legal med midterms.doc

8/12/2019 legal med midterms.doc

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Notes on Legal MedicineLegal medicine (AKA forensic medicine) branch of medicine that deals with application of knowledge to legalproblems and proceedings

Medical jurisprudence - branch of law that deals with application of law to medicine or conversely medical science tolegal problems

Forensics application of scientific knowledge to legal problems and proceedings

- Used in the prsit of !stice in cort proceedings and in the protection of the pblic from environmental ha"ards

Pathology branch of medicine that deals with diagnosis of disease and cases of death by means of laboratorye#ams of body flids$ cell samples and tisses from the body%

- if alive & biopsy- if dead & atopsy' systematic e#ternal and internal e#amination of the dead- a sbspecialty is forensic pathology( a forensic pathologist e#amines persons who died sddenly$

ne#pectedly$ violently or a medically nattended death$ an e#pert in determining the case and manner ofdeath$ involved in crime investigation$ case coordinator for the medical$ forensic and scientific assessment of agiven death may be the lead investigator)$ e#pert in interpreting the scene of death$ assessing theconsistency of witnesses and interpretation of pattern in!ries

Medico-Legal officer physician who is involved in medico-legal dties

- *+,% . ,ode of *anitation( Any medical officer M/0$ 1/0$ 2istrict /ealth 0fficer)$ medical offices from lawenforcement agencies$ ,/1 and members of the medical staff of accredited hospitals%

- Medico-legal cases( deaths or in!ries involving persons who have no means of being identified$ those who areprononced dead on arrival on +1s$ deaths nder the following circmstances 3death occrred within 45 horsof admission$ clinical case of death is nknown$ ne#pected sdden death especially when the person was ofapparent good health$ d6t natral disease bt associated with physical evidence of fol play$ death as a resltof violence$ sicide or poisoning$ death d6t negligence of a 7 rdperson$ inclding cases of child abse$ physicaland se#al abse$ rape$ drg addiction and iatrogenic cases of in!ry$ disease or death one cased by themedical professional sch as the doctor6nrse)$ etc8

Child protection specialist- new kind of specialist in the field of pediatrics' deals with medico-legal cases of childrenwho were allegedly absed

N0 formal training on how one becomes a Medico-legal officer%

Doctor as a witness:

,an either be a professional witness or an ordinary6 fact witness or both

9ive factal medical evidence$ cannot give comments or opinions :U; an e#pert witness can give an opinion

abot medical facts

+#pert witness has special knowledge as well as crrent knowledge or skill gained by edcation$ training$ or

e#perience in the field of e#pertise

+#plain scientific matters that may or may not be nderstood by !dges

Medical e#pert testimony cold either be for the prosection or for the defense

Medical testimony mst be ob!ective and accrate

Law does not make a


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Notes on Legal Medicine=re-trial preparation of the e#pert witness refreshes the level of e#pertise$ enhances


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Notes on Legal Medicine@f the brain does not receive o#ygenated blood within 7-D mintes$ yor heart stops beating% Nerons die if there?sno o#ygen broght to the brain within D mintes%

:rain death follows a stage(>% ;he cerebral corte# or that part of the brain with higher fnctions die first%4% ;he cerebellm the part of the brain that?s for keeping yor balance and coordination) follows%7% ;he last to go is the brain stem% @t is in the brain stem where the cardiac and respiratory centers lie% @t?s the

stem brain that?s what will keep yo alive%

*o we have what we call a persistent vegetative state% Co?re completely nconscios bt yo?re breathing on yorown$ with yor heart beating% 0r yo may have assisted ventilation% And it is assmed in sch a state that the brainitself is fnctioning% /igher brain centers are dead e#cept for the brain stem% :ecase the brain stem is not deadyet$ the cardiac and respiratory centers are working% *o even if yo?re totally nconscios$ yo may be breathingon yor own and yor heart is beating on its own% 0r yor heart is beating bt yor are breathing throgh aventilator% And the only thing that?s needed is to keep feeding the patient% *o these are the people we callvegetables%

iological death:

/ere finally$ even the brain stem dies% All components of the brain die$ closely followed by celllar death%

Cellular death(

;hink of cells as mini tiny factories% *o in celllar death$ these factories sht down one by one% And eventally$they wold !st break p and decay%

,elllar death itself also does not happen all at once% ,ells die slowly% :ecase evidence now is showing that$ let?ssay$ yor skin and bones may remain what yo call metabolically active still alive for many hors)% ;hat?s whyafter death$ if yo need to transplant or se bones or skin$ they may be harvested and cltred p to >4 hors afterthe heart has ceased beating% Nerons of corse die after 7-D mintes% ;he heart and kidney can still be sed ifthey?re harvested within E hors of cessation$ after the person is prononced death% *o it?s very important$especially when we?re talking abot transplantation% ;he person mst be prononced dead by the attendingphysician%

*o death actally takes a long time% @t doesn?t mean that !st becase the person stops breathing and his heart isnot beating$ he?s dead% @t?s a transfer from one state of viability to another and may be slow or rapid depending oncertain factors$ like yor age% ;he very yong and the very old$ they die faster% Fery yong$ becase they?re very

immatre$ the very old becase of the wear and tear% ;hey don?t have defenses anymore so they can die really fast% @fyo?re very thin$ if yo?re malnorished$ if yo have all these diabetes and heart problems$ yor death will be faster% 0renvironmental factors good thing it doesn?t snow here)% @f yo?re sickly and its cold otside$ yo?re not wearinganything$ or yo?re malnorished$ yo?re going to die fast%

*o it?s the physician who prononces death when what yo call the Gpoint of irreversibility? has been breached% Andwhen is thatH hen does a doctor say that the point of irreversibility has been breachedH

;raditionally$ when the doctor doesn?t feel a plse or doesn?t hear the heart beating and the person is no longerbreathing$ we say the person may have died%

>% 0ther ways of finding ot whether that person is really dead is by ptting a mirror on the face$ at the mothand nose$ of the person% @f there?s no condensation on that mirror$ it means the person is not breathing%

4% hat we can do is also look into the eyes$ throgh the ppils% e can see what we call the Gfnds? where yocan see the blood vessels% @f the blood vessels are not plsating$ that means the heart is no longer beating%e can se ++9 electroencephalogram) test% :t in the province$ yo don?t have ++9% ;he doctor sallyses what yo call the ophthalmoscope to look into the eye and check if there?s still plsation% *ometimes$they don?t have a mirror$ so doctors bring compacts$ like the ladies% *o it?s !st a plse or listening to theheartbeat%

7% Co can also try to monitor response by giving painfl stimlation to the patient% 0ne is pressre on theglabella N.B.the space between the eyebrows$ nless yo have a nibrowI)$ pressre on the sternm$ orpinch the finger% *o if the person is alive$ he?s going to drive yo away becase these are very painfl areas%+specially if the person is lying down and yo?re standing p$ and yo pt so mch pressre$ that can be verypainfl%

=age )of !


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Notes on Legal Medicine5% ;he other ones and very importantly$ will be the absence of brain stem refle#es% Meaning the response to pain

stimli in these areas come from the brain stem% @f these are absent$ that means the brain stem is dead%

Corneal refle* what we do is get a wisp of cotton and toch the cornea% Co know how painfl that is% *o aperson will blink% @f yo?re dead$ yo won?t feel anything anyway% *o a live person will be in pain%

'hine light into the pupils if yo?re dead$ yor ppils are e#pected to be dilated% @f yo shine a light$ theppils shold normally constrict% A dead person will not have that refle# anymore%

+culo,estiular response we in!ect ice cold water into the ear% And we normally e#pect the eyes to movethe opposite side% *o if the eyes will not move$ then there?s no refle#%

.ag refle* when yo pt a tbe$ catheter$ or tonge depressor and try to stimlate the back of the throat%Co?re going to gag if yo?re alive%

$pnea testGapnea? means no respiration at all) this is done mostly on people on ventilators% hat is doneis$ we get what we call arterial blood gases% +ssentially$ we want to know what the level of o#ygen and carbondio#ide is in the blood% *o while on the ventilator$ o#ygen is flowing into the lngs% e get the arterial bloodgases then the ventilator is trned off for abot .->J mintes% After that period of time$ arterial blood gasesagain are taken% @f the o#ygen level of the blood is very$ very lowthere?s a certain nmberif the carbondio#ide level is very$ very high$ that is a sign that the patient is not breathing at all% @f all of these are notpresent$ then the person is dead% =ls$ yo can also have a silent ++9 where no more brain activity is going

on%

;here are criteria for death% As @ said earlier$ becase of new developments in medicine$ a person may not bedeclared dead immediately% 0f corse$ the first thing that came p was yor cardiac plmonary resscitation ,=1)%:t we have other advancements% e have fibrillators% irst$ when a person sffers from a heart attack$ it has beenproven that the heart fibrillates% ;he person faints becase the heart fibrillates% /ow does a heart look like when it?sfibrillatingH @magine a bag of live worms% Co look at the otside% @t?s !st going like that% @nstead of pmping blood ot$yor heart is !st going like that when yo sffer from heart attack% @f yo pt yor stethoscope on the chest$ yo?re notgoing to hear it so yo?re going to say he?s dead% :t applying defibrillators can still revive the heart% ;hat?s why its veryimportantif any of yo witness a person who may be ndergoing a heart attackto !st have to call the emergencymedical services% /ere we have +1U% ;hey have defibrillators !st to get yor heart to start pmping immediately%

;here?s what yo call for a person who needs a heart transplant% ;hey have what yo call assisted devices not a

pacemaker)% @t?s practically there pmping becase the heart mscle itself is not pmping$ or inade


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Notes on Legal Medicined% ,onfirmation by two ++9?s there mst be two ++9?s taken 45 hors apart%

@ don?t know if yo remember this person% ;his one person was essentially declared dead% *he?s breathing on her own$her heart is beating$ she was !st being fed% :t the hsband$ probably tired of taking care of her$ went to cort andasked the cort to declare her dead$ so they !st stopped her feeding$ and she died of starvation% ;o me$ she does notfall nder the /arvard criteria or the Uniform 2etermination of 2eath%

*o let?s go to organ and tisse transplantation% @n organ transplantation$ there are instances when the person mst

be dead first% @f yo will look at the 0rgan 2onation Act of >>$ death is defined as(

The irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functionsof the entire brain, including the brain stem. A person shall be medically and legally dead if either:

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

(#) n the opinion of the consulting physician, concurred in by the attending physician, that on the basis ofacceptable standards of medical practice, there is an irreversible cessation of all brain functions" andconsidering the absence of such functions, furthers attempts at resuscitation or continued supportivemaintenance !ould not be successful in restoring such natural functions. n this case, death shall be deemed

to have occurred at the time !hen these conditions first appeared.

The death of the person shall be determined in accordance !ith the acceptable standards of medical practiceand shall be diagnosed separately by the attending physician and another consulting physician, both of !hommust be appropriately $ualified and suitably e%perienced in the care of such patients. The death shall berecorded in the patient&s medical record.

*o the attending physician may call another consltant' he and the attending physician can be the ones to declare aperson dead%

Now going to problems regarding transplantation$ the problems are consent and athori"ationwho will consent orathori"e to donate organs$ who will determine death in case of procrement from a cadaver% And there is a problemof rationing organs$ there?s not enogh organs for transplantation% More so in the U* and +rope where they do a lot

of organ transplantation% *o here for s$ a person who may e#ecte or athori"e to have a part of his body donated isanyone above >E% @n the U*$ there in their driver?s license$ it?s indicated if yo want to donate yor body or a part ofyor body$ and atomatically$ yo?ll be sent to the hospital and the hospital will harvest yor organs% 0f it cold beanybodysomebody of legal age can sign for yo% Cor parents$ siblings$ or gardian% And the organs have to beharvested within E hors% *o yo have to consider the time to remove$ travel time$ time to operate the recipient$ etc%$so yo have to make the decision fast%

Manner of e*ecuting a donation:

;he death of a person from whose body an organ will be removed after its death for the prpose of transportationto a living person$ shall be diagnosed separately and certified by 4


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Notes on Legal Medicine

e do have problems with sing animal tisse$ althogh the =hilippine /eart ,enter sed to transplant pigs?heart valves$ etc% into heart valves of patients bt they?ve stopped%

o /omologos transplantation when tisse is removed from one part of the body and pt back into yor own

body% *o yo scrape skin from yor thigh$ probably to cover a brned area in yor back% 0r yo chip part ofyor pelvis and transplant it to an area where there?s a bad fractre$ for that fractre to heal faster% 0r in casesof Oehovah?s itnesses$ who cannot accept blood from any other person% @ had an e#perience where a patienthad to ndergo an open heart srgery% or those who ndergo open heart srgery$ yo heart has to stop

beating%) *o the blood mst go throgh a cardio-plmonary bypass machine and then retrned back to yorheart$ bypassing the heart and lngs% *o in this case$ it?s the patient?s own blood that?s circlating$ dilted with@F flids%

o Cor tisse is taken from a living donor and these tisses will be matched first with a recipient% @f yo?re

compatible$ yor blood can be e#tracted and transfsed to another person%o ;here?s what yo call bone marrow transfsion$ for patients with lekemia with white blood cell problems%

;here are also people who will donate their own kidneys for a fee%

:t bear in mind the Anti-;rafficking in =ersons Act 4JJ7$ *ec% 5%$ wherein yo?re not allowed to sell yororgans% Now$ cadaver donation is actally the ma!or sorce of all tisses for transplantation% *o yor driver?slicense may indicate that yo want to donate an organ or everything% Most of organs for transplantation comefrom dead people bt they mst be harvested soon after the patient is declared dead%

o ,loning if yo have problems$ they?ll !st give yo yor clone%

hen everybody dies changes can happen% /ow do we estimate the time of deathH

#$2L3 C&$4.#' %&$% &$PP#4 $F%#2 D#$%&:>% 1igor Mortis4% ,adaveric1igidity7% =ost Mortem /ypostasis5% ,ooling of the body after death or Algor Mortis

hen the heart stops and the breathing stops eventally there?s a falling blood pressre$ there?s no more o#ygen andthe cell method will stop working and becase of that yor nerve cells will die and there?s going to be no morenerological activity%

hen blood pressre falls down and there?s no more circlation$ yo wold become pale% ;here wold be pallorpersonae$ there will be eye changes$ refle# is gone$ the ppils will not dilate and will not constrict if it?s shown light$ theblood vessels in the fnds that yo see that are actally retina% Co won?t see any plsation and if yo toch the eye$it?s very soft% Mscles will become flaccid% As soon as there is a loss of the mscle tone it becomes flaccid and this istermed the primary flaccidity and this may retain any activity and may respond to other forms of stimli that?s why yomight see some twitching of the toes or some mscle twitching that?s reacting to the stimli% @t?s not actally dictated byhigher senses% ;here will also be loss of mscle tone so yor anal sphincter will !st come ot% Cor rinary sphincter$yor rine will !st come ot% 0r some semen might !st be emitted bt that doesn?t mean that he had !st had se#before he died% ;here will be revegitate of the gastric contents becase there is a sphincter in the esophags and inthe stomach% ;hat will also be rela#ed so when the person falls on his back or even head down stomach openingrela#es$ gastric sphincter will flow backwards this can be confsed as if the person died becase of asphy#iationgastric contents going into the airway)% ;he only way we can say that a person died becase of asphy#iation fromaspirating food is from eyewitnesses? accont% @f food debris can be fond down to the smallest part of the lng and

then we can say he asphyrated and that is the case of his death%

2igor mortis5;he temperatre dependent physico-chemical changes or chemical reactions occr within motor cellsas a reslt of lack of o#ygen%

2ifference between a normal metabolic pathway and the ano#ic no o#ygen pathway)% A normal metabolic pathwayhappens within yor body$ within yor system% An important reprodction of energy in yor body$ yor A;= singo#ygen% *o if there is no more o#ygen it?s !st glcose that is being sed to prodce A;= bt then withot o#ygen it willnot go throgh this process of o#idity PPPP lactic acid pathway and will prodce a lot of lactic acid in the body% ith thelack of o#ygen$ very little A;= or energy$ more of lactic acid what happens isPPPCor mscles are made p of fibers ofcells-acti enmycin fibers% ;hey bind together and they form a gel and that makes the mscles stiff% @t?s that lactic acid

=age 6of !


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Notes on Legal Medicinethat will case yor mscles to gel p ths become stiff% And this can develop fast especially if there?s no blood in thePPPP levels% +specially dring e#ercise or when the acidic levels are high or when somebody is stressed or dringelectroction when the mscle will be repetitively stimlated$ the mscles will keep fle#ing and fle#ing$ the o#ygenlevels can be low$ glycogen or glcose levels can be low$ it will become acidic so rigor mortis can be very fast% @t maynot be detected in people who have low mscle blk% ;here?s not mch mscle% *o what?s there to hardenH @t issally detectable first arond the eyes and arond the !aws and fingers and it will develop from the head down$ fromthe smaller mscle down to the larger mscle grops% @n determining the presence or absence of rigor mortis$ it is onlyestimating the time of death% 1igor mortis is a variable process becase it can be affected by a lot of environmentalfactors% @t is nreliable to find ot the time when the person died% @f the person is e#posed to a cold temperatre he willdevelop rigor mortis longer as compared to a person who is in a warmer temperatre which will be of shorter dration%@n temperate conditions it?s first detected in the face between > to 5 hors after death$ in the limbs between 5 to Bhors after death$ the strength of rigor will increase in the legs B to >4 hors% After that$ when celllar metabolism ordecomposition of the cells begin$ the mscles now will lose its cohesiveness$ its gel-like property now will get lost% @nthis stage of rigor mortis$ the body ends enters the stage of secondary flaccidity which occrs between 45 to .J horsafter death% ;wo types of rigor mortis( primary flaccidity within 45 hors$ it becomes stiff' after that the stiffness is goneand that?s called secondary flaccidity%

0ne can test for rigors% @f a !oint is fle#ed at death$ apply some pressre% @f it !erks back$ that means there?s rigidity% @fthe body feels warm and is flaccid$ it may have been dead for less than 7 hors% @f it is warm bt stiff$ it may have beendead for 7 to E hors% hen the body is cold and stiff$ it may have been dead for 7B hors% @f it is cold and flaccid p tosecondary flaccidity$ therefore$ more than 7B hors%

Cada,eric rigidity5Another term for this is instantaneos rigor or captalictic rigidity% ;his is based on certain findingswherein some people die holding grass in their hands or holding a gn when he died% Most likely the mechanismbehind has something to do with a nerogenic kind of activity when that person is highly stressed at the time of death%orensically$ if a person dies and is fond in the water and holding on to something like a grass fond otside of thatbody of water then that person was alive before he was fond in the water% 0r that person may be holding somethingthat belongs to the alleged perpetrator or whoever was with that person last may be holding on to something%

Post mortem hypostasis5At death$ circlation stops$ all mscles rela#$ inclding the mscles in the blood vessels%ith the rela#ation of the mscle tone in yor blood vessels$ the blood will settle down in areas where the bloodvessels are dependent% ;he blood has cells and flid% ;he passive settling of the blood cells nder the inflence ofgravitiy to the blood vessels in the lowest area of the body% ;his is forensically important% @t is not always seen in thebody% @t may be absent in the yong or in the old$ those who are anemic% @t may PPPP by that skin colors$ !andice oryellowish coloring of the skin% @t mostly forms on the back$ bttocks sides$ and back of the neck becase sally when

a person dies he?s lying flat on his back bt there are some areas of that persons back that cold be so pressed on acertain part$ like on the bed% A person died on his back so the bttocks probably pressed on the bed will have PPPPcalled blanching% Meaning$ the blood vessels have been s


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Notes on Legal Medicine@t is very important that an e#aminer gives an estimation of the time of death% ;here is a bracket probability giving anearliest or latest time which the doctor feels that death mst have occrred% @t?s within a range%

Decomposition or putrefaction5Most common root of decomposition of the body after death and early changes maybe confsed to be signs of violence or trama% ;here is li


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Notes on Legal Medicine;he prpose of death investigation is to identify and develop an nderstanding of the death of that person%

;wo types of death investigation(>% ,linical death investigation happens within the hospital% ;he doctor or the medical officer or the pathologist wantsto know what that person died of$ what was the illness$ did he die of a certain disease or in!ries$ or of poisoning% @t?s

!st within the hospital setting%

4% Medico legal investigation - maybe there?s some fol play in the case of death% @t may be that there is a policeinvestigation going on regarding the death of that person%

hen that natral death occrs$ the doctor will sign the death certificate$ once the death certificate is signed then thebody can be disposed of the$ the death certificate will inclde the case and manner of death% @f the death is natraland no doctor can complete the certificate then that death mst be investigated and the death be classified% 2eath thatcannot be e#amined by the doctor is e#amined by a variety of legal officers-the medico legal officers or the medicale#aminers%

/erein the contry based on the ,ode of *anitation$ cases where atopsies were performed are those that arere


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Notes on Legal Medicineinvestigation of a dead body performed primarily to determine the case of death and identify the disease that arepresent% @n academic instittion these are only for teaching and research prposes% :t for forensic atopsies it is todetermine whether a given death was an accident$ homicide or sicide or a natral event% An atopsy can beperformed by any doctor bt mst be performed ideally by a properly trained pathologist% 0r medico legal officer hadnot had any formal training in doing atopsies%

=ersons athori"ed to perform atopsies in or contry(

;he aim is identify the body$ estimate the time of death$ identify and docment the natre and nmber of in!ries%

*pecific ob!ectives( interpret significance and the effects of the in!ries$ identify the presence of any natral disease$interpret and identify the significance of the natral disease present$ identify the presence of poisons$ interpret theeffect of any medical or srgical treatment% @t is not !st looking% @t is also analy"ing what is seen and has also to see

what?s not there%

Atopsy will consist of an e#ternal e#amination% +#amine the whole body on the otside% ,ollect and trace evidenceespecially nder the nails$ on the moth$ etc% After condcting an e#ternal e#amination taking all the necessarypictres and docmentation of the in!ries inclding si"es and location of all those in!ries an internal e#amination isdone where the body is ct p$ each internal organ is removed$ weighed and dissected$ in!ries are looked for$ signs ofa natral disease are looked for% Anything that?s abnormal there are looked for% =art of the atopsy is a laboratorye#amination wherein tisses$ flids$ any weapon fragment bllets or whatever are collected and e#amined% Atopsyincldes gross observations and microscopic e#amination of all the tisses% ;hat medico legal atopsy mst determine

the case of death%

,ase of death( @t is the disease process or in!ry responsible for initiating the train of events whether their brief orprolonged sing the fatal end reslts% @t?s that which starts the event%

Mechanism of death( ;he physiologic or biochemical derangement prodced by the above case which is incompatiblewith life that is how the disease or the in!ry leads to death%

Manner of death( ;he fashion or mode in which the case of death came into being% @t may be natral$ accident$sicide$ homicide$ it can be nclassified whether if it is de to alcohol or drg% @t cold be ndetermined% @n thehomicide classification of death$ this is sed to classify the kind of death% @t is not sed to imply criminal intents%,riminal intent is left to the police investigators$ into the legal process not in the doctors% @t is only sed here that theperson died becase of a volitional act of somebody% Undetermined case or manner of death it cold be like there are

so many manners of death that cold have happened and it?s very hard to determine which one weighed more in killingthat person% +#ample( if yo?re a person who loves to drink a lot of alcohol$ eat a lot especially pork$ smoke so yo?reprone to have high blood cholesterol level so yo will develop a coronary artery disease% ,oronary artery disease cancase two problems in yor heart( electrical distrbance and heart failre% :ecase of the block in yor coronary arterythere?s not enogh blood spplying the heart$ so it cold be that the nerves of yor heart or the lethical wires of theheart are not well spplied by blood% *o it?s not going to pmp reglarly and rhythmically% ibrillation or a fibrillatingheart$ like a bag of worms$ so that heart is not pmping blood at all% @t?s not pmping blood ot% +very time yor heartpmps ot of its chamber it will also spply blood to the heart mscles% A heart failre is cased by poor o#ygenationbecase of poor blood flow to the heart mscles% @f a part of yor heart mscle is weak$ it?s not gonna pmp blood%Cor heart?s gonna have an ineffective pmp so yo?re gonna have a heart attack% hen yo die$ the manner of deathis classified as natral% hen yo are stabbed$ yo?ll lose a lot of blood$ that?s the mechanism% /anging$ sicide$stranglation$ the mechanism there is asphy#ia$ a lack of o#ygen in the system%

;he medico legal report mst show these three information% Unfortnately$ or system of death$ according to 2octorortn$ is not scientific based and is haggled by the policy of no aggressive complainant$ no case and the practice ofrelying mostly on witnesses% @f there?s no complaint$ there?s no case%

/ere is a case of a girl who died in a Monday morning% *he was apparently well 5 days prior to her death% ;hefollowing day she did not feel well$ she complained of vage abdominal pain% *he stayed in bed and ate what was fedto her% ;wo days before she died$ she refsed to eat and contined to complain of abdominal pain% /er mother notedthat her abdomen was becoming distended% *he still refsed to eat the ne#t day% And becase of that the mother?s livein boyfriend beat her with an electric wire% ;he child still didn?t eat and died the following day% ;he mother?s live inboyfriend was arrested and was charged with for violating 1A DB>J$ the Anti-,hild Abse Law% ;he atopsy report

=age 1of !


11/28

Notes on Legal Medicineconclded that the child died of pnemonia% As to the manner of death$ there was no report% :ased on the re


12/28

Notes on Legal Medicine +ther mar> measrements from the person

rite down and describe all the person?s individal markings and personal characteristics

@t is flawed$ it does not take into accont changes with age

as replaced with the se of fingerprints%

Fingerprints

%hree main patterns:loops$ whirls and arches or a combination of any of these three%

Used to ascertain a positive @2 of a person

No two persons have the same fingerprint even twins

,annot be altered by time or in!ry

,an be e#tracted in any srface they come into contact with%

%hree %ypes

Patent prints Plastic prints Latent prints

-left when a foreign sbstance

on the skin of a finger comes in

contact with the smooth srface

of another ob!ect

-visible prints

-no need for enhancements

-left when a finger toches a

soft malleable srface

-visible prints

- no need for enhancements

- impressions secreted in a

srface or an ob!ect that is

invisible to the eye$ the reslt

from perspiration from thesweat pores fond on the ridges

of sweat pores

-invisible to the eye

- needs enhancement e%g%

dsting)

No less than >B points of similarity before declaring prints to be identical

;he investigating agency mst already have a file of fingerprints for comparison

For decomposed or damaged odies:se speciali"ed techni


13/28

Notes on Legal Medicine 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 marJ percent of the billions of molecles in the body and only a few percent is

specific to yo alone bt the distribtion is ni


14/28

Notes on Legal Medicine9et a bckle smear from the side of yor moth$ vaginal swabs and anal swabs to determine presence of

semen or C chromosome within D4 hors placed in a ref right away$ blood% *emen on clothing can stay for a

year%

/alf of or chromosomes come from or father and the other half from or mother%

lood groups can only be sed for e#clsion in paternity or maternity testing' not accrate like that of 2NAanalysis%

@f the child?s blood type is 0 and the mother?s blood type is 0$ the father?s cold be A or :%

*amples for 2NA testing( mother$ child and probable father%

@n paternity e#clsion$ if there?s none matching profiles in at least two 2NA locations it can

constitte conclsive proof that the alleged father is not the biological father%

@n child se#al abse cases$ it does not necessarily e#onerate the sspect from the abse

charges' it !st means that the abse did not impregnate the child%

@n paternity inclsion$ complete matches in the 2NA profiles of the child and the alleged father

will not necessarily establish paternity% ;he strength of the matches is determined statistically%

@2+N;@@,A;@0N 0 L@F@N9 AN2 2+A2

Use of 2NA evidence in corts(

@mportant to se 2NA- allowable for @2 and testing of parentage

*, said 2NA can be sed as corroborative evidence together with other evidences

ind ot how sample collected$ handled$ possibility of contaminating samples$ standard procedre followed in

analysis$ proper standards followed in condcting tests and


15/28

Notes on Legal Medicineimproper collection$ handling or storage and can occr when


16/28

Notes on Legal Medicine- ;he sal gide in determining the age of the brises has been discarded% @t was discovered that some

brises will only appear later on when there was already brising in the mscles for a long time%- depends on the site and how bad was the bleeding- they do not accrately reflect the ob!ect casing them bt there are some patterns that indicate the type of

weapon sed- often associated with abrasions and lacerations less associated with incised6stab wonds becase in stab

wonds the blood is allowed to escape6 seep nder the skin- more prominent if force applied on bony areas so if yo see brise on abdomen greater force was applied for a

brise to reslt- ,an occr after death since blood vessels are easily broken when dead% ond on areas on the dependent

part of the body by gravity)

Lacerations

- reslt of blnt force overstretching the skin and there will be a split of the fll thickness of the skin- deep and will bleed- important to look for bridging fibers remain intact in lacerations and will not be ct)- skin can be compressed within the applied force and the nderlying bone- rare in soft fleshy areas of the body- margins are always ragged- if cased by thin sharp ob!ect$ the wond is sharply defined and may be mistaken for incision bt nder the

microscope there cold be abrasions and contsions on the edges and bridging fibers in the laceration

'harp force injuries:

>% @ncised wonds

- also cased by ob!ects with sharp and ctting edge and distingished from a stabbed wond by being longerthan deep

- +dges will give indication of the sharpness of the ob!ect sed% Fery sharp ob!ects will not leave brising on theedges$ no bridging fibers%

- rarely life threatening nless it cts deep into a tisse like yor !glar artery4% *tab wonds

- wonds that are deeper than they are longer

- 2epth of the in!ry will make it fatal becase of the bleeding- Any ob!ect with a point or a tip can case it$ edge need not be sharp%- =ressed into the skin with enogh force to overcome the natral elasticity of the skin- Appearance does not necessarily mimic the cross-sectional shape of the ob!ect sed% ,ontraction of the

elastic fibers of the skin will distort a slit like wond after removing the weapon- *hape of the wond can tell yo if it was a single edged weapon or doble edged knife- =shing the edges of the wond together is not an effective way of measring the si"e of the wond and

determining the si"e of the weapon- *i"e of the wond will depend on the shape of the blade and how it was inserted% Movement of the knife in the

wond will change the shape and can enlarge the wond opening- @f knife flly inserted brising might reslt d6t the hilt of the weapon or by the hand of the assailant

Mechanism of 8njury

) ways of infliction of a wound

>% accident

4% self-infliction

7% action of a third party

=age 16of !


17/28

Notes on Legal Medicine:y looking at the in!ries alone it is very difficlt to determine which of these three cased a wond% Co have to lookat circmstances% 9et a history on how it was incrred%

:ite marks in a child is pathognomonic and the child was definitely absed% ;o identify the teeth marks yo need adentist and yo need to get an impression of the sspect?s teeth and compare% @t can also be a sorce for 2NAcollection%

D#F#4'# "+/4D'

ond in victims who are trying to defend themselves from an attack so it will depend on the kind of weapon sed

Areas ( Underside or posterior sides of the arms and hands

'elf-inflicted injuries - no definite characteristics that define these% :t a person who wants to hrt himself prefer stabor incised or gnshot wonds% @n areas that can be reached$ nsal areas inclde the eyes$ lips$ nipple and genitalia%:lnt force in!ries are rarely self-inflicted%

'ur,i,al:

@f there?s a lot of bleeding the body has a mechanism to prevent shock called Compensated shoc


18/28

Notes on Legal Medicine,onse


19/28

Notes on Legal Medicine0ne% ;he in!ry is not only inflicted bt it?s non-accidental% ;he three mechanisms of in!ry( accidental$ self-inflictedand action of a third party%) ;he pattern of in!ries fit a biomechanical model of trama that is considered% A lot ofin!ries have been scientifically stdied and there have been conclsions are made wherein they said that it can onlybe cased by an absive act of another person% ;he pattern of in!ries may correspond to infliction with an instrmentin a manner that wold not occr throgh play or natral environmental interactions%

*haken baby syndrome% hen the baby is shaken he will have sbdral hematoma$ that?s bleeding within the brain$retinal hemorrhages$ withot any evidence of e#ternal in!ries% ;he baby?s head is bigger than that of the body% ;heneck mscles are weak% ;he baby can present sdden sei"res$ stop breathing$ vomiting$ and poor feeding%

Another in!ry that can happen is rib fractres% ,hest compression in ,=1 does not case this kind of fractres%Another problem that can happen is cervical cord in!ry wherein the baby stops to breathe% hen yo shake thebaby?s head$ it will ct the nerve connections in the brainstem it is where yor respiratory and circlatory centers are$it is what yo call the cervical cord)$ it is known as diffsed a#ional in!ry$ no time for bleeding to happen% 1etinalhemorrhage is a bleeding at the back of the eye% rom a lot of short falls short falls-falls less than 5 feet)$ ma!ority ofchildren do not have serios head in!ries becase the e#tremities hit the grond first% Medical evidences will be themedical history$ family and social history$ investigation of the child?s environment$ physical and laboratory e#amination%

Qestions that yo have to ask(

hen did it happenH here did the in!ry occrH ho witnessed at the time of possible in!ryH hat did the caregiverdo after the in!ryH @n formlating or impression we have to ask these % Artillery sally the big ones)4% irearms - very portable and has a range of accracy of less than one mile%

a% riffled weapon which is a pistol and a riffleb% shot gn

&andgun or pistol the smallest of all firearms$ fired from the hand$ it has a riffled barrel% Co can have a revolverwherein after the bllet is fired a brass case which contains the e#plosive remains in the cylinder nlike an atomaticwhen it is fired the empty cartridge case falls on the grond%

2iffle- it?s a long barrel$ with a high m""le velocity$ a riffled barrel$ and bilt for accracy and long range >%B km) and

yo have to aim to hit yor target'hotgun firearm with a smooth bored barrel designed to fire mltiple pellets that will come ot from the barrel and tobe fired from the sholder% @t is designed to


20/28

Notes on Legal Medicineprodce large volmes of gases nder pressre% ;he tip is the bllet either lead or metal !acketed)$ which is the part ofthe cartridge that leaves the m""le%Projectile from a shotgun- shotgn shell% ,ylindrical cartridge of a plastic or cardboard tbe with a brass base%,ontains tiny lead shots% :ottom of the cylinder is the e#plosive powder and the center is yor detonator% Leaves thebarrel as a composite missile becoming appro#imately 7JJ individal shots as the missile moves frther down thebarrel% ;rigger is s


21/28

Notes on Legal Medicinebecase of the tiny pellets% 0nce ammnition leaves m""le$ pellets will start to separate% Not only central defect canbe seen bt also tiny defects coming from individal pellets%

Long range whole thing breaks ot% Co still see tiny concentric defects from individal pellets%

#*it wounds rarely seen if fired in the chest and abdomen% ,an be seen if fired in the head$ moth of hge rggedappearance%

&ow are they supposed to e in,estigated?

:ody mst be handled as little as possible to avoid loss of evidence

/ands mst be paperbagged not plastic) becase in plastic moistre can develop% :ody transported in a body

bag to preserve trace evidence and avoid contamination

2ring atopsy$ M2 mst take an #-ray and look for metal fragments in the body% Medical +#aminer pls

e#pert mst recover resides with >JS nitric acid and swab the area$ not a paraffin test% =araffin test isobsolete%

;hey mst describe the wonds in detail

f% % is there pro!ectile presentH hereH4% pro!ectile fragments presentH hereH7% type of weapon or ammnitionH

5% path of pro!ectileH

irearms investigation is a comparative investigation% 2one macroscopically and microscopically%

:llets are compared and matched to specific firearms% As well as$ accrately determine the distance of the shooting%:llets will have rifling of the A that was sed% 1ifled A will leave a mark on bllets% +ach A has a ni


22/28


23/28

Notes on Legal Medicine Oglar veins drain venos blood n-o#ygenated blood) from the head% @f there is obstrction$ the blood will

remain in the head% ;he person will swell$ congest or become cyanotic% ;he arterial veins will rptre casing

petechial hemorrhages nderneath the skin%

0bstrction in the carotid artery carries o#ygenated blood) cases cerebral skemia and the person will

collapse becase of lack of o#ygen in the brain%

*timlation of the barrow nerve endings in the neck will bring abot the slowing of the heart%

+#ternal signs( abrasions and brises in the neck area$ laryngeal damage$

.% ;ramatic asphy#ia restricting the movement of the chest) +#ternal pressre is pt on the chest thereby restricting respiration

,lassic signs( very congested from face and neck p$ person becomes very ble or red$ e#tensive petechia

:lood from above the chest cannot retrn to the heart$ it?s !st like obstrcting the !glar veins

B% =ostrial asphy#ia

2isabled or nconscios person lies with the pper half of the body lower than the rest of the body

;here is pressre in the abdomen that does not allow the diaphragm to move' it?s like tramatic asphy#ia

where there is restriction of chest movement

,ommonly seen on persons arrested$ they are pshed to the grond

/emoglobin carries o#ygen bt it prefers carbon mono#ide%

ailre of o#ygen tili"ation will paraly"e the chest mscle%

&3P+B8$5 =artial lack of o#ygen%

$4+B8$5 ,omplete lack of o#ygen%

%2$4'P+2% 84A/28#'@ D2+"484.@ $LC+&+L

) .2+/P' +F ;8C%8M'

=edestrian$ passengers$ cyclists or motorcyclists

%2$4'P+2% 84A/28#':

Primary injuries

from the direct contact of the vehicle =rimary in!ries are recogni"able and may take the pattern of the bmper for e%g%% herever the in!ry is that?s

the point where the pedestrian was hit% ,les as to the speed on the car(

T 4J km6hr thrown off the hood either forward or sideways

4J-BJ km6hr victim may fall on the hood and head may strike windshield

BJ->JJ km6hr victim may fly p in the air and he can fall on the car or beyond the car%

'econdary injuries

from the contact of other ob!ects or the grond after contact with the vehicle 0ften more serios and potentially lethal than primary in!ries e%g% head and spinal in!ries)

Car occupant

;he in!ries sffered will depend on the kind of impact

=age )of !


24/28

Notes on Legal Medicine Fehicle hit from behind called acceleration impact

*ide impact and rollovers least common

rom the front - there will be acceleration then deceleration% 2eceleration impacts withot restraint no

seatbelts) and yo?re accelerating with the car and the car hits another car yor body is still accelerating' yorhead can hit the windshield or yor chest the dashboard and other in!ries on the pper part of the body%;here cold also be in!ries on the lower part of the body$ in the ankles$ hips or knees% 0rgans in yor bodyalso accelerate and in the act of deceleration plmonary veins$ aortic veins attached to the body can be tornoff so there?s internal bleeding% Co may also sstain in!ries within yor brain since the brain moves in yor

skll% yo may have concssions and contsions%

Motorcyle injuries

- de to falls from the machine- yo can have abrasions$ in!ries in the head- bicycles more milder forms since lower speeds bt the problem is when they are hit by other vehicles- wear appropriate safety gears

8MM#2'8+4 $4D D2+"484.

2ifferent things

:odies recovered from water cold have died from natral cases before entering the water% 2etermine 0N victimdied of natral cases before entering the water or while in the water having entered it either volntarily or accidentally%2id he die of nnatral cases before entering the waterH 2id he die from e#posre or hypothermia while in the waterH2ied of in!ries after entering waterH 2id he die of sbmersion or drowningH

'umersion !st actally being in the water% A person who drowns can have signs of being sbmerged bt a personwho was sbmerged in water does not necessarily mean he drowned% @f yo died before yo were placed in the wateryo are sbmerged%

'='* of 'umersion:

>% washerwoman?s fingers6hand4% macerations and skin will peel off after weeks of immersion

7% decomposition5% +ventally yor body will float% ;he only time body won?t float is when yo?re sbmerged in very cold water%

/ow do we know if these in!ries are post-mortem or ante-mortemH

- @n!ries mst be seen nder the microscope and if there?s inflammatory reaction seen then yo know in!riesare before death since there are no inflammatory reactions if yo got in!red after yo died%

D2+"484.

- yo die of sffocation becase of water within yor lngs and yo have to be immersed in water- +ffect depends whether yo drowned in fresh or sea water% resh water is absorbed into or circlatory

system reslting to volme overload and hemodiltion$ eventally leading to cardiac arrest%

- *ea water more concentrated than blood$ so flid in or blood will go ot into or lngs and there?splmonary edema or congestion reslting to hypo#ia$ respiratory arrest$ cardiac failre and cardiac arrest- =ost mortem findings variable and case of death hard to prove- . stages

a% Co strggle$ yo may find brises in yor chest and sholdersb% Co get tired and yo sinkc% Co don?t want to breathe in water so yo stop breathing% :ecase we hold or breath carbon dio#ide

goes p so respiratory centers in or body say breathe so we breathe in waterd% ,ogh vomit$ loss of consciosness% ,onvlsions% @nvolntary respiratory movements and we keep

inhaling water%e% 1espiratory arrest and cardiac arrest%

=age 0of !


25/28

Notes on Legal Medicine- Co cold drown within >J mintes- @n >J-4JS of the victims laryngospasm can happen and since laryn# remains closed water cannot enter lngs

& dry drowning- ;he rest there?s rela#ation of the airway and water enters the lngs- ;here can be blood tinged froth in the moth and nostrils which is more common in seawater drowning%- *and$ silt$ seaweed may be fond in the lngs sign of life before immersion- :U; inding of foreign material in stomach weighs heavier than finding them in the lngs becase there?s a

sphincter of some sort in the stomach which does not rela# when yo?re dead nlike airways which can rela#so water may flow freely%

Mechanism of death as a 1eslt of *bmersion is not always classical drowning becase most of them die % was the person dead or alive when he entered the water4% is the case of death drowningH @f not what is the case of deathH7% why did the victim enter the waterH

5% why was the victim nable to srvive in the waterH 2id this victim have other health problems or he wasalready in!redH

.% what were the circmstances preceding deathH very important to identify the body%B% what were the circmstances when the body was recoveredHD% atopsy findings

?s > and 4 are very important becase these will have to be correlated with atopsy findings and if there?s

concrrence between the two then pathologist can make the findings%

$LC+&+L

Alcohol abse sally encontered in child abse and rape cases%

@t?s a drg and addictive% Makes one prone to accidents and an nderlying case of misdemeanor$ assalt andhomicide%

'='* of alcohol into*ication:

>% +#citement - lack of inhibition or self-control$ feelings of well-being4% @ncoordination and ,onfsion loss of nervos control of yor body$ blnting of perceptions$ no msclar

corrdination$ nasea$ vomiting$ cardiac and respiratory symptoms7% Narcossis or ,oma deep sleep$ slow breathing$ paralysis of cardiac and respiratory centers which can lead

to death

Males cannot say that they cold not have raped a girl becase they were drnk becase erection can happen in thee#citement stage% 0n the other hand$ they take advantage of girls when the girls get into the incoordination and

confsion stage 2rg facilitated se#al abse)

/ow do we diagnose drnkennessH

>% alcoholic smell of breath or vomits4% dry tonge7% e#cessive salivation5% irreglar behavior.% bloodshot eyesB% thickness of speechD% tremors$ error of coordination and orientationE% :est tests( blood alcohol content :A,)$ rine test for alcohol and breath analy"er test

=age of !


26/28

Notes on Legal Medicine

;ests for error of coordination(

>% 1omberg test4% eye movements - place a pen in front of his eyes and there?s nystagms and place the ob!ect on the side of

the eyes and there?s !erky movements7% walk and trn test walk in a straight line heel to toe steps then do a -%>. S - impaired faclties$ not fit to drive vehicles$ if &J%>.S and non-habital drinkers into#icated to the point of staggering$ J%4S habital drinkers at the second stage andJ%.S stage of ,oma%

actors that affect absorption of alcohol(

>% weight- the heavier yo are$ the more water content and since alcohol is solble in water$ alcohol is easilyabsorbed in the water content of or body so a person with more water content does not easily get drnk as aperson with less water content or weight

4% atty foods delay alcohol absorption% Alcohol is absorbed in the small intestine bt yo can delay absorption ifalcohol stays in stomach%

/nderstanding the Child

Child de,elopment:- ,ontinos process that starts from birth to matrity$ and goes to define stages and phases% :efore yo can go to

the ne#t phase$ the child mst master first the previos stage%- Now the skills and the comple#ities as he grows older centers all in the physical$ mental$ social$ and emotional

fnction of that person% @t affects cognitive development$ emotional development$ and social development%

85 First ) to 0 years of ay:

-Nerons start to connect with one another% And the only way these nerons get connected with one another is ifthe baby is stimlated at the time when he is born%

- +#perience leads to neral changes in the brain%- Fisal stimlation shold happen in the first B months for the necessary neral pathway to develop%- Co are now developing commnication with the baby% @f yo meet the needs of the child$ that child will learn to

trst yo and will develop an attachment to yo as a caregiver%- @f yo need the baby to master a certain task$ he mst be stimlated at the right time$ given the right e#perience%

+#ample$ a B-month-old baby$ yo can?t teach that baby to walk$ since he has not developed the mscles tospport his own body to walk or stand on his own or balance himself%

- ;hey learn to recogni"e their father and mother% hen looking at ob!ects and yo hide it right away$ they will thinkthe ob!ect is no longer e#isting% ;hey don?t know the ob!ect is there and eventally as they grow older$ peek-a-boois an important game for babies$ becase they will learn yo are still there actally%

- ;oching is very important for children% or children who are not toched at all$ when they grow p they don?t

want to be toched$ since it?s strange for them to be toched%- ;hese babies are learning to be atonomos$ they are learning how to toilet train and how to be independent and

if yo don?t allow them to toilet train themselves$ learn new skills$ they will not develop self-esteem%- ;hey now have the ability to symboli"e% @n the beginning$ they know the mental image of what an apple is% :y the

time they are > or 7 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 a parent$ they will do

things not to be pnished% ;hat?s all what they care abot for the first 7 years of life%- ;he se#al behavior at this stage is more on toching and looking% ;hese are !st learning% *e#al behavior at

this age is merely knowing abot the difference between the vagina and penis%- As early as two years of age$ they already learn the concept of right and wrong% @t has nothing to do abot

pleasing the parents or they are being pnished% Moral control is internali"ed by age B throgh consistent parental

=age 6of !


27/28

Notes on Legal Medicinemonitoring$ praising of good behavior$ identification of parental vales$ etc%

8mpact of ause at this stage:- or babies$ as they grow$ anything the parents do is correct$ so if the babies sees the father and mother


28/28

Notes on Legal Medicinedevelopment of his morality% *o yo have to look into his backgrond%

8;5 16 years old (3oung adulthood- ;hey contine to develop$ emotionally$ physically$ and morally% Now they get into relationships% hen it comes to

se#$ it?s more on e#perimentation in the early stages% :t as they go into >D->that?s what yo call lateadolescenceit?s already more for being in a relationship% ;his is part of normal development% @t?s p to yo togide yor children%

- 2istingish between occasional e#perimentation and endring patterns of troblesome behaviors% ;hese aresally harmless e#perimentation% *eemingly behavioral problems are not endring problems% e have todistingish those problems that arise dring adolescence and those that have roots in earlier periods% Most teens

who have recrrent problems with the law have problems at home and at school from an early age% /ello$ Ooavanernande"I ;he newspapers keep saying$ Gthe adopted son4#?% ;hey?re !st rbbing it in% /e might not havedeveloped attachment as a child%) hen does attachment developH :efore age >%

- Many of the problems adolescence e#perience are transitory in natre and are resolved at the beginning ofadlthood%

- ;he effects of being absed are( @t can affect their identity$ their intimate relationships%- @n yong adlthood$ yo learn whom yo care to be with% @n adlthood$ yo learn what yo care to do and who yo

care to be$ what and whom yo take care of%

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