medico-legal aspects of physical injuries - fin.pptx

MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES

REPORTERS:LUISITO CORPINJERRY TONGZON

Physical injury : is the effect of some of stimulus on the body.

Stab wound the effect is immediate but a blunt object is delayed production on the contusion.

Causes of Physical Injuries

1. Physical violence 2. Heat or cold 3. Electrical energy 4. Chemical energy 5. Radiation by radioactive substances 6. Change of atmospheric pressure 7. Infection

1. PHYSICAL INJURIES BROUGHT ABOUT BY PHYSICAL VIOLENCE

The effect of the application of physical injury on person is the production of wound.

A disruption of the anatomic integrity of the tissues of the body.

However, not all physical violence will result in the production of wound.

Physics of wound production: MV2a. Kinetic energy = __________ 2`Velocity component is the important factor:

M16 rifle with a velocity of 3200 ft/ sec causes damage morethan 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 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.

= A force transmitted through a tissue containing fluid will force the fluid away from the area of contact in all directions equally, frequently causing the tissue to lacerate.

VITAL REACTION

= It is the sum total of all reactions of tissue or organ to trauma, either observed micro or macroscopically.

a. RUBOR - redness or congestion of the area due to an increase of blood supply as a part of the reparative mechanism.

b. CALOR - Sensation of heat or increase in temperature.

c. DOLOR - pain due to involvement of the sensory nerve.

d. LOSS OF FUNCTION - due to trauma, the tissue may not function.

The presence of vital reaction differentiates an ante-mortem from a post-mortem injury.

EXCEPT: vital reactions not seen even if injury inflicted during life:1.During agonal state of a living person were cells don’t react to the trauma.

2. Sudden death as in sudden coronary occlusion.

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 Piercing a solid organ.

PERFORATING WOUND - Wounding agent produces communication between the inner and outer portion of the hollow organs.

OR piercing or traversing completely a particular part of the body causing communication between the points of entry and exit of the instrument or substance producing it.

5. AS REGARDS TO THE RELATION OF THE SITE OF 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 - opposite the site of the application of force.

c. Coup contre-coup injury - site and also opposite of application of force.

d. Locus minoris resistencia - Physical injury not located at the site nor opposite the site of theapplication of force but in some areas offering the least resistance to the force applied.

Example: Blow in fore head > contusion on the region of the eyeball.

e.Extensive injury - Physical injury involving a greater area of the body beyond the site of the application of force.

Example : Fall or MVA

6. AS TO REGIONS OR ORGANS OF THE BODY INVOLVED

Injuries in various parts of the body

7. SPECIAL TYPES OF WOUNDS

a) DEFENSE WOUNDS- Instinctive reaction of self-preservation. - hands/fractures

b)PATTERNED WOUND- Wound in the nature and shape of theinstrument. - Wheels, abrasions from rope.

c)SELF-INFLICTED WOUNDS - Wound produced on oneself but no intention to end his life.

Motive of producing self-inflicted wounds:1. To create or deliberately magnify an existing injury or disease for pension or workman’s compensation.2. To escape certain obligations or punishment.3. To create a new identity.4. Gain attention or sympathy.5. Psychotic behaviour.

Some ways of self-mutilation:1. Head banging or bumping2. Exposure of body to heat radiation from open fires, radiators3. Penetrating nail to chest wall4. Castration by amputation of the penis5. 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 theorgans 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 - 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, RPC) and administering injurious substance,without intent to kill (Art. 264, RPC).

The main purpose of dividing the provision into four paragraphs

a) Is to graduate the penalties depending upon the nature and character ofthe wound inflicted

b) Their consequences on the person of the victim.

1. Prison mayor - because of the physical injuries inflicted, the injured personbecomes 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.

3. Prision correctional in its minimum and medium periods.

- person injured shall be deformed.- lost any other part of the body,

incapacitated for more than 90 days.

4. Arresto mayor in its maximum period to prision correctional

- If the physical injuries shall have cause the illness or incapacity forlabor for more than 30 days.

Is the offense shall be committed against any of the persons enumerated inArt. 246 Or with attendance of any of the circumstances mentioned in Art. 248

= The case covered by subdivision number 1 of this article will be punished byreclusion temporal in its medium and maximum periods.

= Subdivision number 2 by Prision correctional in its maximum period toprision mayor in its minimum period.

= Subdivision number 3 by prision correctional in its medium and maximum

= Subdivision number 4 prision correctional in its minimum and medium periods.

The provisions of the preceding paragraph shall not be applicable to a parent who shall inflict physical injuries upon his child by excessive chastisement. RA 7610.

It may be committed through a simple negligence or imprudence.

ADMINISTERING INJURIOUS SUBSTANCE OR BEVERAGES Art 264 RPC

Elements:1. The offender inflicted upon another any serious physical injury,

2. There is knowledge that the substance or beverage administered is injurious Or took advantage ofthe victims weakness of credulity.

3. There is no intent to kill in the part of the offender.

If intentional so> frustrated murder. Treachery is inherent in Art. 264 RPC

LESS SERIOUS PHYSICAL INJURIESArt. 265 RPCAny person who shall inflict upon another physical injuries not described in the preceding articles,

= But which shall incapacitate the offended party for labor 10 days or more

= Or shall require medical attendance for the same period

Both of which is 10 days but not more than 30 days and there must be proof to it..

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 offender’s parents, ascendants, guardian, curators,teachers.

4. The victim is 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 physicalinjuries 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 theoffender 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 medicalattendance, 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 ofthe body or mild blow which show no sign of physical violence may still be considered slight physicalinjuries or maltreatment.

PHYSICAL INJURIES INFLICTED IN A TUMULTOUS AFFRAY Art 252 RPCElements:1. There is a tumultuous affray.2. Participants suffered from serious physical injuries.3. The person who inflicted serious physical injuries cannot be identified.4. All those who appear to have used violence upon the person of the offended party shall be penalizedby arrest from 5 to 15 days.

TYPES OF WOUNDS ( MEDICAL CLASSIFICATION)

1. CLOSED WOUND - no breach of continuity of the skin or mucous membrane.a.Superficial - When the wound is just underneath the layers of the skin or mucous membrane.

a.1 PETECHIAE - is a circumscribed extravasation of blood in the subcutaneous tissue or underneath the mucous membrane.Example : mosquito bite, blood disease, hanging

a.2 CONTUSSION - is the effusion of blood into the tissues underneath the skin onaccount of the rupture of the blood vessels as a result of the application of blunt force or violence.= size of contusion greater than the size of the object.= Location of the contusion is not always the site ofapplication of the force. Example: Black eye> Forehead

Medico-legal point of view:

A contusion as indicated by its external pattern may correspond to the shape of the object or weapon used.

Extent -the possible degree of violence applied.

Distribution- indicates the character and manner of injury as in manual strangulation around the neck.

Age of Contusion: appreciated from its color changeThe size tends to become smaller from the periphery to the centerand passes through a series of color changes as a result of the disintegration of the RBC and liberation of hemoglobin.

The contusion is red, purple soon after its complete development.= 4 to 5 days > green=7 to 10 days > yellow and gradually disappears on the 14 or 15 day.The ultimate disappearance of color varies from 1 to 4 weeksdepending upon the severity and constitution of the body.The color changes starts at the periphery.

CONTUSION VS. POST-MORTEM HYPOSTASIS

ContusionBelow the epidermis in the true skin in small bruises or extravasations,below this in larger ones and often much deeper still.The epidermis has no blood vessels to be ruptured.

Post mortem HypostasisIn the epidermis or in the cutis as a simple stain or a showing through theepidermis of the underlying engorged capillaries.

ContusionCuticle was probably abraded by the same violence that produced thebruise. In small punctures such as fleas bites, this is not observed.

Post-mortem hypostasisCuticle unabraded, because the hypostasis is a mere sinking of the blood,there is no trauma.

ContusionA bruise appears at the seat of and surrounding the injury. This may or may not be a dependent part.

Post-mortem hypostasisAlways in a part which for the time of information is dependent.

ContusionOften elevated because elevated blood and subsequent inflammation swell the tissues.

Post-mortem hypostasisNot elevated, because either the blood is still in the vessels or at most has simply soaked into and stained the tissues.

ContusionIncision shows blood outside the vessels. This is the most certain test of difference and can be observed even in very small bruises.

Post-mortem hypostasisIncision shows the blood is still in its vessels and if any oozing occurs drops can be seen issuing from the cut mouths of the vessels.

ContusionColor variegated. This is only true of bruises that are the same days old due to the changes in the hemoglobin produced during life.

Post-mortem hypostasisColor is uniform. The well known change in color produced in blood . Extravasated Into living tissues does not occur in dead tissues with the same regularity.

ContusionIf the body happens to be constricted at or supported on a bruised place, the actual surface ofcontact may be a little lighter than the rest of the bruise but will not be white.

Post-mortem hypostasisIn a place which would otherwise be the seat of hypostasis pressure of any kind even simplesupport is sufficient to obliterate the lumen of the venules and capillaries and so to prevent their fillingwith blood.

White lines or patches of pressure bordered by the dark color of hypostasis are produced and marksof floggings, strangulation, etc. are thus sometimes simulated

FACTORS INFLUENCING THE DEGREE AND EXTENT OF CONTUSSION

1. General condition of the patient.

2. Part of the body affected.

Fatty tissues, bloody parts > contused easilyFibrous areas, muscle> less

3. Amount of force applied ±The greater the force, the more effusion of blood.

4. Disease - Contusion may develop with or without application of force. Example: Aplastic anemia, whooping cough

5. Age - Children and old age tend to bruise easily.

6. Sex - women, obese easily develops unlike boxers.

7. Application of heat and cold

The distinction between ante-mortem and post-mortem contusions in an undecomposed body is that in ;

1. Ante-mortem bruising: there is swelling, damage to epithelium, extravasation, coagulation and infiltration of the tissues with blood

2. Post-mortem bruising there are no such findings.

a.3 HEMATOMA

-is the extravasation or effusion of blood in a newly formed cavity underneath the skin. When theblunt 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

DISTINCTION BETWEEN CONTUSION AND HEMATOMA1. In contusion- the effused blood are accumulated in the interstices of the tissues underneath the skinIn hematoma blood accumulates in a newly formed cavity underneath the skin.

2. In contusion, the skin shows no elevation and is ever elevated, the elevation is slight and is on account of inflammatory changesIn hematoma - the skin is always elevated.

3. In contusion, puncture or aspiration with syringe of the lesion, no blood can be obtained.

In hematoma - shows presence of blood and subsequent depression of the elevated lesion.

Abscess, gangrene, hypertrophy, fibroid thickening and even malignancy are potential complications ofhematoma.

MUSCULO-SKELETAL INJURIES

1. Sprain - partial or complete disruption in the continuity os a muscular or ligamentous support of a joint, due to a blow, kick or torsion force.

2. Dislocation - displacement of the articular surface of bones entering into the formation of a joint.

3. Fracture - solution of continuity of bone resulting from violence or some existing pathology.

a. Close or Simple Fx - no break in continuity of the overlying skin.

b. Open or Compound Fx - Fx is complicated by an open wound caused by the broken bone which protruded with other tissues of the broken skin.

c. Comminuted Fx - Fractured bone is fragmented into several pieces.

d. Greenstick Fx - Fx wherein only one side of the bone is broken while the other is merely bent.

e. Linear Fx - when the Fx forms a crack usually in flat bones.

f. Spiral Fx - break in the bones forms a spiral manner as seen in longbones.

g. Pathologic Fx - Fx caused by weakness of the bone due to disease.

4. Strain - the over-stretching instead of an actual tearing or the rupture of a muscle or ligamentwhich may not be associated with the joint.

5. Sublaxation - Incomplete or partial dislocation.

INTERNAL HEMORRHAGE-rupture of blood vessels which may cause hemorrhage due to the following:

a. Traumatic intracranial hemorrhage.

b. Rupture of parenchymatous organs.

c. Laceration of other part of the body.

CEREBRAL CONCUSSION ( COMMOTIO CEREBRI )

- THE JARRING OR STUNNING OF THE BRAIN CHARACTERIZED BY MORE OR LESS COMPLETESUSPENSION OF ITS FUNCTIONS AS A RESULT OF INJURY TO THE HEAD WHICH LEADS TO SOME COMMOTION OF THE CEREBRAL SUBSTANCE.

- is more severe when the moving or mobile head struck a fixed hard object as compared when thehead is fixed and struck by a hard moving object

Signs and Symptoms1. unconsciousness which is more or less complete.2. muscles are relax and flaccid.3. eyelids are closed and the conjunctivae are insensitive.4. surface of the body is pale, cold and clammy.5. respiration is slow and sighing.

6. pulse is rapid, weak, faltering and scarcely perceptible to the fingers.7. temperature is subnormal.8. sphincters are relaxed with unconscious evacuation of the bowel and bladder.9. reflexes are present but sluggish and in severe cases may be absent.

Loss of memory for events just before the injury is a constant effect of cerebral concussion and is of medico-legal importance.

2.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 bya rub r friction against a hard rough object.

- Contussion with abrasion = forcible contact before friction occurs.

- the shape varies and the raw surface exudes blood and lymph which later dries and forms aprotective 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 whichare 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 locatedin the face, neck, forearms and hands.= abrasions resulting from friction on rough surfaces are located in bony parts and areusually associated with contusion or laceration.= nature of the abrasion may infer degree of pressure, nature of the rubbing object andthe direction of movement.

5. Abrasion heals in a short time and leaves no scar unless if notinfected 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 severallinear 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,abrasion a la signature)- those whose pattern and location provides objective evidence toshow 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

POSTMORTEM ABRASION

COLOR reddish-bronze due to slightexudation of blood

yellowish and transparent

LOCATION any area over bony prominenceRough handling of the cadaver

VITAL with intravital reactionmay show remains of damaged Epithelium

shows not vital reaction and is characterized by a separationof the epidermis fromComplete loss of the former

b. Incised wound ( cut, slash, slice)

-produced by a sharp-edged ( cutting)-or sharp-linear edge of the instrument like a knife, razor, bolo, glass etc.-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 likeSaber - injury is severe

Characteristics of incised wound:1. Edges are clean cut.2. The wound is straight3. Usually the wound is shallow near the extremities and deep at the middle portion.4. Profuse hemorrhage because of the clean cut on the vessels.5. Gaping is usually present due to the retraction of the edges.6. Clothes will also show a clean cut if cut by the instrument.7. Faster healing if without complications.8. Incised wound made by broken glasses

Changes that occur in an incised wound:

1. After 12 hours - edges are swollen, adherent with blood and with leukocyte infiltration.

2. After 24 hours - proliferation of the vascular endothelium and connective tissue cells.

3. After 36 to 48 hours - capillary network complete, fibroblasts running at right angles to the vessels.

4. After 3 to 5 days - vessels show thickening and obliteration

Why a person suffers from incised wound:

1. As a therapeutic procedure.2. As a consequence of self-defense3. Masochist may self-inflict incised wounds for self-gratification.4. Addicts and mental patients

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 involve both accessible and non-accessible parts.

-clothings are usually involved

-defense and other forms of wounds are present

Accidental wounds

- multiple incised wounds observed on the passenger and driver of MVA due to broken windshields.

- kitchen knives in the preparation of food.

SUICIDAL WOUNDS

HOMICIDAL WOUNDS

DIRECTION

Oblique from below left ear,downwards across front neckjust above Adams apple

Usually horizontal belowthe adams apple

SEVERITY Usually not so deep andmay only involve trachea,carotid and esophagus

Usually deep and may causeinvolvement of the cartilageand bones.

SUPERF’LCUT

Usually present before thecommencement of deeperwound.

Practically absent but mayrarely be present when thevictim struggled when attacked

POSITION OF THE BODY

May be sitting or facing a mirror or standing

Usually victim lying on bedor in other place.

SUICIDAL WOUNDS

HOMICIDAL WOUNDS

WOUNDING WEAPON

Firmly grasp (cadaveric spasm) or found lying beside the victim

Weapon is absent

BLOODDISTRIBUTION

Bld found in front part of bodyHand smeared with blood.

Bld found at the back of neck.Hands are clean.

MOTIVE History of mental depression,Financial, social problems, alcoholism

Absence of such history

PREVIOUS HISTORYof SELF-DESTRUCTION

May be present Always absent

3. STAB WOUNDS - produced by the penetration of a sharp and a sharp edged instrument like a knife,scissors.

-if the sharp edge is the one that comes in contact with the skin then it is an incised wound.If the sharp pointed portion first come in contact, it is a stab wound.

- surface length may reflect the width of the wounding instrument.

-smaller when the wound is not so deep.

-wider if upon withdrawal is not in the same direction as seen in slashing movement.

- The presence of an abrasion from the extremity of the skin defect is in line with direction of the slashingmovement.

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 isquite thin.

-The direction of the surface defect may be useful in the determination of the possible relative position ofthe 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 involved3. the degree of force applied

Hemorrhage is always the most serious consequence of stab wound due to the severance of bloodvessels 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

5. location of the stab wound - to include exact measurement from anatomical landmarks.

6. direction of the penetration - must be tridimentional

7. depth of the penetration

8. tissue and organs involved

Stab wounds may be:

A.Suicidal

1. Located over vital parts of the body.2. Usually solitary3. Located over covered parts of the body, the clothing is not involved4. Stab wound is accessible to the hand of the victim

6. Wounding weapon is firmly grasp by the hand of the victim.7. If stabbing is accompanied with slashing movement> the wound tailing abrasion is seen towards the hand inflicting the injury.8. Suicide not may be present9. Presence of a motive for self destruction.10. No disturbance in the death scene with wounding instrument found near the victim.

B. Homicidal -stabbing with homicidal intent is the most common

Characteristics:1. Injuries other than stab wound may be present .2. Stab wound may be located in any part of the body.3. Usually more than one stab wound4. A motive for stabbing, if none then the offender eitherinsane/drugs5. Disturbance in the crime scene

Medical evidence showing the intent of the offender to kill the victim:

1. there are more than one stab wounds2. stab wounds located in different parts of the body3. stab wounds are deep4. serrated stab wounds means thrust and withdrawal of the wounding weapon to increase internal damages.5. irregular or stellate shape skin defects> due to changing direction of the weapon with the portion ofthe instrument at the level of the skin as the lever.

4. PUNCTURED WOUND is the result of a thrust of a sharp pointed instrument.

= 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 bloodyorgans 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 deep3. there are defense wounds on the victim.4. signs of struggle in the crime scene.

Suicidal 1. located in areas of the body where the vital organs are located.2. usually singular, if multiple located in one area.3. parts of body involved is accessible by the hand of the victim.4. clothing usually not involved.5. wounding is made while the victim is in sitting or standing position , bleeding is towards thelower part of the body or clothing.6. no disturbance in the crime scene.7. wounding instrument found near the body.

Puncturing wound with puncturing instrument loaded with poison:

1. poison dart ± cyanide or nicotine2. fish spines3. dog bites with hydrophobia virus4. injection of air and poison as a way of euthanasia.

5.LACERATED WOUNDS ( TEAR, RUPTURE, STRETCH “PUTOK”)- a tear of the skin and the underlying tissues due to forcible contact with a blunt instrument.- May be produced by a hit with a piece of wood, iron bar, fist, stone, butt.- If the force is applied to a tissue is greater than its cohesive force and elasticity> the tissue tearsand a laceration is produced.

Characteristic:1. shape and size of the injury does not correspond to the wounding instrument2. tear on the skin is rugged with extremities irregular, ill-defined.3. injury developed where the blunt force is applied.4. borders of the wound are contused and swollen.5. developed in areas where the bone is superficially located.like scalp.6. examination with the aid of hand lens shows bridging tissue joining the edges and hairs bulbsare intact.7. bleeding is not extensive due to blood vessels are not severed evenly.8. healing process is delayed and has a tendency to develop a scar.

Classification of lacerated wounds:1. Splitting caused by crushing of the skin between two hard objects.Ex: laceration of scalp hit by a bunt instrument, cut eyebrow of a boxer.2. Overstretching of the skin-When pressure is applied on one side of the bone> the skin over the area will be stretched up to abreaking point to cause laceration and exposure of the fractured bone.-In avulsion: the edges of the remaining tissue is that of laceration.

3. Grinding compression-the weight and the grinding movement may cause separation of the skin with the underlying tissues.

4. Tearing-this may be produced by a semi-sharped edged instrument which causes irregular edges on thewound like hatchet and choppers.

Lacerated wounds are rarely suicidal.

INCISED WOUNDS

LACERATED WOUNDS

Edges are clean cut, regular, well defined

edges are roughly cut, irregular, ill-defined

No contusion or swelling around theIncised wounds

swelling and contusion around thelacerated wounds

Extremities of the wound are sharp, may beRound, or contused

extremities are ill-defined and irregular

INCISED WOUNDS

LACERATED WOUNDS

Examination by means of a hand lensShows that hair bulbs are cut

hair bulbs are preserved

Healing is faster healing is delayed

Caused by sharp edged instrument

caused by a blunt instrument

GAPING OF WOUND- Separation of the edges especially in

deep wound may be due to the following:

1. mechanical stretching or dilatationthe 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, inf’tion, 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 theentrance and exit of GSW and removal of necrotic materials.

3. retraction of the edges-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.

Practical ways of determining how much of the skin surface is involved in an injury or disease:-skin functions as a mechanical protection of the body, storage of water.

Determination of how much skin is involved is important in the mode of treatment and prognosisespecially in burns, contusion..

- burns of 70% in children and older age group are fatal.

= rule of nine is used.

Head and neckone upper extremityfront chest and abdomenposterior chest and abdoone lower extremity frontone lower ext(back)pudendum

9%9%18%18%9%9%1%

9%18%18%18%18%18%1%

Factors responsible for the severity of the wound:

1. Hemorrhage may influence the severity of wound by:

a. loss of blood incompatible with life- blood constitutes 1/20 of the body weight of an adult.- 5 to 6 quarts of blood ( one quart is 946 cc)- loss of 1/10 of its volume will cause no significant change.

- loss of one quart> fainting- loss of 1/3 to 2/5 > irreversible shock- males can withstand more loss of blood than females.- hypertension causes more excessive and rapid bleeding.

b. Hemorrhage may result in an increase in pressure in or on the vitalorgans to affect the normal function.- intracranial hemorrhage cause compression of the vital centers ofthe brain.- hemopericardium > pericardial tamp- hemorrhage to the chest> diminution of the respiratory output>anoxia.

c.. Hemorrhage may cause mechanical barriers to the function of organs.- into tracheo-bronchial lumina> asphyxia- into muscles > disturbance in their contractility.

Causes of hemorrhage:a. trauma - destruction of its blood vessel wallb. 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 pregnancy2. Size of injury - burns greater than 1/3 of the body are fatal3. 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 injectedthrough its fangs which is connected to the poison gland.

Snake venom toxicity will depend on:1. potency of venom injected2. 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 patient4. 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

2. Hematoxic - affects particularly the blood- manifestations are pain, swelling on the affected area, IV hemolysis, N,V, pulmonary and cardiacedema

Emergency treatment may be:

1. incision of the wound to promote more external hemorrhage to drain the venom.2. tourniquette above the site of the wound3. placing ice on the bite site4. sucking the wound to drain venom with the mouth5. administration of anti-snake venom serum.

2. Scorpion venom- venom has toxic, hemolytic, hemorrhagic- one punctured wound on the center of a reddened area- pain, edema and reddening

3. Coelenterate sting ( jellyfish )- tentacles penetrate into the skin and cause explosion of the nematocyst and liberation of the venom.- extreme pain. Urticarial rash, dilated pupils, paleness, labored breathing

Absence of medical or surgical intervention- wound may not be fatal but due to neglect or ignorance of its management,

may be serious and fatal.

FATAL EFFECT OF WOUNDS:

1. Wounds may be directly fatal by reason of:

a. Hemorrhage - neck due to carotid bleed.b. Mechanical injuries on vital organsc. shock

2. Wounds may be indirectly fatal by reason of:

a. secondary hemorrhage following sepsisb. specific infectionc. scarring effectd. secondary shock

NATURE OF DEATH DUE TO SECONDARY CAUSES

1. Changes whose natural sequence are direct & obvious ± sepsis, tetanus

2. Changes producing separate pathological lesions which in turn proves to be fatal

Ex: operation to ligate vessel but died of peritonitis despite diligence/skill

3. Changes where a definite pathological condition was present before the injury.

Ex. Person with tumor and stabbed , stab is not capable of death but accused is responsible for his death.

4. Changes where a definite pathological condition of totally different naturearises after the wounding and the consequential sequence is doubtful.Ex. TB meningitis ffg blow to the head

COMPLICATIONS OF TRAUMA OR INJURY1. Shock due to injury to nervous system, anoxemia, endothelial damage2. Hemorrhage3. Infectiona. from the instrumentb. from the organs involved in trauma ex. Bowels injured c. injury may depress general vitalityd. deliberate intro of micro-organism4. Embolism

HEALING OF WOUNDS

1. Power of the human tissue to regenerate -replaced the destroyed tissue by newly formed similar tissue.Regenerates rapidly : C.T., blood forming tissues,surface epith. Skin

Slow to regenrate:sm. Muscles, neurons of CNS, highly specialized glandular tiss.

Time of healing is dependent on:a. vascularityb. age of personc. degree of rest or immobilizationd. nature of the injury

2. Aberrated healing process:

a. formation of exuberant granulation or proud fleshb. keloid formationc. strictured. fistula or sinus formation

MEDICO-LEGAL INVESTIGATION OF WOUNDS

Rule to follow by a physician:1. all injuries must be described2. description of wound must be comprehensive, sketch/photograph3. examination must be influenced be any other information obtained from others in making a reportor a conclusion.

Outline of the medico-legal investigation of physical injuries:1. General investigation of the surroundings:a. examination of place where crime is committed.b. Examination of clothing, stains, cuts, hair, f.b. in the crime scenec. Investigations on possible witnesses to the incidentd. Examination of the wounding instrumente. Photography, sketching, accurate description of the crime scene.

2. Examination of the wounded bodya. examinations applicable to living or the dead- age of the wound from the degree of healing- determination of the weapon used- reasons for the multiplicity of wounds- determination if the wound is accidental, suicidal or homicidal

b. examination applicable only to the living- determination if injury is fatal- determination if injury will produce permanent deformity- determination if wound produces shock- determination if wound produces complications

c. examination applicable to a dead victim only- determination if wound is pre-mortem or post-mortem- determination whether wound is mortal or not- determination whether death is accelerated by a disease present at time of injury.- determination whether wound cause by A,S, H

3. Examinations of wound- character of wound : abrasion, hematoma, laceration etc- location of wound : from some fixed area> to determine trajectory/course- depth of wound : not in the living , only if the outer and inner are fixed

- conditions of the surroundings of the wound

= near GSW ± burning, tattooing= suicidal cuts ± superficial tentative cuts or hesitation cuts= lacerated wounds ± contusion on neighboring skin

- Extent of the wound- = extensive injury - marked degree of

force applied in the production of the wound.

- = homicidal cutthroats are deeper, extensive, numerous than suicide

- direction of the wound > impt. in the position of the victim to the offender

- - number of wounds ± several> homicidal

- - conditions of locality- a. degree of hemorrhage- b. evidence of struggle- c. information as to the position of the

body- d. presence of suicide note- e. condition of the weapon

ANTE-MORTEM WOUNDS

POST-MORTEM WOUNDS

HEMORRHAGE

More profuse, arterialdue to loss of tone of vessels,Absence of heart actionPost-mortem clotting ofblood inside b.v.

Marks of spouting of bloodfrom arteries

Clotted blood

Slight or none, venous

No spouting of blood

Bld not clotted,or soft clot

SIGNS OFINFLAMMATION

Inflammation & reparativeprocessSwelling in the area,Effusion of lymph, pusAdhesion of the edgesUnless if victim is weakened

None

ANTE-MORTEM WOUNDS

POST-MORTEM WOUNDS

SIGNS OFREPAIR

Fibrin formationNo time of repairgrowth of epitheliumScab or scar formation

No time of repair

RETRACTIONOF THE EDGES

Deep staining of the edges and cellular tissuescan be removed by washing

Edges gape owing to the reactionof the skin and muscle fibers

Not deeply stainedcan be removed by washing

Edges do not gape, but areclosely approximated toEach other unless if thewound is 1 to 2 hrsafter death

DETERMINATIONS IF WOUND IS:

HOMICIDAL

SUICIDAL ACCIDENTAL

ABRASIONS Not common unlessIf draggedOr if victim resisted

Rarely observed Extensiveabrasions MVA

CONTUSION

Rare except whenjumping from a height

Found in any portionof the body - Fall

INCISED Commonly observeddepth, location and surroundings

Commonly observedcause of death

Frequent but rarely WOUNDS

- Points to consider in the determination as to whether the wounds is A, S, H.

- 1. external signs and circumstances related to the position and attitude of the body when found.

- 2. location of the weapon or the manner in which it was held

- 3. the motive in the commission of the crime

- 4. the personal character of the deceased

- 5. the possibility for the offender to have purposely changed the truth of the condition.

- 6. other information- a. signs of struggle- b. number and direction of wounds- c. direction of wound- d. nature and extent of the wound- e. state of clothing

- LENGTH OF TIME OF SURVIVAL OF THE VICTIM AFTER INFLICTION OF THE WOUND

- 1. degree of healing> signs of repair of wound appear in less than a day after the infliction of injury.

- 2. changes in the body in relation to the time of death >systematic changes in the body = wasting,

- anemia, bed sore.- 3. age of blood stain ± not reliable- 4. testimony of witness when the

wound was inflicted.

- POSSIBLE INSTRUMENTS WHEN USED BY THE ASSAILANT IN INFLICTING THE INJURIES

- 1. contusion ± blunt- 2. incised wound ± sharp-edged

instrument- 3. lacerated wounds- blunt- 4. punctured wounds ± sharp pointed- 5. abrasion ± body surface is rubbed

on a hard surface- 6. GSW ± the diameter of the

wound of entrance may approximate the caliber of the wounding

- instrument.

- Could the injury have been inflicted by a special weapon?

- A physician cant determine that a specific weapon was used in inflicting a wound.

- It is possible that it is caused by a certain instrument presented.

- He must be cautious in giving categoric statements

- Which of the injuries sustained by the victim caused death?

- If with conspiracy - no need coz the act of one is the act of all.

- If none- offenders are only responsible for their individual acts.

- If multiple injuries: which of the wound injured a vital organ. Or if same organ which caused the degree

- of damage.

- Which of the wounds was inflicted first?

- If multiple for the qualification of the offense committed.

- First - treachery , murder- Last – homicide

- Consider:- 1. relative position of the assailant

and the victim when the first injury was inflicted on the latter.

- 2. trajectory/course of the wound inside the body of the victim

- 3. organs involved and the degree of injury

- 4. testimony of witness

- 5. presence of defense wounds ± inflicte

- Effect of medical and surgical intervention on the death:

- If death followed after operation> offender is responsible if death was inevitable and that even withoperation death is normal and direct consequence of the injury, and the physician is competent and inspite of exercise of degree of diligence still death is the outcome.

- If death ensued even the wounds are minor, and death due to the negligence or incompetence of thephysician then the offender cant be responsible.

- Effect of negligence of the injured person on the death

- If death occurred from complications arising from a simple injury owing to the

- negligence of the injured person in its proper care and treatment

- = the offender is responsible for the death- = a person is not bound to submit himself

to medical tx for the injuries received during the assault.

- = unless if it is proven that the negligence of the victim is deliberate sooffender is not responsible but only for physical injuries.

- Power of volitional acts of the victim after receiving a fatal injury:

- = dying declaration, attempt to kill the offender after the first blow of the offender

- Relative position of the victim and assailant when injury was inflicted:

- 1. location of the wound- 2. direction of the wound- 3. nature of instrument used in inflicting

the injury- 4. testimony of the witness

- EXTRINSIC EVIDENCES OF THE WOUNDS- 1. evidences from the wounding weapon- = position of the weapon - near or grasp

by victim- = blood on weapon - may be stained

with blood- = hair and other substance on weapon- 2. evidences in the clothing of the victim- = soaked with blood - hemorrhage- = gunpowder - distance

- 3. evidences derived from the examination of the assailant

- = paraffin test, tears in clothing, blood stains, intoxication etc.

- 4. evidences derived from the crime scene

- = amount of hemorrhage, wounding instrument etc.

- PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY

- 1. HEAD AND NECK- = not be underestimated- = bleeding from ears, nose, mouth >

basal fractures- = may have normal x-rays yet with

severe head injury

- Factors influencing the degree and extent of head injuries :

- a. nature of the wounding weapon> degree of violence applied depends on the thickness of the scalp and the weight of the weapon.

- b. Intensity if the force > intensity and heavy agent

- c. point of impact >extensive in fx of vaults at side or back

- d. mobility of the skull at the application of force

- if head is mobile, free> effect on the brain is due to the shearing

- movement imparted to the brain.- > may produce contusion, laceration

without fx.- If head is fixed and unsupported>

jarring movement of the brain is absent but the fracture is

- extensive.

- Head injuries are classified as to the site of the application of force:

- 1. Direct or Coup injuries- 2. Indirect injuries- a. contr-coup injuries- b. remote injuries ± fall hitting buttocks>

basal fx- c. locus minoris resistencia - injury in

areas with less resistance- 3. Coup-contre-coup injuries ( direct and

indirect injuries)

- Wounds in the Scalp:

- 1. it is difficult to prevent the spread of infection

- 2. there is proximity of the scalp to the brain

- 3. there are free vascular connection between the structures inside and outside the brain

- 4. it is frequently difficult to determine the extent of damage of the skull.

- 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 gassescoming 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.

- c. Sec. 2691 RAC - failure of personal representative of deceased licensee to surrender firearm.

- d. Art. 155 RPC - Alarms and Scandals- e.Art. 254 RPC ± Discharge of firearms

- CLASSIFICATION OF SMALL FIREARMS:- Small firearms - are those which propel

projectile of less than 1 inch in diameter.- 1. as to wounding power:- = low velocity firearm >muzzle velocity of

not more than 1400 ft per sec.- Ex. Revolver- = high power firearm > muzzle velocity

more than 1400 ft. per second- > usual is 2200 to 2500 ft per second or

more.

- 2.as to nature of the bore:- = smooth bore weapon >inside portion of

the barrel that is perfectly smooth- from the firing chamber to the muzzle. Ex.

shotgun- = rifled bore firearm > the bore of the

barrel with a number of spiral lands- and grooves which run parallel with one

another but twisted spirally from breech to muzzle.

- Ex. Military rifle

3. as to manner of firing- = pistol ± fired with a single shot- Ex. Revolver- = rifle ± may be fired from the shoulder

Ex. Shotgun

4. As to the nature of the magazine- = cylindrical revolving magazine ± the

cartridge is located in a cylindrical- magazine which rotates at the rear portion

of the barrel- Ex. Revolver- = vertical or horizontal magazine ± the

cartridge is held one after another- vertically or horizontally and also held in

place by a spring side to- side or end to end.- Ex. Automatic pistol

- Types of small firearms which are of medico-legal interest:

- 1. revolver ± usual muzzle velocity is 600 feet per second

- 2. automatic pistol ± self-loading firearm, muzzle velocity of 1200 feet per second

- 3. rifle - muzzle velocity of 2500 feet per second and a range of 3000 feet.

- 4. shotgun - projectile is a collection of pellets

- A weapon in order to cause injury must have two principal component parts:

- 1. the cartridge or ammunition - bullet primer, cartridge case, powder charge

- 2. firearm ± instrument for the propulsion of a projectile force of gases from a burning powder.

ENTRANCE WOUND EXIT WOUND

Appears to be smaller than the missileOwing to the elasticity of the tissue

Always bigger than the missile

Edges are inverted Edges are everted

Usually oval or round depending uponthe bullet shape

Does not manifest any definite the angle of approach of

Contusion collar or contact ring is presentdue to invagination of the skinand spinning of the missile

Absent

Tattooing or smudging may be present whenwhen firing is near

Absent

Underlying tissues are not protruding Underlying tissues may be seenProtruding from the wound

Always present after fire May be absent, if missile islodged in the body

Paraffin test may be positive Negative

- INSTANCES WHEN THE SIZE OF THE WOUND OF ENTRANCE DO NOT APPROXIMATE THE

- CALIBER OF THE FIREARM- In distant fire, the rule is that the diameter

of the GSW of entrance is almost the same as the caliber of the wounding firearm except:

- 1. Factors which make the wound of entrance bigger than the caliber:

- a. in contact or near fire- b. deformity of the bullet which entered- c. bullet might have entered the skin

sidewise- d. acute angular approach of the bullet

- 2. Factors which make the wound of entrance smaller than the caliber

- a. fragmentation of the bullet before penetrating the skin

- b. contraction of the elastic tissues of the skin

- Other evidences or findings used to determine entrance of GSW

- 1. examination of the clothing, if involved in the course of the bullet

- a. fabric shows punch in destruction- b. particle of gunpowder- 2. examination of the internal injuries caused

by the bullet- a. bone fragments, cartilage, soft tissues

are driven away from entrance wound- b. destruction of the bone is oval, with sharp

edges at the exit it is irregular, bigger and bevelled

- c. testimony of witness

- Determination of the trajectory of the bullet inside the body of the victim

- 1. external examination- a. shape of wound of entrance- = when bullet is fired at right angle with

the skin> the wound of entrance is circular except in case of near fire.

- = if fired at another angle , it is oval- = when the bullet is deformed no such

characteristics findings will be observed.

- b. shape and distribution of the contusion collar

- = contusion collar is widest at the side of the acute angle of approach of the bullet.

- = if the bullet hits the skin perpendicularly> collar will have a uniform

- width around the GSW except when bullet is deformed or in near fire.

- c. difference in level between the entrance and exit wounds

- d. by probing the wound of entrance ± not with too much force

- 2. internal examination- a. actual dissection and tracing the course

of the wound at autopsy- b. fracture of bones and course in visceral

organs- c. location of bone fragments and lead

particle

- 3. other evidences to show trajectory- a. relative difference in the vertical location

of entrance and exit in the clothing- b. relative position and distance of the

assailant from the victim in the reconstruction of re-enactment

- of the crime.- c. testimony of witness

- EXIT WOUNDS OR OFFSHOOT WOUND- Does not show characteristic shape unlike

the entrance wound due to the absence of external support

- beyond the skin so the bullet tends to tear or shatter the skin.

- Shored GSW of exit: if pressed on a hard object like when victim is lying:

- Wound of exit is circular or nearly circular with abrasion

- ODD AND EVEN RULE IN GSW- = If the number of entrance and exit

wound is even so presumption that no- bullet is lodge in the body- How to determine the number of fires

made by the offender: - 1. determination of the number of spent

shells- 2. determination of entrance wounds in

the body of the victim ± number of entrance wounds may not show the exact number of fire:

- a. not all fire made may hit the body of the victim

- b. the bullet may in the course of its flight hit a hard object thereby splitting it and each

- fragment may produce separate wounds of entrance.

- c. Bullet may have perforated a part of the body and then made another wound in some other

- parts of the body.- 3. number of shots heard by the witness

- Instances when the number of GSW of entrance is less than the number of GSW of exit in the body of the victim:

- 1. a bullet might have entered the body but split into several fragments, each of which made separateexit.

- 2. one of the bullets might have entered a natural orifice of the body. Ex. Nose

- 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.

- Problems confronting Forensic Physician in the identification of GSW:

- 1. alteration of the lesion due to natural process:drying of wound, infn, healing proc..

- 2. medical and surgical intervention: refer to clinical record of patient

- 3. embalming- 4. problems inherent to the injury itself.- 5. x-ray exam ± migratory, external souvenirs

- Examination of the external wearing apparel of the victim of GSW may be significant in

- investigation because:1. it may establish the possible range of the fire:- a.contact fire- =tear in the clothing covering the skin, fibers

turn outward away from body- = soot deposit, gunpowder tattooing, burning

of fibers around the turned fiber- = muzzle imprint- = dirt and greasy deposit may be wipe out

and visible in the torn clothing

- b.not contact but near shot- = same with (a) except for absence of muzzle

imprint and beyond flame range- c. far fire- = there is a hole tear with inward direction of

the thread- 2. it may be useful in the determination as to

which is the point of entry and of exit of the bullet. Entry-

- the fiber are inverted.- 3. it may be useful in locating the bullet

- Special consideration on bullets- 1. souvenir bullet- 2. bullet migration- 3. tandem bullet

- EVIDENCES SHOWING THAT THE GUNSHOT WOUNDS MAY BE SUICIDAL

- 1. shot fired in a closed locked room, or open uninhabited place.

- 2. death open near the place victim was found

- 3. shot fired with the muzzle of the gun in contact with the part of body involved

- 4. location of entrance wound accessible part of body

- 5. shot usually solitary- 6. direction of fire is compatible with the

trajectory of bullet

- 7. personal history may reveal social, economic, business or marital problem which cannot be solve.

- 8. gunpowder presence in the hand of the victim

- 9. entrance wound usually does not contain clothing

- 10.fingerprints of victim on the butt- 11.suicide note at the vicinity- 12.no disturbance in the place of death

- Russian roulette = unfortunate victim has no predetermined desire of self-destruction

- EVIDENCES THAT GSW IS HOMICIDAL- 1. site of wound of entrance has no point of

election- 2. fire is made when the victim is at some

distance- 3. signs of struggle or defense wounds- 4. disturbance in the surroundings- 5. wounding firearm usually not found in the

scene of the crime- 6. testimony of witness

- EVIDENCES TO SHOW THAT GSW IS ACCIDENTAL

- 1. usually one shot- 2. no special area of body involved- 3. consideration on the testimony of the

assailant and determination as to whether it is possible by

- knowing the relative position of the victim- 4. testimony of the witness

- POINTS TO BE CONSIDERED AND INCLUDED IN THE REPORT OF THE PHYSICIAN

- 1. complete description of the wound of entrance and exit

- 2. location of the wound; part of body involved, distance of wound from midline, distance of wound

- from heel or buttock.- 3. direction and length of the bullet track- 4. organs or tissues involved in its course- 5. location of the missile, if lodged in the body- 6. diagram. Photograph, sketch or drawing

showing the location and number of wounds

- QUESTIONS THAT A PHYSICIAN IS EXPECTED TO ANSWER IN COURT;

- 1. COULD WOUND THE WOUND BE INFLICTED BY THE WEAPON PRESENTED TO HIM?

- 2. AT WHAT RANGE WAS IT FIRED?- 3. WHAT WAS THE DIRECTION OF THE FIRE?- 4. IS IT SELF-INFLICTED?- 5. ARE THERE SIGNS OF STRUGGLE?- 6. DID THE VICTIM DIE INSTANTANEOUSLY?- 7. IS IT POSSIBLE FOR THE VICTIM TO

FIRE OR RESIST THE ATTACK AFTE THE INJURY WAS

- SUSTAINED?- 8. WHERE WAS THE POSTION OF THE

ASSAILANT AND THE VICTIM WHEN THE SHOT WAS FIRED?

- The caliber may be inferred from the diameter of the wound of entrance.

- Determination of the length of survival of the victim:

- 1. nature of the GSW- 2. organs involved- 3. presence or absence of infection- 4. amount of blood loss- 5. physical condition of the patient- Capacity of a victim to perform volitional

acts ± depends upon the area of the body involved,

- involvement of vital organs and the resistance of the victim.

- DETERMINATION AS TO THE LENGTH OF TIME A FIREARM HAD BEEN FIRED

- 1. odor of the gas inside the barrel- 2. chemical changes inside the barrel- 3. evidences that may be deduced from the

wound

- DETERMINING WHETHER THE WOUNDING WEAPON IS AN AUTOMATIC PISTOL OR A REVOLVER

- 1. location of the empty shells ± revolver the empty shells are found in the cylindrical magazine

- chamber after the fire- 2. nature of the spent shell ± automatic firearm

= bullet is copper jacketed

- 3. nature of the base of the cartridge or spent shell = base of a revolver has a wider diameter

- than that of the cylindrical body to keep the cartridge stay in the magazine chamber.

- It may be possible for a person who is accustomed to the sounds of firearms of different calibers to

- identify the firearm by the sound produced.- It is not possible to determine the direction of

the shot by determining the direction of the sound except

- when the flash or the person firing the shot is seen at the time the shot was fired

- GSW may not be a near fire or may not appear to be near fire:

- 1. when a device is set up to hold the firearm and to enable it to be discharged at a long range by the

- victim.- 2. when the GSW of entrance does not show

characteristics of a near shot because the clothing are

- interposed between the victim and the firearm.- 3. when the examining physician failed to

distinguish between a near or far shot wound- 4. when the product of a near shot has been

washed out of the wound.

- X-ray

- 1. facilitate the location and extraction of the wound

- 2. reveals fragmentation and its location- 3. shows bone involvement like fracture- 4. reveal trajectory of the bullet- 5. shows effect of the bullet wound, like

hemorrhage, escape of air, laceration

- 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.

- Determination of the presence of gunpowder and primer components:

- Importance:

- 1. Determination of the distance of the gun muzzle from the victim¶s body when fired. Usually not

- more than 24 inches when fired.- 2. Determining whether a person has fired a

firearm. ± dorsum of the hand- = metallic residues, burning and unburned

gunpowder- = in suicide found in the palm

- Procedures in determining the presence of gunpowder:

- 1. Gross examination use of hand lens ± Fine black powder ± not conclusive

- 2. Microscopic examination- 3. Chemincal Test

- Tests for the Presence of Powder residues- 1. On the skin - Dorsum of the hand or Wound

of entrance- Dermal nitrate test ( Paraffin test,

Diphenylamine test, Lung’s test , Gonzales’ test)- = melted paraffin heated at 150 degrees

fahrenheit- Lung’s reagent- = small particles with nitrate or nitrite > blue

reaction- = not conclusive: fertilizers, cosmetics,

cigarettes, urine- = Negative is not conclusive: thorough washing

- 2. On clothings- Walker’s test ( C-acid test, H-acid test)- = glossy photographic paper fixed in

hyposolution for 20 min to- remove the silver salts and washed for 45 min.

and dries.

- 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

- THERMAL INJURIES OR DEATHS- - are those caused by deviation from normal

temperature, capable of producing- cellular or tissue changes in the body.- - Exposure to severe cold- = Frost bite- - exposure to high temperature = burning

scalding

- 1. DEATH OR INJURY FROM COLD- - not common in the Philippines- - Primary cause of death: Decrease dissociation

of O2 from Hgb in the RBC- : Diminished power of the tissue to utilize O2- - Cold damp air is more fatal than cold dry air.- - Women are more resistant to cold > greater

deposits of SQ fats.

- Effects of COLD:- A. Local effect ( Frostbite, Immersion foot, Trench

foot )- 1st- Blanching , paleness of the skin due to

vascular spasm.- 2 nd - Erthyma, edema, swelling due to vascular

dilatation, paralysis and- increased capillary permeability.- 3rd - Blister formation- 4 th - Necrosis, vascular occlusion, thrombosis

and gangrene.- Microscopically: Vacuolization, degeneration of

epidermal cells- : Necrosis of the collage of the SQ tissue- : Occlusion of the vessels due to clumping of RBC

- B. Systemic effects:- - Reflex in nature due to the stimulation and

paralysis of the nerves- - Pulmonary ,Cardiac action is slowed down due

to cerebral anoxia>- resulting to lethargy, delirium, convulsions,

coma or death.

- 2. DEATH OR INJURY FROM HEAT - effect may be local or general

- Classifications of Heat Injury:

- a) General or Systemic effects:- a.1 Heat cramps- a.2 Heat exhaustion- a.3 Heat stroke

- b) Local effects:- b.1 Scalding- b.2 Burns- = Thermal- = Chemical- = Electrical, lightning- = Radiation

- GENERAL OR SYSTEMIC EFFECT: death usually accidental

- 1. Heat cramps( Miner’s Camp, Firemans Camp, Stroker’ s camp)

- - Involuntary spasmodic painful contraction of muscles due to dehydration and excessive loss of chlorides by sweating

- Ex. 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- Ex. Removal of heated area

- . 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/ DUPUYTREN’S CLASSIFICATION

1st degree ERYTHEMA

2nd degree VESICLE FORMATION

3rd degree Destruction of the cuticle,part of skin,painful

4th degree Whole skin is destroyed, ulceration,not painful

5th degree Deep facia, muscles

6th degree Charring of the limbs

BURNS SCALDSCAUSE DRY HEAT – FLAME,

HEATEDSOLD RADIANT HEAT

MOIST HEAT- LIUID, STEAM

LOCATION AT OR ABOVE TE SITE OF CONTACT

OCCURS AT OR BELOW

SINGEING OF HAIR IS PRESENT

ABSENT

BOUNDARY OF NORMAL

NOT CLEAR DISTINCT

INJURY SEVERE LIMITED

CLOTHINGS INVOLVED NOT BURNED

- Proofs that the victim was ALIVE BEFORE burned to DEATH:

- 1. Presence of carbon particles in the air passage.

- 2. Increase carboxy-hemoglobin blood level.- 3. Dermal erythema, edema and vesicle

formation.- 4. Subendocardial left ventricular hemorrhage.

BURNS ANTE-MORTEM BURNS

POST MORTEM BURNS

BLISTER ABUNDANT ALBUMIN / CHLORIDES

SCANTYALBUMIN/ CHLORIDES

AREA OF INFLAMMATION

AROUND THE ANTEMORTEM BURN

ABSENT

BASE OF THE VESICLE

RED NOT MUCH CHANGE IN COLOR

TRACHEO-BROCHIAL LUMEN

PARTICLES OF SOOT OR CARBON

NO FINDINGS

BLOOD ABUNDANCE OF CARBOXY-HGB

ABSENT

- Differential diagnosis of blisters:

- 1. Due to putrefaction ± fluid content is blood stained watery fluid

- - asso. with putrefactive changes in other parts of body.

- 2. Due to disease- heat by the size, distribution

- 3. Due to friction- Hx of application of heat

- 3. Chemical burns- - heat by the size, distribution- - Hx of application of heat

- 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- e. Inflammatory redness of the skin surface- f. Delayed healing

CHEMICAL BURNS

THERMAL BURNS

BLISTER ABSENT PRESENT

SKIN / CLOTHINGS

STAINED CHEMICALS

NO STAINING

ANALYSIS OF SUBSTANCE

SHOWS CHEMICAL CORROSION

ABSENT

LESION BORDERS ARE DISTINCT

DIFFUSED

- Characteristic lesions by different chemicals:

- a. Sulphuric acid ( Oil of Vitriol)- = most intense action, considerable destruction- = ulcerations where acid flowed, clothings

destroyed- = blackish-brown sloughs

- b. Nitric acid- = Clothing is destroyed, brown- = yellow or yellowish brown slough

- c. Hydrocloric acid- = not so destructive- = intense irritation, localized ulceration red or

reddish-gray.

- d. Caustic soda and Potash- = Corrosive action on the tissues with bleached

appearance

- 4. Electrical burns - Contact burns, spark burns, Flash burns

- 5. Radiation burns - x-ray, UV light burns

- PHYSICAL INJURIES OR DEATH BY- LIGHTNING AND ELECTRICITY

- Lightning - is an electrical charge from the atmosphere.

- - 1 million volts/ 2000 amperes

- Elements of lightning that produces injury:- 1. Direct effect from the electrical charge.- 2. Surface flash burns from the discharge -

electrical into heat energy.- 3. Mechanical effect - expansion of air >

laceration- 4. Compression effect - sledgehammer blow

- Spasmodic contraction of cerebral vessels > shock

- Electricity - main cause of death is shock- - Above 300 volts are like the effect of lightning,

- Factors which influence the effect of electrical shock:

- 1. Personal idiosyncracy ± personal condition- 2. Disease ± cardiac dis. Is prone- 3. Anticipation of shock ± Can withstand- 4. Sleep ± increases resistance- 5. Amperage or intensity of the electrical

current ± principal factor- = 70-80 in AC and 250 in DC.

- Factors which influence the effect of electrical shock:

- 1. Personal idiosyncracy ± personal condition- 2. Disease ± cardiac dis. Is prone- 3. Anticipation of shock ± Can withstand- 4. Sleep ± increases resistance- 5. Amperage or intensity of the electrical current ±

principal factor- = 70-80 in AC and 250 in DC.- 6. Resistance of the body- 7. Nature of current ± AC is more dangerous- 8. Earthing- shock is enhanced- 9. Duration of contact- 10.Point of entry ± left more dangerous than the

right

- Mechanism of death in electrical shock:

- 1.Ventricular fib ± leads to rupture of muscle fibers

- 2. Respiratory failure due to bulbar paralysis- 3. Mechanical asphyxia due to violent and

prolonged convulsion.

- Metallization: - specific feature of electrical injury particles of the metal are driven into the epidermis causing darkening of the skin

- Delayed effects of electrical injuries:- = the metal of the conductor is

volatilized and- = necrosis of the area develops into

gangrene- = Damaged arteries becomes brittle,

friable and liable to rupture- = Nervous injuries ± retrograde amnesia,

hemiplegia- = May enter the head > cataract

- DEATH OR PHYSICAL INJURIES DUE TO CHANGE AF ATMOSPHERIC PRESSURE ( BAROTRAUMA)

- Increase of atmospheric pressure ( Hyperbarism)

- -Normal atmospheric pressure at sea level is 760 millimeters of Hg.

- - Henry’s Law - - “At constant temperature, the amount of

gas dissolved in a liquid is directly proportional to the pressure”

- = As he goes deeper there will be an increase in the amount of gas dissolved in the blood and other body fluids.

- = If ascent is made rapidly, the diver will suffer from the effects of the sudden release of the gasses from the body fluids.

- = released of air bubbles in the circulation and act as emboli in different parts of the body causing interstitial emphysema, pulmonary embolism, in big joints called bends.

- Decrease of atmospheric pressure (Decompression)

- 1. Hypobarism - at high altitudes the atmospheric pressure is lower and more gas will be liberated by the body fluid.

- = release of gasses results to:- a) Bends ± joint and muscular pain- b) Chokes ± Substernal distress, non-

productive coughing- c) Substernal emphysema- d) Trapped gas- 2. Anoxia- Hypoxia felt at 8000-15,000 feet

level- - Aircrafts greater than 34,000 feet be

provided with O2.

- AIRCRAFT INJURIES AND FATALITIES- 1. During the flight- a) Altitude: Hypobarism ( Decompression)- b) Speed - spatial disorientation ; sudden

change of direction at a speed of 500 miles drains brain from blood to the lower parts> unconsciousness

- c) Toxins - CO, CO2 saturates cabin resulting to asphyxia

- d) Temperature - At 25,000 feet 40 degree below zero: frost bite , freezing

- e) Pre-existing disease - Coronary dis./Hpn fatal due to sudden change env.

- 2. During crash ± fatalities occur us. during take-off and landing.

- - Fx, Rupture of the heart due to cmpression.

- 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 deathFailure of circulation due to Heart failure, shock, arterial venous obstruction

4.Histotoxic anoxic deathFailure 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 - Breathing is shallow, gasping- Due to paralysis of respiratory center

Classification of Asphyxia:

1. Hanging2. Strangulations: by ligature, manual strangulation, spl forms -palmar3. Suffocation: choking4. Asphyxia by drowning5. Asphyxia by pressure on the chest6. Asphyxia by irrespirable gasses

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 artery4. Subpleural hges.

HANGING STRANGULATION

HYOID BONE FREQUENTLY INJURED FREQUENTLY SPARED

DIRECTION OF LIGATURE MARK

INVERTED V-SHAPE USUALLY HORIZONTAL

LIGATURE LOCATION

AT LEVEL OF HYOID BONE

BELOW LARYNX

LIGATURE LOCATION

DEEPEST OPPOSITE THE KNOT

UNIFORM DEPTH

VERTEBRAL INJURY FREQUENTLY OBSERVED NOT OBSERVED

B.ASPHYXIA BY STRANGULATION - Tightened by force not the weight

Manual strangulation or throttling:- form of asphyxial death where the constricting force is the hand.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 pillowsGagging - application of materials to prevent air to have access to mouth and nostrils.

Plastic bag suffocationChoking- 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 ½ minutes considered fatal.- Average time required for death in drowning is 2 to 5 minutes.

Emergency treatment in Drowning

1. Schaefer’s method - Face down, prone position:operator exerts pressure in ribs

2. Sylveste’ s method- Lying on his back, astride over body, swinging arms

Post-mortem findings:1. External findingsa) Wet clothes, pale face, F.B. clinging on skin surfaceb) “Cutis anserine” or “goose flesh” -skin is pale , contractedNOT Dxticc) Washerwoman’s hands and feet - skin of hands & feet:bleached NOT Dxticd) Postmortem lividity - marked in the head, neck and chest.e) Presence of firmly-clenched hands with objects - Person was alive at firstf) Physical injuries for struggleg) Suicidal drowning - Pieces of stone

2. Internal findingsA. RESPIRATORY SYSTEM1. “Emphysema aquosum” - Lungs are distended overlapping the heart= Due to irritation made by the inhaled water on the mucous membrane ofthe air passage which stimulate the secretion of mucous.2. “Edema aquosum”- Due:Entrance of water into air sacs, Lungs are doughy3. “Champignon d’ocume” - 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 froth5. Blood stained fluid found inside chest cavity.6. Section lungs shows fluid with bloody froth.

B. HEART1. 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

Gettler’s 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 afterdeath.

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)

3.Presence of water in the stomach4. Presence of froth, foam, F.B. in the air passage found in the medium where the victim was found.5. Presence of water in the middle ear due to violent inspiration when the mouth is full of water.

Floating of the body in drowning:-Within 24 H due to the decomposition which causes the accumulation of gas in the body, the body floats.- Body is flexed because of the dominance of the flexor muscles-”tete de negri” - bronze color of head and neck; face as the most dependent portion of the body.

Homicidal D. = struggle, motive, articles found near the place, phys. Injuries

Suicidal D.= note, heavy objects, mentality, Hx of previous attempt

Accidental = Absence of violence in the body., exclusion of suicide, witnesses

E.COMPRESSION ASPHYXIA ( TRAUMATIC CRUSH ASPHYXIA )

- Form of asphyxia where the free exchange of air in the lungs is prevented by the immobility of the chest and abdomen due to external pressure or crush injury.

- Homicidal =offender kneels on the chest

- Accidental = pinned between two big objects

Burking - invented by Burke and Hare= murder for the sale to medical schools- Kneels or sits on the chest and the hands

close the mouth and nostrils

Death by crucifixion- alternative raising and lowering of the body leads to exhaustion, unconsciousness and death from asphyxia = IC mm are stretched

F. ASPHYXIA BY BREATHING IIRESPIRABLE GASES

1. Carbon monoxide “silent killer”, colorless, insoluble in water and alcohol.

- formed by the incomplete combustion of carbon fuel.

Qualitative test for CO in the blood

a) Kunkel’s test ± 4 volume of water + 3x its volume of 1% tannic acid- crimson red if positiveb) Potassium Ferrocyanide test -bright redc) Spectroscope examd) Gas chromatographe) Infra-red analysis

2. Carbon dioxide ± CO2, Carbonic acid gas

- Blown out of the lungs during respiration- Product of complete combustion of carbon containing compounds- End result of fermentation & decomposition of organic matters.- septic tank= The inhalation of pure CO2 may cause immediate vagal inhibition with spasm of the glottis anddeath. = manhole, poorly ventilated rooms

Tests for the presence of CO2

1. Barium nitrate - white precipitate of Barium carbonate with carbonic acid2. silver nitrate - white ppt. of silver carbonate when carbonic acid is added.3. Hydrogen sulfide ( H2S, Sulphuretted hydrogen ) = rotten egg odor- Formed during decomposition process of organic substances containing sulphur- Causes titanic convulsion, delirium, coma, death

4. Hydrogen cyanide - one of the most toxic, rapid acting gas- Formed by the addition of acid to potassium or sodium salt of cyanide- Found in plants; leaves of cherry laurel, bitter almond, kernels of commoncherry, plum, peaches, ordinary bamboo shoots, certain oil seed and beans- Contains AMYGDALIN which in the presence of water and natural enyzmeEMULSIN is readily decomposed to HYDROCYANIC ACID, glucose andbenzaldehyde.= 60-90 mg of Hydrogen cyanide is fatal, death in 2 to 10 min

5. Sulfur dioxide - Heavier than air, pungent odor- employed as disinfectant, bleaching agent,- found in eruption of volcano

WAR GASESClassification based on the physiological action1. Lacrimator or Tear gas - causes irritation with copious flow of tearsa) Chloracetphene (C.A.P.)b) Bromobenzyl cyanide (B.B.C.)c) Ethyl Iodoacetate ( K.S.K.)High concentration- irritation of respiratory passages, lungs, V,N

2. Vesicant of Blistering Gas - contact with skin cause bleb or blister formationa) Mustard gas ( Dichlordiethyl sulfide, yellow cross, Yperite)b) Lewisite ( Chlorovinyl-dichlorarsine)

3. Lung irritants ( Asphyxiant or choking gas)- Dysnea, tightness of the chest, coughing, coma , deatha) Chlorine ( Cl2) - yellowish green gasb) Phosgene (COCl2)c) Chloropicrind) Diphosgene

4. Sternutator - nasal irritants of vomiting gases

5. Paralysants –Nerve gas - like organophosphates

6. Blood poisons -CO, H2S, Hydrogen cyanide

DEATH OR PHYSICAL INJURIES DUE TOAUTOMOTIVE CRASH OR ACCIDENT

Factors responsible to an Automotive Crash

HUMAN FACTOR ( DRIVER)

1. Mental attitude: reckless driving, fatigue, inexperience2. Perceptive defect3. Delayed reaction time4. Disease5. Chemical factor

2. ENVIRONMENTAL FACTOR- Poor visibility, poorly maintained roads,

rain, blind intersection

3. MECHANICAL FACTOR: Poor brake, worn out tires

4. SOCIAL FACTOR: Speed, insurance

5. PEDESTRIAN

Injuries and Death on the Driver and Passengers:

1. First collision: the impact of the moving vehicle with another or fixed object

= The MOVING VEHICLE - rapidly decelerates and stops after impact.

= The degree of damage depends: a) speed b) part of vehicle involved

2. Second collision: Impact of unrestrained occupants with the vehicle interior= 1st Col., Occupants move same direction/velocity towards point of impacta) Front impact> Occupants move forward.b) Side impact ( severe) > moves to the side that was involved in the 1st Col.>The passenger nearest to it will suffer the most.c) Rear impact crash - Acceleration-deceleration injury or whiplashd) Roll over crash ( Turn turtle impact )

= If vehicle is not put into a stop after the 1st Col. > the unrestrained occupants will continue to strike to some parts of the vehicle interior.

Pedestrian-Vehicle Collision:

Death or Physical Injuries to pedestrian

1.Primary impact - Contact with vehicle2. Secondary impact - Subsequent impact of the pedestrian to the ground- Accounts for the multiple injuries3. Run over Injuries

medico-legal aspects of physical injuries - fin.pptx

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