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LEGAL MEDICINE HAND OUT College of Law USA

TABLE OF CONTENTS

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SEX Crimes 2 Medico Legal Aspects of Death 6 Medico Legal Aspects of Physical Injuries 10 Identification 13 Crime Scene Investigation 17 Abortion 19 Paternity and Filiation 20 Impotency and Sterility 21 Disturbance of Mentality 21 Drug Dependence 22 Alcoholism 22 Asphyxia 22 Death of Physical Injuries due to Automotive Crash or Accident 25 Autopsy 26 Casuses of Death 27 Burns 29

SEX CRIMES

 Virginity  Defloration These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 2

 Death related to sexual act 1. General condition of the hymen.  Sex crimes 2. Original shape of the orifice.  Rape 3. If lacerated:  Seduction  Acts of lasciviousness  Abduction  Adultery and concubinage  Prostitution

Sexual abnormalities

Virginity It is a condition of a female who has not experienced sexual intercourse and whose genital organs have not been altered by carnal knowledge.

Kinds of virginity: Degree of laceration Location of laceration 1. Moral virginity Duration of laceration 2. Physical virginity Complications of lacerations 3. True physical virginity 4. False physical virginity Degree of laceration of hymen: 5. Demi-virginity 6. “Virgo intacta” 1. Incomplete laceration -Superficial Determination of virginity: -Deep Parts of the female body: 2. Complete laceration 3. Compound or complicated laceration 1. Breasts 2. Vaginal canal 3. Labia majora and labia minora 4. Fourchette 5. Hymen

Duration of laceration of hymen:

 Fresh bleeding laceration- recent  Fresh healing with fibrin formation with edema of the Defloration: surrounding tissues – after 24 hours It is the laceration or rupture of the hymen as a result of sexual  Healed laceration with congested edges and with intercourse. sharp coaptible borders – 4-10 days  Healed laceration with sharp coaptible borders without Determination of defloration: congestion – 2-3 weeks  Healed laceration with rounded non-coaptible borders  Condition of the vulva-gaping or not and retraction of edges – 1 month  Fourchette- v shaped  Vaginal canal- decrease rugae Complication of laceration of hymen:  Hymen  Secondary infection  Hemorrhage Hymen:  Fistula formation  Stricture

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 Sterility  The carnal relation must be made under any of the following circumstances: Death related to sexual act: -Use of force or intimidation: 1. Death of a male partner: -Death from natural cause: increase demand in the -The woman is deprived of her reason or otherwise cardiovascular system. made unconscious -Death maybe due to the defensive act of a woman- . victim. -The woman victim is less than 12 years old. -Rape committed by depriving the victim of 2. Death of the female partner: her reason or otherwise made unconscious:  In case of oral sex: asphyxia  Accidental suffocation or strangulation during the act -Deprival of reason:  In cunnilingus, air embolism  Infliction of injuries by saddist partner -Rape committed on insane or mentally  Deliberately done to conceal the crime of rape deficient woman.  Shock as a result of extreme physical and mental -Rape committed while the woman is under trauma in rape the influence of alcohol or other depressant  Hemorrhage and infection drugs

3. Death of both partners -Sexual act on a woman under the  CO poisoning influence of sex stimulating drugs.  Homicide-suicide pact -The woman victim is unconscious. Sex crimes: -Sexual act committed while the woman is Characteristics: on her natural sleep. -Sexual act on a woman suffering from  Ancient and universal sleeping sickness.  Close physical contact between the offender and the -Sexual act on a woman who is victim unconscious because she was knocked-  Crime by one sex against the other out.  Sex is an inborn instinct. -Sexual act after administration of narcotics  It is a crime committed in strict privacy. or other knock-out drugs.  Many sex crimes are not reported; undue publicity is prejudicial to the reputation of the victim. -When the woman is under 12 years of age.  More frequent among lower socio-economic class.  Pardon and forgiveness will extinguish criminal liability Instances when rape is punishable by death. of offender.  The severity of punishment does not deter its  When by reason or on the occasion of the rape, the commission. victim becomes insane.  If the offender is past middle age, the victims are  When the rape is attempted or frustrated and a usually children. homicide is committed by reason or on the occasion  The psychic trauma suffered by the victim of sex thereof crimes varies with the moral standard of the victim.  When by reason or on the occasion of the rape, a  Common in month of May. homicide is committed.  Medical evidences in rape: Carnal knowledge: MEDICAL EVIDENCES IN RAPE: It is the act of man in having sexual bodily connection with a Evidences from the victim: woman.  Date, time and place of alleged commission of rape.  Slightest penetration in the sexual organ of the female  Date, time and place of examination. by the sexual organ of a male.  Condition of clothings. Rape:  The physician must observe the gait, the facial Elements of the crime: expression and the bodily and mental attitude of the subject.  The offender has carnal knowledge of the woman. The  Physical and mental development of the victim. victim of the crime must always be a woman while the - Physical exam, mental state offender must inferentially be a man.  Examination of the body for signs of violence. - Tenderness and swelling, age of lesion, x-ray

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 Examination of the genitalia including the breast. - Throat of the victim/ anal canal of the victim - Breast, vulva, hymen, pubic hair, vaginal canal

Medical Examination of seminal fluid:

1. Gross examination 2. Chemical examination

1. Florence test: presence of animal substance; not specific for seminal fluid. 2. Berberio`s test: specific for spermatic fluid.

3. Puramen test: reliable and characteristic of seminal fluid

4. Acid phosphatase test: conclusive for the presence of semen evidences in rape: 3. Microscopic examination 4. Biological examination 1. Examination of the alleged offender. - Precipitin test: human or not - Physical development, mental condition and - Seminal grouping strength - Evidence of physical injury How long after sexual intercourse can spermatozoa be found - Abrasions in the neck, chest, penis in the vaginal canal? - Condition of sex organ. Vagina: 48 hours - Evidence from the pubic hair. Uterus and cervix: 2-4 days - Potency of the offender. - Evidence of genital infection. Can a woman be raped while she is on her natural sleep? 2. Evidences from te companion of the victim. For virgins: highly improbable For multiparous: possible Investigation of the crime scene: Can a woman commit a crime of rape on a man? - Disturbance in the place of the commission. She commits acts of lasciviousness. - Strands of hair, blood, seminal fluid and other stains to prove consummation. Can rape cause death? - Pieces of personal belongings of the Death secondary to bleeding, shock and infection offender/victim maybe recovered. - Investigation of the witness. Can the husband commits the crime of rape on his wife?

Examination of seminal fluid: Other crimes against chastity:

- Semen is a viscid, albuminous fluid with faint Seduction: it is the act of man enticing women to have unlawful grayish-yellow color, having the characteristic intercourse with him by means of persuasion, solicitation, fishy odor and containing spermatozoa, epithelial promises, bribes or other means without employment of force. cells, etc… - Spermatozoa – living organism present in Types: seminal fluid consisting of a head, neck and tail. - 60 million per cc, 80% motile - Qualified seduction - Simple seduction

Specimens to be examined for seminal fluid: Seduction:

- Wearing apparel of the victim and the allege - Qualified seduction: offender. - Vaginal smear from the victim. -Ordinary qualified seduction - Stains on the body of the victim and of the -Incestuous qualified seduction accused. - Stains found at the site of the commission of the - Simple seduction: offense. -deceit These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 5

- Prostitution is one of the venues in spreading venereal disease and other diseases - Medical evidences: - Evidences may be gathered to prove sexual or lascivious acts -Same as in rape but there is no application of force Types: -Issue of age of the victim Acts of lasciviousness: - Bar or tavern pick-up 1. These are acts which tend to excite lust;conduct which is - Street walker wanton, lewd, voluptuous or lewd emotion. - Door knocker -Embracing, kissing and holding the woman`s breast - Factory girl -Placing of the man`s private organ over the girls genital organ. Effects of prostitution:

- Arrest and imprisonment. 2. Acts of lasciviousness - Venereal infection - Use of force or intimidation, depriving of reasons - Social ostracism or unconscious - Poor personal hygiene 3. Acts of lasciviousness with the consent of - Excessive use of alcohol offended party. - Irregular habit or eating and sleeping 4. Medical evidence:presence of physical injuries - Demoralization and physical deterioration.

Sexual abnormalities: Abduction: 1. As to the choice of sexual partner: - It is the carrying away of a woman by an - Heterosexual abductor with lewd design. - Homosexual - Lewd design: is the intent of the abductor to - Overt have sexual intercourse with the woman - Latent abducted - Infantosexual - Pedophilia (homosexual and heterosexual) Two types: - Bestosexual : bestiality or zoophilia - Autosexual: masturbation - Forcible abduction - Gerontophilia - Consented abduction - Necrophilia - Incest Adultery and concubinage: Adultery: committed by any married woman who shall have sexual intercourse with a man not her husband and by the man Reasons why physician fail to detect child sexual abuse. who has carnal knowledge of her, knowing her to be married. - The lack of hard physical evidence of abuse. Concubinage: any husband who shall keep a mistress in the - A belief that sexual abuse does not exist. conjugal dwelling, or, shall have sexual intercourse, with a woman - A fear of antagonizing parents. who is not his wife, or shall cohabit with her in any other place. - Ignorance of how to obtain a detailed sexual history from the child. Prostitution: They are women who, for money and profit, habitually indulge in Theories why adults become interested in children: sexual intercourse or lascivious conduct. Reasons: 1. Emotional congruence - Nondominant - Physiologic and psychological traits - Low self-esteem, immaturity, narcissism - Economic factors 2. Conditioning modeling – early childhood - Home and neighborhood experience - Influence of contraceptive 3. Blockage-alternative sexual gratification is - Poor social background with personality unknown because of unresolved conflicts, handicaps anxiety about sex - Previous sexual experience 4. Disinhibition - Contact with a person in the fringe of prostitution. - Desire for money or forced by loneliness, Sexual abnormalities: desertion or broken promises. 1.As to instinctual strength of sexual urge: Prostitution: Medico-legal aspects: 1. Over sex: compulsive neurosis - Satyriasis These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 6

- Nymphomania Death 2. Under-sex: - Sexual anesthesia - Is the termination of life - Dyspareunia - It is the complete cessation of all vital functions without - Vaginismus possibility of resuscitation. - Old age - It is an irreversible loss of the properties of living matter. 2.As to the mode of sexual expression: Classification: - Oralism - Brain death Fellatio, cunnilingus, anilism  Deep irreversible coma, absence of - Sado-masochism (algolagnia) – pain as a factor electrical brain activity and complete in gratification cessation of all vital functions without possibility of resuscitation Flaggelation, sadism(active), masochism - Cardio-respiratory death (passive), cannibalism, necrosadism, love  Occurs when there is a continuous and bites persistent cessation of heart action and respiration. - Fetishism (an object is necessary for Brain Death gratification) - Unreceptivity and unresponsibility - No movement or breathing Anatomic, necrophilic, clothing, odor - No reflexes (urolagnia, coprolagnia), pygmalionism, - Flat electroencephalogram narcissism, incendiarism, vampirism Importance of death determination 3.As to visual stimulus: - The civil personality of a natural person is extinguished - Voyeurism by death. - mixoscopia - The property of a person is transmitted to his heirs at the time of death. 4.As to the part of the body: - The death of a partner is one of the causes of dissolution of partnership agreement. - Sodomy - The death of either the principal or agent is a mode of - Uranism extinguishment of agency. - Frottage - The criminal liability of a person is extinguished by - partialism death. - The civil case for claims which does not survive is 5.As to number: dismissed upon death of defendant.

- Troilism (menage a trois`) Kinds of Death - Pluralism A. Kinds of Death - Somatic or clinical death Others:  The state of the body in which there is complete, continuous and persistent - Coprolalia (obscene language) cessation of the vital functions of the brain, - Don Juanism heart and lungs which maintain life and - Exhibitionism health. Sexual reversal: - Molecular or cellular death  Death of individual cells - Tranvestism: psychic identification wit the  Occurs about 3 – 6 hours after somatic opposite sex. Sexual maladjustment death - Transexualism: surgical change of anatomic sex. Kinds of Death - Intersexuality: - “Apparent death” or “state of suspended animation” i. Gonadal agenesis  A transient loss of consciousness or ii. Gonadal dysgenesis temporary cessation of vital functions of the iii. True hemaphrodite body iv. pseudohermaphrodite  Important to determine to avoid premature burial B. Signs of Deaths - Cessation of heart action and circulation - Cessation of respiration Medico-legal Aspect of - Cooling of the body (algor mortis) DEATH - Insensibility of the body and loss of power to move These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 7

- Changes in the skin  Post-mortem caloricity – rise of temperature of the - Changes in and about the eye body after death due to rapid and early putrefactive - Action of heat on the skin changes. Usually in the first 2 hours after death - Ex: peritonitis, liver abscess, yellow fever, 1.Cessation of heart action and circulation etc Methods of detecting heart action: Factors influencing the rate of cooling of the body  Palpation of the pulse  Factors that delay cooling  Wrist or neck - Obesity, pyrexial disease, death from  Auscultation of the heart sounds asphyxia at the precordial area - Clothing, small room, warm surroundings  Difficult to hear in  Factors that accelerate cooling stout person, with - Extreme age, leanness of the body, long pericardial effusion standing illness  Flouroscopic examination - Unclothed body, large room permitting the  Use of electrocardiograph – best dissipation of air, body in water method Estimation of time of death based on the cooling of the body Methods of detecting peripheral pulse  When the temp is normal at time of death – the - Magnus’ test average rate of fall during the first 2 hours is one half - Bloodless zone when a ligature the difference of the body temp and that of air; during is applied to the finger the next 2 hours, the fall is ½ of the previous rate..and - Opening of small artery so forth. As a rule the body attains a temp equal to - Blood escapes in jerk. environment 12-15 hours after death - Icard`s test Formula: (N temp) 98.4F – (rectal temp) - Injection of flourescein 1.5 subcutaneously = approx nos of hrs after death - Pressure on fingernails *Schourup`s formula - Zone of paleness at the site of application 4. Insensibility of the body and loss of power to move Diaphanous test  Should be observed in conjunction with other signs - The finger webs are viewed in the strong  Can occur in the living in the ff. conditions: light; it appears red in living and yellow in  Apoplexy dead  Epilepsy Application of heat on the skin  Trance - There will be no blister formation in a dead  Catalepsy man  Cerebral concussion Palpation of radial pulse  Hysteria Dropping of melted wax - There will be no inflammatory edema 5. Changes in the skin around the melted wax.  Pale and waxy looking; dependent area develop livid 2. Cessation of Respiration discoloration due to pooling of blood  Methods of detecting cessation of respiration:  Loss of elasticity of the skin; post-mortem contact - Observe for chest movement flattening - Listen to the chest with aid of stethoscope  Opacity of the skin - Placing a mirror in front of the mouth and  Loss of inflammatory reaction upon application of nostrils ( no dimming in dead) melted wax. - Placing a feather and cotton in front of lips and nostrils (no movement in dead) 6. Changes in and about the eye - Winslow`s test (no movement of the image  Loss of corneal reflex formed by reflecting artificial or sun light  Clouding of the cornea contained in the saucer placed on the chest  Flaccidity of the eyeball or abdomen of dead person)  Pupil is in the position of rest -  Ophthalmoscopic findings 3. Cooling of the body (algor mortis)  “tache noir de la sclerotique”  One of the most prominent signs of death  Fall of temp of 15-20 degrees Fahrenheit is certain 7. Action of heat on the skin sign of death  In a dead person, application of heat produces dry  Temp may fall before death in cases of cancer, sepsis, blister without redness of surrounding skin. cardiovascular collapse

CHANGES IN THE BODY AFTER DEATH These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 8

C. Changes in the body following death  Appears immediately after death  Changes in the muscle  Muscle groups/asymmetrical  Changes in the blood  May or may not appear after death  Autolytic or autodigestive changes  Useful to determine the nature of crime  Putrefaction of the body Changes in muscles 1.Changes in the muscles C. Stage of secondary flaccidity or secondary relaxation A. Stage of primary flaccidity or period of muscular - disappearance of rigor mortis irritability - due to dissolution of the muscle proteins which have - Complete relaxation and softening of all previously been coagulated muscles and sphincters. - Muscles are still contractile and react to Changes in the blood external stimuli A. Coagulation of blood - About 3-6 hours after death ( 1 hour and 50 - blood may remain fluid inside blood vessels for 6-8 min in warm countries hours after death Changes in the muscles - ante-mortem clot: firm in consistency, surface of B. Stage of post-mortem rigidity, or cadaveric rigidity, or death blood vessels raw after clots are removed, homogenous and stiffening, or “death struggle of muscles”, or rigor mortis. uniform in color - Starts 3-6 hours after death and complete by 12 hours -post-mortem clot: soft in consistency, surface of blood - Muscles stiffen due to coagulation of muscle proteins vessels smooth and healthy after clots are removed, clots with - In temperate countries it may last for 2-3 days; in warm distinct layer and can be stripped off countries 24 to 48 hours in cold weather and 18-36 hours in summer - 2.Changes in blood Factors influencing onset of rigor mortis  Post-mortem lividity or cadaveric lividity, or post-  State of the muscles mortem suggilation or post-mortem hypostasis or livor  Rigor mortis appears late and prolonged in mortis healthy muscles  Blood began to accumulate in the most  Age dependent portion of the body  Early onset in extreme of ages  Starts to appear 3-6 hours after death and  Integrity fully developed at 12 hours after .  Delay onset in paralyzed muscles  If the body was moved during the early  Temperature stage of its formation, it may develop in the  Accelerated by high temperature dependent portion of the new position  Moisture Physical characteristics  Rigor mortis starts early but shorter in - It occurs in the most extensive areas of the most duration dependent portions of the body Conditions simulating rigor mortis - It only involves the superficial layers of the skin.  Heat stiffening – if the body is exposed to temp above - It does not appear elevated from the rest of the skin 75 C - The color is uniform but the color may become  Body assumes “pugilistic attitude” with the greenish at the start of decomposition. lower and upper extremities flexed - There is no injury to the skin  Cold stiffening  “frozen”; due to solidification of fat Importance of cadaviric lividity  Cadaveric spasm or instantaneous rigor  It is one sign of the signs of death.  It may determine whether the position of the body has Cadaveric spasm been changed after its appearance in the body.  This is the instantaneous rigidity of the muscles which  It may determine how long the person has been dead occurs at the moment of death due to extreme nervous  It gives us an idea as to the time of death. tension, exhaustion and injury to the nervous system  The color of the lividity may indicate the cause of or injury to the chest. death:  The voluntary muscle contraction does not stop after  Asphyxia – lividity is dark death but is continuous with the cadaveric rigidity  CO poisoning – lividity is bright pink  Anemia – less marked Rigor mortis vs. cadaveric spasm  Phosphorus – dark brown  Rigor mortis  If the body is in ice or snow – it is bright red  3-6 hrs after death  All muscles of body Kinds of post-mortem lividity  Natural occurrence after death  Hypostatic lividity  Utilized to approximate time of death  Cadaveric spasm These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 9

 Blood gravitates to the most dependent  Ova of flies, trunk bloated,face swollen, blisters portion of the body still inside the blood present, moving maggots seen vessels and still fluid in form 72 hours  Occurs in early stage of its formation  Whole body grossly swollen and disfigured,hair and  Any change in the position may lead to nails loose, tissues soft and discolored formation of lividity to another place.  Diffusion lividity 1 week  Appears during the later stage of formation  Soft viscera putrified  Blood has coagulated or diffused into the tissues. 2 weeks  Any change in the position will not change  Soft tissues gone, more resistant viscera the location of the lividity distinguishable

3. Autolytic or autodigestive changes 1 month  Proteolytic, glycolytic, and lipolytic ferments of the  glandular tissue. Body skeletonized  Facilitated by weak acid and higher temperature.  Can be observe in parenchymatous and glandular Putrefactive changes in water 4-5 days tissues.  Rigor mortis may be present. If cold, little changes is 4. Putrefaction of the body seen  It is the breaking down of complex proteins into simpler 5-7days  Hands and feet sodden and bleached,face whitens components associated with evolution of foul smelling gases and accompanied by change in the color of the 1-2 weeks  body. Face swollen and red,greenish discoloration,skin in hands and feet are wrinkled Tissue changes in putrefaction: 4 weeks  Changes in the color of the tissues  Skin wrinkled, scrotum and penis distended with  Change in color from greenish yellow to gas,lungs emphysematous greenish black; earliest seen in the iliac fossa 6 to 8 weeks   marbolization Abdomen distended, skin of hands and feet come off  Evolution of gases in the tissues with nails like a glove  CO2, ammonia, hydrogen, sulphurated Factors influencing the floating of the body in water hydrogen,methane gases  Infants and fetuses floats rapidly  Causes bloating of the body, frothy  Women floats sooner than men secretions, expulsion of fetus  Stout person floats quicker than lean and thin bodies.  Causes floating of the body in water  Hot air of summer hasten putrefaction and floating  Liquefaction of soft tissues  Body float sooner in shallow, stagnant water of ponds Factors modifying the rate of putrefaction and creeks than in running stream.   Age, condition of the body and cause of death Body will float sooner in sea than fresh water.   Free air Presence of weights will delay floating.  Moderate moisture, condition of air, Agents of decomposition temperature of air, light  Bacteria  Earth  Aerobic and anaerobic bacteria  Water (running water vs still water)  Clostridium welchii  Clothings  Flies  Sequence of putrefactive changes in tropical regions Maggots 12 hours  Adult flies  Rigor mortis all over, hypostasis well developed and  Others fixed  Reptiles,rodents,dogs,fishes and crabs  molds 24 hours Duration of Death  Rigor mortis absent, greenish discoloration all over the  Presence of rigor mortis abdomen, distension of abdomen with gases  Presence of post-mortem lividity  Onset of decomposition 48 hours  Stage of decomposition  Entomolgy of cadaver These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 10

 Stage of digestion of food in the stomach  If the absentee appears, or without  Amount of urine in the bladder appearing his existence is proved, he shall  State of clothing recover his property in the condition in  Chemical changes in the Cerebrospinal fluid which it may be found, and the price of any  Post-mortem clotting and decoagulation of blood property that may have been alienated or  Presence or absence of soft tissues in skeletal the property acquired therewith; but he cannot claim either fruits or rents. remains  Condition of bones Presumption of Survivorship  Temperature of the body  Sec. 5 (jj), Rules 131, Rules of Court:  When 2 persons perish in the same Presumption of Death calamity, such as wreck, battle, or  Rule 131, Sec.5, Rules of Court: conflagration, it is not known who died first,  Disputable presumption: there are no particular circumstances from  That a person not heard from for which it can be inferred, the survivorship is seven years, is dead. presumed from the probabilities resulting  Presumption of death: from the strength and age of the sexes,  Art. 390, Civil Code and Sec. 5, according to the following: Rule 131, Rules of Court:  If both were under the age of 15  After an absence of 7 years, the older is presumed to years, it being have survived. unknown whether or  If both were above the age of 60, not the absentee still the younger is presumed to have lives, he shall be survived. presumed dead for all  If one is under 15 and the other purposes, except for above 60, the former is those of succession. presumed to have survived.  The absentee shall  If both over 15 and under 60 and not be presumed the sexes be different, the male dead for the purpose is presumed to have survived; if of opening his the sexes be the same, then the succession till after older. an absence of 10  If one be under 15 or over 60,the years. If he other between those ages, the disappeared after the latter is presumed to have age of 75 years, an survived. absence of 5 years  Art. 43, Civil Code shall be sufficient in If there is a doubt, as between two or more persons order that his who are called to succeed each other, as to which of them died succession maybe first, whoever alleges the death of one prior to another, shall opened. prove the same; in the absence of proof, it is presumed that they  Art. 391, Civil code and Sec.5, died at the same time and there shall be no transmission of rights Rule 131, Rules of Court: from one to another.  The following shall be presumed dead for all purposes, including the division of the estate among the heirs: MEDICO-LEGAL ASPECT OF PHYSICAL INJURIES  A person on board a vessel lost during a sea voyage, or an Causes of physical injuries: aeroplane which is missing, who has not been heard of for 4  Physical violence years since the loss of the  Heat and cold vessel or aeroplane.  Electrical injury  A person in the armed forces Chemical injury who has taken part in the war,  and has been missing for 4  Radiation injury years.  Barotrauma  A person who has been in  Infection danger of death under other circumstances and his existence Wounds: has not been known for 4 years.  Art. 392, Civil Code;  It is the solution of the natural continuity of any tissue of the living body.

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 The effect of physical violence may not always result  Superficial- only the layers of the skin to the production off wound but the wound is always  Deep the effect of physical violence.  Penetrating  Perforating Physics of Wounds: Wound=kinetic energy X time X area X other factors As to the location of impact and injury. Kinetic energy = (mass) (velocity) 2 2  Coup-injury  Contre-coup  The greater the velocity, the greater is the magnitude of injury.  Coup contre-coup  The shorter the period of time needed for the transfer  Locus minoris resistencia of energy, the greater the likelihood of producing  Extensive injuries damage.  The larger the area of contact between the force As to the regions or organs of the body involved. applied on the body, the lesser is the damage. Special types of wounds:  The less elastic and plastic the tissue, the greater the likelihood of laceration to occur.  Defense wounds – result of a person`s instinctive  Movements of body parts will cause stretching of reaction of self protection. tissues causing internal injuries. -Nightstick fracture Tissue reaction to injuries:  Patterned wounds – wound in the nature and shape of an instrument causing it.  “rubor” – redness or congestion of the area due to  Self-inflicted wound- wound produced on oneself. The increase blood supply. person has no intention to end life. (head banging, nail biting)  “calor” – increase in temperature. “dolor” – pain  Legal classification of physical injuries:  Loss of function Mutilation – it is the act of looping or cutting off any part or parts THE PRESENCE OF VITAL REACTIONS DIFFERENTIATES AN of the human body ANTE-MORTEM FROM A POST-MORTEM INJURY. Kinds of mutilation:

Classification of Wounds:  Intentionally depriving a person, totally or As to severity partially of some of the essential organs of reproduction, Fatal – injuries to the heart, big blood vessels, brain,   Intentionally depriving a person of any part spinal cord, lungs or parts of the human body other than  Non-fatal organs of reproduction

As to kind of instrument Is vasectomy and tubal ligation within the purview of mutilation?  Blunt instrument  Sharp instrument Classification of Physical Injuries as to time of medical  Tearing force attendance:  Barotrauma  Temperature Slight physical injury  Explosion  Requiring medical attendance from 1 to 9 days  Infection  Requires medical certification  Explosion  Electrical injury Less serious physical injury

As to manner of infliction  Requiring medical attendance or incapacitated for 10- 30 days  Hit  Requires medical certification  Thrust or stab  Gunpowder explosion Serious physical injury  Sliding, rubbing or abrasion  Requiring medical attendance for more than 30 days As to the depth of the wounds Types of Wounds: These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 12

 Closed wounds  Usually deep  Superficial-wounds in the layers or beneath the skin  Maybe absent superficial cuts i. Petechiae (not always a product of trauma)  Usually lying ii. Contusions – may develop after several  Weapon is absent minutes  Blood at the back of neck, hands clean iii. Hematomas  Absence of mental illness iv. Deep Musculo-skeletal injuries – sprain, dislocation, fracture,  Stab Wound strain and subluxations Descriptions  Internal hemorrhage  Cerebral concussion  Edges – serrated or clean cut  Length of the edges Age of contusions;  Extremities – single blade or double blade,three After injury: red to purple cornered file 4-5 days: greenish 7th-14th day: yellowish  Direction of the surface wound 14th day: gradually disappears.  Depth of penetration Change of color from periphery inwards  Location of the wound . Types of Wounds

 Open wound  Abrasions Suicidal vs Homicidal Stab Wound:  Incised wound  Stab wound Suicidal  Punctured wound  Lacerated wound  Located in vital parts  Avulsed wound  Usually solitary  Accessible to the hand Abrasions  Hands are bloody Types:  Presence of cadaveric spasm Wound tailing abrasion is towards the hand inflicting  Scratch (fingernails)  No disturbance in scene  Graze  Wounding instrument with the victim  Impact or imprint abrasions  History of self destruction  Pressure or friction abrasions 

Distinction between ante-mortem and post-mortem Homicidal Incised Wounds  Located in any parts of the body  Cause by a sharp-edged instruments  Associated with other injuries  Maybe an impact cut, slice cut, chopped or hacked  Multiple stab wounds  Characteristics: clean cut edges, gaping wound  Disturbance in the crime scene  May suicidal, homicidal or accidental

Distinction between suicidal and homicidal cut-throat: Punctured Wound: Suicidal  Opening in the skin is very small  Oblique wound  Cause by a thrust of a sharp-pointed instrument  Usually superficial  Minimal bleeding externally  Presence of superficial cuts Sitting/facing a mirror  Lacerated Wound:  Weapon is grasped or lying beside the victim Characteristics:  Blood is in front of the body, bloody hand  History of mental illness  Edges are irregular and rugged.  The borders of the wound are contused and swollen. Homicidal  The size and shape of the wound does not conform to the wounding instrument.  Horizontal wound These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 13

 Usually located near the bony areas.  Age of the wound, weapon used, whether  Bleeding not extensive. suicidal,homicidal or accidental  Tendency to form scar. Living body Classification of lacerated wound:  Fatal or non-fatal, presence of deformity, complications  Crushing of skin between two hard objects. Dead body  Overstretching of the skin.  Grinding compression.  Ante mortem or post-mortem wound  Tearing  Fatal or nonfatal Factors responsible for the severity of wounds:  Suicidal or homicidal Ante-mortem vs post-mortem wounds:  Bleeding Ante-mortem  Size of injury Organs involved   Copious bleeding Shock   Spouting of blood Foreign body or substance introduced into the body   Clotted blood Absence of medical or surgical intervention.   Deep staining of edges  Gaping of edges Fatal effects of the wounds: Wound maybe directly fatal by reason of:  Presence of inflammatory process Post-mortem  Hemorrhage  Mechanical injuries to vital organs  Minimal bleeding  Shock  No spouting of blood Wound maybe indirectly fatal by reason of:  Non-clotted blood  Edges are not deeply stained  Specific infections  Edges do not gape  Secondary hemorrhage following sepsis  No inflammatory process  Scarring effect IDENTIFICATION  Secondary shock Importance: Nature of death due to secondary causes: • In criminal cases, the identity of the offender and the victim must be established, otherwise it will be a ground for dismissal.  Changes whose natural consequence are direct and • The identity of the person missing or presumed dead obvious. will facilitate settlement of estate, retirement, Changes producing separate pathological lesions  insurance, etc… which in turn proves to be fatal. • Identification resolves the anxiety of the next-of-kin as  Changes where a definite pathological condition was to the whereabouts of the missing person. present before the injury. • Identification is needed in some transactions like  Changes where a definite pathological condition of cashing a check, sale of property, etc…. totally different nature arises after the wounding. Rules • The greater the number of points of similarities and Medico-legal investigation of wounds: dissimilarities of two persons compared, the greater is the probability for the conclusion to be correct. (Law of  Character of the wound Multiplicity of evidence in identification)  Location of the wound • The value of different points of identification varies in  Depth of the wound the formulation of conclusion.  Condition of the surroundings • The longer the interval between death and the examination of the remains, the greater is the need for  Extent of the wound the experts in establishing identity. Direction of the wound  Methods  Number of wounds • By comparison  Condition of the locality • By exclusion • By ordinary method Examination of the wounded body: • By scientific method Living and dead body Methods of Identification • Ordinary methods of identification These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 14

– Characteristics which may be changed – All dental practitioner should keep and easily maintain accurate and complete record of • Color of hair, mustache, clothing the dentition of all their patients. – Characteristics that may not be changed – Upon lapse of 10 years from the last entry, easily the records shall be turned over to the NBI • Speech, Gait, mannerisms, Age based on eruption of teeth facies, L or R handed • Temporary • Scientific methods of identification – Central incisors: 6th month – Fingerprinting, dental identification, – Lateral incisors: 9th month handwriting, skeletal identification – First molars: 12th month Light as a factor in identification – Canines: 18th month • The best known person cannot be recognized by the – 2nd molar: 2 years clearest moonlight at a distance greater than 16 to 17 • Permanent yards. – First molar: 6th year • In broad daylight, an unknown person can be – Central incisors: 7th year recognized at a distance of 25 yards. – First bicuspid: 9th year • With flash of firearm, it is possible to see the person – Canines: 11th year but assailant are usually hidden or the assault is – 3rd molar: 17th-18th year or later unexpected that attention of the person or witness is at Epiphysis its minimum. 1-1 ½ years – anterior fontanelles closed IDENTIFICATION 13 years – ileum and pubic bone should be united • General appearance 18-20 yrs – head of the femur should have joined diaphysis • Personal effects 25 years and > – all the epiphysis have united • Presence of scars, tattoos, moles, birthmarks and Age determination in fetus other permanent marks • Haase`s rule: • Presence of physical deformities or congenital defects – For fetus of less than 25 cm long (crown • Fingerprints feet length), the age is the square root of • Dental identification the length. Ex: In 16 cms fetus, the age is 4 • X-ray and other health records months. • Skeletal remains – For fetus more than 25 cm, divide the General appearance length by 5 and the result is the age. • Estimated weight and height Ex: if fetus is 40 cms, the age is 8 months. • Determination of Age • Age determination in infancy • Determination of Sex • Age based on height and weight • Determination of Race – Newborn: 50 cms • General nutritional status • 6 mos: 60 cms • Color of hair, skin and eyes • 1 yr: 68 cms Methods of approximating the height • 4 yrs: double the birth height • Distance between the tips of the middle fingers with - newborn: 2.5-3 kg arms extended laterally . Increases weight by .5 kg /month • Two times the length from the vertex of the skull to the . At 1 yr weighs 3X the birth weight symphysis pubis • Age determination in infancy • Eight times the length of the head • Physical characteristics of infant Determination of age: Importance – Newborn : skin covered by vernix caseosa • As an aid to identification – After 24 hours: skin firm and less red • Determination to criminal liability – 2nd – 3rd day: skin yellowish tinge, umbilical • Determination of the right of suffrage cord brown and dry • Determination whether a person can exercise civil – 3rd – 4th day: skin becomes more yellow, rights umbilical cord brownish red and flattened • Determination of the capacity to contract marriage – 4th – 6th day : umbilical cord separates from • As a requisite to certain crimes such as rape, abdomen infanticide, seduction – 6th -12th day : cicatrization of umbilical cord Determination of age Other points to consider in determination of age: • Can be determined by: • Growth of pubic hair, beard and muscle – Physical appearance • Changes of the breast in female – Appearance of ossification centers • Development of voice – Union of bones and epiphyses • Changes in the color of hair – Dental identification • Grade or year in school or college – Obliteration of cranial sutures • Menstruation in women • Adult has 32 permanent teeth • Manner of dressing, self beautification and social life • Presidential decree 1575 • Atheromatous changes of blood vessels, opacity of lens and cornea • Wrinkles of the skin These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 15

• Degree of mental development • By opinion of an expert who compares the questioned Determination of Sex writing with that of other writings which are admitted or Legal Importance treated to be genuine by the party against whom the • As an aid in identification evidence is offered. • To determine whether an individual can exercise Practical uses of handwriting examination. certain obligations vested by law to one sex only • Financial crimes • Marriage or the union of a man and a woman • Death investigation • Rights granted by law are different to different sexes • Robberies • There are certain crimes wherein a specific sex can • Kidnapping with ransom only be the offender or victim • Anonymous threatening letters • Social test • Falsification of documents • Genital test • Bibliotics – the science of handwriting analysis • Gonadal test • Graphology – the study of handwriting for the purpose • Chromosomal test of determining the writer`s personality, character and • Exception: gonadal agenesis and true hermaphrodism aptitude. Evidences of sex Primary factors for analysis: • Presumptive evidences • Form – shape of the letter, proportion, slant, angles, • Highly probable evidences of sex lines, retracing, connections and curves • Conclusive evidences • Line quality – results from the type of instrument used, Presumptive evidences: pressure exerted, flow and continuity of the script • General features and contour of face. • Arrangement – spacing, alignment, formatting and • Presence or absence of hair in certain parts of the distinctive punctuation body. • Content – spelling, phrasing, punctuation and grammar • Length of scalp hair. Standard (exemplar) writings: • Clothes or wearing apparel. • Collected (procured) writings – a known specimen • Figures written by an identified person. It maybe from a public • Voice or manner of speech or private records. This is the most appropriate • Adam`s apple standard. • Striaes in breast and abdomen. • Requested standard – the identified person is asked to Highly probable evidences of sex: provide handwriting samples. Contemporaneous. • Possession of vagina, uterus and accessories in Characteristics of disguised writing: female, and penis in male. • Inconsistent slant • Presence of developed and large breast in female. • Inconsistent letter formation • Muscular development and distribution of fat in the • Change of capital letters body. • Lack of free flowing movement Conclusive evidence: • Lack of rhythm • Presence of ovary in female and testis in males. • Unnatural starts and stops Determination of race • Irregular spacing • Color of the skin • Writing with unaccustomed hand • Feature of the face Forgery • Shape of the skull • Traced forgery • Wearing apparel • Simulated forgery Tattoos • Spurious forgery • Information – name, age , date of birth, religion, name Fingerprints of spouse, social status, memberships • Most valuable method of identification • Can be remove by surgical excision, electrolysis, laser • No two identical fingerprints or application by caustic substance • Dactylography – art and study of recording fingerprints Scar as a means of identification. • Remaining mark after healing of the wound • Dactyloscopy – art of identification by comparison of • Characteristic scar may show cause fingerprints. • Age of scar • Poroscopy – study of pores found on the pappilary or Personal effects friction ridges of the skin. • Type of clothing worn Kinds of impressions: • Jewelry • Real impression • Shoes • Chance impression • Atypical object in a victim or immediate vicinity – Visible print – made by chance and visible Handwriting without previous treatment Writing maybe proven by the following: – Plastic print – made by chance by pressing • Acknowledgement by the alleged writer. the fingertips on melted paraffin, • Statement of a witness who saw the writing made. cellophane, plastic tape • By opinion of persons who are familiar with the – Latent print – prints not visible after handwriting of the alleged writer. impression but made visible by addition of substances. Ex: application of fine powder. These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 16

Methods  Forensic science – science that is applied to legal • Plain method matters. • Rolled method • In dead bodies • Automated fingerprint identification system (AFIS) Scientific method: • Arch • Loops  Observation and collection of data • whorls  Conjecture of collected data (analysis) DNA •  Formulation of hypothesis • Forensic DNA  Testing the hypothesis or reconstruction • DNA • First use in 1985  Theory • First accepted as court evidence in 1986 (serial rapist Tommie Lee Andrews) • It cannot distinguish between identical twins. • It should pass tests of acceptability in the scientific Forensic Medicine community. • Faces few challenges from the court.  The application of medical science to elucidate legal • Loopholes: handling of samples,interpretation of problems samples DNA FINGERPRINTING  Dr. Pedro Solis • DNA profile of an individual • Unique DNA sequence  Deals with investigation, preparation, preservation and • Can be determined from any tissues of the body presentation of evidence and medical opinion in courts • DNA data bank: CODIS (Combined DNA Index System Can be useD in the following:  Dr. William J. Currran • Identify potential suspects whose DNA may match evidence left in the crime scenes  Legal Medicine • Exonerate persons wrongly accused of the crimes.  The application of medicine to legal science. • Identify crime and catastrophic victims • Establish paternity and other family relationships  Dr. Pedro Solis DNA technologies: • Restriction Fragment Length Polymorphism (RFLP)  Areas of medicine concerned with relations with • Polymerase Chain Reaction Analysis (PCR analysis) substantive law and with legal institutions • Short Tandem Repeat (STR) Analysis • Mitochondrial DNA Analysis  Dr. William Curran • Y Chromosome analysis Concerns about DNA Databanking • Intrusion into privacy • Expensive Medicolegal practitioners Vidocq Society • The advances in technology (DNA) and profiling of  Doctors handling medicolegal cases criminals causes an increase in re-investigation of Health officers unsolved cases. o • The Vidocq Society is founded by forensic o Medical officers of law enforcement agency professionals to brainstorm on past unsolved cases. o Members of medical staff of accredited • From French police surgeon Eugene Vidocq, the father hospital of modern criminal investigation.  Private practitioners  PNP criminal laboratory  NBI criminal laboratory Forensic Medicine

Goal: Forensic Science in the Philippines

 The goal of this course is to provide law students with  Spanish regime fundamentals of forensic science and equip them with o “Medico Titulares” – in charged of public knowledge needed for the law profession. sanitation and medico-legal aid  American regime o Medico-Titulares under the Board of Health Definition:  Philippine Republic  Latin: forensis – public; of a forum

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o Medico-legal Division was established at Victims of physical injuries cause by any of the following. the PGH and was later transfer under the authority of Department of Justice.  GSW, SW, mauling, etc…. o In 1947, the Medico-legal Division was  VA transferred to the National Bureau of  Asphyxia Investigation  Electrocution, burns  Accident, homicide or suicide Forensic sciences  Poisoning  Forensic anthropology  Cases of child abuse, domestic violence, rape, alcoholism and drug addiction.  Forensic medicine  Forensic pathology  Cases involving mental competency of the patient.  Forensic pschiatry/psychology  Iatrogenic causes brought about by negligent acts or Forensic meteorology  omissions of the hospital staff resulting in violation of  Forensic DNA analysis rights of patients or leading to patient`s physical and  Forensic odontology mental incapacitation, physical injury and death.  Forensic archeologist  Under Philippine Laws, medico-legal deaths must  Forensic entomology undergo mandatory autopsy.  Forensic chemistry and toxicology  Fingerprint experts CRIME SCENE INVESTIGATION:  Handwriting experts  Forensic linguistics  Crime scene: It is the place where the essential Forensic nursing, etc……  ingredients of the criminal act took place.  Crime scene investigation: collection of the physical evidences that may lead to the identity of the Scope of Forensic Medicine perpetrator, the manner the criminal act was executed and other things that may be useful in the prosecution  Crime Scene Investigation of the case.  Medico-legal aspects of Identification  Medico-legal aspect of Death  Causes of Death and Conduct of Autopsy  Medico-legal aspect of Physical Injuries Members of the team:  Ballistics  Sex Crimes  Police investigators  Pregnancy/Abortion/Paternity and Filiation  Medico-legal experts (medical examiners)  Disturbance of Mentality  Fingerprint experts  Alcoholism and Poisoning  Photographer  Chemist  Sketch artist Medico-legal cases  Evidence recorder

 Injuries or death involving persons who have no means of being identified. Methods of conducting the search:  Persons pronounced as “dead on arrival”.  Deaths under the following circumstances:  Strip method  Double strip or grid method  Death occurring within 24 hours of  Spiral method o admission when cause of death is unknown  Wheel method  Unexpected death when the decease is in  Zone method o apparent good health  Death due to natural cause but with o physical evidence of foul play. Salient points:  Death as a result of violence, accident, Determine if the victim is alive or not. o suicide or poisoning.  Preserve the scene of the crime until proper  Death due to improper or negligent act  markings/photographs are taken. o of another person.  The scene of the crime must be cordoned off.  The immediate environment inspected for clue and evidences. These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 18

 Evidence collected must be properly identified, sealed and signed by the investigator and endorsed to the custodian. Death or Physical Injuries caused by Explosion Classification of explosion as to the source of energy:

Evidence  Mechanical (Hydraulic ) explosion  Spray canister, water tank, kerosene burner  All evidences collected must be protected, identified  Electrical explosion and preserved.  Arcing of electricity, lightning Evidence custodian is responsible to preserve the   Nuclear explosion shape, minimize contamination and chemical changes  Atomic explosion and transfer of evidences.  Chemical explosion  Brought about by chemical explosion Types of evidences: Chemical explosion: o Autoptic or real evidence . Limitations  Diffused reactant explosion  Indecency and  Condensed reactant explosion impropriety  Low order explosives  Repulsive objects  High order explosives and those offensive  Stable high order explosives to the sensibilities  Unstable high order explosives o Testimonial evidence . Ordinary witness Injuries are due to: . Expert witness o Experimental evidence  Close contact: complete disintegration or o Documentary evidence fragmentation of the body parts . Medical certification/report  Near the explosion: body in one piece but some parts . Medical expert opinion maybe dismembered. Triad of punctate bruises, . deposition abrasions and lacerations are found  Physical evidence  At a distant: peppering o Corpus delicti evidence  Blast wave:airway injury, rupture of tympanic o Associative evidence membrane o Tracing evidence  Burns: flame or heated gas  Asphyxia: lack of oxygen  Gas poisoning Physical evidence examination should prove:  Falling debris

 That a crime has indeed taken place. Investigation:  Determine the perpetrators MO.  Establish contact between a victim and a suspect.  Presence of crater  Establish contact between a person and a scene.  Traces of detonation mechanism; residues  Support or disprove a witness`testimony  Collection of gas  Provide investigative lead.  Scrapings  Color spot tests

Preservation of evidence Atomic bomb explosion:

 Photographs, audio/video tape, micro film  Fission of uranium producing millions of pounds of gas  Sketching pressure. o Rough sketch  Creates fireball with a diameter of 7,200 feet in ten o Finished sketch seconds and height of 4 ½ miles  Description  Emits radiation: alpha, beta, gamma and neutron rays  Manikin method Effects of atomic explosion in the body:  Preservation in the mind of the witness  Special methods  Local effects: chromosomal aberrations, radiation dermatitis,endothelial necrosis and thrombosis, cataract and sterility

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 General effects: generalized erythema, coma and  To conceal identity and true cause and manner of death, vomiting and leukemia, leukopenia death.  Long term effects: cancer  To kill or with homicidal intent (torch murder).  The victims might have committed suicide by other Other sources of radiation: means and try to hide the cause and manner of death by setting fire on the surroundings.  Natural source  To perpetuate insurance fraud both property and life.  Cosmic  Victim might have been trapped in the building set afire  Terrestial origin accidentally or intentionally  Man-made source  A person in pursuance of a cause may soak himself  Diagnostic x-ray equipment with an inflammable substance and burn himself to  Clinical nuclear pharmaceutical agent death.  Therapeutic radiation apparatus Cause of death in burns:  Nuclear power plants Immediate: shock, associated physical injuries, Thermal Injuries and Death  Death or injury from cold suffocation Systemic: death due to cerebral anoxia and cold stiffening  Delayed: shock, exhaustion, complications- sepsis, multi-organ failure  Local effects: frostbite, immersion foot, trench foot  Time required to completely burn the body:  Depends on: intensity of heat applied, duration, Death or injury from heat physical condition, and presence of clothing Systemic effects:heat cramps, heat exhaustion, heat stroke  In incinerator: 4 hours to transform the body to ashes.

 Local effects: Burns / scald Proof that the victim was alive before burned to death:

Burns:  Presence of smoke in the air passages.  Increase carboxy-hemoglobin blood level.  Moist heat  Dermal erythema, edema and vesicle formation.  Scalding  Subendocardial left ventricular hemorrhage.  “geographical lesions”  Clothings and hair are not burned Distinction between ante-mortem and post-mortem burns  Blisters are formed with redness around Investigation:  Usually not fatal; death is due to sepsis Determine the following:  Dry heat  Establish the identity: clothing, size of footwear,  Thermal properties in the pockets, physical characteristics, Chemical  scars Electrical   Whether the person was alive in the fire. Radiation   Cause of death. Friction   Information indicating a possible cause of fire

Burns: Medico-legal aspect of burns and scald Characteristics:  Branding  From redness to carbonization of the body  Torture  Singeing of hair and carbon deposits  Accidental  Areas involved are without demarcation line.  Spontaneous combustibility Classifications:  Preternatural combustibility

st Others:  1 degree: sunburn  2nd degree: vesicle formation; superficial skin  Chemical burns:  3rd degree:whole layer of the skin  Sulphuric acid  4th degree:whole layer of skin and the subcutaneous  Nitric acid tissues th  Hydrochloric acid  5 degree: muscles  Caustic soda Purpose of intentional fire:  Electrical burns:  Contact burn

These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 20

 Spark burn Age of viability: fetus id potentially able to live outside the  Flash burn mother`s womb although with respiratory aid.  Radiation burns Elements of the crime:  That the expulsion of the product of Physical Injuries or Death by Lightning and Electricity conception is induced. Lightning and electricity:  That the fetus dies either as an effect of the Electricity: violence used, drug administered or the fetus was expelled before the term of its  Domestic lines: 100-250 volts viability. Abortion: Lightning: Clinical type:  Missed abortion  It is an electrical charge in the atmosphere.  Threatened abortion (cervix close)  1,000 million volts and about 2,000 amperes.  Inevitable abortion (cervix dilated)  Incomplete abortion Lightning:  Complete abortion A. Elements of lightning that produce injury: Kinds of abortion: 1. Direct effect from the electrical charge  Spontaneous or natural abortion 2. Surface flash burns  Induced abortion 3. Mechanical effect  Therapeutic abortion 4. Compression effect  Criminal abortion B. Points to consider:  Post-mortem abortion 1. History of thunderstorm How abortion is induced or procured: 2. Evidences in the surrounding  By general violence (inflicted or violent exercise) 3. Absence of other wounds and other injuries  By local violence Lightning: Classes of burns:  By the use of drugs (abortifacient)  By surgical intervention (D & C)  Surface burns Others: amniocentesis, vacuum suction  Linear burns Medical evidences of abortion:  In the living:  Arborescent or filigree burns  Presence of external signs of violence Medico-legal aspect:  Examination of generative tract.  Examination of instrument for the presence  Eliminate the possibility of a felonious act of another of blood, fetal parts person  History  Electrical shock:  Signs of previous pregnancy  Examination of the expelled product of Mechanism of death: conception  In the dead:  Ventricular fibrillation  Evidence of instrumentation  Respiratory failure  Examination of stomach and its contents  Mechanical asphyxia  Examination of the kidney and other organs for irritants Factors that influence the effect of electrical shock:  Examination of the uterine contents.  Biological test.  Personal idiosyncracy  Examination of some untoward effects of  Disease (cardiac) abortion.  Sleep  Infection, toxemia  Electrical voltage, amperage, density of current, nature  In the fetus: of the current  Blood examination for paternity and  Resistance of the body, duration of contact maternity.  Point of entry  Marks of instrumentation  Earthing  Signs of physical violence  Proof of viability or non-viability  Presence of abortive drugs Abortion  Presence or absence of malformation Abortion:  Completeness of the placenta.  Expulsion (forcible) of the contents of gravid uterus Grounds for therapeutic abortion: anytime before full term or age of viability.  Cardiovascular condition such as CHF, severe cardiac arrthymias, repeated hemoptysis. These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 21

 Renal condition such as Renal failure.  Complete examination shows marks of physical  Advanced TB violence.  Blood dyscrasias  Examination of the mouth and gastro-intestinal tract  Organic nervous condition such as psychosis shows signs of poisoning.  Diabetes, toxic goiter  Injuries to the air passages and lungs.  Hereditary insanity  Fractures of the bone, lacerations of internal organs.  Toxicology reports of internal organs. Reasons why it is difficult to prosecute physicians committing the crime of abortion: Paternity and filiation:  The crime is performed clandestinely. Paternity: civil status of the father with respect to the child  The physician has several reasons to justify the act. begotten by him.  The product of conception is removed or disposed. Filiation: civil status of the child in relation to its mother or father.  The pregnant woman is in connivance with the Legal importance:  For succession physician.  Medical society has a lukewarm attitude on abortionist.  For enforcement of the naturalization and Infanticide: immigration laws.  The killing of a child less than 3 days old. Paternity and Filiation. A. Medical evidence  Motives: 1. Parental likeness  To conceal dishonor 2. Blood group test  Financial reason 3. Evidences from the mother  Desired number of children has already a. proofs of previous delivery been attained. b. proofs of physical potency and fertility  Congenital abnormality of the child. c. proof of capacity to have access with the  Belief that the child will bring bad luck to the husband family. 4. Evidences from the father Criminological characteristics: a. proof of physical potency and fertility  It is most often committed by the mother. b. proof of access  The criminal act is almost always committed at home. B. Non-medical evidence  The crime scene has no disturbance. Parental likeness:  The trauma applied si so minimal.  General feature  A newly born child found dead was born dead.  Manner of gesture  Personal pecularities How the crime is committed:  Personal deformities  By omission or neglect  Gait, speech, movement  By failure to protect the child from heat or  Color and texture of hair cold  Color of the eyes  Failure to take the necessary help of a  General built and size midwife or a skilled physician Non-conventional method of procreation:  Failure to supply the child with proper food.  Artificial insemination: the semen is introduced into the  Failure to remove the child from the vagina by means other than copulation mother`s discharge which resulted to  In-vitro fertilization suffocation.  Artificial inovulation  Type of evidences in infanticide:  Embryo transplantation Prosecution must show the following proofs:  Parthenogenesis  That the child was born alive.  Cloning  That the child was deliberately killed. Artificial insemination:  That the child killed was less than 3 days Types: AIH, AID, AIHD old. Indications: failure of coitus, poor motility or paucity By commission: Selections: screening  Inflicting physical injuries. Precautions  Suffocation  Consent  Strangulation  Status of a child  Drowning  In vitro fertilization  Poisoning Procedure  Burning Possible situations  Deliberate exposure to heat or cold  Wife (fallopian tube is blocked)  Shaken baby syndrome  Husband  Shaken baby syndrome  Surrogate mother Post-mortem findings in infanticide:  Sperm donor Problems: These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 22

 Defective baby Methods of sterilization:  Problem of surrogate mother  Male: removal of testis, ligation of tubular  Status of the child passage of sperm (vasectomy) Basis of legality of in-vitro fertilization:  Female: removal of ovary, ligation of  Right of procreation fallopian tube  Right of marital privacy  Removal of uterus  Right to decide whether to bear or beget Causes of sterility: Male and female  Right of self-determination.  General: pre-pubertal age Marital union:  Local: congenital conditions, acquired  Causes of sexual dissatisfaction after marital union: (disease or trauma)  Fear of consequence of repeated abortion Disturbance of Mentality:  Fear of unwanted pregnancy Insanity: prolonged departure of the individual from his natural mental state. Inability to adapt oneself to the ordinary  Faulty contraceptive methods (inadequate environment. opportunity for orgasm) Factors having positive correlation with the development of  Dyspareunia (vaginismus, improper mental disorder. technique)  Heredity  Fear of coitus  Incestuous marriage  Emotional frustration due to fertility.  Impaired vitality  Ignorance of the reproductive process and  Poor moral training and breeding genital anatomy.  Psychic factors  Aversion to coitus. (frigidity)  Physical factors  No sex desire  Non-toxic  Anatomic cause of unsatisfaction in coitus  toxic (tight hymen, size and location of clitoris, Factors having positive correlation with the development of extreme obesity, infantile genital dev. mental disorder.  Disparity in age  Heredity  Venereal disease  Incestuous marriage  Masturbation preferred to coitus.  Impaired vitality- grief, mental worry  Infidelity  Poor moral training and breeding  Marital union and dissolution:  Psychic factors Causes of non-consummation of sexual act:  Physical factors  Septate hymen, thick hymen, fear of pain or  Toxic inability to stand pain, ignorance of genital anatomy,ignorance of sex technique, fear of  Non-toxic pregnancy, sense of shame regarding sex Manifestations of mental disorders: and coitus 1. Disorder of cognition (knowing) Contraceptive methods 1. Perception: illusion, hallucination  Condom, coitus interruptus, 2. Memory: dementia, amnesia douche,suppository, safe period, no sex, 3. Content of thought: delusion, obsession vaginal diaphragm,contraceptive 4. Trend of thought: mania, melancholia jelly,external coitus,lactation,abstinence, 2. Disorder of emotion (feeling) vasectomy Exaltation, depression, apathy, phobia, fear of illness Impotency and Sterility or death Impotency- is the physical incapacity of either sex to allow or 1. Disorder of volition or conation (doing) grant to the other legitimate sexual gratification. Impulsion or impulse (kleptomania, pyromania)  Causes: age, illness, emotion, hormonal Steps in diagnosis of mental affection: 1. Family history, personal history, information from dysfunction, congenital defects, disease or relatives, friends and neighbors. accident 2. Physical examination Sterility – is the loss of power of procreation 3. Instrumentations: EEG, CT scan  Absolute (azoospermia) and oligospermia 4. Mental examinations: Legal importance of impotency: Pyschological testing  Impotency, if proven, will overthrow the presumption of  Psychiatric evaluation legitimacy.   Impotency may be a ground for the annulment of Mental deficiency: Classification: marriage.  Profound: IQ under 20  Impotency maybe a defense in rape. Severe: IQ of 20-35  Impotency maybe a cause to the development of Moderate: IQ of 36-51 abnormal sexual behavior. Mild: IQ of 52-67  Impotency maybe a cause for the development of  Idiot :IQ of 0-20 suicide tendency. imbecile :IQ of 20-40 These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 23

Feeble-minded: IQ of 40-70 (moron)  50 mg% self-confidence, inhibitions, diminution of Moral defective attention, judgment and control. Methods of estimating mental capacity:  100 mg% Intoxicated; “under the influence”;mental  Intelligence tests confusion, incompetency  Intelligence quotient  150-300 mg% Loss of muscular coordination, slurred Other conditions manifesting disturbance of mentality: speech  Somnabulism  >300mg % Stuporous, loss of sphincter control  Semisomnolence  400 mg% Anesthetic level; death  Hypnotism or mesmerism Degree of intoxication:  Delirium  Slight inebriation: flushing Drug Dependence  Moderate inebriation: talkative, argumentative and Dangerous drug overconfident  Prohibited drug  Drunk: confused, movement uncontrolled, behavior  Opium, heroin and morphine uncontrollable  Coca leaf, cocaine  Very drunk: disoriented, motor incoordination, difficulty  LSD in speech  Regulated drug  Coma: stuporous or comatose  Sedatives Diagnostic point of drunkeness:  Amphetamines  Alcoholic smell of the breath or vomitus.  Hypnotic drugs  Dry furred tongue or with excessive salivation. Drug addiction:  Irregular behavior Is a state of periodic or chronic intoxication produced by the  Congestion of the conjunctiva. repeated consumption of a drug, whether synthetic or natural and  Hesitancy or thickness of speech with impaired found to be detrimental to the individual. articulation. Characteristics:  Tremor or error of coordination and orientation.  An overpowering desire or need  Examination of the blood and urine. (compulsive) to continue taking the drug or  History of having taken alcoholic beverages. to obtain it by any means. Physical test to determine drunkeness:  A tendency to increase the dose. Romberg`s test  A psychological and physical dependence  Let subject stand straight with one foot ahead of the on the effects of the drug. others. Compare.  A detrimental effect to the society and to  Let subject sit comfortably and get samples of individual. handwriting. Compare. Pharmacologic Classification of Dangerous Drugs:  Let subject bend down and pick up a small object from  Hypnotics the floor.  Opiates and their derivatives  Let subject walk straight forward to a corner of a room  Sedatives and tranquilizers and back without stopping.  Barbiturates, methaqualone, Blood alcohol level:  Hallucinations and psychomimetics  0.5 % or < - presumed not influenced by alcohol  Marijuana, LSD  0.5% to 0.10% - possibly under the influenced of  Stimulants alcohol.  Amphetamines,cocaine  0.10% to 0.15% - presumption that the person is  Deliriants and intoxicants drunk.  Skin popping: subcutaneous cocaine injection Why are chronic alcoholics able to tolerate better?  Subcutaneous hemorrhage: cocaine injection  Consumption tolerance  Diagnosis of drug dependence:  Constitutional tolerance  Blood AIDS/HIV  HIV infection  Acquired Immune Deficiency Syndrome (AIDS) Alcoholism:  Misconceptions  Made from ethyl alcohol formed out of the fermentation  Mode of transfer of various grains, fruits etc…  Best protection  Provisions of law regarding alcoholism.  Rights and duties of HIV carrier and AIDS victims: Classification of alcoholic beverages:  Discrimination in the workplace  Wine  Discrimination in school  Distilled liquor: whiskey, gin,rum, vodka  Discrimination in hospitals and health institutions  Malt liquors: ale, beer, stout  Responsibilities of infected individual Effects of alcohol:  10 mg% Pleasant clearing of the head. Death by asphyxia  20 mg% Physical feeling of well-being. Types of asphyxial death: These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 24

 Anoxic death  Inhibition of the respiratory center due to  Anemic anoxic death pressure ion the vagus and sympathetic  Stagnant anoxic death nerves  Histotoxic anoxic death Asphyxia by hanging: Phases of asphyxial death: Time required in the process of death depends on:  Dyspneic phase  Severity of constricting force  Convulsive phase • Jugular veins – 2 kilos  Apneic phase • Carotid artery – 5 kilos • Trachea – 15 kilos Classification of asphyxia: • Vertebral artery – 30 kilos  Hanging  Point of application of the ligature of the  Strangulation knot  Suffocation  Physical condition of the subject  Asphyxia by submersion or drowning Postmortem findings in hanging versus strangulation:  Asphyxia by pressure on the chest  Hanging  Asphyxia by irrespirable gases  Hyoid bone is frequently injured Asphyxia by hanging:  Direction of the ligature is inverted V shape  The constricting force is the weight of the body. with apex as the site of the knot Mechanism of death  Ligature is at the level of hyoid bone  Constriction of the larynx  Ligature groove is deepest at the opposite  Compression of veins and arteries side of the knot  Compression of nerves  Vertebral injury is frequently observed  The thinner and tougher the ligature, the more  Strangulation by ligature pronounced the mark in the skin  Hyoid bone is frequently spared  The presence of a noose  Ligature mark is usually horizontal  Application of ligature  Ligature is usually below the larynx.  Position of the knot  Ligature groove is uniform in depth in its As to the location of ligature: whole course  Typical  Vertebral injury is not observed  Atypical Asphyxia by strangulation: As to the amount of constricting force:  Strangulation by ligature  Complete  Ligature tightened by force  Partial  Common in infanticide As to symmetry:  Manual strangulation or throttling  Asymmetrical Manual strangulation or throttling:  Symmetrical Methods of throttling Ligature in hanging:  Manner of death:  Materials used in ligature  Blockage of air passage  Noose  Compression of blood vessels  Mode of application of the ligature  Compression of the nerves  Position of the knot  Suicidal throttling is not possible  Course of ligature around the neck.  Accidental throttling Hanging: Investigation  Common method in infanticide  The rule is that hanging is suicidal unless there are Special forms of strangulation: evidences to show that it is not.  Palmar strangulation  Determine whether hanging is ante-mortem or post-  Garroting mortem  Form of judicial execution  Presence of vital reaction  Mugging (strangle hold)  Determine whether hanging is accidental, homicidal or  As seen in wrestling suicidal  Presence of signs of struggle  Compression of the neck with a stick  Presence of other injuries or defense Asphyxia by suffocation:  wounds Occlusion of air from the lungs by closure of air Asphyxia by strangulation: openings or obstruction of the air passageway Compression of the neck by means of a ligature which is  Smothering maybe in the form of: tightened by force  Overlaying Causes of death:  Accidental smothering of epileptic  Asphyxia due to occlusion of windpipe  Gagging  Coma due to arrest of cerebral circulation  Plastic bag suffocation  Shock or syncope  Choking:impaction of foreign body in the airway: food, vomitus, dentures, blood These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 25

 Café`coronary  Presence of water and fluid in the stomach contents. Asphyxia by submersion or drowning:  Presence of froth, foam or foreign bodies in the air  Phases: passages.  Respiration de surprise  Presence of water in the middle ear.  Phase of resistance Floating of body in drowning:  Dyspneic phase  Body floats within 24 hours of death due to  apneic phase decomposition (gas formation).  Terminal respiration  Floating is with flexed extremities, head submerged  Causes:  “tete de nigre” – dark bloated face as seen in  Typical drowning- asphyxia decomposing body in water.  Atypical drowning-cardiac inhibition,  Compression asphyxia(Traumatic or crush asphyxia) laryngeal spasm, unconscious  Exchange of air is prevented by the immobility of the  Other condition – the body strikes a hard chest and abdomen due to external pressure or crush object in the water, intoxicated, presence of injury: cramps, cold exposure  Assailant may kneel on the chest of the Drowning: victim or between arms and legs as in  Average time for death to occur: 2-5 minutes; the wrestling. amount of froth in the respiratory tract is proportional to  Sudden fall of earth or masonry the length of survival.  Pinned under the rubble of a collapsed  Questions: building.  Did death occurs prior to entry in the water?  Crushed in a highway accident.  Did drowning cause death?  Crushed in crowd.  Were there any ante-mortem injuries? Traumatic asphyxia:  Were there any post-mortem injuries?  Burking:  Was there a natural disease or any  Burke and Hare evidence of poisoning?  Traumatic asphyxial death  What was the manner of death?  Sitting or kneeling on the chest of the victim  Post-mortem findings: with hands closed on the nostrils and  External findings mouth.  Clothes are wet, face is pale  No external marks  Skin is puckered, pale, contracted (cutis  Crucifixion anserina or gooseflesh) Asphyxia by breathing irrespirable gases:  Penis and scrotum are contracted and  Carbon monoxide retracted.  Carbon dioxide  Washerwoman`s hand and feet  Hydrogen sulfide  Mouth half-opened with tongue protruding  Hydrogen cyanide  Post-mortem lividity is most marked in the  Sulfur dioxide head, neck and chest.  War gases  Presence of cadaveric spasm Carbon monoxide:  In suicidal drowning, pieces of stone in the  Incomplete combustion of carbon fuel. pockets  Also called the “silent killer”  Postmortem findings:  Its main action is oxygen deprivation since  Internal findings: carboxyhemoglobin is 250X more stable than  “Emphysema aquosum” oxyhemoglobin.  “edema aquosum”  Symptoms include: mild headache, lethargy, fatigue,  “champignon d`ocume” convulsions and coma.  Painless deaths  Heart: the blood chloride content is greater  Use in judicial death by gas chamber. in the left side of the heart if drowning took place in salty water (Gettler`s test) Carbon dioxide:  Stomach: absence of water in the stomach  Product of complete combustion of carbon containing shows death is rapid or submersion is compounds. made after death.  Found in drainage pipes, deep wells, sewage tanks  Brain: congested  Symptoms include hypotension, anesthesia, muscular  Blood: difference in the chloride content, it weakness,coma, convulsions and death. becomes dark, decrease hemoglobin  Post-mortem findings: cyanotic face, swollen, frothy  Findings conclusive that the person died of drowning: mouth, pupils are dilated

 Presence of materials in the hands of the victim. Hydrogen sulfide: (H2S)  Decomposition of substances containing sulphur. (clenching)  Increase in volume and edema of the lungs.  Found in septic tank, sewers, deep wells or byproducts in some industries These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 26

 Colorless transparent gas with odor similar to a rotten • Diphosgene: intense lacrimator egg. Classification:  Produce irritation to the eyes, air passages followed by  Sternutator (nasal irritants or vomiting gases) headache, vomiting, cyanosis and labored breathing.  Causes coryza, nausea, headache,  Post-mortem findings: putrefaction is early, offensive vomiting, salivation and chest pain odor on opening the body  Paralysants (nerve gas) Hydrogen cyanide:  Blood poisons  One of the most toxic and rapid acting gases.  Naturally found in bitter almond, kernels of berry, Death of Physical Injuries due to Automotive Crash or plums, peaches, bamboo shoots, oil seeds and beans. Accident  As tablet: 60-90 mg is fatal  As vapors: symptoms within seconds and death within Factors responsible for automotive crash: minutes  Human factor  Post-mortem findings:Body is livid or violet in color.  Environmental factor Lividity is bright red or pink  Mechanical factor Sulfur dioxide:  Social factor  Colorless gas with pungent odor  Pedestrian  Found in eruption of volcanoes Human Factor:  Use as disinfectant, bleaching agent  Mental attitude  Causes irritation of respiratory system and eyes.  Reckless driving, inattention, fatigue, War gases: inexperience  Characteristics:  Perceptive defect  The substance must be heavier than air.  Defective vision and hearing  It must be capable of spreading rapidly on  Delayed or sluggish reaction time the area where the chemical effects is  Disease desired.  Driver suffer from epileptic fit or heart attack  It must be capable of producing effect even while driving in low concentration. Chemical factor  It may be a true gas, smoke, volatilized  Alcohol, drugs, marijuana, CO liquid or finely divided solid. Environmental factor:  It can be manufactured in big quantity.  Poorly maintained road, poor visibility, rain, blind  It must be stable substance or not easily intersection, parked vehicle, trees, absence of road made non-toxic by rapid chemical reaction. signs  It is capable of storage for an ample length  Stiff and slippery road prolonged sked time of time. Mechanical factor: Classification:  Defect in the steering wheel, poor brake, transmission  Lacrimator or tear gas failure,worn out tires  Causes irritation and copious flow of tears. Social factor: • Chloracetophenone (CAP)  Speed is an added dimension of our life. • Bromobenzyl cyanide (BBC)  Car insurances develop “devil may care” attitude • Ethyl iodoacetate (KSK) Collisions:  Vesicant or blistering gas  First collision  Contact with skin causes bleb or blister  Impact of a moving vehicle with another formation. vehicle or a fixed object. • Mustard gas sulfide (yellow  Second collision cross, “yperite”):dichlordiethyl  The impact of the unrestrained occupant sulfide; mustard like odor with the interior of the vehicle. • Lewisite (chlorovinyl-  Front impact crash: dichlorarsine):odor of geranium  Driver Classification:  Driver may strike the steering wheel,  Lung irritants (asphyxiant or choking gas) windshield, side window and the  When inhaled causes dyspnea, coughing, dashboard; “accordioned” car injuries vomiting, coma and death  Front seat passenger • Chlorine: yellowish green gas;  Like the driver; injuries include- abrasions pungent iritating odor; death is and lacerations in face and scalp, fracture due to laryngeal spasm. of the skull, crashing of the neck, laceration • Phosgene (COCl2): 10X more or rupture of the heart, lacerations and toxic than chlorine but has poor contusions of the heart, fracture of ribs and solubility sternum, laceration of liver and spleen. • Chloropicrin: 4X more toxic than  Rear seat occupants chlorine These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 27

 Strike the back of the front seat  From the victim  Side impact crash  Crush injury  Common in street intersections  Tire thread marks  Injuries more severe because sides of the  Abrasion marks car less rigid; ribs fractures, contusions and  Paint marks lacerations of the lungs  Blood, hair or clothings of the victim  Rear impact crash  Physical defects of the victim  Causes ‘whiplash” injury  Inebriation of the victim  Roll over crash Purposes of the autopsy:  Injuries from striking the interior of the  The examiner can give his opinion as to the deceased vehicle position in the vehicle or the pattern of the injuries  Because of process of rolling, severe correlated to the point of contact with the vehicle. injuries are rarely seen.  Examination will determine the true nature of the Homicide by motor vehicle: cause of death.  Simulation of a crash to conceal a prior homicide.  The examiner can form an opinion as to who from  Driver maybe shot while driving among them survived the longest. (survivorship) Pedestrian-vehicle collision:  The size of the monetary reward in a civil suit may  Primary impact: depend on the nature and extent of the injuries.  First contact between the pedestrian and the vehicle  If the impact is below the center of gravity, pedestrian moves toward the vehicle; AUTOPSY above the center of gravity, the body is Autopsy moving away from the vehicle. o It is a comprehensive study of a dead body,  Average height of bumper: 40-60 cms performed by a trained physician employing  Bumper fracture: fracture of leg bones recognized dissection procedure and  If brake is applied, injuries to the legs are techniques. Tissues maybe removed for lower. further examination and preservation.  Secondary impact: Autopsy vs Post-mortem Examination  Impact of the pedestrian to the ground after the first  Post-mortem examination- external examination of a impact. dead body without incision being made. Blood and  This accounts for the multiple contusions and body fluids maybe collected for examination. Autopsy- in addition to external examination, the body abrasions on the body.  is opened and an internal examination is conducted. Run over injuries: Kinds of Autopsies  Usually occurs in children  Hospital or non-official autopsy  May occur after the initial impact or thereafter  Medico-legal or official autopsy  Crash fracture, skid or tire marks, rupture of internal  Hospital Autopsy organs maybe seen Purpose: Hit and run injuries: o Determine the cause of death  Injuries sustained from vehicular accident with the o Provide correlation of clinical diagnosis and vehicle getting away from the scene without regard to clinical symptoms the unfortunate victim. o Determine the effectiveness of therapy  Thread marks, abrasion prints of parts of the vehicle o Study the natural course of disease process and paints detached from the vehicle found in the body o Educating students and physicians or crime scene may be compared with the suspect car.  Consent of the rightful person needed.  The suspect car maybe examined for blood stain, hair Medico-legal Autopsy and clothings.  Purpose: Evidences in vehicular crash: o Determine the cause, mode and time of  From the scene of the crime death.  Photographs of the scene; skid and tire o Recover, identify and preserve evidentiary marks on the road; condition and position of material. the victim;condition of the vehicle involved; o Provide interpretation and correlation of blood, paint stain; narration of the facts and circumstances related to death witnesses o Provide a factual, objective medical report  From the driver for law enforcement, prosecution and  Fitness to drive;alcoholic defense agencies drunkeness;injuries due to second collision o Separating death due to disease from death  Alcohol blood level: 0.15% and more due to external cause for protection of the considered drunk innocent.

These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 28

When shall an autopsy be performed?  Improper histological examination.  Whenever required by special laws.  Lack of toxicological or other laboratory aids.  Upon order of a competent court, a mayor and a  Pathologist incompetence provincial or city fiscal. CAUSES OF DEATH  Upon written request of police authorities. Cause of Death  Whenever the Solicitor General, Provincial or City fiscal as authorized by existing laws, shall deem it  It is the injury, disease or the combination of both necessary to disinter and take possession of the responsible for initiating the trend or physiologic remains for examination to determine the cause of disturbance, brief or prolonged, which produces the death fatal termination.  Whenever the nearest kin shall request in writing the authorities concerned in order to ascertain the cause Cause of Death of death.  Immediate (primary) cause of death: it is when trauma  Persons authorized to conduct autopsies: or diseases kill quickly that there is no opportunity for  Medical health officers sequelae or complications to develop.  Medical officers of law enforcement agencies  Proximate (secondary) cause of death:it is when the injury or disease was survived for a sufficiently  Members of the medical staff of accredited hospital prolonged interval which permitted to the development Guidelines in the performance of autopsies: of serious sequelae which actually caused the death. It should follow the protocols in conducting autopsies.  Mechanism of death  It must be comprehensive.  Bodies which are mutilated, decomposing or burned  It is the physiologic derangement or biochemical are still suitable for autopsy. disturbance incompatible with life which is initiated by  Autopsies must be performed in a manner which show the cause of death. Ex: hemorrhagic shock, sepsis, respect of the dead body. respiratory depression.  Proper identity of the deceased autopsied must be  Cardio-respiratory arrest should never stand as the established in non-official autopsy. cause of death.  A dead body must not be embalmed before autopsy.  The body must be autopsied in the same condition Manner of Death when found in the crime scene. Stages in the conduct of Autopsy:  It is the explanation as to how the cause of death  Preliminary examination came into being or how the cause of death arose. o Examination of the surrounding  Natural: death is caused solely by a disease. o Examination of the clothing  Violent or unnatural death: death due to injury of any o Identity of the body sort.  External examination Medico-legal Masquerade o Examination of the body surfaces Violent deaths maybe accompanied by minimal or no o Determination of the position and  approximation time of death external evidence of injury or natural death maybe accompanied by signs of violence.  Internal examination Degree of certainty to the cause of death: Mistakes in autopsies:  When the structural abnormalities established beyond  Error or omission in the collection of evidence for doubt the identity of the cause of death. identification.  When there is that degree of probability amounting to o Failure to take photographs, fingerprints almost certainty the cause of death.  Error or omission in the collection of evidence required  When the cause of death is established primarily by for establishing the time of death historical facts. o Failure to report rectal temperature.  When neither history, laboratory and anatomic findings  Error or omission in the collection of evidence required is sufficient to determine the cause of death but merely for other medico-legal examination. speculate as to the cause of death. (“probably”) Failure to collect nail scrapings, sample of o Instantaneous physiologic death: hair,, seminal fluid  Sudden death within seconds or minutes after a minor Error or omission result in the production of  trauma or peripheral stimulation. Circulatory failure is undesirable artifacts or in the destruction of valid caused by vagocardiac stoppage of heart and evidence. dilatation of blood vessels. (urination, kick in the o Using hammer and chisel to open skull scrotum) Negligent autopsy:  Death by inhibition: diagnosis by exclusion Failure to have an adequate history or facts and   Diseases with no pathognomic findings: circumstances surrounding the death. o Sudden infant death syndrome  Failure to make a thorough external examination. o Sudden unexplained nocturnal death  Inadequate or improper internal examination. These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 29

 For cases where there is no working diagnosis upon Penal Classification of Violent Death: death, the cause of death should be “undetermined”. A.Accidental death Medico-legal Classification:  Natural death  Death due to misadventure or accident  Violent death  Elements of provision: o Accidental death  A person is performing a lawful act. o Negligent death  He performed it with due care. o Infanticidal death  He caused injury to another by mere o Parricidal death  accident. o Murder  He is without fault and with no intention o Homicidal death  of causing it. Natural death  Affection of the CNS B. Negligent death  Affection of the circulatory system  Affection of the respiratory system o Death due to reckless imprudence,  Affection of the gastrointestinal tract negligence, lack of skill or lack of foresight  Affection of the genito-urinary tract C. Suicidal death  Affection of the glands  Sudden death in young children o Acts punishable in giving assistance to  If violence was applied on a dead person, the person suicide inflicting the physical injuries cannot be guilty of o The offender assisted in the commission of murder, homicide or parricide. suicide which was consummated.  If the violence inflicted on a person suffering from a o The offender gave assistance in the natural disease only accelerated the death of the commission of suicide to the extent of doing victim, the offender inflicting such violence is the killing himself which is consummated. responsible for the death of the victim. o The offender assisted another in the  If the victim died of a natural cause and the physical commission of suicide which is not injuries inflicted is independent of the cause of death, consummated. the accused will not be responsible for the death but merely for the physical injuries he had inflicted. D. Parricidal Death  To make the offender liable for the death of the victim, Requisite for the crime: it must be proven that the death is the natural o A person was killed by the offender. consequence of the physical injuries inflicted. o The person killed was the father, mother, or  The physician must determine for the interest of justice child whether legitimate or illegitimate in with absolute care at autopsy and laboratory relation with the offender, or other legitimate examination the real cause of death. ascendants, or descendants or spouse of Violent death the offender. The following should be established: E. Infanticidal Death o The the victim at the time the physical  Requisite to a crime: injuries were inflicted was in normal health. o A person was killed. o That the death maybe expected from the o The person killed was a child less than 3 physical injuries infected. days old. o That the death ensued within a reasonable F. Murder time. Requisite for the crime of murder. Classification of trauma or injuries: o The offender killed the victim.  Physical injury o The killing was attended by any of the  Thermal injury qualifying circumstances mentioned;  Electrical injury o There was the intent of the offender to kill  Atmospheric injury the victim. The killing is not parricide or infanticide.  Chemical injury o G. Homicidal Death  Radiation injury Requisite of the crime of Homicide: Infection  o The victim of a criminal assault was killed; Refusal of the victim to submit to a surgical operation  o The offender killed the victim without any do not relieve the accused from the natural and justification. ordinary result of the felonious act and does not relieve o There is the intention on the part of the him of his criminal liability. victim and such presumption can be  The presence of infection on the wounds inflicted if not inferred from the death of the victim. deliberately induced by the victim makes the offender also responsible for it.

These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 30

o That the killing does not fall under the  Male > female definition of the crime of murder, parricide  Usually occurs at home. and infanticide. Psychological classification of suicide: Death under special circumstances: o First degree – deliberate, planned  Death caused in a tumultuous array o Second degree – impulsive, unplanned  Death or physical injuries inflicted under exceptional o Third degree – “accidental” circumstances. o Suicide which suggest lack of capacity for  Pathological classification of the causes of death. intention.(ex. psychotics)  Death from syncope o Self destruction due to self negligence. o Death from sudden cessation of heart (reckless driving) action o Justifiable suicide (incurable diseases)  Death from asphyxia Evidences that will infer death is suicidal. o Death from low or absent oxygen in the  History of depression, mental disease or unresolved blood and tissues. personal problem.  Death from coma  Previous attempt of self destruction. o Death resulting from arrest in the function of  In committed by inflection of physical injuries, the the brain. wounds are located in areas accessible to the hand, Special Deaths vital parts of the body and usually solitary.  Judicial death  Others: presence of cadaveric spasm in in hand  Euthanasia holding the gun; bottle of poison;absence of signs of  Suicide struggle.  Death from starvation  Presence of suicide note.  Suicide scene in a place not susceptible to public view. Judicial Death Death from starvation:  Death by electrocution  Types:  Death by lethal injection o Acute starvation  Death by hanging o Chronic starvation  Death by musketry  Causes:  Death by gas chamber o Suicidal  Others o Homicidal o Beheading o Accident o Crucifixion o o Stoning BURNS Burns: 1st degree o Smothering - Burns: 2nd degree Euthanasia - Burns: 3rd degree Types of euthanasia - Burns: 3rd degree Active euthanasia o 1. Scalding burns . Active euthanasia in demand 2. Charred bodies: o Passive euthanasia 3. Chemical burn . Orthothanasia – when an 4. Chemical burn incurably ill person is allowed to 5. Electrical burn die a natural death without the 6. Electrical burns application of any operation or treatment. Indication for admission: . Dysthanasia – when there is an - 2nd and 3rd degree burns greater than 10% of total body attempt to extend the life span of surface area in patients under 10 or over 50 years of a person by the use of age extraordinary treatment without which the patient would have - 2nd and 3rd degree burns greater than 20% of total died earlier. body surface area in other age groups. Who may perform euthanasia  The patient himself. - 2nd and 3rd degree burns involving the face, hands,  The physician, with or without the knowledge and feet, genitalia, perineum and major joints consent of the patient.

rd Suicide: - 3 degree burns greater than 5 % in any age group.  It is an unfortunate consequence of mental illness and - Electrical burns, lightning injury] social disorganization. Rare in children, common in adults and elederly.  - Chemical burns These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 31

- Inhalational burns

- Burns in patients with pre-existing medical problems

- Burns patients with other traumatic injuries such as fracture, cerebral traum

-Burn injury in patients requiring special social, emotional and/or long term rebilitative support such as drug depedents.

These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members. 32

These are the official 2014 Gulp Club 7 Hand Outs for Legal Med prepared and released by members of the Gulp Club 7 and are distributed only in soft copy primarily and exclusively to the GULP CLUB 7 members.