wound.
Changes that occur in an uncomplicated incised
wound:
12 hours ; Edges red and swollen- adherent
with blood and lymph with
leukocytic infiltration.
24 hours ; Proliferation of the vascular
endothelium and connective
tissue cells.
38-48 hours ; Capillary network complete
Fibroblasts running at right
angles to the vessels.
3-5 days ; Vessels show thickening and
obliteration.
Incised wounds may be suicidal, homicidal or accidental:

a. Suicidal incised wounds:

a. They are characterized by the peculiar location of
the injuries. They are usually located at the region of
the throat, on the flexor surfaces of the extremities,
at the region of the elbow, groins and kneels. In
suicidal cut-throat, the direction of the cut is
oblique, which may be to the right or to the left
depending as to whether the person is left or right
handed. There are usually supeficial-tentative cuts.
(Hesitation cuts).
b.Homicidal incised wounds:

Homicidal incised wounds are

usually deep, multiple and
involving the accessible and the
non-accessible portions of the
body.
 INSERT PICS OF
HOMICIDAL INCISED
WOUNDS
c. Accidental incised wounds:

This type of incised wounds are

rare. They usually brought about by
broken glasses, edges of iron
sheets, or oyster shells.
INSERT PICS
OF
ACCIDENTAL
INCISED
WOUNDS
 Distinctions between Homicidal and Suicidal Cut-throat
Wounds:

Suicidal Cut-throat Homicidal Cut-throat

1. Direction- Oblique , from below left ear, 1. Usually horizontal or from below
downwards, across front neck just above upwards through or below Adam’s apple.
Adam’s apple, then slightly upwards on
the right side. May be horizontal or even
from below upwards.

2. Severity varies. One or all large vessels 2. They may be of any depth but seldom
on the side are usually completely show any hacking or cuts in the bones or
severed. All structures down to spinal cartilages of the spine.
column and even the cartilages of the
disc. May be divided or only the wind pipe
may be divided.
3. There may be several cuts at the 3. Practically never seen in homicide, there
commencement of the large wound. may be several superficial cuts but in other
situations, the result of struggling on the
part of the victim.
4. Position of the body- May be found in 4. Features and limbs may be contorted,
front of shaving mirror be spattered with clothes torn and disarranged, cuts on palm
blood. aspect of hands lying on a bed, etc.

5. Position of weapon- May be firmly 5. Cadaveric spasm can not be artificially

grasped by the hand (cadaveric spasm) or induced. Weapon may be absent.
lying near it.

6. Distribution of blood- Blood flows down 6. If victim is lying down the blood flows
front of body; hand generally severed with backward there will be little on the front.
blood ; absence of any bloody foot or finger Hands may be clear except from cuts
marks of other person. received in trying to avoid knife. There may
be bloody or finger marks of another
person.
7. History of mental depression of financial 7. Absence of such history
worries or threat of suicide, alcoholism, etc.
SUICIDAL CUT-THROAT
HOMICIDAL CUT-THROAT
“ Chopping or hack wounds” are wounds caused by blow
with a sharp splitting edges of a firmly heavy instrument like
the hatchet, axe or saber.

INSERT PICS OF
CHOPPING OR HACK
WOUNDS
INSERT PIC OF
STAB WOUND:
d. Therapeutic incised wounds:
These are wounds produced by surgical
incision, The absence of infection, they heal by
primary intention.

There is free bleeding in an incised wound

and after 36 hours the wound is covered with
lymph. The edge of the wound are strongly
adherent in three days. Complete healing with a
linear scar takes place about seven days.
 INSERT PICS OF
THERAPEUTIC INCISED
WOUND:
4. PUNCTURED WOUND:
This is brought about by sharp
pointed instrument. The outside
dimension is small but the depth is
to a certain degree.
 INISERT PICS OF
PUNCTURED
WOUNDS LIKE
NAILS, HOOKS, PINS,
ETC.
3. STAB WOUND:
Stab wound is produced by the penetration of
a sharp pointed and sharp edged instrument. If the
sharp edge the instrument first comes in contact
with the body the wound is an incised wound, but if
the sharp point will be the first one to come in
contact with the body, the wound produced is a stab
wound. If both edges are sharp, the extremities of
the wound are sharp. If only one edge is sharp one
extremity of the wound is sharp while the other may
be rounded, sharp and contused. The edges of the
wound like that of the incised wound are always
clean-cut, regular and distinct.
 Stab wounds are usually homicidal.
Suicidal wounds may occur in areas of
the body accessible to the hands of the
deceased. The most frequent site is the
region of the heart. Accidental stab
wounds are rare and are usually caused
by falling against projecting sharp
objects like broken pieces of glass or
iron bars.
INSERT PICS OF STAB
WOUNDS .
5. Lacerated wounds:
Lacerated wound is tear of the
skin due to the forcible contact with a
blunt instrument. The edges of the
wound are irregular and do not
correspond with the wounding
instrument. It is usually accompanied
with varying degree of swelling and
contusion.
INSERT PICS OF
LACERATED
WOUNDS:
Classifications of Lacerated Wounds:
a. Splitting by crushing of the skin between two
hard objects is best seen with lacerations of the scalp.
Laceration of other parts of the body can occur in a
similar manner, as, for example, the cut eyebrow of the
boxer or the laceration of the chin of motor cyclist.
 b. Overstretching of the skin, if it is fixed , causes laceration
when a weight passes over a limb or when a bone is bent or
broken. This is merely due to over-stretching until the point is
reached when the skin must break, producing flap or tear. It is
well seen in injuries caused by run over by a motor car or can
give indication of direction of the moving pressure.
 c. Grinding compression by a weight may produce
separation of the skin from the underlying tissues, leaving a
pocketful of fat and blood with some “pulping” of the
muscle.
 d. Tearing may be caused by irregular or sharp object such
as protruding hinge or door handle of a car. It is really an
overstretching similar to that already described.
 e. Cut lacerations may be inflicted by a heavy cutting
instrument such as chopper or hatchet. In such cases the skin is cut
and bruised at the edges, and some hair are forced into the wound.
The underlying tissues will be penetrated, usually with involvement
of bone, thus giving some indication of the nature and shape of the
weapon.
 Nature of Incised, Lacerated and Punctured Wounds:

Description of Incised Lacerated Punctured

wound
Manner of By sharp objects By blunt objects or By pointed weapon which
production or weapons. weapons. may be sharp or blunt.

Shape Linear or spindle Varies, usually Linear or irregular- according

shaped. irregular. to nature of weapon.

Edges Clean-cut and Rugged and often Varies according to nature of

reverted. undermined. weapon, but edges often
reverted form withdrawal of
weapon.

Dimensions Usually longer Depth varies, but Depth greater than length
than deep, but hand-lens and width.
often gaping. examination reveals
bridges of tissue
joining the edges.
Hemorrhage Usually longer Not pronounced. Varies-profuse if vessels are
from wound than deep, but cut in depth of wound.
often gaping.
Condition of Bruising may or Bruising usually Bruising rarely present.
skin may not be present.
surrounding present.
wound edges.
 Distinctions between an Incised Wound and
Lacerated Wound:

Incised Wound Lacerated Wound

1. Edges clean-cut, regular and well- 1. Edges, roughly cut, irregular and ill-
defined. defined.
2. No swelling or contusion around the 2. There is swelling and contusion around
incised wound. the lacerated wound.

3. Extremities of the wound sharp or may 3. Extremities of the wound ill-defined

be round or contused. and irregular.
4. Examination by means of a magnifying 4. Examination with a magnifying lens
lens show that the hair bulbs are cut. shows that the hair bulbs are preserved.

5. Healing faster. 5. Healing delayed.

6. Scar linear or spindle shaped. 6. Scar irregular.

7. Caused by sharp-edged instrument. 7. Caused by blunt instrument.

EFFECTS AND COMPLICATIONS OF WOUNDS

Factors influencing the severity of wounds:

1. Amount of hemorrhage:
Blood forms 1/20 of the body weight of adult. The loss of 1/3
to 2/5 is usually fatal. The amount of loss which the body can
survive depends upon the rate of the loss and the previous
health of the person. Male can stand loss of blood more than
female. Hemorrhage may be fatal if occurring in certain vital
parts of the body, as the brain or pericardium.

2. Size of the Injury:

Burns affecting on-third of the body surface of the third degree
type is usually fatal. Bigger wounds are more exposed to
infection and other physical conditions of the surroundings.
3. Organs Involved:
Trauma the vital organs of the body are always serious.
Crushing wounds of the heart, brain or lungs are almost fatal.

4. Shock:
Shock may occur with or without violence. A slight blow on
the genitalia, slight burns in children or old age, or slight violence
on the head or neck may cause severe shock. However, violent
trauma to healthy, strong person may not produce shock.

5. Presence of foreign body or substance introduced into

the body:
Incision with an sterilized scalpel may not be serious as the
bite of a venominous snake. A foreign substance or body may be
toxic by itself or may act as s physical irritant.
6. Absence of medical or surgical intervention:
A wound may not be fatal but on account of neglect or
ignorance in its management, it may become serious and may become
fatal.

Fatal Effect of wounds:

1. Wound may be directly fatal by reason of:
a. Hemorrhage:
An incised wound at the lateral aspect of the neck involving
the carotid artery without surgical intervention is fatal due to
hemorrhage. While wounds in some areas of the body where big
blood vessels are not present and the retraction of the tissues is
strong, death will not be a direct consequence due to hemorrhage
in the absence in the absence of complication that may set in.
b. Mechanical injuries on the vital organs:
A blow on the head may not necessarily produce
external lesions but may produce severe meningeal
hemorrhage producing compression of the brain. A
punctured wound of the heart, even though how small,
may produce death on account of the tamponade of the
heart.

c. Shock:
This is the disturbance of the balance of fluid in
the body capable of producing delayed or immediate
death.
 INSERT PICS

Avulsion of the skin at the forehead with exposure of

the fractured skull and part of the brain.
INSERT PICS

Multiple incised wounds (Homicidal)

INSERT PICS

Stab wound of the chest.

2. Wound may be indirectly fatal by reason of:

a. Secondary hemorrhage following sepsis:

A wound because of its nature and location is not
capable of producing severe hemorrhage, but on account
of infection that sets in, deeper tissues are involved
including big blood vessels thereby producing severe
hemorrhage.

b. Specific infliction:
Pathogenic micro-organisms may develop and
multiply in the wound causing septicemia, bacteremia, or
toxemia. Tetanus, gas gangrene infection are common in
open wounds.
c. Scaring effect:
Chronic gonorrheal infection may cause
stricture of the urethra. Stricture of the
esophagus may follow ingestion of irritant
poison. Keloid formation in burns may not only
cause deformity but disturbance of the normal
respiration or locomotion.

d. Secondary shock.
Complications of trauma or Injury:

1. Shock:
Shock is the disturbance of fluid balance resulting to
peripheral deficiency which is manifested by the decreased
volume of blood, reduced volume of flow, hemoconcentration and
renal deficiency. It is clinically characterized by severe depression
of the nervous system. Three major factors operate in the
production of shock and all are likely to be associated together as
the condition develops:
a. Injury to the receptive nervous system.
b. Anoxemia – Reduction of effective volume or oxygen carrying
capacity of the blood.
c. Endothelial damage, thus increasing capillary perme ability.
Kinds of shock:
a.Primary shock:
This is caused by immediate nerve impulse
set up at the injured area which are
conveyed to the central nervous system. The
impulse may also whelm the vital center in
the medulla thereby it develop within a short
time due to vasomotor collapse. If the
reaction is not intense, the patient may live
longer or may recover complete from the
effects of shock.
b. Delayed or secondary shock:

Patient shows signs of general collapse

which develop sometime after the infliction
of injury. It is characterized by low blood
pressure, subnormal temperature, cold
clammy perspiration, muscular in
coordination, rapid and shallow respiration.
The shock may be severe to produce death or
the patient may recover completely from its
effects.
2. Hemorrhage:

Hemorrhage is the extravasation or

loss of blood from the circulation brought
about by wounds in the cardio-vascular
system. The degree and nature of
hemorrhage depends upon the size, kind
and location of the blood vessel cut.
Kinds of hemorrhage:
a.Primary Hemorrhage:
It is the bleeding which occurs immediately
after the traumatic injury of the blood vessel.

b. Secondary hemorrhage:
This occurs not immediately after the infliction
of the injury but sometime thereafter on or
near the injured area.
3. Infection:
Infection is the appearance, growth and development of
micro- organisms at the site of injury.

How injury or trauma acquires infections:

a. From the instrument or substance which produces injury.
b. From the organs involved in the trauma applied. A bullet
wound may involve the intestine and cause its contents to spill
out in the peritoneal cavity causing peritonitis.
c. As an indirect effect of the injury which creates a local area
of diminished resistance causing the invasion and multiplication
of micro-organisms.
d. Injury may depress the general vitality, especially among the
aged and the young children and which make the patient
succumb to terminal disease.
e. Deliberate introduction of micro-organisms at the site of
injury.
4. Embolism:
This is a condition in which foreign matters are
introduced in the blood stream causing block to the
blood flow in the finer arterioles and capillaries.
The most common emboli in the blood stream are:
a. Fat Embolus:
Causes of fat embolism:
(1) By injection of oily substance into the
circulation.
(2) By injury of the adipose tissue which forces fat
into the circulation.
b. Air embolism:

Causes of air embolism:

(1) Gaping incised wound of the jugular vein.
(2) Injection of soapsuds or air into pregnant uterus for
the purpose of tubal insufflations or criminal abortion.
(3) Injection of air into the urinary bladder for
radiological study.
(4) Insuflation of the other non-potent tubes or hollow
organs.
(5) Injection of air under pressure into the nasal sinus
after a therapeutic larvae.
HEALING OF WOUNDS:

Small clean-cut wound is covered with lymph in 36

hours.
The edges adhere in two days and the wound
heals on the 7th day leaving a linear scar.
Larger incised wound shows swelling of the edges
8 to 12 hours. Blood –stained serum is present in 2 days
which afterwards become zero-purulent on the 3rd day,
lasting in state from from 4 to 5 days. Small red
granulation forms in 12 to 15 days and the epithelium
grow from the edges. Scar develops later.
 In cases wherein a definite infection is present, the
time of healing is very indefinite, however, at the advent of
antibiotic and sulfa drugs, healing is somewhat accelerated.

The time of healing of wounds is dependent on the

following:
a. Vascularity
b. Age of the person
c. Degree of rest or immobilization
d. Location
e. Nature of the injury
Kinds of Healing Wounds:

1. Healing by primary intention:

The edges of the wound are united by small amount of
fibrinous exudates which later organize into in-growth of
connective tissues. This kind of healing is present when no
infection has set in.

2. Healing by granulation tissue or by secondary intention:

This kind of healing is observed:
a. When there is loss of a definite substance so that the
wound will not approximate.
b. When there is great damage to the tissue on the surface
of the wound.
c. When there is intervening infection.
3. Healing by third intention:
This denotes non-union of the two granulation
surfaces.

4. Healing under scab formation:

This is a modification of the healing by second
intention in which reparative process takes place under a
dry scab or crust.
 MEDICO – LEGAL INVESTIGATION OF WOUNDS
The following rules must always be observed
by the physician in the examination of wounds:
1. All injuries must be described however small for
it may b important later.
2. The description of the wounds must be
comprehensive and if possible a sketch or
photograph must be taken.
3. The examination must not be influenced by any
other information obtained from others in
making a report or conclusion.
Examination of wounds:
a. Character of the wound:
The description must first state the type of wound, e.g.
abrasion, contusion, hematoma, incised, lacerated, stab
wound, etc. It must include the size, shape, nature of the
edges, extremities and other characteristics marks. The
presence of contusion collar in case of gunshot wound of
entrance, scab formation in abrasion and other open wounds,
infection, surgical intervention, etc.

b. Location of the wound:

The region of the body where the wound is situated must
be stated. It is advisable to measure the distance of the
wound from some fixed point or body prominence to
facilitate reconstruction. This is important in determining the
trajectory or course of the wounding weapon inside the body.
c. Depth of the wound:
The exact depth of the wound must not be attempted in a
living subject if in so doing it will prejudice the health or life.
Depth is measurable if the outer wound and the inner end is
fixed. Law attempt must be made in measuring the stabbed
wound of the abdomen because of the movability of the
abdominal wall.

d. Condition of the surroundings:

The area surrounding the wound must be examined. In
gunshot wound, near or contact fire wall produce burning or
tattooing of the surrounding skin. In suicidal incised wound, there
may be superficial tentative cuts (hesitation cuts). Lacerated
wound may show contusion of the neighboring skin.
e. Extent of the wound:
Extensive injury may show marked degree of force
applied in the production of wound. In homicidal cut-
throat, it is generally deeper than in cases of suicide.
Homicidal wounds are extensive and numerous.

f. Direction of the wound:

The direction of the wound is material in the
determination of the relative position of the victim and
the offender when such wound had been inflicted. The
direction of the incised wound of the anterior aspect of
the neck may differentiate whether it is homicidal or
suicidal.
g. Number of wounds:
Several wounds found in different parts of
the body are generally indicative of murder or
homicide.

h. Conditions of the locality:

(1) Degree of hemorrhage
(2) Evidence of struggle
(3) Information as to the position of the
body.
(4) Presence of letter or suicide note.
(5) Condition of the weapon.
 Determination whether the wounds were inflicted
during life or after death:

1. Hemorrhage:
As a general rule, hemorrhage is more profuse
when the wound was inflicted during the lifetime of
the victim. In wounds inflicted after death, the
amount of bleeding is comparatively less if at all
bleeding occurred. This is due to the loss of tone of
the blood vessels, absence of heart action and post
mortem clothing of blood inside the blood vessels.
Violence inflicted on a living body may not show the
formation of a bruise until after death.
2. Signs of Inflammation:
There may be swelling of the area
surrounding the wound, effusion of lymph or
adhesion f the edges. Other vital reactions are
present whenever the wound was inflicted during
life, although it may be less pronounced when
the resistance of the victim is markedly
weakened. Post mortem wounds do not show any
manifest signs of vital reaction.
3. Sign of repair:

Fibrin formation, growth of epithelium,

scab or scar formation conclusively show
that the wound was inflicted during life. But
the absence of signs of repair does not
show that injury was inflicted after death.
The tissue may not have been given ample
time to repair itself before death took place.
4. Retraction of the edges of the wound:

Owing to the vital reaction of the skin and

contractility of the muscular fibers, the edges of
the wound inflicted during life retract and cause
gaping. On the other hand, in the case of wound
inflicted after death, the edges do not gape and
are closely approximated to each other because
the skin and the muscles have lost their
contractility.
 Points to be considered in the determination as to
whether the wound is homicidal, suicidal or accidental:

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 is
held.
3. The motive underlying the commission of the crime
and the like.
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:
Absence of signs of struggle is more in suicide,
accident or murder.
Contusion or abrasion may indicate fist, finger
or feet of the assailant.
Presence of hair or portion of the
skin(epidermis) on the nails of the assailant or
deceased may be a clue in the determination whether
death is suicidal, homicidal or accidental.
b. Number and direction of wounds:
Multitude wounds in concealed portions of the
body generally are indicative of homicide.
Single wound located in a position that the
deceased could have conveniently inflicted is usually
suicidal.

c. Direction of the wound:

This is important in cases of cut-throat. It is
generally transverse in case of homicide while it is
oblique in case of suicide.
d. Nature and extent of the wound:
Homicidal wounds may be brought about by any
wounding instrument. Suicidal wounds are frequently
due to sharp instruments. Accidental physical injuries
may be of any kind.

e. State of the clothing's:

There is usually no change in the condition of the
clothing's in suicide. In homicidal death, on account of
the struggle which took place before death, the clothing's
of the victim are in a disorderly fashion.
 Length of time of survival of the victim after
infliction of wound:

1. Degree of healing;
2. Changes in the body in relation to the time of
death;
3. Age of blood stain;
4. Testimony of witness when the wound was
inflicted;
 Possible instruments used by the assailant in inflicting
the injuries:

The determination of the wounding instrument may be

made from the nature of the wound found in the body of the
victim:
1. Contusion - produced by blunt instrument.
2. Incised wound – produced by sharp- edged instrument
inflicted by hitting.
3. Lacerated wound – produced by blunt instrument.
4. Punctured wound – produced by sharp-pointed instrument.
5. Abrasion – body surface is rubbed on a rough hard surface.
6. Gunshot wound – the diameter of the wound of entrance may
approximate the calibre of the wounding firearm.
 Relative Position of Victim and Assailant When Injury
Was Inflicted:

In the determination of the relative position

of the victim and the assailant when the wound
was inflicted, the following points must be
considered by the physician:
1. Location of the wound in the body of the
victim.
2. Direction of the wound.
3. Nature of the instrument used in inflicting th
injury.
4. Testimony of witnesses.
 Extrinsic Evidences in Wounds:

1. Evidences from the wounding weapon:

a. Position of the weapon:
b. Blood on weapon:
c. Hair and other substance on weapon:
2. Evidences in the clothing's of the victim:
3. Evidences derived from the examination of the
assailant:
4. Evidences derived from the scene of the crime:
INSERT PICS

EXTENSIVE SUBDURAL HEMORRHAGE

 Physical Injuries in Different Parts of the Body.
I. HEAD AND NECK INJURIES

Injuries of the head must not be underestimated and must be

treated with extreme care. This absence of an external wound of
the head does not itself permit a conclusion that there is no
internal damage.
The presence of the bleeding from the ear, nostrils and
mouth may be associated with basal fracture. Fracture of the
vault and other portions of the cranial box may cause
unconsciousness and which may be mistaken for simple
intoxication. It is preferable to have the patient under careful,
intelligent and continuous observation for at least 12-24 hours to
avoid risk on the life of the patient. X-ray examination may be
useful for the determination of the presence of fracture but it is
not uncommon that no fracture is observed yet the intracranial
injury is quite severe.
 Factors Influencing the Degree and Extent of Head
Injuries:
1. Nature of the wounding agent:
2. Intensity of the force: