Legal Medicine
Legal Medicine
Legal Medicine
CONSIDERATION
CRISBERT I. CUALTEROS, M.D.
http://crisbertcualteros.page.tl
Legal Medicine is a branch of medicine which deals with the application of
medical knowledge to the purposes of law and in the
administration of justice.
Legal medicine
DIFFERENCE :
a) Injury/Disease
point of view -
ORDINARY PHYSICIAN
MEDICO-LEGAL OFFICER
Treatment
Cause
b) Examine a
patient
Diagnose
Testify / justice
c) Minor injuries
Ignored
Sym/ParaS
= Use of control questions > Most reliable & effective questioning technique.
= Supplemetary tests:
a. Peak of tension test - peak of tension on relevant questions
b. Guilt complex test - does not response to added relevant quest.
c. Silent answer test - subject verbal response creates distortion in
the tracing or clearing of the throat.
Reason for admissibility to the court of the result of Polygraph exam :
1. Have not received the degree of standardization of acceptance.
2. Trier of fact is apt to give almost conclusive weight to the experts opinion
3. No way to assure the a qualified examiner administered the test.
4. May waive right against self-incrimination.
5. It has many errors.
Factors responsible to 25% errors:
1. Nervousness experienced by a subject who is telling the truth
- apprehension by the fact that he is a suspect.
- over-anxiety to cooperate
2. Physiological abnormalities > BP inc. or dec., Cardiac prob.
3. Mental abnormalities
4. Unreponsiveness in a guilty subject no fear of detection
5. Attempt to beat the machine
Can a person be compelled? No, use of intelligence and other faculties.
B. Word association test:
-Time interval between the words uttered by the examiner and the answer of
the subject is recorded.
C. Psychological Stress Evaluator
- when a person is under stress/lying, the microtremor in the voice utterance
is moderately or completely suppressed.
- degree of suppression varies inversely to degree of psychological stress .
II.
HYPNOSIS
- alteration of consciousness, not all subjects can be hypnotized
IV.
OBSERVATION
Physiological and psychological signs and symptoms of guilt:
a) Sweating, color change
b) Dryness of the mouth
c) Excessive activity of adams apple
d) Fidgetting
e) Peculiar feeling inside
f) Swearing, spotless past record
g) Inability to look at the investigator
V.
INTERROGATION
- emotional appeal, mutt and jeff technique
VI.
CONFESSION
- expressed acknowledgement of his guilt.
TOKYO DECLARATION
- contains guidelines to be observed by physician concerning torture, inhuman
and degrading punishment.
d) mannerism
e) handedness-left /right
i) facies
j) degree of nutrition
Age of Scar:
Recently formed: Slightly elevated, reddish/bluish, tender to touch
Few week-2 months: Inflammatory redness, soft, sensitive
2 6 months: brownish, free from contraction, soft
> 6 months: white, glistening, contracted, tough
Scar formation is delayed by: sepsis, age, depth of wound, mobility
May not develop mall, superficial, healed by first intention.
8. Tribal marks, Sexual organs, blood exam
ANTHROPOMETRY ( BERTILLON SYSTEM) Alphonse Bertillon
- utilizes anthropometrical measurement of the human body for identification.
Basis:
1. Human skeleton is unchangeable after 20 years.
2. No two human beings have exactly the same bones.
3. Use of simple instrument
Information:
1. Descriptive data color of hair, eyes, shape of nose
2. Body marks
3. Anthropometric measurement height
4. Measurement of the head, limbs
Portait Parle ( spoken picture) picturesque description of a person
2. DENTAL IDENTIFICATION
= possibility of 2 persons to have the same is remote
= enamel is the hardest substance of the body,
outlast other tissues in putrifaction
3. HANDWRITING
= BIBLIOTIC
: Science of handwriting analysis
= GRAPHOLOGY : study of handwriting for the purpose of determining the
writers personality, character and aptitude.
4. IDENTIFICATION OF THE SKELETON
human shape, size, general nature
single individual plurality or excess of bones
Height add 1 to 1 in. for the soft tissues
Pearsons formula for the reconstruction of the living stature of long bones
Topinard and Rollet
= two French anatomist devised a formula for the determination of the
height fro males and females.
Humphreys table
= Table of different height of bones for different ages and their
corresponding statures.
Manouvrier made the following co-efficient for the determination of height.
Determination of sex of the skeleton:
a) Pelvis
d) Femur
b) Skull
e) Humerus
c) Sternum
Difference between
Male
PELVIS
Female
1) Construction
Wall
Heavier
More pronounced
Lighter
Less pronounced
2) Height
3) Pubic arch
4) Diameter of the true
pelvis
Greater
Narrow & less round
Lesser
Wider/rounder
Less
Greater
Lower level
Wide
Wider
Rounded
triangular
Long and wide
FEMALE
1) Shaft
less curve
more curve
2) Mastoid process
larger
smaller
3) cranium placed horizontally
mastoid process
occipital& maxillary bones
rest on
4) Styloid process
shorter
longer/slender
5).Forehead
higher, more oblique
less high, more vertical
6) Superciliary ridges
less sharp, more rounded
sharper
7) Zygomatic arches
more prominent
less prominent
8) Lower jaw
larger & wider
narrower and lighter
9) Face
larger in proportion to cranium
smaller
Determination of the duration of interment:
- All soft tissues in a grave disappear within one year.
Basis of the estimate fro duration of interment:
1) Presence or absence of soft tissue adherent to the bones.
2) Firmness and weight, brittleness, dryness of the bones.
3) Degree of erosion of the surface of the bones.
4) Changes in the clothings, coffin, and painting.
5. IDENTIFICATION OF SEX
Test to determine the sex:
1. Social test
2. Genital test
3. Gonadal test
4. Chromosomal test barr cells in females
Evidences of sex:
1. Presumptive evidence
= General features, hair in some parts
= Transvestism sexual deviation by desire to assume the attire and be
accepted as a member of the opposite sex.
10
2. Highly probabale
= vagina, large breast
3. Conclusive evidence
= ovary in females
6. DETERMINATION OF AGE
Legal importance
a) Aid to identification
b) Determination of criminal liability
c) Determination of right of suffrage
d) Determination whether a person can exercise civil rights
e) Determination of the capacity to marriage
f) Requisite to certain crimes
Determination of age of fetus:
Hesss rule or Haases rule
a) Fetus of less than 25 cm long- get square root of length in cm, result in months
b) > 25 cm- divide the length of the fetus by 5 and the result is the age in month.
7. IDENTIFICATION OF BLOOD AND BLOOD STAINS
Legal importance:
a) Disputed parentage
b) Circumstantial evidence against perpetrator of a crime
c) Determination of the cause of death
d) Determination of the direction of the escape
e) Determination of the appropriate time crime was committed
f) Determination of the place of the crime
g) Determination of the presence of certain diseases.
Physical examination
a) Solubility test
b) Heat test
c) Luminescence test: 3 amino-phtalic-acid-hydrazide-HCL,
Sodium peroxide , distilled water
> Bluish-white in a dark room
Chemical examination:
a) Saline extract of the blood plus ammonia brownish > alkaline hematin
b) Benzidine test blue color in white filter paper
c) Guaiacum test ( Van Deens Dyas or Schombeins test) - blue
11
Microscopic examination
- saline extract of stain
Micro-chemical tests:
1. Hemochromogen crystal or Takayama test:
2. Teichmanns blood crystals or Hemin crystal test= Sodium chloride dark brown rhombic prisms of chloride, hematin formed
= best of the micro-chemical test.
3. Acetone-haemin or Wagenhaar test
Spectrospcopic examination
- blood pigments have the power to absorb light of certain length and produce the
characteristic absorption bands on the spectrum.
= Fresh blood oxyhgb, Hgb, reduced hematin
= olders stains methemoglobin, alkaline hematin
Biologic examinations
1. Precipitin test blood is human or not
2. Blood grouping
Age of blood stains:
Hgb converted to Methgb of hematin red to red-brown
= warm weather- within 24 hours
HUMAN
In fine grains
Invisible w/out tx in H2O
Fuzz w/out medulla
ANIMAL
large or small sacks
Easily visible
Fuzz w/ medulla
12
Cortex
1.
2.
Cuticle
1.
thin scales
13
14
15
= Heat applied while alive produced blister with serum and redness around
the area.
= Following combinations of signs show death has occurred:
a) Loss of animal heat to a point not compatible with life
b) Absence of response of muscle stimulus
c) Onset of rigor mortis.
CHANGES IN THE BODY FOLLOWING DEATH
1. CHANGES IN THE MUSCLE complete relaxation of the whole
muscular system.
Three Stages After Death:
a) Stage of primary flaccidity ( POST-MORTEM IRRITABILITY)
= muscle relax, may contract, dilated pupil, sphincters are relaxed
= presence of molecular life
= warm place: 1 hour and 51 minutes
= chemical reaction of muscle is alkaline
b) Stage of post-mortem rigidity ( CADAVERIC RIGIDITY ,
DEATH STRUGGLE OF MUSCLES OR RIGOR MORTIS)
= whole body is rigid due to contraction of the muscles
= starts at muscle of neck, lower jaw
= Reaction is acidic due to inc. of lactic acid
= develops 3 to 6 hours after death in temperate, earlier in warm
= last from 2 to 3 days in temperate, warm: 24-48H cold weather
18-36H summer
c) Stage of Secondary flaccidity or Commencement of putrefaction
( DECAY OF MUSCLES)
= muscle are flaccid, not respond to stimuli, reaction is alkaline
= due to dissolution of muscle proteins
FACTORS INFLUENCING THE TIME OF ONSET OF RIGOR MORTIS
(1) Internal Factors
a) State of the muscles
= healthy appears late
= Onset is hastened in:
a.1 hunted animal
a.2 prolonged convulsion/lingering illness
a.3 death from- TY, Cholera, Phthisis, typhus
b) Age
= early onset aged and newborn
= delayed good health, good muscular development
16
c) Integrity of nerves
= section of the nerve will delay onset, paralyzed muscle
RIGOR MORTIS
Losses transparency
Loss elasticity
Acidic
Absolute flaccidity
CADAVERIC SPASM
Immediately after death
Certain group
May or may not appear
Determine nature of death
MUSCLE CONTRACTION
More or less transparent
Very elastic
Neutral or sl. alkaline
Possess inherent
contraction
POST-MORTEM CLOT
17
1. Consistency
2. Surface of blood vessels
3. Clots
Firm
Soft
Raw after clots are removed Smooth, health after
Homogenous
Can be stripped
cant be stripped
off in layers
18
CONTUSSION (BRUISE)
POST-MORTEM HYPOSTASIS
2. Cuticle
Unabraded
3. Bruise
4.
6.
Uniform color
Color variegated
SIMPLE CONGESTION
Uniform, all organs
Not in congestion
Not seen
19
20
21
IN TROPICAL REGION
12 HOURS
24 HOURS
48 H
72 H
ONE WEEK
TWO WEEKS
ONE MONTH
22
3. Maceration
= softening of the tissues when in fluid medium in the absence of putrefactive
mircro-org, seen in death in utero
reddish or greenish color, skin peeling off and arms flaccid and frail.
HOW LONG A PERSON HAS BEEN DEAD?
DURATION OF DEATH
1. Presence of rigor mortis : 2-3 hours after death
12 H fully developed
18-36 H disappears concomitant with putrefaction
2. Presnce of Post-mortem lividity
3-6 H after death
appears as small petechia-like red spots
3. Onset of decomposition
24-48 H after death
manifested watery. foul smelling froth, mouth, nostrils
4. Stage of decomposition
5. Entomology of the cadaver 24 H before eggs are hatched, maggots
6. Stage of digestion
23
PRESUMPTION OF SURVIVORSHIP
1. under 15 y.o. older survives
2. above 60 y.o.- younger
3. under 15, above 60 - former
4. over 15 and under 60 y.o. male, older
5. under 15, or over 60 y.o. and the other in between - latter
24
1.
2.
3.
4.
5.
Dead body belongs to the state for cases that requires medico-legal autopsy.
PATHOLOGICAL AUTOPSY
1. Requirement
2. Confirmation
3. Emphasis
4. Conclusion
5. Minor
MEDICO-LEGAL AUTOPSY
25
CAUSES OF DEATH
Primary purpose of a medico-legal autopsy:
Determination of the cause of death.
Death is the direct and the proximate consequence of the criminal or negligent act.
findings.
4. When neither history, laboratory and anatomic findings, taken individually or in
combination is sufficient to determine the cause of death but merely speculate
as to the cause of death.
Ex. Crib death among infants.
27
6. Homicidal death
If signs of violence are associated with the natural cause of death:
* Did the person die of a natural cause and were the physical injuries
inflicted immediately after death?
- violence applied in a dead person : Impossible crime.
* Was the victim suffering from a natural disease and the violence only
accelerate the death?
= Offender responsible of the death of the victim.
= Criminal liability shall be incurred by any person committing a felony
although the wrongful act done be different from which he intended.
(Art.4 no.1 RPC)
* Did the victim die of a natural cause independent of the violence inflicted?
- accused will not be responsible for the death but merely for the physical
injuries he had inflicted. Ex. Slapping a person with heart problem, only
slight physical injury.
- to make the offender liable for the death of the victim, it must be proven that
the death is the natural consequence of the physical injuries inflicted.
The following are deaths due to natural causes:
1. Affection of the CNS
a. Cerebral apoplexy sudden loss of consciousness followed by paralysis or
death due to Hemorrhage from thrombosis or
embolism in the cerebral vessels.
b. Abscess of the brain
c. Meningitis of the fulminant type
2. Affection of the circulatory system
a. Occlusion of the coronary vessels :
=most common cause of Sudden death due to natural causes.
b. Fatty or myocardial degeneration of the heart.
c. Rupture of the aneurysm of the aorta
d. Valvular heart disease
e. Rupture of the heart
3. Affections of the Respiratory system
a. Acute edema of the larynx
b. Tumor of the larynx
c. Diptheria
28
d.
e.
f.
g.
29
30
SPECIAL DEATHS
1. Judicial deaths Art. III Sec.1 Par. 19 Phil. Const. cruel and
unusual punishment shall not be inflicted. ; electrocution, hanging,
musketry, gas chamber.
2. Euthanasia or mercy killing
3. Suicide
Automatism - due to drug may be considered as accidental
rather than suicidal.
Evidences that will infer death is suicidal:
1.
2.
3.
4.
31
32
33
Sec. 2695 RAC Penalizes the desecration of burial premises; tombstone, plant,
tree, fence, post or wall. P200/ not greater than 6 months.
Sec. 90 code of Sanitation Burial Grounds requirements
1. It shall be unlawful for any person to bury the remains in places other than
those legally authorized .
2. At least 25 meters from any dwelling house and no house shall be
constructed within the same distance from any burial ground.
3. Not within 50 meters from any water source.
Other burial requirements:
1. Shipment of remains abroad shall be governed by the rules and
regulations of the Bureau of Quarantine.
2. The burial or remains in city or municipal grounds shall not be prohibited
due to race, nationality, religious or political reasons.
3. Except when required by legal investigation or when permitted by the local
health authority, no embalmed remains shall remain unburied longer than
48 hours.
FUNERALS
Art. 305 CC The duty and the right to make arrangements for the funeral of a
relative shall be in accordance with the order of support under Art. 294.
Descendants : Eldest
Ascendants : Paternal
For support as mentioned in Art. 294
1. Spouse
2. The descendants of the nearest degree
3. Ascendant of the nearest degree
4. Brothers and sisters
Art. 306 CC ; In keeping with the social position of the deceased.
Art. 307 CC ; In accordance to the expressed wishes of the deceased.
Art. 309 CC ; Showing of disrespect to the dead shall be liable to the family of
the deceased for damages, materials or moral.
Art. 132 RPC: Interruption for religious worship.
Art 133 RPC: Offending the religious feeling
Art. 2219 CC: Provides for the moral damages may be recovered for acts
34
35
2. Known scientist
3. Medical or scientific institutions
Requirements for a valid authorization
1. It must be in writing
2. It must specify the person or institution grated the authorization.
3. Must specify the organ or part to be removed.
4. Signed by the grantor and two disinterested person.
5. Copy of the authorization must be submitted to the Secretary of Health.
EXHUMATION
The deceased buried may be raised or disinterred upon the lawful order of the
proper authorities.
Sec 1082 RAC
Sec. 1097 RAC
36
5. After opening the coffin, the body must be viewed by any person who can
identify the deceased.
6. Actual autopsy and adoption of the procedure is needed to accomplish the
purpose of the exhumation.
7. Disinfection of the body and all areas involved must be carried out with the
assistance of the local health officer and the return of the body to the
burial place.
Physical violence
Heat or cold
Electrical energy
Chemical energy
Radiation by radioactive substances
Change of atmospheric pressure
Infection
MV2
Kinetic energy = __________
2
`Velocity component is the important factor:
M16 rifle with a velocity of 3200 ft/ sec causes damage more
than a heavier .38 caliber.
b.
Time
= The shorter the period of time needed for the transfer of energy,
the greater the likelihood of producing damage.
= If a person is hit on the body and the body moves towards the
direction of the force applied, the injury is less as when the body
37
is stationary.
= The longer the time of contact between the object or instrument
causing the injury, the greater will be the dissipation of energy.
c.
Area of transfer
= The larger the area of contact between the force applied on the
body, the lesser the damage to the body.
= By applying an equal force, the damage caused by stabbing is
greater compared to a blunt instrument.
d. Other factors
= The less elastic and plastic the tissue > the greater that a
laceration will result.
=
Elasticity :
Ability of the tissue to return to its normal sizes and shape after
being deformed by a pressure.
38
CLASSIFICATION OF WOUNDS:
1. AS TO SEVERITY
a. Mortal wound caused immediately after infliction that is capable of
death.
Parts of body that are mortal heart, vessels, CNS, lungs, other organs.
b. Non-mortal wound - Not capable of producing death after infliction.
2. AS TO KIND OF INSTRUMENT USED
a. Blunt instrument contusion, hematoma, lacerated wound.
b. Sharp instrument
= Sharp-edge instrument> incised wound
= Sharp pointed
> punctured wound
= Sharp edge and sharp-pointed > stab
c. Wounds brought about by tearing force lacerated wound
d. By change in atmospheric pressure barotraumas.
e. Wounds brought about by heat or cold frostbite, scald, burns.
f. Wounds brought about by chemical explosion GSW, shrapnel wound
g. Wounds brought about by infection.
3. AS TO THE MANNER OF INFLICTION
a) HIT means of bolo, blunt instrument, axe.
b) TRUST or STAB bayonet dagger
c) GUN POWDER EXPLOSION Projectile or shrapnel wound.
d) SLIDING or RUBBING or ABRASION
4. AS REGARDS TO THE DEPTH OF THE WOUND
a) Superficial wound involves only the layers of the skin.
b) Deep inner structures beyond the layers of the skin.
PENETRATING WOUND - Wounding agent did not come out or
39
40
5. Psychotic behaviour.
Some ways of self-mutilation:
1. Head banging or bumping
2. Exposure of body to heat radiation from open fires, radiators
3. Penetrating nail to chest wall
4. Castration by amputation of the penis
5. Trichotillomania- pulling of body hair
LEGAL CLASSIFICATION OF PHYSICAL INJURIES
1. MUTILATION
= Art. 262 RPC
Kinds of mutilation:
a. Intentionally depriving a person, totally or partially of some of
the essential organs for reproduction.
b. Intentionally depriving a person of any part or parts of the
human body other than the organs for reproduction.
Mutilation to be punishable it must be intentional or not physical injury.
MAYHEM is the unlawful and violent deprival of another of the use of a
part of the body so as to render him less able in fighting, either
to defend himself or to annoy his adversary.
Vasectomy/Tubal ligation are not mutilation and a legitimate method of
contraception despite the fact that it is done intentionally and deprives a person
of his power of reproduction.
SERIOUS PHYSICAL INJURIES
Any person who shall wound, beat or assault another Art. 263 and
administering injurious substance, without intent to kill Art. 264.
The main purpose of dividing the provision into four paragraphs
a) Is to graduate the penalties depending upon the nature and character of
the wound inflicted
b) Their consequences on the person of the victim.
1. Prison mayor because of the physical injuries inflicted, the injured person
becomes insane, imbecile, impotent or blind.
2. Prision correctional in its medium and maximum periods
- loss of speech, hear or smell
- loss of eye, hand, foot, arm, leg
= loss of the use or incapacitated for the habitual work he used to do.
41
42
The crime of less serious physical injuries may be qualified and a fine of a higher
penalty is imposed when:
1. There is a manifest intent to insult or offend the injured person.
2. There are circumstances adding ignominy to the offense.
3. The victims is the offenders parents, ascendants, guardian, curators,
teachers.
4. The victim is a person of rank or person of authority, provided the crime
is not direct assault.
P.D. 169 Obligation imposed on Physicians treating persons suffering serious
and less serious physical injuries required to report to law enforcement agencies.
SLIGHT PHYSICAL INJURIES AND MALTREATMENT Art 266 RPC
1. Arresto menor- when the offender has inflicted physical injuries which
shall incapacitate the offended party for labor form 1 to 9 days or shall
require medical attendance of the same period
2. Aresto menor or fine not exceeding P200 and censure when the offender
has cause physical injuries which do not prevent the offended party
from engaging in his habitual work nor require medical attendance.
3. Arresto menor in its minimum period or a fine not exceeding P50 when the
offender shall ill treat another by deed without causing any injury.
If there is no evidence to show actual injury or incapacity for labor or
period of medical attendance, the accused can only be guilty of slight physical
injuries.
So a tender slap on the face, holding the arm tightly, application of
pressure in some parts of the body or mild blow which show no sign of physical
violence may still be considered slight physical injuries or maltreatment.
( Parag 3 )
43
44
45
46
a.3 HEMATOMA
is the extravasation or effusion of blood in a newly formed cavity
underneath the skin. When the blunt instrument hit a hard part of the body
like a bony part which is superficially located.
Force causes the subcutaneous tissue to rupture on account of the
presence of a hard structure underneath..
47
OPEN WOUNDS
a. Abrasion ( Scratch, graze, impression mark, friction mark )
- it is an injury characterized by the removal of the superficial epithelial
layer of the skin caused by a rub r friction against a hard rough object.
- Contussion with abrasion = forcible contact before friction occurs.
48
- the shape varies and the raw surface exudes blood and lymph which later
dries and forms a protective covering as SCAB or CRUST.
Characteristics of abrasion:
1. It develops at the precise point of the force causing it.
2. Grossly or with the aid of a hand lens the injury consists of
parallel linear injuries which are in line with the direction of rub or
friction causing it.
3. It may exhibit the pattern of the wounding material.
4. Usually ignored by attending physician. Medico-legal viewpoint
= abrasions caused by fingernails may indicate struggle or assault
and are usually located in the face, neck, forearms and hands.
= abrasions resulting from friction on rough surfaces are located in
bony parts and are usually associated with contusion or
laceration.
= nature of the abrasion may infer degree of pressure, nature of
the rubbing object and the direction of movement.
5. Abrasion heals in a short time and leaves no scar unless if not
infected or if the whole thickness of the skin is involved.
Forms of abrasion
1. Linear abrasion appears as a single line, straight or curve.
= pinching with fingernails = curve a.
= sliding the point of a needle = straight linear ab.
2. Multi-linear develops when the skin is rubbed on a hard rough
object producing several linear marks parallel to one another.
Example: MVA
3. Confluent linear marks in the skin are almost indistinguishable
on account of the severity of friction and roughness of the object.
4. Multiple several abrasions of varying sizes and shapes may be
found in different parts of the body.
Types of abrasion
1. Scratch caused by sharp pointed object which slides across the skin,
like pin, thorn or fingernail.
- Injury usually parallel to the direction of slide.
= Fingernail scratch > broad at point of commencement with
tailing at the end.
2. Graze usually caused by forcible contact with rough, hard objects
resulting to irregular removal of the skin surface.
= course indicated by a clean commencement and tags on the end.
3. Impact or imprint abrasion ( patterned abrasion, stamping abrasion,
49
abrasion a la signature)
- those whose pattern and location provides objective evidence to
show cause, nature of the wounding instrument and the manner
of assault or death.
= marks of grid of radiator, thread marks of wheel, teeth marks.
4. Pressure or friction abrasion caused by pressure accompanied by
movement usually observed in hanging or strangulation.
= spiral strands of the rope as seen in the skin in hanging.
Differential diagnosis:
1. Dermal erosion - gradual breakdown or very shallow ulceration of the
skin which involves only the epidermis and heals without scarring.
2. Marks of insects and fishes bites skin injury is irregular with no vital
reaction and usually found on angles of the mouth, margins of
nose, eyelids and forehead.
3. Excoriation of the skin by excreta found in infants and the skin
lesions heals when the cause is removed.
No apparent history of rubbing trauma on the affected area.
4. Pressure sore usually found at the back at the region of bony
prominence. History of longstanding illness, bed ridden.
ANTEMORTEM ABRASION
COLOR
LOCATION
any area
VITAL
with intravital reaction
REACTION may show remains of damaged
Epithelium
POSTMORTEM ABRASION
yellowish and transparent
over bony prominence
Rough handling of the cadaver
shows not vital reaction and
is characterized by a separation
of the epidermis from
Complete loss of the former.
50
=
=
=
1.
2.
3.
4.
5.
6.
7.
8.
Impact cut > when there is forcible contact of the cutting instrument
with the body surface.
Slice cut > when cutting injury is due to the pressure accompanied
with movement of the instrument
Chopped or Hacked wound > when the wounding instrument is a
heavy cutting instrument like saber
> injury is severe
Suicidal wounds usually located in peculiar parts of the body, accessible to the
hand.
- the most common site is the wrist, radial artery and the neck.
Homicidal wounds usually deep, multiple and involves both accessible and
non-accessible parts.
- clothing are usually involved
- Defense and other forms of wounds are present.
51
SUICIDAL WOUNDS
HOMICIDAL WOUNDS
SEVERITY
SUPERFL
CUT
Weapon is absent
BLOOD
Bld found in front part of body
DISTRIBUTION Hand smeared with blood.
MOTIVE
Always absent
52
The extremities of stab wound may show the nature of the instrument used.
- a doubled bladed weapon shows both extremities to be sharp.
- A single bladed weapon one of its extremities as rounded and contused,
not seen if instrument is quite thin.
The direction of the surface defect may be useful in the determination of the
possible relative position of the offender and the victim when the wound was
inflicted.
As to whether the wound is slit-like or gaping depends on the direction of the
wound to the Langers line.
The depth of the wound may be influence by:
1. size and sharpness of the instrument.
2. area of the body involved
3. the degree of force applied
Hemorrhage is always the most serious consequence of stab wound due to
the severance of blood vessels or involvement of bloody organs.
How to describe stab wound:
1. length of the skin defect edges must be coaptated first
Tailing the direction of withdrawal of the wounding weapon.
2. condition of the extremities
= sharp extremity > sharpness of the instrument used.
= If Both extremity are sharp > double bladed weapon is used.
3. condition of the edges.
= edges are regular and clean cut> due to one stabbing act.
= serrated or zigzag in appearance > several stabbing wounds ( series
of thrust
and withdrawal.)
4. linear direction of the wound it may be running vertically, horizontally, or
upward medially or laterally.
53
54
4. PUNCTURED WOUND
= External injury is quite small but the depth is to a certain degree.; ice-pick, nail
- Nature of the external injury depends on the sharpness of the end of the
wounding instrument:
= contusion of the edges> if end is not sharp
= opening may be> round, elliptical, diamond shaped or cruciate.
- External hemorrhage is limited although internal injuries may be severe.> blood
vessels and bloody organs is fatal if no intervention applied.
- Site of external wound can be easily sealed by dried bld, serum, or clotted bld.
- Punctured wounds are usually accidental
Characteristics:
1. The opening of the skin is very small, wound is much deeper than it
is wide.
2. External hemorrhage is limited than internally may be severe.
3. Sealing of external opening is favorable for the growth and
multiplication of anaerobic organism like bacillus tetani.
Homicidal 1. multiple and usually located in different parts of the body.
2. wound are deep
3. there are defense wounds on the victim.
4. signs of struggle in the crime scene.
Suicidal 1.
2.
3.
4.
5.
located in areas of the body where the vital organs are located.
usually singular, if multiple located in one area.
parts of body involved is accessible by the hand of the victim.
clothing usually not involved.
wounding is made while the victim is in sitting or standing position ,
bleeding is towards the lower part of the body or clothing.
55
56
4. Tearing
- this may be produced by a semi-sharped edged instrument which causes
irregular edges on the wound like hatchet and choppers.
Lacerated wounds are rarely suicidal.
INCISED WOUNDS
LACERATED WOUNDS
Healing is faster
healing is delayed
GAPING OF WOUND
- Separation of the edges especially in deep wound may be due to the
following:
1. mechanical stretching or dilatation
- the presence of a mechanical device on the edges to prevent coaptation
will cause separation. Example: drain in an abscess, retractor during
operation.
2. loss of tissue due to:
a. Destruction due to pressure, inftion, cell lysis, burning, chemical reaction.
b. Avulsion or physical or mechanical stretching resulting to separation of a
portion of the tissue.
c. Trimming of the edges debridement of the skin which come in contact
with the bullet at the entrance and exit of GSW and removal of necrotic materials.
3. retraction of the edges
57
underneath the skin are dense networks of fibrous and elastic connective
tissue fibers running on the same direction and forming a pattern more or
less present in all persons.
This pattern of fiber arrangement is called cleavage direction or lines of
cleavage of the skin and their linear representation on the skin is called
Langers line.
9%
9%
18%
18%
9%
9%
1%
9%
18%
18%
18%
18%
18%
1%
58
Causes of hemorrhage:
a. trauma - destruction of its blood vessel wall
b. natural causes
- intracerebral hemorrhage(apoplexy)> lenticulostraite br. MCA
- Spontaneous subarachnoid hemorrhage > saccular berry aneurysm
- rupture of arteriosclerotic aneurysm
- rupture of esophageal varices
- pulmonary hemorrhage due to PTB, lung abscess, bronchiectasis
- ruptured ectopic pregnancy
2. Size of injury - burns greater than 1/3rd of the body are fatal
3. Organs involved usually fatal to heart, brain, lungs.
4. Shock blow to genitalia, slight burns to young and old.
5. Foreign body or substance introduced into the body - bacterial, viral, foreign
body, chemical,
TOXIN.
1. snake bites> 2 punctured wds at the center of the reddened affected area.
The venom is injected through its fangs which is connected to the poison
gland.
Snake venom toxicity will depend on:
1. potency of venom injected
2. amount of venom injected by the fang will depend on
- season of the year
- the length of time the snake has eaten.
- if a snake has just killed its prey> toxic content is smaller.
3. size of the patient
4. immediate treatment instituted.
Snake venoms are two principal classes:
1. Neurotoxic primarily paralysis the respiratory and cardiac center of the brain.
- may cause N,V, ascending paralysis, coma, convulsion, c/p arrest
59
60
61
62
POST-MORTEM WOUNDS
No spouting of blood
Clotted blood
SIGNS OF
Inflammation & reparative
INFLAMMATION
process
Swelling in the area,
Effusion of lymph, pus
Adhesion of the edges
Unless if victim is weakened
None
SIGNS OF
REPAIR
No time of repair
Fibrin formation
growth of epithelium
Scab or scar formation
RETRACTION
Deep staining of the edges
Not deeply stained
OF THE EDGES and cellular tissues
can be removed by washing
OF THE WOUND which is not removed by washing
Edges gape owing to the reaction
63
closely approximated to
Each other unless if the
wound is 1 to 2 hrs
after death
SUICIDAL
Rarely observed
ACCIDENTAL
Extensive
abrasions MVA
64
contusion blunt
incised wound sharp-edged instrument
lacerated wounds- blunt
punctured wounds sharp pointed
abrasion body surface is rubbed on a hard surface
GSW the diameter of the wound of entrance may approximate the
caliber of the wounding instrument.
65
66
67
GUNSHOT WOUNDS
Death or physical injuries brought about by powdered propelled
substances:
1. Firearm shot
= the injury is caused by the missile propelled by the explosion of the
gunpowder located in the cartridge shell and the rear of the missile.
2. detonation of high explosives - grenades
= explosion inside the metallic container will cause fragmentation of the
container.
I. FIREARM WOUND
= Firearm : is an instrument used for the propulsion of a projectile by the
expansive force of gasses coming from the burning of gunpowder.
(technical definition)
= includes rifles, muskets, shotguns, revolvers, pistols, other deadly weapons
which a bullet, ball, shell or other missile may be discharged by means of
gunpowder or other explosives.
= includes air rifle except of small calibers and limited range.
= the barrel of any firearm shall be considered as a complete firearm for all
purposes thereof.
Penal provisions of laws relative to firearm:
a. Sec. 2692 RAC unlawful manufacture, dealing in acquisition,
disposition or possession of firearms or ammunitions therefore or
instrument used or intended to be used in the manufacture of
firearms or ammunition.
b. Sec. 2690 RAC selling of firearms to unlicensed purchaser.
68
69
ENTRANCE WOUND
EXIT WOUND
Absent
Absent
Negative
70
71
72
3. there might be two or more bullets which entered the body through a
common entrance and later making individual exit wounds .
4. in near shot with a shotgun, the pellets might have entered in a common
wound and later dispersed while inside the body and making separate
wounds of exit.
Instances when the number of GSW of entrance is more than the number of
GSW of exit in the body of the victim:
1. when one or more of the bullet is not through and through and the bullet is
lodged in the body.
2.when all of the bullets produce through and through wounds but one or
more made an exit in the natural orifices of the body.
3. when different shots produced different wounds of entrance but two or
more shots produced a common exit wound.
Instances when there is no GSW of exit but the bullet is not found in the
body of the victim:
1. when the bullet is lodged in the GIT and expelled through the bowel or
lodged in the pharynx and expelled through the mouth.
2. near fire with a blank cartridge produced a wound of entrance but no slug
may be recovered.
3. the bullet may enter the wound of entrance and upon hitting the bone the
course is deflected to have the wound of entrance as the wound of exit.
Antemortem GSW hemorrhage, swelling, vital reaction.
- microscopically: congestion and leucocytic infiltration.
73
74
75
3.
4.
5.
6.
7.
76
SHOTGUN WOUNDS
Is a shoulder fired firearm having a barrel that is smooth-bored and is intended
for the firing of a changed compound of one or more balls or pellets.
Measure the distance between the two farthest shot(pellets) in inches and
subtract one, the number obtained will give the muzzle-target distance in
yards.
77
Tests for the presence of Primer Components metallic primer residues like
barium, antimony, and lead.
1. Harrison and Gilroy test :Cotton swab moistened with 0.1 molar HCl to
gather the primer component.
= Reagent sodium rhodisonate yields red color with the primer components.
= Add 1.5 HCl to the red area> blue-violet or pink in lead or barium
= lacks specificity, sensitivity
2. Neutron Activation Analysis (NAA)
= Sample obtained by paraffin or by washing with dilute acid
= Extremely sensitive, even with small quantity
3. Flameless Atomic Absorption Spectroscopy (FAAS)
4. Use of Scanning electron microscope with a Linked X-ray analyzer
78
79
b) Local effects:
b.1 Scalding
b.2 Burns
= Thermal
= Chemical
= Electrical, lightning
= Radiation
GENERAL OR SYSTEMIC EFFECT: death usually accidental
1. Heat cramps( Miners Camp, Firemans Camp, Strokers camp)
- Involuntary spasmodic painful contraction of muscles due to dehydration and
excessive loss of chlorides by sweating
- Tx: Fluids with chlorides
2. Heat Exhaustion ( Heat collapse, Syncopal Fever, Heat syncope,
Heat prostration)
- Due to heart failure, cause:Heat precipitated by exertion/warm clothes
= Sudden syncope, face turns pale, dim vision
- Tx: removal from the heated area
3. Heat stroke(Sunstroke,Heat Hyperpyrexia,Comatous form,Thermic Fever)
- Working in ill-ventilated places with dry temperature or exposure to the sun
LOCAL EFFECTS OF HEAT
1. Scald:
Caused by hot liquid
The injury by scalding is not severe as burns:
a. Scalding liquid runs on the body surface distributing the heat
b. Easily cools off
c. Temperature not as high except : oils and molten metals
2. Thermal burns: Caused by heat or chemical substances like fire, radiant heat,
friction, solid substances, electricity.
: Classification of burns/ DUPUYTRENS CLASSIFCATION
1st Degree erythema
2nd
- vesicle formation
3rd
- destruction of the cuticle, part of true skin, painful
4th
- whole skin is destroyed, ulceration, not painful
5th
deep fascia, muscles
6th
- charring of the limbs
BURNS
1. CAUSE
SCALDS
Moist heat liquid, steam
radiant heat
2. LOCATION
Occurs at or below
80
3. SINGEING
of hair is present
4. BOUNDARY OF NORMAL
Not clear
Absent
Distinct
5. INJURY
Severe
Limited
6. CLOTHINGS
Involved
Not burned
ANTE-MORTEM BURNS
Abundant albumin/chlorides
Scanty albumin/chlorides
2. AREA OF
Around the antemortem burn
INFLAMMATION
Absent
3. BASE OF
THE VESICLE
Red
4. TRACHEOBRONCHIAL
LUMEN
5. BLOOD
Abundance of carboxy-Hgb
No findings
Absent
3. Due to friction
- Hx of application of heat
3. Chemical burns
Characteristics of lesions:
a. Absence of vesication
b. Staining of the skin or clothing by the chemical
c. Presence of the chemical substance
d. Ulcerative patches of the skin
81
1. BLISTERS
2. SKIN/CLOTHINGS
3. ANALYSIS OF
SUBSTANCE
4. LESION
CHEMICAL BURNS
THERMAL BURNS
Absent
Stained by chemicals
Shows chemical cause of corrosion
Present
No staining
Absent
Diffused
82
83
84
DEATH BY ASPHYXIA
Asphyxia Applied to all forms of violent death due to interference with process
of respiration
- Conditions in which the supply of O2 to the blood or tissues or both
has been reduced below normal level.
Types of asphyxial death:
1. Anoxic death
Failure of arterial blood to be normally saturated with O2 due to:
a) Breathing in an atmosphere with insufficient O2- High altitude
b) External obstruction of the air passage traumatic crush asphyxia
c) Paralysis of the respiratory center poisoning, injury, anesthesia
d) Mechanical interference of the passage of air- drowning, asthma
e) Shunting of blood
2. Anemic anoxic death
Decrease capacity of the blood to carry O2 due to Hge, CO poisoning, Low Hgb
3. Stagnant anoxic death
Failure of circulation due to Heart failure, shock, arterial venous obstruction
4.Histotoxic anoxic death
Failure of the cellular oxidative process, cannot be utilized in the tissues. Cyanide
Phases of asphyxial death:
1.Dyspneic phase Breathing is rapid and deep, PR inc., Rise of BP
- due to lack of O2 and retention of CO2
2. Convulsive phase Cyanosis more pronounced, pupils dilated, unconscious
- Tardieu spots =petechia /hges in the visceral organs
- due to stimulation of CNS by CO2
3. Apneic phase
85
Classification of Asphyxia:
1. Hanging
2. Strangulations: by ligature, manual strangulation, spl forms palmar
3. Suffocation: choking
4. Asphyxia by drowning
5. Asphyxia by pressure on the chest
6. Asphyxia by irrespirable gasses
A. ASPHYXIA BY HANGING
= Not necessary the whole body is suspended: Pressure at side of neck
= Mechanism of death: Air passage is constricted by pressure of the rope
; Compression of carotids, jugs, Sup. Laryng nerve> Cereb. anoxia
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.
4. Syncope due to pressure on the vagus and carotid sinus.
5. Injury in the spinal column
6. Combination of the above.
Hanging is ante-mortem: Vital reaction= principal criterion
1. Redness or ecchymosis at the site of ligature.
2. Ecchymosis of the pharynx and epiglottis.
3. Line of redness or rupture of the intima of the carotid artery
4. Subpleural hges.
B. ASPHYXIA BY STRANGULATION Tightened by force not the weight
HANGING
1.HYOID BONE
Frequently injured
Frequently spared
2.DIRECTION
OF LIGATURE
MARK
Inverted V-shape
Usually horizontal
3. LIGATURE
LOCATION
4. LIGATURE
GROOVE
5. VERTEBRAL
INJURY
Frequently observed
Below larynx
Uniform depth
Not observed
86
C. ASPHYXIA BY SUFFOCATION
- Occlusion of air from the lungs by closure of air openings
or obstruction of the air passageway from the external openings to the air
sacs.
Smothering:
- A form of asphyxial death cause by closing the external respiratory orifices.
Overlaying most common in children : pressure of pillows
Gagging application of materials to prevent air to have access to mouth and
nostrils.
Plastic bag suffocation
Choking- Form of suffocation by the impaction of F.B. in the respiratory
passage.
D. ASPHYXIA BY SUBMERSION OR DROWINING
- Form of asphyxia where the nostrils and mouth has submerged in watery fluid.
Time required for death in drowning:
- Submersion for 1 minutes considered fatal.
- Average time required for death in drowning is 2 to 5 minutes.
Emergency treatment in Drowning
1. Schaefers methodFace down, prone position:operator exerts pressure in ribs
2. Sylvesters method- Lying on his back, astride over body, swinging arms
Post-mortem findings:
1. External findings
a) Wet clothes, pale face, F.B. clinging on skin surface
b) Cutis anserine or goose flesh skin is pale , contracted
NOT Dxtic
c) Washerwomans hands and feet skin of hands & feet:bleached NOT Dxtic
d) Postmortem lividity marked in the head, neck and chest.
e) Presence of firmly-clenched hands with objects Person was alive at first
87
2. Internal findings
A. RESPIRATORY SYSTEM
1. Emphysema aquosum Lungs are distended overlapping the heart
= Due to irritation made by the inhaled water on the mucous membrane of
the air passage which stimulate the secretion of mucous.
2. Edema aquosum Due:Entrance of water into air sacs, Lungs are doughy
3. Champignon docume whitish foam accumulates in the mouth/nostrils
= Due: abundance of mucous secretion
= One of the indications that death was due to drowning.
4. Tracheo-bronchial lumen congested, filled with froth
5. Blood stained fluid found inside chest cavity.
6. Section lungs shows fluid with bloody froth.
B. HEART
1. Both sides of heart may be filled or emptied with blood.
2. Salt water drowning Blood chloride content is greater than left side.
Fresh water- Blood chloride is more I the right side. FRESH- RIGHT
Gettlers Test:
- Quantitative determination of the chloride content of the blood in the right and
left ventricle of the heart. :
Difference of at least 25 mg.
C. STOMACH
- Presence food in the stomach but absence of water.> Death is rapid or
submersion made after death. Impossible for water to get into the stomach if
body is submerged after death.
FINDINGS CONCLUSIVE THAT THE PERSON DIED OF DROWNING
1. The presence of F.B. in the hands of the victim.
The clenching of the hands is a manifestation of cadaveric spasm in the
effort of the victim to save himself from drowning.
2. Increase in volume (emphysema aquosum)
edema of the lungs ( edema aquosum)
88
89
90
91
92
93
94