notes on legal medicine

8/10/2019 Notes on Legal Medicine

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June 21

Legal medicine (AKA forensic medicine) branch of medicine that deals with application ofknowledge to legal problems and proceedings

Medical jurisprudence - branch of law that deals with application of law to medicine orconversely medical science to legal problems

Forensics application of scientic knowledge to legal problems and proceedings

- Used in the pursuit of justice in court proceedings and in the protection of the public fromenvironmental haards

Pathology branch of medicine that deals with diagnosis of disease and causes of death bymeans of laboratory e!ams of body "uids# cell samples and tissues from the body$

if alive % biopsy

if dead % autopsy& systematic e!ternal and internal e!amination of the dead

a subspecialty is forensic pathology' a forensic pathologist e!amines persons who diedsuddenly# une!pectedly# violently or a medically unattended death# an e!pert in determiningthe cause and manner of death# involved in crime investigation# case coordinator for themedical# forensic and scientic assessment of a given death (may be the lead investigator)#e!pert in interpreting the scene of death# assessing the consistency of witnesses andinterpretation of pattern injuries

Medico-Legal ofcer physician who is involved in medico-legal duties

*+$ , +ode of anitation' Any medical o.cer (/01# 201# 3istrict 0ealth 1.cer)# medicalo.ces from law enforcement agencies# +02 and members of the medical sta4 of accreditedhospitals$

/edico-legal cases' deaths or injuries involving persons who have no means of beingidentied# those who are pronounced dead on arrival on *2s# deaths under the followingcircumstances 5death occurred within 67 hours of admission# clinical cause of death isunknown# une!pected sudden death especially when the person was of apparent good health#d8t natural disease but associated with physical evidence of foul play# death as a result ofviolence# suicide or poisoning# death d8t negligence of a 9rdperson# including cases of childabuse# physical and se!ual abuse# rape# drug addiction and iatrogenic causes of injury# disease

or death (one caused by the medical professional such as the doctor8nurse)# etc:

Child protection specialist - new kind of specialist in the eld of pediatrics& deals withmedico-legal cases of children who were allegedly abused

;1 formal training on how one becomes a /edico-legal o.cer$

Doctor as a itness!

+an either be a professional witness or an ordinary8 fact witness or both

an e!pert witnesscan give an opinion about medical facts


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*!pert witness has special knowledge as well as current knowledge or skill gained byeducation# training# or e!perience in the eld of e!pertise *!plain scientic matters that may or may not be understood by judges

/edical e!pert testimony could either be for the prosecution or for the defense

/edical testimony must be objective and accurate

?aw does not make a @ualication of an e!pert physician based on a medical specialist (solook into their @ualications# their formal training etc)

+hild rotection has set @ualications of a doctor who can provide care for the se!ually abusedchild and these are doctors who can also give e!pert testimony in court$

pediatrician# gynecologist# pediatric gynecologist# family medicine (important that thereBse!posure to children) formal training

updated with research studies

e!perience

regular conference# consult one another here and abroad etc

re-trial preparation of the e!pert witness refreshes the level of e!pertise# enhances @uality ofopinion e!pressed and saves time$ ?awyers must also be prepared in their @uestioning$

ermit the witness to e!plain and ?C>*;$

Know the value of the medical literature presented$ Dhen it comes to research the best level ofevidence is a blind test that is random$

rotect your witness$ 3o not allow your witness to be harassed by the other side$ Cf itBs a childwitness know the rules in e!amination of a child witness$

"hat you should not do!

ask a @uestion you do not already know the answer

do not @uarrel with the witness

ask clear @uestions

Allow witness to e!plain his answer$ An e!pert witness has a right to e!plain$

do not ask long and comple! @uestions especially with children do not ask absolute @uestions (always# never etc) nor use unnecessary adjectives

June 2#

D$%&'

A person is alive because of the 9 main parts of the body' >he brain&

>he respiratory center& and

>he circulatory center

E Fou heart pumps blood throughout the body to circulate o!ygenated blood$ >hese are the twomost important systems' your cardiac and circulatory system and respiratory system that willkeep you alive# and the main center for control is the brain$


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Denition o) death!

>he cessation of life in a previously living organism$ Ct is a process# not a single event$

E /edical and legal status of death' /edical 3octor proclaims or pronounces a person dead$

?egal *!tinction of the personBs identity# etc$

E >he ascertainment of death is a chemical problem$ Ct s the doctor who will determine when aperson has died$

*tages o) Death!

+linical or somatic death

=rain death

=iological death

+ellular death

Clinical or somatic death!

>he respiratory and circulatory functions have ceased$ =ut because of an advancement inmedicine# the circulatory and respiratory functions may be restored through resuscitatingmeasures$

Fou may end up as a person whoBs wide awake# continuously breathing# heart still beating$1r you may end up as a person whoBs awake# heart beating# but youBre not breathing onyour own$ 1r you may end up as a person whoBs just out$ Fou are unconscious and cannotcommunicate with your environment$ FouBre breathing# either on your own with your heartbeating on your own# or your respiration is being assisted# with your heart beating on itsown$

Cf thereBs irreversible unconsciousness# with spontaneous respiration and heart beat# itcannot be accepted as true death$ >he person is still breathing on his own$ 0eBs

unconscious but heBs breathing on his own# his heart beating$

+rain death!Cf the brain does not receive o!ygenated blood within 9-G minutes# your heart stopsbeating$ ;eurons die if thereBs no o!ygen brought to the brain within G minutes$

=rain death follows a stage' >he cerebral corte! or that part of the brain with higher functions die rst$

>he cerebellum (the part of the brain thatBs for keeping your balance and coordination)follows$ >he last to go is the brain stem$ Ct is in the brain stem where the cardiac and respiratorycenters lie$ CtBs the stem brain thatBs what will keep you alive$

o we have what we call a persistent vegetative state$ FouBre completely unconscious butyouBre breathing on your own# with your heart beating$ 1r you may have assistedventilation$ And it is assumed in such a state that the brain itself is functioning$ 0igher braincenters are dead e!cept for the brain stem$ =ecause the brain stem is not dead yet# thecardiac and respiratory centers are working$ o even if youBre totally unconscious# you maybe breathing on your own and your heart is beating on its own$ 1r your heart is beating butyour are breathing through a ventilator$ And the only thing thatBs needed is to keep feedingthe patient$ o these are the people we call vegetables$

+iological death!

0ere nally# even the brain stem dies$ All components of the brain die# closely followed bycellular death$

Cellular death'>hink of cells as mini tiny factories$ o in cellular death# these factories shut down one by


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one$ And eventually# they would just break up and decay$

+ellular death itself also does not happen all at once$ +ells die slowly$ =ecause evidencenow is showing that# letBs say# your skin and bones may remain what you call metabolicallyactive (still alive for many hours)$ >hatBs why after death# if you need to transplant or usebones or skin# they may be harvested and cultured up to H6 hours after the heart hasceased beating$ ;eurons of course die after 9-G minutes$ >he heart and kidney can still be

used if theyBre harvested within I hours of cessation# after the person is pronounced death$o itBs very important# especially when weBre talking about transplantation$ >he personmust be pronounced dead by the attending physician$

E o death actually takes a long time$ Ct doesn t mean that just because the person stopsbreathing and his heart is not beating# he s dead$ Ct s a transfer from one state of viability toanother and may be slow or rapid depending on certain factors# like your age$ >he very youngand the very old# they die faster$ Jery young# because they re very immature# the very oldbecause of the wear and tear$ >hey don t have defenses anymore so they can die really fast$ Cfyou re very thin# if you re malnourished# if you have all these diabetes and heart problems#your death will be faster$ 1r environmental factors (good thing it doesn t snow here)$ Cf you resickly and its cold outside# you re not wearing anything# or you re malnourished# you re goingto die fast$

E o it s the physician who pronounces death when what you call the point of irreversibility hasbeen breached$ And when is that Dhen does a doctor say that the point of irreversibility hasbeen breached

>raditionally# when the doctor doesnBt feel a pulse or doesnBt hear the heart beating and theperson is no longer breathing# we say the person may have died$

1ther ways of nding out whether that person is really dead is by putting a mirror on theface# at the mouth and nose# of the person$ Cf thereBs no condensation on that mirror# it meansthe person is not breathing$ Dhat we can do is also look into the eyes# through the pupils$ De can see what we call the

LfundusB where you can see the blood vessels$ Cf the blood vessels are not pulsating# thatmeans the heart is no longer beating$ De can use **< (electroencephalogram) test$ =ut in theprovince# you donBt have **he doctor usually uses what you call the ophthalmoscope tolook into the eye and check if thereBs still pulsation$ ometimes# they donBt have a mirror# sodoctors bring compacts# like the ladies$ o itBs just a pulse or listening to the heartbeat$

Fou can also try to monitor response by giving painful stimulation to the patient$ 1ne ispressure on the glabella (N.B.the space between the eyebrows# unless you have a unibrowM)#pressure on the sternum# or pinch the nger$ o if the person is alive# heBs going to drive youaway because these are very painful areas$ *specially if the person is lying down and youBrestanding up# and you put so much pressure# that can be very painful$ >he other ones and very importantly# will be the absence of brain stem re"e!es$ /eaningthe response to pain stimuli in these areas come from the brain stem$ Cf these are absent# thatmeans the brain stem is dead$

Corneal re,e what we do is get a wisp of cotton and touch the cornea$ Fou knowhow painful that is$ o a person will blink$ Cf youBre dead# you wonBt feel anythinganyway$ o a live person will be in pain$

*hine light into the pupils if youBre dead# your pupils are e!pected to be dilated$ Cfyou shine a light# the pupils should normally constrict$ A dead person will not have thatre"e! anymore$

.culo/esti0ular response we inject ice cold water into the ear$ And we normallye!pect the eyes to move the opposite side$ o if the eyes will not move# then thereBs nore"e!$

ag re,e when you put a tube# catheter# or tongue depressor and try to stimulatethe back of the throat$ FouBre going to gag if youBre alive$


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%pnea test(LapneaB means no respiration at all) this is done mostly on people onventilators$ Dhat is done is# we get what we call arterial blood gases$ *ssentially# wewant to know what the level of o!ygen and carbon dio!ide is in the blood$ o while onthe ventilator# o!ygen is "owing into the lungs$ De get the arterial blood gases then theventilator is turned o4 for about -HN minutes$ After that period of time# arterial bloodgases again are taken$ Cf the o!ygen level of the blood is very# very lowOthereBs a

certain numberOif the carbon dio!ide level is very# very high# that is a sign that thepatient is not breathing at all$ Cf all of these are not present# then the person is dead$lus# you can also have a silent **< where no more brain activity is going on$

E >here are criteria for death$ As C said earlier# because of new developments in medicine# aperson may not be declared dead immediately$ 1f course# the rst thing that came up was yourcardiac pulmonary resuscitation (+2)$ =ut we have other advancements$ De have brillators$Pirst# when a person su4ers from a heart attack# it has been proven that the heart brillates$>he person faints because the heart brillates$ 0ow does a heart look like when it s brillatingCmagine a bag of live worms$ Fou look at the outside$ Ct s just going like that$ Cnstead ofpumping blood out# your heart is just going like that when you su4er from heart attack$ Cf youput your stethoscope on the chest# you re not going to hear it so you re going to say he s dead$=ut applying debrillators can still revive the heart$ >hat s why its very important if any of you

witness a person who may be undergoing a heart attack to just have to call the emergencymedical services$ 0ere we have *2UP$ >hey have debrillators just to get your heart to startpumping immediately$

E >here s what you call for a person who needs a heart transplant$ >hey have what you callassisted devices (not a pacemaker)$ Ct s practically there pumping because the heart muscleitself is not pumping# or inade@uately pumping$ Fou have you ventilators$ >hese are machinesthat help you breathe$

E =ut we have a problem wherein because of modern resuscitation technology# even if all brainfunctions will have ceased e!cept for the cardiac and respiratory centers your heart can still bebeating# but you may still be connected to a ventilator$ o are you going to say that the personis practically dead >he heart is still beating$ >he brain stem is still alive$ +an you say thatperson is dead

Cf you discontinue ventilation# is it homicide =ecause itBs very hard to keep this person alivefor a long time$ Ct can be physically# emotionally# nancially draining$ >he care there is everyhour# every minute$ Fou turn that person to sides and heBs not even responding to you$

E o how does one determine death

ni)orm Determination o) Death %ct denes death as either'

irreversible cessation of the circulatory and respiratory functions& or

irreversible cessation of functions of the entire brain# including the brain stem$And the determination of death must be made in accordance with accepted medicalstandards$

'ar/ard Criteria essentially the same denition$

Unreceptivity and unresponsiveness meaning thereBs a total unawareness of e!ternally-applied stimuli# pain stimuli# etc$ >here must be complete unresponsiveness despite applicationof painful stimuli$ ;o spontaneous movement or breathing absence of spontaneous muscular movement orbreathing# as well as absence of response to stimuli# such as pain# touch# sight# etc$ ;o re"e!es

+onrmation by two **o me# she does not fall under the 0arvardcriteria or the Uniform 3etermination of 3eath$


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E o let s go to organ and tissue transplantation$ Cn organ transplantation# there are instanceswhen the person must be dead rst$ Cf you will look at the 1rgan 3onation Act of H,,H# death isdened as'

QThe irreversible cessation of circulatory and respiratory functions or the irreversiblecessation of all functions of the entire brain, including the brain stem. A person shall bemedically and legally dead if either:

(1) n the opinion of the attending physician, based on the acceptable standards ofmedical practice, there is an absence of natural respiratory and cardiac function and,attempts resuscitation !ould not be successful in restoring those functions. n this case,death shall be deemed to have occurred at the time these function ceased " or

(#) n the opinion of the consulting physician, concurred in by the attending physician,that on the basis of acceptable standards of medical practice, there is an irreversiblecessation of all brain functions" and considering the absence of such functions, furthersattempts at resuscitation or continued supportive maintenance !ould not be successfulin restoring such natural functions. n this case, death shall be deemed to haveoccurred at the time !hen these conditions $rst appeared.

The death of the person shall be determined in accordance !ith the acceptablestandards of medical practice and shall be diagnosed separately by the attendingphysician and another consulting physician, both of !hom must be appropriately%uali$ed and suitably e&perienced in the care of such patients. The death shall berecorded in the patient's medical record.R

o the attending physician may call another consultant& he and the attending physician can bethe ones to declare a person dead$

E ;ow going to problems regarding transplantation# the problems are consent andauthoriation who will consent or authorie to donate organs# who will determine death in caseof procurement from a cadaver$ And there is a problem of rationing organs# there s not enoughorgans for transplantation$ /ore so in the U and *urope where they do a lot of organ

transplantation$ o here for us# a person who may e!ecute or authorie to have a part of hisbody donated is anyone above HI$ Cn the U# there in their driver s license# it s indicated if youwant to donate your body or a part of your body# and automatically# you ll be sent to thehospital and the hospital will harvest your organs$ 1f it could be anybody somebody of legalage can sign for you$ Four parents# siblings# or guardian$ And the organs have to be harvestedwithin I hours$ o you have to consider the time to remove# travel time# time to operate therecipient# etc$# so you have to make the decision fast$

Manner o) eecuting a donation!

>he death of a person from whose body an organ will be removed after its death for thepurpose of transportation to a living person# shall be diagnosed separately and certied by6 @ualied physicians# neither of who should be a member of the recipient team$ >hesurgeon who will be the one to remove the organ cannot be the people who will declare that

person dead# etc$ CtBs con"ict of interest$ Ct should only be the attending physician$

*ources o) organs!

Petus contains cells which we call Lstem cellsB$ >hey contain cells that have the potentialto become any kind of tissue# provided that tissue is placed in the right environment$ o if youput a tissue in the area of the heart# that tissue will develop into heart cells$ Anencephalyinfants are babies born with only the brain stem intact$ >hey donBt have a skull cap# they donBthave the higher brains# but just the tiny brain stem$ >hatBs why theyBre alive# they have allthose re"e!es# theyBre breathing e!cept for that abnormal head$ =ut when they die# their heartscan be used for transplanting to babies with congenital heart diseases$ Articial animal transplants >he problem here is# itBs not matching$ C donBt know howcompatible you can be with a pig or a cow$ And the problem there also is# that animal may have

some kind of disease which the human never gets$ DhatBs going to happen is# itBs passed on tothe human being who received the disease from the pigBs heart$ o how are you going to curethat illness


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reproduction of energy in your body# your A> using o!ygen$ o if there is no more o!ygen itBsjust glucose that is being used to produce A> but then without o!ygen it will not go throughthis process of o!idity TTTT lactic acid pathway and will produce a lot of lactic acid in thebody$ Dith the lack of o!ygen# very little A> or energy# more of lactic acid what happensisTTTFour muscles are made up of bers of cells-acti enmycin bers$ >hey bind together andthey form a gel and that makes the muscles sti4$ CtBs that lactic acid that will cause yourmuscles to gel up thus become sti4$ And this can develop fast especially if thereBs no blood in

the TTTT levels$ *specially during e!ercise or when the acidic levels are high or whensomebody is stressed or during electrocution when the muscle will be repetitively stimulated#the muscles will keep "e!ing and "e!ing# the o!ygen levels can be low# glycogen or glucoselevels can be low# it will become acidic so rigor mortis can be very fast$ Ct may not be detectedin people who have low muscle bulk$ >hereBs not much muscle$ o whatBs there to harden Ct isusually detectable rst around the eyes and around the jaws and ngers and it will developfrom the head down# from the smaller muscle down to the larger muscle groups$ Cn determiningthe presence or absence of rigor mortis# it is only estimating the time of death$ 2igor mortis is avariable process because it can be a4ected by a lot of environmental factors$ Ct is unreliable tond out the time when the person died$ Cf the person is e!posed to a cold temperature he willdevelop rigor mortis longer as compared to a person who is in a warmer temperature which willbe of shorter duration$ Cn temperate conditions itBs rst detected in the face between H to 7hours after death# in the limbs between 7 to hours after death# the strength of rigor will

increase in the legs to H6 hours$ After that# when cellular metabolism or decomposition of thecells begin# the muscles now will lose its cohesiveness# its gel-like property now will get lost$ Cnthis stage of rigor mortis# the body ends enters the stage of secondary "accidity which occursbetween 67 to N hours after death$ >wo types of rigor mortis' primary "accidity within 67hours# it becomes sti4& after that the sti4ness is gone and thatBs called secondary "accidity$

1ne can test for rigors$ Cf a joint is "e!ed at death# apply some pressure$ Cf it jerks back# thatmeans thereBs rigidity$ Cf the body feels warm and is "accid# it may have been dead for lessthan 9 hours$ Cf it is warm but sti4# it may have been dead for 9 to I hours$ Dhen the body iscold and sti4# it may have been dead for 9 hours$ Cf it is cold and "accid up to secondary"accidity# therefore# more than 9 hours$

Cada/eric rigidity7Another term for this is instantaneous rigor or captalicticrigidity$ >his isbased on certain ndings wherein some people die holding grass in their hands or holding agun when he died$ /ost likely the mechanism behind has something to do with a neurogenickind of activity when that person is highly stressed at the time of death$ Porensically# if aperson dies and is found in the water and holding on to something like a grass found outside ofthat body of water then that person was alive before he was found in the water$ 1r that personmay be holding something that belongs to the alleged perpetrator or whoever was with thatperson last may be holding on to something$

Post mortem hypostasis7At death# circulation stops# all muscles rela!# including the musclesin the blood vessels$ Dith the rela!ation of the muscle tone in your blood vessels# the blood willsettle down in areas where the blood vessels are dependent$ >he blood has cells and "uid$ >hepassive settling of the blood cells under the in"uence of gravitiy to the blood vessels in the

lowest area of the body$ >his is forensically important$ Ct is not always seen in the body$ Ct maybe absent in the young or in the old# those who are anemic$ Ct may TTTT by that skin colors#jaundice or yellowish coloring of the skin$ Ct mostly forms on the back# buttocks sides# and backof the neck because usually when a person dies heBs lying "at on his back but there are someareas of that persons back that could be so pressed on a certain part# like on the bed$ A persondied on his back so the buttocks probably pressed on the bed will have TTTT called blanching$/eaning# the blood vessels have been s@ueeed# so blood vessels could settle in this area$ >hepart of the butt not in contact with the bed may be found to have a post mortem hypostasis$Fou can tell the personBs position when he died$ Dhen heBs hanging# hypostasis will be on thelower e!tremities not in the torso$ here may be somechanges in the color after death$ Cf the color changes in a cherry pink color# most likely thatperson died of carbon mono!ide poisoning& dark red# by poisoning& brone# infection caused by

an organism called TTTT$ Cf the body was moved and hypostasis is already happening# therecould be layering of that hypostasis$

%lgor Mortis7>he body will take on the temperature of the environment$ Ct is useful indicator


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of the time of death during the rst 67 hours post mortem$ >he use of body temperature asestimation applies only to cool and temperate climates not much in tropical areas because thecooling of our body will not be as much because our environment is warm$ CtBs best measuredusing core temperature like rectal temperature taken at e!amination or on discovery$ Using oraltemperature is not advisable$

*!amining gastric contents at the time of death will only tell you what he ate the last time$ Ct is

di.cult to use this estimation of the time of death$ =efore# it was believed that our stomachempty into the intestines within one hour$ >hatBs no longer correct$ Ct also depends on the kindof food that you eat$ Patty foods remain longer in the stomach compared to non-fatty food$Another method is looking at the presence of insects in the body$ >here are some insects thatlike to feed on the human body$ 3epending on what stage of the insect$ Fou have to get aforensic entomologist$ Cn other countries# depending on the season# they look at the animalbites$ Cn the winter season# itBs just the bears that are there in the forest$ Cf itBs summer# itBsjust the s@uirrels that are there$

Ct is very important that an e!aminer gives an estimation of the time of death$ >here is abracket probability giving an earliest or latest time which the doctor feels that death must haveoccurred$ CtBs within a range$

Decomposition or putre)action7 /ost common root of decomposition of the body afterdeath and early changes may be confused to be signs of violence or trauma$ >here isli@uefaction of soft tissues over a period of time$ >he earlier the process starts the faster itprogresses$ Cn a week or so the body cavities will burst and the tissues will li@uefy and drainaway onto the ground$

/ummication7>he body cavities dry up and it usually happens in hot or warm environmentand also in cold dry areas$

Adiposerum$ >hereBs a chemical change in the body fat& the features are retained apparently nodecomposition happens$

8mmersion7 Ct slows down the process of decomposition$ A body will decompose in air fasterthan in water$ >he most common position of the body in the early stage is# if the chest containsair then the chest is "oating and the limbs are hanging in the water so your hypostasis ise!pected to be in the hands and in the feet$ Cf there are animals in the water# e!pect also thatthere will be bites in your hands and feet$ Cf the water is shallow# e!pect the hands and the feetto be dragging on the river bed$ ?oss of epidermis rst and then there will be gaseousdecomposition so that the body will start to "oat$ >here could be adiposere formation if thebody is under water$ Dhen the body is buried it will decay more slowly but if the surrounding iswet# very acidic# the body will decompose faster$ *ventually your skin will fall o4$ Dithin twoyears# no more skin tissues# it will then be all skeletal and what will remain will be yourtendons# your ligaments# hair and nails$ Dithin ve years# nothing is left on the bones and allthe joints now will be disarticulated$ Fou can use the bone marrow to get the mytocondreal3;A$ CtBs one way of identifying a person$ =ut the mytocondreal 3;A is only that of the mother$

Post mortem injuries7Ct can be determined by looking at the edge of the wound$ Cf you areinjured before you died# there will be in"ammatory response after your injury$ Cf youBre injuredafter your death# there will be no more in"ammatory process that will go on$

$m0alming7 Ct is a physically invasive process in which special device are implanted andchemicals and techni@ues are used to give an appearance of restful repose$ Pirst the bag isplaced on the stainless steel# place the person in table washed with insecticide and germicideand olfactant# the insides of the nose and mouth are swabbed with solution# the muscles aremassaged to soften it# creams is placed on the face and then massage so it will look soft$ >hefacial features are set by putting cotton in the nose so itBs not gonna collapse# putting eye capsbelow the eyelids so it will not look sunken$

%rterial em0alming7>hey inject an embalming "uid into an artery$ >hey inject one gallon orso of a mi!ture of formaldehyde and other chemicals with water$ +hemicals are also injectedthru syringe into the other parts of the body$


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Ca/ity em0alming7>he trucar is inserted intto the navel and an instrument is inserted topuncture organs that contain air$ his is the whole embalmingprocess$

$humation7 >his is the province of a skilled and e!perienced forensic pathologist$ Cf thecause of death is poisoning# the pathologist must also get soil samples because there might be"uid in the body that may have seep into the soil or in the co.n and "uid from these areas isbest taken to determine if thereBs any poison present there to determine if the person reallydied of poisoning$ Dhen you e!hume a body you have to ask the court# there has to be a courtorder rst$ >here must be legal reason for e!huming a body$

July 12

3*A>0 C;J*>CC1;$$ Ct involves police investigation and the application of forensic science$

Kinds of death that re@uire investigation in the hilippines# understand the principles of deathinvestigation including the autopsy$ ?earn and understand the contents of a medico legalautopsy report and how the medico legal ndings become useful to the legal system$

>he purpose of death investigation is to identify and develop an understanding of the death ofthat person$

>wo types of death investigation'H$ +linical death investigation happens within the hospital$ >he doctor or the medical o.ceror the pathologist wants to know what that person died of# what was the illness# did he die of acertain disease or injuries# or of poisoning$ CtBs just within the hospital setting$

6$ /edico legal investigation - maybe thereBs some foul play in the cause of death$ Ct may bethat there is a police investigation going on regarding the death of that person$

Dhen that natural death occurs# the doctor will sign the death certicate# once the deathcerticate is signed then the body can be disposed of the# the death certicate will include thecause and manner of death$ Cf the death is natural and no doctor can complete the certicatethen that death must be investigated and the death be classied$ 3eath that cannot bee!amined by the doctor is e!amined by a variety of legal o.cers-the medico legal o.cers orthe medical e!aminers$

0erein the country based on the +ode of anitation# cases where autopsies were performed arethose that are re@uired by special laws upon the orders of a competent court# a mayor orprovincial or city scal upon the written re@uest of police authorities whether the solicitorgeneral or the city or provincial scals are authoried by e!isting laws shall be when necessaryto disTTT and to take possession of the remains for e!amination to determine the cause ofdeath# whenever the nearest of kins shall re@uest in writing the authorities concerned to acertain cause of death$ Cn order to be autopsied you have to get the consent of the relativesand more often than not they will not consent$ Cf there is foul play you have to run through thispeople like the city scal or the police just to ask for a re@uest for autopsy$ And the policeauthorities wonBt even ask for the autopsy for the medico legal investigation of the death of theperson$ >hese are the problems in our country itBs very hard to go beyond$ Ct might be that amember of the family killed that person$ Cf somebody is in the hospital and somebody in theroom killed that patient# the doctor will wonder how he can die suddenly$ udden infant deaths$>hese are the cases that need medico legal investigation$

31As# people who died and had not been identied# une!pected sudden death especially whenthe deceased was in an apparent good health# death with natural disease but associated withphysical evidence suspicious of foul play# death as a result of violence# accident# suicide#poisoning# death due to the negligent or improper act of another person# deaths of persons


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+ause of death' Ct is the disease process or injury responsible for initiating the train of eventswhether their brief or prolonged using the fatal end results$ CtBs that which starts the event$

/echanism of death' >he physiologic or biochemical derangement produced by the abovecause which is incompatible with life that is how the disease or the injury leads to death$

/anner of death' >he fashion or mode in which the cause of death came into being$ Ct may benatural# accident# suicide# homicide# it can be unclassied whether if it is due to alcohol ordrug$ Ct could be undetermined$ Cn the homicide classication of death# this is used to classifythe kind of death$ Ct is not used to imply criminal intents$ +riminal intent is left to the policeinvestigators# into the legal process not in the doctors$ Ct is only used here that the person diedbecause of a volitional act of somebody$ Undetermined cause or manner of death it could belike there are so many manners of death that could have happened and itBs very hard todetermine which one weighed more in killing that person$ *!ample' if youBre a person wholoves to drink a lot of alcohol# eat a lot especially pork# smoke so youBre prone to have highblood cholesterol level so you will develop a coronary artery disease$ +oronary artery diseasecan cause two problems in your heart' electrical disturbance and heart failure$ =ecause of theblock in your coronary artery thereBs not enough blood supplying the heart# so it could be thatthe nerves of your heart or the lethical wires of the heart are not well supplied by blood$ o itBs

not going to pump regularly and rhythmically$ Pibrillation or a brillating heart# like a bag ofworms# so that heart is not pumping blood at all$ CtBs not pumping blood out$ *very time yourheart pumps out of its chamber it will also supply blood to the heart muscles$ A heart failure iscaused by poor o!ygenation because of poor blood "ow to the heart muscles$ Cf a part of yourheart muscle is weak# itBs not gonna pump blood$ Four heartBs gonna have an ine4ective pumpso youBre gonna have a heart attack$ Dhen you die# the manner of death is classied asnatural$ Dhen you are stabbed# youBll lose a lot of blood# thatBs the mechanism$ 0anging#suicide# strangulation# the mechanism there is asphy!ia# a lack of o!ygen in the system$

>he medico legal report must show these three information$ Unfortunately# our system ofdeath# according to 3octor Portun# is not scientic based and is haggled by the policy of noaggressive complainant# no case and the practice of relying mostly on witnesses$ Cf thereBs nocomplaint# thereBs no case$

0ere is a case of a girl who died in a /onday morning$ he was apparently well 7 days prior toher death$ >he following day she did not feel well# she complained of vague abdominal pain$he stayed in bed and ate what was fed to her$ >wo days before she died# she refused to eatand continued to complain of abdominal pain$ 0er mother noted that her abdomen wasbecoming distended$ he still refused to eat the ne!t day$ And because of that the motherBs livein boyfriend beat her with an electric wire$ >he child still didnBt eat and died the following day$>he motherBs live in boyfriend was arrested and was charged with for violating 2A GHN# theAnti-+hild Abuse ?aw$ >he autopsy report concluded that the child died of pneumonia$ As to themanner of death# there was no report$ =ased on the re@uest of the mother this child wase!humed$ >his is the case where 3octor Portun felt an abnormality in the childBs rib$ >he child

had bruises$ >he police were saying that she died of beating$ 3octor Portun found out that herintestines had telescope unto itself (the smaller part will enter into the bigger part) there willbe intestinal obstruction$ >he cause of death is intussusception$ >he mechanism of death is thebiological and physiological changes in the body& youBre not eating# youBre starving# youBll havelactic acidosis and your heart is going to stop beating if itBs in an acidic medium$ >he manner ofdeath is homicide because the motherBs live in boyfriend refused to bring the child to thehospital even when the mother pleaded to bring the child to the hospital$ =ut maybe itBsunintentional because he probably just did not know$

July 29

8D$6&8F8C%&8.6 .F &'$ L8:86 %6D &'$ D$%D

/edical reasons for establishing the identity of a living person and a dead body'


13/32

a person is comatose

infant

person who has mental defect

there is language barrier

the person may tell false information regarding his identity

even if details is known but personal details are needed to be conrmed for

purposes of immigration or inheritance

for paternity and liations for proper support# inheritance and parental authority

for investigation of the death especially if it involves mass disaster for purposes of

inheritance# insurance# retirement# immigration# etc

Fou need the help of e!perts or forensic people like forensic pathologist# orthodontologist#

anthropologist when the dead bodies are severely injured or severely mutilated# decomposedor skeletied$

>he identity of a person is established by comparing or matching the parameters that can bemeasured with the parameters of another person which is suspected to belong to the bodybeing measured$ >he best feature on how to identify a person is his specic features that arematched to one that is known to a certain person$

/*>013 1P C3*;>CPC+A>C1;'

Morphological characteristics7 >his is a method of identifying criminals thru

height# weight# general physi@ue# hair color and length# presence of beard and

mustache# skin pigmentation and other facial appearances# eye color# shape of the lips#and chin$ >hese can di4erentiate one person from another (e$g$ race)$

Picture!get the frontal and the side view shot (more often than not# your left prole

is di4erent from the right prole)

>o determine the age' hite thing around the eye# teethonly up to age 6 and a

range is given# -ray(o!ication centers# bone growth)

Clothing and jeelry7

&attoos7

.ther mar;s!triae# pimples# cleft lip# tribal marks# body piercing$

'ealth records(scar# disease)

:ertillian system o) identication7


14/32

Fingerprints

&hree main patterns!loops# whirls and arches or a combination of any of these

three$

Used to ascertain a positive C3 of a person

;o two persons have the same ngerprint even twins

+annot be altered by time or injury

+an be e!tracted in any surface they come into contact with$

&hree &ypes

Patent prints Plastic prints Latent prints

-left when a foreign

substance on the

skin of a nger

comes in contact

with the smooth

surface of another

object

-visible prints

-no need for

enhancements

-left when a nger

touches a soft

malleable surface

-visible prints

- no need for

enhancements

-impressions

secreted in a

surface or an object

that is invisible to

the eye# the result

from perspiration

from the sweat

pores found on the

ridges of sweat

pores

-invisible to the eye

-needsenhancement (e$g$

dusting)

;o less than H points of similarity before declaring prints to be identical

>he investigating agency must already have a le of ngerprints for comparison

For decomposed or damaged 0odies! use specialied techni@ue from a

ngerprint e!pert& can be obtained from despomatedskin of the underlying epidermis

after shedding the stratum corneum (the srt layer) when it comes to prolonged

submersion& using the surface below the stratum corneum

Palm printsand sole printsit is believed that people do not have the same

Lip crease pattern

$ar-shape

:ein patternin the dorsal part of the hands

+ite mar;

+ones' se!# age only up to age 6# height# race# personal identiy' dependent on


15/32

ante-mortem data

Facial reconstruction' soft tissue thickness of the skull

Photo superimposition' photo of possible individual is overlaid with a

photographic transparency of the skull which has been scaled down to the eyes

&issue and cell samples! blood type# protein comple!es# blood enyme systems#

etc

D6% proling! used in e!clusion and identication thru body "uids# hair strands&

3;A analysis can yield a positive identity

Principles

no two persons have the same 3;A pattern e!cept for identical twins or clones

each part of your body contains the same 3;A

Cf the 3;A pattern left at the scene of the crime does not match the suspectBs 3;A

pattern# the suspect was never in that scene$ Cf it matches the suspectBs 3;A pattern# it

puts the suspect in the vicinity of the scene of the crime but does not necessarily mean

that he is guilty of the crime$

>he 3;A molecule consists of two strands of sugar and phosphate molecules that

link to one another to form a double heli!$

>en percent of the molecule is used for genetic coding and the rest are silent$ >hese

silent ones repeat themselves# meaning# there is only HN percent of the billions of

molecules in the body and only a few percent is specic to you alone but the distribution

is uni@ue for each one of us# the se@uencing is di4erent$

>he 3;A is found in the nucleus and it is a double heli!$ Ct is very stable but the

specimen that contains the 3;A that is to be analyed can easily be contaminated by

the collector$

3;A typing is a well-established means of identifying human remains and is a

powerful tool resorted to when traditional methods of identication are not helpful$

3;A ngerprinting is the last resort in identifying people$ CtBs used for healthcare#

pharmaceutical research# evolution and forensic$

>here are 9 ways of determining 3;A se@uences$

>ypes of samples needed for 3;A analysis' it must have nucleus (white blood cells#

hair root# spermatooa)$


16/32

+lood groups can only be used for e!clusion in paternity or maternity testing& not

accurate like that of 3;A analysis$

Cf the childBs blood type is 1 and the motherBs blood type is 1# the fatherBs could be

A or =$

amples for 3;A testing' mother# child and probable father$

Cn paternity e!clusion# if thereBs none matching proles in at least two 3;A locations

it can constitute conclusive proof that the alleged father is not the biological father$

Cn child se!ual abuse cases# it does not necessarily e!onerate the suspect from the

abuse charges& it just means that the abuse did not impregnate the child$

Cn paternity inclusion# complete matches in the 3;A proles of the child and the

alleged father will not necessarily establish paternity$ >he strength of the matches is

determined statistically$

JL5 CPC+A>C1; 1P ?CJC;< A;3 3*A3

Use of 3;A evidence in courts'

Cmportant to use 3;A- allowable for C3 and testing of parentage

+ said 3;A can be used as corroborative evidence together with other evidences

Pind out how sample collected# handled# possibility of contaminating samples# standardprocedure followed in analysis# proper standards followed in conducting tests and @ualicationsof the analysts who conducted the 3;A tests (@uestions that should be answered when youpresent evidence in court) =y itself 3;A cannot establish the guilt of an individual (powerful corroborative evidence) only 3;A e!perts can say that the 3;A samples belong to the suspect 3;A e!perts are the most appropriate persons to answer @uestions regarding 3;A forensicprocess$ Pind out his professional @ualications# how reliable is their 3;A testing process andthe laboratory itself$ *!pert witness will interpret the 3;A results and will e!plain the match or e!clude a suspectas a possible source of the 3;A$

3;A report contains'

what were the samples tested

the controls used

3;A prole of sample consistent with that of the suspectBs

tatistics of the probability that the evidence sample came from the suspect

+onclusion based on the results of their test

0ow are these interpreted

Cndependent 3;A proles of the victim (se!ually assaulted kid) and the reference samples arecompared$ >he results are either inconclusive or thereBs an e!clusion or an inclusion$


17/32

8nconclusi/e- 3;A testing did not produce info that would include or e!clude the suspect$/ay result from improper collection# handling or storage and can occur when @uantity of intact3;A is insu.cient or sample contains comple! mi!ture from several individuals (do notcontaminateM)

$clusion- if the 3;A prole from the sample does not match the prole of the suspectBs3;A reference sample$ uspect e!cluded as a source of the 3;A but does not e@uate toinnocence and does not automatically absolve suspect of the crime because he may have

committed the crime but did not leave any 3;A samples$ /ay indicate involvement of anotherperson$

8nclusion 3;A sample from the suspectBs 3;A reference sample matches the 3;A proleof the sample taken from the victim or scene of the crime$ uspect is included as a potentialsource of the 3;A but does not automatically determine the suspectBs guilt$ Fou have topresent other evidences to prove if heBs guilty or not$

tatistical analysis will estimate signicance of the match'

random match pro0a0ility- probability that an innocent individual who is unrelated tothe suspect and chosen randomly from the population will match the 3;A prole taken fromthe crime scene

Li;elihood ratio ratio of the probability that the 3;A prole in the evidence samplecame from the suspect and the probability that the 3;A sample came from a random unrelatedperson$ 2atio of the probability of the match given that the defendant is guilty to theprobability of a match that the defendant is innocent$ T H# NNN % very strong evidence to prove that this 3;A belongs to defendant

C;SU2C* - from blunt and sharp forces

"ounds> injuries tissue damage from mechanical force or from non mechanical forces&breach in the skin& caused by outside objects or force either physical or chemical

- 2esults from accident# act of self-harm (self-in"icted) or from action of a third party

0ow caused

H$ ?inetic caused by application of mechanical or physical force

/echanical force causes two types of trauma' blunt and sharp

=lunt force trauma causes abrasions# contusions and lacerations

harp force trauma leads to incised wound or stab wound

6$ 6on-;inetic injuries come from non-motion trauma like thermal# chemical# electrical#radiation or e!posure to atmospheric pressure

Cmportant when describing the wound how it looks like# what kind 3emand from doctor# youhave to know whether blunt or sharp force# what are the dimensions# positions# etc$

%0rasion


18/32

supercial type& involves epidermis& no bleeding involved& e$g$ scratch& deep abrasions canhave bleeding because of blood vessels >angential glancing impact (something falls on your body) crushing& sie and shape willdepend on the kind of object which comes into contact with the skin ?inear abrasion# broad# crushed$

Contusions# bruises (ecchymosis# hematoma)

breakage or rupture of blood vessels cause escape of blood from blood vessels to thedermis resulting to discoloration *!ternal bruising and internal bruising (bruises on internal organs)

>he greater the force the greater the bruising

the site of bruising does not necessarily reveal the site of trauma because blood is notstatic# can move by gravity initially reddish 8 purplish to yellowish or brown (d8t breakdown of hemoglobin)

>he usual guide in determining the age of the bruises has been discarded$ Ct was discoveredthat some bruises will only appear later on when there was already bruising in the muscles fora long time$ depends on the site and how bad was the bleeding

they do not accurately re"ect the object causing them but there are some patterns thatindicate the type of weapon used often associated with abrasions and lacerations less associated with incised8stab woundsbecause in stab wounds the blood is allowed to escape8 seep under the skin more prominent if force applied on bony areas so if you see bruise on abdomen greaterforce was applied for a bruise to result +an occur after death since blood vessels are easily broken when dead$ Pound on areas onthe dependent part of the body (by gravity)

Lacerations

result of blunt force overstretching the skin and there will be a split of the full thickness ofthe skin deep and will bleed

important to look for bridging bers (remain intact in lacerations and will not be cut)

skin can be compressed within the applied force and the underlying bone

rare in soft "eshy areas of the body

margins are always ragged

if caused by thin sharp object# the wound is sharply dened and may be mistaken forincision but under the microscope there could be abrasions and contusions on the edges andbridging bers in the laceration

*harp )orce injuries!

H$ Cncised wounds

also caused by objects with sharp and cutting edge and distinguished from a stabbedwound by being longer than deep *dges will give indication of the sharpness of the object used$ Jery sharp objects will notleave bruising on the edges# no bridging bers$ rarely life threatening unless it cuts deep into a tissue like your jugular artery6$ tab wounds


19/32


20/32

shoc;7=ut if he will not get any medical attention and body canBt maintain it# body will go touncompensated shock and will lead to death$

%ug 2

Jiolence against women$ 2A ,66$ Dhen do violence against women and their children occur

Jiolence according to the D01' the intentional use of physical force or power# threatened oractual against oneBs self or another person (here weBre talking about another person) thatresults in or has a highlight resulting in injury# death# psychological harm# mal-development ordeprivation$ >he intentionality is always associated with the committing of the act itselfirrespective of the outcome of the violence$ Cf somebody hurts another person or threatens tohurt another person that in itself# the intentionality is there already$ >here must be arelationship wherein one person perceives himself or herself as more powerful than the otherperson$ o this would include threats# intimidation# neglect acts of omission or all types ofphysical# se!ual and psychological abuse$ uch an abuse could also happen within a marriage$Ct does not necessarily lead to injury# disability or death but it will pose substantial burden onindividuals# families# communities# healthcare systems worldwide and this conse@uences caneither be immediate# latent or can lasts for years after the initial abuse$ >he conse@uencessuch as psychological harm do not e!pect it to happen immediately all the time$

2A ,66 is gender based$ According to the U; 3eclaration on the elimination of violenceagainst women# itBs a gender based violence performed by a husband or an intimate partner$ Cnthe U# most of the recorded incidents of injuries in women are from violence of their intimatepartners$ Ct occurs everywhere$ Ct refers to any behavior within in an intimate relationship thatcauses physical# psychological# se!ual harm# to those in the relationship$ And the term batteryissues the abuse occurs repeatedly in the same kind of relationship$

3i4erent forms' physical aggression# psychological abuse# economic abuse$

Pactors' the man grew up in an abusive atmosphere# witnessing domestic violence by children#couple married very young# the man is alcoholic abuse8substance abuse# economic stress# no

support fort the family in the community# if culture accepts that men have the right to hitwomen$

>wo types of violence' the severe and escalating form of violence and the moderate form ofviolence$ >raditionally# manBs beating is a conse@uence the manBs right to in"ict physicalpunishment on his wife$ >here are many cultures that believe that a wife is a manBs property$

Dhat are the events that trigger partner violence Doman refuses to have se!$ ;ot preparingthe food$ Doman asks where the money goes$ A lot of men have no work$ Ct is essentially aboutpower and control$ =ut women still stay in the relationship$

+ycle of violence$ Pirst# tension building$ econd# honeymoon stage$ =ack again to the tensionbuilding$

*!cuses of the batterers' QC only pushed herR& QC did not hit herR& QCtBs her faultR& QheBshystericalR& Qshe bruises easilyR

Domen in a violent relationship try to protect their children$ >hey try to adopt in such a waythat the children will be protected from harm$ Ditnessing domestic abuse by children is anabuse in itself$

+onse@uences' they keep complaining of pain everywhere in their body even if there is nothingwrong with them# they may end up smoking# overeating# or they will stay idle# they becomedepressed

/yths about domestic violence' it is not a common occurrence& women are just as violent as

men& men are brought up to be the aggressive person& women are brought up to be thesubmissive group& alcohol abuse causes domestic violence (alcohol inhibits your actions so youare braver to hit the other person)& domestic violence is usually a one-time domesticoccurrence& men who batter are often good fathers$


21/32

7N to GN percent of men who hit their wives abuse their own children either physically# se!uallyor psychologically$ Dhen there is violence in the family all members are participating in thedynamics# therefore# all must change to stop the violence$ =attered women are machuchisyicand provoke the abuse they must like it or they would leave$ 0C>>C;< C ;1> 3C+C?C;C;hinking properly becomes disrupted$ ocially# she will not know to relate with herchildren and she may be even become abusive to her children# she will not know how to relateto her neighbors because all that sheBs trying to do is survive$ =ecause of so much fear otherparts of the brain will wear out$ he may either create permanent memories of what has beenhappening to her and she may foresee that everything will just keep happening$ >here could

also be e!treme an!iety$ 3epression$ 3i.culty forming attachment to other people$ Cn a way#she isolates herself$ he can have sleep problems$ he can be a very impulsive person$ >heywill appear helpless$ *!posure to a remand of earlier trauma to perceive threats or togeneralie reminders will make either respond an!iously# sheBs gonna start to become panic#aggressive may even provoke threatening behaviors from others$

>here could be a post traumatic stress disorder$ Any intrusive recollections of the traumaticevents will create hyper-arousal or hyper-vigilance$ >hereBs avoidance behavior# emotionallonging# disrupted interpersonal relationship# body image distortion and se!ual intimacy issues$Dhen the cycle of violence becomes worse it may come to a point where she could kill the manwhen he is asleep or is drunk because that is the time that she is stronger# or she herself willend up dying$

>he medical evidences should include the interview of the woman as to what had happened$ Asocial workerBs interview and investigation is also needed$ Dhat the doctor can add to thatinterview will the physical e!amination and documentation of the injuries# the laboratorye!amination# and psychological or psychiatric evaluation will also be good if the woman intendsto le a case and other evidence that should include crime scene investigation# accounts fromwitnesses# and a social workerBs investigation also$

hysical abuse$ D01' +hild abuse or maltreatment that consists of all forms of physical# and8oremotional maltreatment# se!ual abuse# neglect or negligent treatment of commercial or othere!ploitation resulting in the actual or potential harm to the childBs health# survival#development or dignity in the conte!t of the relationship of responsibility# trust and power$ Pormedical evaluation we have to include the comprehensive medical history or child-sensitiveforensic interview# physical and laboratory e!amination$ De treat that patient and we do crisis

interventions and referrals$ >he purpose of our evaluation is to evaluate the medical problems#gather evidences# and give the child a therapy by making sure that the child is safe andprotected$ Cn the U# it is the interviewer who tells the court what the child told her$ >he child-sensitive interview is done using the appropriate language depending on the childBs age# non-leading @uestions are asked initially and when the child starts to disclose everything down tothe specics thatBs when we ask specic @uestions but make sure not to ask yes or no@uestions and make sure that the story comes from the childBs mouth$ >ake into considerationthe language development of the child$ +hildren do not keep time$ +hildren jump from oneevent to another$

hysical abuses are acts of commission by a caregiver$ >here has to be a relation of trust#power and authority$ Cn 2A GHN# although child abuse refers to in"iction of physical injury#physical injury in 2A GHN includes but is not limited to lacerations# fractured bones# burns#

internal injuries# severe injuries su4ered by a child$ Ct does not say who in"icts this injury# itdoesnBt say whether itBs intentionally in"icted kind of injury which D01 adds the wordQintentional$R


22/32

1ne$ >he injury is not only in"icted but itBs non-accidental$ (>he three mechanisms of injury'accidental# self-in"icted and action of a third party$) >he pattern of injuries t a biomechanicalmodel of trauma that is considered$ A lot of injuries have been scientically studied and therehave been conclusions are made wherein they said that it can only be caused by an abusiveact of another person$ >he pattern of injuries may correspond to in"iction with an instrument ina manner that would not occur through play or natural environmental interactions$

haken baby syndrome$ Dhen the baby is shaken he will have subdural hematoma# thatBsbleeding within the brain# retinal hemorrhages# without any evidence of e!ternal injuries$ >hebabyBs head is bigger than that of the body$ >he neck muscles are weak$ >he baby can presentsudden seiures# stop breathing# vomiting# and poor feeding$

Another injury that can happen is rib fractures$ +hest compression in +2 does not cause thiskind of fractures$ Another problem that can happen is cervical cord injury wherein the babystops to breathe$ Dhen you shake the babyBs head# it will cut the nerve connections in thebrainstem (it is where your respiratory and circulatory centers are# it is what you call thecervical cord)# it is known as di4used a!ional injury# no time for bleeding to happen$ 2etinalhemorrhage is a bleeding at the back of the eye$ Prom a lot of short falls (short falls-falls lessthan 7 feet)# majority of children do not have serious head injuries because the e!tremities hitthe ground rst$ /edical evidences will be the medical history# family and social history#

investigation of the childBs environment# physical and laboratory e!amination$Vuestions that you have to ask'

Dhen did it happen Dhere did the injury occur Dho witnessed at the time of possible injuryDhat did the caregiver do after the injury Cn formulating our impression we have to ask these@uestions$ 3oes the history reasonably e!plain the injury Das there any e!planation given asto how the child incurred the injuries Cs the statement given consistent with the developmentcapabilities of the child Cs there any delay in seeking medical care Cs the history vague

/edico legal principles' we can only o4er an opinion of the presence of an abuse because wewant to put the child in a safe place after$ De cannot give you an opinion about the guilt of analleged perpetrator nor can we give you an opinion of his intents$

%ugust @C;SU2C* P21/ PC2*A2/Firearm- weapon that res single or multiple projectiles propelled at high velocity by gasesproduced through rapid conned burning of a propellant$

Projectile any object that is sent through space by the application of force$ Por rearms# theprojectile is called a bullet or a pellet or a shot which is made of metal (usually lead)$ omeprojectiles will fragment inside the target while others do not$

&o 0asic types o) rearms!

Artillery (usually the big ones)

Pirearms - very portable and has a range of accuracy of less than one mile$ riWed weapon which is a pistol and a riWe

shot gun

'andgun or pistol the smallest of all rearms# red from the hand# it has a riWed barrel$ Foucan have a revolver wherein after the bullet is red a brass case which contains the e!plosiveremains in the cylinder unlike an automatic when it is red the empty cartridge case falls onthe ground$

4iAe- itBs a long barrel# with a high mule velocity# a riWed barrel# and built for accuracy andlong range (H$ km) and you have to aim to hit your target

*hotgun rearm with a smooth bored barrel designed to re multiple pellets that will comeout from the barrel and to be red from the shoulder$ Ct is designed to @uickly hit a movingtarget$ Fou donBt need to aim# just point and shoot


23/32


24/32

/ule to target distance is greater than HN feet all you will see is the hey must describe the wounds in detail

Pf$ @uestions must be answered' is there projectile present Dhere

projectile fragments present Dhere

type of weapon or ammunition

path of projectile

Pirearms investigation is a comparative investigation$ 3one macroscopically andmicroscopically$

=ullets are compared and matched to specic rearms$ As well as# accurately determine thedistance of the shooting$ =ullets will have ri"ing of the PA that was used$ 2i"ed PA will leave amark on bullets$ *ach PA has a uni@ue ri"ing pattern$ Cf no marks on the bullet then gun usedhas smooth barrel without any ri"ing$

%CC8D$6& *8C8D$ .4 M4D$4B*uicide no notes are left in majority of cases$ Dound site within the range of the deceased$Usually contact wounds$ ites of the wound usually include the head# chest and abdomen$Unusual location# think homicide$ Deapon should be present at the scene of the crime$ /ay notbe near the victim since he may have moved if he did not die instantly$ Cf suicide ruled out itcould either be accident or homicide so look at the circumstances$ /ultiple PA wounds suggesthomicide$

*ept 9

86J48$* F4.M $PL.*8:$*

$plosi/e7A mi!ture of an o!idiing agent and fuel$


25/32

&o parts!H$ ?ow e!plosives e!ert a throwing e4ect in a factory or people nearby of any object6$ 0igh e!plosives they can e!plode between H thousand to I# NN meters per second causingmore shattering and devastating e4ects in a farther distance

$plosion7A result of endothermic chemical reaction wherein there is a generation of hugeamount of gas with the release of vast amount of heat that occurs very @uickly$

DiEerent types o) 0om0s!H$


26/32


27/32

&4%6*P.4& 86J48$* D4."686 %LC.'.L

< 4.P* .F :8C&8M*

edestrian# passengers# cyclists or motorcyclists

&4%6*P.4& 86J48$*!

Primary injuries

from the direct contact of the vehicle

rimary injuries are recogniable and may take the pattern of the bumper for e$g$$Dherever the injury is thatBs the point where the pedestrian was hit$ +lues as to the speed on the car'

Z 6N km8hr thrown o4 the hood either forward or sideways

6N-N km8hr victim may fall on the hood and head may strike windshield

N-HNN km8hr victim may "y up in the air and he can fall on the car or beyond thecar$

*econdary injuries

from the contact of other objects or the ground after contact with the vehicle

1ften more serious and potentially lethal than primary injuries (e$g$ head and spinalinjuries)

Car occupant

>he injuries su4ered will depend on the kind of impact

Jehicle hit from behind called acceleration impact

ide impact and rollovers least common

Prom the front - there will be acceleration then deceleration$ 3eceleration impacts withoutrestraint (no seatbelts) and youBre accelerating with the car and the car hits another car yourbody is still accelerating& your head can hit the windshield or your chest the dashboard andother injuries on the upper part of the body$ >here could also be injuries on the lower part of

the body# in the ankles# hips or knees$ 1rgans in your body also accelerate and in the act ofdeceleration pulmonary veins# aortic veins attached to the body can be torn o4 so thereBsinternal bleeding$ Fou may also sustain injuries within your brain since the brain moves in yourskull$ you may have concussions and contusions$

Motorcyle injuries

due to falls from the machine

you can have abrasions# injuries in the head

bicycles more milder forms since lower speeds but the problem is when they are hit byother vehicles wear appropriate safety gears

8MM$4*8.6 %6D D4."686


28/32


29/32

because thereBs a sphincter of some sort in the stomach which does not rela! when youBredead unlike airways which can rela! so water may "ow freely$

/echanism of death as a 2esult of ubmersion is not always classical drowning because mostof them die @uickly and the result is usually cardiac arrest$

;o universally accepted laboratory test to conrm drowning$ Cf they nd diatoms in the blood orlungs itBs just corroborative evidence of drowning$ Porensic pathology - if thereBs water in thelungs victim was alive when he entered the water and if thereBs no water in the lungs it can bedry drowning or death prior to submersion$ athologist must determine if thereBs laryngospasm$

Vuestions to answer in an investigation'

was the person dead or alive when he entered the water

is the cause of death drowning Cf not what is the cause of death

why did the victim enter the water why was the victim unable to survive in the water 3id this victim have other healthproblems or he was already injured what were the circumstances preceding death very important to identify the body$

what were the circumstances when the body was recovered

autopsy ndings

[Bs H and 6 are very important because these will have to be correlated with autopsyndings and if thereBs concurrence between the two then pathologist can make the ndings$

%LC.'.L

Alcohol abuse usually encountered in child abuse and rape cases$

CtBs a drug and addictive$ /akes one prone to accidents and an underlying cause ofmisdemeanor# assault and homicide$

*>* o) alcohol intoication!

*!citement - lack of inhibition or self-control# feelings of well-being

Cncoordination and +onfusion loss of nervous control of your body# blunting of perceptions#no muscular corrdination# nausea# vomiting# cardiac and respiratory symptoms ;arcossis or +oma deep sleep# slow breathing# paralysis of cardiac and respiratory centerswhich can lead to death

/ales cannot say that they could not have raped a girl because they were drunk becauseerection can happen in the e!citement stage$ 1n the other hand# they take advantage of girlswhen the girls get into the incoordination and confusion stage (3rug facilitated se!ual abuse)

0ow do we diagnose drunkenness

alcoholic smell of breath or vomitus

dry tongue

e!cessive salivation

irregular behavior


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bloodshot eyes

thickness of speech

tremors# error of coordination and orientation

=est tests' blood alcohol content (=A+)# urine test for alcohol and breath analyer test

>ests for error of coordination'

2omberg test

eye movements - place a pen in front of his eyes and thereBs nystagmus and place theobject on the side of the eyes and thereBs jerky movements walk and turn test walk in a straight line heel to toe , steps then do a @uick turn

1ne leg stand

nger to nose test

let him pick a small object from the "oor without falling o4

may also be asked to do some tasks like recite the alphabet in a rapid fashion

=A+ ;ormal below N$Y ( /aybe /aBam meant N$N)# $H-$H Y - impaired faculties# not t to

drive vehicles# if % N$HY and non-habitual drinkers into!icated to the point of staggering#N$6Y habitual drinkers at the second stage and N$Y stage of +oma$

Pactors that a4ect absorption of alcohol'

weight- the heavier you are# the more water content and since alcohol is soluble in water#alcohol is easily absorbed in the water content of our body so a person with more watercontent does not easily get drunk as a person with less water content or weight Patty foods delay alcohol absorption$ Alcohol is absorbed in the small intestine but you candelay absorption if alcohol stays in stomach$

*ept7 2

nderstanding the Child

Child de/elopment!

+ontinuous process that starts from birth to maturity# and goes to dene stages andphases$ =efore you can go to the ne!t phase# the child must master rst the previous stage$ ;ow the skills and the comple!ities as he grows older centers all in the physical# mental#social# and emotional function of that person$ Ct a4ects cognitive development# emotionaldevelopment# and social development$

87 First < to G years o) 0a0y! ;eurons start to connect with one another$ And the only way these neurons get connectedwith one another is if the baby is stimulated at the time when he is born$ *!perience leads to neural changes in the brain$

Jisual stimulation should happen in the rst months for the necessary neural pathway todevelop$ Fou are now developing communication with the baby$ Cf you meet the needs of the child#that child will learn to trust you and will develop an attachment to you as a caregiver$ Cf you need the baby to master a certain task# he must be stimulated at the right time#given the right e!perience$ *!ample# a -month-old baby# you canBt teach that baby to walk#since he has not developed the muscles to support his own body to walk or stand on his own orbalance himself$

>hey learn to recognie their father and mother$ Dhen looking at objects and you hide itright away# they will think the object is no longer e!isting$ >hey donBt know the object is thereand eventually as they grow older# peek-a-boo is an important game for babies# because theywill learn you are still there actually$


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>ouching is very important for children$ Por children who are not touched at all# when theygrow up they donBt want to be touched# since itBs strange for them to be touched$ >hese babies are learning to be autonomous# they are learning how to toilet train and howto be independent and if you donBt allow them to toilet train themselves# learn new skills# theywill not develop self-esteem$ >hey now have the ability to symbolie$ Cn the beginning# they know the mental image ofwhat an apple is$ =y the time they are H or 9 years old# now they can say this is an apple$

o they are ready to play with other people$ >hey will only do things for the approval of aparent# they will do things not to be punished$ >hatBs all what they care about for the rst 9years of life$ >he se!ual behavior at this stage is more on touching and looking$ >hese are just learning$e!ual behavior at this age is merely knowing about the di4erence between the vagina andpenis$ As early as two years of age# they already learn the concept of right and wrong$ Ct hasnothing to do about pleasing the parents or they are being punished$ /oral control isinternalied by age through consistent parental monitoring# praising of good behavior#identication of parental values# etc$

8mpact o) a0use at this stage!

Por babies# as they grow# anything the parents do is correct# so if the babies sees the fatherand mother @uarreling# they would see that as a normal thing to happen$ Dhen they are abused at this age# especially when it comes to corporal punishment# theywill only understand the pain& they donBt understand the reason for the punishment$ >hese children are egocentric in thinking$ *verything is C# me mine$ >hey cannot relatethemselves to the outside world$ CtBs up to the parents to teach the child to relate with theoutside world by allowing the child to play# to converse and talk with him# to interact with hisenvironment# to do things on his own$ +hildren have immature reasoning$ >hey think everything that happens is their fault$ Cf theyget physically abused# the child thinks# LCtBs my fault$B Cn court# lawyers should argue objections out of the childBs hearing$ >he child will think itBshis fault' Q/y lawyer is shouting at me because C probably did something wrong$R

887 Preschool!

/ay signal the start of mental and behavioral problems$ >he child grows older# learns newskills# learns to be industrial# etc$ Cf the child doesnBt learn new things# she will learn not to takeany initiative at all and not develop self-esteem$ /orally# they will do things to please the other people other than the parents$ ;ow theyhave a conscience and are aware of social norms$ A 7-year-old victim will say# Q0indi ako magsasabi kahit kanino kasi Lyan ang sabi nila$R 1rQ0indi naman ito bad kasi ginawa ni tatay$ 0indi naman masakit# nakakakiliti nga$R A ,-year-old victim will say# Q=astos Ltong ginagawa ko$ Kung magsumbong ako# kawawanaman si tatay# baka makulong din siya$R A 7-year-old is more inward-looking as compared witha ,-year-old$

8mpact o) a0use at this stage! 2esearch shows that those with multiple personalities disorders and other forms ofdisassociation su4ered abuse prior to I or , years old$

8887 %dolescence

>he o4set of adolescence for girls is at HN-H7# boys H9-H7$ >heyBre now learning how tothink abstractly# but their thinking is still egocentric$ >hey cannot handle hypotheticalsituations yet$ >hey now follow rules and the values of society# but they may not understand the conceptof values and rules$ =ut here# theyBre nally learning who they are$ Cnitially# it was thought that the brain develops only in the rst 7 years of life# when all theneural connections are being made$ Ct was found that during the adolescent stage# a lot of theneuron pathways that were hardly used got pruned away and new pathways are being created$


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notes on legal medicine

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