Concepts of Legal Medicine PDF

CONCEPTS OF LEGAL MEDICINE ========================== Legal Medicine -------------- Legal medicine is a branch of medicine that deals with the application of medical knowledge for the purpose of law and administration of justice. Specifically, it is the application of medical and paramedical scien...

CONCEPTS OF LEGAL MEDICINE ========================== Legal Medicine -------------- Legal medicine is a branch of medicine that deals with the application of medical knowledge for the purpose of law and administration of justice. Specifically, it is the application of medical and paramedical sciences to clarify legal matters. It is synonymously used with the term FORENSIC MEDICINE. Nature of Study in Legal Medicine --------------------------------- 1. acquisition of facts which are essential; 2. the power to arrange these facts in logical order; and 3. drawing of conclusion. The approach of nature of the study is derived from the scientific method. Aside from being observant, a medical jurist should be able to deliver his thoughts in writing or verbally to avoid unnecessary confusion during court proceedings. A physician may be engaged in legal (or forensic) medicine while a lawyer with identical interests is said to be in medical jurisprudence. It just depends upon the direction you are coming from. "Medical Jurist, Medical Examiner, Medicolegal Officer, Medicolegal ------------------------------------------------------------------- **Examiner" r**efers to a physician who specializes primarily with medico-legal duties. **Point of View** **ORDINARY PHYSICIAN** **MEDICO-LEGAL OFFICER** ----------------------- ------------------------ ------------------------------------- A\) INJURY / DISEASE B\) EXAMINE A PATIENT C\) MINOR INJURIES Records all / qualify it as a crime Principles of Law Applied to Legal Medicine ------------------------------------------- - Principle of Stare Decisis **Evidence** is the means sanctioned by the Rules of Court in ascertaining a judicial proceeding the truth respecting the matter of fact. Types of Medical Evidence ------------------------- a. Real or Autoptic Evidence -- made known or addressed to the senses of the court Sec. 1, Rule 130, Rules of Court: b. Testimonial Evidence -- given orally in open court and under oath or affirmation - A physician may be placed at the witness stand to answer questions propounded to him by counsels or parties or by the presiding officer of the court. c. Experimental Evidence -- a medical witness may be required to perform experiments to prove a certain matter of fact. It must not be offensive to decency, sensibilities, and propriety. d. Documentary Evidence -- any written evidence presented by a physician in court which is relevant to the subject matter in dispute and not excluded by the Rules of Court. Formal written reports - Written opinions - Certificates - Depositions - Dying declarations **Autopsy -** a post-mortem examination to discover the cause of death or the extent of disease. An autopsy is derived from the Greek word \"autos\" - oneself and \"opsis\" - sight/view. 1. Health officers 2. Medical officer of law enforcement agencies 3. Members of the medical staff of accredited hospitals 1. Written request of nearest kin to ascertain the cause of death 2. Order of the competent court, mayor, prosecutor 3. Written request of a law enforcement officer 4. When required by a special law 5. Solgen, prosecutor to determine the cause of death Principal Aim of An Autopsy --------------------------- 1. To determine the cause of death 2. To determine the state of health of the person before he or she died, 3. To determine whether any medical diagnosis and treatment before death were appropriate. Types of Autopsies ------------------ 1. Medico-Legal Autopsy or Forensic or coroner\'s - autopsies seek to find the cause and manner of death and to identify the decedent. 2. Clinical or Pathological autopsies are performed to diagnose a particular disease or for research purposes. 3. Anatomical or Academic Autopsies - are performed by students of anatomy for study purposes only. 4. Virtual or Medical Imaging Autopsies - are performed utilizing imaging technology only, primarily magnetic resonance imaging (MRI) and computed tomography (CT). 5. Forensic Autopsy - is used to determine the cause and manner of death. ANATOMIC PATHOLOGY ------------------ This involves the examination of biopsy samples taken by surgeons to determine whether or not a growth is cancerous to examining the bodies of victims which could be used in investigating and prosecuting. **CLINICAL PATHOLOGY** FORENSIC ANTHROPOLOGY --------------------- the human remains are in the advanced stages of decomposition A forensic anthropologist can read the evidence in a skeleton like you read a book. The techniques they use to answer questions in criminal cases can be applied to skeletons of any age, modern or ancient. Various Crime Scene Incidents ----------------------------- a. Homicide b. Homicide by poisoning c. Suicide d. Accident e. Natural deaths f. Sudden and unexplained infant death. The medico legal expert should visit the death scene before the autopsy if it is possible. Although, death investigation differs in different countries, there is always a crime scene investigation team. If the medico legal expert does not have the opportunity to visit the death scene himself, he would check the documents (notes, sketches, photographs, etc.) which crime scene investigation team prepared. Many medico-legal deaths may be resolved by death scene investigation. A medico legal expert should never forget: If the death scene investigation is not performed before the autopsy, that autopsy will be an imperfect autopsy. **MEDICO LEGAL ASPECTS OF INJURIES AND WOUNDS** Definition of Wounds ==================== In the forensic medical context, physical injury refers to the damage inflicted on "any part of the body due to deliberate or accidental application of mechanical or other traumatic agent". A wound is a disruption of the continuity of tissues and lining epithelium (layer of the skin) produced by external, mechanical force. The term injury is used synonymously with wound, but the former can have a wider meaning, which encompasses not only damage produced by physical force, but also damage produced by other means such as heat, cold, chemicals, electricity, and radiation. **General Types of Wounds** - **Blunt force injuries** - are those resulting from forceful contact with a blunt object such as fists, hammers, baseball bats, furniture, floors, walls roads, trees, or the interior surfaces of vehicles. They are among the most common types of trauma encountered by forensic pathologists. - **Sharp force injuries** - refer to damage to tissues or organs by objects or weapons with sharp edges or pointed ends. They are generally classified into three, namely: incised, stab and chop wounds. Classification of wound ----------------------- 1. **Open wound** - is a break in the skin\'s surface resulting in external bleeding. [Classification//Categories of open wounds] 1. Incised wound - caused by a clean, sharp-edged object such as a knife, razor or a glass splinter. 2. Laceration - irregular tear like wound caused by some blunt trauma. 3. Abrasion - (grazes) - superficial wound in which the top most layer of the skin is scraped off. Are often caused by a sliding fall into a rough surface. 4. Puncture wound - caused by an object puncturing the skin such as nail. 5. Penetration wound - caused by an object such as a knife entering and coming out from the skin. 6. Gunshot wound - caused by a bullet or similar projectile driving into or through the body. There may be two wounds, one at the site of entry and one at the site of exit generally referred to as through and through. 2. **Closed wound** - the skin is not broken open and remains intact. [Classification/Categories of closed wound] 7. Contusions - commonly known as bruises, caused by a blunt force trauma that damages tissue under the skin. 8. Hematoma - called blood tumor, caused by damage to a blood vessel that in turn causes blood to collect under the skin. 9. Crush injury - caused by a great or extreme amount of force applied over a long period of time. Specific Types of Wounds ======================== BLUNT FORCE INJURIES -------------------- Three main types of blunt force injuries A. Abrasions - Abrasions are also known as scrapes, scratches or grazes. They refer to superficial injuries involving only the outer layer of the skin.; they do not penetrate the full thickness of the epidermis. 1. Brush Abrasions are broad patches, the frictional element of which gave rise to the term brush burns (e.g., carpet burns). Brush burns are commonly seen in their most florid form as road rash following a motor/vehicular accident in which the victim slides along the road surface. 2. A scratch is a linear abrasion produced by drawing a sharp point over the surface of the skin or mucus membrane. Skin scraping may be recovered from beneath the fingernails used for scratching, and likewise be linked to the person who was scratched through serology or DNA techniques. B. Contusions ------------- P a g e \| ### C. Lacerations  Laceration refers to the splitting of tissues and the forceful tearing of the skin when an object impacts the skin with a force that exceeds its elastic capacity. Lacerations result from blunt force or acceleration/deceleration injuries, and are different from incised wounds resulting from sharp objects. Direct crushing, typically between an underlying object on the one side and underlying bone on the other, will result in split-like lacerations of the skin. Such skin splits occur most commonly where the skin lies close to the underlying bones, such as on the scalp, eyebrows, cheeks, elbows, knuckles, knees, and shins. SHARP FORCE INJURIES A. Incised Wound ------------------------------------- Incisions or incised wounds refer to cuts or slices caused by sharp edged object that has impacted the body in an approximately parallel or tangential direction. Most often, the object that caused the injury was moving in a slashing motion, with the angles at either end having a sharp appearance. Incised injuries usually have clean edges, minimum bruising, and no bridging of nerves or vessels. Wounds tend to be straight and longer than their depth, with no contusions and abrasions. Blood vessels and nerves are cleanly divided and bleeding is often profuse. When caused by a blade slash, the incision will appear deeper at their origin and shallower at the end from which the blade is withdrawn. In general, however, it would be impossible to determine the direction at which and incised wound was inflicted (for example from right to left across the neck). Penetration of at least the full thickness of the skin is usual, but shallow and partial thickness skin cuts can also occur, such as the common "paper cut". B. Stab Wounds -------------- A stab wound is the result of a pointed or sharp and pointed object forced inward. A stab wound is also sometimes called puncture, perforating or penetrating wounds. The direction of force is usually perpendicular to the skin surface. It is often caused by a weapon being thrust at, or into a victim. However, a stab wound may also be the result of a moving body against a relatively stationary pointed object. The typical feature of stab wounds is a depth greater than their width or length. They often have little or no external blood but present danger to vital organs. Stabbing can cause serious penetrating injuries that, in turn, can lead to hemorrhages (or occasionally air embolism) and result in rapid death. The victim may also die later from infection, pulmonary embolism or other complications. Causative objects include knives, daggers, scissors screwdrivers and pokers. On one hand, a dagger with sharp point and double-edged blade tends to produce an elliptical wound with sharp edges and clean-cut ends. The single-edged blade of the kitchen knife, on the other hand, may cause squaring of fish-tailing of one extremity of the wound caused by the non-cutting back of the blade. When a pair of scissors is used for stabbing, the wounds look more rounded with bruising surrounding the margins. Although the above instances show that the appearance of the wound in the skin can point to a possible weapon, the wound could also have a jagged appearance when the weapon is withdrawn at a different angle from the way if entered the body. Further, the skin's elasticity enables it to close tightly around the stabbing object and close again if the object is removed. Hence, the length off the wound could shorten and the width could increase. ### C. Chop Wounds ### D. Defensive Wounds E. Self-Inflicted Wounds ------------------------ Other type of Injuries ====================== FIREARMS INJURIES ----------------- Wound Ballistics ---------------- Gunshot Wounds -------------- GUNSHOT ENTRY WOUND ------------------- GUNSHOT EXIT WOUNDS ------------------- SHOTGUNS WOUNDS ------------------------------------- BURNS ----- Classification of Burns ----------------------- 1. First Degree Burns 2. Second Degree Burns 3. Third Degree Burns 4. Fourth Degree Burns Types of Burns -------------- A. [Dry Burns] -- Dry heat sources result in dry burns. Examples of such sources are ovens, stove tops, hot engines, mufflers, radiator grills, clothes, irons, hair dryers, heating pads and furnaces. In children, such burns may be either accidental or inflicted. Fire-related injuries also involve dry burning. B. [Scalds] -- scalds are produced by moist heat or steam, or any hot liquid such as water, oil or even molten rubber or metal. They are typically less severe than burns produced by dry heat. The scalded area appears erythematous (abnormal redness of the skin resulting from dilation of blood vessels) with desquamation (loss of bits of outer skin) and blistering of the usually sharply demarcated area of injury. Scalds do not cause charring of the skin or singeing of hair, but may result in first-, second-, or third-degree burns. C. [Chemical Burns] -- Chemical burns are produced through contact with corrosive acids and alkalis. Most of these injuries involve direct tissue damage, which causes drying and blistering, destruction of proteins or fat, or interference with cellular metabolic processes. It may take several hours before the burns manifests. D. [Fire burns] -- burns that occur from building or home fires are the most common types of thermal injuries encountered in death investigation. Such burns can be caused by the radiant heat injury alone, from tissues being in contact with burning clothes or beddings, or from the victims actually being on fire. Death investigations in fires involve identifying the victim nd ascertaining whether the victim died during or before the fire occurred. E. [Radiant Burns] -- Radiant burns are caused by a heat source close to the victim or electromagnetic energy radiating out from an energy source. They may produce skin blisters and erythema, and charring may result from prolonged exposure. Sources of electromagnetic energy include ultraviolet and ionizing radiation. In contrast to dry burns where direct contact with the heat source is required, radiant heat burns do not require direct contact with a heat source. EXPLOSION AND BLAST INJURIES ---------------------------- ELECTRICAL INJURIES AND ELECTROCUTION ------------------------------------- LIGHTNING INJURIES ------------------ The injuries sustained may be electrical burns, or Head Injuries ------------- COUP and CONTRA-COUP INJURIES ----------------------------- **MEDICO-LEGAL ASPECTS OF DEATH** Basic Concepts of Death ======================= Importance of Death Determination --------------------------------- 1. Personality of a person is extinguished by death. 2. Criminal liability is extinguished by death 3. Property of a person is transmitted to heirs or nearest of kin. 4. Basis of immediate removal of organs for transplantation. 5. Civil case for claim is dismissed. Kinds of Death -------------- 1. Somatic Death A. Sociological Death -- type of death wherein the withdrawal and separation from the patient by others producing a sense of isolation and abandonment. Sociologic death can last for years if patient is abandoned by the family, unvisited and let alone to die. B. Psychic Death -- the condition of death wherein the patient regresses, gives up or surrenders accepting death prematurely and refuses to continue living. C. Biologic Death -- type of death characterized by the absence of cognitive function or awareness, although artificial support system may maintain organs functioning. D. Physiologic Death -- type of death when all vital organs cease to function. 2. Molecular Death or Cellular Death 3. Apparent Death or State of suspended Animation Signs of Death -------------- 1. Is the body dead? 2. How long has the body been dead? 3. What is the cause of death? External Signs of Death ----------------------- 1. Loss of power to move and insensibility of the body as determined by visual inspection of the central nervous system which consist of the brain and spinal cord, the seat of all the faculties of senses and the power of locomotion. 2. Stoppage of respiration. 3. Stoppage of Heart Action and Circulation 4. Loss of Body heat resulting to Cooling of the body (ALGOR MORTIS) 5. Change in the eye 6. Changes in the skin Changes in the Body After Death ------------------------------- **Stages of Muscular Change** A. Stage of Primary Flaccidity ------------------------------ B. Stage of Post Mortem Rigidity or Rigor Mortis ------------------------------------------------ Conditions Simulating Rigor Mortis 1. Heat Stiffening -- A condition characterized by hardening of the muscles due to coagulation of muscle proteins when the dead body is exposed to intense heat as by burning or immersion in a hot liquid. 2. Cold Stiffening - A condition characterized by hardening of the muscles due to solidification of fats, muscles and fluid when the dead body is exposed to extremely cold temperature. 3. Cadaveric Spasms or Spontaneous Rigidity -- It is the instant stiffening of a certain group of muscles which occurs immediately at the moment of death, although its cause is unknown, it is associated with violent death due to extreme nervous tension, and injury to the central nervous system ### C. Stage of Secondary Flaccidity - After 1-2 days (24-48 hours) - Rigor mortis absent, putrefaction changes, muscles soft and flaccid. Greenish discoloration over the abdomen. Some veins beneath the skin seen as interlacing purplish brown network over the shoulder, chest and abdomen known as marbolization. - 3^rd^ day (72 hours) - Abdomen distended with gases, trunk bloated, hair and nails loosened from its attachment. Blister formation nd blebs. Face grossly swollen and discolored. Maggots seen - week (7 days) - Further bloating of the body and discoloration of the skin. Bursting of blisters and denudation of the skin. Soft tissues continue to putrefy. - 2 weeks (14 days) - Detachment of the hairs and nails from its attachment. Bursting of the thorax and abdomen. Further dissolution of more resistant viscera. - 1 month -- Body completely skeletonized Three Special Forms of Putrefaction ----------------------------------- A. Mummification -- a condition where there is removal of the body fluid before decomposition sets in that resulted to sinking and preservation of the body. B. Saponification or Adipocere Formation -- It is a formation of a soft, friable and brownish white greasy substance. This substance is called adipocere and formed by the post mortem hydrolysis and dehydrogenation of the body fats. Adipocere is a soapy or waxy material, rancid in smell, dissolves in alcohol and ether when burned produces yellow flame. C. Maceration -- It is the condition of the dead body usually the fetus characterized by softening and discoloration of tissues as well as formation of blisters in the skin due to action of autolytic and proteolytic enzymes in the absence of putrefactive bacteria. Changes in Blood After Death ---------------------------- A. **Change in color** -- After death, the heart stops beating followed by stoppage of circulation. The stasis in the circulation will drain the blood from the capillaries and veins to accumulate in the most dependent portions in the body due to pull of gravity producing discoloration in those areas not subjected to pressure. B. **Post Mortem Lividity or Livor Mortis -** A discoloration of the body after death when blood tends to pool in the blood vessels of the most dependent portions of the body which appears 20-30 minute after death and complete in about 12 hours. The usual color is dull red or reddish purple with some bluish black peterbiae due to rupture of small engorged capillaries. Importance of Livor Mortis 1. One off the signs of death 2. Determines the protein maintains by the body after death. Basis in Estimating the Time of Death ------------------------------------- 1. General Physical Changes -- a warm supple of body with moist, transparent cornea nd moist lips as well as the absence of post mortem lividity is a condition of recent death. 2. Post Mortem Lividity or Livor Mortis -- The onset of post mortem lividity is 20-30 minutes and complete in about 12 hours. 3. Post mortem Rigidity or Rigor Mortis -- Onset is 3-4 hours after death completed in about 12 hours. May lasts 24-36 hours in tropical countries. 4. Onset and stage of Decomposition -- In tropical countries, the onset of decomposition is 12 days after death and skeletonized in a month's time. 5. Life Cycle of Flies -- the egg or ova laid on dead bodies will hatch to form maggots within 24 hours. The maggots will feed vigorously on the damaged dead bodies, then transform into pupal stage and finally into adult flies within a few days. 6. Change in the Body Temperature -- Upon death, body temperature decreases gradually until it reaches the temperature of the environment. The rate of fall of the temperature is from 15^o^F to 20^o^F is considered as a sign of death. 7. Changes in the Blood -- the blood remains fluid in the body after death for 6- 9 hours. 8. Changes in the Stomach -- it usually takes 3-4 hours for the stomach to empty its content after meals. 9. Changes in the hair -- The rate growth of hair loss has been estimated from 0.4mm -- 0.5 mm / day 10. Changes in the Urinary Bladder -- The amount of urine in the bladder may indicate the time of death when taken into consideration the time when a person urinates or evacuates his urinary bladder. 11. States of Clothing -- if the dead person is well-dressed, it is more likely that death occurs at daytime, but if wearing pajamas or nightgowns, it is possible that death occurs at night and probably at home. 12. Presence or Absence of Fleas in the Clothing of dead person in water -- If fleas in the clothing of a drowned person are still alive, then the person has been in water less than 24 hours. Survival of the fleas is not possible. If they are in the water for more than 24 hours. Presumption of Death -------------------- - Disputable presumption -- Rules of Court Sec.96, Rule 123, that a person not heard, seen, or absent for seven years is dead. - A person on board a vessel who was lost during a sea voyage r an airplane which is missing who had not been heard for four years. - A person in the military or armed forces who has taken part in war and has been missing for 4 years. - A person who has been in danger of death under other circumstances and his existence has not been known for 4 years. Lesson 4.2. Death Investigation =============================== Death Investigation ------------------- Goals and purpose in death investigation: - To help and serve the living - To seek the truth objectively, intellectually and without bias or emotional coloration; - To document guilt and protect the innocent; - To determine the identity of the deceased; To determine the medical cause of death; and - To determine the manner of death. Death Scene Investigation ------------------------- 1. To observe the scene and take detailed contemporaneous notes; 2. To conform the death has taken place; 3. To ensure the trace evidence is not removed or destroyed form the body or its surroundings; 4. To offer an opinion as to the possible nature of death; and 5. To assist and supervise the removal of the body from the scene where necessary. Cause of Death -------------- Classification as to the Cause of Death --------------------------------------- A. Natural Death -- it is death that occurs due to a disease or ailment in the body. The disease may occur spontaneously or it might have been consequence of the physical injury inflicted prior to its development. The termination of life comes quickly and unexpectedly or delayed due to lingering illness. Sudden death is the termination of life whose arrival is not expected. A good example of this and it is frequently observed among males, from 18 years old up to 35 years old and very common among lowincome group called Sudden Unexpected Nocturnal Death (SUND) commonly called "Bangungot". B. Violent Death -- It is a death due to injuries by some forms of outside force wherein the physical injuries inflicted is the proximate cause of death. Classification of Physical Injuries ----------------------------------- 1. Physical Injury -- use of physical force 2. Thermal Injury -- caused by heat or cold 3. Electrical Injury -- death caused by electrical energy. 4. Atmospheric injury -- death or injury caused by change in atmospheric pressure. 5. Chemical Injury -- death or injury caused by chemicals. 6. Radiation -- death or injury caused by radioactive substances 1. Accidental Death -- due to misadventure and outside your will. 2. Negligent Death -- death due to reckless imprudence, negligence, lack of skill or lack of foresight. 3. Infanticidal Death -- death due to killing of infant less than 3 days old. 4. Parricidal Death -- It is death due to killing of one's relative. Any person who shall kill his father, mother or child whether legitimate or illegitimate, or any of his ascendants or descendants or his spouse, shall be guilty of parricide and shall be punished by a penalty ranging from Reclusion Perpetua to death. 5. Homicidal Death -- Homicide is killing of another person with intent without justification. 6. Murder -- It is the unlawful killing of another person committed with any of the following attendant circumstances: a. With treachery taking advantage of superior strength, with the aid of armed men or employing means to weaken the defense or of means of person to insure or afford impunity. b. In consideration of a price, money, reward or promise. c. With evident premeditation. d. With extreme cruelty by deliberately augmenting the suffering of the victim. 7. Euthanasia or Mercy Killing -- It is a willful acceleration of death of a person in order to lessen his sufferings. There are instances wherein a person suffering from a hopeless incurable disease, ailment or condition will be placed to death to lessen his sufferings and for financial reason as agreed by the physician and relative concerned. In some countries, mercy killing is against the law for reason that everyone has the right to live. 8. Suicidal Death -- It is a death due to killing or destruction of one's self. A person who commits suicide but was not consummated is not penalized by law but a person who assists another person to commit suicide is punishable by law. 1. ACCIDENTAL -- Marooned in an island, where there is scarcity or no supply of food and water, as in airplane accident or trapped in a miner's camp 2. HOMICIDAL -- Intentional and deliberate deprivation of food and water 3. SUICIDAL -- as in the case of hunger strike Key points ---------- - The physical examination is primarily conducted to address health issues. If it is performed within 5 days of the assault, there may be value in collecting forensic specimens. All examinations should be documented. - Penetrative sexual activity of the vagina, anus or mouth rarely produces any objective signs of injury. The **hymen** may not appear injured even after penetration has occurred. Hence, the absence of injury does not exclude penetration. The health practitioner cannot make any comment on whether the activity was consensual or otherwise. - There are different purposes and processes for the collection of specimens for health (pathology) and legal (forensic) investigations. **Pathology specimens** are analyzed to establish a diagnosis and/or monitor a condition. **Forensic specimens** are used to assess whether an offence has been committed and whether there is a linkage between individuals and/or locations. Pathology specimens may have a significant forensic importance, especially if a sexually transmitted infection is found. - The **forensic laboratory** requires information about the specimen (time, date, patient name/ID number, nature and site of collection) and what is being looked for. - - - - - - - **Hair** -- cut scalp hair may be useful if there is concern of covert drug administration. - Careful labelling, storage and chain-of-custody recording is required in all cases. - Samples should not be placed in culture media and should be dry before being packaged. - **Clothing** (especially underwear) and toxicological samples should be collected if required. - **Photographs** provide a useful adjunct to injury documentation. Issues of consent, access (respecting privacy and confidentiality) and sensitivities (particularly if genital photographs are taken) need to be addressed and agreed with the victim. - Sexual violence should be considered during an **autopsy** examination. Documentation and specimen collection should occur in such cases. - If sexual assault results in a **pregnancy**, then consideration should be given to collection of specimens for paternity testing. Definitions ----------- 1. **Mons pubis:** where the labia majora meet in front and covered with hair after puberty 2. **Urethral opening**: opening of the urethra to external environment to allow urine to be expelled 3. **Hymen** (shaded): membrane at the vaginal opening, almost always with a visible opening 4. **Posterior fourchette:** where the labia minora meet at the back in the midline 5. **Perineal raphe:** the visible line running from the genitalia to the anus 6. **Perineum:** region between the thighs that is bounded by the vulva in the front and the anus at the back 7. **Fossa navicularis**: the concave area between the back of the vaginal wall and the posterior fourchette 8. **Labia minora**: skin folds that cover or partially cover the hymen and vagina 9. **Labia majora**: broad skin fold that surrounds the labia minora (covered with hair after puberty) 10. **Clitoris**: erectile tissue that expands when stimulated 11. **Vulva**: all of the components of the external genitalia, including the mons pubis, labia majora, labia minora, clitoris and vaginal orifice 12. **Vagina** (not displayed): a tubular canal between the cervix and the hymen 13. **Anus**: outlet for feces. Comments -------- - In most cases, penetration of the adult vagina or anus does not result in injury. - The hymen may not appear injured, even after penetration has occurred. The hymen is a poor marker of penetrative sexual activity or virginity in post-pubertal girls. - Digital examinations of the vagina and anus are rarely warranted. They should not be used to assess the tone of the orifice or to comment on the likelihood or frequency of penetration. - Penetration of the prepubertal genitalia (and some other forms of sexually abusive actions) do not necessarily result in Definitions ----------- 1. **Penis:** male organ of copulation and of urinary excretion 2. **Glans** (head): the expanded head of the penis 3. **Shaft:** the cylinder of tissue between the body and the head of the penis 4. **Testicle**: the egg-shaped glands housed within the scrotum 5. **Scrotum:** the pouch of skin containing the male reproductive glands (testes) 6. **Anus:** outlet for feces Asphyxia ======== 1. Suffocation- deprivation of oxygen, either from lack of oxygen in the surrounding environment or obstruction of the upper airway. 2. Smothering -- mechanical obstruction of the flow of air from the environment into the mouth or nose. 3. Strangulation -- may occur by ligature, or by manual pressure using one or both hands when the term throttling may be used. 4. Choking -- usually occurs when a foreign object becomes lodged in the throat or windpipe blocking the flow of air. 5. Garroting -- to achieve the strangulation of a person where an iron collar is being placed around the neck and tightened by a screw driver. 6. Chest compression -- due to fixation of the external chest wall as a result of crushing. 7. Hanging -- by another, deliberate self-harm, or autoerotic asphyxia. SUFFOCATION ----------- SMOTHERING -------------------------------- CHOKING ------- CHEST COMPRESSION ----------------- STRANGULATION ------------- HANGING ------- 1. Occlusion of the carotids and vertebral arteries; 2. The base of the tongue is pressed to the back and upwards inside the neck occluding the nasopharynx; 3. Direct laryngeal or tracheal damage and occlusion; and 4. Cervical fracture ("drop" hanging) causing brainstem injury. DROWNING -------- Post-mortem Forensic Toxicology ------------------------------- Specimen Collection ------------------- - **Blood** is the most common and preferable sample to use, when possible. It is a relatively easy sample to obtain and store. For post-mortem studies, peripheral blood is more desirable than central blood as it is less affected by post-mortem redistribution. - **Urine** can be used as a second sample for confirmation of a drug's presence. It is good as a screening sample as it tends to have less interfering substance, and provides qualitative information on past exposure or use. It is also relatively easy to obtain and store. - **Vitreous** is an excellent specimen to use in the absence of blood. It is less subject to contamination, is not affected by embalming, and demonstrate good stability. Vitreous is an excellent specimen for water-soluble substances, including ethanol and barbiturates. - **Bile** is usually not a first-line specimen but can be useful in qualitative screening. Bile is not always present, and when it is available, it is usually in limited quantities. It is most often used for detecting opiates and morphine. - **Tissue specimens** are commonly collected at autopsy and are readily available in large quantities. However, interpretation of drug concentration can be difficult since data is not often available for comparison. Tissue concentrations may also be elevated in oral overdoses and chronically administered drugs. Muscle is preferred tissue sample. Liver can be used as a secondary sample when blood is not available; there is an extensive data available for comparison of post-mortem drug concentration. Kidney specimen is used mainly in heavy-metal testing; spleen for cases of carbon monoxide poisoning; and adipose tissue for pesticide poisonings and volatile analysis. - **Stomach contents** are often collected in cases where an oral drug overdose is suspected. Odors may be present that give a clue of agents present. - **Hair** is an excellent screening source for arsenic poisoning and is becoming more commonly used in screening for the chronic use of illicit drugs, including morphine, cocaine, and amphetamines. Drugs can be deposited in hair as it grows, allowing hair samples to yield information about drug intake over a period of several months to years, depending on the length of hair sampled. - **Other samples** include fly larvae, blood stains, soil samples and cremation ash, which may contain drugs or poisons. Tablets, capsules, vials, and various household products may also be collected at the death's scene. Medico-Legal Process ==================== Steps of Death Scene Investigation ---------------------------------- a. Planning of the death scene investigation b. Cooperation among investigators c. Documentation of the scene d. Taking notes at the death scene e. Videotaping, photographing and sketching at the death scene f. Identification of the deceased and examination of the body g. Scene information collection h. Collecting evidences which may be found at the death scene i. Interviewing persons regarding the death j. Estimating the post-mortem interval at the scene k. Ending the death scene i