MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES

 Definition
o physical injuries – effect of some form of stimulus on the body
 effects may be immediate or delayed
 immediate – thrust to the body by a sharp pointed or a sharp
edged instrument
 delayed – hit by a blunt object

 Classification of wounds
o as to severity
 mortal wound – capable of causing death
 heart and big blood vessels
 brain and upper portion of the spinal cord
 lungs
 stomach, liver, spleen and intestines
 non mortal wound – not capable of producing death
o as to the kind of instrument used
 blunt instrument – contusion, hematoma, lacerated wound
 sharp instrument
 sharp-edged – incised wound
 sharp-pointed – punctured wound
 sharp-edged and sharp-pointed – stab wound
 tearing force – lacerated wound
 wound brought about by change of atmospheric pressure –
barotrauma
 heat or cold – frostbite, burns and scald
 chemical explosion – gunshot or shrapnel wound
 infection
o as to the manner of inflection
 hit – bolo, blunt instrument
 thrust or stab – bayonet dagger
 gunpowder explosion
 sliding or rubbing or abrasion
o as regards to the depth of the wound
 superficial
 deep – inner structures
 penetrating
 perforating
o as regards to the relation of the site of the application of force and location
of injury
 coup injury
Physical Injuries - Marfori, Francis Anthony V, MD, BSN 2

 wound at the site of application of force

 contre-coup injury
 wound opposite the site of the application of force
 coup contre-coup injury
 located at the site and also opposite the site of application of
force
 “locus minoris resistencia”
 not at the site nor opposite site but on areas with least
resistance to the force applied
 blow on the forehead  contusion at the region of the eyeball
 extensive injury
 greater area of the body beyond the site of the application of
force
o special types of wounds
 defense wound
 result of a person’s instinctive reaction of self-protection
 patterned wound
 wound takes the shape of the object or instrument causing the
wound
 self-inflicted wound
 produced by oneself
o type of wounds (medical classification)
 closed wound
 petechiae – circumscribed extravasation of blood (hemorrhage)
which are very small or pin size

o not always a product of traum

o may be post-mortem – in asphyxial death, death by
hanging
 contusion – rupture of blood vessels  blood underneath the
skin
o application of blunt force or violence
o size of contusion is usually greater than the size of the
object used
o medico-legal viewpoint
 may indicate the shape used
 suggest degree of violence applied
 indicate the character and manner of injury
o age of contusion
 new – red, sometimes purple
 4 to 5 days – green
Physical Injuries - Marfori, Francis Anthony V, MD, BSN 3

 7 to 10 days – yellow
 14 to 15 days – disappear

 open wound
 abrasions / scratch
o removal of the superficial epithelial layer of the skin
o caused by rub or friction against a hard rough surface
o importance in medico-legal
 abrasions caused by fingernails
 indicate struggle or assault
 located in the face, neck, forearms and hands
 abrasions resulting from friction on rough surfaces
(intentional or accidental)  over bony parts
 nature of abrasions may give the direction of
movement
o types
 scratch
 commencement and termination are well
defined
 if fingernails – broad at the commencement
and may terminate with a tailing
 gaze
 forcible contact with rough, hard objects
 clean commencement and tags on the end
 impact or imprint abrasion
 provides objective evidence to show cause,
nature of the wounding material or instrument
and the manner of assault or death
 pressure or friction abrasion
 observed in hanging or strangulation

Distinction between ante-mortem and post-mortem abrasions

Point of distinction Ante-mortem Post-mortem
Color Reddish-bronze Yellowish and translucent
Location Any area Over bony prominence due
to rough handling
Vital reaction May show remains of Loss of epidermis
damaged epithelium

 incised wound (cut, slash, slice)

Physical Injuries - Marfori, Francis Anthony V, MD, BSN 4

o produced by a sharp-edged or sharp-linear edge of the

instrument
o If axe, big bolo, saber  wound is called chopped or
hacked wound
o characteristics
 edges are clean-cut
 wounds are straight
 shallow wound near the extremities and deeper at
the middle portion
 profuse hemorrhage – due to a clean-cut blood
vessels
 gaping is usually present
 clothes may also show clean-cut
o why persons suffer from incised wound
 Therapeutic procedure
 Self-defense – may be held by the victim in an
attempt to avoid the offender
o may be suicidal, homicidal or accidental
 Suicidal
 location – peculiar parts of the body (neck,
elbow, groin and knee), wrist and accessible
to hand in inflicting the injury
 most common instrument – razor blade
 may have a hesitation cuts
 Homicidal
 deep, multiple and involve both accessible
and non-accessible region / parts of the body
 defense wounds may be present
 clothing are always involved
 Accidental
 multiple incised wound

Distinction between suicidal and homicidal cut-throat

Suicidal Homicidal
Direction Oblique, from below left Usually horizontal and
ear, downwards, across below Adam’s apple
front neck just above
Adam’s apple
Severity Not so deep Usually deep
Superficial cut Usually present Absent
Position of the body Sitting, facing mirror or Lying in bed
Physical Injuries - Marfori, Francis Anthony V, MD, BSN 5

standing
Wounding weapon Firmly grasped (cadaveric Absent
spasm) or lying beside
victim
Blood distribution Blood in front of the body; Blood at the back of the
hands smeared with blood neck; hands clean
Motive Mental depression, Absence
domestic, financial and
social problems
Previous history of self- Present Absent
destruction

 stab wound
o penetration of a sharp-pointed and sharp edged
instrument
o edges are clean-cut, regular and distinct
o surface length of the wound may reflect the width of the
wounding instrument
o may be wider when during withdrawal of instrument
o double bladed weapon – both extremities of wound are
sharp
 if single bladed – one extremity is rounded
o may be suicidal, homicidal or accidental
 Suicidal
 over vital parts
 solitary
 on covered parts of the body
 accessible to the hand of the victim
 (+) cadaveric spasm on the wounding
instrument
 (+) suicidal note – not always
 (+) motive
 no disturbance in the death scene with
instrument near victim
 Homicidal
 other injuries / wound aside from stab wound
are present
 located any part of the body
 more than one stab wound
 (+) motive
 (+) disturbance of the scene
Physical Injuries - Marfori, Francis Anthony V, MD, BSN 6

 Accidental
 rare
 falling against a sharp object
o Medical evidences showing intent of the offender to kill
the victim
 More than one stab wound
 Wounds – different parts of the body or where vital
parts are
 Stab wounds are deep
 Stab wounds with serrated or zigzag borders –
indicate alternate thrust and withdrawal to increase
internal damages

 punctured wounds
o result of a thrust of a sharp pointed instrument
o external injury is small but depth is to a certain degree
o opening may be round, elliptical, diamond-shape
o usually accidental but may be homicidal or suicidal
o opening on the skin may be small; much deeper
o External hemorrhage – limited; internal hemorrhage is
severe
o Homicidal
 Multiple and on several parts of the body
 Deep
 (+) defense wounds
 (+) signs of struggle
o Suicidal
 Located in areas of the body where vital organs are
 Singular
 Accessible to the hand
 Clothing not involved
 Victim is sitting or standing with bleeding towards
the lower part of the body
 (-) signs of struggle or disturbance of the scene
 (+) suicide note – not always
 Instrument – near the body
o Lacerated wound / tear / rupture
 Tear of the skin due to forcible contact with blunt
instrument
 Characteristics
Physical Injuries - Marfori, Francis Anthony V, MD, BSN 7

 Size and shape of the wound – do not

correspond to the instrument
 Rugged tear of the skin; irregular and ill-
defined
 Injury is at the site where the blunt object is
applied
 Swollen border
 Developed on the body where the bone is
superficially located
 Bleeding is not extensive

Distinctions between ante-mortem and post-mortem wounds

Ante-mortem Post-mortem
Hemorrhage – copious and generally Hemorrhage – slight or non at all and
arterial always venous
Marks of spouting of blood from arteries No spouting of blood
Clotted blood Not clotted
Deep staining of the edges and cellular edges and cellular tissues are not deeply
tissues, which is not removed by washing stained
(+) inflammation (-) inflammation