LECTURE VII:

MEDICO-LEGAL
ASPECTS
OF PHYSICAL INJURIES

Atty Molly Cr Abiog, MD

College of Law
University of the Cordilleras
 Physical Injury
• Physical injury
• Effect of some forms of stimulus on the body
• Causes of Physical Injuries:
A. Physical Violence
B. Heat or Cold
C. Electrical Energy
D. Chemical Energy
E. Radiation by Radioactive Substance
F. Change of Atmospheric Pressure (Barotrauma)
G. Infection
 PHYSICAL INJURIES

• Wound
• Dissolution of the natural continuity of any
tissue of the living body
• Effect of the application of physical violence on
a person
• Effect of the physical violence may not always
result to wound production but the wound is
always the effect of physical violence
 Physics of Wound Production
• Wound = Kinetic Energy x Time x Area x
“other factors”

• K E = MV2 where M = Mass

2 V = Velocity

• Example: Velocity of M-16 bullet at 3,200ft/sec. will

produce more damage than .38 cal. – bullet heavier,
slower V= 600 ft/sec
 Physics of Wound Production
• Time
• The shorter the period of time for the transfer of
energy, the greater the damage
• The longer time of impact, the lesser injury
• Area of Transfer
• The larger the area of contact between the force applied
on the body, the lesser damage or lesser injury
• Other factors
• The less elastic & plastic the tissue, the greater
likelihood that a laceration will result
 Damage done by
Bullet Cavitation and tumbling
Contact Gunshot Entrance wound
Close & Intermediate Range

Powder Tattooing & Intermediate Range GSW &

Bullet Tumble in Flight Powder Tattooing
Abrasion Ring &
Clear Muzzle Imprint
 Vital Reaction

• Vital Reaction
• Sum total of all reactions of tissue or organ to trauma:
• Cardinal Signs of Inflammation
• Rubor (Redness)
• Calor (Sensation of Heat)
• Dolor (Pain)
• Tumor (Tumor)
• Laesa functio (Loss of Function)
 Vital Reaction

• Presence of vital reaction differentiates injury

inflicted during life or post-mortem except:
• Physical Injuries inflicted immediately before death
• Death is sudden e.g. massive myocardial infarction
 Classification of Wound
1. As to Severity
• Mortal wound
• Non-mortal wound
2. As to Kind of instrument Used/agent
• Blunt instrument – contusion, hematoma, lacerated wound
• Sharp instrument
• sharp edged – incised wound
• sharp pointed – punctured wound
• sharp-edged & pointed – stab
• Tearing force – lacerated wound
• Change of atmospheric pressure – barotrauma
• Heat or cold – burns, scald, frostbite
• Chemical explosion – gunshot or shrapnel
• Infection
 Classification of Wounds:
3. As to the Manner of Infliction
• Hit – bolo, blunt instrument, axe
• Thrust or stab – bayonet, dagger
• Gunpowder explosion – projectile or shrapnel
wound
• Sliding or rubbing or abrasion
 Classification of Wounds:
4. As regards to Depth of Wound:
• Superficial
• Includes only layers of the skin
• Deep
• Inner structures beneath the skin
1) Penetrating – 2 meanings:
a. wounding agent enters the body but did not come out
b. the mere piercing of a solid organ or tissue of the body
 Classification of Wounds

2) Perforating – 2 meanings
a. Wounding agent produces communication between
inner and outer portion of the hollow organs
b. Piercing or traversing completely as particular part
of the body causing communication between the
points of entry and exit of the instrument or
substance producing it
 Classification of Wounds

5. Relationship of the Site of the Application

of Force and the Location of Injury
a. Coup Injury
• Physical Injury which is located at the site of the
application of force
b. Contre-Coup Injury
• Physical injury found opposite the site of the
application force
5. Relationship of the Site of the Application
of Force and the Location of Injury
c. Coup Contre-Coup Injury
• Physical Injury located at the site and also
opposite the site of application of force
5. Relationship of the Site of the Application
of Force and the Location of Injury
d. “Locus Minoris Resistencia”
• Physical injury located not al the site nor opposite
the site of the application of force but in some
areas offering the least resistance to the force
applied
• A blow on the forehead may cause contusion at the
region of the eyeball because of the fracture on the
papyraceous bone forming the roof of the orbit
5. Relationship of the Site of the Application
of Force and the Location of Injury
E. Extensive Injury
• Physical injury involving a greater area of the
body beyond the site of the application of force
• e.g. fall from a height; run-over victim of vehicular
accident may suffer from multiple fractures, laceration
of organs, and all types of skin injuries
6. As to the Regions or Organs of the Body
Involved

7. Special types of Wounds

a) Defense Wound
• Result of a person’s instinctive reaction of self-
protection/preservation
b) Patterned Wound
• Wound in the nature/shape of an object or
instrument and which infers the object or
instrument causing it
• e.g. hanging rope, plastic cord
7. Special Types of Wounds
• Self-inflicted wounds – wound produce on
one-self as distinguished from suicide; person
has no intention to end his life
• Motive of Producing Self-inflicted Wounds:
• Deliberately magnify an existing injury or disease for
pension or workman’s compensation
• Escape certain obligation or punishment.
• Create a new identity or destroy the exiting one
• Gain attention or sympathy
• Psychotic behavior
 Legal Classification of Physical
Injuries
• Mutilations
• Intentional act of looping or cutting off any part
or parts of the living body
• Kinds of Mutilation Punishable by Law
• Intentionally depriving a person totally or partially
of some of the essential organs for reproduction
• Intentionally depriving a person any part or parts of
the human body other than the organ of
reproduction
 Legal Classification of Physical
Injuries

• Mayhem
• Unlawful and violent deprival of another of the
use of a part of the body so as to render him
able in fighting either to defend himself or to
annoy his adversary
• Mutilation of other parts of the body other than
the organ of reproduction may be classified as
mayhem
• But if not deliberate, serious physical injuries
Serious Physical Injuries – Art.
263, RPC
• Any person who shall wound, beat or assault
another shall be guilty of SPI & shall suffer
• Penalty of prision mayor, as consequence of the SPI,
the injured shall become insane, imbecile, impotent, or
blind
• Penalty of prision correccional, in its medium and
maximum periods, injured shall have lost the use of
speech, power to hear or to smell, or shall have lost one
eye, a hand, a foot, an arm, or a leg or shall lost the use
of any such member or shall become incapacitated for
the work he was theretofor habitually engaged
Serious Physical Injuries – Art.
263, RPC
• Any person who shall wound, beat or assault
another shall be guilty of SPI & shall suffer
• Penalty of prision correccional, in its minimum &
medium periods, shall have become deformed, loss any
other part of body or the lost thereof, have been ill or
incapacitated for work which he was habitually
engaged for a period of more than ninety days
Serious Physical Injuries – Art.
263, RPC
• Any person who shall wound, beat or
assault another shall be guilty of SPI &
shall suffer
• Penalty of arresto mayor in its maximum period
to prision correccional in its minimum period,
if the physical injuries inflicted shall have
caused the illness or incapacity for labor of the
injured for more than thirty days
Serious Physical Injuries – Art.
263, RPC
• Crimes may be due to
• Wounding
• Beating
• Assaulting
• Administration of injurious substances without
the intent to kill
• Note: par..3 and 4 of Art. 363, RPC no mentioned
periods of medication attendance but merely
incapacity
 Less Serious Physical Injuries
- Art. 265, RPC
• More or less than 10 days but not more than 30
days incapacity or medical attendance
• Proof of period of medical attendance or period o
incapacity.
• Basis to detention whether Physical Injuries is less serious or
not medico-legal aspects of Physical Injuries-coverage of
M.T.E.
• The fact that injury requires only medical treatment for 2 days
but incapacitated the victim for 28 days makes the crime less
serious physical injuries
• In the absence of proof of medical attendance or incapacity,
fact that the wound healed more than 30 days makes only the
crime of slight Physical injuries
 Less Serious Physical Injuries
• Crime of LSPI may be qualified & a Fine or
a Higher Penalty is imposed when:
• A manifest intent to insult or to offend
• Circumstances adding ignominy to the offense
• Victim is the offender’s parents, ascendants,
guardian, curator or teacher
• Victim is a person of rank or in authority,
provided crime is not direct assault
 Slight Physical Injuries – Art.
265 RPC
• Kinds:
• Physical Injuries which incapacitate victim for labor
from 1-9 days or require medical attendance for the
same period
• Requires medical certificate as to the duration of
medical attendance, or period of incapacity. In case of
divergency in the duration of medical attendance and
incapacity, the physician must always consider the best
interest of the victim in the determination of the period
 Slight Physical Injuries
• Physical Injuries which did not incapacitate or
require medical attention.
• Ill-treatment of another by deed without causing
injury
• Review Physical Injuries inflicted in
Tumultuous Affray Art. 252
Types of Wounds
• Closed Wounds
• Superficial
• Petechiae
• Contusion
• Hematoma
• Deep
• Musculoskeletal Injuries
• Fracture
• Dislocation
• Subluxation
• Sprain
• Strain
Types of Wounds
• Closed Wounds
• Deep
• Internal Hemorrhage
• Cerebral concussion
• Open Wound
• Abrasion
• Incised wound
• Stab wound
• Punctured
• Lacerated
 Types of Wounds
A. Closed Wounds – no breach in continuity of skin
• Superficial – wound is within skin / mucous

membrane
• Petechiae
• circumscribed extravasation of blood in subcutaneous tissue
• Contusion
• effusion of blood into the tissues underneath the skin on
account of the rupture of the blood vessels as a result of the
application of blunt force or violence
 Closed Wounds
• Contusion
• Age of contusion can be appreciated from its color
changes
• Red or sometimes purple
• Green – 4 to 5 days
• Yellow – 7 to 10 days then disappears
• Hematoma
• extravasation or effusion of blood in a newly formed
cavity underneath the skin.
 Closed Wound
• Distinction between Contusion and
Hematoma:
• In contusion the effused blood are
accumulated in the interstices of the tissue
underneath the skin, while in hematoma
blood accumulates in a newly formed cavity
underneath the skin
 Closed Wound
• Contusion, skin shows no elevated – if only slight
acct. of inflammatory, while in hematoma – skin
always elevated
• Contusion – aspiration with syringe – no blood can
be obtained; aspiration of blood is positive in
hematoma
• Abscess, gangrene, hypertrophy, fibroid,
thickening, and even malignancy are potential
complications of hematoma.
• Ecchymosis – “kiss mark”, a type of hematoma
 Closed Wound
• Deep:
• Musculo-Skeletal Injuries:
• Sprain – partial or complete disruption in the continuity of a
ligamentous support of a joint. Caused by blow, kick or
torsion force
• Strain – partial or complete disruption in the continuity of a
muscle or tendon. Caused by blow, kick or torsion force
• Dislocation – complete displacement of the articular surface
of bones
• Subluxation – partial or incomplete dislocation of a joint
 Closed Wound
• Fracture – dissolution of continuity of bone
resulting from violence or existing pathology
• Types:
a. closed or simple
b. open or compound
c. Comminuted Fracture
d. Greenstick Fracture
e. Linear Fracture
f. Spiral fracture
g. Pathologic Fracture
 Closed Wound
• Internal Hemorrhage
• Caused by rupture of blood vessel due to
trauma, eg,
• Intracranial hemorrhage
• Rupture of parenchymatous organs
• Laceration of other parts of the body
• Cerebral Concussion (commotio cerebri)
• Stunning or jarring of the brain characterized
by more or less complete suspension of its
functions, as a result of injury to the head,
which leads to some commotion of the cerebral
substance
• loss of memory for events just before the injury
Mechanism of Injury to the Brain
 Open Wound
• Breach in the continuity of the skin or
mucous membrane.
• Abrasion (Scratch, Graze, Impression Mark,
Friction Mark)
• Injury characterized by the removal of the
superficial epithelial layer of the skin caused by a
rub or friction against hard, rough surface
• May be associated with contusion if there is forcible
contact
 Characteristics of Open
Wound
• develops at the precise point of impact
• injury consist of parallel linear of the rub or
friction causing it
• may exhibit the pattern of the wounding material
• usually ignored by attending physician for it does
not require medical treatment but it has far-
reaching importance in the medico-legal
viewpoint
• abrasion heals in a short time and leaves no scar
Medico-legal Importance of
Abrasions
• abrasions caused by fingernails may indicate
struggle or assault, usu located in the face, neck,
forearms & hands
• Abrasions from friction on rough surfaces usually
located in bony parts of the body associated with
contusions and laceration
• nature of abrasions may infer degree of pressure,
nature of rubbing object and the direction of
movement
 Abrasion
• FORMS OF ABRASION
• Linear
• multi-linear
• confluent
• multiple
 Types of Abrasion
1. Scratch – sharp pointed object which
slides over skin
2. Graze – forcible contact
3. Impact or Imprint Abrasion (Patterned
abrasion, stamping abrasion or “abrasion a
la signature”)
4. Pressure or Friction Abrasions – hanging
or strangulation
 Types of Abrasion
• Patterned abrasion, stamping abrasion or
“abrasion a la signature”
• Marks of the grid of radiator
• Tire thread marks
• Muzzle imprint – contact piercing
• Teeth impression – skin bites
 Other types of Open Wounds

• Incised wound (Cut, slash, slice)

• produced by a sharp edged or sharp-linear edge
of the instrument
• (e.g. knife, razor, bolo, glass, metal sheet)
• Types
• Impact cut
• Slice cut
• Chopped or Hacked wound
 Characteristics of Incised
Wound
• Edges – clean cut, both extremities are sharp
• Wound straight or shelving – acute to body
• Wound shallow near extremities; deeper at middle position
• because clean cut; profuse hemorrhage is a feature
• Gaping
• If incised wound is located in parts covered by clothing,
clothing shows clean cut of its texture
• Healing by primary intention
• Incised wounds may be suicidal, homicidal or accidental
 Other types of Open Wounds

• Stab wound
• produced by the penetration of a sharp-pointed
and sharp-edged instrument, like a knife, saber,
dagger, scissors
• if sharp-edged portion is the first to come in contact
with the skin – incised wound produced.
• If sharp-pointed – first –stab wound produced
 Stab Wound
• Like incised wound edges are clean-cut, regular
and distinct
• Surface length – reflect/withdrawal – not same
direction as introduction or stabbing
accompanied by slashing movement
• Direction of the surface defect may be useful in
determination of relative position of the offender
and the victim when the wound was inflicted
• Hemorrhage is always the most serious
consequence of a stab wound
Description of the stab wound,
the ff. must be included:
• Length of skin defect, abrasion tailing –
measured separately- infers direction of
withdrawal of the wounding weapon
• Condition of the extremities-
• Condition of the edges- one stabbing act –
edges regular and clear cut
• Several stabbing act – edges serrated or
zigzag
Description of the stab wound,
the ff. must be included:

5. Linear direction of the surface wound –

vertically, horizontally, or upward
medially or laterally
6. Location of the stab wound – see pg. 268
7. Direction of penetration
8. Depth of penetration
9. Tissue and organs involved
 Stab Wound
• Stab wound may be suicidal, homicidal,
accidental :
• suicidal – evidences
• homicidal – most common
• Accidental – quite rare, usu caused by falling
against a sharp projecting object
 Characteristics of Homicidal
Stab Wound
• presence of other injuries
• location – any part of body
• more than one stab wound – gradually
• + motive for stabbing if w/o motive, the
offender must be insane or under the
influence of drugs
• + disturbance in the crime scene
 Homicidal Stab Wound
• Medical evidences showing intent of offender to
kill the victim:
• > 1 stab wounds
• stab wounds located in different parts of the body or
parts where vital organs are found
• deep
• serrated or zigzag borders
• irregular or stellate shape – due to changing direction
of weapon – greater internal damage
• Most common – immediate cause of death is
hemorrhage
 Punctured Wound
• Produced by a thrust of a sharp – pointed
instrument
• external injury small – depth is usually deep
• produced by ice pick, needle, nail, spear, pointed stick,
thorn, fang of animal – hook
• nature of external injury – depends on sharpness and
shape of the end of the wounding instrument
• contusion of edges may be present if end not so sharp
 Punctured Wound
• external hemorrhage – minimal – internal
injuries severe.
• site of the external wound can be easily sealed
by the dried blood,
• serum or clotted so that introduction of
anaerobes e.g. tetanus – secondary infection
• Punctured wound – usually accidental,
rarely homicidal
 Lacerated Wound
• Lacerated wound (Tear, rupture, “Putok”,
stretch)
• Tear of the skin + underlying tissues due to
forcible contact with a blunt instrument
• e.g. piece of wood, iron bar, fist blow, stone, butt
of firearm
 Characteristics of Lacerated
Wound
1. Shape and size of injury does not
correspond to wounding instrument
2. Tear of skin – rugged with extremities
irregular and ill-defined
3. Injury at the site where blunt force is
applied
4. Borders of wound – contused and swollen
 Characteristics of Lacerated
Wound
5. Usually develops in areas where bone is superficially
located e.g. scalp, malar portion of face, dorsum of
foot, shin portion of leg
6. Exam with hard lens – bridging tissues and intact hair
bulbs
7. Bleeding not extensive because blood vessels are not
severed evenly
8. Healing process delayed – scars usually develop
• It may be homicidal or accidental but rarely
suicidal
 Distinction between Incised
wound vs. Lacerated wound
Differentiating Pt Incised Lacerated
Wound edges Clean-cut, well-defined, Roughly cut, irreg,
regular ill-defined
Swelling or contusion around (-) (+)
Extremities of the wound Sharp, round, contused Ill-defined, irregular
Magnifying lens exam Hair bulbs cut Hair bulbs not cut
Healing rate Faster Delayed
Scar shape Linear or spindle-shaped Irregular
Wounding agent Sharp-edged instrument Blunt instrument
Fatal effect of Wounds:
• Wound may be directly by reason of:
• Hemorrhage
• Mechanical Injuries to vital organs
• Shock
• Indirectly by:
• secondary hemorrhage due to sepsis
• specific infection
• secondary shock
• scarring effect
• Kinds of Healing of wounds:
• Healing by primary intention
• Healing by secondary intention
• Aberrated healing process:
• formation of exuberant granulation tissue or
“ground flesh”
• belvish formation
• fistula or sinus formation
Examination of the wound
• character
• location
• depth of the wound
• condition of the surrounding (?)
• extent of the wound
• direction of the wound
• number of wounds
• conditions of the surroundings (?)
Examination of the wound
• Condition of the surroundings
• degree of hemorrhage
• evidence of struggle
• position of body
• presence of letter or suicide note
• condition of the wound
• Contusion age:
• 4-5 days – color becomes green
• 7-10 days – color becomes yellow
• 14-15 days – disappears gradually
• up to – 4 weeks
• Distinction between ante-mortem and
post-mortem contusions in an
undecomposed body is that:
• Ante-mortem bruising – there is swelling,
damage to epithelium extravasation,
coagulation, and infiltration of tissues with
blood
• Post-mortem contusion - none
In the presence of several injuries, the
medico-legal officer should answer
the following questions:
• 1. Which of the injuries sustained by the victim
caused death?
• in conspiracy not necessary to determine who among several
offenders inflicted the fatal wound.
• In “free for all” – it is necessary to determine. (P.I./death is
tumultuous affray)
• In case where victim sustained multiple injuries – medico-
legal problem? Examine wound individually.
• Important to determine degree of damage of each wound.
• Which of the wounds was inflicted first?
• necessary to qualify offense
• fatal wound inflicted 1st with treachery – Crime
committed is murder
• fatal wound inflicted last – possible crime
committed – Homicide
 How to determine which
wound was inflicted first?
• Relative position of assailant and victim when the
first injury was inflicted to latter
• Trajectory or course of the wound inside the body
• Organs involved and degree of injury sustained
• Testimony of witness
• Presence of defense wounds of victim.
• defense wound must be inflicted first before fatal
wound
• Effect of negligence of the injured person
on the death:
 Extrinsic Evidence in
Wounds
• Evidences from the wounding weapon
• position of wound
• blood in weapon
• Hair and other substances on weapon
• Evidence in the clothing of victim
 Extrinsic Evidence in
wounds
• Evidence derived from assailant
• clothing
• marks of violence
• paraffin test
• degree of intoxication, mental coordination,
physical power
• Evidences derived from the scene of the
crime
Open Wound type - Abrasion
Open type of wound – abrasion from Belt whacking
Abrasion pattern wounds
Abrasion Pressure from Hanging
Open type of wound – Defense wounds
Open wound type – Hack wounds
Multiple Incised Wounds
Incised & Stab Wounds of the Face & Neck
Multiple Stab wounds, Slash, Blisters
Multiple Stab Wounds, in Livor Mortis
Closed Wound type - Contusion
Close type of wound - Contusion
Closed wound type – Contusion, Decomposing
Penetrating Wound through the Sternum
Gunshot wound – Perforating type
Cephalhematoma, Zigzagging type of Fracture
Gunshot wound, Point of Entry
Gunshot wound – Exit point
Blunt Trauma to Head with Scalp Contusions with
subgaleal collection of blood
Contusion to the Arm
Patterned Abrasion, skin of abdomen, gross
Laceration of the Head
Subcutaneous Hemorrhage from Drug Injection
Single Edge Stab Wound With & Without Hilt
Pattern of Stab Wound
Defense wound, forearm from Jim Bowie Knife
Slit-like Exit Wound
Face Injury in Diving Competition
My Prayer before I bid adieu

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