legal-medicine

June 30, 2016 | Author: donedziel | Category: Types, Legal forms
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LEGAL MEDICINE : GENERAL CONSIDERATION CRISBERT I. CUALTEROS, M.D. http://crisbertcualteros.page.tl Legal Medicine – is a branch of medicine which deals with the application of medical knowledge to the purposes of law and in the administration of justice. Legal medicine

– Application of medicine to legal cases.

Forensic medicine – Application of medical science to elucidate legal problems. Medical jurisprudence – Knowledge of law in relation to the practice of medicine. SCOPE: Application of medical and paramedical sciences as demanded by law and administration of justice. NATURE OF THE STUDY OF LEGAL MED: - The ability to acquire facts, arrange them and draw a conclusion from facts in the administration of justice. Medical jurist, Medical examiner, Medicolegal officer, Medicolegal expert - A physician who specializes primarily with medico-legal duties. - Imhotep – 2980 B.C. earliest medico-legal expert.

DIFFERENCE : a) Injury/Disease point of view -

ORDINARY PHYSICIAN

MEDICO-LEGAL OFFICER

Treatment

Cause

b) Examine a patient

Diagnose

Testify / justice

c) Minor injuries

Ignored

Records all / qualify crime 1

PRINCIPLE OF STARE DECISIS: - When the court has once laid an interpretation of law as applied to certain facts, it will adhere to and apply to all future cases where the facts are substantially the same. BASIC PRINCIPLES GOVERNING APPLICATION AND EFFECTS OF LAWS: 1. “Ignorantia legis nominem excusat “ – prevent use as defense in violation 2. Law shall have no retro-active effect. 3. Rights may be waived, unless the waiver is contrary to law, public order, public policy, morals or good customs, or prejudiced to a third person with a right recognized by law. 4. Customs which are contrary to law, public order or public policy shall not be countenanced. 5. Laws are repealed by subsequent ones, and their violation or non-observance shall not be excused by dis-use, custom or practice to the contrary. Persons authorized to perform autopsies: 1. Health Officers 2. Medical officer of law enforcement agencies. 3. Members of the medical staff of accredited hospitals. Autopsies shall be performed in the following cases. 1. Required by special laws 2. Order of competent court, mayor, fiscal 3. Written request of police officers 4. SolGen, fiscal disinter to determine cause of death. 5. Written request of nearest kin to ascertain cause of death. MEDICAL EVIDENCE - is the means sanctioned by the rules of court of ascertaining in a judicial proceeding the truth respecting a matter of fact. Types of evidence: 1. Autoptic or Real evidence – made known to the senses 2. Testimonial evidence – oral under oath 3. Experimental evidence 4. Documentary evidence

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Methods of preserving evidence: 1. Photo, videotape,photocopy 4.Manikin method 2. Sketching 5.In the mind of the witness 3.Description 6. Special methods: embalming

DECEPTION AND DETECTION Knowledge of truth is important in the administration of justice, lies solely in the ability to evaluate the statement given by the suspect or witness. Methods of deception detection: 1. Devices which record the psycho-physiological response: a) Use of a polygraph or lie detector machine b) Word association test c) Psychological stress evaluator 2. Use of drugs that try to “ inhibit the inhibitor” a) Administration of the truth serum b) Narcoanalysis or Narcosynthesis c) Intoxication 3. Hypnotism 4. By observation 5. Scientific interrogation 6. Confession I.

RECORDING OF PSYCHO-PHYSIOLOGICAL RESPONSE

Nervous control – CNS/ANS

Sym/ParaS

Sympathetic – influenced by physical and emotional stimuli, effects Parasympathetic – works to restore things A. Use of a Lie Detector or Polygraph = The fear of the subject when not telling the truth activates the symp. = To a series of automatic and involuntary physiological changes which are recorded by the instrument.

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= Use of control questions > Most reliable & effective questioning technique. = Supplemetary tests: a. Peak of tension test - peak of tension on relevant questions b. Guilt complex test - does not response to added relevant quest. c. Silent answer test - subject verbal response creates distortion in the tracing or clearing of the throat. Reason for admissibility to the court of the result of Polygraph exam : 1. Have not received the degree of standardization of acceptance. 2. Trier of fact is apt to give almost conclusive weight to the experts opinion 3. No way to assure the a qualified examiner administered the test. 4. May waive right against self-incrimination. 5. It has many errors. Factors responsible to 25% errors: 1. Nervousness experienced by a subject who is telling the truth - apprehension by the fact that he is a suspect. - over-anxiety to cooperate 2. Physiological abnormalities > BP inc. or dec., Cardiac prob. 3. Mental abnormalities 4. Unreponsiveness in a guilty subject – no fear of detection 5. Attempt to beat the machine Can a person be compelled? No, use of intelligence and other faculties. B. Word association test: -Time interval between the words uttered by the examiner and the answer of the subject is recorded. C. Psychological Stress Evaluator - when a person is under stress/lying, the microtremor in the voice utterance is moderately or completely suppressed. - degree of suppression varies inversely to degree of psychological stress . II.

USE OF DRUGS THAT INHIBIT THE INHIBITOR - Not admissible in court

A. Administration of truth serum - Hyocine hydrobromide given hypodermically until state of delirium which the subject feels a compulsion to answer the question truthfully. B. Narcoanalysis or Narcosynthesis

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- Sodium amytal or sodium penthotal C. Intoxication with alcohol - In wine there is truth III.

HYPNOSIS - alteration of consciousness, not all subjects can be hypnotized

IV.

OBSERVATION Physiological and psychological signs and symptoms of guilt: a) Sweating, color change b) Dryness of the mouth c) Excessive activity of adams apple d) Fidgetting e) Peculiar feeling inside f) Swearing, spotless past record g) Inability to look at the investigator

V.

INTERROGATION - emotional appeal, mutt and jeff technique

VI.

CONFESSION - expressed acknowledgement of his guilt.

TOKYO DECLARATION - contains guidelines to be observed by physician concerning torture, inhuman and degrading punishment.

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MEDICO-LEGAL ASPECTS OF IDENTIFICATION - determination of the individuality of a person Importance of identifying a person: 1. In the prosecution of a crime, the identity of the offender and victim. 2. Settlement of estates, retirement, insurance 3. Resolves anxiety of nest of kin. 4. In some transactions – sales, release of dead body Rules in personal identification: 1. Law of multiplicity of evidence in identification – greater number of similarities 2. Value of different points of identification – fingerprints , moles Visual recognition of relatives –lesser value than fingerprints/dental 3.The longer interval between death the more experts are needed in establishing the identity. 4.The team to act in shortest time because it is perishable. 5. No rigid rule in the procedure of identification of the person. Methods of identification: 1. By comparison – Id found in the crime scene compared with the file. 2. By exclusion IDENTIFICATION OF PERSONS A. Ordinary methods of identification 1. Characteristics which may easily be changed: a) growth of hair, beard d) grade of profession b) clothing e) body ornamentations c) frequent place of visit 2. Characteristics that may not be easily be changed: a) mental memory f) hands and feet b) speech g) complexion c) gait h) changes in the eyes

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d) mannerism e) handedness-left /right

i) facies j) degree of nutrition

Points of identification applicable to both living and dead before onset of Decomposition: 1. 2. 3. 4. 5. 6. 7.

Occupational marks – painters have stains Race: Malay:brown, flat nose round face, Round head, Wearing apparel Stature: Tips of middle fingers of both hands extended laterally Tatoo marks Weight – not good point – changes from time to time Deformities, injuries leaving permanent deformities Birth marks moles, scar

Age of Scar: Recently formed: Slightly elevated, reddish/bluish, tender to touch Few week-2 months: Inflammatory redness, soft, sensitive 2 – 6 months: brownish, free from contraction, soft > 6 months: white, glistening, contracted, tough Scar formation is delayed by: sepsis, age, depth of wound, mobility May not develop – mall, superficial, healed by first intention. 8. Tribal marks, Sexual organs, blood exam ANTHROPOMETRY ( BERTILLON SYSTEM) Alphonse Bertillon - utilizes anthropometrical measurement of the human body for identification. Basis: 1. Human skeleton is unchangeable after 20 years. 2. No two human beings have exactly the same bones. 3. Use of simple instrument Information: 1. Descriptive data – color of hair, eyes, shape of nose… 2. Body marks 3. Anthropometric measurement – height 4. Measurement of the head, limbs Portait Parle ( spoken picture) – picturesque description of a person

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Extrinsic factors in identification: 1. ornamentation 2. personal belongings 3. wearing apparel 4. foreign bodies 5. identification by close friends, police records, photographs Light as a factor in identification: 1. Clearest moonlight = Less than 16-17 yards Starlight = Less than10-13 yards 2. Broad daylight = Not farther than 100 yards not seen before Almost strangers =recognized at 25 yards 3. Flash of firearm = 2 inches letters can be read with the aid of the flash of 22 caliber at a distance of 2 feet. 4. Flash of lightning – sufficient light to identify 5. Artificial light – relative to the intensity of light B. Scientific methods of identification 1. Fingerprinting 2. Dental identification 3. handwriting 4. Identification of skeleton 5. Determination of Sex, Age 6. Identification of blood, blood stains 7. Identification of hair, fibers 1. FINGERPRINTING = most valuable method of identification. a) No two identical fingerprints 1 : 64,000, 000, 000 b) Not changeable - 4th month formed in the fetus = Practical uses a) Identity of dead bodies b) Prints recovered at crime scene c) Prints on file for comparison d) Right thumb print is substitute for signature = DACTYLOGRAPHY : art and study of recording fingerprints as means of id. = DACTYLOSCOPY: art of id by comparison of fingerprints = POROSCOPY : study of pores found on the pappillary friction ridges of skin Fingerprints can’t be effaced: =as long as the dermis of the bulbs of the finger is not completely destroyed.

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2. DENTAL IDENTIFICATION = possibility of 2 persons to have the same is remote = enamel is the hardest substance of the body, outlast other tissues in putrifaction 3. HANDWRITING = BIBLIOTIC : Science of handwriting analysis = GRAPHOLOGY : study of handwriting for the purpose of determining the writers personality, character and aptitude. 4. IDENTIFICATION OF THE SKELETON human – shape, size, general nature single individual – plurality or excess of bones Height – add 1 to 1 ½ in. for the soft tissues Pearson’s formula – for the reconstruction of the living stature of long bones Topinard and Rollet = two French anatomist devised a formula for the determination of the height fro males and females. Humphrey’s table = Table of different height of bones for different ages and their corresponding statures. Manouvrier – made the following co-efficient for the determination of height. Determination of sex of the skeleton: a) Pelvis d) Femur b) Skull e) Humerus c) Sternum Difference between

Male

PELVIS

Female

1) Construction Wall

Heavier More pronounced

Lighter Less pronounced

2) Height 3) Pubic arch 4) Diameter of the true pelvis

Greater Narrow & less round

Lesser Wider/rounder

Less

Greater

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5) Curve of iliac crest 6) Greater Sciatic notch 7) Body of pubis 8) Iliopectineal line 9) Obturator foramen 10) Sacrum CRANIUM

Reaches higher level Narrow Narrow Sharp Egg-shaped Short and narrow MALE

Lower level Wide Wider Rounded triangular Long and wide FEMALE

1) Shaft less curve more curve 2) Mastoid process larger smaller 3) cranium placed horizontally mastoid process occipital& maxillary bones rest on 4) Styloid process shorter longer/slender 5).Forehead higher, more oblique less high, more vertical 6) Superciliary ridges less sharp, more rounded sharper 7) Zygomatic arches more prominent less prominent 8) Lower jaw larger & wider narrower and lighter 9) Face larger in proportion to cranium smaller Determination of the duration of interment: - All soft tissues in a grave disappear within one year. Basis of the estimate fro duration of interment: 1) Presence or absence of soft tissue adherent to the bones. 2) Firmness and weight, brittleness, dryness of the bones. 3) Degree of erosion of the surface of the bones. 4) Changes in the clothings, coffin, and painting. 5. IDENTIFICATION OF SEX Test to determine the sex: 1. Social test 2. Genital test 3. Gonadal test 4. Chromosomal test – barr cells in females Evidences of sex: 1. Presumptive evidence = General features, hair in some parts = Transvestism – sexual deviation by desire to assume the attire and be accepted as a member of the opposite sex.

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2. Highly probabale = vagina, large breast 3. Conclusive evidence = ovary in females 6. DETERMINATION OF AGE Legal importance a) Aid to identification b) Determination of criminal liability c) Determination of right of suffrage d) Determination whether a person can exercise civil rights e) Determination of the capacity to marriage f) Requisite to certain crimes Determination of age of fetus: Hess’s rule or Haase’s rule a) Fetus of less than 25 cm long- get square root of length in cm, result in months b) > 25 cm- divide the length of the fetus by 5 and the result is the age in month. 7. IDENTIFICATION OF BLOOD AND BLOOD STAINS Legal importance: a) Disputed parentage b) Circumstantial evidence against perpetrator of a crime c) Determination of the cause of death d) Determination of the direction of the escape e) Determination of the appropriate time crime was committed f) Determination of the place of the crime g) Determination of the presence of certain diseases. Physical examination a) Solubility test b) Heat test c) Luminescence test: 3 amino-phtalic-acid-hydrazide-HCL, Sodium peroxide , distilled water > Bluish-white in a dark room Chemical examination: a) Saline extract of the blood plus ammonia – brownish > alkaline hematin b) Benzidine test – blue color in white filter paper c) Guaiacum test ( Van Deen’s Dyas or Schombein’s test) - blue

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d) Phenolpthalein test ( Kastle-Meyer test) - pink e) Leucomalachite Green test

Microscopic examination - saline extract of stain Micro-chemical tests: 1. Hemochromogen crystal or Takayama test: 2. Teichmann’s blood crystals or Hemin crystal test= Sodium chloride – dark brown rhombic prisms of chloride, hematin formed = best of the micro-chemical test. 3. Acetone-haemin or Wagenhaar test Spectrospcopic examination - blood pigments have the power to absorb light of certain length and produce the characteristic absorption bands on the spectrum. = Fresh blood – oxyhgb, Hgb, reduced hematin = olders stains – methemoglobin, alkaline hematin Biologic examinations 1. Precipitin test – blood is human or not 2. Blood grouping Age of blood stains: Hgb converted to Methgb of hematin red to red-brown = warm weather- within 24 hours

8. IDENTIFICATION OF HAIR AND FIBERS Differences between hair forcibly extracted and naturally shed hair: - bulb is irregular , undulating surface, excrescence of diff, size and shape HAIR Medulla 1. Air network 2. Cells 3.

HUMAN In fine grains Invisible w/out tx in H2O Fuzz w/out medulla

ANIMAL large or small sacks Easily visible Fuzz w/ medulla

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Cortex 1. 2.

Looks like a thick muff Pigments in the form of fine grains

Cuticle 1.

thin scales

Fairy thin hollow cylinder irregular grains thick scale

MEDICO-LEGAL ASPECTS OF DEATH Importance of Death determination: 1, The civil personality of a natural person is extinguished by death. 2.The property of a person is transmitted to his heirs at the time of death. 3. The death of a partner is one of the causes of dissolution of partnership agreement. 4. The death of either the principal or agent is a mode of extinguishment of agency. 5. The criminal liability is extinguish by death. 6. The civil case fro claims which does not survive is dismissed upon death of the defendant. Death – is the termination of life. Kinds of death: 1. Somatic or clinical death – persistence of vital functions 2. Molecular or cellular death – 3 to six hours after cessation of life 3. Apparent death or State of suspended animation – transient loss of consciousness in hysteria, uremia, electric shock Signs of death: 1. Cessation of heart action and circulation., Usually the auricle contract after somatic death fro a longer period than the ventricle, last to stop so called ULTIMEN MARIENS. Methods of detecting the cessation of heart action and circulation: a) Examination of the heart- pulse, aucultation, flouro, ECG b) Examination of peripheral circulation = Magnus test – application of ligature around the base of the finger - bloodless area at site of application - dead man – no change = Opening of small artery- spurting

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= Icards test – injection of flourescein SQ - greenish yellow discoloration in the whole skin - dead man only in the area of injection = Pressure on fingernails = Diaphanous test – fingers are spread wide through a strong light- Red = Application of heat on the skin - blister = Palpation of Radial pulse = Dropping of melted wax 2. Cessation of respiration – more than 3 ½ minutes Methods of detecting cessation of respiration: a) Observance of movement of chest and abdomen b) With the aid of stet. c) Examination with a mirror d) Examination with a feather or cotton fibers e) Examination with a glass of water f) Winslow’s test – no movement in the image formed by reflecting artificial light on the water in a saucer and placed in the chest if respiration is taking place. 3. Cooling of the body ( ALGOR MORTIS) - After death the metabolic process inside the body ceases. - The progressive fall of the body temp. is one of the most prominent signs. - First two hours after death the cooling is rapid. - Fall of temp. of 15 to 20 degrees Fahrenheit is considered as a certain sign of death. POST-MORTEM CALORICITY – is the rise of temp. of the body after death due to rapid and early putrefactive changes. Usually in the first 2 hours. = seen in cholera, liver abscess, tetanus, RF,Strynine poisoning, Peritonitis A.

Conditions connected with the body:

Factors delaying the rate of cooling of the body: 1. Acute pyrexial disease 2. Sudden death in good health 3. Obesity of person 4. Death from asphyxia 5. Death of the middle age Factors accelerating cooling: 1. Leaness of the body 2. Extreme age 3. Long-standing illness 4. Chronic pyrexial disease with wasting

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B. Conditions that are connected with the surroundings Factors delaying cooling: 1. Clothings 2. Want of access of air to the body 3. Small room 4. Warm surroundings Factors accelerating cooling: 1. Unclothed body 2. Conditions allowing the access of air 3. Large room permitting the dissipation of heat 4. Cooling more rapid in water than in air Methods of estimating how long a person has been dead from the cooling of the body: 1. If body temp. is normal at the time of death: = the average rate of fall of the temp. during the first 2 ½ hours is ½ of the difference of the body temperature and that of the air. = the body attains the temp. of the surrounding air from 12 to 15 hours after death in tropical countries. 2. Chemical Method ( Schourup’s formula for the determination of the time of death of any cadaver whose CSF is examined for the concentrations of L.A., NPN, A.A. = L.A> 15 mg to 200 mg/100cc rapid in 1st 5 hours. = NPN inc. from 15 to 40 mg/100 cc in 1st 15 hours = A.A. inc. from 1 mg to 12 mg% 1st 15 hours. 4. INSENSIBILITY OF THE BODY AND LOSS OF POWER TO MOVE = may be seen in the living with- apoplexy, epilepsy , trance, catalepsy, hysteria 5. CHANGES IN THE SKIN – opacity, flattening, loss of elasticity 6. CHANGES IN AND ABOUT THE EYE a) Loss of corneal reflex – seen I n live pts: G.A., uremia, narcotic poisoning b) Clouding of cornea c) Flaccidity of the eyeball d) Pupil in the position of rest. e) TACHE NOIR DE LA SCLEROTIQUE – spot found in the sclera after death. 7. ACTION OF HEAT ON THE SKIN

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= Heat applied while alive – produced blister with serum and redness around the area. = Following combinations of signs show death has occurred: a) Loss of animal heat to a point not compatible with life b) Absence of response of muscle stimulus c) Onset of rigor mortis. CHANGES IN THE BODY FOLLOWING DEATH 1. CHANGES IN THE MUSCLE – complete relaxation of the whole muscular system. Three Stages After Death: a) Stage of primary flaccidity ( POST-MORTEM IRRITABILITY) = muscle relax, may contract, dilated pupil, sphincters are relaxed = presence of molecular life = warm place: 1 hour and 51 minutes = chemical reaction of muscle is alkaline b) Stage of post-mortem rigidity ( CADAVERIC RIGIDITY , DEATH STRUGGLE OF MUSCLES OR RIGOR MORTIS) = whole body is rigid due to contraction of the muscles = starts at muscle of neck, lower jaw = Reaction is acidic due to inc. of lactic acid = develops 3 to 6 hours after death in temperate, earlier in warm = last from 2 to 3 days in temperate, warm: 24-48H cold weather 18-36H summer c) Stage of Secondary flaccidity or Commencement of putrefaction ( DECAY OF MUSCLES) = muscle are flaccid, not respond to stimuli, reaction is alkaline = due to dissolution of muscle proteins FACTORS INFLUENCING THE TIME OF ONSET OF RIGOR MORTIS (1) Internal Factors a) State of the muscles = healthy – appears late = Onset is hastened in: a.1 hunted animal a.2 prolonged convulsion/lingering illness a.3 death from- TY, Cholera, Phthisis, typhus b) Age = early onset – aged and newborn = delayed – good health, good muscular development

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c) Integrity of nerves = section of the nerve will delay onset, paralyzed muscle

(2) External factors a) Temperature = Hastened by high temperature = > 75 degrees will produce heat stiffening b) Moisture = rapidly but with short duration in moist air Conditions simulating RIGOR MORTIS: 1. Heat stiffening - > 75 degrees coagulates muscle proteins resulting to rigidity. = “ Pugilistic attitude” flexed upper and lower limb = hands clenched, flexor stronger than extensors, burned to death 2. Cold stiffening = due to solidification of fats when exposed to cold temp. 3. Cadaveric spasm or Instantaneous Rigor = instantaneous rigidity due to extreme nervous tension, exhaustion, injury to the nervous system. = weapon in hand, weeds RIGOR MORTIS 1. Time of appearance 3-6H after death 2. Muscles involved All muscles 3. Occurrence Natural phenomena 4. Medico-legal signif. Approximates time of death 1. Contracted muscle 2. Elasticity 3. Litmus reaction 4. Contraction

RIGOR MORTIS Losses transparency Loss elasticity Acidic Absolute flaccidity

CADAVERIC SPASM Immediately after death Certain group May or may not appear Determine nature of death MUSCLE CONTRACTION More or less transparent Very elastic Neutral or sl. alkaline Possess inherent contraction

2. CHANGES IN THE BLOOD a) Coagulation of blood = blood may remains fluid inside the blood vessels 6-8H after death. ANTE-MORTEM CLOT

POST-MORTEM CLOT

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1. Consistency 2. Surface of blood vessels 3. Clots

Firm Soft Raw after clots are removed Smooth, health after Homogenous Can be stripped can’t be stripped off in layers

b) Post-mortem Lividity or Cadaveric Lividity , or Post-mortem Suggilation or Post-mortem Hypostasis or Livor Mortis = Stoppage of heart action and loss of tone of b.v. accumulates in dependent areas except in bony areas. = capillaries coalesce > purplish in color called Post-mortem lividity. = Hasten by death due to cholera, uremia, Typhus fever = appears 3 – 6 H after death and fully developed 12 H after death. Physical characteristics of Post-mortem Cadaveric Lividity 1. Occurs in the most dependent areas. 2. Involves the superficial layer of the skin 3. Does not appear elevated from the rest of the skin. 4. Color is uniform. 5. No injury of the skin Kinds of Post-mortem Cadaveric Lividity 1. Hypostatic lividity 2. Diffusion lividity Importance of Cadaveric lividity: 1. One of the signs of death. 2. Determines the position of the body has been changed after it’s appearance in the body. 3. Color of lividity may indicate the cause of death. a) asphyxia – lividity is dark b) CO poisoning – pink c) Hemorrhage – less marked d) Hydrocyanic acid – bright red e) Phosphorus – dark brown f) Potassium chlorate – coffee brown 4. Determines how long the person has been dead 5. Gives us an idea as to the time of death. Points to be considered which may infer the position of the body at the time of death: 1. Posture of the body when found.

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2. Post-mortem hypostasis or lividity 3. Cadaveric spasm

CONTUSSION (BRUISE)

POST-MORTEM HYPOSTASIS

1. Small bruises – Below epidermis in true skin larger ones - below this

In the epidermis or cutis

2. Cuticle

Unabraded

Abraded by the same violence that produce the bruise.

3. Bruise

Appears at the seat or surrounding Always dependent may or may not be dependent

4.

Elevated, inflammatory condition CONTUSSION (BRUISE)

Not elevated, blood in b.v. POST-MORTEM HYPOSTASIS

5. Incision shows blood outside the b.v. = most certain test of difference

Blood inside the vessels

6.

Uniform color

Color variegated

Internal hypostasis in Visceral organs: 1. Lungs 2. Loops of intestine 3. Brain POST-MORTEM LIVIDITY OF ORGANS 1. Post-mortem staining in organs Irregular, most dependent parts 2. Mucous membrane Dull,lusterless 3. Inflammatory exudate Not seen

SIMPLE CONGESTION Uniform, all organs Not in congestion Not seen

Other changes in the blood 1. Hydrogen ion concentration – acid pH CO2, L.A., After 24H alkaline ammonia.

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2. Breakdown of liver glycogen leads to accumulation of dextrose in the IVC and the right side of the heart. 3. Rise in NPN and Free A.A. 4. Chemical: = chloride in the plasma/RBC decrease due to extravascular diffusion, in 72 H only ½ of its content. = Mg – increases due to diffusion from without. = K – increases due to diffusion from the vascular endothelium. 3. AUTOLYTIC OR AUTODIGESTIVE CHANGES AFTER DEATH - After death, proteolytic, glycolytic and lipolytic ferments of the glandular tissues continue to act which lead to the autodigestion of organs. 4. PUTREFACTION OF THEBODY - Is the breaking down of complex proteins into simpler components associated with the evolution of foul smelling gasses and accompanied by the change of color of the body.

Tissue changes in putrefaction: 1. Changes in the color of the tissue Hemolysis of blood within blood vessels > Hgb diffuses through the walls Reddish-brown in color In the tissues > Hgb undergo chemical change Greenish-yellow 1st seen at R Iliac fossa MARBOLIZATION – prominence of the superficial veins with reddish discoloration which develops on both flanks of the abdomen, neck, and shoulder = look like “marbled” reticule of branching veins. 2. Evolution of gasses in the tissues CO2, ammonia, H2, Suphurated hydrogen, methane.= offensive odor Effects of pressure of gasses of putrefaction: a) displacement of the blood – bleeding in open wounds b) bloating of the body c) fluid coming out from nostrils, mouth d) extrusion of the fetus in a gravid uterus e) floating of the body

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3. Liquefaction of the soft tissues Putrefy rapidly : Eyeball, lining of trachea, larynx , brain, stomach, intestine, liver, spleen Putrefy late : Highly muscular organs and tissues, Esophagus, diaphragm, heart, lungs, kidneys, U.B., uterus, P.G.

Factors modifying the RATE of putrefaction: 1. INTERNAL FACTORS a) age : healthy adults, NB not yet fed, later than infants b) condition of body : full grown/obese – rapid , Stillborn- late c) cause of death : infection - rapid 2. EXTERNAL FACTORS a) Free air a.1 air : free air hastens decomposition a.2 moderate moisture - accelerates a.3 loaded with septic bacteria – early aerobes, later anaerobic - Clostridium welchii= decomposition b) Earth b.1 dry absorbent soil - retards b.2 moist fertile soil - accelerates c) Running water- more rapid than still water d) Clothings – early it hastens but delays in the later stage. - tight clothings - delay Factors influencing the changes in the body after burial: 1. state of the body before death – thin slower, mummify 2. time elapsed between death and burial and environment of the body 3. effect of coffin – later 4. clothings and other coverings on the body when buried – pressure, insects 5. depth at which the body was buried - greater the later 6. condition and type of soil 7. inclusion of something in the grave which will hasten decomposition-food 8. access of air to the body after burial 9. mass grave – rapid 10. trauma to the body – violent death - slow CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN TEMPERATE REGIONS

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1-3 DAYS AFTER DEATH 3-5 DAYS 8-10 DAYS 14-20 DAYS 2-5 MONTHS

- greenish discoloration over iliac fossa, soft eyeballs - frothy blood from mouth, nostrils - abdominal distention, nails firm - blisters all over the body, maggots - skull exposed, orbits empty

IN TROPICAL REGION 12 HOURS 24 HOURS 48 H 72 H ONE WEEK TWO WEEKS ONE MONTH

Rigor mortis all over, hypostasis, greenish-discoloration caecum Rigor mortis absent all over, abdominal distention Ova of flies, trunk bloated, face discolored Whole body grossly swollen, hairs and nails loose Soft viscera putrefied Soft tissues largely gone Body skeletonized

BEEN SUBMERGED IN WATER FIRST 4 OR 5 DAYS FROM 5 – 7 DAYS 1 – 2 WEEKS 4 WEEKS 6 – 8 WEEKS

Cold water little change, in rigor mortis Skin on hands, feet is bleached, face faded white Face swollen and red, skin of hands and feet wrinkled Skin wrinkled, nail intact Abdomen distended, skin of hands/ feet come off with nails

Factors influencing the floating of the body in water: 1. age – fully developed, well nourished - rapid 2. sex – females floats sooner 3. conditions of the body – obese float quicker 4. season of the year – moist hot air – putrefaction – floats due to gas 5. water- shallow and stagnant water of creeks, higher specific gravity - sea water floats sooner than fresh water, higher specific gravity 6. external influence – heavy-wearing apparel - slower Only teeth, bones and hair remain for an indefinite time. Flat bones disintegrates faster than round bones. SPECIAL MODIFICATION OF PUTREFACTION 1. Mummification = is the dehydration of the whole body which results in the shivering and preservation of the body. = usually occurs when buries in a hot, dry with free access of hot air 2. Saponification or Adipocere fromation = a condition where the fatty tissues of the body are transformed to soft brownish-white substance known as ADIPOCERE at SQ level.

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3. Maceration = softening of the tissues when in fluid medium in the absence of putrefactive mircro-org, seen in death in utero – reddish or greenish color, skin peeling off and arms flaccid and frail. HOW LONG A PERSON HAS BEEN DEAD? DURATION OF DEATH 1. Presence of rigor mortis : 2-3 hours after death 12 H fully developed 18-36 H disappears concomitant with putrefaction 2. Presnce of Post-mortem lividity 3-6 H after death appears as small petechia-like red spots 3. Onset of decomposition 24-48 H after death manifested watery. foul smelling froth, mouth, nostrils 4. Stage of decomposition 5. Entomology of the cadaver – 24 H before eggs are hatched, maggots 6. Stage of digestion

- 3-4 H gastric empty 6-8 distal ileum, cecum 7. Presence of live flies in the clothing in the drowning victim – less than 24H 8. State of clothings - pajama , night 9. Changes in CSF 10. Blood clots inside the b.v. in 6 –8 H after death. 11. Soft tissues of the body may disappear 1 to 2 years after burial. Post-mortem conditions simulating disease, poisoning or injury: 1. post mortem hypostasis – contusion, inflammation , poisoning 2. blisters of the cuticle – scald and burns 3. swelling, detachment or splitting - injury PRESUMPTION OF DEATH Disputable presumption - not heard in 7 years Presumption of death Absence of 7 years except succession 10 years Vessel for 4 years Armed forces 4 years In danger of death 4 years

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PRESUMPTION OF SURVIVORSHIP 1. under 15 y.o. – older survives 2. above 60 y.o.- younger 3. under 15, above 60 - former 4. over 15 and under 60 y.o. – male, older 5. under 15, or over 60 y.o. and the other in between - latter

MEDICO-LEGAL INVESTIGATION OF DEATH Inquest Officer – is an official of the state charged with the duty of inquiring into certain matters. - in medico-legal examination: manner and cause of death The following officials of the government are authorized to make death investigations: 1. Provincial and City Prosecutors 2. Judges of the RTC, MTC 3. Director of NBI 4. SolGen Stages of MEDICO-LEGAL INVESTIGATION: 1.Crime Scene Investigation – investigation of place of commission of the crime 2.Autopsy - investigation of the body of the victim 1. Crime Scene Investigation - place where the essential ingredients of the crime took place. - Person composed the Search Team: a) Physician MLI trained b) Photographer c) Assistant, evidence collector, note taker 2. Autopsy - comprehensive study of a dead body, in addition to the external examination . Post-mortem examination- external exam without incision being made. Purpose of autopsy: 1. Determine cause of death 2. Correlate clinical diagnosis and symptoms 3. Determine effectiveness of treatment 4. Study the natural course of the disease 5. Educate students and physicians MEDICO-LEGAL OR OFFICIAL AUTOPSY:

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1. 2. 3. 4. 5.

Determine cause, manner, time of death Recovering, identifying, preserving evidentiary material Provide interpretation and correlation of facts related to death Provide factual, objective medical report Separating death due to disease from external causes.

Dead body belongs to the state for cases that requires medico-legal autopsy. PATHOLOGICAL AUTOPSY 1. Requirement 2. Confirmation 3. Emphasis 4. Conclusion 5. Minor

MEDICO-LEGAL AUTOPSY

Consent of next of kin Clinical findings of research

Law that gives the consent Correlate tissue changes to criminal act Notation at all abnormal findings Effect of wrongful act Summation of all abnormal findings Specific to the purpose Need not be mentioned Included if useful

The following manner of death should be autopsied: 1. Death by violence 2. Accidental deaths 3. Suicides 4. Sudden death of persons who are in good health 5. Death unattended by physician 6. D.O.A. with no clinical diagnosis 7. Death occurring in an unnatural manner Mistakes in autopsy: 1. Error or omission in the collection of evidence for identification 2. Errors or omission in the collection of evidence required fro establishing the time of death 3. Errors or omission in the collection of evidence required fro the medicolegal examination. 4. Errors or omission result in the production of undesirable artifacts or in the destruction of valid evidence. Negative autopsies - if after all efforts including gross and microscopic studies and toxicological analysis fail to reveal a cause of death. Negligent autopsy No cause of death is found due to imprudence, negligence, lack of skill, lack of foresight.

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CAUSES OF DEATH Primary purpose of a medico-legal autopsy: Determination of the cause of death. Death is the direct and the proximate consequence of the criminal or negligent act.

Defense wounds on the victim: Qualify the crime to homicide. Series of cuts in the borders of the wound: Multiple trust- intent to kill. Cause of death: is the injury or disease or both which initiates the physiological disturbance resulting to a fatal termination. 1. Immediate or Primary cause of death – when injury or disease kills quickly the victim and no opportunity for complications to develop. Ex: extensive brain injury 2. Proximate cause or Secondary cause - the injury or disease was survived for a longer period Mechanism of death: is the physiologic derangement or biochemical disturbance incompatible with life which is initiated by the cause of death. Ex: Hemorrhagic shock, pulmonary depression, cardiac arrest, tamponade metabolic problem. Manner of death: is the explanation as to how the cause of death arose. 1. Natural death – fatality is cause solely by disease. Ex: pneumonia, cancer 2.Violent or unnatural death – due to injury Medico-legal masquerade- violent deaths may be accompanied by minimal or no external evidence of injury or natural death where signs of violence may be present. Degree of Certainty to the cause of death: 1. Structural abnormalities established beyond doubt the cause of death. Ex. SW with H. 2. Degree of probability amounting to the cause of death. Ex: Electrical shock 3. History establishes cause of death and confirmed by anatomic or chemical 26

findings. 4. When neither history, laboratory and anatomic findings, taken individually or in combination is sufficient to determine the cause of death but merely speculate as to the cause of death. Ex. Crib death among infants.

Steps in the Intellectual Process in the determination of the cause of death: 1. Recognition of the structural organic changes or chemical abnormalities responsible for the cessation of vital functions. 2. Understanding and exposition of the mechanism by which the anatomic and other deviations from normal caused the death. Instantaneous physiologic death or Death from inhibition, death from primary shock, Syncope with instantaneous exitus. - This is sudden death which is cause within seconds or minute or two after a minor trauma or peripheral stimulation of relatively simple nature. - The peripheral stimulation initiates the cardio-vascular inhibitory reflex. Ex: Vagocardiac slowing or stoppage of the heart. Blow to the larynx, solar plexus, scrotum, pressure to the carotid sinus. Diseases with no specific findings of a disease: 1. Sudden infant death syndrome (SIDS) or crib death 2. Sudden unexplained nocturnal death (SUND) DOA – means actually dead or dying, provided the physician had not been given ample opportunity to arrive at a working diagnosis as to the cause of death. Undetermined - if the physician cannot determine the cause of death. MEDICO-LEGAL CLASSIFICATION OF THE CAUSES OF DEATH a. Natural death – cause by natural disease condition in the body. b. Violent death 1. Accidental death 2. Negligent death 3. Infanticidal death 4. Parricidal death 5. Murder

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6. Homicidal death If signs of violence are associated with the natural cause of death: * Did the person die of a natural cause and were the physical injuries inflicted immediately after death? - violence applied in a dead person : Impossible crime.

* Was the victim suffering from a natural disease and the violence only accelerate the death? = Offender responsible of the death of the victim. = Criminal liability shall be incurred by any person committing a felony although the wrongful act done be different from which he intended. (Art.4 no.1 RPC) * Did the victim die of a natural cause independent of the violence inflicted? - accused will not be responsible for the death but merely for the physical injuries he had inflicted. Ex. Slapping a person with heart problem, only slight physical injury. - to make the offender liable for the death of the victim, it must be proven that the death is the natural consequence of the physical injuries inflicted. The following are deaths due to natural causes: 1. Affection of the CNS a. Cerebral apoplexy – sudden loss of consciousness followed by paralysis or death due to Hemorrhage from thrombosis or embolism in the cerebral vessels. b. Abscess of the brain c. Meningitis of the fulminant type 2. Affection of the circulatory system a. Occlusion of the coronary vessels : =most common cause of Sudden death due to natural causes. b. Fatty or myocardial degeneration of the heart. c. Rupture of the aneurysm of the aorta d. Valvular heart disease e. Rupture of the heart 3. Affections of the Respiratory system a. Acute edema of the larynx b. Tumor of the larynx c. Diptheria

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d. e. f. g.

Edema of the lungs Pulmonary embolism Lobar pneumonia Pulmonary hemorrhage

4. Affections of the GIT a. Ruptured PUD b. Acute intestinal obstruction 5. Affections of the GUT a. Acute strangulated hernia b. Ruptured tubal pregnancy c. Ovarian cyst with twisted pedicle 6. Affection of the glands a. Status thymico-lymphaticus b. Acute hemorrhagic pancreatitis 7. Sudden death in young children a. Bronchitis b. Congestions of the lungs c. Acute broncho-pneumonia d. Acute gastroenteritis e. Convulsion f. Spasm of the larynx B. Violent death - are due to injuries inflicted in the body by some forms of outside force. The physical injury must be the proximate cause of death. = That the victim at the time the physical injuries were inflicted was in normal health. = That the death may be expected from the physical injuries inflicted. = That the death ensued within a reasonable time.

CLASSIFICATION OF TRAUMA OR INJURIES 1. 2. 3. 4. 5. 6. 7.

Physical injury – trauma sustained through the use of physical force. Thermal injury – injury by heat or cold Electrical injury – electrical energy. Atmospheric injury – due to change of atmospheric pressure. Chemical injury – chemicals Radiation injury – radiation Infection – microbic invasion

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PENAL CLASSIFICATION OF VIOLENT DEATHS 1. Accidental deaths – due to misadventure or accident. Art. 12 no. 4 RPC Any person who while performing a lawful act with due care, causes an injury by mere accident without fault or intention of causing it. Ex. Patient died of ATS injection after proper skin test. 2. Negligent death – felonies may be committed when the wrongful act is due to reckless imprudence, negligence, lack of skill or foresight. Ex. Surgeon left a pack – Homicide through reckless imprudence 3. Suicidal death , destruction of one’s self - not punished, unfortunate being. - Art 253 RPC Giving assistance to suicide. Punishable because he has no right to destroy or assist in the destruction of life of another. 4. Parricidal deaths Art. 246 father, mother, child, (leg/illeg) ascendant, descendant, spouse (leg.) 5. Infanticidal deaths – Art. 255 killing of a child less than 3 days 6. Murder Art. 248 - treachery, consideration, means of inundation, occasion of calamities, - evident pre-meditation, cruelty 7. Homicidal deaths Art 249 DEATHS UNDER SPECIAL CIRCUMSTANCES 1. Death caused in a tumultuous affray Art 251. 2. Deaths or physical injuries inflicted under exceptional circumstances. Art 247 2. PATHOLOGICAL CLASSIFICATION OF THE CAUSES OF DEATH a. Death due to syncope – fatal and sudden cessation of the action of the heart.

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b. Death from asphyxia – a condition in which the supply of oxygen to the blood or to the tissues or to both has been reduced below normal working level. Stage of increasing dyspnea 1 min Stage of Expiratory convulsion Stage of exhaustion 3 min c. Death from coma

SPECIAL DEATHS 1. Judicial deaths – Art. III Sec.1 Par. 19 Phil. Const. “cruel and unusual punishment shall not be inflicted. ; electrocution, hanging, musketry, gas chamber. 2. Euthanasia or mercy killing 3. Suicide Automatism - due to drug may be considered as accidental rather than suicidal. Evidences that will infer death is suicidal: 1. 2. 3. 4.

History of depression, mental disease. Previous attempt Injuries are located in areas accessible to hand. Effects of the act of self-destruction may be found in the victim;, empty bottle 5. Presence of suicidal note. 6. Secluded, not in public view. 7. Evidences which rule out H,M, P 4. Death from starvation : Cause may be due to suicidal, homicidal or accidental. The human body without food losses 1/24th of its weight daily. And 40% loss>death Factors that influence the length of survival: age, condition of the body, sex, environment.

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DISPOSAL OF THE DEAD BODY Sec.1103 Revised Administrative Code : Persons charged with the duty of burial. 1. Deceased was married: the surviving spouse 2. If unmarried : the nearest of kin of the deceased; adults, within the Phil. And in possession of sufficient means to defray the necessary expenses. 3. If none of the above – municipal authorities. Sec 1104 RAC Right of custody Any person charged by law with the study of burying the body of a deceased person is entitled to the custody of such body for the purpose of burying it, except when an inquest is required by law for the purpose of determining the cause of death. If communicable, the local board of health or local health officer or municipal council. Concept of possession – the right of custody over a dead body.. The right of custody does not mean ownership of the dead body. Executors right of custody superior to the right of spouse dead body. An executor is the person mentioned in a will who will carry on the provision of the will. In the absence of a testamentary disposition, the right of the surviving spouse is paramount. METHODS OF DISPOSAL OF THE DEAD BODY 1. Embalming – 6 to 8 quarts of antiseptic solutions of formalin, perchloride of mercury or arsenic which is carried into the internal carotids and the femoral arteries. 2. Burial or inhumation a. Sec 1092 RAC buried within 48 hours if unembalmed. Within 12 hours, if communicable. Except: 1. Subject of legal investigation. 2. Authorized by the local health authorities that may be buried

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more than 48H. 3. Impliedly when embalmed. b. Death certificate necessary before burial: Sec. 1087 RAC Requirement of Death Cert. and the duty of the physician to issue or the local health officer, or if none by the mayor, secretary, councilor of the municipality to issue the certificate..

Sec 91 P.D. 856 Code of Sanitation ; Burial requirement: - death cert., issued by physician. c. Permission from the Provincial fiscal or from the municipal mayor. Is necessary if death is due to violence or crime. = Sec. 91(f) P.D. 856 Code of Sanitation Sec. 1094 Revised Administrative Code – Disposition of body and belonging of person dying of dangerous communicable disease. Ex. Meningococcemia in Bagiuo City 1. The body of a person who died of any dangerous communicable disease shall not be carried form place to place except for burial or cremation. 2. Duty of the local health official to disinfect the body before being prepared for burial; the furniture, house, either disinfect or burned if capable of conveying infection. Sec. 91(h) P.D. 856 Code of Sanitation 1. Remains shall be buried within 12 hours after death. Cause of death is due to a dangerous communicable disease; 2. Not to be taken any place of public assembly. 3. Only adult members of the deceased are allowed to attend the funeral. Sec. 1091 RAC Death Certificate must be presented before burial. Sec. 1099 the placing of the body of any deceased person in an unsealed overground tomb is prohibited unless if permanently sealed. Except: 1. Tombs and vaults which are strictly receiving vaults for bodies or remains awaiting final disposition. 2. Embalmed bodies awaiting final disposition. Sec. 1100 of RAC, Sec. 91© of P.D. 856 Code of Sanitation The depth of the grave must be at least 1 ½ meters deep, filled well and firmly.

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Sec. 2695 RAC Penalizes the desecration of burial premises; tombstone, plant, tree, fence, post or wall. P200/ not greater than 6 months. Sec. 90 code of Sanitation Burial Grounds requirements 1. It shall be unlawful for any person to bury the remains in places other than those legally authorized . 2. At least 25 meters from any dwelling house and no house shall be constructed within the same distance from any burial ground. 3. Not within 50 meters from any water source. Other burial requirements: 1. Shipment of remains abroad shall be governed by the rules and regulations of the Bureau of Quarantine. 2. The burial or remains in city or municipal grounds shall not be prohibited due to race, nationality, religious or political reasons. 3. Except when required by legal investigation or when permitted by the local health authority, no embalmed remains shall remain unburied longer than 48 hours. FUNERALS Art. 305 CC The duty and the right to make arrangements for the funeral of a relative shall be in accordance with the order of support under Art. 294. Descendants : Eldest Ascendants : Paternal For support as mentioned in Art. 294 1. Spouse 2. The descendants of the nearest degree 3. Ascendant of the nearest degree 4. Brothers and sisters Art. 306 CC ; In keeping with the social position of the deceased. Art. 307 CC ; In accordance to the expressed wishes of the deceased. Art. 309 CC ; Showing of disrespect to the dead shall be liable to the family of the deceased for damages, materials or moral. Art. 132 RPC: Interruption for religious worship. Art 133 RPC: Offending the religious feeling Art. 2219 CC: Provides for the moral damages may be recovered for acts

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mentioned in Art. 309 CC. LIMITATIONS TO THE FUNERAL RITES 1. Will of the deceased. 2. Burial of a person sentenced to death must not be held with pomp. 3. Restrictions as to funeral ceremonies in cases of deaths due to communicable disease. 3. Disposing of the dead body in the sea - Provided the deceased is not suffering from dangerous communicable deceased. - Sec. 1093 RAC Permit for conveyance of body to sea for burial. 4. Cremation – is the pulverization of the body into ashes by the application of heat. - First must be identified, - Permit and in a crematory made for the purpose. NOT GRANTED: a. If the deceased left a note. b. Identity of the person is not definite. c. Exact cause of death cannot be ascertained and the need for further inquiry or examination. 5. Use of body for scientific purposes - Corpse of prisoners - Any person to be buried for public expense and which is unclaimed for 24 hours. Sec. 98 P.D. 856 Code of Sanitation Special precautions for safe handling of cadavers containing radioactive isotopes. RA 349 as amended by RA 1056 Permission to use Human organs or any portions of the human body for medical, surgical or scientific purposes under certain conditions. - in writing, specific use, signed by the grantor and two disinterested witness. Sec. 96 Code of Sanitation; Donation of human organs for medical , surgical and scientific purposes according to the Sanitation Code. Persons permitted to detach human organs: 1. Licensed physicians

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2. Known scientist 3. Medical or scientific institutions Requirements for a valid authorization 1. It must be in writing 2. It must specify the person or institution grated the authorization. 3. Must specify the organ or part to be removed. 4. Signed by the grantor and two disinterested person. 5. Copy of the authorization must be submitted to the Secretary of Health.

EXHUMATION The deceased buried may be raised or disinterred upon the lawful order of the proper authorities. Sec 1082 RAC Sec. 1097 RAC

Cemetery permits even to NBI agents Exhumation in case of death from dangerous communicable disease after 5 years from burial. Sec 92 Code of Sanitation 3 years if non-dangerous communicable disease. Remains shall disinfected before burial. Requirements to be satisfied in exhumation: 1. Duration of interment as required. 2. Exhumation permit 3. Compliance of sanitary requirements Procedures followed in MedicoLegal Exhumations: 1. A formal request from any of the law enforcement agency or any person authorized by law. a. Name of the person, place of interment, date of interment, suspicion as to cause of death. b. To determine the cause of death. c. To determine as to identity of the person. d. To recover organs or tissues for further examination for : = Toxicological analysis = Histopath exams = Smears from vaginal canal and blood for alcohol determination 2. Set the date and time of exhumation, if physician has a strong reason to believe that for the justification and strong probability. 3. Written request to the Regional director or Secretary of Health. 4. Grave must be properly identified by the person who was present when the body was interred.

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5. After opening the coffin, the body must be viewed by any person who can identify the deceased. 6. Actual autopsy and adoption of the procedure is needed to accomplish the purpose of the exhumation. 7. Disinfection of the body and all areas involved must be carried out with the assistance of the local health officer and the return of the body to the burial place.

MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES 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. 2. 3. 4. 5. 6. 7.

Physical violence Heat or cold Electrical energy Chemical energy Radiation by radioactive substances Change of atmospheric pressure 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: a.

MV2 Kinetic energy = __________ 2 `Velocity component is the important factor: M16 rifle with a velocity of 3200 ft/ sec causes damage more than a heavier .38 caliber.

b.

Time = The shorter the period of time needed for the transfer of energy, the greater the likelihood of producing damage. = If a person is hit on the body and the body moves towards the direction of the force applied, the injury is less as when the body

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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.

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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

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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 the application 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 the instrument. > Wheels,abrasions from rope.

c)SELF-INFLICTED WOUNDS - Wound produced on oneself but no intention to end his life. 1. 2. 3. 4.

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

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5. Psychotic behaviour. Some ways of self-mutilation: 1. Head banging or bumping 2. Exposure of body to heat radiation from open fires, radiators 3. Penetrating nail to chest wall 4. Castration by amputation of the penis 5. Trichotillomania- pulling of body hair LEGAL CLASSIFICATION OF PHYSICAL INJURIES 1. MUTILATION = Art. 262 RPC Kinds of mutilation: a. Intentionally depriving a person, totally or partially of some of the essential organs for reproduction. b. Intentionally depriving a person of any part or parts of the human body other than the organs for reproduction. Mutilation to be punishable it must be intentional or not physical injury. MAYHEM – is the unlawful and violent deprival of another of the use of a part of the body so as to render him less able in fighting, either to defend himself or to annoy his adversary. Vasectomy/Tubal ligation are not mutilation and a legitimate method of contraception despite the fact that it is done intentionally and deprives a person of his power of reproduction. SERIOUS PHYSICAL INJURIES

Art. 263 RPC

Any person who shall wound, beat or assault another Art. 263 and administering injurious substance, without intent to kill Art. 264. The main purpose of dividing the provision into four paragraphs a) Is to graduate the penalties depending upon the nature and character of the wound inflicted b) Their consequences on the person of the victim. 1. Prison mayor – because of the physical injuries inflicted, the injured person becomes insane, imbecile, impotent or blind. 2. Prision correctional in its medium and maximum periods - loss of speech, hear or smell - loss of eye, hand, foot, arm, leg = loss of the use or incapacitated for the habitual work he used to do.

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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 for labor for more than 30 days. Is the offense shall be committed against any of the persons enumerated in Art. 246 Or with attendance of any of the circumstances mentioned in Art. 248 = The case covered by subdivision number 1 of this art. Will be punished by reclusion temporal in its medium and maximum periods. = Subdivision number 2 by Prision correctional in its maximum period to prision 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 of the 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 INJURIES Art. 265 RPC Any 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..

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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 a person of rank or person of authority, provided the crime is not direct assault. P.D. 169 Obligation imposed on Physicians treating persons suffering serious and less serious physical injuries required to report to law enforcement agencies. SLIGHT PHYSICAL INJURIES AND MALTREATMENT Art 266 RPC 1. Arresto menor- when the offender has inflicted physical injuries which shall incapacitate the offended party for labor form 1 to 9 days or shall require medical attendance of the same period 2. Aresto menor or fine not exceeding P200 and censure when the offender has cause physical injuries which do not prevent the offended party from engaging in his habitual work nor require medical attendance. 3. Arresto menor in its minimum period or a fine not exceeding P50 when the offender shall ill treat another by deed without causing any injury. If there is no evidence to show actual injury or incapacity for labor or period of medical attendance, the accused can only be guilty of slight physical injuries. So a tender slap on the face, holding the arm tightly, application of pressure in some parts of the body or mild blow which show no sign of physical violence may still be considered slight physical injuries or maltreatment. ( Parag 3 )

PHYSICAL INJURIES INFLICTED IN A TUMULTOUS AFFRAY Art 252 RPC Elements: 1. There is a tumultuous affray 2. Participants suffered from serious physical injuries.

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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 penalized by 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 on account 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 of application 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 change The size tends to become smaller from the periphery to the center and 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 th or 15th day. The ultimate disappearance of color varies from 1 to 4 weeks depending upon the severity and constitution of the body.

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The color changes starts at the periphery.

CONTUSION VS. POST-MORTEM HYPOSTASIS Contusion Below 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 Hypostasis In the epidermis or in the cutis as a simple stain or a showing through the epidermis of the underlying engorged capillaries. Contusion Cuticle was probably abraded by the same violence that produced the bruise. In small punctures such as fleas bites, this is not observed. Post-mortem hypostasis Cuticle unabraded, because the hypostasis is a mere sinking of the blood, there is no trauma. Contusion A bruise appears at the seat of and surrounding the injury. This may or may not be a dependent part. Post-mortem hypostasis Always in a part which for the time of information is dependent. Contusion Often elevated because elevated blood and subsequent inflammation swell the tissues. Post-mortem hypostasis Not elevated, because either the blood is still in the vessels or at most has simply soaked into and stained the tissues. Contusion Incision shows blood outside the vessels. This is the most certain test of

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difference and can be observed even in very small bruises. Post-mortem hypostasis Incision 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. Contusion Color 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 hypostasis Color 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. Contusion If the body happens to be constricted at or supported on a bruised place, the actual surface of contact may be a little lighter than the rest of the bruise but will not be white. Post-mortem hypostasis In a place which would otherwise be the seat of hypostasis pressure of any kind even simple support is sufficient to obliterate the lumen of the venules and capillaries and so to prevent their filling with blood. White lines or patches of pressure bordered by the dark color of hypostasis are produced and marks of 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 easily Fibrous 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,

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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 the blunt instrument hit a hard part of the body like a bony part which is superficially located. Force causes the subcutaneous tissue to rupture on account of the presence of a hard structure underneath..

DISTINCTION BETWEEN CONTUSION AND HEMATOMA 1. In contusion- the effused blood are accumulated in the interstices of the tissues underneath the skin In hematoma blood accumulates in a newly formed cavity underneath the skin. 1. in contusion, theskin shows no elevation and is ever elevated, the elevation is slight and is on account of inflammatory changes In hematoma – the skin is always eelevated. 2. 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 of hematoma. 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.

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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 long bones. 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 ligament which 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 COMPLETE SUSPENSION 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 the head is fixed and struck by a hard moving object. Signs and Symptoms 1. 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 by a rub r friction against a hard rough object. - Contussion with abrasion = forcible contact before friction occurs.

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- the shape varies and the raw surface exudes blood and lymph which later dries and forms a protective covering as SCAB or CRUST. Characteristics of abrasion: 1. It develops at the precise point of the force causing it. 2. Grossly or with the aid of a hand lens the injury consists of parallel linear injuries which are in line with the direction of rub or friction causing it. 3. It may exhibit the pattern of the wounding material. 4. Usually ignored by attending physician. Medico-legal viewpoint = abrasions caused by fingernails may indicate struggle or assault and are usually located in the face, neck, forearms and hands. = abrasions resulting from friction on rough surfaces are located in bony parts and are usually associated with contusion or laceration. = nature of the abrasion may infer degree of pressure, nature of the rubbing object and the direction of movement. 5. Abrasion heals in a short time and leaves no scar unless if not infected or if the whole thickness of the skin is involved. Forms of abrasion 1. Linear abrasion – appears as a single line, straight or curve. = pinching with fingernails = curve a. = sliding the point of a needle = straight linear ab. 2. Multi-linear – develops when the skin is rubbed on a hard rough object producing several linear marks parallel to one another. Example: MVA 3. Confluent – linear marks in the skin are almost indistinguishable on account of the severity of friction and roughness of the object. 4. Multiple – several abrasions of varying sizes and shapes may be found in different parts of the body. Types of abrasion 1. Scratch – caused by sharp pointed object which slides across the skin, like pin, thorn or fingernail. - Injury usually parallel to the direction of slide. = Fingernail scratch > broad at point of commencement with tailing at the end. 2. Graze – usually caused by forcible contact with rough, hard objects resulting to irregular removal of the skin surface. = course indicated by a clean commencement and tags on the end. 3. Impact or imprint abrasion ( patterned abrasion, stamping abrasion,

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abrasion a la signature) - those whose pattern and location provides objective evidence to show cause, nature of the wounding instrument and the manner of assault or death. = marks of grid of radiator, thread marks of wheel, teeth marks. 4. Pressure or friction abrasion – caused by pressure accompanied by movement usually observed in hanging or strangulation. = spiral strands of the rope as seen in the skin in hanging. Differential diagnosis: 1. Dermal erosion - gradual breakdown or very shallow ulceration of the skin which involves only the epidermis and heals without scarring. 2. Marks of insects and fishes bites – skin injury is irregular with no vital reaction and usually found on angles of the mouth, margins of nose, eyelids and forehead. 3. Excoriation of the skin by excreta – found in infants and the skin lesions heals when the cause is removed. No apparent history of rubbing trauma on the affected area. 4. Pressure sore – usually found at the back at the region of bony prominence. History of longstanding illness, bed ridden. ANTEMORTEM ABRASION COLOR

reddish-bronze due to slight exudation of blood

LOCATION

any area

VITAL with intravital reaction REACTION may show remains of damaged Epithelium

POSTMORTEM ABRASION yellowish and transparent over bony prominence Rough handling of the cadaver shows not vital reaction and is characterized by a separation of the epidermis from Complete loss of the former.

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.

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= = =

1. 2. 3. 4. 5. 6. 7. 8.

Impact cut > when there is forcible contact of the cutting instrument with the body surface. Slice cut > when cutting injury is due to the pressure accompanied with movement of the instrument Chopped or Hacked wound > when the wounding instrument is a heavy cutting instrument like saber > injury is severe

Characteristics of incised wound: Edges are clean cut. The wound is straight Usually the wound is shallow near the extremities and deep at the middle portion. Profuse hemorrhage because of the clean cut on the vessels. Gaping is usually present due to the retraction of the edges. Clothes will also show a clean cut if cut by the instrument. Faster healing if without complications. Incised wound made by broken glasses maybe irregular, needs to be removed.

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. 1. 2. 3. 4.

Why a person suffers from incised wound: As a therapeutic procedure. As a consequence of self-defense Masochist may self-inflict incised wounds for self-gratification. 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 involves both accessible and non-accessible parts. - clothing are usually involved - Defense and other forms of wounds are present.

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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 neck just above Adams apple

Usually horizontal below the adams apple

SEVERITY

Usually not so deep and may only involve trachea, carotid and esophagus

Usually deep and may cause involvement of the cartilage and bones.

SUPERF’L CUT

Usually present before the commencement of deeper wound.

Practically absent but may rarely be present when the victim struggled when attacked

POSIT’N OF May be sitting or facing a THE BODY mirror or standing

Usually victim lying on bed or in other place.

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

Weapon is absent

BLOOD Bld found in front part of body DISTRIBUTION Hand smeared with blood. MOTIVE

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

History of mental depression, Absence of such history Financial, social problems, alcoholism

PREVIOUS Hx May be present Of SELF-DESTRUCT’N

Always absent

3. STAB WOUNDS – is 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.

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-

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 slashing movement.

The extremities of stab wound may show the nature of the instrument used. - a doubled bladed weapon shows both extremities to be sharp. - A single bladed weapon – one of its extremities as rounded and contused, not seen if instrument is quite thin. The direction of the surface defect may be useful in the determination of the possible relative position of the offender and the victim when the wound was inflicted. As to whether the wound is slit-like or gaping depends on the direction of the wound to the Langers line. The depth of the wound may be influence by: 1. size and sharpness of the instrument. 2. area of the body involved 3. the degree of force applied Hemorrhage is always the most serious consequence of stab wound due to the severance of blood vessels or involvement of bloody organs. How to describe stab wound: 1. length of the skin defect – edges must be coaptated first Tailing – the direction of withdrawal of the wounding weapon. 2. condition of the extremities = sharp extremity > sharpness of the instrument used. = If Both extremity are sharp > double bladed weapon is used. 3. condition of the edges. = edges are regular and clean cut> due to one stabbing act. = serrated or zigzag in appearance > several stabbing wounds ( series of thrust and withdrawal.) 4. linear direction of the wound – it may be running vertically, horizontally, or upward medially or laterally.

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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 solitary 3. Located over covered parts of the body, the clothing is not involved 4. Stab wound is accessible to the hand of the victim 5. Hand of victim is smeared with blood 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 present 9. 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 wound 4. A motive for stabbing, if none then the offender either insane/drugs 5. Disturbance in the crime scene Medical evidence showing the intent of the offender to kill the victim: 1. there are more than one stab wounds 2. stab wounds located in different parts of the body 3. stab wounds are deep 4. 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 of the instrument at the level of the skin as the lever.

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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 bloody organs is fatal if no intervention applied. - Site of external wound can be easily sealed by dried bld, serum, or clotted bld. - Punctured wounds are usually accidental Characteristics: 1. The opening of the skin is very small, wound is much deeper than it is wide. 2. External hemorrhage is limited than internally may be severe. 3. Sealing of external opening is favorable for the growth and multiplication of anaerobic organism like bacillus tetani. Homicidal 1. multiple and usually located in different parts of the body. 2. wound are deep 3. there are defense wounds on the victim. 4. signs of struggle in the crime scene. Suicidal 1. 2. 3. 4. 5.

located in areas of the body where the vital organs are located. usually singular, if multiple located in one area. parts of body involved is accessible by the hand of the victim. clothing usually not involved. wounding is made while the victim is in sitting or standing position , bleeding is towards the lower part of the body or clothing.

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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 nicotine 2. fish spines 3. dog bites with hydrophobia virus 4. injection of air and poison as a way of euthanasia. 5.LACERATED WOUNDS ( TEAR, RUPTURE, STRETCH “PUTOK”) - is 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 tears and a laceration is produced. Characteristic: 1. shape and size of the injury does not correspond to the wounding instrument 2. 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 bulbs are 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 a breaking 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.

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4. Tearing - this may be produced by a semi-sharped edged instrument which causes irregular edges on the wound like hatchet and choppers. Lacerated wounds are rarely suicidal.

INCISED WOUNDS

LACERATED WOUNDS

Edges are clean cut, regular, well defined defined

edges are roughly cut, irregular, ill-

No contusion or swelling around the Incised wounds

swelling and contusion around the lacerated wounds

Extremities of the wound are sharp, may be irregular Round, or contused

extremities are ill-defined and

Examination by means of a hand lens Shows 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 dilatation - the presence of a mechanical device on the edges to prevent coaptation will cause separation. Example: drain in an abscess, retractor during operation. 2. loss of tissue due to: a. Destruction due to pressure, 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 the entrance and exit of GSW and removal of necrotic materials. 3. retraction of the edges

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-

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 prognosis especially in burns, contusion.. = burns of 70% in children and older age group are fatal. = rule of nine is used.

Head and neck one upper extremity front chest and abdomen posterior chest and abdo one lower extremity front one 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 1/10th of its volume will cause no significant change. - loss of one quart> fainting - loss of 1/3rd to 2/5th > 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 vital organs to affect the normal function. - intracranial hemorrhage cause compression of the vital centers of the 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.

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- into tracheo-bronchial lumina> asphyxia - into muscles > disturbance in their contractility.

Causes of hemorrhage: a. trauma - destruction of its blood vessel wall b. natural causes - intracerebral hemorrhage(apoplexy)> lenticulostraite br. MCA - Spontaneous subarachnoid hemorrhage > saccular berry aneurysm - rupture of arteriosclerotic aneurysm - rupture of esophageal varices - pulmonary hemorrhage due to PTB, lung abscess, bronchiectasis - ruptured ectopic pregnancy 2. Size of injury - burns greater than 1/3rd of the body are fatal 3. Organs involved – usually fatal to heart, brain, lungs. 4. Shock – blow to genitalia, slight burns to young and old. 5. Foreign body or substance introduced into the body - bacterial, viral, foreign body, chemical, TOXIN. 1. snake bites> 2 punctured wds at the center of the reddened affected area. The venom is injected through its fangs which is connected to the poison gland. Snake venom toxicity will depend on: 1. potency of venom injected 2. amount of venom injected by the fang will depend on - season of the year - the length of time the snake has eaten. - if a snake has just killed its prey> toxic content is smaller. 3. size of the patient 4. immediate treatment instituted. Snake venoms are two principal classes: 1. Neurotoxic – primarily paralysis the respiratory and cardiac center of the brain. - may cause N,V, ascending paralysis, coma, convulsion, c/p arrest

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

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 wound 3. placing ice on the bite site 4. sucking the wound to drain venom with the mouth 5. 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 6. 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 organs c. shock 2. Wounds may be indirectly fatal by reason of: a. secondary hemorrhage following sepsis b. specific infection c. scarring effect d. 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

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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 nature arises after the wounding and the consequential sequence is doubtful. Ex. TB meningitis ffg blow to the head COMPLICATIONS OF TRAUMA OR INJURY 1. Shock due to injury to nervous system, anoxemia, endothelial damage 2. Hemorrhage 3. Infection a. from the instrument b. from the organs involved in trauma ex. Bowels injured c. injury may depress general vitality d. deliberate intro of micro-organism 4. 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. vascularity b. age of person c. degree of rest or immobilization d. nature of the injury 2. Aberrated healing process: a. formation of exuberant granulation or proud flesh b. keloid formation c. stricture d. fistula or sinus formation

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MEDICO-LEGAL INVESTIGATION OF WOUNDS Rule to follow by a physician: 1. all injuries must be described 2. description of wound must be comprehensive, sketch/photograph 3. examination must be influenced be any other information obtained from others in making a report or 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 scene c. Investigations on possible witnesses to the incident d. Examination of the wounding instrument e. Photography, sketching, accurate description of the crime scene. 2. Examination of the wounded body a. 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

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- 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 HEMORRHAGE

POST-MORTEM WOUNDS

More profuse, arterial due to loss of tone of vessels, Absence of heart action Post-mortem clotting of blood inside b.v.

Slight or none, venous

Marks of spouting of blood from arteries

No spouting of blood

Clotted blood

Bld not clotted,or soft clot

SIGNS OF Inflammation & reparative INFLAMMATION process Swelling in the area, Effusion of lymph, pus Adhesion of the edges Unless if victim is weakened

None

SIGNS OF REPAIR

No time of repair

Fibrin formation growth of epithelium Scab or scar formation

RETRACTION Deep staining of the edges Not deeply stained OF THE EDGES and cellular tissues can be removed by washing OF THE WOUND which is not removed by washing Edges gape owing to the reaction

Edges do not gape, but are

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of the skin and muscle fibers

closely approximated to Each other unless if the wound is 1 to 2 hrs after death

DETERMINATIONS IF WOUND IS: HOMICIDAL ABRASIONS Not common unless If dragged Or if victim resisted CONTUSION INCISED WOUNDS

SUICIDAL Rarely observed

ACCIDENTAL Extensive abrasions MVA

Rare except when Found in any portion jumping from a height of the body - Fall Commonly observed Commonly observed * depth, location and surroundings

Frequent but rarely cause of death

Points to consider in the determinat’n 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.

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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. 2. 3. 4. 5. 6.

contusion – blunt incised wound – sharp-edged instrument lacerated wounds- blunt punctured wounds – sharp pointed abrasion – body surface is rubbed on a hard surface GSW – the diameter of the wound of entrance may approximate the caliber of the wounding instrument.

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 – inflicted first.

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Effect of medical and surgical intervention on the death: If death followed after operation> offender is responsible if death was inevitable and that even with operation death is normal and direct consequence of the injury, and the physician is competent and in spite 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 the physician 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 so offender 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 = tears - struggle 3. evidences derived from the examination of the assailant = paraffin test, tears in clothing, blood stains, intoxication etc.

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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.

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FRACTURES OF THE SKULL p. 302

GUNSHOT WOUNDS Death or physical injuries brought about by powdered propelled substances: 1. Firearm shot = the injury is caused by the missile propelled by the explosion of the gunpowder located in the cartridge shell and the rear of the missile. 2. detonation of high explosives - grenades = explosion inside the metallic container will cause fragmentation of the container. I. FIREARM WOUND = Firearm : is an instrument used for the propulsion of a projectile by the expansive force of gasses coming from the burning of gunpowder. (technical definition) = includes rifles, muskets, shotguns, revolvers, pistols, other deadly weapons which a bullet, ball, shell or other missile may be discharged by means of gunpowder or other explosives. = includes air rifle except of small calibers and limited range. = the barrel of any firearm shall be considered as a complete firearm for all purposes thereof. Penal provisions of laws relative to firearm: a. Sec. 2692 RAC – unlawful manufacture, dealing in acquisition, disposition or possession of firearms or ammunitions therefore or instrument used or intended to be used in the manufacture of firearms or ammunition. b. Sec. 2690 RAC – selling of firearms to unlicensed purchaser.

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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

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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 missile Owing to the elasticity of the tissue

Always bigger than the missile

Edges are inverted

Edges are everted

Usually oval or round depending upon the angle of approach of the bullet

Does not manifest any definite shape

Contusion collar or contact ring is present due to invagination of the skin and spinning of the missile

Absent

Tattooing or smudging may be present when when firing is near

Absent

Underlying tissues are not protruding seen

Underlying tissues may be Protruding from the wound

Always present after fire

May be absent, if missile is lodged 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

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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 d. x-ray exam

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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. = verified by x-ray 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 separate exit. 2. one of the bullets might have entered a natural orifice of the body. Ex. nose

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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 The effects of the clothing on the movement of the bullet depend on:

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1. number of layers of fabric between the muzzle and subjacent skin 2. nature of the fabric; closely woven 3. muzzle- clothing distance

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

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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 selfdestruction EVIDENCES THAT GSW IS HOMICIDAL 1. 2. 3. 4. 5. 6.

site of wound of entrance has no point of election fire is made when the victim is at some distance signs of struggle or defense wounds disturbance in the surroundings wounding firearm usually not found in the scene of the crime 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?

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3. 4. 5. 6. 7.

WHAT WAS THE DIRECTION OF THE FIRE? IS IT SELF-INFLICTED? ARE THERE SIGNS OF STRUGGLE? DID THE VICTIM DIE INSTANTANEOUSLY? 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:

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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. 2. 3. 4. 5.

facilitate the location and extraction of the wound reveals fragmentation and its location shows bone involvement like fracture reveal trajectory of the bullet 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. Chemical test:

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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

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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. 2nd – Erthyma, edema, swelling due to vascular dilatation, paralysis and increased capillary permeability. 3rd - Blister formation 4th – 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

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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 - Tx: Fluids with chlorides 2. Heat Exhaustion ( Heat collapse, Syncopal Fever, Heat syncope, Heat prostration) - Due to heart failure, cause:Heat precipitated by exertion/warm clothes = Sudden syncope, face turns pale, dim vision - Tx: removal from the heated area 3. Heat stroke(Sunstroke,Heat Hyperpyrexia,Comatous form,Thermic Fever) - Working in ill-ventilated places with dry temperature or exposure to the sun LOCAL EFFECTS OF HEAT 1. Scald: Caused by hot liquid The injury by scalding is not severe as burns: a. Scalding liquid runs on the body surface – distributing the heat b. Easily cools off c. Temperature not as high except : oils and molten metals 2. Thermal burns: Caused by heat or chemical substances like fire, radiant heat, friction, solid substances, electricity. : Classification of burns/ DUPUYTREN’S CLASSIFCATION 1st Degree –erythema 2nd - vesicle formation 3rd - destruction of the cuticle, part of true skin, painful 4th - whole skin is destroyed, ulceration, not painful 5th – deep fascia, muscles 6th - charring of the limbs BURNS 1. CAUSE

Dry heat – flame, heated solid

SCALDS Moist heat – liquid, steam

radiant heat

2. LOCATION

At or above the site of contact

Occurs at or below

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3. SINGEING

of hair is present

4. BOUNDARY OF NORMAL

Not clear

Absent Distinct

5. INJURY

Severe

Limited

6. 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 1. BLISTERS

ANTE-MORTEM BURNS

POST MORTEM BURNS

Abundant albumin/chlorides

Scanty albumin/chlorides

2. AREA OF Around the antemortem burn INFLAMMATION

Absent

3. BASE OF THE VESICLE

Not much change in color

Red

4. TRACHEOBRONCHIAL LUMEN

Particles of soot or carbon

5. BLOOD

Abundance of carboxy-Hgb

No findings

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 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

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

1. BLISTERS 2. SKIN/CLOTHINGS 3. ANALYSIS OF SUBSTANCE 4. LESION

CHEMICAL BURNS

THERMAL BURNS

Absent Stained by chemicals Shows chemical cause of corrosion

Present No staining Absent

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

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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. 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. = the metal of the conductor is volatilized and particles of the metal are driven

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into the epidermis causing darkening of the skin Delayed effects of electrical injuries: = 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

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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 death Failure of circulation due to Heart failure, shock, arterial venous obstruction 4.Histotoxic anoxic death Failure of the cellular oxidative process, cannot be utilized in the tissues. Cyanide Phases of asphyxial death: 1.Dyspneic phase – Breathing is rapid and deep, PR inc., Rise of BP - due to lack of O2 and retention of CO2 2. Convulsive phase – Cyanosis more pronounced, pupils dilated, unconscious - Tardieu spots =petechia /hges in the visceral organs - due to stimulation of CNS by CO2 3. Apneic phase

– Breathing is shallow, gasping - Due to paralysis of respiratory center

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Classification of Asphyxia: 1. Hanging 2. Strangulations: by ligature, manual strangulation, spl forms –palmar 3. Suffocation: choking 4. Asphyxia by drowning 5. Asphyxia by pressure on the chest 6. Asphyxia by irrespirable gasses A. ASPHYXIA BY HANGING = Not necessary the whole body is suspended: Pressure at side of neck = Mechanism of death: Air passage is constricted by pressure of the rope ; Compression of carotids, jugs, Sup. Laryng nerve> Cereb. anoxia Causes of death in hanging: 1. Simple asphyxia by blocking the air passage. 2. Congestion of the venous blood vessels in the brain. 3. Lack of arterial blood in the brain. 4. Syncope due to pressure on the vagus and carotid sinus. 5. Injury in the spinal column 6. Combination of the above. Hanging is ante-mortem: Vital reaction= principal criterion 1. Redness or ecchymosis at the site of ligature. 2. Ecchymosis of the pharynx and epiglottis. 3. Line of redness or rupture of the intima of the carotid artery 4. Subpleural hges. B. ASPHYXIA BY STRANGULATION – Tightened by force not the weight HANGING

STRANGULATION WITH LIGATURE

1.HYOID BONE

Frequently injured

Frequently spared

2.DIRECTION OF LIGATURE MARK

Inverted V-shape

Usually horizontal

3. LIGATURE LOCATION

At level of Hyoid bone

4. LIGATURE GROOVE

Deepest opposite the knot

5. VERTEBRAL INJURY

Frequently observed

Below larynx Uniform depth Not observed

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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 pillows Gagging – application of materials to prevent air to have access to mouth and nostrils. Plastic bag suffocation Choking- Form of suffocation by the impaction of F.B. in the respiratory passage. D. ASPHYXIA BY SUBMERSION OR DROWINING - Form of asphyxia where the nostrils and mouth has submerged in watery fluid. Time required for death in drowning: - Submersion for 1 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. Sylvester’s method- Lying on his back, astride over body, swinging arms Post-mortem findings: 1. External findings a) Wet clothes, pale face, F.B. clinging on skin surface b) “Cutis anserine” or “goose flesh” – skin is pale , contracted NOT Dxtic c) Washerwoman’s hands and feet – skin of hands & feet:bleached NOT Dxtic d) Postmortem lividity – marked in the head, neck and chest. e) Presence of firmly-clenched hands with objects – Person was alive at first

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f) Physical injuries for struggle g) Suicidal drowning – Pieces of stone

2. Internal findings A. RESPIRATORY SYSTEM 1. “Emphysema aquosum” – Lungs are distended overlapping the heart = Due to irritation made by the inhaled water on the mucous membrane of the air passage which stimulate the secretion of mucous. 2. “Edema aquosum”– Due:Entrance of water into air sacs, Lungs are doughy 3. “Champignon 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 froth 5. Blood stained fluid found inside chest cavity. 6. Section lungs shows fluid with bloody froth. B. HEART 1. Both sides of heart may be filled or emptied with blood. 2. Salt water drowning – Blood chloride content is greater than left side. Fresh water- Blood chloride is more I the right side. FRESH- RIGHT 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 after death. FINDINGS CONCLUSIVE THAT THE PERSON DIED OF DROWNING 1. The presence of F.B. in the hands of the victim. The clenching of the hands is a manifestation of cadaveric spasm in the effort of the victim to save himself from drowning. 2. Increase in volume (emphysema aquosum) edema of the lungs ( edema aquosum)

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3. Presence of water in the stomach 4. 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. -Main action is O2 deprivation 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 positive b) Potassium Ferrocyanide test – bright red c) Spectroscope exam d) Gas chromatograph e) Infra-red analysis

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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 and death. = manhole, poorly ventilated rooms Tests for the presence of CO2 1. Barium nitrate – white precipitate of Barium carbonate with carbonic acid 2. 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 common cherry, plum, peaches, ordinary bamboo shoots, certain oil seed and beans - Contains AMYGDALIN which in the presence of water and natural enyzme EMULSIN is readily decomposed to HYDROCYANIC ACID, glucose and benzaldehyde. = 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 GASES Classification based on the physiological action 1. Lacrimator or Tear gas – causes irritation with copious flow of tears a) 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 formation a) 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 , death

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a) Chlorine ( Cl2) – yellowish green gas b) Phosgene (COCl2) c) Chloropicrin d) 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 TO AUTOMOTIVE CRASH OR ACCIDENT Factors responsible to an Automotive Crash A. HUMAN FACTOR ( DRIVER) 1. Mental attitude: reckless driving, fatigue, inexperience 2. Perceptive defect 3. Delayed reaction time 4. Disease 5. 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 impact a) Front impact> Occupants move forward. b) Side impact ( severe) > moves to the side that was involved in the 1 st Col. >The passenger nearest to it will suffer the most. c) Rear impact crash – Acceleration-deceleration injury or whiplash d) 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:

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Death or Physical Injuries to pedestrian 1.Primary impact – Contact with vehicle 2. Secondary impact – Subsequent impact of the pedestrian to the ground - Accounts for the multiple injuries 3. Run over Injuries 4. Hit and run Injuries

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