9/9/2016

FORENSIC MEDICINE

Objectives

0 To be familiar with the tenets of forensic medicine

0 KTo determine the medico-legal aspectsof death

To determine the medico-legal aspects of Identification

To have a perspective of the different physical Injuries

To determine sexualabuse

i] WARNING

"some slides contain vivid pictures that may cause discomfort to the audience, viewers
discretion Is advised."

fTi

Objectives
JTo be familiar with the tenets of forensic medicine

|Fo determine the medico-legal aspects of death

Vb determine the medico-legal aspects of Identification

To have a perspective of the different physical Injuries
To determine sexualabuse

5[M] Definition: Forensic

foTen-sIc [fa renslk, fa xe\\z\W\adj

1. crime-solving: relating to the application of science to decide questions arising from

crime or litigation

[Mld-17th century. From Latin /&re/75/5"of legal proceedings/'originally "of the forum
(as a place of discussion)/'
6[Ml Forensic Medicine
Deals with the Interaction of medical science with.the law.
"Forum"

All branches of medicine can have forensic aspect.

The main objective Is the TRUTH based on the evidence.

7^ HISTORY OF FORENSIC MEDICINE

E Forensic Medicine/ Forensic Pathology/ Legal Medicine
It describes all aspects of forensic work Including both forensic pathology and clinical
forensic medicine

0 Forensic Pathology
Branch of medicine which investigates death
Clinical Forensic Medicine

Branch of medicine which involves an Interaction between the law, the judiciary and
police Involving living persons

sjMl HISTORY OF FORENSIC MEDICINE

0 China = In 1975 found bamboo pieces from Qin dynasty dating 220BC w/c had Info on
rules and regulations for examining Injuries

0 Iraq - Code of Hammurabi (king of Babylon) w/c dates 2200BC about rights and
duties of physicians including malpractice

9p) HISTORY OFFORENSIC MEDICINE

a
121

India = laws of Manu dating lOBC about competencies of witnesses in courts

Roman Egypt = papyri dating 4th century AD about forensic medical examination or
Investigation

10 p] FUNCTIONS OF MEDICO-LEGAL DIVISION

1. AUTOPSY
2. PHYSICAL EXAMINATION
3. ANTHROPOLOGY

4. ODONTOLOGY
5. HISTOPATHOLOGY
6. SEROLOGY
7. DNA
8. SOCO

9. COURT DUTY

10.RESEARCH, LECTURES

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ii|M| Medico-Legal Officer

Conducts physical examination on living persons (7 working days)
Conducts genital examination to determine sexual abuse and time of infliction of
injury.

Conducts physical examination persons involved in physical injury cases to determine

the presence and extent of injuries
Conducts physical examination of persons for investigation, detention or release
Conducts autopsies to determine the exact cause, manner, mechanism and
approximate time of death. (7 working days)
Conducts exhumation to determine the cause of death and identity of persons
Conducts SOCO processing to identify, collect, examine, and present before the courts
evidence at the crime scene

Conducts Field Laboratory Work

Appears and testifies in court as expert witness
Lectures to different police/military institutions, government agencies and
private/public schools
Orients and trains new personnel and on-the-job trainees on the mission, functions
and capabilities of the division;

12[M1

Odontological Examination
Examination of human dentition and applying the characteristics in identification of
individuals (5 working days)
Histopathological Examination
To determine the cause of death thru microscopic tissue examination (28 workings
days)
Serological Examination
To determine presence of human blood,type and characteristics
To determine the presence of semen (4 working days)

13 [Ml Requirements to be a
forensic investigator
College graduate (passed CSC, NAPOLCOM)
Preferably with PRC: criminology, medical technology, chemistry, doctor of medicine
In house training program.
Most specialized area in Crime Lab has no counterpart academic program locally.

hIMI Objectives
B To be familiar with the tenets of forensic medicine
g]

To determine the medico-legal aspects of death

To determine the medico-legal aspects of identification
To have a perspective of the different physical injuries
To determine sexualabuse

15 IP MEDICO-LEGAL DEATHS
1. VIOLENT DEATHS

- accidents
- suicides
- homicides

2. SUSPiaOUS DEATHS

3. SUDDEN UNEXPECTED DEATHS /

MEDICALLY UNEXPLAINED DEATHS
4. UNATTENDED DEATHS

16 Ig! MEDICO-LEGAL DEATHS

5. DEATH IN CUSTODY

6. POISONING
7. POSSIBLE THREAT TO PUBLIC
HEALTH

8. DEATH RELATED TO EMPLOYMENT

9. DEATH ASSOCIATED TO

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THERAPEUTIC AND DIAGNOSTIC

PROCEDURE

17g] MEDZCO-LEGAL DEATHS

10. UNLAWFUL TERMINATION OF
PREGNANCY
11. BODIES TO BE CREMATED

12. UNCLAIMED CADAVERS

13. SUSPiaOUS CHILD DEATHS

14. UNEXPECTED DEATH OF PUBLIC

OFROAL

18 [^1 Introduction to medico-legal case work

Five categories of medico-legal cases
1. Violent deaths

2. Suspicious deaths
3. Sudden and unexpected
4. Unattended death

5. Death in custody

19 [M] Objectives of medico-legal examination of a bodyare:

1. To determine the cause of death
2. To determine the manner of death
3. Estimate the time of death

4. To document all findings

5. To determine or to exclude other fectors
6. To collect trace evidence in criminal cases

7. To positively Identify a body

8. To testify in court
9. Interpret findings
10.

zoiWj Autopsies
Comprehensive study of a dead body, performed by a trained physician employing
recognized dissection procedure and techniques.
Removal of tissues for further examination

21 [M] Kinds of autopsies

Hospital or non-official autopsy
Medico-legal or official autopsy
22

Kinds of autopsies
A. HOSPITAL/ NON-OFnCIAL AUTOPSY
0 Consent from relatives

Spouse, descendants of the nearest degree, ascendants of nearest degree, brothers

and sisters (decreasing order)
23Kinds of autopsies
A. HOSPITAL/ NON-OFFICIAL AUTOPSY

Purpose:
Determine cause of death

Provideclinical correlation of diagnosis and clinical symptoms

Determine the effectiveness of therapy
Study natural course of the disease process
Educating students and physicians

24 [M] Kinds of autopsies

B. MEDICO-LEGAL or OFRCIAL AUTOPSY

oDead body belongs to the state for protection of public interest

All that needs to be turned over to the next of kin would be burial of the deceased

25[Ml Kinds of autopsies

B. MEDICO-LEGAL or OFRCIAL AUTOPSY

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" Purpose:
Determine cause, manner and time of death

Recovering, identifying and preserving evidentiary matet iai

Providing interpretation and correlation of facts and circumstances related to death

Providing a factual, objective medical report for law enforcement, prosecution and
defense agencies
Separating death due to disease and death due to extemal cause

26

Difference of Hospital
and Forensic Autopsy

27

When shall an autopsy be performed on a dead body

Whenever required by special laws
Upon order of a competent court, a mayor and a provincial or city fiscal
Upon written request of police authorities

Whenever the solicitorgeneral, provincial or city fiscal as authorized by existing laws

shall deem it necessary to take possession of the remains and determine cause of
death

28 [Ml Persons who are authorized to perform autopsies and dissections

Health officers

Medical officers of the law enforcement agencies

Members of the medical staff of accredited hospitals

291^1 Cause, Manner, Mechanism

1. Cause of Death: Disease or injury that results in the individual dying.
- COD: Cardiopulmonary arrest. X
Cardiac Arrest. X

2.

Manner of Death: How the cause of death came about.

a. Suicide

d. Natural

b. Homicide

e. Undetermined

c. Accident

30

Cause, Manner, Mechanism

Manner of Death: Examples

- homicide: sepsis due to GSW
- poisoning?
- rabies?

- boxing?
- therapeutic misadventures?
- electric chair?
- traffic accident?

sijMI Cause, Manner, Mechanism

Manner of Death: Examples
- Death by fear?
- Post-traumatic seizure disorder?

- Failure to prescribe meds?

-HIV?

32

Manner of deaths that must be autopsied:

Death by violence

331^1 Manner of deaths that must be autopsied:

Sudden death of persons who are apparently in good health

34IM] Manner of deaths that must be autopsied:

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0 Suicide

35 @ Cause, Manner, Mechanism

36IM) 3 steps in medico-legal investigation

1. Circumstances

-witnesses
-history

-investigators
-the scene

-medical records

2. Examination of Body
-search!

3. Laboratory test
-ballistics

-toxicology

37[Ml Ex. body search

38 [Ml Handling of bodies
1.
2.
3.
4.

Document first- photos, sketches

Minimal handling of the body
Protect the hands- use paper bag

Wrap the body in white clean sheet/ cadaver bag

5.
1.
1.
I.

39

Handling of bodies
5. Encircle the injection sites
6. In the hospital, don't remove tubes

7. Document the location, number of injuries

8. Medical records/ procedures done must accompany tiie body

40 g) Con't
9. In the morgue, must log the case, include
Who brought the body, what time, who received it

10. Don't wash the body! Examining the clothing is an important part of autopsy.
II. Photo before and after cleaning the body.
Re-examine after cleaning.
12. X-ray: GSW and child abuse

41 gj Con't Handling of bodies

13. Photo with ruler each injury.
14. Internal examination-autopsy proper
15. Lab test: toxicology, histology, neuropathology,
microbiology, serology, ballistics

16. Lastly, fingerprint and palm print

42 gj AUTOPSY REPORT
S External Examination

- age/sex, race, physique, height, nourishment

-Congenital malformations

-Brief description of clothing

-General description of body state
Degree of rigor/livor mortis

Hair (length and color), facial hair, alopecia

Eye appearance, eye color, teeth, dental plates, scars, tattoos, old injuries
unrelated to death, evidence of recent medical intervention

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43 jM] Con't Autopsy

II. Evidence of Injuries

-external and Internal injuries

-GSW: assign number, location, characteristics, trajectory

-pertinent negatives
-entrance and exit

-describe the slug, location

-all bullets should be recovered

44 [g Con't autopsy
III. Internal Examination

-weight of organ Is Important, dimensions of organs not needed.

IV. Microscopic Examination
V. Toxicology
VI. Findings
VII. Opinion

45 fM] Con't Autopsy

46 [M] Physical Evidence

a. Biological evidence
- Blood
- Semen
-Hair

- Tissue

- Fingernails
- Bite marks

- Saliva

47 g) Con't
B. Non-biological evidence
-clothing
-bullets
-fibers

-paint
-glass
-soil

48 jg] Procedures for collection of biological evidence

Blood for DNA -lavender top test tube (EDTA)
Dried blood-scrape and put Into the test tube
If wet, use sterile gauze pad then air dry
Semen: 2 cotton tipped swabs; 2 smears

If dry, moistened with saline solution then air dry

49 [Ml Con't
Hair: note the location where you got It
0 control hairs taken from the cadaver

Pubic hair should be combed forforeign hairs and samples of victim's pubic and scalp
hair must be collected
DNA test can be done on the hair bulb

soj^ Con't
Tissue- put In sterile tube and refrlgirate
Fingernails- cut off the ends of the finger nails. Broken nails found on the scene can
be matched

Scraped epithelial cells underneath the nails can be tested for DNA.

Bite marks: swab the bite with sterile gauze moistened with saline solution

Take photos with ruler

51

Procedures for collection of non-biological physical evidence

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A. CLOTHING: do not cut, air dry; place In paper bag, label for submission
B. BULLET: don't use forceps to pick up the bullet. Markings are Inscribe on the tip or
base. Don't remove foreign material

C. RBER /PAINT/ GLASS: collected for comparison. Tested for chemical composition and
other characteristics
ex. refraction Index

52 [M] Timeof Death-Decomposition

I. Factors used In estimating time of death

-llvor mortis (post mortem livldlty)

-rigor mortis (muscle stiffening)
-algor mortis (body temp)
-vitreous (eye) potassium
-stomach contents

-environmental factors

53

Philippine Criteria of Brain Death

I. An Individual who has sustained:

A. Irreversible cessation of circulatory and respiratory functions; or

B. Irreversible cessation of all functions of the entire brain. Including the brain stem

54g] UVORMORTIS
55 [M] LIVOR MORTIS
Reddish, purplish blue color
Begins In 30 mins
Intensifies over time

May result In post mortem petechlae

Its not a contusion
Llvor vs contusion?

56 |B|

57 g] RIGOR MORTIS
Stiffening of the body after death
Due to postmortem muscle contraction

0Depletion of ATP

stable complex of actin and myosin

begins within 2 hours after death

.jaw
face
upper ext
6-12 hours - full rigor mortis

lower ext

58 |M) RIGOR MORTIS

Lost due to decomposition
0Temperate climates - persists for 36-48 hours
Warm climates - persists less than 24 hours

Cold weather - persists for several days

Cadaveric spasm-rare

59 [g BODY TEMPERATURE
S Algormortis
35.6C-38.2C

Not accurate If used solely

Body cooling Is not uniform
Does not follow a linear pattern
Fastest during first 2 hours

Body habitus may Influence rate of cooling

HI Infants cool faster due to body mass/surface area ratio
Higher in girls
Obese cools at lower rate

60

The following rules of thumb may be used in conjunction with the cadaver's

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state of rigor mortis (with caution):

61 iWi Vitreous Potassium

E Determined by degree and rapidity of decomposition

Accelerated decomposition raises potassium level
Time is only one factor so unreliable solely

62 [M| STOMACH CONTENTS

Gastricemptying varies from person to person, amount of meal and time of the day
Half gastric emptying time: 4 hrs
Stress will delay digestion

63 [Ml Factors influencing the position and condition of the decedent's last meal
Size of the last meal

The stomach usually starts to empty within 10 minutes after the first mouthful has
entered.

light meal -11/2 to 2 hrs

medium sized meal - 3 to 4 hrs

heavy meal 4 to 6 hrs

64ENVIRONMENTAL FACTORS

Insect activity- from egg stage to adult stage.

How long he has been dead? Any guess?

65

DECOMPOSITION

Autolysis: - aseptic breakdown

- pancreas

Putrefaction: breakdown due to bacteria

1st sign is greenish color of LQ abdomen

greenish-black color of face/neck
swelling
protruded eyes and tongue
purge fluid

66 [Mi Cont: decomposition

Gas formation- slippage of skin with blister and marbling (rxn of hgb and hydrogen
sulfide). Skin from green to black.
Hair will slip from the scalp
brain: liquefied
Decomposition: after 24hrs in hot weather while slower process in a wk or 2 in
temperate climates
Skeletonization: a week to years
Adipocere: fats will undergo fatty acid transformation
67CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN
TROPICAL REGIONS

685 CHRONOLOGICAL SEQUENCE OF PUTREFAOIVE CHANGES OCCURING IN

TROPICAL REGIONS

69

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES WHEN THE BODY

HAS BEEN SUBMERGED IN WATER

705 Objectives
$ kTo be familiar with the tenets of forensic medicine

To determine the medico-legal aspects of death

To determine the medico-legal aspects of identification

To have a perspective of the different physical injuries
To determine sexualabuse

71 [Ml Identification of bodies

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a.

non-sclentific methods

-by relatives, friends

-by documents, clothing, scar tattoo
-jewelries
-by exclusion
a.

72Con't ID of body
b. Scientific methods

-fingerprints
-dental Identification

-DNA testing
-ante and postmortem x-rays

73 [M] ID of Remains
Importance of ID

0 filing / prosecution of case

0 filing of death certificate
0 Insurance claim

0 Repatriation
o Peace of mind

among relatives

74 @ I. Intact Human Remains

Scientific:

1. flngerprlnt-

" Mostdesirable system to establish positive Identity

Based upon classification of finger ridge patterns
- complete set Is needed In forensic cases

3 fundamental principles:
No two fingerprints have yet been found to possess Identical ridge characteristics
A fingerprint will remain unchanged during an Individual's lifetime
Fingerprints have general ridge patterns that permit them to be systematically
classified

75

Con't Intact Human Remains

2. Dental: 2"^ most reliable. X-ray, Desirable

-metal filings, sinuses, bony structure, roots
-Ideally charted, photographed and x-rayed
before the body Is released
- Antemortem record must exist for comparison
76 [M] Dental
Humans have 20 deciduous (baby) teeth
4 maxillary Incisors, 4 mandlbular Incisors
0 2 maxillary cuspids, 2 mandlbular cuspids
4 maxillary molars, 4 mandlbular molars

EXAMPLE: (dental eruption)

1. Mandlbular Incisor: usually at 6-7 months
2.
molar: 17-24 years old

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77|B| Dental

Humans usually develop 32 permanent

teeth

-4 maxillary, 4 mandlbular incisors

-2 maxillary cuspids, 2 mandlbular cuspids

-4 maxillary premolar, 4 mandlbularpremolar
- 6 maxillary molars, 6 mandlbular molars

"

78Con't Intact Human Remains

3. Radiographs: such as sinuses, prosthesis, etc.

4. DNA: deoxyribonucleic acid
- each person is unique
- except for monozygotic twins
- Blood: tube with EDTA, stored at 4C

79(9 NON-SCIENTIFIC METHODS OFID

1. Comparison of physical attributes

2. Distinctive marks- tattoo, scar, jewelry

3.

Visual ID

4. Circumstancial evidence- dentures, wallet, clothes, eyeglass

8019 Decomposed, Charred, Non-skeletonized Human Remains

Scientific

Fingerprint: remove the skin

Dental x-ray
Total body radiographs- bullet

DNA: muscle, marrow, molar-dental pulp

81 (9 Con't decomposed or charred bodies

Non-Scientific

1. Hydrogen peroxide (Agua oxinada) - to clean the skin to see tattoo

2. Carefullyobserving the jewelries
3. UV or infrared light may show tattoo
82 |M] Skeietal Remains
-determine if it is human!

- Then get DNA- bone with marrow

- Collectthe clothing, jewelry, personal

effects

- Forensic anthropologist- may determine the sex, race, age, height.

83(9 NATURAL DISEASE

^Causes of sudden natural death in adults

" sudden, unexpected death due to natural disease is relatively uncommon between
ages of 1 and 30."
Sudden death: died within 24 HRS

84 [M] Sudden Deaths

Instant

Non-Instant

- W/in seconds

85 9

-W/in minutes

I. Causes of sudden natural death in adults

A. CAD - 75% of all sudden deaths

- mechanism of death: fatal cardiac arrhythmia. 80% from ventricular Arryh.

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20% from asystole

- most common autopsy findings:

coronary artery atherosclerosis.

- for death to occur 75% of coronaries must be blocked

86 [Ml Con't Sudden death

CAD

- 2^ most frequent findings: Ischemic fibrosis

- Infarcts <24Hrs, "wavy fibers."
- Arrhythmia, no gross findings.
- Cause of Death: Arterioscierotic Cardiovascular Disease (ASCVD)
87 [Ml Con't of Sudden death
B. Hypertensive Cardiovascular Disease

- heart >350 gm
- associated with renal findings and coronary atherosclerosis.
C. Cardlomyopathles
- congestive (CHF) dilated cardlomyopathy
-asso. with chronic alcohol abuse

-perl / post partum cardlomyopathy

88|M| Con't Sudden death
-Hypertrophic Cardlomyopathy: enlarged but not dilated. Thickened septum
-50% Is autosomal dominant

-history of dropping dead during exercise

-Restrictive Cardlomyopathy-least common
-amyloldosis
-sarcoldosis

-glycogen storage disease

-hemochromatosis

89 jM] D. Other coronary artery abnormalities w/c may cause sudden death

Coronary artery spasm-prlnzmetal angina

Coronary artery dissection
Congenital anomaly

90 I'M] E. Valvulardisease that may cause sudden death

Floppy mitral valve- myxold degeneration

Calclfic aortic stenosls-RHF
endocarditis
!

91F. Myocarditis

Infectious- multiple sections of the heart for histopath

Hypersensltlvlty
Giant cell myocarditis

92 [M| G. Abnormalities of aorta

Acute aortic dissection- asso. with atherosclerosis and hypertension

Syphllyticaortic aneurysm

93 jM] II. Central Nervous System Disorder

A. Epilepsy- negative autopsy

oMay have bite wounds to the tongue in 25 %

Mechanism of death: cardiac arrhythmia.

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" Accidental if drowns or fell from height.

B. Subarachnoid Hemorrhage
- Ruptured berry aneurysm- congenital

94

CNS Disorders

C. Intracerebral Hemorrhage (stroke)

-mostly due to hypertention
D. Cerebral Inferct (stroke)
-less frequently asso. with sudden death
E. Meningitis:
- menlngococcemia: h'gic adrenals
F. Hydrocephalus

G. Psychiatric D/0: schizophrenia

95 [M] ni. Respiratory

Infrequent, 10% of sudden deaths
a. Pulmonary thromboembolism
-varicous veins

-bed ridden

-pregnancy
-OCP

b. Amniotic fluid embolism

96|M| Con't respiratory

c. Asthma

- usually die at night or early morning

- autopsy findings: hyper-inflated lungs
- get more sections from the bronchial tree

for histopath. Eosinophils

d. Pneumonia: uncommon for sudden death

e. Acute epiglottltis: edema of epiglottis

97 iM] Con't respiratory

f. Massive hemoptysis - PTB

g. Spontaneous pnemothorax
- due to emphysematous bullae
- autopsy: one lung is collapsed

98 [g ASTHMA DEATHS
a

EPIDEMIOLOGY
20% children

5% adults

Increasing
prevalence
SD RISK FACTORS

Increasing age
Increasing disease severity
Low socio-economic group
Inner city living
Smoking/drugs/alcohol

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No spouse

No meds/prescription
Poor compliance/ denial
Overlooking nocturnal symptoms

99 (M) AUTOPSY IN SUSPECTED ASHTMA DEATHS

Scene. Presence of inhalers

History - absent/ incorrect; allergen?

latrogenic cause- bronchoscopy /
beta blockers

External- exclude trauma/ subcutaneous emphyjema

Internal- pneumothorax?

Lungs- hyperinflated, outline of ribs, resist pressure to collapse, petechlal h'ge, airway
plugging, edematous mucosa

100 |M] ASTHMA

CAUSE OF DEATH DETERMINATION

Asthma as cause of death is not enough

Need evidence of disease severity
ex.

Mucus plugs
severe Inflammation

Inadequate treatment history

compliance problems

101

ASTHMA-DIFFERENTIAL DX

PULMONARY EMBOLISM- wheeze Iscommon but no mucus plugging, no Inflammatory

cells.

COPD- may co-exist w/ BA. Visible In microscopy. RVH common In COPD

Sickle cell- crisis may be precipitated by severe BA.

Anaphylaxis- edema, plugging, hyperlnflatlo. But no airway remodelling.
102 |M] IV. Gastrointestinal - sudden death
a. Massive hematemesis

- vomiting of blood
-

Asso. With alcoholism

b. massive stomach bleeding

- ulcer

c. Strangulated hernia
- may lead to Intestinal infarct, peritonitis

103 |M] Con*t gastrointestinal

d. Diabetes mellltus

- don't do post mortem blood sugar

- vitreous sugar level must be

>200mg/dl

e. Pancreatitis

- Usually hemorrhagic
- asso. With alcohol Ingestlon

- mechanism of death: electrolyte Imb.

104 [Ml

105 |M] pancreatitis

Cardinal symptom: abdominal pain, mild to severe
Resultsto leukocytosis, hemolysis, DIC, fluid sequestration, ARDS, diffusefat necrosis.

Electrolyte Imbalance, endotoxemla, release of q^oklnes &vasoactlve agents (NO, PG,

PAP)

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106 jM] pancreatitis

CAUSES

y Cholelithiasis
Chronic alcoholism

Drugs/medications
trauma

Ischemia
Virus

genetics

107 [M] V. Liver Diseases-sudden death

a. Liver: Massive fatty change
-asso. w/ chronic alcohol abuse
-mechanism of death: metabolic cause

or electrolyte imbalance
-advance cirrhosis

108 @1 Con't Liver

b. non-traumatic abdominal hemorrhage
- liver shows micronodular cirrhosis

109 |MI VII. Spleen

Rupture

-Undiagnosed leukemia
-malaria

-infectious mononucleosis

Absence of spleen

110 [M] VIII. Miscellaneous sudden causes of death

Rupture tubal pregnancy
Undiagnosed cancer

iiilM] Sudden Death in Children

I. Sudden infant death syndrome (SIDS)
-crib death

-negative autopsy

-between 1 week and 1 year old

-prone sleeping position
-cause unknown

-scene investigation should

be done

112 |M] Sudden Infant Death Syndrome

- incidence: approximately 2/1000 live births in US
- greatest no. of death: 2 and 4 months of age
- season: winter

- premature infants are at high risk

- Maternal risk factors:
Low socioeconomic

<20y/o at
pregnancy
Cigarette and smoking during and after pregnancy
Use of illicit drugs
- Scene investigation:
1. Age of infant: prior birth and medical hx., immunization hx.
2. Last time infant was seen alive, time found deceased or unresponsive
3. Last time infant was fed, amount and matter, and by whom
113

4. How was the infant put down ( position and bed coverings), how
found

5. Was infant sleeping alone

was infant

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6. The type and condition of bed and mattress

7. Temperature of room
8. Was resuscitation attempted
9. Recent health of infant

10. Was the infant currently taking medications, prescriptions and

non

prescriptions
11. Had other family members been sick
12. History of other SIDS death In the family

1141^1 Objectives
S To be familiar with the tenets of forensic medicine

To determine the medico-legal aspects of deatn

To determine the medico-legal aspects of Identificatloti
To have a perspective of the different physical Injuries
To determine sexualabuse

115 [M] Wound

A break or solution In the continuity of the skin or tissues of the body.
Types:
o Close wound

Open wound

116 |M1 Blunt Force Injury

Definition: Injury produced by blunt object striking the body or Impact of the body
against a blunt surface.
Severity due to several factors
Nature of weapon
oAmount of body surface
Amount of force
'Time

' Region

117 g] Close Wound

- wound where there is no break In the overlying skin or tissue.
a. Superficial close wound
1. Petechiae
2. Contusion
3. Hematoma

b. Deep close wound

1. Sprain
2. Fracture

3. Dislocation
4. Concussion

5. Internal Hemorrhage
118

Superficial Close Wound

1. Petechiae - minute, pin-point, circumscribed extravasation of blood In the

subcutaneous tissues or underneath the mucuos membrane.

119 [M] Superficial Close Wound

2. Contusion (Bruise) - discolorations of the skin caused by bleeding Into the tissues
from ruptured blood vessels.
120

Color changes of contusion

Color is not always reliable
Red, violaceous, purple, dark blue
Hemoglobin: broken down to color green, dark yellow, pale yellow
Resolve from days to weeks

1211"^ Superficial Close Wound

3. Hematoma - large extravasation of blood In a newly formed cavity secondary to
trauma characterized by swelling, discoloration of tissues, and extravasation of blood
underneath the tissues.

122

Deep Close Wound

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1. Sprain - straining or tearing of the articular tendons, ligamentsand muscles

characterized by swelling, discoloration of tissues involved and extreme pain.
123

Deep Close Wound

2. Fracture - it is a break solution in the continuity of the bone tissue resulting from
violence or from some existing pathology.

124 iM| Deep Close Wound

3. Dislocation - displacement of the articular surfaces of the bones forming the joints
usually secondary to trauma.

125 [Ml Deep Close Wound

4. Concussion - resulting from a sudden jarring or stunning.of the brain which follows a
head injury.

126|M] Deep Close Wound

5. Internal Hemorrhage - bleeding usually in the cavity or organs inside the body.
127 [Ml Open Wound
- wound where there is break in the overlying skin or tissue.
1. Abrasion
2. Incised wound
3. Lacerated wound

4. Punctured wound
5. Stab wound

6. wound produced by explosion of explosive

material

7. Avulsion

8. Gushot & Shotgun wound

128 [Ml Open Wound

1. Abrasion - An injury to skin in which there is removal of the epidermis by friction
against a rough surface or destruction of the superficial layers by compression.
>Antemortem abrasion

reddish brown appearance

Heal without scarring
Postmortem abrasion -

oYellow, translucent, parchment iikeappearance

129

130

Types of abrasions

1. scrape abrasions- scraping type of injury. Ex. Dragging abrasion, scratches

2. Brush burn abrasion- commonly use in large area of the body
3. Impact (pressure) abrasions: skin crushed by force.
4. Patterned abrasion: pattern of object imprinted on the skin.

131 |M| Stages of Healing

1st stage: Scab Formation, within 24 Hrs

2"d stage: Epithelial Regeneration.

visible in 3rd day post injury
3"^ stage: Subepidermal Granulation.
5-8 days

4^ stage: Regression. Dec. vascularity

12 days post injury

132 iM] Open Wound

2. Incised wound - produced by forcible contact with a sharp-edged instrument

characterized by gaping smooth edges of the wound; sharp extremities; shelving and
profuse bleeding of the wound.

133 [Mi Open Wound

3. Lacerated wound - produced by blunt instrumentand is characterized by irregular
edges of the wound.

134[Ml Laceration

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135 |M| Open Wound

4. Punctured wound - produced by sharp-pointed instrument and Is characterized by

small opening of the wound.

136 |M] Open Wound

5. Stab wound - produced by sharp-edged and sharp-pointed Instrument.
137

6. Avulsion - Aform of laceration ripping the skin and soft tissue off the underlying
fascia or bone.

138 [Mi Blunt Force Injury to the Chest

May have severe Internal Injuries sans external evidence.
Rib / sternal fractures: maybe due to CPR
Cardiac rupture due to steering wheel

139Blunt Force to the Abdomen

Liver most frequently Injured

-transcapsular vs subcapsular
Spleen: minimal force may cause rupture In typhoid, malaria, IM, hemophilia, leukemia
Kidney: most common Is contusion

140 iM| Skeletal Fractures due to Blunt Force Trauma

2

direct

trauma

- Focal: transverse

- Crush: comminuted

- Penetrating: GSW
Indirecttrauma

-Traction: bone pulled apart

-Angulatlon: transverse

-Rotational: spiral
-Vertical Compression

141IM] Extremities Injury due to Blunt Force Trauma

"Bumper fracture"
-must measure the location from the heel

Complication of fractures:
-fat embollzatlon: seen in histopath sections of the lungs
Defense and Offensive wounds

142 iM] Head Injuries Caused by Blunt Force

Epidural Hematoma
Subdural Hematoma

Subarachnold H'ge
Intracerebral H'ge

143 |M| Epidural hematoma

90% of cases with skull fracture

Usually temporal bone

Usually damage to the menlngeal artery, rarely from vein.
Unilateral
30% with loss of consciousness

144 [@| Subdural hematoma

Acceleration-deceleration injuries

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Due to tearing of parasaglttal bridging veins

Common in elderly and alcoholics
75% due to fall

Fracture maybe absent

50 ml of blood may cause death
Liquified/seroma: 3-4 wks old

145[Ml Subarachnoid hemorrhage

Most common injury of blunt trauma
Minor or severe

Focal or diffuse

Hyperextension of neck

Damage to vertebral / basilar artery

146 |M1 Intracerebral hemorrhage

Blunt force injury
Asso. with skull fracture

Sypmtoms maybe delayed

147IM"! Biunt force injury to the head

Scalp : will show the extent of injury

148 |M| Con't
Skull fracture does not always correlate with brain injury
Death due to brain injury can occur w/o skull fracture

149 [M] Con't Head Injuries

Cerebral Contusion
Cerebral Laceration

Diffuse Axonal Injury

Cerebral Concussion

Cerebral Swelling

150

Cerebral contusion

Bruise of the external surface of the brain

Coup: along the point of impact

Contrecoup: opposite the point of impact
common than coup
Asso. With falls

151 [M] Cerebral laceration

Massive skull trauma

More common in infants

Must determine if its artefactuai

152IM] Diffuse axonal injury (DAI)

Whiplash injury- stretching or shearing of brain cells
History of prolonged coma more than 6 hrs
Not asso. With bleeding

Notvisible in histopath until after 12 hrs post injury

153 [M] Cerebral concussion

Mild- amnesia

Severe - transient loss of consciousness

Less than 6 hrs

Diffuse brain injury, disturbance of neuronal activity

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154 [Ml BrainSwelling

Compiication of blunt trauma of the head

Increase in blood supply or

Increase In water content (edema)

Cause of death Is cerebral herniatlon

155 jB! Blunt Force to the Neck

Alteration in the normal alignmentof the

cervical vertebral column

Hyperflexlon (chin to chest)

Hyperextenslon (head backwards)
Compresslve (head landing)
Torsion

Elongation (Hanging)
Axis or C2, most commonly Injured

156 [M] Sharp Wounds

Stab wounds
Incised wounds

Chop wounds

157 [Ml Stab wounds

Produced by pointed Instrument like knife or Ice pick

Skin markings may tell the type of weapon used
Homicidal, suicidal or accidental
Defensive stab wounds

158 [a] stab wounds

It Is common for stab wounds to be altered by surgeons.

MELO must determine Ifpx was brought to hospital
Don't remove the knife from the body unless fingerprint was taken.
Examine the clothes

Post-mortem SW- yellow to tan In color

159 [M] Incised wounds

Wound produced bysharp weapon. Wound is longer than the depth.

Lacking bridging tissue
Usually not fatal
Defensive Incised wound

160 [Ml Chop wounds

Caused by heavy instrumentor weapon

Ex. Axes, machete, meat cleaver

Incised wound with bone cut/groove

Softtissue h'ge means px is still alive when Injury was Inflicted

161 [ Gun Shot Wounds

Whenever a gun Is fired, the exiting bullet Isaccompanied by:
Ajet of flame, 1-2 Inches In length
(3 Inches Pistol, 6 Inches Rifle)- Soils
A cloud of gas
Unburnt gunpowder
Carbon or soot from burnt gunpowder
Vaporized metal from the bullet

(Di Malo)

162 |M| GUNSHOT WOUNDS

163Distinction between Entrance and Exit Gunshot Wound

164[^ Distinction between gunshot Wound of Entrance and Exit

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165 @ Entrance wound

166 |M| Exit wound
167

Here is a slit-like exit wound. Note that there is no powder or soot visible.

168 g] GRAZE WOUND

Bullet travels across the skin

Very shallow angle

Elongated area of abrasionwithoutactually perforating the skin

169[ An abrasion ring, formed when theforce ofthegases entering below theskin
blow the skin surface back against the muzzle of the gun, is seen here in this
contact range gunshot wound to the right temple.
170

Abrasion/ Contusion Collar

171

Categories of Gunshot Wounds

Contact

Near contact

Intermediate
Distant

172 iWl Contact Wounds

A. Hard-contact

The muzzleof the gun Is pressed against the skin

All the materials exiting the muzzlegoes beneath the skin

Ironing effect - detailed Imprint of the heated muzzle to the skin

1731Wj

Amuzzle Imprint Is virtually pathognomonic of a contact range gunshot wound.

174 |M1
Hard Contact Wound

Stellate Vt/ound - tears that radiatefrom the edge of the wound caused bythe blast
effect that follows the sudden release of gases between the skin and underlying bone
(skull)

175 [M] Image shows stellate pattern of tearing in contact wound

176 [M] Contact Wounds
B. Loose Contact

Ironing effect

Soot and small amount of gunpowder Is deposited on the wound edges

If the gap between the skin and muzzle Is angled, products escape In one direction teardroD oattern

178 [M] Near Contact

2-3 Inches to 6-7lnches

Scorching of the skin, but no Ironing effect

large amount of soot/ smudge Is deposited

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Little amount of gunpowder may be scattered on the surface

179 [Ml
180 |M|

181 [Mj Intermediate Range/ Close-Range

6-7 Inches to 12-18 inches (Spitz)

The principal indicator ofclose range fire isstippling or powder tattooing.

Tattooing or Stippling iscaused by unburned particles of gunpowder striking the skin

resulting in punctuate abrasions in the skin surrounding the entrance wound
May be distributed circumferentially or more denselyscattered on one side.

Powdertattooing cannot be wiped away

182 [M]
183 [M] Distant Gunshot
>12-18 inches (Spitz)
> 2 feet (24 inches), >36 inches (long firearm)

Round to oval with sharp punched out margin

Absenceof ironing, smudging or tattooing

Abrasion ring - scraping the raw edges of the skin

Irregular abrasion ring - Impactat an angle

185 [M]
186 |M| GSW

One cannot determine the caliber of bullet by examining the GSW.

However 9mm, usually produces 9mm holes

Suicide: most use hand gun, most are contact, most are on the head, single shot.
Temple, mouth, under the chin, between the eyes
25% w/ suicide note; gun still on hand
187

ASPHYXIA

Asphyxia: inadequate oxygenatlon of tissue

Asphyxial Deaths:
Suffocation

Strangulation
Chemical asphyxia

188 |M] Suffocation

Failure of oxygen to reach the blood
A. environmental suffocation: "no air"

-negative autopsy
B. smothering: obstruction of nose and
-accidental, homicidal, suicidal
-may show bruising on the mouth

189 i"Mi Choking

Blockage of internal airways

Most are accidental

mouth

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Aspiration of food among stroke victims

25% agonai aspiration
Children: toys

190

Mechanical asphyxia
Pressure on the chest and abdomen
Accidental

Ex. Parent roiled overthe babyduring sleep

Autopsy: congested face, neck, scleral h'ge
191 g] STRANGULATION
Occlusion of blood vessels in the neck 2"'' to external pressure
TYPES

-hanging
-ligature
-manual

Mechanism of Death: pressure on the neck artery >>> no oxygen to the brain

192 fM] Con't Strangulation

Blood to the brain, 2/3 supplied by carotid artery
li lbs necessary to occlude the carotid
15 sec of occlusion>>> loss of consciousness

193 [M] Hanging

Weight of the head is 10-12 lbs

Complete suspension is not necessary

All hanging are suicide
Inverted "V" at the side of the neck

Above the larynx

Furrow is yellow then brown on drying

194 |M] Hanging

1/4 of cases with conjunctival h'ge
10% with fractured hyoid

Marking on the neck may suggest the type of cord used

Linen, no nriarking

195 [M] LigatureStrangulation

Most are homicide

Victim: Woman in relation to rape

Ligature mark is horizontal

Belowthe larynx
Face congested with scleral, conjunctival h'ge

196 [Ml Manual Strangulation

Always homicide

Death is not due to vaso-vagal stimulation

Death is due to occlusion of blood vessels
Victims: Woman

Marks on the neck

H'ge on the soft tissue of the neck

Hyoid fracture is valid when surrounded by h'ge

197 |M] ChemicalAsphyxiant

Carbon monoxide

Hydrogen cyanide
Hydrogen sulfide

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198 gj Murder of infants and children

Neo-naticide

-killing of newborn
-born alive or dead?

-hydrostatic test

199 g] Shaken BabySyndrome

No external head trauma

Positive h'ge In the brain

Due to violent shaking
of the head

200 g SEXUAL ABUSE

201 gl Objectives
E To be familiar with the tenets of forensic medicine

E To determine the medico-legal aspects of death

To determine the medico-legal aspects of Identification
To have a perspective of the different physical Injuries
To determine sexualabuse

202g SEXUALABUSE
How to determine Ifshe was raped?
Examination of an adult female Is more difficult to evaluate.

Penile penetration Is not required In a case of rape.

Virginity has many definitions.
Female organ has many variations.
203 ANATOMY

204 ANATOMY

205 TYPES OF HYMEN

205g] SEXUALABUSE
No evident Injury at the time of examination but medical evaluation cannot exclude
sexual abuse.
INTERPRETATION:

1. No abuse happened

2. Abuse happened but did not cause Injury.

3. Caused Injuries but healed completely.

207g SEXUALABUSE
Noevident Injury at the time of examination but medical evaluation cannot exclude
sexual abuse.

Theano-genltal findings seen In this patient are to be expected In a child who describes
this type of molestation.

208g SEXUALABUSE
Medical evaluation shows ano-genltal findings that are suggestive of sexual abuse or
contact.

Criteria:

1. Deep notches/clefts

2. Attenuated hymen
3. Apparent genital v/arts
4. Herpes type 1 and 2.
209 [pj SFXUAL ABUSE

Medical evaluation shows definite evidence ofsexual abuse or(RECENT) sexual contact.
Criteria:

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1. Positive for sperm or seminal fluid.

2. Pregnanc/

3. Gonorrhea, Syphilis, Trichomonas, Chlamydia and HIV

4.

210 g] SEXUAL ABUSE

Ano-genltal findings are diagnostic of recent/previous blunt force or penetrating trauma.

Criteria:

1. Acute hymenal injury-partial or complete

2. Perianal lacerations

3. Healed hymenal lacerations

4. Acute Injuries on the labia, fourchette.
5.
5.

2111^{ What to say to a rape survivor

DO'S

1. Listen carefully
2. Re-phrase your question

a. Did he put his penis In your mouth? /

b. Did you put your mouth on his penis? X
3. Get complete Information

4. Tell her she don't deserve to be raped

1.
1.
212

DON'T

1.

Don't ask why?

2. Don't ask whatshe waswearing without explaining why you needto know.
3.
4.

Don't tell her what you would have done In that situation.
Don't place blame on the victim.

5. Don'tforce the minor victim to under go examination

213

Always remember
yWe don't diagnose rape

We simplydocument Injuries and Identify the evidence

We testify on the manner by which Injuries were Inflicted
Intact hymen not synonymous with virginity

Definition of sexual Intercourse bya child maybe different from yours.

214 [M] Tipson how to avoid

being a rape victim
1. Go out with friends, don't go out alone.

2. Tell your whereabouts to your parents.

3. Don't drink with the guys.

4. Always considera male as a potential suspect.

5. Introduce your suitors to your parents.

2151^1 If your friend is a victim...

1. Don't wash, don't change clothes
2. Proceed to Camp Crame for examination
3. Report It Immediately to a police
4. Don't erase your texts; take notes
5. Seek professional help

216 gj THANK YOU

217IM]

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2181^1

219 [Ml
220 [Ml I.S.O. Certified
221 ;M1

222 [M]
223 [M]
224 iMj

225 [M]

226 [^ PNP Crime Lab Forensic Experts

227 g] BALLISTICS
228 |M]

229 [Ml POLYGRAPH

230

QUESTIONED DOCUMENTS

231

FINGERPRINT

232 [M] MEDICO-LEGAL

233DNA

234 g) CHEMISTRY
235 [M] PHOTO
236

the law has made you a witness,

Remain a man of science.

You have no victim to avenge.

No guilty or innocent person to ruin or save.
You must bear witness

within the limit of science."

237

"The search for truth is the essence of forensic pathology.

This truth forms an essential link between the enforcement of law and the protection of
the public in the administration of justice."
Spitz and Fisher's
Medicolegal Investigation Of Death

Guidelines for the Application of Pathology to Crime Investigation

"/f is the unknown we fear when

we look upon death and darkness,

nothing more."
- Albus Dumbledore

238