legal medicine lecture

8/10/2019 Legal Medicine Lecture

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LEGAL MEDICINE : GENERALCONSIDERATION

Legal Medicine is a branch of medicinewhich deals with the applicationof medical knowledge to thepurposes of law and in the

administration of justice.Legal medicine Application of medicine tolegal cases.Forensic medicine Application of medicalscience to elucidate legal problems.Medical jurisprudence Knowledge of law inrelation to the practice of medicine.

SCOE: Application of medical and paramedicalsciences as demanded by law andadministration of justice.NAT!RE OF T"E ST!D# OF LEGAL MED:- The ability to acuire facts! arrange them and

draw a conclusion from facts in theadministration of justice.

Medical juris$% Medical e&aminer%Medicolegal o'cer% Medicolegal e&per$- A physician who speciali"es primarily withmedico-legal duties.- #mhotep $%&' (.). earliest medico-legale*pert.

DIFFERENCE : ORDINAR#"#SICIAN MEDICO(LEGAL OFFICERa+ #njury,isease point of iew - Treatment)auseb+ /*amine a patient iagnose

Testify , justicec+ 0inor injuries #gnored1ecords all , ualify crime

RINCILE OF STARE DECISIS:- 2hen the court has once laid an interpretationof law as applied to certain facts! it will adhereto and apply to all future cases where the factsare substantially the same.

)ASIC RINCILES GO*ERNINGALICATION AND EFFECTS OF LA+S:3. 4#gnorantia legis nominem e*cusat 4 preent use as defense in iolation$. Law shall hae no retro-actie e5ect.6. 1ights may be waied! unless the waier is

contrary to law! public order! public policy!morals or good customs! or prejudiced to athird person with a right recogni"ed by law.

7. )ustoms which are contrary to law! publicorder or public policy shall not becountenanced.

8. Laws are repealed by subseuent ones! andtheir iolation or non-obserance shall not bee*cused by dis-use! custom or practice to thecontrary.

ersons au$,ori-ed $o per.orm au$opsies:3. 9ealth ;cers$. 0edical o;cer of law enforcement

agencies.

6. 0embers of the medical sta5 ofaccredited hospitals.Au$opsies s,all /e per.ormed in $,e.ollo0ing cases.

3. 1euired by special laws$. rder of competent court! mayor! en!


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Cerous control )C=,AC= =ym,?ara==ympathetic inDuenced by physical andemotional stimuli! e5ects?arasympathetic works to restore thingsA. se of a Lie etector or ?olygraph E The fear of the subject when not tellingthe truth actiates the symp.

E To a series of automatic and inoluntary

physiological changes which are recorded by theinstrument. E se of control uestions F 0ost reliable Ge5ectie uestioning techniue. E =upplemetary tests:

a. ?eak of tension test - peak oftension on releant uestions

b. >uilt comple* test - does notresponse to added releant uest.

c. =ilent answer test - subjecterbal response creates distortionin the tracing or clearing of thethroat.

Reason .or admissi/ili$1 $o $,e cour$ o. $,eresul$ o. ol1grap, e&am:3. 9ae not receied the degree ofstandardi"ation of acceptance.$. Trier of fact is apt to gie almost conclusieweight to the e*perts opinion6. Co way to assure the a uali


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0ethods of identi


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E Transestism se*ual deiation bydesire to assume the attire and be accepted asa member of the opposite se*.$. 9ighly probabale E agina! large breast6. )onclusie eidence E oary in femalesB3 DETERMINATION OF AGE

Legal impor$ancea+ Aid to identis rulea+ Ietus of less than $8 cm long- get suare rootof length in cm! result in monthsb+ F $8 cm- diide the length of the fetus by 8

and the result is the age in month.

3 IDENTIFICATION OF )LOOD AND )LOODSTAINSLegal impor$ance:

a+ isputed parentageb+ )ircumstantial eidence against

perpetrator of a crimec+ etermination of the cause of deathd+ etermination of the direction of the

escapee+ etermination of the appropriate time

crime was committedf+ etermination of the place of the crimeg+ etermination of the presence of certain

diseases.,1sical e&amina$ion

a+ =olubility testb+ 9eat testc+ Luminescence test: 6 amino-phtalic-acid-

hydra"ide-9)L! =odium pero*ide!distilled water

(luish-white in adark room

C,emical e&amina$ion:a+ =aline e*tract of the blood plus ammonia

brownish F alkaline hematinb+ (en"idine test blue color in white uaiacum test M Jan eenOs yas or=chombeinOs test+ - blue

d+ ?henolpthalein test M Kastle-0eyer test+ -pink e+ Leucomalachite >reen testMicroscopic e&amina$ion- saline e*tract of stain0icro-chemical tests:3. 9emochromogen crystal or Takayama test:

$. TeichmannOs blood crystals or 9emin crystaltest-

E =odium chloride dark brown rhombicprisms of chloride! hematin formed

E best of the micro-chemical test.6. Acetone-haemin or 2agenhaar testSpec$rospcopic e&amina$ion- blood pigments hae the power to absorb light

of certain length and produce the characteristicabsorption bands on the spectrum. E Iresh blood o*yhgb! 9gb! reducedhematin

E olders stains methemoglobin! alkalinehematin)iologic e&amina$ions

3. ?recipitin test blood is human ornot

$. (lood groupingAge of blood stains:9gb conerted to 0ethgb of hematin red to red-brown

E warm weather- within $7 hours3 IDENTIFICATION OF "AIR AND FI)ERSi5erences between hair forcibly e*tracted andnaturally shed hair:- bulb is irregular ! undulating surface!e*crescence of di5! si"e and shape "AIR "!MANANIMALMedulla3. Air network #n


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@. The ciil case fro claims which does notsurie is dismissed upon death of thedefendant.Dea$, is the termination of life.7inds o. dea$,:

3. =omatic or clinical death persistence ofital functions

$. 0olecular or cellular death 6 to si*

hours after cessation of life6. Apparent death or =tate of suspendedanimation transient loss ofconsciousness in hysteria! uremia!electric shock

Signs o. dea$,:;3 Cessa$ion o. ,ear$ ac$ion andcircula$ion.! sually the auricle contract aftersomatic death fro a longer period than theentricle! last to stop so called !LTIMENMARIENS3 Methods of detecting the cessation of heartaction and circulation:

a+ /*amination of the heart- pulse!aucultation! Douro! /)>b+ /*amination of peripheral circulation

E 0agnus test application of ligaturearound the base of the


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E C?C inc. from 38 to 7' mg,3'' cc in 3st

38 hours E A.A. inc. from 3 mg to 3$ mgS 3st38hours.

=3 INSENSI)ILIT# OF T"E )OD# AND LOSSOF O+ER TO MO*EE may be seen in the liing with- apople*y!

epilepsy ! trance! catalepsy! hysteria53 C"ANGES IN T"E S7IN opacity!Dattening! loss of elasticityB3 C"ANGES IN AND A)O!T T"E E#E a+ Loss of corneal reDe* seen # n lie pts:>.A.! uremia! narcotic poisoning b+ )louding of cornea c+ Ilaccidity of the eyeball d+ ?upil in the position of rest.

e TAC"E NOIR DE LA SCLEROTI!E spot found in the sclera after death.3 ACTION OF "EAT ON T"E S7IN E 9eat applied while alie produced blister

with serum and redness around the area. E Iollowing combinations of signs showdeath has occurred:

a+ Loss of animal heat to a point notcompatible with life

b+ Absence of response of musclestimulus

c+ nset of rigor mortis.

C"ANGES IN T"E )OD# FOLLO+ING DEAT";3 C"ANGES IN T"E M!SCLE completerela*ation of the whole muscular system. T,ree S$ages A.$er Dea$,: a S$age o. primar1 accidi$1 9 OST(MORTEM IRRITA)ILIT# E muscle rela*! may contract! dilatedpupil! sphincters are rela*ed E presence of molecular life E warm place: 3 hour and 83 minutes E chemical reaction of muscle isalkaline / S$age o. pos$(mor$em rigidi$19 CADA*ERIC RIGIDIT# % DEAT" STR!GGLEOF M!SCLES OR RIGOR MORTIS E whole body is rigid due to contractionof the muscles E starts at muscle of neck! lower jaw

E 1eaction is acidic due to inc. of lacticacid E deelops 6 to @ hours after death intemperate! earlier in warm E last from $ to 6 days in temperate!warm: $7-7&9 cold weather3&-6@9 summer

c S$age o. Secondar1 accidi$1 orCommencemen$ o. pu$re.ac$ion 9 DECA#OF M!SCLES+

E muscle are Daccid! not respond tostimuli! reaction is alkaline E due to dissolution of muscle proteins

FACTORS INFL!ENCING T"E TIME OFONSET OF RIGOR MORTIS9; In$ernal Fac$ors a+ =tate of the muscles

E healthy appears late E nset is hastened in: a.3 hunted animal

a.$ prolongedconulsion,lingering illness

a.6 death from- TN! )holera!?hthisis! typhus

b+ Age E early onset aged and newborn

E delayed good health! goodmuscular deelopment

c+ #ntegrity of neres

E section of the nere will delay onset!paraly"ed muscle94 E&$ernal .ac$ors a+ Temperature

E 9astened by high temperature E F 8 degrees will produce heatsti5ening

b+ 0oisture E rapidly but with short duration inmoist airCondi$ions simula$ing RIGOR MORTIS:3. 9eat sti5ening - F 8 degrees coagulatesmuscle proteins resulting to rigidity. E 4 ?ugilistic attitudeB De*ed upper andlower limb E hands clenched! De*or stronger thane*tensors! burned to death$. )old sti5ening

E due to solidi


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7. 0edico-legal signif. Appro*imates time ofdeath etermine nature ofdeath

RIGOR MORTISM!SCLE CONTRACTION3. )ontracted muscle Losses transparency0ore or less transparent

$. /lasticity Loss elasticityJery elastic6. Litmus reaction AcidicCeutral or sl. alkaline7. )ontraction Absolute Daccidity?ossess inherent

contraction43 C"ANGES IN T"E )LOOD a+ )oagulation of blood E blood may remains Duid inside the bloodessels @-&9 after death.

ANTE(MORTEM CLOTOST(MORTEM CLOT3. )onsistency Iirm

=oft$. =urface of blood essels 1aw after clots areremoed =mooth! health after6. )lots 9omogenouscanOt be stripped )an be stripped o5 inlayers

b+ ?ost-mortem Liidity or )adaeric Liidity !or ?ost-mortem =uggilation or ?ost-mortem9ypostasis or Lior 0ortis

E =toppage of heart action and loss of toneof b.. accumulates in dependent areas e*ceptin bony areas.

E capillaries coalesce F purplish in colorcalled os$(mor$em li2idi$1. E 9asten by death due to cholera! uremia!

Typhus feerE appears 6 @ 9 after death and fully

deeloped 3$ 9 after death.

,1sical c,arac$eris$ics o. os$(mor$emCada2eric Li2idi$1

3. ccurs in the most dependent areas.

$. #noles the superies us an idea as to the time of death.oin$s $o /e considered 0,ic, ma1 in.er$,e posi$ion o. $,e /od1 a$ $,e $ime o.dea$,:

3. ?osture of the body when found.$. ?ost-mortem hypostasis or liidity6. )adaeric spasm

CONT!SION 9)R!ISE

OST(MORTEM"#OSTASIS

3. =mall bruises (elow epidermis in true skin#n the epidermis or cutis larger ones -below this$. )uticle Abraded by the same iolence

nabraded

that produce the bruise.6. (ruise Appears at the seat or

surrounding Always dependentmay or may not be dependent7. /leated! inDammatorycondition Cot eleated! blood in b..

8. #ncision shows blood outsidethe b.. (lood inside the essels

E most certain test ofdi5erence@. )olor ariegated

niform colorIn$ernal ,1pos$asis in *isceral organs:

3. Lungs

$. Loops of intestine6. (rain OST(MORTEMLI*IDIT# OF ORGANS SIMLECONGESTION3. ?ost-mortem staining in organs #rregular!most dependent partsniform! all organs$. 0ucous membrane ull!lusterless

Cot in congestion6. #nDammatory e*udate Cot seen

8


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Cot seen

ther changes in the blood3. 9ydrogen ion concentration acid p9 )$!L.A.! After $79 alkaline ammonia.$. (reakdown of lier glycogen leads toaccumulation of de*trose in the #J) and the

right side of the heart.6. 1ise in C?C and Iree A.A.7. )hemical: E chloride in the plasma,1() decreasedue to e*traascular di5usion! in $ 9 only P ofits content. E 0g increases due to di5usion fromwithout.

E K increases due to di5usion from theascular endothelium.


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37-$' AN= - blisters all oer thebody! maggots$-8 0CT9= - skull e*posed!orbits empty

IN TROICAL REGION3$ 91= 1igor mortis all oer! hypostasis!greenish-discoloration caecum

$7 91= 1igor mortis absent all oer!abdominal distention7& 9 a of Dies! trunk bloated! facediscolored$ 9 2hole body grossly swollen!hairs and nails looseC/ 2//K =oft iscera putre


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6. under 38! aboe @' - former7. oer 38 and under @' y.o. male! older8. under 38! or oer @' y.o. and the other inbetween - latter

MEDICO(LEGAL IN*ESTIGATION OF DEAT"Inues$ O'cer is an o;cial of the statecharged with the duty of inuiring into certain

matters. - in medico-legal e*amination:manner and cause of deathT,e .ollo0ing o'cials o. $,e go2ernmen$are au$,ori-ed $o ma?e dea$,in2es$iga$ions:

3. ?roincial and )ity ?rosecutors$. Wudges of the 1T)! 0T)6. irector of C(#7. =ol>en

S$ages o. MEDICO(LEGAL IN*ESTIGATION:

3.)rime =cene #nestigation inestigation ofplace of commission of the crime$.Autopsy - inestigation ofthe body of the ictim

;3 Crime Scene In2es$iga$ion - place where the essential ingredients of thecrime took place. - ?erson composed the =earch Team:

a+ ?hysician 0L# trainedb+ ?hotographerc+ Assistant! eidence collector! note

taker43 Au$ops1 - comprehensie study of a dead body! inaddition to the e*ternal e*amination . os$(mor$em e&amina$ion- e*ternal e*am withoutincision being made.urpose o. au$ops1:

3. etermine cause of death$. )orrelate clinical diagnosis and

symptoms6. etermine e5ectieness of treatment7. =tudy the natural course of the disease8. /ducate students and physicians

MEDICO(LEGAL OR OFFICIAL A!TOS#:3. etermine cause! manner! time of death$. 1ecoering! identifying! presering

eidentiary material6. ?roide interpretation and correlation of

facts related to death7. ?roide factual! objectie medical report8. =eparating death due to disease from

e*ternal causes.

ead body belongs to the state for cases thatreuires medico-legal autopsy.

AT"OLOGICAL A!TOS#MEDICO(LEGAL A!TOS#

3. 1euirement)onsent of ne*t of kinLaw that gies the consent

$. )on


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Cause o. dea$,: is the injury or disease or bothwhich initiates the physiological disturbanceresulting to a fatal termination.

3. #mmediate or ?rimary cause of death when injury or disease kills uickly theictim and no opportunity forcomplications to deelop./*: e*tensie brain injury

$. ?ro*imate cause or =econdary cause -the injury or disease was suried for alonger period

Mec,anism o. dea$,: is the physiologicderangement or biochemical disturbanceincompatible with life which is initiated by thecause of death.

/*: 9emorrhagic shock! pulmonarydepression! cardiac arrest! tamponademetabolic problem.

Manner o. dea$,: is the e*planation as to how

the cause of death arose. 3. Catural death fatality is cause solely bydisease. /*: pneumonia! cancer

$.Jiolent or unnatural death due to injuryMedico(legal masuerade(iolent deathsmay be accompanied by minimal or no e*ternaleidence of injury or natural death where signsof iolence may be present.Degree o. Cer$ain$1 $o $,e cause o. dea$,:3. =tructural abnormalities established beyonddoubt the cause of death. /*. =2 with 9.$. egree of probability amounting to the causeof death. /*: /lectrical shock6. 9istory establishes cause of death andcon


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SECIAL DEAT"S

1. udicial dea$,s Art. ### =ec.3 ?ar. 3%?hil. )onst. 4cruel and unusualpunishment shall not beinDicted. electrocution! hanging!musketry! gas chamber.

43 Eu$,anasia or merc1 ?illing


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Sec3 ;9, 3D3 5B Code o. Sani$a$ion3. 1emains shall be buried within 3$ hours

after death. )ause of death is due to adangerous communicable disease

$. Cot to be taken any place of publicassembly.

6. nly adult members of the deceased areallowed to attend the funeral.

Sec3 ;; RAC eath )erti


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Sec3 3D3 5B Code o. Sani$a$ion=pecial precautions for safe handling of

cadaers containing radioactie isotopes.

RA


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E 9oweer! not all physical iolence willresult in the production of wound.

,1sics o. 0ound produc$ion: 0J$

a. Kinetic energy E XXXXXXXXXX $

YJelocity component is theimportant factor:03@ riDe with a elocity of 6$''

ft, sec causes damage more than a heaier .6&caliber. b. Time E The shorter the period of timeneeded for the transfer of energy! the greaterthe likelihood of producing damage. E #f a person is hit on the body and

the body moes towards thedirection of the force applied! theinjury is less as when the body is

stationary. E The longer the time of contactbetween the object or instrumentcausing the injury! the greater will bethe dissipation of energy.

c. Area of transferE The larger the area of contact

between the force applied on the body! thelesser the damage to the body. E (y applying an eual force! thedamage caused by stabbing is greatercompared to a blunt instrument. d. ther factors

E The less elastic and plastic thetissue F the greater that a laceration will result.

Q Elas$ici$1 : Ability of the tissue to return toits normal si"es and shape after being deformedby a pressure. E A force transmitted through a

tissue containing Duid will force theDuid away from the area of contactin all directions eually! freuentlycausing the tissue to lacerate.

*ITAL REACTION E #t is the sum total of all reactions of tissueor organ to trauma! either obsered micro ormacroscopically.

a3 R!)OR redness or congestion of thearea due to an increase of blood supply as apart of the reparatie mechanism. /3 CALOR =ensation of heat or increase intemperature. c3 DOLOR - pain due to inolement of thesensory nere. d3 LOSS OF F!NCTION- due to trauma! thetissue may not function.

The presence of ital reaction di5erentiates anante-mortem from a post-mortem injury.ECET:ital reactions not seen een if injuryinDicted during life: 3. uring agonal state of a liing personwere cells donOt react to the trauma.

$. =udden death as in sudden coronaryocclusion.

CLASSIFICATION OF +O!NDS:!. '% , %E/E+&$

a. 0ortal wound caused immediately afterinDiction that is capable of death.

?arts of body that are mortal heart!essels! )C=! lungs! other organs.

b. Con-mortal wound - Cot capable ofproducing death after inDiction.2. '% , 0&)D ,1 &)%+UE) U%ED a. (lunt instrument contusion!hematoma! lacerated wound.

b. =harp instrument

E =harp-edge instrumentFincised woundE =harp pointed F

punctured woundE =harp edgeG sharp-

pointed F stab c. 2ounds brought about by tearingforce lacerated wound

d. (y change in atmospheric pressure barotraumas. e. 2ounds brought about by heat orcold frostbite! scald! burns. f. 2ounds brought about bychemical e*plosion >=2! shrapnel wound g. 2ounds brought about by infection.3. '% , #E '))E+ ,1 &)1(&C&,) a+ 9#T means of bolo! bluntinstrument! a*e. b+ T1=T or =TA( bayonet dagger c+ >C ?2/1 /U?L=#C ?rojectile or shrapnel wound. d+ =L##C> or 1((#C> or A(1A=#C

4. '% +E-'+D% , #E DE"# ,1 #E,U)D

a+ =uper


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points of entry and e*it of the instrumentor substance producing it.

5. '% +E-'+D% , #E +E('&,) ,1 #E%&E ,1 '""(&C'&,) ,1 1,+CE ')D #E(,C'&,) ,1 &)*U+$ a. )oup #njury ?hysical injury which islocated at the site of the application of force.

b. )ontre-coup injury opposite the site of theapplication of force.

c. )oup contre-coup injury site and alsoopposite of application of force. d. Locus minoris resistencia ?hysical injury

not located at the site nor opposite the siteof the application of force but in some areaso5ering the least resistance to the forceapplied. /*ample: (low in fore head Fcontusion on the region of the eyeball.

e./*tensie injury ?hysical injury inoling agreater area of the body beyond the site of theapplication of force

/*ample : Iall or 0JA

. '% , +E-&,)% ,+ ,+-')% ,1 #EB,D$ &)/,(/ED #njuries in arious parts of the body

. %"EC&'( $"E% ,1 ,U)D% a+ /I/C=/ 2C= #nstinctiereaction of self-preseration. Fhands,fractures b+ ATT/1C/ 2C 2ound in thenature and shape of the instrument. F2heels!abrasions from rope. c+=/LI-#CIL#)T/ 2C= - 2ound

produced on oneself but no intention to end hislife. Mo$i2e o. producing sel.(inic$ed0ounds:

3. To create or deliberately magnify ane*isting injury or disease forpension or workmanOscompensation.

$. To escape certain obligations orpunishment

6. To create a new identity7. >ain attention or sympathy8. ?sychotic behaiour

=ome ways of self-mutilation:3. 9ead banging or bumping$. /*posure of body to heat radiation

from open


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attendance of any of the circumstancesmentioned in Art. $7& E The case coered by subdiision number 3of this art. will be punished by reclusiontemporal in its medium Gma*imum periods. E =ubdiision number $ by ?rision correctionalin its ma*imum period to prision mayor in itsminimum period.

E =ubdiision number 6 by prision correctionalin its medium and ma*imumE =ubdiision number 7 prision correctional in

its minimum and medium periods.

The proisions of the preceding paragraphshall not be applicable to a parent who shallinDict physical injuries upon his child bye*cessie chastisement. 1A @3'. #t may becommitted through a simple negligence orimprudence.

ADMINISTERING IN!RIO!S S!)STANCE OR

)E*ERAGES Ar$ 4B= RC/lements:3. The o5ender inDicted upon another any

serious physical injury!$. There is knowledge that the substance,

beerage administered is injurious r tookadantage of the ictims weakness ofcredulity.

6. There is no intent to kill in the part of theo5ender. #f intentional soF frustrated murder.

Treachery is inherent in Art. $@7 1?)

LESS SERIO!S "#SICAL IN!RIES Ar$34B5 RC

Any person who shall inDict upon anotherphysical injuries not described in the precedingarticles!E (ut which shall incapacitate the o5endedparty for labor 3' days or moreE r shall reuire medical attendance for thesame period (oth of w,c is 3' days but not F6'days G there must be proof to it..

The crime of less serious physical injuries maybe uali


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account of the rupture ofthe blood

essels as a result ofthe application of bluntforce or iolence.

E si"e of contusiongreater than the si"e of the object.

E Location of the

contusion is not always the site of application ofthe force. /*ample: (lack eyeF IoreheadMedico-legal point of view: A contusion as indicated by itse*ternal pattern may correspond to the Fshape of the object or weapon used.

/*tent F the possible degree of iolenceapplied. istributionF indicates the characterand manner of injury as in manual strangulationaround the neck.

Age of Contusion: appreciated from its color

changeThe si"e tends to become smaller from theperiphery to the center and passes througha series of color changes as a result of theisintegration of the 1() and liberation ofhemoglobin.

The contusion is red! purple soon afterits complete deelopment. 7 to 8 days F green to 3' days F yellow and graduallydisappears on the 37thor 38thday. The ultimate disappearance of color ariesfrom 3 to 7 weeks depending upon the seerity

and constitution of the body. The color changes starts at the periphery.

CONT!SION *S3 OST(MORTEM"#OSTASISCon$usionE(elow the epidermis in the true skin in smallbruises or e*traasations! below this in largerones and often much deeper still.The epidermis has no blood essels to beruptured.os$ mor$em "1pos$asisE#n the epidermis or in the cutis as a simple

stain or a showing through the epidermis of theunderlying engorged capillaries.Con$usionE)uticle was probably abraded by the sameiolence that produced the bruise. #n smallpunctures such as Deas bites! this is notobsered.os$(mor$em ,1pos$asisE)uticle unabraded! because the hypostasis isa mere sinking of the blood! there is no trauma.

Con$usionEA bruise appears at the seat of andsurrounding the injury. This may or may not bea dependent part.os$(mor$em ,1pos$asisEAlways in a part which for the time ofinformation is dependent.Con$usion

Eften eleated because eleated blood andsubseuent inDammation swell the tissues.os$(mor$em ,1pos$asisECot eleated! because either the blood is stillin the essels or at most has simply soaked intoand stained the tissues.Con$usionE#ncision shows blood outside the essels.Thisis the most certain test of di5erenceG can beobsered een in ery small bruises.os$(mor$em ,1pos$asisE#ncision shows the blood is still in its esselsGif any oo"ing occurs! drops can be seen issuing

from the cut mouths of the essels.Con$usionE)olor ariegated. This is only true of bruisesthat are the same days old d,t the changes inthe hemoglobin produced during life.os$(mor$em ,1pos$asisE)olor is uniform. The well known change incolor produced in blood /*traasated #nto liingtissues does not occur in dead tissues with thesame regularity.Con$usionE#f the body happens to be constricted at orsupported on a bruised place! the actual surfaceof contact may be a little lighter than the rest ofthe bruise but will not be white.os$(mor$em ,1pos$asisE#n a place which would otherwise be the seatof hypostasis pressure of any kind een simplesupport is su;cient to obliterate the lumen ofthe enules and capillaries and so to preenttheir


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/*ample: Aplastic anemia!whooping cough 8. Age )hildren and old age tend to bruiseeasily.

@. =e* women! obese easily deelopsunlike bo*ers.

. Application of heat and cold

T,e dis$inc$ion /e$0een an$e(mor$em andpos$(mor$em con$usions in anundecomposed /od1 is $,a$ in 3. Ante-mortem bruising: there is swelling!

damage to epithelium!e*traasation!coagulation and in 1 =TCC#C> I T9/ (1A#C

)9A1A)T/1#Q/ (N 01/ 1 L/==)0?L/T/ ==?/C=#C I #T= IUC= A= A1/=LT I #CW1N T T9/ 9/A 2,) L/A=

T =0/ )00T#C I T9/ )/1/(1AL=(=TAC)/.

- is more seere when the moing or mobilehead struck a


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&. sphincters are rela*ed with unconsciouseacuation of the bowel and bladder.

%. reDe*es are present but sluggish and inseere cases may be absent.

VVLoss of memory for eents just before theinjury is a constant e5ect of cerebral concussionand is of medico-legal importance.

2. ,"E) ,U)D% a3 A/rasion 9 Scra$c,% gra-e%impression mar?% .ric$ion mar? +

- it is an injury characteri"ed by theremoal of the superrossly or with the aid of a handlens the injury consists of parallel linearinjuries which are in line with thedirection of rub or friction causing it.

6. #t may e*hibit the pattern of thewounding material.

7. sually ignored by attendingphysician. 0edico-legal iewpoint

Eabrasions caused by


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ANTEMORTEM A)RASIONOSTMORTEM A)RASION

)L1 reddish-bron"e due to slighte*udation of blood yellowish andtransparentL)AT#C any areaoer bony prominence rough handling of thecadaer

J#TAL with intraital reactionshows not ital reaction and1/A)T#C may show remains of damaged/pithelium characteri"ed by aseparation of the epidermis from

)omplete loss of the former./3 Incised 0ound 9 cu$% slas,% slice

produced by a sharp-edged M cutting+

or sharp-linear edge of the instrument like aknife! ra"or! bolo! glass etc.

E #mpact cut F when there is forcible contactof the cutting instrument with the body surface.

E =lice cut F when cutting injury is due to thepressure accompanied with moement of theinstrument

E )hopped or 9acked wound F when thewounding instrument is a heay cuttinginstrument like saber! injury is seere C,arac$eris$ics o. incised 0ound:

3. /dges are clean cut.$. The wound is straight6. sually the wound is shallow near the

e*tremities and deep at the middleportion.

7. ?rofuse hemorrhage because of the

clean cut on the essels.8. >aping is usually present due to the

retraction of the edges.@. )lothes will also show a clean cut if cut

by the instrument.. Iaster healing if without complications.&. #ncised wound made by broken glasses

maybe irregular! needs to be remoed. C,anges $,a$ occur in an incised0ound:

3. After 3$ hours edges are swollen!adherent with blood and with leukocytein


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3. %'B ,U)D% is produced by thepenetration of a sharp and a sharp-edgedinstrument like a knife! scissors.

- if the sharp edge is the one that comesin contact with the skin then it is anincised wound.

- #f the sharp pointed portion


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with the portion of the instrument at theleel of the skin as the leer.

4. "U)CU+ED ,U)D - is the result of athrust of a sharp pointed instrument.

E /*ternal injury is uite small but the depthis to a certain degree. ice-pick! nail

- Cature of the e*ternal injury depends on

the sharpness of the end of the woundinginstrument:E contusion of the edgesF if end is not

sharpE opening may beF round! elliptical!

diamond shaped or cruciate.- /*ternal hemorrhage is limited although

internal injuries may be seere.F bloodessels and bloody organs is fatal if nointerention applied.

- =ite of e*ternal wound can be easily sealedby dried bld! serum! or clotted bld.

- ?unctured wounds are usually accidental

C,arac$eris$ics:3. The opening of the skin is erysmall! wound is much deeper thanit is wide.

$. /*ternal hemorrhage is limited thaninternally may be seere.

6. =ealing of e*ternal opening isfaorable for the growth andmultiplication of anaerobicorganism like bacillus tetani.

"omicidal (3. multiple and usually located in

di5erent parts of the body.$. wound are deep6. there are defense wounds on the

ictim.7. signs of struggle in the crime

scene.Suicidal (

3. located in areas of the body where theital organs are located.

$. usually singular! if multiple located inone area.

6. parts of body inoled is accessible bythe hand of the ictim.

7. clothing usually not inoled.8. wounding is made while the ictim is in

sitting or standing position !bleeding is towards the lower partof the body or clothing.

@. no disturbance in the crime scene.. wounding instrument found near the

body.

unc$uring 0ound 0i$, punc$uringins$rumen$ loaded 0i$, poison:

3. poison dart cyanide or nicotine$.


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Lacerated wounds are rarely suicidal.

INCISED +O!NDS LACERATED+O!NDS

/dges are clean cut!regular! well de


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GAING OF +O!ND - =eparation of the edges especially in deepwound may be due to the following:;3 mec,anical s$re$c,ing or dila$a$ion

- the presence of a mechanical deice onthe edges to preent coaptation willcause separation. /*ample: drain in anabscess! retractor during operation.

43 loss o. $issue due $o:a. estruction due to pressure! infOtion! celllysis! burning! chemical reaction. b. Aulsion or physical or mechanicalstretching resulting to separation of a portion ofthe tissue.

c. Trimming of the edges debridement ofthe skin which come incontact with the bulletat the entrance ande*it of >=2 andremoal of necroticmaterials.


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;3 sna?e /i$esF $ punctured wds at thecenter of the reddened a5ected area. Theenom is injected through its fangs whichis connected to the poison gland.

Sna?e 2enom $o&ici$1 0ill depend on:3. potency of enom injected$. amount of enom injected by the fang

will depend on - season of the year - the length of time the snake haseaten.

- if a snake has just killed its preyFto*ic content is smaller.

6. si"e of the patient7. immediate treatment instituted.

Sna?e 2enoms are $0o principal classes:3. Ceuroto*ic primarily paralysis therespiratory and cardiac center of the brain.

- may cause C!J! ascending

paralysis! coma! conulsion! c,p arrest$. 9emato*ic - a5ects particularly the blood - manifestations are pain! swellingon the a5ected area! #J hemolysis! C!J!pulmonary and cardiac edema.

Emergenc1 $rea$men$ ma1 /e:3. incision of the wound to promote more

e*ternal hemorrhage to drain the enom.$. tourniuette aboe the site of the wound6. placing ice on the bite site7. sucking the wound to drain enom with

the mouth8. administration of anti-snake enom

serum.@. Absence of medical or surgical

interention wound may not be fatalbut due to neglect or ignorance of itsmanagement! may be serious and fatal

43 Scorpion 2enom - enom has to*ic! hemolytic! hemorrhagic - one punctured wound on the center of areddened area

- pain! edema and reddening


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c. degree of rest orimmobili"ation

d. nature of the injury

$. Aberrated healing process:a. formation of e*uberant

granulation or proud Deshb. keloid formation

c. strictured.


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ANTE(MORTEM+O!NDS OST(MORTEM +O!NDS

9/0119A>/: -0ore profuse! arterial dueto loss of tone of essels! =light or none!enous Absence of heart action?ost-mortem clotting of

blood inside b.. -0arks of spouting of bloodfrom arteries Co spouting of blood

-)lotted blood(ld not clotted!or soft clot

=#>C= I #CILA00OC: #nDammation Greparatie process =welling in the area! Cone /5usion of lymph! pusAdhesion of the edges

nless if ictim is weakened

=#>C= I 1/?A#1: Iibrin formation growth of

epithelium =cab, scar formOn Co time ofrepair

1/T1A)T#C I T9/ eep staining ofthe edges and cellular tissues Cotdeeply stained/>/= I T9/ 2C w,c is not remoedby washing can be remoed by washing

/dges gape owing to thereaction of the skin and /dges do not gape! butare closelymuscle =2 the diameter of the wound of

entrance may appro*imate the caliber ofthe wounding instrument.

Could $,e injur1 ,a2e /een inic$ed /1 aspecial 0eaponJ A physician canOt determine that a speci


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#f none- o5enders are only responsible fortheir indiidual acts. #f multiple injuries: which of the woundinjured a ital organ. r if same organ which caused thedegree of damage.+,ic, o. $,e 0ounds 0as inic$ed 8rs$J#f multiple for the uali


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+ounds in $,e Scalp:3. it is di;cult to preent the spread of

infection$. there is pro*imity of the scalp to the

brain6. there are free ascular connection

between the structures inside andoutside the brain

7. it is freuently di;cult to determine thee*tent of damage of the skull.

I1A)T1/= I T9/ =KLL p. 6'$

C"ATER ;AT1/ L)AT#C At leel of9yoid bone (elow laryn*

7. L#>AT1/ >1J/ eepestopposite the knot niformdepth

8. J/1T/(1AL #CW1N Ireuentlyobsered Cot

obsered

Manual s$rangula$ion or $,ro$$ling:- form of asphy*ial death where theconstricting force is the hand.

C3 AS"#IA )# S!FFOCATION- cclusion of air fr. the lungs by closure of a

openings, obstruction of the air passagewthe e*ternal openings to the air sacs

40


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Smo$,ering: A form of asphy*ial deathcaused by closing the e*ternal respiratoryori


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9omicidal . E struggle! motie! articles foundnear the place! phys. injuries=uicidal .E note! heay objects! mentality! 9*of preious attemptAccidental E Absence of iolence in the body.!e*clusion of suicide! witnesses

E3 COMRESSION AS"#IA 9 TRA!MATIC

CR!S" AS"#IA- Iorm of asphy*ia where the free e*changeof air in the lungs is preented by theimmobility of the chest and abdomen dueto e*ternal pressure or crush injury.

- 9omicidal Eo5ender kneels on the chest- Accidental E pinned between two big

objects)ur?ing inented by (urke and 9areE

murder for the sale to medical schools - Kneels or sits on the chest and the

hands close the mouth and nostrilsDea$, /1 cruci8&ion- alternatie raising

and lowering of the body leads toe*haustion! unconsciousness anddeath from asphy*ia E #) mm arestretched

F3 AS"#IA )# )REAT"ING IIRESIRA)LEGASES;3 Car/on mono&ide silen$ ?iller%colorless! insoluble in water and alcohol. - formed by the incomplete combustion ofcarbon fuel. -0ain action is $ depriation

uali$a$i2e $es$ .or CO in $,e /looda+ KunkelOs test 7 olume of water Z 6*its olume of 3S tannic acid

- crimson red if positieb+ ?otassium Ierrocyanide test brightredc+ =pectroscope e*amd+ >as chromatographe+ #nfra-red analysis

43 Car/on dio&ide CO4% Car/onic acid gas - (lown out of the lungs during respiration - ?roduct of complete combustion of carboncontaining compounds - /nd result of fermentation G decompositionof organic matters.- septic tank

E The inhalation of pure )$ may causeimmediate agal inhibition with spasm ofthe glottis and death. E manhole! poorlyentilated rooms

Tes$s .or $,e presence o. CO43. (arium nitrate white precipitate of(arium carbonate with carbonic acid$. siler nitrate white ppt. of silercarbonate when carbonic acid is added.


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53 aral1san$s Cere gas - likeorganophosphatesB3 )lood poisons )! 9$=! 9ydrogen cyanide

DEAT" OR "#SICAL IN!RIES D!E TOA!TOMOTI*E CRAS" OR ACCIDENT

Fac$ors responsi/le $o an Au$omo$i2e

Cras,A3 "!MAN FACTOR 9 DRI*ER+3. 0ental attitude: reckless driing! fatigue!ine*perience$. ?erceptie defect6. elayed reaction time7. isease8. )hemical factor)3 EN*IRONMENTAL FACTOR- ?oor isibility!poorly maintained roads! rain! blind intersectionC3 MEC"ANICAL FACTOR: ?oor brake! wornout tiresD3 SOCIAL FACTOR: =peed! insurance

E3 EDESTRIAN

Injuries and Dea$, on $,e Dri2er andassengers:;3 Firs$ collision:the impact of the moingehicle with another or J/9#)L/ rapidly deceleratesand stops after impact. E The degree of damage depends: a+ speedb+ part of ehicle inoled

43 Second collision: #mpact of unrestrainedoccupants with the ehicle interior E 3st )ol.! ccupants moe samedirection,elocity towards point of impact a+ Iront impactF ccupants moe forward. b+ =ide impact M seere+ F moes to theside that was inoled in the 3st)ol.

FThe passengernearest to it will su5er the most.

c+ 1ear impact crash Acceleration-deceleration injury or whiplash

d+ 1oll oer crash M Turn turtle impact +

E #f ehicle is not put into a stop after the 3st)ollision! the unrestrained occupants willcontinue to strike to some parts of the ehicleinterior.

edes$rian(*e,icle Collision:Dea$, or ,1sical Injuries $o pedes$rian3.?rimary impact )ontact with ehicle$. =econdary impact =ubseuent impact of thepedestrian to the ground - Accounts for the multipleinjuries6. 1un oer #njuries7. 9it and run #njuries

C"ILD A)!SE OR NEGLECTEDC"ILD9 )a$$ered c,ild% )a$$ered c,ilds1ndrome% Mal$rea$men$ s1ndrome%Mal$rea$ed c,ild% ,1sicall1 a/usedc,ild% Ill($rea$ed c,ild

E #t is the physical and mental injury ormaltreament of a child by a person who is

responsible for the childOs welfare.Du$ies o. paren$s: Art 7@ the child and youthwelfare )ode E To gie him a5ection! e*tendbenes ,eal$,or 0el.are:

3. ?hysical abuse The law allowschastisement for discipline

but it may be physicalabuse when it inoles ofinstrument or


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6. /stablishment of public and priate welfareinstitutions for the care of abused!neglected! abandoned! inross e*aminations$. 0icro-chemical e*aminations

a+ Ilorence testb+ (erberioOs test specianguliOs method

7. (iological e*aminations a+ ?recipitin testM (iological test ofIarnum+ semen is of human origin

b+ =eminal grouping

OT"ER CRIMES AGAINST C"ASTIT#:;3 Seduc$ion #s the act of a man enticing

women to hae unlawful intercourse- 2ith means of persuasion!solicitation! promises or bribes or other meanswithout employment of force!

- A irgin oer 3$ y.o. but below 3&y.o.

- 2ith the use of abuse of authorityor con


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7. #ndian hemp and its deriaties8.ther drugs whether natural or synthetic withthe physiological e5ect of narcotic drug.

Regula$ed drugs:3. =elf-inducing sedaties such as secobarbital!phenobarbs$. any salt of an isomer of amphetamine like

ben"idrine6. 9ypnotic drugs such as methaualone

denti*cation of some dangerous drugs: Colortest

a. pium and its deriaties together withamphetamine 0aruis test:b. (arbiturates illie Koppanyi test! Qwikkerstestc. 0arijuana uuenois-Leine testd. L= Jan rk teste. )ocaine )obalt Thiocyante test

ALCO"OLISME$,1l alco,ol /thanol or grain alcoholEfermentation of arious )9 in grains! fruits orDowers

- sed as solents! antiseptic!beerageAlco,olic /e2erages 0i*ture of water andethyl alcohol

Congeners : substances simultaneouslyproduced during fermentation.

: odor of alcohol

Drun?ard A person who habitually uses anyinto*icating alcoholic liuor."a/i$ual drun?ard ne who e*cessielyuses into*icating drink.

ro2isions o. La0 regarding alco,olism:3. #CTU#)AT#C #= AC ALT/1CAT#J/)#1)0=TAC)/ T )1#0#CAL L#A(#L#TN Art. 38!1?)

- 0itigating circumstanceE 5endercommitted a felony in a state ofinto*ication! if not habitual or subseuentto the plan to commit said felony

- Aggraating circumstance E if into*icationis habitual

E if into*ication is subseuent to theplan to commit felony.

$. ?(L#) =)ACAL )00#TT/ (N A ?/1=C29#L/ 1CK #= ?C#=9A(L/. Art. 388! 1?)

- Any person while into*icated or otherwiseshall cause any disturbance or scandal inpublic places.

6. )CT1A)T= A>1// T #C A =TAT/ I1CK/C/== A1/ J#A(L/ Art. 36$&! )iilcode.

7. T9/ LA2 ?/CAL#Q#C> 0ACIA)T1/ IL#R1 2#T9T L#)/C=/ #= JAL#.8. T9/ =TAT/ 0AN ?1/J/CT =0/ ?/?L/I10 1#CK#C> 9#>9LN =?#1#T/ 2#C/

Absorption and distribution of alcohol:E 0a*imum period of absorption occurs 6' to@' minutes after initial intake.EThe optimum concentration of alcohol inbeerages between 3' $'S is the mostrapidly absorbed.E #t is not the uantity of alcohol consumed thatdetermines into*ication but the amount actuallygets into the blood stream. ,unces of B

;.S FORM!LAQ

(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((3

,armacologic e@ec$s o. alco,ol:3. epresses the )C=.$. Acuity is progressiely diminished to thepoint comparable to wearing dark glasses atnight.6. 9earing decrease! talks louder! canOt heathe sound of horns.7. iminished sense of touch! burns


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7'' mg S anesthetic leel! deathleel

S$ages .ollo0ing alco,ol inges$ion:3. =tage of e*citement Iew minute after

ingestion! feeling of well being$. =tage of incoordination or confusion

blunting of perception.

6. =tage of narcosis or coma =lowbreathing! pupils dilated.

,1sical $es$s $o de$erminedrun?enness:3. 1ombergOs test=tanding straight with eyesclosed !heels together for 3 min.$. =tand straight with one foot ahead of theother6. =ample of handwriting compared when he

is free from alcohol.7. 2alk to a corner and back

Condi$ions simula$ing alco,olicin$o&ica$ion:3. =eere head injuries$. 0etabolic disorders! iab. ?recoma!

uremia6. Ceurologic conditions assoc. with ata*ia!

tremor! drowsiness7. /5ect of drug like insulin! barbs!

antihistaminic! morphine8. ?re-e*iting psychological dos-order.@. 9igh feer

resump$i2e limi$s o. alco,ol:'.'8S alcohol or less in their blood uninDuenced by alcohol'.'8 - .3'S E considered to be under theinDuence of alcohol3;6 $o 3;56presumption that theperson is drunk.'.$S - into*icated! staggering'.8S comaVVThe amount of alcohol in the breath isproportional to the concentration of alcohol inthe blood.VViseases associated with or as acomplication of alcoholism Iatty lier!cirrhosis.

Delirium $remens =udden withdrawal fromalcohol may su5er a state of e*citement withhallucination.7orsa?o0>s ps1c,osis a syndrome charac.by hallucination! disorientation! multipleneuritis! loss of memory of recent eents.

KKKThere is no iolation of constitutionalpriilege against self-incrimination becausethe priilege applies only to testimonialcompulsion and does not apply to the takingof physical eidence from an accused.

Q urel1 mec,anical and i$ doesno$ u$ili-e $,e men$al .acul$ies o. $,esu/jec$3

La/ora$or1 e&amina$ion .or alco,olism:3. Analysis of blood most widely accepted$. Analysis of breath6. Analysis of the urine7. Analysis of body tissue8. Analysis of salia! perspiration! spinal Duid

O/jec$i2es o. alco,ol e&amina$ion:3. Ior screening Apparatus: Alcoly"er!Alcosensor$. Ior eidentiary purpose E determinesuantity of alcohol

Me$,ods used in alco,ol de$ec$ion:3. )hemical method *ides -chromate$. /n"ymatic method coen"yme

Cicotinamide adenine nucleutide MCA+6. >as chromatographic method7. #nfrared absorption method

To hae an accurate determination as to theuantity of alcohol in a specimen! immediatee*amination must be done.

The longer the time interal between e*tractionand e*amination! the more it increases thealcohol contents of the sample.

MEDICO LEGAL ASECT OF OISONINGoison anything other than agencies which iscapable of destroying life! either in chemicalaction on the tissues of the liing body

- or by physiological action byabsorption into the liing system.Fa$al dose smallest dose known to causedeath.Signs and s1mp$oms $,a$ ma1 lead one$o suspec$ poisoning:3. =udden appearance of the complaints andsymptoms.$. The symptoms appear when the person isat the state of health.6. The symptoms appear after a meal! food!medicine.

7.2hen seeral persons partake the food!drug at the same time.

legal medicine lecture

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