Chapter IX MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES Pysia injury isthe effet vome forms of stimulus on the body, The effect may only. be apparent whet the stimulus applied is tnaificiet to cause injury and the body rosistance is great. It may Dbeves| when the effect is vse The effect of the may be delayet. A thrust to the body of sbarp pointed and sharp ‘ued isiument ill ad to the immecite production of x sab ‘round, while « i by « blunt object may cause the delayed produc Causes of Physical Injuries: ‘A Physial Violence 1 Heat or Cold € Hletriea Emory D.Chemieal Energy A PnYSICAL NJURIS ROUGH ABOUT 1 INSICAL VIOLENCE The ete ofthe aptation of eapoaionstrend. aaa "A wownd te sion toe thn bay te di aa ofthe ody I Sal oles may not the wound away aeLEGAL MEDICINE 4. tow of function — On account of the trauma, the tame may tot be able to function normally. ction differentiates an ante-nortem ‘The presence of the vial 1 from postmortem ary Inthe following isiances vital reactions or changes may not Be perv even injury was inflicted during We ‘Lif phyrical injurioe are inflicted uring the agonal tate of « ving person. The body cols rtsme during the period mayo Tanger neve the potential eapacty to react to the traum; and bef death sso aden a8 not to gre the iamus of the body, the Chance to cose properly. ‘This commonly observed in deaths (due uo sudden coronary Cecio. CLASSIFICATION OF WOUNDS. 4 Mortal Wound — Wound which \s coud immediately after lnfiction or tory thereafter that eapable of eausig death. Parts of the Body where the Wounde Inflcted are Considered (a) Heart ae big bod vessels (2) bina poe prion of he win cons (3) Lang (4) Stomach, tr, seloen and intestine. b, Nommentl wound ~ Wound whic ot capaho proecng death lnredintaly fer infiton of sty thereat, 2 Aato the Kind of Inatrament Used: ‘Wound brought about by bhi indrumen (sontudon, hams tome hersed wound) “ 1. Wound wrought shot by arp ite (1) Serpe iru: nbd wound () Reap polee baremeat (poeteelgaiaal {5) Sharp eyed wa harp pind ne i wound), Wound brought sot by tsa fda ducal wows Sale Gert { Wousd broughtknoatm vs mung eat hie fm, i ant rd ad my a using injures on the foeLEGAL MEDICINE n the female genitalia to induce abor tiom or promotes het (6) Sobeutane (9) Prieking of acre eruption (8) Subcutaneous injction of air to create a condition of emphysema (0) Nalt-iting (onychophgia) which may lend to maceration of the akin and an infection (20) Grinding ofthe teeth (bevxiam) is frequently wean in the mentally retard and ean lead to abnormal tooth wea, a bilateral hypertrophy of the maseter and a pain on chewing (11) Pressure on the subcutaneous thaue by a tightly applied ond or belt around the body (a) Teel customs of metal band around the neck or a leg by ome Alfican tribes may cause a permanent astiguvement. (b) Use of shore mate of metal by Chinese womea, (22) Paling of the body bar CTrichotillonnia) (Forensic Medicine A. Study im Trauma & Envronmental Hasorde by Tedesch, Eehert © Tedeteht, Vol. 1, p. 496) [LEGAL CLASSIFICATION OF PHYSICAL INJURIES: Mutdation Ast. 262, Revised Penal Code: ‘The penalty of reckision temporal to recudon imposed upon any perso, Wir Gal by depriving hin, ether totally or reproduction Any other intentional mut mayor init medium and ma tayection of fecal matters to. promote to lead to a severe facal die Kinds of Mutilation 1, IntentionallyLEGAL MEDICINE 263, Revi Pana Cae ny peron who shall wound, Dent, or swat another call be putt iene unpaid saa {ine poaly of prison mayo, i 1m consequence ofthe phy Te Perce mart peach eal become inane beet, moter od 5 1 ie poly of prion conection! ts medium and maxima Pree Camquence of the physical juries inicted, the Pv injured al ve fut the Woe f speech or the power £9 Corrie ann or sa have oe am exe whan, a fob ana, hy ev Sl hve Hot the woe of any sch member, or sal five bore ncaa! fr the work tn Which he was thereto- fer habianly ened ‘Te penalty of prion comeccionl ins minim and mediom pevoay if i comequance ofthe phyakal jis inied, he Ferme ured nal have Secome defor, of dal have oy Cher pr of he body, or sal avelox the ue tere, shall Sire vem tor iacapacaes forte peconsanee ofthe work tien be was ably engage fora prod of more tan ety Sire 4. The penalty of aresto mayor sts maximum pared Yo prion orrccional ts minimum peviod, f the Phyl ination ficted all nee suaed the ulna or ncapacty for labor ofthe Injured person for more than hay ays 1 the offense dal hae been commited gana shy ofthe pettone soumerated in ance 246, or wih aacdanos of ny of the cheumsancos wentioned in arti 248 te owe soveed by tsteviain murber 1 of ts aril dha be panied by rerkion temporal in ke medium snd macimum prods, te cs covered ty mibdtion sumer 2 by prion comecloa! iit maximum evo to prion mayor ke mn tad ee ened By aubdiviion number 309 bron coneceona he ted fd" maximum periods and the cas, cova tmumter 4 by prion corecinal in te ods ‘Tho provisions of the abi toa patent who sal by exceuine chastisomentf toe next preceding ace shall be he respective came 29 any Person whe, without inet feet oF by taking sGresoges of tag wes of mind or esuity Elements of the erin 4. The offender inflict pom32 LEGAL MEDICINE ‘obigation moan on Figscins Who have Treated Persons Suffer By Bros Senous and Les Serious Poel Inari ‘PRESIDENTIAL DECREE NO. 168 10, din Seer deaiament of the afocemsd gual, and to enable sent tic tomecinte ant senry that al persons treating a SLEGAL MEDIEWE ghica injuries mhich did not prevent the offenced party from gating in his habtaal work oF which did not require medial ‘tendance, if the vstim merely sufered from unall contusion or perfil auxasion which does not requite medical attendance or incapacity, Un falls the paragraph of lant physical Mreutmes of another by deed without causing eny injury ‘A sient dap onthe face or holding tghly the arm of the vstim which did not even develop sedneae ofthe skin may bo a form of rtreatment. 1 thore ts no evtence to show actual inftry, oF incapacity for labor, or period of medical ationdanco, the accused an only be ‘ealty of slgit phystel Injuries (People s Pensea, 82 Phi $08 People Amarao etal, C.A. 86 0.6. $453). 'A tender slap on the fn, holding the arm tghaly,applstion| of prowure in some part of the boxy, ar wild blow whieh show to ign of payne vslencn may al be conasdened sight phy Injen oe maltreatnet (ec! patra Physical Ines Inficted in « Tumuleuous Aten ‘Art 252, Revise Penal Cod When na tamul.vous affey gare fonly serious physical. ju Payx6 LEGAL MEDICINE When 4 blunt force is applied, momentarily compresses the cette lu the point of contact, thereby temporarily forcing the reek at of the afea and sting up a id wave under presi Wher the presure exceeds the cohesive force of the cells forming te expilny,arerol, or venue wal the ves ruptures. ‘naumuc ati wed to take more time forthe blood to ge out of thw blood vessel, contusion dose not immediately develop after the SPollaton of force. Te may develop ater » lapse of minutes or TEEn hours ater the application of fore. The waintion depends on the part of the body injured, tenderness of the tisues affected {condition of the blood veurls involved, and naturel ease, Women foe much more exsly bruised than men while boxers a xs prone {orsitfer contusion inepta of heavy punishment.——————— LEGAL MEDICINE minimized, After i has alrexdy developed, application of (rar compre wil hasten fs disppearance The distinction tween ante mortem ae postmortem contusions in an undecomposed body fe tht in antemortem beuising, there is truvamtion,coxgulation nd inf tention of Un nies with blood, while fa port mortem beulng there fe no ich findings Hematoms (Blood Cys, lood Tumor, “Bako”: ematoma isthe extrvastion of effusion of blood In a newly formed eavly underneath the #0. Tt ually develops when th bin natrmont applied in part ofthe body where bony tae fipeticialyTocate, Uke the Mead chest ae anterior aspect. of the Iigu The force applied cause te subeutanoots thie to Fuptury 0 count of the prewncr of a hard structure underneath, ‘he truetion of the edeutanoous Uaeuo wil lead tothe accumulation of blood eautng to elera Distinction Deteen Contuson and Hematoma (2) In contusion the effaed blood are ngewe in de iter ‘ico of the tne undersea the ss, whe hematoma boo accumulates In newly formed cavity uaderneth the (In Scam, hn ha hn ae “vated, tho elevation itt de on a ro owx0 LEGAL MEDICINE sh unconselous evacuation of (ay Sphincter ar relaned peta he bowel and bladder time but suggishand Sn wvere cae (0) Batiges beet Loaner moony fo eens ju before the inary (retrograde oy ftecl of cereal concussion and ie of medieo rex wows aan rch, Gn, lprain Met Petn Me: ie enrol by fhe removal of the pete! coh es hn cam era oe iin aint Tie came thee force cont biore Te rm ery cea a SS econ face eats Sout acm eae Tae So recone eet wen 0D ou= LEGAL MEDICINE Grave Those are usually caused by foreibla contact with rough, hard ghjcts frulting to treglar removal of the skin surfoce, ‘Fhe mature of the injury is dependent upon the degre of rough: teas of the object and the amount of pressure in the cours of {he sing. ‘The course will be indicated by a clean commence: int Abrasion (Patterned Abrasion, Stamping “Abrasion & La Signature”) ‘Those whowe pattern and location jrovides objective evince o show cause, nature of the wounding material or ineunsent fad tne mane of sss of death (1) Marke the grid of the radiator may be imprinted on the sk. (2) Tite thread marke may be seen on the skin in vehicular (2) Mucaie imprint in contact fice gunshot wound of entrace (3) Teeth imprestion mark in skin bites. 4, Presure or Proton Abrasion: ‘Abrasion caused. by preaure accompanied apally observed in hanging or sangulaion Df the rope may be reflected om the Tesion may dry up and sesame a ke consitoneya LEGAL MEDICINE Hacked wound. ‘The injury i quits severe, edges may 0 reese! depending on the nature of the edge of the Ansa sent used. CCharacteritic of Ireted Wound: ‘Edges ate clean-cut and both exteemities are sharp, exsept in ‘ers the shin s ooue or foked at the time of inition. ‘The wound is aight and may be delving if inflicted with he unding atrument plied with an acu angle to the miace the body nvaed Tnually the wound is thalow near the extremitie and deepet tie mide portion. However, this finding may be modified ty the shape af the wounding Instrument and part of the body uve the blond vals Involved are clean-cut, profuse be- ‘morthage te invari a feuture Gaping is usally prevnt due to the retraction of the edges bot Mtapresmce and degree of retraction depends on the direction Of te inced wound withthe line of elenvage (Lange's ie) 1 she inciged wound ie fcated in pasts of the body covered rin clothes, tbe clthlng. haf wi Io the ication and/or when there i damper involvement present healing is rally fe aoe he See nag tot or may develop women broken edge of ae ry be indmay appeurtkes punctured ot dab wounds fas may bet with thei from the incl Wa Alter 12 hos ‘Awe 24 hour, ‘er 348 howe = Alter 3:5 aye ron van,LEGAL MEDICINE ommon sls of wuekal inked wounds sre on the wrist with Involvement of the radial artery and the neck, Homicidal ~ The incised wounds are deep, mulipe and inolve oth acceuible afd nomeestedble parte of the body to the hands of the victim, Defense and other forms of wounds may te present. Clothngs ate always involved dental ~ Multiple ines wound is commonly observed on re asengers and driver of vehicular secients om account of the broken windshield and gles parts of windows. Stepping on cyst shell, broken glues, sharp edger of metal sheets ate common causes of ictal wound on the sole of the foat Those assciaied in the te of Kitchen knives in the preparation of food, eapentere nd handicraft workers who we tarp aged Inscruments ae frequent vctinn of accent icied wounds, Dutinction Between Suid and Homctal Culthroat Sule! Homie Direction Oblique, from below lft Usually horizontal below far, downwnacdn, across the Adan apple front ack. jst above ‘Adan’ ape Severity Uaully sot v0 deep ant! sally dep and may tay only kvolve tnchew cau volemert of the ‘oti and somtimes the sophagus is lnvoled Supertisal nal present aa et oor os Bm tener ray. raey ‘be precat deeper wound ‘theo ‘the vk rap fied when tached Poukion May be siting facing Unally viet Tying on ot the rfvoror sanding bdo other pace, oily 7 Mounding. Pim rasped (Catavrio_ Weapon i absent seam) or. fond ing Blood found in fe Blood found atthe back Anion orally smeared with oe Mouwe Utory of mental depres Abn son, domeatic, ianelal ‘cht probiems, alcohol SamaraLEGAL MEDICINE The extremes of sab wound. rey show the nature of te Instrument toed doublebinded weapon tay came the po Ateton of boc extreme the. A sg ed amen Ing price atone of inerzomile rounded and conte. This lection ey ot be clty Gente the Inasurmene qe ‘The dteton ofthe wife deck may be useful nthe eter ination of the youble ‘late postion of th offender md the vic wen he wound war ified. Aa to wither the mound al he oping depend on te leone of the sn‘ the destion ofthe wound tothe ine Ot cemag (Langer ae The depth may be influenced by the se and sharpmes of the inument, een ‘of the boy ince, nd the. depen of ores ‘opled Involvement of the bones may eau teat facts oa A ponen of he wounding Indrumen, ly the peng py ine amintons maybe nde Homomiae is aways the mos sits comoguence of «sab ound, "Thies de the wererane cf blood wea nee tet of bloody onna tetLEGAL MEDICINE (00) No disifbance in the death seme, wounding Instrument ound neat the victim. Homicidal ~ Stabbing with homicidal intent ithe most common. (Q) Injuries other than sab wound may be present (@) Stab wound may be located any part of the body. (2) Unually there ate more than ove rab wound, (4) Thete en motive for the mubbing I wiebout motive, the offender must be inne or under the infhuence ) Tere i disturbance inthe crime ncenem LEGAL MEDICINE «Sealing of the external opening willbe fhvorahle for the growth tnd moliplication of anaerobic microorganism like bacllhs tetanl, Medical evidences tht tod to show i x Homcial 4 Its multiple and uruallylocatod in different parts of the body. Te may however be found in certain areas of the body, The wounds are deep, ‘There are defense wounds on the victim, 4. There is dsturtunce in the grime eoene (sign of strug, Proof to show tt Sueidal: ' Locate in areas of the body where the vial organs ar located, > Unualy slnguiat but may be multiple out located in one area of the body.snd i rated Wound roughly ut Wound le Eyes an ine ise welling and cont DP WOUNDLECAL MEDICINE be significant in cases of burns, contusion and dermal menifes- In cams of burns in children and old age persons, involvement of more than 70% of the body surface are almost inversly fatal {In the estimation as to how much (oy percentage) of the body surface is involved, the rule of nine is Used. Body surface expressed ox pes entage using the rae of nie ‘Whole of heed and neck % OR Whole of one upper extremity 9% 188 Whole of front chest and abdomen 188 188 Whole of postorcr chest and abdomen... 185% 18% Whole of one lower extremity (tront) 9% 18% Whole of one lower extremity (back) oz eR Pusentsl ares a: 18 Total 100%, Factors Responsible forthe Severity of Wounds 1. Hemorrhage & Hemorshage may influence the severity of wound by (1) Low of 800d incompatioe with ite Blood constitutes shout 1/29 of the body weight of an sult.” By volume, an average sze adult hes 829 6 quarts (f blood (one quart is $46 cx). A low of one teath af yolume may ot cause any significant cinieal change, low of one quar: may cause fainting trem tthe 1ying down. aut a low of 1/8 boLEGAL MEDICINE vil, Spontancous rupture of cavernous hem bepatoma. ‘ii Rapture of the enlarged spleen (malaria, if onomaclokis, typhoid fever) (utedien log Investigation of Deeth by Fischer, p. 108 Ste of Inury Burne affecting onethind of the body aurface of the third ree type is umually fatal, Bigger wounds are more exponed ovinfection and other physial conditions of the suroundings Trauma on the vital organs of the body are always serious cinhing wows of the beast brain or hinge ane almost fatal, ‘Shock may occur with or without violence. A aight blow on ali slght ures in chikiren or ld persons, oF slight mce on the head of neck may cae wvete shock. Howerer, ‘estas to heal, etong persona sua n0t produce shook, Rody or Substance Introduced into the Body notion with ay ansteized scape may not be serious athe ‘ofa venomous snake, A fore albaance of Body May Be. i by Wal or tay act ava phy rant, The Roreign Body or Subelence may be Dathogente mieroonanin Vie Hsophobia ins eagments Sete Cyanie oT22 LEGAL MEDICINE 4. Wound may be Directly Fatal by Reason of: a: Hemenrhage An incised wound at the lateral ampect of the neck involving the carotid artery without surgical isterention is fatal due 16 hemorrhage. Wile wounds in some areas of the body where big blood vowels are nct present and the retraction of tames are strong. death will not be a diet consequence due to hemor ‘hage inthe abuence of complication that may b.Meehonca Ingres on the Vital Organs A tow on the heed may not necesaily produce external lesions but may. produce severe meningeal hemorrhage, pro: sdocing compression of the brain, "A punetared wound of the hart even thouah how smal, may produce death on account ‘of tho tamponade of the Ror. This is the disturbance of the balance of flu! inthe body apable of producing dslayed or immetite death, Wound may be Indeety Fatal by Reason of 1 Secondary Hemorrhage Folow ng Sepas: ‘A wound because of its notre and Toeation isnot producing severe hemorrhage, fit om acount of nf Ses i deeper tases are volved including hi blood vss there producing sewere hemor Specie fection Pathogmie microorganisms may divelop and mul {angrene Infection are common in open wound «Searing Beet, Chronic gonorshes! infection may cau urethra” Strctare of Ue esophagus may 1 Sritant poison. Keto formation in bur Geformity but distarbunce of the Mara A Secondary Shock Nature of Beth Dus to el ee ay han ‘Te 1a», Dotayed oF Secondary Shag Patent shows eign of tio after the tafhetiom of blood prenire, whnormal tion, rouse incooed nai The ahock tay be severe 0 recover completly trom el 2. Hemorrhage thage is the extravasiion ‘bout by, WOME "The degree and nate of hi not the blood! Kinds of Hernornage 1 it the Binding whieh oosire immediatly matic inary ofthe bivod vest Secondary Hemerthes This occurs not immadistely ster the inition injury but sometime thereafter on oF ment the ajar Infection Infection the appearance, gromth and development of mcr formed on Ube aitfce on acca of the dehipation ofthe After three days. the neutrophils wil be replaced by the smaceopieges coc Mombasa wil apes Che opal jee Collagen bere will bridge the raw aren and epithelial prot foraton will then cover the raw sea. Newly formed capi laren spout on all aes to form the vascular network and Cellagen fete become abundant nd diterentotedairace as beg lo prliferse to cover the exposed wre Complete return of the aro to is normal state may after a lapse of one month with ot without the fo Ths tales place when the ungay of cella and timuen ad exudate that hag