Legal Med

SHRAPNEL WOUNDS
Shrapnel wounds are those brought about by

the flying missiles which came from the
fragmentation of the shell due to the detonation
of high explosives.
Legal definition of explosives:
Sec. 290, Commonwealth Act No. 466

T he word “explosive” and “explosives” shall mean gunpowder,
powder used for blasting, all forms of high explosives, blasting materials,
dynamites, fuses, detonators or detonating agents, smokeless powder,
and other chemical compound or chemical mixture that contains any
combustible units or other ingredients in such proportion, quantities or
packing that ignition by fire, by friction, by concussion, by percussion, or
by detonation of all or any part of the compound or mixture may cause
such a sudden generation of highly heated gasses that the resultant
gaseous pressure are capable of producing destructive effects on
contagious objects or of destroying life or limb.
Law penalizing illegal possession of
explosives:
Public Act No. 2255 as amended by Public Act No. 3023:
Sec. 1 – The manufacture, distribution, storage, use or possession of gunpowder,
dynamites, explosives, blasting supplies or ingredients thereof, except in accordance
with the provision hereof and Act No. 1499 as amended, is hereby declared illegal.
PROVIDED HOWEVER, (exemption granted to the acquisition or possession, of explosives
by the U.S. ARMED FORCES, PROVIDED, FURTHER that the Chief of Constabulary, may,
upon application, under such rules and regulation as may be promulgated by him and
approved by the Secretary of Interior, issue licenses as follows:
 Dealer’s License
 Manufacturer’s License
 Purchaser’s License
 Foreman’s License (use in quarries, road construction, wrecking, or for use in any other
legal and lawful public or private works).
Law penalizing illegal possession of
explosives:
Sec. 2 – Any person violating the provision

of the preceding section shall be punished by
a fine of not less than P600.00 nor more than
P2, 000.00 and by imprisonment of not less
than 3 months nor more than 2 years, in the
discretion of the court.
The following high explosives may cause
shrapnel wounds:
1. Grenade – rifle or hand

2. Bomb – demolition or incendiary
3. Mines – underground or submarine
4. Exploding missiles – anti-aircraft
Injuries due to the detonation of high
explosives may be due to the following
causes:
1. Blast wave injury:
The explosion causes sudden increase of atmosphere
pressure which is immediately followed by a sudden fall.
This compression-decompression effect produces
displacement, distortion or bursting of the tissues
especially of the brain and visceral organs. Aside from
those injuries, there is rapid development of scattered
foci of small hemorrhages mostly in organs which easily
change in shape and rich in blood supply.
causes:
2. Burns from the flame or heated gas:
Explosion of the powder causes emission of live flame and heated
gases in the neighborhood. Body surface in contact with the flame or
exposed to the heated air will develop burns, the degree of which
depends upon the intensity and degree of exposure.
3. Asphyxia due to lack of oxygen:

The detonation causes consumption of oxygen in the surrounding
atmosphere thereby limiting the amount available for human
consumption.
causes:
4. Poisoning by inhalation of carbon monoxide, nitrous or nitric gases, hydrogen sulfide,
sulfur dioxide, or hydrocyanic acid gas:
The byproduct of combustion may be protoplasmic poison or may cause death by
interfering with the normal transportation and utilization of air by the tissues of the body.
Any of the gasses may cause interference with the normal respiration so that it
produces asphyxia.
5.Direct injury by the flying missiles:
The injury due to the flying missiles is influenced by the proximity of the individual to
the detonation, velocity of the missiles, manner of approach of the missiles on the body
surface, part of the body involved, and subsequent complications arising from such injury.
In near blast, the injury sustained may not only be attributed to
the shrapnel but also to the sudden change of atmospheric pressure,
burns and chemical changes in the atmosphere. Usually the whole
body is fragmented and mutilated with portions almost
indistinguishable. Parts of the body may be carried by the flying
missiles and may be found clinging in branches of trees or in electric
or telephone lines.
The shrapnel wounds may be through and through or the shrapnel
may be lodged in the body depending upon the velocity and nature
of the part of the body involved in the course of the missiles.
The edges of the missiles are usually irregular or
maybe smooth that if the sharp edge comes in contact
with the skin, the wound produce may simulate an
incised or stab wound. If the flat surface comes in
contact with the skin, it may produce severe laceration
with contusion of the surrounding skin area.
THERMAL INJURIES OR
DEATHS
THERMAL INJURIES OR DEATHS
Thermal injuries are those caused by appreciable

deviation from normal temperature capable of
producing cellular or tissue changes in the body.
Thermal death is one primarily caused by thermal
injuries.
Exposure to severe cold may cause frost-bite, while
exposure to high temperature may cause burning or
scalding.
I.DEATH OR INJURY FROM COLD
Death or injury due to cold is not common in tropical

countries. The primary cause of death is attributed to the
decrease dissociation of oxygen from hemoglobin in the
red blood cells and diminished power of the tissue to
utilize oxygen. Cold produces first a vascular spasm which
results to anemia of the skin surface followed by vascular
dilatation with paralysis and increase capillary
permeability. Prolonged exposure may cause necrosis and
gangrene.
The degree of damage depends upon severity of the cold,

duration of exposure, area of the body involved, sex and humility.
Cold damp air is more fatal than cold dry air. A short exposure to
freezing temperature maybe deleterious to the body as long as
exposure to low but not freezing temperature, children and aged
individual are more susceptible to cold weather on account of their
limited thermotaxic reserves. Individuals whose vitality has been
diminished by fatigue, lack of food, alcoholism, and previous ill-
health are less able to withstand the effects of colds. Women are
more resistant to cold than men on account of their grater deposits
of subcutaneous fat.
The action of cold in the body is partly local and partly

reflex in the circulatory system. Exposure to cold will
diminished the dissociation power of oxygen from
hemoglobin, thus starving the brain and other nervous
center with oxygen.
The effect of low temperature consist of local damage to
the exposed tissue and systemic change involving the whole
body.
Effects of Cold:
A. Local Effect: (Frostbite; Immersion foot; Trench Foot)

First – There is blanching and paleness of the skin due to
vascular spasm.
Second – The vascular spasm is followed by erythema, edema,
and swelling due to vascular dilatation paralysis and increased
capillary permeability.
Third – In advanced stage of vascular paralysis, there will be
blister formation.
Fourth – Continued exposure to severe cold will later lead to
necrosis, vascular occlusion, thrombosis and gangrene.
On account of the expansion of the tissue and individual cells in
the process of solidification, the cell membrane may rapture, tissue
and organ may rapture, and the skull may be fractured.
Microscopically:
There is vacuolization and degeneration of the epidermal cells,
necrosis of the collagen of the subcutaneous tissue, perivascular
exudates of red and white cells, occlusion of vessels lumen by clump
of red blood cells, and prolification of the endothelium.
Effects of Cold:
B. Systematic Effects:
The systematic effects are reflex in nature brought
about by the stimulation and paralysis of the nerves.
Respiration, heart action, metabolic process is slowed
down on account of cerebral anoxia. There is called
stiffening of the body with blister formation and gangrene
of the exposed part of the body.
Signs and Symptoms:
1. Gradual lowering of the body temperature

accompanied by increasing stiffness (cold stiffening),
weariness and drowsiness.
2. The person may be lethargic, passing the stage of
coma to death.
3. Person may suffer from delusion, convulsion, and
delirium.
4. Palpation of the cutaneous surface shows hardening
and coldness.
Post-Mortem Findings:
A. Externally: Nothing characteristic.

a. Cold stiffening
b. Surface of the body pale
c. Reddishpatches specially in exposed portions of the
body (frost-erythem)
d. Onset or rigor mortis delayed.
Post-Mortem Findings:
B. Internally: Nothing characteristic.
a. Blood is generally fluid in the heart and blood vessels with bright red color.
b. Parenchymatous organs are congested with occasional petecheal hemorrhages.
c. Audible cracking sound on flexing the knee and other big joints apparently due
to the breaking down of the frozen synovial fluid.
d. Petecheal hemorrhages in the lungs, brain and kidneys.
e. If death occurs after sometime, pathological findings related to complications,
like bronco pneumonia, toxemia due to gangrene, etc. may be found.
The body tissue fluid evaporates slowly is the body is frozen, hence,
mummification develops later. However the individual cells, tissues and organs are
well preserved.
II. DEATH OR INJURY FROM HEAT
The effect of heat in the body maybe local

at the application, or general when the
whole body is affected.
Classification of heat injury:
A.General or systemic effect:
1. Heat cramps
2. Heat exhaustion
3. Heat stoke
B.Local effect:
1. Scald
2. Burns
1. Thermal
2. Chemical – acids and alkalies
3. Electrical and lightning
4. Radiation – x-ray, ultraviolent, etc.
A. General or Systemic Effect
1. Heat Cramp – (Miner’s Cramp, Fireman’s Cramp, Stoker’s

Cramp).
This is the involuntary spasmodic painful contraction of
muscles essentially due to dehydration and excessive loss of
chlorides by sweating. This is seen among laborers working
in rooms with high temperature and with profused
perspiration.
Symptoms:
a. The onset is usually sudden as muscle cramps with agonizing pain.
b. The cramp is accompanied by headache, dizziness and vomiting.
c. The face is flushed, pupils are dilated with tinnitus and abdominal
pain.
d. The amount of chloride excretion through the urine is markedly
diminished.
Usually the condition do not end fatally. A liberal administration of
fluid with chlorides relieves the patient. However, intravenous
administration of saline solution rapidly restores the patient to normal.
2. Heat Exhaustion – (Heat collapse, Syncopal Fever, Heat

Syncope, Heat Prostration).
This is due to heart failure primarily caused by heat
and precipitated by muscular exertion and warm clothing.
Symptoms:
a. Sudden attack of syncope, general body weakness, giddiness and staggering
movement.
b. The face is pale, the skin is cold, and the temperature is subnormal.
c. The pupils are dilated, pulse small and thread, and respiration is sighing.
d. There may be diarrhea, dimness of vision and dilated pupils.
e. Exhaustion comes gradually with throbbing in the temple.
f. The patient usually recovers if made to rest, but occasionally the condition
may become worse and the patient dies of heart failure.
The treatment is purely symptomatic and
removal in heated area.
Postmortem findings is nothing typical,
except probably cloudy swelling of the heart
musculature.
3. Heat Stroke – (Sunstroke, Heat Hyperpyrexia,

Comatous Form, Thermic Fever)
This usually occurs among those working in
ill-ventilated places with dry high temperature
or due to direct exposure to the sun.
Symptoms:
a. Sudden onset or may be followed by premonitory symptoms of headache,
malaise, giddiness and weakness of the legs.
b. Temperature rises suddenly and the skin becomes dry, with burning sensation
and flushed skin and complete cessation of sweating.
c. Face is congested.
d. Pulse full and bounding.
e. Respiration later becomes irregular.
f. The pupils are usually contracted.
g. Death occurs in ½ to 1 hour after the onset of symptoms.
Postmortem Findings:
a. Cadaveric rigidity comes soon and passes off soon.
b. Putrefaction occurs early.
c. Lividity is marked.
d. Petecheal hemorrhages may be found in the brain and in the
heart.
e. Congestion of the internal organs.
f. The temperature may rise after death.
Medico-Legal Importance of Heat Cramps,
Heat Exhaustion and Heat Stroke:
If ever deaths occur, they are most often accidental.

Laborers who are working under the sunshine, in a heated
room, or in a poorly ventilated place may suffer from any of
the conditions. Alcoholism, ill-death, disease and fatigue may
be some of the predisposing factors. Although most accidental,
physician must perform the necessary post-mortem
examination in the bodies to eliminate the possibility of foul
play. However, it may be homicidal or suicidal in rare instances.
Children may be victims of infanticidal act when subjected to
conditions promoting their development.
B. Local Effects of Heat
1. Scald:
Scalds are injuries produced by the application to the body
liquid at or near boiling point, or in its gaseous state. The term
applies to tissue destruction by moist heat. The injury by
scalding is not as severe as burns because (a) the scalding liquid
or vapor run on the body surface thereby distributing its heat,
(b) the scalding material easily cools off, and (c) the
temperature of the scalding substance is not as high as those
producing burns, except oils and molten metals. The effect of
scalding is the same as burns.
Characteristics of scalds:
a. Scalds often have s distribution called “geographical lesion”.
It follows the portion involved in the splashing of the
scalding fluid together with the rule of gravity.
b. The skin lesion may be located in covered portions of the
body without affecting the clothings.
c. There is no burning of the hair or deposit of carbonaceous
material on the skin surface.
d. The lesion is usually first, second and third degree, except in
cases of heated oil or molten metals.
e. Inhalation of the heated vapor may lead to inflammatory reaction in
the air passage which may lead to respiratory obstruction due to edema
of the glottis.
f. Usually there is redness of the skin immediately after the application,
later a blister is formed. Pricking of the blister and removal of the
epidermis will show a pink raw surface from which the liquid ooze. The
base will later become red in about six hours. There will be leucocytic
infiltration and granulation tissue will develop.
g. Sepsis with development of pus may appear in one or two days.
Healing may be accompanied by the formation of scar which may result
in contracture.
Scalds are usually painful specially the second and third
degrees.
It is less fatal as compared with burns except when it
involves a great area of the body surface.
Death is usually due to septic complications which occur
after a day.
Scalding is usually accidental in kitchens. Homicidal
scalding by throwing boiling water on the face and body is
quite rare.
Burn scald second degree
Staphylococcal Scalded Skin Syndrome
the scald burn injury to a child.
badly scalded by the hot water poured on him by his step-
mother.
2. Thermal Burns:
Burns are lesions which are caused by the application
of heat or chemical substances to the external or internal
surfaces of the body, the effect of which is destruction of
the tissues of the body. It includes all lesions produced by
fire, radiant heat, solid substances, fire, friction and
electricity.
Classification of Burns:
a. Thermal
b. Chemical
c. Electrical
d. Radiation
e. Friction
Characteristics of Burns:
a. The lesion varies from simple erythema to complete carbonization of the
body.
b. Usually there is singeing of the hair and carbon deposits on the area
affected.
c. The area involved is general and without usually any demarcation line of
the affected and unaffected parts.
d. Lesions in covered portions of the body also involve burning of the
clothings over it.
e. In death by burning in a conflagration, it is necessary to indentify the
victim and determine whether burns are ante-mortem or post-mortem.
Classification by Degree of Burns:
(Dupuytren’s Classification)
1. First degree:
There is erythema or simple reddening of the skin without
destruction of the tissue. The redness may disappear on
pressure. There may be slight or superficial swelling with
moderate pain which may be relieved by contact with cold
substance. The redness and swelling may disappear in a few
hours, but may last for several days when the upper layer of
the skin peels off. In as much as there is no destruction of the
underlying tissue, no scar is produced on healing.
2. Second degree:
There is blister formation which may appear after
the application of heat or after sometime. There is
destruction of the outer layer of the skin. Suppuration
may develop if blister is destroyed. Healing is not
usually accompanied with too much scar.
3. Third degree:
The dermal layer is partially or completely destroyed. The nerve
endings are preserved but exposed thereby making this type of burn the
most painful. Scar formation is usually observed of healing because the
elements of the true skin is involved.
4.Fourth degree:
There is destruction of the whole layer of the skin including the
papilla and nerve endings. It usually involves the subcutaneous tissue.
Healing is accompanied with great scaring and deformity.
5. Fifth degree:
The deep fascia and muscles are involved. The whole
structures are carbonized. Healing is accompanied with
marked deformity and scar formation.
6.Sixth degree:
The bones are involved, with charring of the limbs,
adjacent tissues and organs. If burn is localized in a
portion of extremity, amputation may be required. This
condition is commonly seen in victims of conflagration.
Factors Influencing the Effect of Burns in
the Body:
1. Degree of heat applied:

The effect in body tissue by heat varies with the
temperature of the heated object causing it. The effect
will be more severe if the heat applied is great.
2. Duration of exposure or contact:
The longer is the time of exposure or contact, the
greater will be the destruction. The underlying tissue will
be liable to be subject to the high temperature.
the Body:
3. Extent of the surface involved:

Involvement of more than one-third of the body surface to a
second or third degree burn usually ends fatally. This is due to
pain, dehydration, hemoconcentration, and shock.
4.Portion of the body involved:
Burns of the extremity is not as serious as that of the
head, neck and trunk. Burns of the genital organs and that of
the lower portion of the abdomen are usually serious. Burns in
serious cavities are greater than in skin.
the Body:
5. Age of the victim:

Adults can withstand burns longer than the children and the aged
individuals. Children can withstand suppuration.
6. Sex of the victim:
Men can resist burns better than women.
7. Septic infection:
This may bring about complications in other parts of the body and may lead
to death.
8. Depth of burns:
In 6th degree burn whereby the muscles and bones are involved, there is
more likelihood to terminate in death due to shock.
Causes of Death in Burns and Scalds:
A. Immediate Fatal Result:

a. Death from shock
b. Death with concomitant physical injuries with
burns
c. Suffocation
Causes of Death in Burns and Scalds:
B. Delayed Fatal Result:
a. Exhaustion
b. Dehydration with hemoconcentration
c. Secondary shock
d. Hypothermia
e. Complications:
1. Septicemia
2. Pneumonia
3. Nephritis
4. Inflammation of serious cavities and internal organs
f. Changes in the blood due to heat
In conflagration, the early death is due to primary or
neurogenic shoch following a painful irritation of the
multiple nerve endings in the skin.
The suffocation is brought about by the formation of
carbon monoxide hemoglobin or by the action of other
noxious gases of the fume.
Death may occur from an accident occurring in an
attempt to escape from the burning house or from injuries
inflicted by wall and timbers falling on the body.
The loss of body fluid, blood plasma, chlorides and other
substances of the blood is due to evaporation from the raw
skin surface.
Absorption of toxic materials from the site of
the injury may lead to necrosis of the liver, renal
tubular degeneration, and cloudy swelling of other
organs.
Inhalation of the fumes may cause
inflammatory reaction of the respiratory passages.
Secondary infection of the wound which may
lead the septicemia and inflammation of other
organs and serous cavities.
Time Required to Completely Burn a Human
Body:
The time required to transform the human body to ashes

is dependent upon several factors, namely:
a. Degree of intensity of heat applied
b. Duration of the application of heat
c. Physical condition of the body
d. Presence of clothings and other protective materials.
Time Required to Completely Burn a Human
Body:
About 72% of the human body weight is water and this

is responsible for the delay in its combustion, however
there is about 5% fat which may enhance combustion on
account of its combustibility.
In gas furnace incinerator, it requires about four hours
continuous application of heat to transform the body into
ashes.
Age of the Burns:
A very recent burn will show no pus, or much healing,

or edema.
When the pus is already present and the red
inflammatory zone has disappeared, it is about 36 hours or
a few days.
There is superficial sloughing in a third degree burn in
about a week.
The deeper sloughs are thrown off in two weeks and
are attended with suppuration.
When the red granulation tissue is present,
it is about two weeks.
The age of older burns is estimated by the

amount of granulation tissue present, by its
depth, and by the extent of the growth of
epidermis from circumference.
Is the burning the cause of death?
The physician must determine whether the lesions due to

burning are by themselves sufficient to cause death. He must also
determine whether there are evidences of other lesion which may
account for the death.
The following findings may prove that death is due to burning:
1. Presence of vital reaction of the heated areas.
2. Presence of carboxyhemoglobin in the blood.
3. Presence of carbon particles in the trcheo-brochial lumina.
Scars of burn
Scars of superficial are thin and pliant. In severe

burns, these are irregularly thick with patches and
bond of fibrous tissue causing contractions. Keloid
formation is common in scars from burns.
Distinctions between Antemortem from
Postmortem Burns:
The principal basis of the distinction is the presence of or absence of the vital
reaction, like inflammation, vesicle formation, congestion and granulation tissue.
The principal points of distinction are:
1 the blister form in antemortem burns contains abundant albumen and
chlorides, while in postmortem burns the blister contains scanty albumen and
chlorides.
2. There is area of inflammation around an antemortem burn which is not
present in the case of postmortem burns.
3. The base of the vesicle is red in antemortem burns while there is not much
change in color in the case of postmortem burns.
Distinctions between Antemortem from
Postmortem Burns:
4. In burns due to a conflagration, the tracheo-bronchial Lumina may contain

particles of soot or carbon, while in the case of postmortem burns there is no
such finding.
5. Blood will show presence and abundance of carboxyhemoglobin in cases of
antemortem burns, but not in cases of postmortem burns.
The absence of sings in vital reactions at the site of the burns does not
necessarily indicate that the lesion in postmortem. Death may have occurred too
quickly for those changes to develop, or the injuries might be antemortem but
the body resistance is so diminished to produce the vital reactions.
Distinctions between antemortem from
postmortem blisters:
1. Ante mortem blisters contain fluid rich with albumen and chlorides, while
postmortem blisters may contain air or scanty amount of albumen and
chlorides.
2. Heating the fluid contents of antemortem blisters will cause solidification,
while heating of a postmortem blister will show slight loudening but not
solidification.
3. The base of an antemortem blister is reddish with signs of inflammatory
changes in the periphery, but there is no such finding in case of postmortem
blisters.
4. Fluid content of an antemortem blister is abundant, while in the case of
post mortem blister it is scanty.
Differential Diagnosis of blister Due to Heat
1. Blister due to putrefaction

The fluid content is blooded stained watery fluid and accompanied
by putrefactive changes in other parts of the body.
2. Blister due to disease
This can be differentiated from blister due to heat by the size,
distribution and absence of other signs of the effect of heat application.
3. Blister due to friction
History and absence of signs of the application of heat in the
neighborhood will differentiate it from blister due to burns.
Heat Rupture:
This is the splitting of the soft tissues

of the body, like the skin, due to
exposure before or after death of the
body to considerable heat.
Differential diagnosis:
1. Incised wound- a heat rapture may be mistaken for an incised wound.

It may be distinguished by the absence of blood in as much as heats
coagulate blood inside the blood vessels. In heat rapture the blood
vessels and nerves are kept intact at the point of the rupture. On
close in section, the margins are irregular unlike as in the case of
incised wounds.
2. Lacerated wounds- in lacerated wound there is contusion and other

vital reactions at the margin, which is not present in cases of heat
rupture. The roaster condition of the skin is prominent in cases of
heat rupture.
Heat stiffening:
This condition is found in dead bodies which have been

subjected to heat. The heat coagulates the aluminous
materials inside the muscle making it stiff and
contracted. The limbs are flexed and the fingers partially
clenched simulating a pugilistic position of a boxer. There
is flexion of the limbs and fingers on account of the fact
that the flexor muscles are stronger than the extensors.
The heat stiffening remains for sometime until the body
softens due to the unset of decomposition.
Investigation of death in a Conflagration
Examination of the burnt body should be directed to obtain the following

informations,
1. Identity, which may be established from,

Clothing. Careful handling must be stressed, as charred materials can yield
considerable information in expert hands, but can also be easily destroyed. The
size or footwear may be of importance.
Property in the pockets such as key, money, papers and the like.
Height-sex-age-color of eyes-color of hair.
Naturals disease or stigma such as scars, old deformities or injuries and
detention.
2. Whether the person was alive in the fire,

which can be decided from the presence of
carbon particles in the air passages and the
estimation quantitatively of carbon monoxide
in the blood.
3. Cause of death
4. Information indicating a possible cause of the fire, as shown by

examination of the deceased. Evidences of the following should be
noted.
Alcoholic intoxication ( blood and Urine estimation for alcohol}
Natural disease which might have caused collapse, such as epilepsy,
hypertension, myocardial fibrosis.
Site of origin of the fire, as shown by maximal effects in relation to
position of the body.
Demonstration of injuries which could have been sustained before
the fire commenced.
Postmortem Findings: (burns and Scald)
A. External Findings
Presence of external lesion depending upon the degree of burning
and scalding of the body.
“Pugilistic position” of the body.
Blackening of the body surface in case of burns.
Rupture of skin, muscles, or destruction of limbs or skull.
Exposure of external organs.
Singeing of the scalp and others hairs of the body.
B.Internal Findings
Blood is cherry-red in color owing of the presence of car boxy-hemoglobin.
Increase in the lymphoid tissue, especially of the intestine and lymph glands.
Marked Dehydration.
Hemoconcentration with increased capillary permeability.
Congestion of visceral organs.
Cloudy swelling of liver and kidneys.
Enlargement of the adrenal glands with hemorrhagic infracts.
Lungs are shrunken, mucous membrane of the bronchi are congested

and sub-serous hemorrhages present.
Intestinal mucous membrane are congested especially the brunner’s
glands of the duodenum.
Spleen enlarged and soft.
Brain and spinal cord shrunken and hyperemic.
Presence of carbon particles in the respiratory tract.
Fatty degeneration in the liver.
Medico-legal Aspect Of Burns And Scalds:
During the ancient and medieval times, branding is a means to secure

identity. Red-hot metals shaped in letters or figure are pressed in the arm
and thigh. With the improvement of the present method of identification,
branding is now only made in domestic animals.
Extraction of confession by burning the fingers, application of heated
metals on the skin, or pouring boiling water on the body is now punishable.
Killing of a person and setting afire the building for the purpose of
concealing the crime or of the purpose of destroying of the crime is quite
common. It is in the connection that the physician must exert all efforts to
determine the true nature of the case.
Medico-legal Aspect Of Burns And Scalds:
Burning and scalding is usually accidental, but occasionally homicidal or

suicidal.
Accidental cases are common among women and children on account ot their
loose garments which easily catch fire. Children, mentally deficient persons and
intoxicated individuals may expose their bodies to boiling water or live flame.
A number of persons may die from burns when fire breaks out in an inhabited
house, or when an explosion occurs in a factory.
The Revised Penal Code considers the killing of a person by means of a fire
as murder. The setting of a building on fire must be an intentional means to kill
the person inside the building to make it murder.[art. 238]. There should be the
actual designs to kill and that the use of fire should be purposely adopted as a
means to that end. [People v. burns 41 Phil. 418].
Spontaneous Combustibility:
It is claimed by some authorities that the human

body can ignite itself spontaneously and burn itself to
death. This is hardly possible on account of the high
percentage of water in the human body. Spontaneous
combustibility may be utilized as a defense in case of
homicidal burns if it is really probable.
Preternatural Combustibility:
It is claimed that human body is inflammable

on account of the presence of gases which easily
ignite. The gases are said to be the products of
the action of micro-organisms in the body. This
explains the presence of phosphorescent light in
the graveyard during night time. If ever the
theory is true, then there can only be partial
combustion of the human body.
C. Chemical burns: (corrosive burns)

Chemical burns are the action of strong acids and
alkalies and other irritants chemical which cause
extensive destruction of the tissue. Healing is quite slow
and may require plastic surgery. The most common the
chemical are concentrated sulfuric acid, nitric acid,
hydrochloric acid, caustic soda and potash, Lysol, etc.
chemical burns may be followed by keloid scars.
Characteristics 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. Healing is quite delayed on account of the action of the
chemicals to the underlying tissue
Distinctions between thermal burns and
chemical burns:
a. There is absence of blister in cases of chemical burns while blister

may be present in thermal burns.
b. The skin and clothing may be stained with chemical in cases of
chemical burns, but there is no such staining in thermal burns.
c. Analysis of the substances around the lesion will show the chemical
causing the corrosion. Nothing of this nature is found in thermal
burns.
d. In thermal burns the lesion is diffused while in chemical burns the
borders are distinct and simulating a geographic appearance.
Characteristics lesions by different
chemicals:
1.Sulphuric acid (oil of vitriol), which has the most intense action, cause a
considerable amount of destruction of the tissues with the formation of a blackish-
brown sloughs. The face or other part will show plash marks where the acid has
fallen, and usually there will be lines of ulceration where the acid run down the
surface of the body.
The clothing will be destroyed in the places where the acid has spilled.
2. Nitric acid cause a yellow or yellowish-brown slough, and the spot of yellow color
will be seen on the skin. The clothing is destroyed and is brown in color.
3. Hydrolic acid, though not so destructive as either sulphuric or nitric acid, causes
an intense irritation and localized ulceration of a red or reddish-gray color.
4. Caustic Soda and Potash have a corrosive action on the tissues, giving a bleached
appearance and greasy feeling to the skin. The skin subsequently becomes brown and
parchment- like.
Treatment:
1. Neutralization of the corrosive substances.

2. Protection of the eye from the involvement.
3. Prevention of infection of the lesion.
4. Other supportive or symptomatic treatments.
Burns from corrosive fluids are quite rare and
are usually due to accidents in chemical
laboratories. Vitriol throwing is common in
England. Intentional spilling or throwing of
corrosive fluid is physical injuries and on account
of the deforming scar it produces, it becomes
serious physical injuries. Corrosive burns are
commonly observed in suicidal ingestion with
spilling of the chemical around the mouth and
neck.
D. Electrical burns:
There are three kinds of electrical burns:
1. Contact burn- due to close contact with an electrically live object and the
degree will vary from small and superficial lesion to charring of skin if contact
is maintained.
2. Spark burn- due to poor contact and resistance of dry skin and shows a
pricked appearance with central white zone (parchment) and surrounding
hyperemia.
3. Flash burn- the appearance varies from the arborescent pattern of lighting
burns to the “crocodile skin” appearance of high voltage flash.
E. Radiation burns:
1. Burns from X- Ray
The burns from X-ray depend upon the degree of intensity and period of
exposure. Slight over-exposure will produce reddening and inflammation of the
skin which will pass away within a short time leaving a bronze color of the skin.
Higher degree of ever-exposure may produce blister, atrophy of the superficial
tissue and obliteration of the superficial blood vessels.
2.Ultraviolet light burns:
Overdose of ultra-violet light may lead to severe and persistent dermatitis. There
is uncomfortable irritation of the skin and may later develop into blister.
PHYSICAL INJURIES OR DEATH
BY LIGHTNING AND
ELECTRICITY
DEATH OR PHYSICAL INJURY BY LIGHTNING
Lightning is an electrical charge in the atmosphere. Its

place of occurrence and intensity is unpredictable. The
flash of lightning is due to the passage from a thunder
cloud to the earth of a direct electric current of enormous
potential, amounting to something like 1,000 million volts
and about 2,000 amperes. Along the path of the current, a
great portion of its energy is liberated most of which is
converted to heat. The size of the tract is variable and
may produce branching along its course.
Elements of lightning that produce injury:
1. Direct effect from the electrical charge:

The electrical charge of lightning may pass to the body producing
electrocution. The human body especially its nerve is a good conductor
of electric current.
2.Surface “flash” burns from the discharge:

Some of the electrical energy is a lightning is transformed to heat
energy. The superheated air may cause burning of the skin of the victim.
The flash burn may produce arborescent marking but are by no means
typical.
Elements of lightning that produce injury:
3. Mechanical effect:
The expansion of the air on account of the superheated atmosphere may bring
about mechanical injury. It may result to laceration of the body surface, severe
tearing of the clothing and displacement of parts of the body.
4. Compression effect:
The compressed air pushed before the current with superheated atmosphere may
produce a backward wave. This causes the “sledge hammerblow” on the body of
the victim thereby producing concussion, shock, unconsciousness to the victim.
Points to be considered in making a
Diagnosis of death from lightning:
1. History of a thunderstorm that took place in the

locality.
2. Evidences of the effect of lightning are found the
vicinity, like damages to houses, trees, and other
objects; death of other person and animals nearby.
3. Metallic articles are fused and magnetized
4. Fusion of glass materials on account of severe heat.
Points to be considered in making a
Diagnosis of death from lightning:
5.Absence of wound and other injuries

indicating suicidal or homicidal death.
6.Skin often shows arborescent markings due
to superficial erythema which may disappear in
a day or two if the persons lives.
7.Burns may be present, but may be limited to
the part under the pieces of metals such as
watch, knife or bunch of keys. The burns are
superficial or may be very deep.
Classes of burns due to lightning:
1. Surface burns- these are superficial burns usually seen

under metallic objects worn or carried by the victim.
2. Linear burns- these are found where areas of the skin
offer less resistance, notably in the moist creases and
folds of the skin. It may vary in length from one to
twelve inches.
3. Arborescent or filigree burns- these are radiating
burns from a point, similar to electrocution.
Effects of lightning in the human body
Death is usually the immediate effect due to the involvement of the

central nervous system. The shock is produced by the instantaneous
anemia of the brain brought about by the spasmodic contraction of the
cerebral vessels. The lightning may cause immediate loss of
consciousness and because of the intense disturbance of the air, the
clothing may be removed from the body or torn severely.
Occasionally a person may recover from the effect of the lightning
stroke but in most cases suffer from certain degree of neurological
disturbances.
1. Symptoms in mild attack:
a. external lesion of almost any description

b. unconsciousness
c. slow, deep and interrupted respiration
d. pulse slow and weak
e. pupils dilated and sensitive to light
f. relaxation of the entire muscular system
g. headache, dizziness and noise in the air
h. in severe cases it may lead to blindness, deafness and loss of speech.
Delayed effects:
a. Insomnia and defective memory

b. Irritability and inability to concentrate
c. Paralysis or increasing weakness of the limbs with
progressive wasting of the muscles
d. Hemiplegia, apasia , deafness, epilepsy
e. Progressive cerebellar syndrome
Treatment:
1. Artificial respiration
2. Air passage must be kept free
3. Lumbar puncture to release the tension in the
cerebro-spinal fluid
4. Rectal hypnotic to combat delirium
5. Treatment to combat shock
6. Treatment to build the resistance of the victim
Postmortem findings:
A. External:
 Marked tearing of the wearing apparel
 Burns of different degrees of the skin surface
 Wounds of almost any description
 Magnetization of metals in the wearing apparel
 Fusion of metals and glasses
 Singeing of the hair of the scalp and other parts of the body
 Blindness, deafness and paralysis
B. Internal:
 Fracture of bones
 Hemorrhage due to laceration or rupture of organs
 Petecheal hemorrhages of the lungs, pericardium, brain
 Rupture of blood vessels and internal organs
Medico-Legal Aspect:
Investigation of death due to lightning is

not by itself of any medico-legal interest foe
it is an accidental death. No one can be held
responsible to the effect of a fortuitous
event. However, its investigation may be
useful to eliminate the possibility that death
is due to the felonies act of another person.
II. DEATH OR PHYSICAL INJURIES FROM
ELECTRICITY
The main cause of death in electricity is shock. Ordinary domestic line is

from to 250 volts and is sufficient to produce death. The effect of 300 volts
and above may be similar to lightning stroke. Voltage is not only the factor
causing the injury. As a matter of fact amperage or intensity of the electrical
current is the principal factor.
The damage of the body by electrical discharge depends upon several
factors which may increase or decrease the electrical conductivity of the
body. The presence of moist skin, wet floor, barefoot and proximity of
metals increase t the conductivity of the body to electricity. Dryness of the
skin, presence of rubber boots or shoes, dryness of the floor and better
insulation of the metallic conductor increase the resistance, an increase in
the conductivity of the body will promote more injury.
Factors which influences the effect of
electrical shock:
1. Personal idiosyncracy- individual personality, physical condition and the existence

of mental or bodily distress at the time influence the effect of a shock.
2. Disease- person suffering from cardiac disease are disposed to death from
electrical shock.
3. Anticipation of a shock- when a person is aware of the possibility of a shock, the
victim can withstand one which might otherwise be dangerous.
4. Sleep- sleep increases the resistance to an electrical current.
5. Electrical voltage or tension- most fatalities follow shock from current at a
tension of 220-250, although 50 volts which are used for therapeutic purpose also
show fatality.
6. Amperage or intensity of electrical current- this is the principal factor. This is
determined by dividing the voltage by the resistance of the conductor, amperage
of 70-8- in alternating current or 250 in direct current is dangerous to man.
7. Density of the current.
Factors which influences the effect of
electrical shock:
8. Resistance of the body- factors that will reduce the resistance of the body offers
to the electrical flow will promote more injury.
9. Nature of the current- it is claimed that alternating current is more dangerous
than direct current.
10. Earthing- the development of shock is enhanced if the victim is grounded or
earthed. Earthing will promote continuous flow of the electric current.
11. Duration of contact-low tension may kill when contact is maintained for several
minutes. Shorter duration of contact is required to high tension to produce death.
12. Kind of electrodes- some electrodes conduct a free flow of electric current while
others do not.
13. Point of entry- contact of the left side of the body is claimed to be more
dangerous than that of the right side.
Mechanism of Death in Electrical Shock:
1. Ventricular fibrillation which may lead to rupture of

some of the muscle fibers and focal hemorrhages in
low voltage.
2. Respiratory failure due to bulbar paralysis in high
voltage.
3. Mechanical asphyxia due to violent and prolonged
convulsion.
Nature of Electrical Burns:
The electrical burns is sometimes called “electrical necrosis.”

Some called it electrical marks or “current markings,” and may be
seen at the point of entrance and exit of the current. The skin is
puckered with gray color and traversed by deep impressions arranged
at right angle.
The electrical marks are painless and show no vital reaction.
When an accompanied by burns the hair in the region of the mark is
intact. Repair is by a process of aseptic necrosis, lowed by luxuriant
granulation and healing leaves a smooth, thin pink scar.
The absence of mark does not exclude electrocution but the
presence raises a strong presumption of death from electrocution.
Microscopically:
There is compression of the stratum corneum. There is

also superficial carbonization. Deeper in the epidermis
there is focal cavitation due to the sudden production of
steam by the current. The papillae of the corium are
flattened by the current. The papillae of the corium are
flattened with vascular contraction, especially at the
center of the mark.
Symptoms:
If death does not occur after contact, the person may show the
following symptoms:
 Surface of the body cold and moist

 Breath is stertorous
 Pulse rapid, filiform and may be irregular
 Pupils dilated and insensitive
 Pale face
Metallization:
This is claimed to be a specific feature of

electrical injury. The metal of the conductor is
volatilized and particles of the metal are driven into
the epidermis. Extensive areas of the body may be
darkened by metallization. The color may vary from
black to black. If the conductor is iron it is usually
yellow-brown while if it is copper, copper salts may
be produced to yield a blue mark.
Delayed Effects of Electrical Injuries:
Necrosis of the area involved may later develop into gangrene.

Because of the arterial damage, the gangrenous area may be far may be
far more extensive than the gangrenous electrical injury.
The damaged arteries may become brittle and friable that it is liable
to rupture at a slight provocation causing severe hemorrhage.
The late nervous injuries may be manifested in the form of
retrograde amnesia, changes in personality, hemiplegia, aphasia, and
post concessional syndrome.
The current might have entered the head and produce cataract of
the lens in the form of flaky opacities.
There is nothing specific, or may show no lesion at all.

 Electrical arborization
 Burns with metallization
 Intense vascular congestion of the dura mater
 Eyes congested and pupils dilated
 Trachea may be congested
 Lungs deeply engorged and edematous
 Congestion of visceral organs
Treatment:
1. Removal of the victim from live wire installation. Close the

switch and remove the victim and in which case care must be
exercised by the rescuer.
2. Artificial respiration which must continue for about an hour
until positive proof of death is present.
3. Treatment of shock or coma. As soon as spontaneous respiration
is established, raise the temperature of the patient by the
application of hot water bottles and blankets. Cerebral edema
ma be treated by lumbar puncture. Stimulant may be given to
improve the health.
Medico-Legal Aspect:
Death by electrocution is mostly

accidental. Very rarely are they suicidal or
homicidal. Accidental electrocutions usually
occur in grounded laundry line, electric
stoves and outlets.
JUDICIAL ELECTROCUTION
The Revised Penal Code considers only one

way of executing death penalty; that is, by
electrocution. In judicial electrocution, the
convict is seated and strapped in a chair with
electrodes placed on the head and both ankles.
An alternating current of 1,700 to 2,000 volts is
put o until the convict dies.
Art. 81, Revised Penal Code
When and how death penalty is to be
executed:
The death sentence shall be executed with
preference to any other and shall consist in
putting the person under sentence to death by
electrocution. The death sentence shall be
executed under the authority of the Director of
Prisons, endeavoring so far as possible to mitigate
the sufferings of the person under the sentence
during the electrocution as well as during the
proceedings prior to the execution.
If the person under sentence of desires, he shall
ne anesthetized at the moment of electrocution.
The only death penalty recognized by law is by
electrocution.
It must be the duty of the director of prisons to
mitigate as much as possible the sufferings of the
person electrocuted.
Anesthesia may be employed during the
execution of the death sentence if the convict so
desires.
Art 82, Revised Penal Code
Notification and execution of the sentence and
assistance to the culprit:
The court shall designate a working holiday for the execution, but
not the hour thereof; and such designation shall not be communicated
to the offender before sunrise of said day, and the execution shall not
take place until after the expiration of at least eight hours following the
notification, but before sunset. During the interval between the
notification, and the execution, the culprit shall, in so far as possible,
be furnished such assistance as he may request in order to be attended
in his last moments by priest or ministers of the religion he professes
and to consult lawyers, as well as in order to make a will and confer
with members of his family or persons in charge of the management of
his business, of the administration of his property, or of the care of his
descendants.
Notification and execution of the sentence and
assistance to the culprit:
The information as to the time of execution of the
death sentence must be made after sunrise and the
execution must be made before sunset to prevent the
convict commit suicide or attempt to escape
The convict is given at least eight hours to carry on his
last request and to accomplish the things he may request
during that last hours.
The convict mat make a will, consult a priest or
minister or his lawyer.
Suspension of the execution of the death
sentence:
The death sentence shall not be inflicted
upon a woman with in the three years next
following the date of the sentence or while
she is pregnant, nor upon any person over
seventy years of age. In this case, the death
sentence shall be commuted to the penalty of
reclusion perpetua with the accessory
penalties provided in Article 40.
Suspension of the execution of the death
sentence:
Death penalty shall be suspended when the accused
is a:
a. Woman, within three years following the date of the
sentence;
b. Woman, while pregnant;
c. Person over seventy years old.
d. It may also be added that if the convict becomes
insane after the sentence has been pronounced.
Place of execution and persons who may witness
the same:
The execution shall take place in the
penitentiary of Bilibid in a space closed to the
public view and shall be witnessed only by the
priest assisting the offender and his lawyers and by
his relatives, not exceeding six, if he so request, by
the physician and the necessary personnel of the
penal establishment, and by such persons as the
Director of Prisons may authorize.
Place of execution and persons who may
witness the same:
The presence of a physician is an in dispensable
witness to the execution because it is he who will
pronounce after electrocution that the convict is
dead. The penalty is death by electrocution so
that if after the passage of current the convict is
still alive as certified by the physician, it is
necessary to apply some more current until the
convict dies.
Provision relative to the corpse of the person
executed and burial:
Unless claimed by his family, the corpse of the culprit shall,
upon the completion of the legal proceedings subsequent to the
execution, be turned over to the institute of learning or scientific
research first applying for it, for the purpose of study and
investigation, provided that such institute shall take charge of the
decent burial of the remains. Otherwise, the Director of Prisons
shall order the burial of the culprit at government expense,
granting permission to be present thereat to the members of the
family of the culprit and the friends of the latter. In no case shall
the burial of the body of a person sentenced to death be held with
pomp.
Provision relative to the corpse of the person
executed and burial:
The body of the culprit if not claimed by the family
may be given to institution of learning provided that
decent burial will be given after the study or
investigation is done.
The body may buried at government expense by the
Director of Prisons with members of the family and
friends provided that the burial is not held with pomp.
The reason is to prevent making a hero out of a
criminal.
Cutaneous manifestation of lightning injury with bilateral below-
elbow gangrene.
Shrapnel wounds from an Improvised Explosive Device (IED)
blast injuries to both legs
RADIATION BY RADIO-ACTIVE
SUBSTANCES
Natural and artificial radio-active substances emit
three kinds of rays from radium, namely:
1.Alpha rays- The alpha rays has little penetrating power and can be stopped by
a sheet of paper. It is composed of positively charged helium
2.Beta rays- The beta rays has a higher penetrating power than the alpha rays
but their ionizing power is much less. It consist of a stream of electrons traveling a
very high velocities, in some cases approaching the speed of light. The stream of
electrons is like cathode rays vacuum tube.
3.Gamma rays- This rays is short, not affected by electrical and magnetic fields,
analogous to X-ray. It has a high energy and greater penetrating power. The gamma
rays is emitted along with either alpha or beta radiation. It appears that the gamma
radiation arises as a result of internal readjustments which occur in the nucleus after
the loss of an alpha or of a beta particle.
Gamma rays destroys human tissue quite rapidly,
and burns resulting from them are painful and slow
to heal. Fortunately, it kill malignant growth much
faster than they do healthy tissues, which accounts
for their wide use in cancer therapy. The absorption
of radio-active emanations by the body is highly
dangerous. Serious poisoning and even death
resulted from prolonged exposure to the rays of
uranium salts used for painting luminous watch and
instrument dials.
Destructive Effects of Radiation:
The intensity of radiation decrease with the distance
according to the inverse square law. The people are
protected to varying extent by the absorbing material
through which the rays pass. In atomic bomb explosion,
people inside heavily constructed buildings or
underground shelters are less severely affected than
those in the open.
It has been found out that the dose of gamma
radiation is the one responsible for the production of
symptoms in human beings.
I.ATOMIC BOMB EXPLOSION
Atomic bomb is a modern weapon of

warfare and at present considered to be
the most destructive of all. Although its
destructive effects are quite enormous, it
has not yet been outlawed as a means of
warfare like the use of poisonous gases.
I.ATOMIC BOMB EXPLOSION
The destructive effects the human beings of atomic bomb were
well observed in Nagasaki and Hiroshima. The population of the two
cities was 500,000 of which 120,000 died;65,000 were severely
injured and 130,000 were in need of immediate medical care. In
each city about1/6 of the total number of casualties were killed
instantly or died under circumstances in which no medical help was
possible. About 1/7 of the total number of casualties escaped
mechanical injuries and burns but received a sufficient dose of
radiation to make them become ill from one to five weeks later. The
effects of the blast and heat burns were noticed as much as 20 miles
away from the center of the explosion.
Kinds of Atomic Explosion:
1.Aerial explosion- the atomic bomb is

made to explode in the air.
2.Ground explosion
3.Submarine explosion
Effects of Atomic Explosion in the Human
Body:
The effects of the atomic explosion in the human body may be brought
about by the following:
1.Blast injury-The sudden increase and decrease of the atmospheric pressure
may cause marked destructive effect in the human body.
2.Heat injury-The atomic explosion is capable of emitting radiation about
3000 degree centigrade, even sufficient to melt the sand.
3.Mechanical injury-This is due to flying objects which may be observed as a
result of the blast.
4.Radiation injury:-Symptoms and Findings
Majority of people affected experienced nausea and vomiting
several hours after the explosion, though symptoms were brief. The
subsequent course depended on the dose received. In those who
received the largest doses of radiation, fever and diarrhea appeared on
the day after bombing. Purpura appeared 4 to 7 days later, and the
patient then failed rapidly and died suddenly. The blood showed
reduction or total lack of leucocytes and platelets . necropsy revealed
moderate purpura hemorrhagica with widespread petechea and
hemorrhagic erosions of the gastro-intestinal tract. In one group,
subarachnoid hemorrhage was fond in 60% of the patient. The bone
marrow was pale and the spleen and lymph nodes were small. The
spleen and marrow, lymphocytes and marrow cells disappeared, only
the stroma and framework remaining, but with some evidence of the
beginning of regeneration.
The majority of those affected developed symptoms due to gamma radiation in
from 7 to 28 days after the explosion. Those patients showed epilation, gastro intestinal
disturbances, usually intractable diarrhea, purpura, fever, leucopenia and pneumonia.
Larynginitis, pharynginitis, tonsillitis and gingivitis developed in the majority of the
patients. Most of thoselesions progressed, producing severe necrotic ulcerations. The
process was similar to that seen in agranulocytic angina from any cause. Petechea and
purpura, epistaxis, melena, metrorrhagia, and hematuria were regularly observed. The
loss of hair from the scalp were complete in only a few patients. In the majority it
began to grow again 2 to 3 months time. Epilation of other parts of the body was
infrequent leucopenia was universal, and recovery was rare among patients whose
white cell counts dropped below 600 per cu. Mm. anemia became progressively more
pronounced for 1 to 2 weeks after the maximum depletion of white cells was observed .
The hemorrhagic tendency increased the anemia and where this was prominent the
patients died badly. Associated with the leucopenia and ulceration were overwhelming
infections, many going on to septicemia; this, together with pneumonia, was the
general cause of death at this stage. Failure of spermatogenesis was constant in patient
exposed to sufficient radiation to produce clinical symptoms.
A milder form of radiation injury occurred in
other patients, some of these developing epilation
in the third week, with much less of constitutional
symptoms. They developed weakness, malaise,
diarrhea and mild inflammation of the mouth, with
some leucopenia and pneumonia. Anemic was the
most covered died in 2 to 4 months from aplastic
anemia. The tissues of the female reproductive
system were affected to a much smaller extent than
the male.
Treatment of Radiation Injuries:
It is necessary to maintain fluid and acid-base

balance, control infections, combat the
hemorrhagic tendency, and correct the anemia. It
is thought that, had adequate hospital facilities
been available, with plasma, electrolyte solutions,
whole blood and penicillin in adequate amount,
mortality would have been much lower.
II. X-RAY RADIATION
The effect of X-ray radiation has been already discussed

n the subject matter burns. Idiosyncrasy and dosage of
radium are the principal factors determining the degree of
injury. Lymphoid and blood-forming tissues are very sensitive
to radiation. Big dosage causes injury to the lymph tissues,
spleen and bone marrow. Cancer cells are more sensitive as
compared with normal tissues.
In the skin it may produce erythema, ulceration and later
sloughing. Prolonged exposure to X-ray may lead to aplastic
anemia and sterility.
Test for the presence of radio-active
substances:
1.Geiger-Muller Counter-this is an instrument which by

the number of tick the presence and approximate quantity
may be determined. In the Philippines, the civil defense
administration is utilizing the instrument to detect radio-
activity.
2.Use of the electroscope
3.Death an X-ray plate-this procedure is utilized in
objects which are suspiciously exposed to radio-activity.
Test for the presence of radio-active
substances:
Procedure:--
Place the object or ashes on an unexposed X-ray plate which has been
covered by black paper.
Allow this to stand in a dark room for a wreck or more.
Develop a plate.
If a radio-active material is present in the material tested, an exposed
light space will appear on the plate in the area on which the specimen was
placed. Both beta and gamma rays of radio-active substances will penetrate
the black protective paper on the film and will bombard and expose the area
of contact.
DEATH BY ASPHYXIA
DEATH BY ASPHYXIA
Asphyxia is the general term applied to all

forms of violent death which results primarily
from the interference with process of respiration
or to the condition in which the supply of oxygen
to the blood or to the tissues or both has been
reduced below normal level.
Types of Asphyxial Death:
1. Anoxic Death
This is associated with the failure of arterial blood
to become normally saturated with oxygen. It may be due
to:
a. Breathing in an atmosphere without or with insufficient
oxygen, as in high altitude.
b. Obstruction of the air passage due to pressure from
outside, as in traumatic crush asphyxia.
c. Paralysis of the respiratory center due to poisoning,
injury or anesthesia, etc.
Anoxic Death
d. Mechanical interference with the passage of air into or
down the respiratory tract due to :
1) Closureof the external respiratory orifice, like in
smothering and overlaying.
2) Obstruction of the air passage, as in the drowning,
chocking with foreign body impact, etc.
3) Respiratory
abnormalities, like pneumonia, asthma,
emphysema and pulmonary edema.
e.Shutting of blood from the right side of the heart to the left
without passage through the lungs as in congenital anomalies
like potent foramen ovale.
2.Anemic Anoxic Death

This is due to a decreased capacity of the blood to carry
oxygen. This condition may be due to :
a. Severe hemorrhage
b. Poisoning, like carbon monoxide
c. Low hemoglobin level in the blood.
3. Stagnant Anoxic Death

This is brought about by the failure of circulation. The
failure of circulation may be due to ;
a. Heart failure
b. Shock
c. Arterial and venous obstruction incident to embolism,

vascular spasm, varicose veins, or use of tourniquet.
4. Histotoxic Anoxic Death

This is due to the cellular oxidative process and
although the oxygen is delivered to the tissues, it
cannot be utilized properly. Cyanide and alcohol are
common gents responsible for histotoxic anoxic death.
Phases of Asphyxia Death
1. Dyspenic Phase
The symptoms are due to the lack of oxygen and the
retention of carbon dioxide in the body tissue. The
breathing becomes rapid and deep, the pulse rate
increases, and there is a rise in the blood pressure.
The face, hands and fingernails became bluish,
especially in the infants.
2. Convulsive Phase
This is due to the stimulation of the central nervous system by
carbon dioxide. The cyanosis becomes more pronounced and the eyes
become staring and pupils dilated. Examination of the visceral organs
shows small petecheal hemorrhages, commonly known as Tardieu Spots.
The Tardieu Spots are caused by the hemorrhages produced by the
rupture of capillaries on account of the increase of intracapillary
pressure. It usually appears in places where the tissue is soft and the
capillaries are not well supported by the surroundings, as in visceral
organs, skin, conjunctivae and capsules of glands.
The victim may become unconscious during the convulsive stage.
3. Apneic Death
The apea is due to the paralysis of the respiratory
center of the brain. The breathing becomes shallow and
gasping and the rate becomes slower till death. The
heart later fails.
Recovery at this stage is almost nil due to the
permanent damages in the brain on account of the
prolonged cerebral anoxia.
Classification of Asphyxia
1. Hanging
2. Strangulations
a. Strangulations by ligature
b. Manual strangulations or throttling
c. Special forms of strangulations
a. Palmar
b. Garroting
c. Mugging or yoking
d. Compression of the neck with stick
Classification of Asphyxia
3. Suffocation:
a. Smothering or closing of the mouth and nostrils by solid
objects
b. Choking or closing of the air passage by obstruction of its
lumen
4. Asphyxia by submersion or drowning
5. Asphyxia by pressure on the chest(Traumatic crush asphyxia)
6. Asphyxia by irrespirable gases
I. ASPHYXIA BY HANGING
Asphyxia by hanging is a form of violent death brought

about by the suspension of the body by a ligature which
encircles the neck and the constricting force is the weight
of the body.
It is not necessary that the whole body will be left
suspended. The victim may be sitting or lying with the
face downward provided that the pressure is present
in front or in the side of the neck.
Classification of Asphyxia by Hanging:
1. As to the location of the Ligature and Knot

a. Typical –when the ligature runs from the midline
above the thyroid cartilage symmetrically encircling
the neck on both sides to the occipital region.
b. Atypical-when the ligature is tied or noose is present
on one side of the neck, in front or behind the ear,
or on the chin.
Classification of Asphyxia by Hanging:
2. As to the Amount of Constricting Force
a. Complete-when the body is completely suspended and the
constricting force is the whole weight.
b. Partial-when the body is partially suspended as when the victim is
sitting, kneeling, reclining, prone or other positions.
3. As to Symmetry:
a. Symmetrical-when the knot or noose is at the midline of the body
either at the occiput or just below the chin.
b. Asymmetrical-when the knot or noose is not in the midline but on the
sides, with the head tilted to the side opposite the location of the
noose or knot.
Mechanism of Death
There is a lightning around the neck with a knot or with a sliding
noose and the other end is fasteened to an elevated object like peg,
nail, window casing, door knob, tree, etc.
Upon suspension of the body, the weight causes the noose or
band to tighten producing pressure at the region of the neck.
The pressure of the band will cause the air passage to constrict,
the larynx is pushed backwards and its opening is closed by the
contact of the anterior to the posterior laryngeal wall producing
cerebral anoxia.
Mechanism of Death
The form of furrow that develops in the neck depends upon

the type of ligature, number of loops around the neck and the
point of suspension.
Protrusion of the tongue depends upon how pressure is applied
around the neck. If above the larynx and in a upward direction,
the tongue will be pushed outward and will protrude from the
mouth, but if the pressure is below the larynx, the tongue is kept
inside the buccal cavity.
Ligature in Hanging:
1. Material used as ligature:
The thinner is the ligature and the tougher is the material, the
more pronounced will be the mark on the skin of the neck. If the
material is soft and broad the ligature impression on the neck is
less marked.
If hanging is done with evident premeditation as in the case of
suicide, special quality of material may be used.
Rolled beddings, leather belts joined together, rope, electric
wire and vines are oftenly used. The rope is commonly used as
ligature because it is easily available and strong.
2. Noose
There may be no sliding noose at the ligature. It may be
tightened after it has been encircled around the neck and the
pressure on the air passage, blood vessels and nerves of the
neck is established when the body is suspended. Metal buckle,
ring, or sliding noose may be attached to the end to make it
slide.
3. Mode of Application of the Ligature:

The ligature may be placed around the neck with a single
loop or with two or ore loops. This can be distinguished on the
nature of the ligature marks. In the single loop, there is but
one ligature furrow, but if there are several loops, there will be
several ligature marks with an intervening redness between the
furrows, there is more tendency to have more pressure in
single loop ligature on account of the concentration of force of
the weight as compared with two or more loops.
4. Position of the Knot

The knot or joint is usually located on either side of the
neck. The head is flexed opposite the location of the knot. The
level of the ligature around the neck may differentiate hanging
from strangulation by ligature. In hanging, the ligature is
usually found above the thyroid cartilage on account of the
upward pull of the constricting force, while in cases of
strangulation by ligature, the loop is found below the thyroid
cartilage. It is not easy to retain the knot beneath the chin.
5. Course of the Ligature around the Neck

The usual appearance is that the groove or ligature mark is
deepest opposite the location of the knot. However, if the knot
is just underneath the chin, the groove at the back of the neck
is not deep on account of the firmer skin and muscular tissue.
The course of the ligature forms an inverted V-shape with the
vertex as the location of the knot.
Symptoms:
 -Gradual loss of sensibilities
 -Sensation of constriction of the neck
 -loss of the consciousness and muscular power
 -Numbness of the legs and clonic convulsion
 -Sensation of ringing of the ear
 -Sensation of flash of light before the eyes
 -Face becomes red, with eyes prominent and feeling of heat in the head
If the victim is timely rescued and revived after artificial respiration, he will suffer
the following symptoms:
 -Whistling of the eyes
 -Watering of the eyes
 -Difficulty of breathing and swallowing
 -Sensation of numbness of both legs
All of the above symptoms may last for 12 days after the rescue.
Amount of tension in the ligature sufficient
to occlude the vital structures of the neck:
Jugular veins …………………..2 kilos (4.4 lbs)
Carotid artery ………………….5 kilos (11,0 lbs)
Trachea …………………15 kilos (33.0lbs)
Vertebral artery …………………30 kilos (66.0lbs)

Causes of Death in Hanging:
1. Simple asphyxia by blocking the air passage.

2. Congestion of the venous blood vessels in the brain.
3. Lack of arterial blood in the brain due to pressure on the
carotid arteries.
4. Syncope due to pressure on the vagus and carotid sinus on the
carotid sinus which lead to reflex irritation and paralysis of the
medullary autonomic centers.
5. In jury on the spinal column and spinal cord.
6. It may be any combination of the above-mentioned causes.
Time Occupied in the Process of Death:
The time required to produce Death in hanging is influenced by

the following factors:
1. Severity of the constructing force:
If the constricting force is only sufficient to occlude the
windpipe, death may be delayed; but if the pressure is sufficient
to occlude the carotid arteries, jugular veins and vagus nerve,
unconsciousness develops immediately and death is accelerated.
2. Point of application of the ligature:

When the ligature is made below the larynx, death is almost
instantaneous, but when applied above the larynx, death may not
occur for three to five minutes. Hanging with the knot situated on
one side of the neck may delay death because the closure of the
cerebral vessels cannot be completely maintained . if the knot is
just below the jaw, maximum pressure is at the back of the neck
and causing merely partial occlusion of the windpipe and blood
vessels of the neck thereby delaying death.
3. Other factors:
a. Physical condition of the subject.
b. The rate of consumption of oxygen in the blood and tissues.
The loss of sensibility is due to the pressure of the ligature on
the blood vessels causing disturbance in the cerebral circulation.
Ordinarily respiratory movement may persist one to two minutes
and the heart action for 15 to 30 minutes so that artificial
respiration may successfully revive the victim.
Treatment :
1.Induce the natural acts of respiration.

 Ligature must be loosened and the mouth must be wiped to
remove all obstacles to free air.
 Tongue must be pulled forward and the body must be laid
on back rest.
 Place the patient where there is free current of fresh air.
 Electrical stimulation of the phrenic nerve.
 Administration of respiratory stimulant, like ammonia.
Treatment :
2.Stimulate the heart to renew action if it has ceased to beat:

 Apply heat at the region of the precordium.
 Hypodermic injection of coramine, strychnine, or other
stimulants.
 Administration of brandy.
3.Maintain the natural body temperature
 Cover the body with blanket.
 Place the patient in a warm room.
Postmortem Findings in Death by Hanging:
A. General External Appearance

 Neck elongated and stretched with the head inclined on the
side opposite the knot or noose.
 Eyes closed or partially opened with pupils usually dilated on
one side and small on the other side (Le facies sympathetic).
 Lividity or pallor of the face with swelling and protrusion of
the tongue.
 Hands clenched firmly and purple color fingernails.
A. General External Appearance
 Lips livid or blue.

 Saliva dribbled from the mouth with froth.
 Staten of erection or semi-erection of the penis with seminal
fluid in the urethral meatus.
 Postmortem lividity with ecchymosis most marked at the
legs.
 Urination or defecation due to loss of power of the sphincter
muscles.
B. Internal Finding
 Engorgement of the lungs.
 Venous system contains dark-colored fluid blood.
 Right side of the heart and big blood vessels connected with
it distended with blood.
 Kidneys are congested.
 Sub-pleural, sub-pericardinal punctiform hemorrhages
(Tardieu Spots).
C .Findings in the Neck:
 Neck flexed opposite the side where the knot is located.
 Ligature mark which forms a groove and deepest opposite the knot. The
width of the groove is about or rather less than the width of the ligature.
The skin of the groove is pale or parchment like. Microspically , there is
characteristic abrasion with slight desquamation and flattening of the
cells of the epidermis.
 The course of the ligature is inverted v-shape with the apex of the “v” the
site of the knot. There may be interruption of the ligature marks.
 The skin at the sight of the ligature is hard with red line of congeston and
hemorrhage in some points.
 Eccyhymosis of the neck depends upon the width and softness of the
ligature.
C. Findings in the Neck:
 There may be rupture of the underlying blood vessels,

muscles and other soft tissues.
 The lining membrane of the blood vessels may be lacerated.
 Fracture of the upper cervical vertebrae and injury of the
spinal cord in long drop hanging or in judicial hanging.
 Contusion of the ligature marks.
Differential Diagnosis:
1. Fold markings in the neck in obese individuals but in

this case the marks is not continuous and removed
on stretching the skin of the neck.
2. Marks of tight neckwear. The location and history
will differentiate this from ligature marks.
Causes of Death in Judicial Hanging
In the Philippines, death penalty imposed by

the civil court must only be by electrocution.
Hanging is not recognized as a means of
executing death sentence, although decision of
military tribunal may impose death by hanging.
Causes of Death in Judicial Hanging
The following are the causes of death in judicial hanging:

1. Dislocation or fracture of the upper cervical vertebrate.
2. Partial or complete severance of the spinal cord.
3. Rupture of the cervical muscles.
4. Asphyxia due to the pressure on the vagus nerve.
5. Syncope due to the pressure on the vagus nerve.
6. Cerebral anemia wich results to inhabitation of the vital
centers of the brain.
Determinations Whether Hanging is
Antemortem or Postmortem
The principal criterion in the determination whether

hanging is antemortem or postmortem is the vital
reaction. But, hanging made immediately after death may
also show to a certain extent vital reaction, while hanging
of a living subject whose bodily resistance has been
markedly weakened may show only slight vital reaction.
Antemortem or Postmortem
The following findings show that hanging is antemortem:

1. Redness or ecchymosis at the site of ligature
2. Ecchymosis of the pharynx and epiglottis
3. Line od redness or rupture of the intima of the carotid
artery
4. Sub pleural, subpericardial punctiform hemorrhages
It is advisable to look for other injuries capable of
producing death to eliminate the possibility of hanging as the
cause of death.
Accidental, Homicidal or Suicidal:
1.Homicidal hanging
a. Nature of the windows and doors-see whether it was
forcibly opened in the entrance or escape of the offender
in homicidal cases.
b. Presence of signs of struggle in the clothings, furniture,
and blessings-the furniture and beddings may be disturbed
whenever there was previous struggle before hanging.
c. Presence of stains, bodily injuries in the body of the
victim.
d. Presence of defense wounds in the body of the

victim.
“Lynching” is a form of homicidal hanging usually found
in southern states of the United States. It is usually
practiced by American. Against the Negroes who commit
crime against the white American. Whenever the colored
offender are apprehended they are hanged by means of a
rope in a tree or some similar objects. The Negroes are
executed without due process of law.
2.In suicidal hanging, the materials used are those that are
easily accessible, like handkerchief, mosquito net, beddings,
etc. his mental condition and presence of suicidal note infer
that hanging is suicidal.
The rule is that hanging is suicidal unless there are
evidences to show that it is not.
3.Accidental hanging is very rare.
This homosexual male was found hanged at his apartment.
As you can see the victim is wearing the white ladies panties.
Another victim of autoerotic asphyxiation. The interesting fact was
that this case initially was considered to be a common suicide
II. ASPHYXIA BY
STRANGULATION
I. STRANGULATION BY LIGATURE
Strangulation by ligature is produced by compression of

the neck by means of a ligature which is tightened by a force
other than the weight of the body. Usually, the ligature is
drawn tight by pulling the ends after crossing the back or
front of the neck, or several folds of the ligature may be
around the neck tightly placed and ends knotted, or a loop is
thrown over the head and a stick inserted beneath it and
twisted till the noose is drawn tight.
If the ligature is made of soft material and applied
smoothly around the neck, no visible mark will be observed
after death. Hard rough ligature applied with force more than
required to kill may produce extensive abrasion and contusion
at the area of application.
Strangulation by ligature may be observed in infanticide
using the umbilical cord as the constricting material. This must
be differentiated from accidental strangulation by the
umbilical cord during child birth. In accidental strangulation
during childbirth, the umbilical cord is abnormally long and
there is no disturbance in the Wharton’s jelly.
Strangulation by ligature is commonly observed in rape
cases, but the presence of findings in the genitalia and other
physical injuries are the distinctive findings.
Distinctions in the Postmortem Findings in
the Neck between Death by Hanging and
Death by Strangulation with Ligature:
Hanging Strangulation by Ligature
1. Hyoid bone is frequently injured. 1. Hyoid bone is frequently spared.
2. Direction of the ligature mark is 2.Ligature mark is usually horizontal
inverted V-shaped with the apex and the knot is on the same
the site of the knot. horizontal plane.
3. Ligature is usually at the level of 3.Ligature is usually below the
the hyoid bone. larynx.
4. Ligature groove is deepest opposite 4.Ligature grooved is uniform in
the site of the knot. depth in its whole course.
5. Vertebral injury frequently 5.Vertebral injury not observed.
observed.
Causes of Death in Strangulation by
Ligature:
1. Asphyxia due to the conclusion of the

windpipe.
2. Coma due to arrest of cerebral circulation.
3. Shock or syncope.
4. Inhibition of the respiratory center due to
pressure on the vagus and sympathetic
nerves.
Treatment:
1. Removal of the ligature

2. Artificial respiration, and if there is a block in
the laryngeal passage, tracheotomy must be
performed.
3. Preventions of complications:
a. Edema of the glottis.
b. Pneumonia.
c. Abscess formation at the site of injury.
1. External Examination:
a. Face livid and swollen
b. Eyes wide open, prominent, congested and pupils
dilated.
c. Tongue swollen, dark colored and protruded.
d. Bloody froth may escape from the mouth and
nostrils.
e. Tardieu’s Spot are found beneath the
conjunctivae, face, neck, chest and lungs.
2. Internal Examination:
a. Intense venous congestion of both lungs with numerous
petechial hemorrhages.
b. Blood-stained froth found in big bronchi.
c. Right side of the heart filled with dark fluid blood.
d. Congestion of the brain.
e. Congestion of the visceral organs.
3. Examination of the Localized Lesion in the Neck:

a. Mark of violence on the neck in the form of ligature
mark, abrasion, or ecchymosis.
b. Fracture of the larynx or tracheal rings.
c. Laceration of the tunica intima of the carotid and
jugular vessels.
Accidental, Homicidal or Strangulation by
Ligature:
Homicidal strangulation is the most common of the three forms of

strangulation by ligature. Aside from the ligature mark in the neck, there are
evidences of struggle or marks of violence in other parts of the body. A
A person may be rendered helpless by a blow, intoxicating liquor or by initial
throttling. The ligature may be passed around the neck and then the feet
and hands are bound together. Smothering may be done by placing a
handkerchief gag in the mouth.
Suicidal strangulation by ligature is quite rare. It may be done by
placing a ligature around the neck and tightened by means of twisting a
piece of stick.
There are a few instances of strangulation which are accidental and
most of the victims are children or epileptics who are helpless and incapable
of extricating themselves.
2. MANUAL STRANGULATION OR
THROTTLING:
This is a form of asphyxial death

whereby the constricting force applied
in the neck is the hand.
Methods of Throttling:
1. Using one hand and the neck may be grasped in front with the thumb
exerting pressure on one side and the other fingers on the other side.
The palm may exert pressure in front of the neck.
2. Using both hands with the assailant in front. The thumbs digging in over
the
Anterior part of the larynx and pressing on the sides and back of the
neck.
3. Using both hands with the assailant at the back. The fingers of both
hands grasp
The throat in front and exerting a backward and medial compression
while the
Thumbs press against the side and back of the neck.
Manners of Death in Manual Strangulation:
1. The air passage may be blocked and death is due to asphyxia.

2. The pressure on the neck may cause compression of the blood
vessels and
Disturb the blood supply of the brain.
3. The nerves of the neck may be traumatized especially the
superior laryngeal
Branch of the glossopharyngeal and hypoglossal nerves and the
plexus
Surrounding the bifurcation of the common carotid artery or of
the vagus producing shock.
1. Cyanosis of the face.

2. Sub pleural and subpericardial hemorrhage is not
so conspicuous.
3. Heart, especially the right side is distended with
blood.
4. Over distention of the lungs with interstitial
emphysema occasionally observed in children.
5. Findings on the neck:

a. There may be no external injury on the skin but there may be contusion with
the form and shape of the fingers.
b. Curved thumb nail or group fingernail abrasions may be found in front or at
the back of the neck.
c. Interstitial hemorrhages in the muscles of the neck.
d. Fracture of the laryngeal cartilage may occasionally be found.
e. Petecheal hemorrhages and congestion of the larynx and pharynx.
f. There may be bruising of the tongue at its anterior border and the tongue
itself may be bitten and protruded.
g. Hemorrhages present in the capsule of the thyroid, submaxillary and even
parotid glands
Accidental, Homicidal or Manual
Strangulation:
1. Suicidal throttling is not possible because the pressure of the person’s

own hand must be maintained for sometime but when unconsciousness
begins the hand are relaxed and the victim recovers.
2. Accidental throttling may occur but the victim never died of asphyxia
but of some other causes. A sudden application of manual pressure in the
neck during the moments of excitement or passion may cause cardiac
inhibition or cerebral apoplexy.
3. Homicidal manual strangulation is the most common. It is a method of

choice in infanticide. In most cases there are evident signs of struggle.
SPECIAL FORMS OF STRANGULATION:
1. Palmar strangulation:
The palm of the hand of the offender is pressed in front of the neck
without employing the fingers. The pressure must be sufficient to occlude
the lumen of the windpipe
2. Garroting:
A ligature, a metal collar or a bowstring is placed around the neck and
tightened at the back. The subject may be placed with the back to the post
and a spike may be placed in the post to force into the nape of the neck
when the constricting band is tightened
Garroting is a mode of judicial execution during the 19th century and
it’s still practiced in Spain and Turkey.
SPECIAL FORMS OF STRANGULATION:
3. Mugging:
This is the form of strangulation with the assailant standing at the back
and the forearm is applied in front of the neck. The pressure on the neck is
brought about by the pressure of the flexed elbow.
Mugging may be the cause of death in wrestling. The knee may also be
used and it will produce the same effect as that of the elbow.
4. Compression of the Neck with the Stick:
This victim may be required to place his back behind a post. The assailant
with a piece of stick placed in front of the neck pulls with two hands passing on
both sides of the post backwards with sufficient strength to occlude the trachea.
Asphyxia By Strangulation
Bruising of the neck in manual strangulation
External findings other than in
neck
Homicidal strangulation with a soft silk ligature. The folding of the
material has caused the deep grooved mark and the fainter red
mark above it.
Conjunctival haemorrhages in manual strangulation
Petechial hemorrhages on the eyelid in a case of manual
strangulation.
III. ASPHYXIA BY
SUFFOCATION
1. SMOTHERING:
This is a form of asphyxia death caused by the closing of the

external respiratory orifices, either by the use of the hand or by
some other means. The nostrils and mouth may be blocked by the
introduction of foreign substances, like mud, paper, cloth, etc.
If the buccal and nasal orifices are occlude by the hand,
there may be abrasion and contusion of the nose and mouth.
Finding in death by mothering will be that of asphyxia.
Suicidal smothering by means of his own hand is not
possible. The moment the victim becomes unconscious the
instinctive release of the pressure will save him.
Homicidal and accidental smothering is
frequent. Accidental smothering may occur
when a person is under the influence of
alcohol, epilepsy or in any other helpless state.
Accidental smothering is common among
children.
Overlaying is the most common accidental
suffocation in children. The children may be
suffocated either from the pressure of the
beddings and pillows or from pressure of
unconscious or drunk mother.
2. CHOKING:
This is a form of suffocation brought about by the impaction of foreign body in
the respiratory passage.
The most common foreign bodies impacted are:
a. Vomitus, especially when the person is under the influence of alcohol.
b. Regulation of food from the stomach, as the coagulated milk in children.
c. Bolus of food.
d. Detached membrane in diphtheria.
e. False set of teeth.
f. Blood in tonsillectomy operation.
g. Respiratory hemorrhage as in tuberculosis.
Most of suffocation by choking is
accidental, although it may be utilized in
suicide or homicide.
The postmortem finding in
suffocation by choking is the same as
other forms of asphyxia plus the presence
of the foreign body in the respiratory
tract.
IV. ASPHYXIA BY SUBMERSION
OR DROWNING
IV. ASPHYXIA BY SUBMERSION OR
DROWNING
This is a form of asphyxia where in the nostrils

and mouth has been submerged in any watery, viscid or
pultaceous fluid for a time to prevent the free entrance
of air into the air passage and lungs. It is not necessary
for the whole body to be submerged in fluid. It is
sufficient for the nostrils and the mouth to under the
fluid. Children may be drowned in an ornamental pool or
“tilapia” pond, and epileptic or drunk person may be
found drowned in a shallow creek.
Mechanism of drowning:
When a person who does not know how to swim falls into deep body of
water, his body will sink on account of the momentum of the fall and because the
specific gravity of the human body is slightly more than that of water. Later the
body will be buoyed because of the instinctive movement of the individual
coupled with the presence of air underneath his clothings. While under water, the
breath is held but upon-reaching the surface there is an attempt to breathe. Air
and water then got into the mouth and nostrils. Then he will endeavor to raise his
hand which will cause him to sink under water. He then alternately appears and
disappears on the surface and every time he attempts to breath, water will get
in. Because of the entrance of the fluid, there will be violent coughing which will
expel the air in the lungs and creates an imperative desire to breathe, during
which more water is drawn in. The drawn-in water may go to the lungs or to the
stomach. The water fills the bronchioles forcing the residual air to be in the lung
surface and causing the lungs to balloon and become soggy and edematous. Death
usually occurs 2 to 5 minutes later.
Phases of drowning:
1. “Respiration de surprise” occurring at the moment when the
mouth and nose are covered with fluid consisting of one deep
inspiration.
2. Phase of resistance which consists of a short period of apnea due
to the irritation of the sensory laryngeal nerve endings by the cold
water.
3. Dyspneic phase with a forceful respiratory movement.
4. Another apneic phase.
5. Terminal respiration, after which the breathing stops
permanently.
(Broundel cited by Gradwhol p.227).
Causes of Death in Drowning:
1. Typicaldrowning:
The primary cause of death in
ordinary submersion in water is asphyxia.
The water interferes with the free ex-
changed of air in the air sacs.
2. Atypical drowning:
In atypical drowning cases, the causes of death may be due to the
following:
a. Cardiac inhibition following submersion due to the stimulation of the
vagus nerve.
b. Laryngeal spasm due to submersion. The inhaled water may cause spasm
of the larynx.
c. Submersion when unconscious. A person may be drunk, or suffering from
cerebral aneurysm, cerebral hemorrhage, heart disease, and suddenly collapse
and fall in a body of water and be unconscious when submerged. A complete
picture of drowning may not be found at the autopsy table.
3. Other conditions associated with drowning:
a. The body might have fallen into the water and his body strikes on a
solid hard object which is capable of producing death itself.
b. The body might be under the influence of alcohol or other depressants
and incapable of helping himself.
c. Cramps might have prevented him from saving himself.
d. Shock due to fright or sudden exposure to cold might have caused
sudden heart failure.
e. The person might have died of some other causes independent of
drowning, like apoplexy, cardiac failure, etc.
f. The body might have been dead and thrown into the water.
Time Required for Death in Drowning:
Submersion for 1 ½ minutes is considered fatal if

ordinary efforts for respiration is made, however a
person may survive even after 4 minutes of
submersion. The average time required for death in
drowning is 2 to 5 minutes. It has been claimed that
the length of survival in drowning is proportional to
the amount of froth in the respiratory tract.
Time Required for Death in Drowning:
The power of recovery in human beings in

drowning is inversely proportional to the amount of
froth in the air passage and the penetration of
water into the lung tissue. The amount of mucous
froth and the degree of penetration of water into
the lungs as well as the degree of subpleural
ecchymosis is proportional to the effort made to
save himself.
Emergency Treatments in Drowning:
Removed the bodily clothings especially the tight ones

and wrap the body with blanket.
Place the face down and perform artificial respiration,
using any of the following methods:
1. Schaefer’s method:
With the face down, the patient must be in prone
position. The operator kneels astride the body and exerts
pressure on the lower ribs at the rate of
12 to 15 times a minute.
Emergency Treatments in Drowning:
2. Sylvester’s method:
With the patient lyingon his back, and the operator
astriding over the body, swinging the arms forward up and
then pressing the chest wall. This is repeated every 3 to 5
seconds.
Administration of stimulants as ammonia, aromatic
vinegar, etc.
Injection of strychnine, coramine, caffeine, etc.
Inhalation of oxygen combined with 5% to 8% carbon
dioxide to stimulate respiration.
1. External findings:
a. Clothes wet with face pale, with foreign bodies clinging on
skin surface.
b. Skin puckered, pale, contracted in the form of “cutis
anserine” or “gooseflesh” particularly those of the extremities
and when the body is recovered in cold water. This is due to
the contraction of the erector pili muscles. This is not
diagnostic of drowning because it may appear before or after
death. The erectors pilorum muscles may contract during the
process of rigor mortis so that “cutis anserina” may develop
after death.
c. Penis and scrotum may be contracted and retracted especially

when the body is found in cold water.
d. Washerwoman’s hand and feet. The skin of the hands and feet is
bleached, corrugated and sodden appearance. Not diagnostic of
drowning but proves only that the body has remained in water for some
time without reference as to the cause of death.
e. Eyes half –opened or closed, with eyelids livid, conjunctivae
injected and pupils dilated.
f. The mouth may be closed or half-opened with the tongue
protruding.
g. Postmortem lividity is most marked in the head, neck and chest. This is due
to the gravitation of blood in those areas when the body was immersed in water.
h. Presence of firmly-clenched hands with objects as weeds, stones, sand, etc.,
indicative that the persons was alive when placed in the water ( cadaveric
spasm).This is also indicative that there was struggle of the victim for life.
i. Physical injuries may be present on the body surface which may be indicative
of previous struggle with an offender, effort of the victim to save himself,
hitting hard and rough object while in water by the force of the current, or some
other causes.
j. In suicidal drowning, pieces of stone or other heavy objects may be recovered
in pockets of clothings to facilitate submersion.
2. Internal findings
a. Respiratory systems:
(1) “Emphysema aquosum”- The lungs are distended like balloons,
Overlapping the heart, with rib markings on the surface and protruded
out of the chest upon removal of the sternum. This is due to the irritation made
by the inhaled water on the mucous membrane of the air passage which
stimulate the secretion of mucous. The lungs are progressively distended and the
emphysema is due to the fact that the air is driven by the fluid on the lung
surface.
(2) “Edema aquosum”-This is due to the entrance of water into the air
sacs which makes the lung doughy, readily pit on pressure, and excludes water
and froth on section.
(3) “Champignon d’ocume”-This is the whitish foam

which accumulates in mouth and nostrils. It is due to
the abundant mucous secretion of the respiratory
passage which by respiratory movements whips up the
substance into foam. Removal of the foam and followed
by pressure on the chest will produce further foam in
the mouth and nostrils. This finding is considered to be
one of the due to drowning.
(4) Tracheo-bronchial lumina is markedly congested and

filled with fine froth with foreign bodies which are also found
in the fluid medium where the body is recovered.
(5) Blood-stained fluid may be found inside the chest
cavity and this is due to the permeation of water trapped
inside the air sacs.
(6) The whole lung field may be congested but if there is
abundance of water in the air sacs, it may appear pale.
(7) Section of the lungs show the presence of fluid with
bloody froth.
b. Heart:
(1) Both sides of the heart may be emptied or filled with
blood. The right side may be distended with blood while the
left may be emptied on account of the distention of the air
sacs thereby limiting the capillary flow.
(2) If drowning took place in salty water, the blood chloride
content is greater on the left side of the heart than on the
right, but if drowning took place in fresh water, the blood
chloride is more in the right than on the left. This is one of the
means to determine the place where a victim was drowned.
Gettler’s test:
This is a quantitative determination of the

chloride content of the blood in the right and left
ventricle of the heart. The demonstration of a
difference of at least 25 mg. proves that the death
occurred in fresh or salt water pool and drowning is
the cause of death.
Basis of the test:
Normally the chloride contents of the blood is the

same in both sides of the heart. But when water enters
the alveoli it goes with the circulation and is diffused with
the blood. So that if drowning took place in salt water
pool the chloride content in the right side of the heart
will be less as compared with the left, and the reverse is
true when the victim was drowned in fresh water. The test
will not only determine the cause of death as drowning
but also where such drowning took place-in fresh or salty
water pool.
Fallacies of the test
(a) The victim might have been drowned in a salt water pool where the
chloride content of the water is quantitatively similar as that of the blood.
Inhalation of such fluid will not make any difference in the chloride contents of
the left or right side of the heart. However, the cellular count and hemoglobin
percentage may be different.
(b) Reduction in blood chloride after death is a common postmortem
phenomena .It could be possible that the rate of reduction may not be the same
on the right and on the left side of the heart, thereby producing a difference
although death was not due to drowning.
(c) Blood chloride estimation obtained twelve or more hours after death
from drowning in fresh water are of little diagnostic value on account of the
diffusion of the fluid on both chambers of the heart.
c. Stomach:
There is plenty of fluid and other foreign materials
are also found in the case of drowning. The absence of
water show that the death is rapid or submersion is made
after death. It is impossible for water to get into the
stomach if the body is submerged after death.
d. Brain:
The brain is congested and the big blood vessels
are engorged.
e. Blood:
Aside for the difference in the chloride contents, the blood
becomes dark an account of the absorption of all its available
oxygen. There is reduction of its hemoglobin contents on account of
dilution. The red blood cells may be crenated.
d. Other organs:
The liver is engorged with dark fluid blood. The spleen and
the kidneys are dark in color and congested. Water may be present
in the middle ear due to violent inspiration when the mouth is full
of water.
Findings Conclusive that the Person Died of
Drowning:
1. The presence of materials or foreign bodies of the

hands of the victim which were found in the water.
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) and
edema of the lungs (edema aquosum).
Findings Conclusive that the Person Died of
Drowning:
3. Presence in the stomach contents, water and fluid

corresponding the
Medium where the body is recovered.
4. Presence in the air passage froth or foam or foreign
bodies found in the
Medium where the victim was found.
5. Presence of water in the middle ear.
Floating of the Body in Drowning:
The body may not immediately be recovered after

drowning because it is under water. The specific gravity of
the human body is slightly more than that of water. Within
24 hours, on account of decomposition which causes the
accumulation of gas in the body, the body floats. The
floating of the body is markedly influenced by the
weather, condition of the fluid medium where drowning
took place, presence of wearing apparel, age, sex and
body built. The body when recovered floats usually with
flexed extremities.
Floating of the Body in Drowning:
This is due to the dominance of the flexor muscles over
the extensors in the process of rigor mortis. The head is
submerged because it has a higher specific gravity than the
rest of the body. And because the head is now the most
dependent portion of the body, more blood accumulates in
the face. This explains the dark bloated condition of the
face during the early stage of decomposition, otherwise
known as “tetede negri” or the bronze color of the head and
neck of the person who died in water during the process of
decomposition.
Determinations Whether Drowning is
Suicidal, Homicidal or Accidental:
1. Suicidal drowning:
a. Heavy articles or weight may be found in the pocket of
clothings.
b. Presence of suicidal note.
c. Determination of the strong reason for him to commit
suicide.
d. Mentally of the person.
e. Study of the character and manner of the person previous
to the commission of suicide.
2. Homicidal drowning:
a. There is evidence of struggle like physical injuries and destruction of the
clothings of victim.
b. Articles belonging to the assailant may be found near the place where the
deceased was recovered.
c. Presence of a motive for the killing.
d. Presence of ligature on the hands or legs which could not possibly be applied
by the victim himself.
e. Presence of physical injuries which could not have been self-inflicted, like
gunshot wound at the back, severe injuries in the head, etc.
f. Testimony of witnesses.
3. Accidental drowning:
a. Absence of mark of violence on the body surface.
b. Condition and situation of the victim immediately
before death which may make one inclined to believe that it
is accidental.
c. Exclusion of suicidal or homicidal nature of the
drowning.
d. Testimony of witness who saw the accident.
Profuse blood-tinged froth around the mouth and nose in drowning.
V. COMPRESSION ASPHYXIA
OR CRUSH ASPHYXIA
V. COMPRESSION ASPHYXIA OR CRUSH
ASPHYXIA
This is a form of asphyxia whereby 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.
In homicidal cases, the assailant may kneel on the chest
of the victim or squeeze the victim between the arms and
legs as in wrestling.
In accidental cases, the body may be pinned between
two big objects or collapsing building on ground.
Very rarely is traumatic asphyxia attempted
in suicide.
It may be caused by:
1. Sudden fall of earth or masonry or when the victim is
buried under a pile of sand.
2. The victim might be pinned under the rubble of a
collapsed building.
3. Crushed in a highway accident.
4. Sudden fall of materials from a roof of a road in
mines.
5. Crushed in a crowd, usually accidental.
1. The body exhibits a purplish-black cyanosis of the face

and body.
2. Clothings may produce irregular pattern on the skin and
areas where buttons are located may be pale.
3. Small subcutaneous petecheal hemorrhages on the skin of
the face, chest,
Shoulder and neck.
4. Congestion and petecheal hemorrhages of the sclera and
conjunctiva.
5. Compression might be sufficient to fracture the ribs.

6. Heart and big blood vessels engorged with dark fluid
blood.
7. Contusion with petecheal hemorrhage of the lungs.
8. Other signs of physical injuries brought about by the
compressing material.
Burking:
This is a form of traumatic asphyxia death invented

by Burke and Hare for the purpose of murdering people
to be sold to medical schools for dissection. The
murderer kneel or sit on the chest and within the
hands, nostrils and mouth are closed. By this method
there will be no external marks to indicate how
respiration has been obstructed. Internal examination
may show signs of asphyxia.
VI. ASPHYXIA BY BREATHING
IRRESPIRABLE GASES
VI. ASPHYXIA BY BREATHING IRRESPIRABLE
GASES
Asphyxia by inhalation of irrespirable gases is a form of
death whereby a person is subjected to the influence of
gases which are deleterious to health and life. A person
may be placed in an enclosed premise, like a garage, box,
trunk, etc. wherein the free access of normal air is
prevented. This is the principle involved in “trunk
murders” and in “death in gas chambers.”
The most common gases which cause asphyxia death
are carbon dioxide, carbon monoxide, hydrogen sulfide
and sulfur dioxide.
I. CARBON DIOXIDE:
Carbon dioxide is colorless, faintly sweet odor,

nontoxic gas which includes asphyxia through the
exclusion of oxygen. The accumulation of carbon
dioxide in the blood accelerates respiration by its
stimulation effect in the respiratory center. The gas is
heavier than air and therefor it collects at a lower
level. It has a specific gravity of 1.52.
I. CARBON DIOXIDE:
Concentration of 0.1% to 0.5% in the blood will

produce symptoms of headache; 8% to 9%, there is
danger of suffocation and higher percentage is likely to
be fatal.
The concentration of carbon dioxide is observed
to be more inside the
Manhole, small room without proper ventilation,
deep wells or in brewery bat.
Symptoms of poisoning:
a. There may be giddiness, nausea and with a sensation of

pressure in the head.
b. Sensation of ringing of the ear and tingling of the nose.
c. Drowsiness, muscular weakness, with rise of blood
pressure and intense cyanosis.
d. Later the respiration becomes rapid, decrease in the
pulse rate and collapsed.
 Froth may be present in the mouth.

 Face is markedly bluish with congestion of the eye.
 All organs are intensely congested.
 Blood is deep red with the right side of the heart distended.
 Petecheal hemorrhages in the pericardium, pleura, and
galea of the scalp.
 Blood examination shows qualitative increase in the carbon
dioxide content.
2. CARBON MONOXIDE
Carbon monoxide when inhaled and comes in contact with the

red blood cells to form a stable carboxyhemoglobin which is 210 times
more stable than oxyhemoglobin. As a result of such union, there is
produce tissue anoxia.
Carbon monoxide is produced during the process of incomplete.
Combustion of carbon, one of the inflammable components of
illuminating gas. Carbon monoxide is an unsaturated carbon which when
ignited produce carbon dioxide.
Carbon monoxide may be found in exhaust of motor cars, slow
combustion stoves, mine explosion, closed compartments with motors
like tank, airplane and other motor vehicles.
Symptoms:
The symptoms in carbon monoxide poisoning depend upon the

concentration of the gas in the blood. The individual will not
manifest symptoms unless the concentration reaches 20% in which
case there will be general body weakness and headache.
At 30% there will be giddiness, fainting, nausea, muscular
weakness with pulse and respiration increased.
Between 30% to 50% saturation, there will be muscular
weakness, in coordination, giddiness, mental confusion,
diminution of sight and hearing, palpitation and dyspnea.
Symptoms:
Between 50% and 70% saturation, there will be complete

paralysis, coma and painless death supervenes.
Concentration above 70% is rapidly fatal.
Chronic poisoning may occur in ill-ventilated rooms
where there are slow combustion gas or in congested
thoroughfare with heavy motor traffic. The symptoms are
general malaise, headache, nausea, and loss of appetite,
loss of weight, dyspnea and muscular pain. There may be
neuritis and mental depression.
Treatment:
Administration of oxygen with 5% carbon dioxide to

stimulate respiration.
Removal of the body to a place with abundant fresh air.
Artificial respiration may be made if victim is not
breathing freely.
Adrenaline and coramine may be given to stimulate
heart action.
Other symptomatic treatments for headache, weakness,
abdominal pain but alcohol may not be given.
a.Bright pink color of the blood, skin, lips,

postmortem lividity and also of the internal organs.
b. Fine fronth may be seen in the mouth and both
nostrils.
c. In the nervous system, there are :
(1) Petecheal hemorrhages in the white
matter.
(2) Softhening of the globus pallidus.
(3) Hyaline trombi of the small arteries.
(4) Focal areas of necrosis.

In the heart:
(1) Necrosis of the papillary muscles.
(2) Vascular ditalation, congestion, inter mascular
hemorrhages, necrosis and atrophy of
muscles fibers.
(3) Hyaline trombi of small blood vessels.
d. Trophic arythema and blister formation of the skin of the chest,
face and extremites.
e. Congestion of the trache-bronchical lumina with other

signs of asphyxia.
f. Qualitative and quantitative determination of carbon

monoxide in the show above-treshold level.
Cause :
Accidental and suicidal death by carbon monoxide

poisoning is common. Victims my be accidentally
imprisoned or deliberately enclosed themselves in a room
or garage with motor engine running or slow burning
furnace is present.
Judicial death execution by gas chamber is utilized in
some states of the United States. Sudden exposure to high
consentration of the will cause almost painless death.
Test for CO in blood:
1. Kunkel’s test :
Blood sample is diluted four times in volume. Add
small quantity of 3% tannic acid and shake well. It will show
bright pink deposit which will later become dirty brown.
2. Spectroscopic test :
Hemoglibin saturated with carbon monoxide will
show two well-defined bands between D and E lines which
will not alter by addition of reducing agents.
3. Hydrogen Sulfide :
Hydrogen sulfide is a colorless transparent gas. It has a
characteristic odor of a rotten egg. It occurs in sewer,
decomposition of organic materials containing sulfur, and in
laboratories where in the acids react with organic sulfides. It
is a surface irritant and when inhaled it is a violent
systematic poison.
Hydrogen sulfide do not combine with oxyhemoglibin
but unite with methemoglibin to form sulfmethehemoglibin.
It is not a cumulative poison and readily unites with oxygen to
form an inert sulfate.
3. Hydrogen Sulfide :
Symptoms:
Mild concentration may bproduce irration of the air passage,
cough, giddiness, nausea and feeling of oppression. There may
be cyanosis of the face, lacrimation, labored breathing,
mascular weekness, irregular heart beat and prostration.
Severe poisoning may couse languor and sleepiness and
death may develop in a short while after a period of
unconiousness.
Local effects in the eyes may be congestion and swelling of
the cojunctivae, lacrimation and photopobia.
Postmortem Findings :
 Presence of sings of asphyxia.

 Characteristic odor similar to rotten egg.
 Color of the visceral organs are darker than usual.
 Body decomposition is quite rapid .
 Pulmonary edema or broncho-pneumonia may be
present.
Test for the presence of hydrogen sufide :
1. Spectroscopic examination :
The presnce of red band midway between C and D and
ill-defined band between D and E.
2. Moister a filter with lead acetate and expose it to thge
air. Ig blakened, hydrogen sulfide is present. Lead
acetate reacts with hydrogen sulfide gas to form black
lead sulfide.
4. Sulfur Dioxide :
Sulfur dioxide is a coloeless gas, which is heavier than air with
pagent odor. It is employed as disinfectant, as a bleaching agent, a
powerful reducing agent, and found usually in eruption of volcanoes.
The gas produce irritation of the respiratory passage, thus
causes sneezing, coughing, spasm of the glottis, and sulfocation.
It also irritates the eyes and causes congestion and
lacrimation.
Postmortem findings is not characteristics. There may be
cyanosis, with signs of asphyxia.
DEATH OR PHYSICAL INJURIES FROM
DIFFERENCES IN ATMOSTPHERIC PRESSURE
Death or physical injuries brougth about by atmostpheri

pressure may be due to the presence of the person in a
place where the pressure is higher or lesser than the normal
pressure of the earth surface, or the sudden change from a
low to high or from high to low-pressured area. This is
observed frequently in aircraft flight, divers in the sea, the
mauntain climbers, and observation balloons.
I. CAISSON DISEASE
(Bend or Diver’s disease) :
When a person goes several fathoms deep below sea level,
the atmostpherisc pressure becomes higher and the
combining power of the blood is increased. There will be
accumulation of gas in the circulation like oxygen, nitrogen
and carbon dioxide. The sudden ascent of the individual from
the depth of the sea to the surface will cause sudden
liberation of the gas circulation thereby producing ill effects
to the individual. Air embolism may be present in the soft
tissues, emphysema may develop which will in turn cause the
abnormal condition and death.
I. CAISSON DISEASE
Symptoms:
1. Localized pain in one or more extrimites.
2. Vertigo.
3. monoplegia or diplegia due to cerebral irritation attributable to the
presence of gas bubbles in the central nervous system.
4. Cutaneous manifestation as itchiness and crepitation.
5. Mascular pain and abdominal cramps
6. Deafness.
7. Paralysis of the extremites.
8. Cyanosis and mottling of the skin.
9. Coma and death.
I. CAISSON DISEASE
Complications :
If the person lives from effects of Caisson disease, the
following complications may later develop.
1. Coisson myelitis:
The air embolism in the thoratic region of the spinal cord
will produce destractive effects in the gray and white matters
and give rise to paraplegia. On account of the diminished
resistance of the effected area, infection is liable to set in,
producing inflamation of the cord.
I. CAISSON DISEASE
2. Permanent involvement of the joints and bones:
Gas in the articular cavities and bubbles in the particular
tissues cause arthralgia. Septic necrosis of bones or infarct develop
due to the disturbance of circulation.
3. Permanent impairment of hearing:
The permanent damage to the auditory apparatus is due to the
sudden variation in the atmostperic pressure in both sides of the
tympanic membrane. The marked increase in the pressure in the
other side of the eardrum causes the membrane to rupture and
produce permanent deafness.
Post-mortem Findings:
1. Right side of the heart and veins may be foaming with

nitrogen and carbon dioxide bubbles.
2. Bubbles of gases may be found in the masenteric,
meningeal and coronary vessels.
3. Petecheal hemorrhages in the spinal cord and may be
with inflamatory changes.
4. Myrochardial degenerration.
5. Softening of the voluntary muscles.
6. Mottling of skin and with some degree of crepitation.
II. MOUTAIN SICKNESS:
When a person climbs at a higher altitude where the

atmospheric pressure is low, the combining power of the
blood with oxygen is diminished therby producing strain in
the circulation and nervous system. There is marked
deficiency of oxygenation of the blood at the hieght of
10,000 feet. In aircraft flight, the sudden ascent to a high
altitude also produces the same effects as mountain
climbers although it is more violent and sudden.
II. MOUTAIN SICKNESS:
Symptoms:
1. Frontal headache, malaise and mental dullness.
2. Abnormality in vision.
3. Noosebleed.
4. Cyanosis, nausea, vomiting and thirst.
5. mascular weakness.
6. Pulse accelerated and systolic blood pressure moderately raised.
7. There may be dyspnea and tachycardia.
8. As the height increses the temperature is lowered and the person may
suffer from frost-bite or fatal freezing.
AIRCRAFT INJURIES AND
FATALITIES
AIRCRAFT INJURIES AND FATALITIES
In this age of speed, airplane is the most convinient

means of tranportation. Speed and comfort are well
developed that the people prefer to take the plane rather
than other means or tranportation. Although it has been
well developed, plane crashes still are quite common.
Factors causing aircraft fatalities :
A. Environmental factors:
1. Altitude:
a. Ante-mortem hypoxia- The elevation of the lactic acid in the
central nervous system more than 20% is a proof of hypoxia.
b. Decompression sickness- The precense of fat embolus due to
decompression. The adipose tissue contains a supersaturation gas,
with bubble formation accuring upon decompression which is
followed by rupture of cells and release of their fat and gas into the
vascular system.
2. Speed:
a. Spatial disorientation
b. Windblast
3. Toxin – Saturation of carboxyhemoglebin
4. Temperature:
a. Exposure to cold.
B. Traumatic factor.
C. Pre-ezisting disease:
1. Coronary attack.
(from: Modern Concept in Investigation of Aircraft fatalities by F. Townsend and V. Stombridge, USAF, published in the
journal of forensic science, Vol. 3, No. 4 )
1. Crash accident:
Most of the aircraft fatalities accur during the take-off and
landing. The passengers and creware fastened with their safety seat-
belts which cross the abdomen just above the pubis. The sudden crash
causes the head to be thrown foreward due to the foreward
momentum. The head strikes the back of the front seat causing
fracture of the skull.
The seats may not be fastened securely to he body of the plane
that the force of the impact may bring crashing injury to the body of
the passengers.
The impact of the plane to the ground or water causes
unconsciousness or shock.
Most of the plane crashes cause fire due to the high
octane fuel causing thermal injuries to yhe person inside.
Yhe flame causes severe soffocation of the passengers which
make him not able to extricate himself from the inside.
The crash may cause physical injuries of whatever
discription due to the impact of the body to some destroyed
parts of the plane.
2. Flight injuries:
The most common cause of injuries and fatalities in aircraft
flight is sudden change of atmospheric pressure, or the altitude
gained by the aircraft which is compatible to normal life.
Decompression sickness like those sysmtoms found in Caisson
disease and mountain sickness may be observed. Modern planes are
pressurized to avoid sudden change of atmospheric pressure.
The sudden change of direction at a speed of 500 miles an hour
tends to drain blood from the brain to the lower parts of the body
resulting to momentary black-out or unconsciousness.
The sudden ascent to high altitude causes giddiness,
nausea, mascular weakness, dyspnea and tachycardia. There
is impairment of memory and delayed reaction time. It may
lead to circulatory collapse and death. The sudden ascent
may result to release of nitrogen gas which is desolved in
the blood and tissues forming bubbles which may result to
embolism or emphysema.
At high altitude, the temperature falls and at the
height of 25,000 feet, it is 40 F below zero. Death may
be due to frostbite or freezing of the body.
Sudden ascent may produce sysmtoms similar to
Caisson disease.
DEATH OR PHYSICAL INJURIES
DUE TO VEHICULAR
ACCIDENTS
DEATH OR PHYSICAL INJURIES DUE TO
VEHICULAR ACCIDENTS
Probably the most common cause of violent death and

physical injuries is that caused by vehicular accidents.
Emergency wards of hospitals and autopsy tables are
frequently congested with motor vehicle accidents cases.
In this age of epeed people has ignored caution and the
welfare of his fellowman.
Causes of Vehicular Accidents:
1. Defects of the driver:

The driver may not be physically fit to drive. He may be
suffering from eye defects, physically not capable to move the
steering wheel and to step on the brake. He may lack sufficient
training in the driving procedures, or may be under the influence
of alcohol.
2. Defects of the engine:
The motor vehicle may have defective brake or worn-
outtires. Modern cars have high powers engines which can easily
be accelerated to high speed. The car may be overload that is
not stable especially in rough roads.
Causes of Vehicular Accidents:
3. Defects of the traffic regulations and enforcements:

In highways, traffic signs are not common to the sight of
travelers. Drivers are not warned of danger sites and acute curves, and
the speed limits.
the traffic rules are enforced loosely and traffic officers are
liable to the bribed by violators.
4. Defects of pedestrians:
Most pedestrians do not follow traffic rules in crossing streets.
Most of them ignore traffic signs. Children are allowed to play in busy
streets. Some prefer to walk in the streets rather than in sidewalks.
Factors to be considered by an investigator
in vehicular accident cases:
1. Reaction time:
This is the space of time the driver percieved an impending danger and
the actual application of the brake. Some person react quickly at the sight of
a pedestrian and rhe car is made to stop before the expended impact. If the
driver requires ample time to react at a given peril, there is more chance for
accident to accur.
2. Sked time:
This is the space of the time between the actual apllication of the
brake and the stopping of the car. The sked time is influenced by the condition
of the tire, condition of the ground, and amount and weight of the load. Cars
with tire threads worn-out have the tendency to prolong the sked time.
Sloping and smooth roads whereby the vehicle is running downward will
prolong the sked time.
3.Condition of the brake:
A brake with a strong grip on the wheels will make the carstop
immediately thus preventing the accurence of accident. Modern air or hydraulic
brakes facilitate transmission of pressure almost instantaneously to the wheel.
4. Personal qualifications of the driver:
Some persons drive without knowing the mechanical procedure of driving
and traffic rules and regulations. Some know how to drive but becouse of
physical defects, like poor vision, weak arms and legs, etc. Make them
susceptible to accident. The driver may be under the influence of alcohol or
other depressant drugs.
5. Investigator of actual accidents:

The investigator must be able to make a scketch of what really
happened to determine who is responsible.
Kinds of Injuries in Vehicular Accident
Cases:
In motor vehicle accidents, it is not only

the pedestrian that is liable to be injured
but also the driver and the poassengers.
I. Injuries Sustained by the Pedestrians
A. Impact injuries:
They are injuries sustained by the pedestrian on account of the
impact of his body of the moving motor vehicle. It may be:
1. Primary Impact Injuries:
These are injuries sustained by the pedestrian during the initial
impact of his body with the vehicle and whichmay cause him to fall to
the ground or towards the vehicle. To determine which injury is caused
by the primary impact, the relative position of the pedestrian and part
of the vehicle which caused it must be established. A person may be hit
in front, on the side, or at the back and the primary impact may be
brought about by the fender, wheel, headlight, or the door of the moving
vehicle.
The medical evidence may be the
injuries sustained. Part of the vehicle
damaged, or paint removed and found on
the body and clothings of the victims.
Parts of the body like hair, skin or blood
may be found on that portion of the car
which cause the injuries.
2. Subsequent Impact injuries:

These are the injuries sustained by the pedestrian
after the initial impact. The subsesquent impact
injuries must be with the carand with the other objects.
The pedestrian may be hit in some parts of his body
initially, they may subsequently hit on other parts of the
car, like the engine hood, mud gaurd or the wind shield.
B. Secondary injuries:
These are injuries sustained by the pedestrian due to fall on
the ground or other objects other than the vehicle. The most common
injuries are located in the chest and head.
C. Run Over Injuries:
The pedestrian may be run over by the moving vehicle during
yhe initial impact or thereafter. Crush fracture, sked marks, rupture
of organs and internal hemorrhage may be seen at autopsy. Usually
the victims dies of shock and death in most cases is instantaneous,
especially where there is crashing injury in the head.
II. Injuries Sustained by Driver and
Passengers
The injuries sustained by the drriver and passengers may be:
A. Impact injuries:
Due to the sudden stop of the vehicle, the inertia of
motion will force the body to move forward and hit some
objects. The driver has usually the advantage of foreseeing an
impending accident and he holds firmly on the steering wheel.
However, he may escape injuries due to impact but he may be
injured by brocken wind shield, steering wheel or dust board.
The impact of the steering wheel on the chest may cause
cardiac contusion.
The front passengers usually sustain more serious injuries as
compared with the driver even if he is aware of the impending
impact. He has nothing to hold on to protect him from any
impact of the foreward movement of the body due to the
inertia of motion.
The passengers t they escape injury rear seats may escape
injury but in most cases may suffer injuries on account of the
impact of the body with the front seat.
II. Injuries Sustained by Driver and
Passengers
B. “Turn-table” Injuries:
These are injuries sustained by the driver
and passengers when the vehicle turns table. The
passengers may be pinned down, crused or may
be thrown away and fall on the ground.
Medical Evidences in Vehicular Accident
Cases:
A. Evidences from the victims:

1. Crush injury:
The victim may manifest crushing injuries on the head with
multiple fractures at different parts of the body. Usually the injuries
are localized in certain area of the body, especially when the victim is
run over by the vehicle. All the ribs may be fractured. Injuries of
whatever description may be found.
2. Tire tread marks:
The pressure of the fire on the body surface may produce
abrasion marks. This may be utilized in the identification of the vehicle
in “hit and run” cases.
Cases:
3. Abrasion prints:
The most common is the marks of the radiator, if
the portion of the body of the victim hits the radiator of the
vehicle.
4. Paints marks:
Accasionally, the portion of the car that
produces the injury leaves its paint on the skin or clothings
of the victims, The paint may be scraped for the purpose of
comparing it with the suspect’s car.
Cases:
5. Blood, hair or clothings of the victim may be found sticking on the part
of the vehicle which hit the victim. A careful removal and submission to
the labaratory for camparison with that of the victim’s is important.
6. Physical defects of the victim which may diminish his power to prevent
the injury like poor eyesight, sluggish response to a given stimulus, etc.
7. Inebration of the victim:
The victim might have been under the influence of alcohol and
other depressant drugs. If dead, the organs, principally the blood and
brain must be submitted for quantitative determination of alcohol.
Cases:
B. Evidences from the driver:

1. Physicaly defect of the driver, like poor eyesight,
and other physical incapacities which will make him un
unsafe driver.
2. Alcoholism of the driver.
3. History of grudge between the driver and the
victim.
DEATH FROM STARVATION
DEATH FROM STARVATION
Starvation or inanitation is the deprevation of

a regular and constant supply of food and water
which is necessary to normal health of a person.
Types of Starvation :
1. Acute starvation- When necessary food has been

suddenly and completely with held a person.
2. Chronic starvation- When there is gradual or

defficient supply of food.
Causes of Starvation :
1. Accidental- in cases of imprisoned minors,

marooned sailors, fall in pit.
2. Homicidial- in neglected infants, old and
helpless persons illegitimate children.
3. Suicidal- among prisoners, lunatics who go on
“hunger strike” .
Length of survival :
The human body without food loses 1/24th of

its weight daily, and a loss of 40% of the weight
results to death.
The length of survival depends upon the
presence or absence of water. Without food and
water, a person can not survive more than 10
days, but with water a person may survive
without food for 50 to 60 days.
Length of survival :
The length of survival depends upon the following:

a. Presence or absence of water.
b. Partial or complete withdrawal of food.
c. Surroundings.
d. Females survive better than males, but children and
older persons die quickly.
e. Condition of the body.
Symptoms:
1. Acute feeling of hunger for the first 30 to 48 hours and this is

suceeded by localization of the pain at the epigastrium which
can be relieved by pressure.
2. Feeling of extreme thirst.
3. The face is pale and cadaverous.
4. Four or five days later, there is general emaciation and
absorption of subcutaneous fat.
5. The eyes are sunkened, glestining with dilated pupils and with
anxious expression.
6. The lips and tongue are dry with cracks while the breath is foul
and offensive.
Symptoms:
7. The voice becomes weak, faint and inaudible.
8. The skin is dry, rough wrinkled and emitting a peculiar
disagreeable odor.
9. The pulse are weak and the temperature is subnormal.
10. The abdomen is sunkened and the extrimites are thin,
flaccid with marked loss of mascular power.
11. The intellect may remain for sometime but later becomes
delirious and convulcion or coma appears before death.
12. Symptoms of secondary infection may later appear on
account of the weakened resistance of the body.
Post-mortem findings:
A. External findings:
a. Body greatly emaciated and emittind peculiar offensive
odor.
b. The eyes are dry, red and open with the eyeballs
sunkened.
c. The skin is dry, shrivelled and sometimes with secondary
skin infection.
d. Bed sores may be present.
B. Internal findings:
a. The muscles are pale, soft, wasted with the subcutaneous fat almost
completely disappeared.
b. There is genaral reduction in the size and weight of all organs, except the
brain.
c. The brain is pale and soft while the meningeal vessels are congested and
frequently there is serious effusion in the vebtricle.
d. The heart is small, with the muscles flabby and pale and yhe chambers
generally empty.
e. The lungs are edematous with hypostatic congestion.
f. The stomach is small, contracted and empty with the macous membrain less
stained with bile.
g. The intestine is thin and empty with the wall thin and tranlucent and with the
disappearance of the mucosal folds.
h. There may be superficial or extensive ulcerationof the colon as in ulcerative colitis.
i. The liver, spleen, kidneys and pancreas are small and hrunken. Microscopically, the
liver shows necrosis of the central zone. The liver damages was due to protien
deficiency.
j. The gal bladder is distented with bile while the urinary bladder is empty.
k. There is demineralization of bones and in pregnat woman it may produce
osteomalacia..
l. Findings referrable to concomitant disease which may develop on account of the
diminished resistance.
Effects of the chronic starvation:
Incomplete withdrawal of food to the body may cause of different

effect. The person will manifest symptoms referrable to the food
deficiency.
a. Deprevation of protien in the diet reduces the amount of
protien in the serum, and adema, anemia, leucopenia, and weakened
cardiac function develop.
b. Absence of various vitamins in the food for a long period of
the may cause nutritional disturbance:
Defficiency in Vitamin A will cause hyperkeratosis of the skin
atrophy of the mucous membrane, drying up of the
salivary and lacrimal glands and night blindness.
Effects of the chronic starvation:
Defficiency of Vitamin B will cause neuritis, sore tongue,

hypertrophy of the heart, and other manifestations of beri-beri.
Defficiency of Vitamin C will cause hemorrhage in various part of
the body, kidneys, periosteum. Massive hemorrhage in the gums is
observed in adults.
Defficiency of Vitamin D and calcium may be followed by
respiratory catarrh, anemia, osteomalacia, and skeletal deformities.
c. Defficiency of sugar, fat minerals produce various
disturbance of the body.
Medico-legal Question in Death due to
starvation:
1. Determination whether death was caused by starvation:

It is necessary to examine carefully the internal
organs and to search for the existence of any disease
which may possibly be the cause of death. Some desease
may also lead to pathological emaciation, like malignant
disease, tuberculosis, diabetes mallitus, anemia and
chronic diarrhea. Absence of any disease which may cause
severe emaciation and the presence of a cause for the
deprivation of food are the basis for the dianosis of death
by starvation.
Medico-legal Question in Death due to
starvation:
2. Determination of the cause of the starvation:

Starvation may be suicidal, homicidal or
accidental. The condition of the surroundings, history
and previous life of the victim and his mental
condition before he starved must be taken into
consideration in the determination of the cause.
Ligature mark of hanging and dried stain of dribbled saliva
Sarie Rossouw is slowly starving to death
Starved Vietnamese man, who was deprived of food in a Viel
Cong prison camp.
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SHRAPNEL WOUNDS

Shrapnel wounds are those brought about by

Sec. 290, Commonwealth Act No. 466

Sec. 2 – Any person violating the provision

1. Grenade – rifle or hand

3. Asphyxia due to lack of oxygen:

Thermal injuries are those caused by appreciable

Death or injury due to cold is not common in tropical

The degree of damage depends upon severity of the cold,

The action of cold in the body is partly local and partly

A. Local Effect: (Frostbite; Immersion foot; Trench Foot)

1. Gradual lowering of the body temperature

A. Externally: Nothing characteristic.

The effect of heat in the body maybe local

1. Heat Cramp – (Miner’s Cramp, Fireman’s Cramp, Stoker’s

2. Heat Exhaustion – (Heat collapse, Syncopal Fever, Heat

3. Heat Stroke – (Sunstroke, Heat Hyperpyrexia,

If ever deaths occur, they are most often accidental.

1. Degree of heat applied:

3. Extent of the surface involved:

5. Age of the victim:

A. Immediate Fatal Result:

The time required to transform the human body to ashes

About 72% of the human body weight is water and this

A very recent burn will show no pus, or much healing,

The age of older burns is estimated by the

The physician must determine whether the lesions due to

Scars of superficial are thin and pliant. In severe

4. In burns due to a conflagration, the tracheo-bronchial Lumina may contain

1. Blister due to putrefaction

This is the splitting of the soft tissues

1. Incised wound- a heat rapture may be mistaken for an incised wound.

2. Lacerated wounds- in lacerated wound there is contusion and other

This condition is found in dead bodies which have been

Examination of the burnt body should be directed to obtain the following

1. Identity, which may be established from,

2. Whether the person was alive in the fire,

4. Information indicating a possible cause of the fire, as shown by

Lungs are shrunken, mucous membrane of the bronchi are congested

During the ancient and medieval times, branding is a means to secure

Burning and scalding is usually accidental, but occasionally homicidal or

It is claimed by some authorities that the human

It is claimed that human body is inflammable

C. Chemical burns: (corrosive burns)

a. There is absence of blister in cases of chemical burns while blister

1. Neutralization of the corrosive substances.

Lightning is an electrical charge in the atmosphere. Its

1. Direct effect from the electrical charge:

2.Surface “flash” burns from the discharge:

1. History of a thunderstorm that took place in the

5.Absence of wound and other injuries

1. Surface burns- these are superficial burns usually seen

Death is usually the immediate effect due to the involvement of the

a. external lesion of almost any description

a. Insomnia and defective memory

Investigation of death due to lightning is

The main cause of death in electricity is shock. Ordinary domestic line is

1. Personal idiosyncracy- individual personality, physical condition and the existence

1. Ventricular fibrillation which may lead to rupture of

The electrical burns is sometimes called “electrical necrosis.”

There is compression of the stratum corneum. There is

 Surface of the body cold and moist

This is claimed to be a specific feature of