Forensic Notes PDF

NMT11
NMT11
Forensic Medicine Notes
Contents
Page
• Identification …………………………………………………………… 1
• Blood Stains ……………………………………………………………… 29
• Death ………………………………………………………………………. 36
• Wounds ……………………………………………………………………. 56
• Head Injuries …………………………………………………………… 72
• Firearm injuries ………………………………………………………. 88
• Thermal injuries ……………………………………………………… 103
• Asphyxia ………………………………………………………………….. 115
• Sexual offences ………………………………………………………. 128
• Pregnancy ……………………………………………………………….. 135
• Delivery …………………………………………………………………… 138
• Abortion …………………………………………………………………… 141
• Infanticide ………………………………………………………………. 144
• Child abuse ……………………………………………………………… 149
• Medical ethics …………………………………………………………. 152
Contents
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Identification
1. Assailant =
2. Victim =

3. Medico legal importance (MLI)
4. Corona = medico legal expert
5. Sexual offence
6. Asphyxia
7. Firearm injury
8. Suicidal = ‫أري‬
9. Homicidal =
10.accidental
11.Execution (‫ = )إ! ام‬capital sentence of death
(Hanging)
12.Thermal injuries
13.Disputed paternity
1 Identification
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Identification Of bones
Bones 1.Age 4. Animal or human?
⇒ (NAS) 2.Sex 5.Stature
3.Negroid or not 6. No of persons?
⇒ 2 D? 7.Deformity
8. Death Why?
When?
P.M. Interval
(Post Mortem)
Q1: Animal or Human Bone ?
A P
Anatomical features Precipitation test
Antiglobulin inhibition test
2 Identification
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Q2: Number of persons >>>>>3

>>>>>3
1. Same single bone e.g. Skull, Mandible
2. 2 Rt or 2 Left
3 3. Rt Male & left Female
& Diff.age and sex
Diff. Age of bones
Q3: Death?
Why? When?
Cause of death
1. Traumatic Skull Head injury
Bone Beveling
Bullet Flat bones only
Hyoid bone Asphyxia
Throttling Strangulation
Direct by hand NOT by hands
2. Pathological (2T) TB
Tumors
3. Poisoning Metallic poisoning
Deposits
Hair, nail, teeth & bone
3 Identification
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Q3: Death (MCQ + Practical)
Why? When? (P.M. Interval)
1. Soft tissue Six month

2. Tails attached to bone Twelve months
3 (Ligaments)
3. >1 year only bone

4. More time passes bones becomes Lighter
Whiter
Brittle
Less smelly
It may also depend on place of burial Preservation
Rapid dissication
Q4: Deformity (MCQ + Practical)

Congenital e.g. Cleft palate
3 Extra finger
Acquired Malunion of fracture
Occupational Shoe Maker Depressed sternum
4 Identification
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Q5: Stature (Written) >>>>>>>> Karl Pearson's Formula
To get the
length of Femur 25% of the height
the person
from the Humerus 18% of the height
bone
Q6: Negroid or not ? Or Identification of race from

bone?
(Written)
X shaped, other humans H shaped
Job of negroid
Name of the
M N T/ D J
only negroid in Jaw flat hard palate + protruded
the pasty incisors or upper jaw called
proganthism
2M
2N
Dolicocephally
1. Metopic suture 1. Depressed nasal

(Persistent) septum
2. Mastoid process 2. Wide nasal opening
(small)
5 Identification
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Identification of bone
AGE:
Ossific center
Skull Epiphsel line
Medullr
cvit
Medullary cavity
cavity:
Anatomical neck Surgicl neck
ers
> < ers
Medullr cvit
6 Identification
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Ossific Centers:
Centers:
L.L. U.L.
‫ا
ا‬
7 Identification
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Epiphyseal lines UL, L.L., Clavicle
Upper Limb:
1. Trochlea+ Capitulum
14
14month
2. Trochlea+ capitulum +shaft
‫ از‬
>15yr
3. ‫ آــــ‬see in your palm

Hands 18 months
4. Watch & bag 20 yrs.
Skull
1- Dimensions:full term13inches(circumference)
2- Sutures: 8 fontalnelle:
8 Identification
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Mandible:
Child Adult Old
mandible permanent teeth
milk
teeth
mental foramen Mental foramen Mental foramen
Lower limb:
9 Identification
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Teeth eruption(Dentation)
+MLI in book
Milk permanent
5 5 8 8
5 5 8 8
#20 #32
Sutures:
1. Hyoid 40 years ( body of hyoid with greater cornu).
Flat 2. Sternum
bones
3. Skull discussed before
10 Identification
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4. Pelvis
Take Care:
After puberty, In female:
Same (-2yrs) in growth
as
male
11 Identification
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V.V.imp
. MLI of teeth
1) Personal 2) Bite marks 3) Poisoning

Identification
*Dental record: 4A a)Discoloration of gum-
1- Something you are teeth:
born with Assailant Plumbum Blue
2- Acquired Size compare with Mercury Gray
3-From the dentist's the bite (gangrene)
records Abrasions & bruises Cadmium Cigarette
4-Age: Yellow
Write all the ages of Animal or human Bithmus Black
milk & permanent Cu Green
dentition
5-Sex By DNA test b)Discoloration of teeth:
6-Race Age of bite *Tetracycline All the
7-Occupation e.g: tailor Exception teeth
8-Social standard Assaults Become
Battered baby yellow
Rape
After 25 years:
Aging of teeth:
1) Attirition
2) Apical migration of periodontal membrane due to attrition of teeth
so the membrane doesn't go up but the teeth go down towards the
membrane
3) 2ry dentine deposition in the pulp
4) Root resorption
5) Root transparent
6) Cement deposition on the root
12 Identification
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Identification of sex:
1- After puberty
2- ♂ larger
heavier
rough surface
3- Bone ORAL 1- long bones In
2- Flat bones order
3 – Skull 95% accurate from
4- Sternum 70% accurate up to
5- Pelvis 98% accurate “most accurate " down
ORAL: always choose according to the seq. of most accurate
* * * Sternum :
- body > 2 × manubrium ♂
- body < 2 × manubrium ♀
13 Identification
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.*Skull

‫و‬ Eminence
Fronto-nasal junction
Mastoid Occipital
Process condyle
Exception
In female wide & broader
*Pelvis Rem. Delivery

(Study from the book) In females
‫و
و‬
1) Iliac crest
2) G.S.N V female
U male
3) Ischial spine
4) Periauricular sulcus
5) Pubic bone
6) Obturator foramen
7) Subpubic angle
8) Ilio pectineal line
9) Rem.
Periauricular sulcus
Pregnancy Present in female only
14 Identification
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10) Sacrum
11) Acetabulum
15 Identification
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Identification of Hair
Hair
1 – Identification.
2 – Scalping.
3 – Sexual offences .
4 – Burn.
5 – Firearm singed at inlet.
6 – Toxicology.
Type of wound from Hair :-
Cut wound hair Sharply cut
Contused wound Hair brushed tip
Identification of hair:
1 - Hair or Fibre 4 – Site of hair .

3H 2 – Human or Animal hair 3S 5 – Special person .
3 – Hair tip or root 6 – Son or not .
16 Identification
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A- Hair or fibre :-
1 – Cotton Curved & twisted ribbons
2 – Silk Shiny + No segments
3 – Linen Segments or Swellings " similar to animal hair "
" Bamboo-like " .
4 – Wool +Scales
B- Human or Animal :-
Human Animal
1 – Cuticle 1 layer of cells > 1 layer

" can't be seen "
2 – Cortex Continuous & thick
3 – Medulla Man only

‫
و‬
17 Identification
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C- Hair tip & Root :-
Root
Bulky healthy root + Flattened atrophied root

ruptured sheath + No sheath Fallen by
Pulled by force Sign of itself.
struggle & resistance.
Tip of hair Date of cutting
Type of Instrument (Type of Wound)
Sharply cut Crushed

1 – Cut wound Contused
Date: 2 – Recently cut Blunt
Tapering tip Rounded
Looks like > Reduced
Date: cut > than 2 weeks Date: cut < 2 weeks
Certain person or Not :-

Forms
1 – Fizzy with flattened & elliptical cut end Negroid .
2 – Curled with oval cut section Caucasians
3 – Silky with rounded cut section Mongolians
18 Identification
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Special person :-
Sex DNA "Chromosomal analysis"
"Karyotyping"
Y chromosome ♂
By fluorescent microscope of hair follicle cells
Identification of living
1 – Condition of identification of unknown. C
2 – Methods by police. M
3 – Methods. M
4 – Dactylography . D
5 – Disputed paternity. D
Conditions of identification of unknown:

⇒ Child disputed paternity
Lost infants & children .
Maternity hospitals .
⇒ Adults No I .D
Marriage & inheritance
⇒ Old true amnesia
Mental retardation
⇒ Accused Assailant
Impersonation
19 Identification
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Anthropometry
1) Body
(Measurements) 2) Head + ear
3) Lt. arm + foot
Draw back 4) Ear
5) Middle finger
Delicate Human
Instruments errors
Methods of police
3P
1) Bertillonage syst. 2) Portrait Parle 3) Prints

Fill in gaps a) Face _ Finger print
(photo) _ Retinal
+ 2 photos _ Voice
+ face views _ Palatal
b) Profile _ Iris
_ shape _ DNA
_ size _ Foot prints
_ color of:
- Hair
- Moustache
- Beard
- Iris
_ Voice
20 Identification
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Methods
1) Consent
1&2&3 4) Blood 5) Peculiar 6) Clothes 7) Culture 8) Features

group + DNA marks & contents
Similar to E.g: _ Money _ Language _ Gait
police _ Tattoo _ Letters _ Education _ Accent
_ Scars _ Cards _ Hand
_ Congenital _ Articles writing
anomalies _ Special
_ Previous tics
wounds
_ Operations
_ Birth marks
1 – Finger prints : 2 – Foot prints Assailant
Babies "hospital
changes"
a- First appear 3 – Retinal
b- Forms
c- Filing 4- Voice / Palatal / Sinus
d- Function
e- Failure 5 – DNA finger prints
f- Factors affecting
21 Identification
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a) First appear? 4th Month Intra uterine
Arches
b) Forms whorls
loops
small finger (65%)
c) Filing skin Printer ink Press on paper
Detected at Scene of air
d) Function Identification of living
Identification of dead even after putrifaction
Points of similarities 16-20 prints
Pores copy Pores of sweat
shape Size Spacing Glands distribution
e) Failure it’s very successful method
f) Factors affecting (4s) 1)Skin disease
2)Sulphoric acid
3)Surgery
4)Separation
22 Identification
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Disputed Paternity (study from book)
2D 2P
Discribtion DNA Prints Blood grouping
Complexion Finger RBC
Hair Iris HLA
Nose Mucous Rugae Serum
Ear Hard palate protein
Eye polymorphism
23 Identification
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Identification of dead
1) Cloth
2) Feature
3) Congenital anomalies + scars + tattooing
4) Sex, age, race, stature (SARS)
5) Occupation
Identification of dead
1) Tattooing
To Marking
3T 3M
1) Type of persons 1) MLI (Addicts, sailors, solders

(Sailors, addicts, solders homosexual)
Homosexual) 2) Marked by surgery, caustics
2) Type of pigments skin disease as eczema
(Insoluble, eg: indigo, aniline 3) More than 1 design, eg: (initials,
Carbon) address, religion, violence, love
3) Type of tissues dermis intentions)
Permanently fixed
MCQ:
Social status
&
Occupation Pigeon chest shoe makers
Clothes
Palm Manual worker
Clerks
Painters
24 Identification
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2) Features
1) Complexion of skin
2) Facial characters:
a) Shape Mouth
Ears
Eye
Nose
b) Slope of forehead
c) Hair
d) Shape Eye brows
Moustache
Beard
e) Corneal opacities or scars
f) Teeth
3) Photographs
4) Finger prints
3) Sex Identification
1) Presumptive signs eg: dress, hair, moustache
2) Probable signs eg: gonads
3) Sure signs 22
Nuclear sexing Male Y-chromosome
X-chromosome seen cells of hair follicles, sheath

Search for nerve cells, dental pulp by fluorescent
Microscopy
Davidson body called ‫دم‬ Barr body called
25 Identification
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4) Advanced putrefaction uterus in female
Prostate in male
*Intersex P.T.O
Coexist in varying proportions:
1) Gonads agenesis (Absent gonads)
2) Gonads dysgenesis Klein filter syndrome "XXY"
Turner syndrome "XO"
3) True hermaphrodite ovary + testis
4) False hermaphrodite Ovary Testis
Labia Penis
26 Identification
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Identification of age of dead body
(Intrauterine)
1th 2nd 3rd 4th 5th 6th 7th 8th 9th

month
Fetus __ __ 30g 100g 300g 750g 1.5Kg 2.5Kg 3.5Kg
Placenta __ __ Formed 100g 200g 300g 400g 500g 600g
Fetus 1cm Square of (32) (42) (52) 30cm 35cm 40cm 45-50cm
the month 9cm 16cm 25cm
= 4cm
__ __ __ __ __ Talus Femur Knee +
Calcenous
Cuboid
__ __ __ __ Testis Internal External Scrotum
Inguinal inguinal
Kidney ring ring
__ __ __ __ __ __ __ __ Posterior
Fontanelle
__ Two __ Four Fifth Sixth Seven 5+7+9 Closed
Month +
(2nd month) (4th month) Fissure Small hair Skin is Head "13"
2 openings Finger prints + vernix Wrinkled ‫ر ا‬
Appearance caseosa ‫ ا ر
ش‬Separated
+ female or From Nine
Male Mother
Nails
Above
__ __pupis 50 cm
__ __ __ __ __
27 Identification
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Period from birth to 25 years
- Birth 25 years
- 1st 2 years Milk teeth
- 2-6 years 3S Stature 5cm/year
Size & wt. 2Kg/year
Suture Pubis (ischium unit pubic ramus)
- 6-12 years Permanent teeth
- 12-14 years Menses in female / ejaculation in males
Hair pubic hair appears early
Breast in females / penis in male
- 14-23 years Bones
- Above 25 years:
Not accurate
Imp.
Written
Age of MLI
MLI Estimation
Six School
Seven Start punishment

(Discrimination)
Ten / Twelve To mother
Fourteen False male
Sixteen ‫ ا"ت‬ Female
ID card Male (16+2=18)
Eighteen Consent for rape Female
18 Male (18+2=20)
Twenty one Total civil rights
28 Identification
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Blood Stains
Stains
v.imp.
1) Is red stain blood or not?

2) Human or animal?
3) Belong to a certain person?
1) Is red stain blood or not?
Preliminary Confirmatory
Blood (-ve) (oxidase) 1) Microscopical RBC
+ H 2O 2 Man or animal
+ color change 2) Spectroscopical Hb
1) Guaiacum Green Toxins
2) Benzidine Blue 3) Microchemical:
3) Phenolphthalein
(Kasthe_meyer) Depends Aim Reagent Result
Pink on + procedure
a)Takayama Hb Blood Alkalies R.A
Or + Haematin
not Bl.reagent Or
Hemocedrin
(Pink)
b)Teichman Hb Blood Acid Acid
Or + Haematin
not Bl.reagent (Brown)
1) spectroscope
2) Microscope
Animal Mammilated Non_mammilated

Rounded + Oval + Oval +
Non_nucleated Non_nucleated Nucleated
29 Blood Stains
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2)Human or animal?
I. Microscopically
II. precipitin test
Principle Aim Antigen Antibody Procedure Method

Protein Human ??? Antihuman 1)Macro
Ag-AB Or Serum 2)Micro
Reaction Animal 3)Gel diffusion
(precipitation) protein
Animal
Inoculated
With human
Protein
Response
Reaction of AB
(Anti_human
serum)
APCD
• Average
(Neutral)
To prevent
Precipitation
by PH changes
• Potent
• Clear
• Diluted
(to be specific)
To prevent
other group
reaction
30 Blood Stains
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3) Certain person or not?
1) Blood: a) RBCs
b) WBCs
c) Serum protein
a) RBCs:
1) Antigen:
a) ABO
b) RH M
c) MN N
d) Lewis MN
e) Kell
f) Lutheran
g) Kidd
h) S-factor
I) P-factor
2) Hemoglobin: Hb A Adult hemoglobin

Hb F Fetal hemoglobin
3) Iso-enzymes: - G-6-PD
- PGM
- PGD
b) WBCs: HLA A, B, C, D
DR, DQ
c) Serum: Haptoglobin, lipoprotein, GC, GM
31 Blood Stains
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ABO
Phenotype A B AB O
Genotype AA Or AO BB Or BO AB OO
Antigen A B A&B No
Antibody Anti-B Anti-A ___ No Anti-B

& Anti-A
MLI:
1) Identification
2) Disputed paternity
3) Hemolytic transfusion
MN
Phenotype M N MN
(25%) (25%) (50%)
Genotype MM NN MN
Antigen M N M&N
Antibody X X X
MLI:
1) Identification
2) Disputed paternity
32 Blood Stains
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RH
Phenotype 85% RH + 15% RH -

Genotype DD Or Dd dd
Antigen Cc, Dd, Ee __
Antibody __ Anti-D
MLI:
1) Blood transfusion
2) Erythroblastosis fetalis
DNA
Procedure MLI
1) No/Yes 1) PCR Amplification D N A
identification 2) RFLP Endonucleosis
D Disputed paternity
Disasters
Electrophoresis
2) Nucleated cells
Body Mixed
remains stains
3) Nucleotides N Non-coding
Sex identification
4) Non-coding/coding A Assailum
area
33 Blood Stains
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MLI of blood grouping:
1) Identification 2) Disputed paternity 3) I.C.B.T

a) Civil Conditions: I.C.B.T
1. Personal identity 1. Mistake in hospital
2. Premarriage (Mixing)
Increase
3. Blood transfusion 2. Mistake of child
in temp Tubule
b) Criminal (lost)
1. Semen 3. Mistake of mother
Chest pain
2. Saliva (Father denies)
(obstruct by
3. Blood - ABO, RH, MN Bilirubin Hb)
- DNA
Jaundice
Investigations
N.B:
ICBT= Incompatible
Blood transfusion
34 Blood Stains
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Microchemical Tests
Test Aim Reagent Procedure Result

1)Takayama Confirmatory Reducing agent Reduce alkaline
Hematin or
Hemochromagin
Alkalies Blood or not Most famous
Is Glucose
+ Pink
Pyridine crystals
+
H2O
2) Teischman Confirmatory Glacial acetic Brown rhombic
test Acid Shaped crystals
+
(Sodium #$ )
. Na chloride Acidic hematin
. Na Iodide Or
. Na Bromide hemohydrochloride
2) DNA:
a) PCR (Amplification) polymerase chain

reaction.
b) RFLP Restriction fragment length

polymorphism.
35 Blood Stains
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Death
Oral 1- Causes of death far causes of death

2- Causes proximate (modes of dying)
3- Manner
4- Mechanism
• Far causes of death Accident

Poisoning
Disease
• Proximate causes CNS

CVS
Respiratory
• Manner Suicidal
Homicidal
Accidental
Natural
• Mechanism Physiological derangement e.g. (Hge, septicemia,

cardiac arrhythmia)
Proximate causes of death: (Modes of dying)

1- CNS Comatosed before death
2- CVS Syncope before death (HF)
3- Respiratory Asphyxia
36 Death
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Accident Disease Poisoning

• Hge • Tumor • Narcotics
1- CNS • Depressed bone • Uremia
(coma) (metabolic
disorders)
• Stab wound • Infarction • Digitalis
2- CVS
• Reflex cardiac • Aneurysm • Nicotine
(syncope)
inhibition (R.C.I.) • Aconitine
• Throttling • Pulmonary • Oxalic acid
• Strangulation disease e.g. • Strychnine
Diphtheria • Morphine
3- Respiratory
• Oedema of
(asphyxia)
glottis
• Tumors of RC
in medulla
Stages of death
* Phases *
Molecular life
Somatic death Molecular (cellular)
Permanent (Clinically dead) Death
cessation of
integrated CNS CVS Resp. • Death of cells or tissues
functions of an (2ry to cessation
individual of circulation)
associated with
Irreversible loss of circulation, respiration & Circulation
brain functions
O2
• Molecular life: It is the period of tissue Cell damage

from somatic death molecular death
Cell death
• MLI organ transplantation e.g. Nerve tissue (Brain)
after 3 min
Muscles after 3 hrs
Spermatozoa
Viable in epididymis
for no. of days
37 Death
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V.Imp
written 1- Suspended animation (apparent death)
2- Sudden natural death
3- Surgical death
4- Brain death
1- Suspended animation: ( ‫)إ

ء‬
A. Definition Vital process

+ life (still compatible)
B. Causes a) Involuntary: 3S
Shock Drowning
In these causes Electrocution
don't announce
that the person
is dead until
Sedatives & Narcotic drugs
proved
Surgical shock (Anesthesia)
b) Voluntary: e.g. yoga practitioners
C. MLI 3E
These tests are 1. ECG, EEG, (electrical instruments are used to prove if person
done to confirm if is dead or not)
death has occurred
or not and
therefore avoid
early burial‫د‬
2. Early burial (pre-mature burial) Avoided until proved
38 Death
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2- Sudden natural death:

SIDS SN (Adult) death
(Sudden Infant Death Syndrome) (sudden natural)
SUDI= cot or crib death syndrome
Definition: Definition: Healthy person / 24hrs of
1. Sudden(unexpected) terminal
2. Symptoms illness
3. Sings
4. P.M. no cause of death Causes: 1. CNS 2. CVS 3. Resp.
1. CNS 3. Resp.
1-Infection & Meningitis Pneumonia
Causes: inflammation (e.g. .....) (e.g. .....)
1. Viral or bacterial Thrombo- Thrombo-
Milk 2. Allergy embolism embolism
2-Vascular
Salt 3. Electrolyte imbalance (e.g. (e.g.
cerebral) pulmonary)
Vit
4. Vitamin (deficiency) Brain Bronchial
3-Tumors
5. CVS Neurogenic shock tumors carcinoma
Arrhythmia • Obstruction
Hge ,e.g.
6. Resp. Infection of larynx
4- Intra-
Laryngeal spasm • Asthma &
cerebral
7. CNS Head injury Pneumothorax
8. Adrenal
9. Para-
Insufficiency
thyroid
2. CVS:
1. Vascular
P.M. picture: Rheumatic
Syphilitic
ext. Nose bloody froth, tinged 2. Congenital heart diseases (e.g. ASD
oedema in nostrils & VSD)
3. Pericardial sac fibrinous, purulent
int. Lung congestion & pet. hge. haemo-pericardium
4. Myocardium cardio-myopathy
Hist. Bronchi cellular infiltration 5. Aorta aneurysm Rupture
Internal he
Character: 6S 6. Coronaries obstruction
1. Sex ♂>♀ Angina (Partially occlusion)
2. Season winter Infarction (complete occlusion)
3. Socioeconomic low
4. Small in size, wt &age 2-4months old
5. Sleep √√ (3-4 am)
6. Symptoms no
39 Death
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3- Death under anesthesia:

e.g. Unskilled incision
of big BV or aneurysm
• Causes:
1. Surgeon Accidental (surgical mistakes)
Prolonged operation (surgical exhaustion or surgical shock)
2. Patient Accident (injury necessitating operation)

Pre-existing disease e.g. HF
3. Anesthesia
Dr. (inexperience) Airway obstruction (post operative)
Pipes connection (intubation)
(R.C.I)
Anesthetic drug
Local CNS Depression or excitation
CVS Depression
Spinal Spinal nerves infections, hge or sensory

nerve affection (damge or paralysis)
Brain alteration of vol. of fluid protecting
the brain & spinal cord
General
1. Anesthetic agents Cardiovascular depressants
Vasodilators
Respiratory center
depressants
2. Bombs (explosions) esp. with cyclopropane & ether
3. unConsciousness
4. CVS problems Vagal shock (Parasympathetic shock)

as a result of problem with
technique of administration
eg. CVS inhibition vagal
by gas conc.
& may be Sypathetic shock
dueto severe pain adrenaline
ventricular Fibrillation
40 Death
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• Investigations of cases of death under anaesthesia: RAT
1. Report Consent
Ask about surgery in details
2. Autopsy Mistake of surgeon (e.g. perforation of the organ)

Mistake of patient (e.g. pre-existing disease as infarction)
Mistake of anesthesia doctor (e.g. airway obstruction by cotton)
3. Toxicological analysis Alveolar air

Lung
Brain
Blood
4- Brain death:
1. Definition: Electric activity in the brain
2. Types Cortical(physiological)e.g.: cerebral hypoxia, toxic condition, brain injury

Brain stem(anatomical) e.g. ICP, cerebral edema, intracerebral hge
Total common
3. Clinical criteria of brain stem death:

a. The patient deeply comatozed
b. The patient maintained on ventilator
c. Irreversible structural brain damage
Immediate signs of death: 5

1. Brain death
2. Cessation of circulation
3. Cessation of respiration
4. Primary flaccidity
5. Cadaveric spasm
41 Death
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Immediate signs of death: 5
Cessation of Cessation of
Brain death Respiration Muscle
CVS
(study from book)
1)Clinically 1-Coma 1- Palpation 1- Inspection 1ry flaccidity
2- On ventilator 5min 2- Auscultation
3-irreversible palselessness repeated < &
organ damage 2- Auscultation 5min
5min Cadaveric
absence of spasm
heart sounds
2) Investigation EEG + CT scan ECG or Cheyne strokes
+Doppler oscillometer
3)Tests 1) Brain stem 1- Flame test 1-Fluid test
(refer to book) reflexes lost 2- Folorescent (winslow's test)
1. No corneal test 2-Feather or
reflex (Icard test) candle test
2. No pupil 3- Flow test 3-Mirror test
reflex no 4- Finger test
respond to
light
3. No gag

bronchial
stimulation
4. No Fnger
Lgture
respiratory mgnus
webtest
movements

without Trnsumnton
ventilator
5. No response
to stimulus
Absent 6. Oculo-
(Barany's test) vestibular
Absent
(caloric test)
7. Oculo_ceph
alic
(doll's eye sing)
or Cautelle's
sign present
8. No response
on pressure
above the
eye
42 Death
NMT11
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Written
Organ transplantation:
1. Types of donors Death (cadaver)(within the molecular life)

Brain death
Living sign consent + witness
2. Types of tissue Blood (replaceable)

Kidney (paired organ)
Eye illegal (essential for life)
* Scheme *
(Follow it in the signs of death)
Death
1. Definition
2. Due to
5D 3. Describe shape
4. Date site
5. D.D.
6. MLI
in Cooling
7. Factors R.M. ONLY
Putrefactions
43 Death
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flattening: ( ‫)ارء او‬

Primary flaccidity & contact flattening
1. Definition: Relaxation (all muscles) + loss of reflexes + respond to electricity

ryfccdty
fccdty R.M. ndry
fccdty
Moecurfe
Somtc
deth Dted
pup Moecurdeth
2. Due to: loss of muscles tone
3. Describe: Site All muscles

Shape
D.D. (only oral)
1) Peaceful look:
1- Apparent drowned person
2- Vagal inhibitory phase • Drop of jaw
3- Epilepsy, Trauma & catalepsy 3D • Drop of urine
4- Narcosis • Dilated pupil
5- Electrocution 2) Contact flattening
6- ttt with ms. relaxant
Ask these Qs.
rimary flaccidity
Primary Why?
When?
air hours → 2 hours after death
4. Date: Pair Where?
5. D.D.: 2ry flaccidity (+ve

ve response of muscles to electric stimuli only with 1ry)
6. MLI: Valuable indication of the alternation of position after death
Immediate sing of death

Cadaveric spasm
( ‫)ا ا‬
• Definition: Spasm Group of voluntary At time of

Contraction muscles death
• Due to: Emotional
motional stress ((Nervous
ervous tension) nervous stimulation of muscles
Hands grasp 1. Suicidal
something
2. Homicidal
in the scene
of crime 3. Accidental drowning
It is persistent after death due to emotional or physical stress

immediately before death (it is possibly neurogenic)
44 Death
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• Describe: severe muscles contraction 1ry flaccidity in one group of muscles
• Date: Immediate 1ry flaccidity
• Site: Hands Mainly, most of the time

Jaw
• D.D: R.M
Heat stiffness
Oral Cold stiffness
• MLI Manner of death Suicidal

not cause Homicidal
of death Accidental
1. Cooling
2. Hypostasis
Early signs of death
3. Rigor mortis
4. Body fluid changes
5. Skin & eye changes
Body fluids:
C.S.F(Blood) Vitreous humour(no blood)
1- ↑K 1. Ammonia
2- Electrolytes, minerals 2. Potassium
3- Lactic acid 3. Succinate dehydrogenase
4- Amino acid
5- Urea
6- Non-Protein N2
45 Death
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Cooling: (Not a must it depend on external temp.)
• Definition: Body loses temp. atmospheric temp.
Conduction Convection Radiation
• Due to: 1- No metabolic process

(oxidation) No heat
production
2- Cold external temp
• Describe: Cold
Chemical thermometer
Rectal Vaginal Abdominal
Sure • 21˚C
sings of • Progressive
death fall of temp.
Rate of cooling: (Simpson's formula)
Date: 1˚C/hr 2.5˚C⁄hr 1st 6 hrs

1.5˚C-2˚C⁄hr 1st 12 hrs
18 hrs to reach room temp
• D.D: No
• MLI: When?? but rare because you

40˚ 4hrs 36˚
must know the temp
at the time of death
46 Death
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• Factors: 1- Cold temp Ventilation

H2O
2- Clothes Naked
Rem 3- Cutaneus fat Obese

Female
5C 4- Child children cool > adults Large

surface area in ratio to his body mass
C ooling 5- Cause of death

Asphyxia
Heat Stroke Rate
Electrocution
Hge Immediate loss of heat Rate
Blood changes
Hypostasis
= Livor mortis = Suggilations Fibrinolytics
= Cadaveric lividity = Vibices P.M bleeding
N.B.: Asphyxia ‫دم‬
CO2 endothelial damage Fibrinolysis
• Definition: bloody discoloration & staining Most depending area not

of the skin and tissue subjected to pressure
• Due to: Gravitation

Stagnation
• Describe: Site Supine back

Prone ventral
Hanging legs
Drowning upper part
Shape : appears first as patches which gradually increased &
coalesce until it stains the whole dependent areas except the
sites of compressionwhich remain pale (contact flattening)
47 Death
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• Date:
1 8
Appears after 1hr Becomes fixed and complete
• D.D: Bruises and contusions ( Table discussed later in Ch3)
• MLI: 1- Where? Position of body at the time of death

2- When? From the extent of hypostasis
3- Why? Color idea about cause of death
(cause of death)
• Factors:
(1) Colour Cause of death

1- Pale blue Normal death
2- Deep blue Asphyxia
3- Red 3C Co
Cyanide
Cold
4- Brown K Chlorate poisoning
Nitrite poisoning
5- Pale Hge
Fluidity Volume
(2) Extent Cause

Asphyxia (Because CO2
endothelial damage
fibrinolycin ‫دم‬
Hge
48 Death
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Rigor Mortis
• Definition: Rigidity Voluntary &

After Death
Stiffness Involuntary
• Due to: 1. Decrease ATP production
3D 2. Dehydration
Chemical 3. Dehydrated complexed actine & myosine

reaction
• Describe: Site Voluntary Eye lid muscle, tempromandibular joint

(refere (descending
to book) order)
Involuntary Eye (constricted pubil)

Erector pilae (goose skin)
Heart
Shape contaction of all muscles
• Date:
2 × 6 = 12 ×3
36
Starts Takes 12 completely
after peak more hrs disappears
death to start to
disappear
S.D 2hrs 6hrs 18

12hrs
49 Death
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• MLI: 1- When? Extent

Rate of disappearance
2- Why? Cause time of onset

disappearance
3- Where? * -sure sign of death-
• Factors: ATP Rigor mortis
ATP R.M.
Athlete
(1) Ms bulk and age Emaciated
Child
(2) Ms activity Convulsion Asphyxia
Electricution
Cold
(3) Temperature
Hot
Skin and Eyes

• Skin:
1. Circulation Non reactive

tinted Cadaveric
2. Color Hypostasis
4 “C”
3. Cold & Pale
4. Contraction of erector pilae muscle Goose fleshing
5. Elasticity
50 Death
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• Eyes: ( !)
acc. of dust on
cell debris
1. Cornea
indicative of death
within 2 hours
After No reflex
2hrs
from 2. Retina vessels
death Arteries pale widening &
narrowing
Veins of B.V
segmented
Taicking of raifways (from it’s app.)
with 15` 1-2hs
Color change
Up to 15hs
3. Pressure Zero flaccidity due to IOP

3g ½ hs & nil 2hrs
4. Sclera Black spot Tacheuoire
Trois (3hrs) due to dissication

of tissues + acc of
debris & dust
5. Pupil
1.
2. No reflex
3. Pupillary margin distortion within 24hrs
4. Ms. tissue in iris losses tone
51 Death
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6. Putrefaction
7. Adipocere
Late changes (late sings of death)
8. Mummification
9. Maceration
Putrefaction
• Definition Break down of tissues
• Due to 1. Tissue Enz.
Aerobic
2. Bacterial Enz. Large intestine
3. Insects & protozoa & fungi
• Description
(2 days)
1. Green 1st Rt. iliac fossa (caecum store of bacteria)
+2 Sulphaemoglobin (Hb + H2S)
Colour changes
(4 days)
2. Grass Arabinzation ( marbling)
+2 Purpleishred
(6 days)
3. Gases Bad odor
Blesters
Body cavities
Pressure
Any opening discharge of frothy blood + contenets
(weeks)
4. Gloves Skin Fat
Protien Breakdown &
Hair liquefy
origin
Nail (3rd week)
• D.D No
• M.L.I 1. Sure sign of death

2. Time passed since death extent
3. Cause of death rate
52 Death
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• Factors affecting putrefaction : (bacteria)
Bacteria Bacteria
1.Temperature 25 - 40 ××
• Drowning(H2O)
2.Air Air • Sealed coffins.
3.Water • Dehydrated (e.g. metallic
• Drowning after extraction
poisoning)
• Oedematous
4.Blood • Hemorrhage
• CHF
• Prostate and uterus (last
5.Organ • Liver, spleen
organs to putrefy)
Metallic poisoning (bactericidal)
Septicaemia
6. Cause of death + dehydration
Bacteraemia
No bacteria (sterile intestine)
• Special investigations in putrefied body:

1. Bacteriological
2. Biochemical
3. Histopathological
4. Toxicological
5. Changes in hair
6. Changes in bone
53 Death
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V.V.IMP.
Date (3w – 6 month) (3w – 12 month) (3day-7day) Still birth

Adipocere Mummification Maceration Sterile
Hydrolysis and Dehydrogenation + Sterile autolysis +

Definition: hydrogenation of fat. dessication of body intrauterine fetal
tissues. death.
• + H2O (drowning) • H2O (desert) Tissue enzymes
• Unsaturated F.A H2
Cause:
saturated Inhibits growth of
putrefactive organisms.
• Waxy • Black • Rancid odour
• Greasy • Shivelled • Blisters+lacerated
• White • No odour skin
• Heat (inflammable) • Skin is dry , hard • Red brown coloured
• Alcohol or ether and adherent to the skin
dissolves it shrunken body. • Spoulding sign
• Rancid odour • Internal viscera
Describe: • No bacteria and becomes soft,
chemical moist, discoloured
degradation and the limbs are
easily separated
from body (exposure
to air should be
prompt since
exposure to air
____ where there is permits the
+++ fat occurrence of
e.g. S.C fat of cheeks, putrefactive
Site: changes).
breasts, buttocks,
abdomen & abd.
Internal organs
MLI:
1. When? - From date and - From the extent - 3 day 7 day (EXTENT)
texture
2. Why? - From recognized - Nullifies infanticide
injuries Intrauterine fetal death
3. Where? - Water - Hot dry atmosphere - Intrauterine fetal
death
4. Who? - Male or female - Presentation of - ×××
features
identification
54 Death
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P.M interval
• Definition:
Immediate Early Late
CNS 1.Cooling 1)Putrefaction
CVS 2.Hypostasis 2)Adipocere
Respiration 3.Rigor mortis 3)Mummification
Muscles (primary flaccidity) 4.Skin 4)Maceration
Cadaveric spasm 5.Eye
Worm ___ feeds

on the cadaver
Oral
When
finds
• Para fauna of cadaver Why in case of
or poisoning only
maggots
or
larvae
Depending
on its stage of
development time of death can be estimated
55 Death
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Wounds
Classification:
Legal Medicolegal
Permanent No. of
infirmity days for Mechanical injury Thermal injury
healing 1) Dry burn
1) Simple XX <21 Sharp Blunt 2) Moist scald
2) Dangerous a + >21 ‫ق‬
X - 3) Electricity
3) Fatal * Dead* *Dead* Stab Firearm Electrocution
Cut 4) Chemical
(Incised) corrosive
5) Radiation
ionization
Abrasions Non-ionization
Contused
Bruises
(Contusions)
N.B:
Permanent infirmity = #$%&' #‫ه‬
loss of functioning organ or loss of function in this organ
Reading
Factors affecting nature & extent of wounds:
1)
a) Instrument:
Sharp Localized space damage
Blunt Wide surface damage
Plastic Wide surface ,, ,,
b) K.E 1/2 MV2 so velocity is more important than the mass

c) Condition of K.E Striking mobilize body less damage
Striking immobilized body more damage
d) Factor which period of time over which energy is discharged destructive
effect of the blow
56 Wounds
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2) Tissues: Bone > than
Muscle (great elasticity & plasticity)

Skin Resist to traction force
Subcutaneous Plastic
Joints Movement governed by muscle action
Gases & fluids incompressible
Scheme of wound:
1) Definition & causal instrument

2) Types & examples
3) Characters & MLI
Cut = incised Contused = lacerated #01

1) Def. Wound due to drawing the edge Lacerated or destroy
of sharp object on the skin Grinding + compression
e.g. knife, razor, glass
2) C.I - Sharp instrument Heavy blunt instrument
- Cut skin & underlying tissue Car, Bar, Tar (ground)
3) E.g. - Cut throat - Perineal tear delivery
- Cut wrist - Scalp stick
4) Types 1) Hesitation marks: (Suicidal) Rem. FCA
Hesitative= Experimental 1) Flap (torn) Factory
*Superficial 2) Crush Car
3S *Small 3) Avulsion ‫ـ‬ by
*Separate grinding & compression
*Beginning 4) Cut lacerated by sharp end of
stone
2) Defensive wound:
- Site In hand & forearm
Web of thumb
Thigh
MLI:
a) Homicidal
b) Not taken by surprise
c) Conscious
d) Partially mobile
3) Fabricated wounds:
- Self inflicted not suicidal
57 Wounds
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Oral - Aim:
a) accuse an enemy
b) Escape from military service
c) Escape from work in prison
d) Allege from bad ttt by police
e) Rape
- Characters: CCSS
a) Circumstantial evidence
b) Clothes No tear
c) Shape superficial
Parallel lines
d) Site safe area
Reach the hand
5)Characters More long than deep
a) Skin: - Shape: - Shape:
*Edge: regular & clean *Edge: irregular
(Irregular) except: except: Scalp
W W Chin of tibia
Because skin is
- Object: Weapon Wrinkled stretched on the bone
area
- e.g.: -Broken glass -Axilla
o Abrasion - Surrounded XXXXXX - Abrasion & Bruises

& Bruises: By: Absent
b)Hair: - Sharply cut - Crushed tip of hair
c)Blood - Cut Free external bleeding - Crushed No bleeding (Blood

Vessels: No infection rapid healing clots)
infection Slow healing
o Healing: - By 1ry union - By 2nd union thick scar

6) Tissues - No - Yes
bridging bridging
- Gapping - No gapping
o Sepsis *Less "minimal tissue destruction" *More " tissue destruction"
58 Wounds
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7) AM & PM AM PM AM PM
1) N.E 1) N.E XXX
- Vital tissue XXXX - Vital tissue
reaction reaction
(Healing & (Healing &
sepsis) sepsis)
2) M.P 2) M.P
leucocytic XXXX leucocytic XXX
infiltration infiltration
3) Gapping XXX 3) Bruises XXX
4) Bleeding XXX
10) Age From healing by 1ry union

One Oedema + Blood clot
(Red swollen edge)
Two Tree of blood vessels
(Growth of new)
Five Fibrosis of blood vessels
(Organization of blood clot)
10 days Complete healing by 1ry NO AGING
union (Intention)
3 wks Red scar
3 ms. Brown scar
6 ms. Pale white scar
May be invisible, sub skin,
avascular scar
11)Shape Linear or spindle shape
12)Complicat Complicated by hge. & laceration
-ion of internal organs
13)Sepsis Minimal contamination & foreign
Bodies less liability to sepsis.
59 Wounds
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Abrasions = scratches ‫ت‬67! Bruises = contusions ‫آ&ت‬

1) Definition * superficial e.g. cuticle * Extravasations of blood in
tissues space (between blood
serum vessel & intact
skin) due to rupture of blood
- scar vessel
scab
2) Instrument Blunt Blunt
e.g. stick or ligature e.g. stick or ligature
3) Examples - Bite marks - Bite marks
- Nail marks - Nail marks
- Ligature marks - Ligature marks
4) Types a) Pressure (patterned) a) superficial
= perpendicular force b) Deep > 48 hrs.
b) Sliding (friction) = dragging Blood appears after
force is tangential to the > 48 hrs. to appear
surface of skin Superficial.
c) Crushing (impact) Need 2nd Examination.
force is vertically applied to
the skin
5) MLI Rem.
(TEN SAD)
1) Type a) Pressure a) Superficial
b) Dragging b) Deep
2) Edge
3) No. Sign of struggle & Sign of struggle &
resistance resistance
(Homicidal) (Homicidal)
4) Site - Sort of crime - Sort of crime
Sort of Oral
crime: The same
- Mouth & +
nose Smothering Site
Throttling N.B: May be in Another Site
- Neck Strangulation Due to gravity & Ms. Attachment
Hanging e.g. Scalp (forehead) bruises
- Mouth + in eye lid ( Black eye)
nose
+ wrist + Rape
thigh
+ Female
60 Wounds
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6) Shape Shape Shape of Assailant

CI. 1) Whip Curved
1) Finger aa
nail
2) Stick Elongated
2) Human aa
bite
3) Finger tip Round
3) Animal aa discord
bite Shape
4) Ligature aa
mark
5) Car aa
7) days 2 3 1-2 weeks 2-3 2-3

Age/Healing 1st 2 days
Soft dry Weak Form Red oxy Hb
reddish Brownish scab complete 2-3 days
Scab red scab (falls) epithelizat. Blue reduced Hb
2-3 days
AM PM Green Biliverdin
2-3 days
1) N.E Similar as Bilirubin
Yellow
before - color fade 1-4 weeks
2) M.P Similar as depends on
before Site, size, depth.
3) Redness XXX
4) Bruises Absent AM PM
1) V.T.R XXX
2) Healing XXX
color changes No color
present changes
3) Redness XXX
4) Big size Small size
8) MLI -Differentiate cut ( No abrasions) Differentiate cut ( No abrasions)
from contused from contused
-Differentiate Bruises from DD. from hypostasis
hypostasis Since they are
present around Bruises & not
hypostasis.
61 Wounds
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9) Factors Factors affecting size of

affecting bruises: 5B
1) Blow (severity)
2) Pericardial death (onset of
death)
3) Blood disease
4) Person Age Young
Elderly
Sex Female
Bruises
More fatty
delicate tissue
5) Place:
a) Tough Fatty fibrous tissue
(palm & sole)
b) Vascular Bl.vs (eye lid &
labia)
c) Underlying Bone (severe
bruises)
Ms. (Minimal bruises)
10) DD. 4B 1) Pathological -Purpura
1) Bites (fish, insects…etc) -Hemophilia
2) Babies (excoriation) "Napkin -Liver cirrhosis
dermatitis" -Alcoholism
3) Putrefaction -Fulminating
meningococcal
4) Bed sores infection
2) Hypostasis
Postmortem denudation 4D v.v.imp.
Occur to skin in putrefaction Bruises hypostasis
Row area of dermis simulating 1) Def. - Extra- - Intra-
Abrasions when dried. vascular vascular
2) Due - Trauma - Normal
to death
3) Date - AM or PM - PM
4) 1) Color 1) One
Descri- changes color
be 2) Raised 2) Not raised
3) Well 3) ill-defined
defined 4) No
4)Abrasions abrasions
5) Not 5) washable
washed 6) No
6)leucocytic blood cells
infiltration
62 Wounds
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♦ N.B:
Talk about:
Edge -Direction
-Depth
T E N S A D -DD
Type No. -Site -AM or PM

-Size -Age
-Shape
Stab wounds
1-Definition:
-forcing
-sharp pointed object into body e.g. dagger or knife
2-examples and types:
-chest
-abdomen
-back
3-Types:
ypes:
-Transfixingpenetrate 2 corresponding surfaces e.g. limb
Or connect 2 organs
-Puncture: not sharp edged instrument but pointed e.g. Iron bar-poker
4- DD :
-firearm injuries
-cut wound
63 Wounds
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5- Characters
Characters or medico legal importance:( TENSAD ):
):
1- Type: -transfixing
-puncture
2- Edge: everted due to withdrawal
3- Number: homicidal
4- Site: back (homicidal)
5- Shape: -triangular (single sharp bladed e.g. Knife)
-fusiform (double sharp bladed e.g. dagger)
6- Size: length of the wound = Breadth of the weapon
But may be:
- widened during withdrawal
- or reduced due to healing of the skin
N.B.: use TENSAD in abrasions, bruises and stab
6-Direction:
-dissection (in dead body)
-Dye x-ray (in living)
7- Depth:
- Deeper than longer
-injury to internal organsHemorrhage
Infection sepsis
-tip of broken weapon inside wound identify weaponidentify
assailant
-length of weapon=depth of the wound
Except in:
- Chest area : not all the weapon enter due to opposition by rib cage
- Abdomen: depth is more than the length of the weapon due to
compression of the abdomen during penetration
in any crime there are the following:

victim--assailant
victim assailant--wound –weapon
weapon--circumstantial evidence
64 Wounds
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Suicidal Homicidal Accidental

1-Circumstantial
evidence(5D)
1- Door -√ -X
2- Disturbance of -X -√
furniture
3- Depression -√ -Threatening
4- Daily note -√ -Any belong to ass
5- Dactylography -Victim -Assailant
2-Victim(6S)
1- Sex -♂ -♂ or ♀
2- Site of body -In front of Mirror -Any site
3- Spasm -Weapon -Belong to assail.
(cadaveric)
4- Second injuries -Previous attempts -Defensive wound
5- Sign of struggle -Absent -Present
6- Site of blood -Ventral aspect -Dorsal aspect
(Cut Throat)
3-Assailant(3B)
1- Buttons and -Tears
clothes
2- Blood groups -Compare with
and prints those in the scene
of crime
3- Body -Abrasion & bruise

4- Weapon(3w)
1- Which type -Any Type -Sharp
2- Where -Present -Absent
3- Witness -Finger prints of -FP of the assailant
victim
5-Wound:TENSAD
• Type -Cut or stab never -Any type
contused
• Edge
• Number -Single -Multiple
• Site -cut throat -Anywhere
-cut wrist
-High in neck above -Low below thyroid
• Direction& Depth thyroid cartilage cartilage
Direction
Depth -Oblique -Transverse
-Superficialdeep
sup.(Tailing) -Deep
65 Wounds
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Causes of death from wounds
Early Late:4S+DIC
1- Shock 1- Sepsis:
2- Embolism infection intravenous thrombosispulmonary
embolism
septicemia, pyemia
V.Imp peritonitis, pericarditis
Written & 2- Surgical interference Success
Oral
3- Suprarenal hemorrhage
-Car Accident Impact loins
–few days after trauma(2-20)
4- Syndrome: A. Crush syndrome:-MuscleMyoglobin
-BL vessel HB
Collecting Tubules
Obstruction of renal tubules
Acute Renal failure
5- DIC( Disseminated Intravascular Coagulation)

D Damage to vessels
I Immobilization & stasis
CCoagulation factors & Cell factors
B. ARDS :adult respiratory distress syndrome

- Alveolar damage progress to Resp. Failure
- Renal & CVS failure
66 Wounds
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Early causes of death (S

(Shock )
1ry Neurogenic shock 2ry
Haematogenic
shock
Vagal shock Sympathetic Hemorrhagic Hematogenic
shock shock shock
1-causes Vagal area Severe The Commenst
Tragus,carotid pain cause of Death. • trauma
sinus ,larynx, -Def. blood loss • surgical
epigastrium, -Types:(refer to ↓
Abdomen,externa book) ↓ total blood
genitalia 1-ext. 2L(1/3 BV) vol..
-Very bad news 2-Int.-pericardium
Sudden psychic 200cc (cardiac a- fluid loss
shock temponade) b- toxic
-Application of -pleura100cc absorption
catheter -peritoneum histamine-like
-Severe cervical 500cc substance in
dilatation -brain 10-20cc injured tissues
1-1ry
immediately after
wound
2-reactionary :
recovery↑ BP
Several hours to 1
day
3-2ry: sepsis or
infection(bacteria
erosion of vessel
wall) 10th -16th day
2-C/P BP ↓↓↓
BP BP ↓↓↓ Temp ↓↓↓
Temp. ↓↓↓↓↓ ↑↑↑↑ Temp. ↓↓↓ Resp.: rapid &
Resp. Resp.: rapid & shallow
pulse shallow Pulse: rapid&weak
Pulse: rapid&weak
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1ry Neurogenic shock 2ry

Haematogenic
shock
Vagal shock Sympathetic Hemorrhagic shock Hematogenic
shock shock
3- mech.& Vagus RCI Adrenaline ↓ blood in circulation Histamine
cause of vagal release
death escape +↓BVGeneral
phenomenon ventricular ized loss of
fibrillation Cap. Tone
This can help
person to HF
survive from VD +↑ capillary
death Lt RT permeability
side side
Congested ↓↓venous
lung return CO
Congested
organs HF
-diseased
heart as Tissue anoxia
angina & ↑Capillary
infarction atony &
(ppl with permeability
normal
healthy
heart can Vicious
survive) circulation
HF
External Internal
4- PMP 1- pale organs 1- congested -Effusion
-Pale body -Pale organs
2- empty vessels organ -Petechial
-pale -sub-
2- congested hemorrhage
Hypostasis endocardial
lung Hge -Dilatation of
-blood on
3- diseased ground& (explain) capillaries
heart -contracted (engorgement
clothes
spleen
corrugated
capsule
-blood in
body cavitie
68 Wounds
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Subendocardial hemorrhage occurs in hemorrhagic shock because of

forceful contraction of the heart with low blood volume in the
circulation rupturing of the walls of the heart together
injurysubendocardial hemorrhage
Embolism (Early cause of death)
1- Air embolism:
Venous(pulmonary) Arterial(coronary ,cerebral)
Cause 1- Criminal abortion 1- Bad doctor (artificial
2- IV infusion Pneumothorax)
3- Cut throat 2- Bad diver: Ascent & Descent
4- Tubal insufflations & tubal 3- Bad person: stab connecting
patency test bronchus to pulmonary artery
Postmortem 1- X-Ray: Air bubbles in RT 1-X-Ray

picture side of heart, pulmonary 2-H2O
arteries 3-Retinal, Coronary, Cerebral
2- H2O arteries Beaded
Cause of Venous air embolism Occlusion of coronary & cerebral

death stoppage of pulmonary arteries
circulation because air
bubbles are large & block
flow of blood through minute
pulmonary veins & venuoles
2- Fat embolism:
FAT
Fracture of long bones
Ampoules of fatty dye
Trauma to fatty tissue
Thermal injury
69 Wounds
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Postmortem picture:
1-Stain lung section: Osmic acid & Sudan III to stain fat cells
2-Globules of liquid fat in:
RT side of the heart
Pulmonary artery
Arterioles
3- Brain- Heart- Kidney Fat embolism
Injuries of internal organs
Heart Lung Abdomen Neck

1-Rupture a- Traumatic
TTBB
Tar Break
Tyre Blow
b- Pathological
1-Infarction b-Pathological b-Pathological
rupture xxx Hollow organs:
2- Aneurysm Peptic ulcer- Typhoid
rupture
3- Extensive fatty Solid organs:
degeneration of Bilharziasis –Malaria
its muscles
4- Myocardial Duodenum(BEB)
fibrosis Traum Pathol-
-atic ogy
History √ √
Bruises √ x
Edge Irreg. regular
Bulging √ x
GIT healthy diseased
disease mucosa mucosa
RVI Hypostatic Vagal shock 1-All types of

2-Blow pneumonia wounds
(inf. Due to except:
stasis of -Contused
blood) -Cut is the
commenst
2-Causes of
70 Wounds
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Atrium > ventricle Wide 1- Injury of internal death:

3-Perforat- ↓ Type of organ a. Carotid
ion Thin Thick wall weapon 2- Internal bleeding sinus
(stab) wall + Valve 3- Infection vagal
↓ like mech. shock
Hge b. Carotid
( RT > LT) artery
↓ He.
Thinner wall c. Internal
jugular
veinair
4-Bleeding -Subendocardial - Subplueral - Stab wounds embolism
hge (vvvimp): Hge: d. Trachea
(5B) **Tardieu chocking
1- Blow rupture spots e. Lung
2- Blood Pneumonia
disease
↑capillary 3- Homicidal/
permeability Suicidal/
3- Blood Accidental
loss(Hge) Similar to the
hypovolemia table see
4- Burns before
5- Poisoning (Pb&
As)
4, 5 Toxic
capillaritis.
71 Wounds
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Head Injury
(Most imp chapter in forensic oral & written)

1) Scalp injuries Types
Complications
Types:
a. Bruises (contusions) blunt instrument

Skin subcutaneous
C.T
Aponeurosis sub aponeurotic
Loose areolar
Periosteum
homicidal
b. Cut c. Contused e
(commonest) accidental
By heavy sharp *similar in

Object - shape regular edges
E.g. fass, axe - severe bleeding
*Differentiate between them by

Hair
Abrasion and bruises
Gapping
d. Firearm wounds
72 Head injury
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Complications of scalp injuries:
1) Hge (due to rich blood supply to scalp)

2) Erysipelas skin inf. By strept
3) tetanus
4) Infection Meningitis
Encephalitis
Brain abscess opp. The injury
Cavernous sinus thrombosis rare affect
longitudinal and lateral sinus
Meningitis
(Forensic (ENT) (Community
medicine) Otitis media medicine)
Traumatic Meningococcal
History Head injury Otitis media Neck rigidity
Bacteria Non specific as Non-specific Gram -ve
Staph. Or
strept.
Pus site Opp. The Temporal Basal (Circle of will’s
lesion in the at the base of the
scalp brain or due to
gravity)
73 Head injury
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2) SKULL
1) Factors affecting skull fracture.
2) Types
3) Healing and sepsis.
1) Factors affecting (governing) skull fracture:

Fissure Comminuted
stick car, bar, tar
spider web
Low momentum or mosaic fracture High momentum
Depressed Firearm (beveling)
hammer
Bullet
Localized striking surface
Cut fracture:
- Fass, axe (sharp edged)
♦ Factors affecting:- ‫ا ب‬
(‫ا ب)ا وب‬
• ‫ا ب‬
fissure
1. Blunt or sharp Blunt comminuted
Sharp depressed info. From table
Firearm
2. Size of striking surface
3. Momentum= K.E = ½ mv2
• (‫ا ب )ا وب‬

- Skull supported Polar fracture
Not supported
74 Head injury
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Polar fracture (3B)
1. Bulging poles of the skull

2. Bisect
3. Parallel to the direction of striking force/axis of compression
2) Types of skull fractures:
1) Comminuted fracture:
a) Results from: previous page
b) Composed of:
2) Cut:
a) Results from:
- Linear+ loss of bone (regular,straight)
- Sharply (moderate) cut edges
- Knife
- Axe (triangular in shape if strike with axe angle,the
base of the triangle is nearer to the assailant)
- Fass
-
3) Depressed fracture:
a) Results from: (as before)
b) Draw ( signature fracture take the shape of the
striking surface)
c) Drium inward in part of the contour which is nearer
to the assailant
d) Drop ( in infants) due to high elasticity of skull
bone
( POND FRACTURE) no fracture only concave
depression
75 Head injury
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4) Compound fracture:
- Comminuted depressed fracture
ALL features of depressed
fracture + some comminution in
the base.
Depressed fracture with fragmentation of the depressed piece of bone.
5) Fissure fracture:
- Starts from point of trauma and extends parallel to the
direction of the blow.
- 2 fissures meet, the complete one occurs before the
interrupted.
DPT
Diastatic fracture Polar (as before) thermal fracture
Fissure in supported skull
-Thermal fracture
- Tar (ring fracture)
Fall from hight on feet

Fracture in sutures occur in
non-united sutures of children. Ring fracture around Foramen magnum
76 Head injury
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N.B D.D. Thermal (natural) and Traumatic (homicidal) followed by burning
Thermal (Acc.) Traumatic followed by

burning
1) Scalp wound ‫آ‬ ‫ق‬ ‫ق‬ ‫آ‬
X √
2) Skull fracture fissure Any type
3) Extradural hematoma small big
4) Brain Small, shrunken, thin gyri Not shrunken
and wide sulci oedematous
5) P.M. or A.M. p.m picture of burn P.M
3) Healing and sepsis:
1) Fissure 3 months (completely unit)

If there is necrotic tissue preventing union another 3 ms
edges are smooth bone ebernation or ivory
formation
2) Skull defects: as trephine operation
1- Bone vertex: 2- Permanent infirmity : 3- start 3 months
Never fills with bone, - Infection complete memb. formation
But fibrous membrane - weather Tissue Twelve months

being membranous in - Trauma
origin (permanent infirmity) - Jacksonian epilepsy
77 Head injury
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4) Sepsis: Bone erosion involving outer, inner or both tables of skull

(4-6) Six weeks to develop
Its presence denotes that the cause of death is probably
“Septic intracranial complication” Meningitis
Encephalitis
Brain abscess
Cavernous sinus thrombosis
3) Brain injuries:
injuries:
1. Cutting/Lacerations:
- Occurs usually in comminuted and depressed fractures and
firearm injuries
- Rapid or immediate death
- Majority of cases no ttt Death
2. Concussion
3. Compression
Concussion Compression
1- Def. 1- Def
2- Mechanism 2- Mechanism
3- C/P 3- C/P
4- Fate 4- Cause of death
5- ttt 5- ttt
6- MLI 6- Causes
78 Head injury
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Concussion
Def. :
Sudden transient loss of consciousness after head injury enter state of
surgical shock severity of which is influence rate of or failure of
recovery
OR Temporary arrest of brain stem functions.
Mechanism:
Vibration wave affecting brain stem reticular formation
OR
Diffuse neuronal injury only functional abnormality of
submicroscopical neuronal dimensions of nerve cells and their connections
Clinical pic. of concussion:

Signs and symptoms Neurological Investigation
1) Vibration No signs of
Loss of consciousness lateralization
(Sudden and transient)
1. Pupil (equal) normal
In severe cases
slightly dilated.
2) Vomiting +ve or –ve
Common and may cause 2. Motor power EEG
suffocation (General flaccidity) diffuse
changes
3) Vital signs: 3. Reflex
(signs of shock)
• BP Last to disappear
• Pulse rapid and weak and first to
• Temp. reappear corneal
• Resp. Rapid and and then sphincter
shallow
Fate:
79 Head injury
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1) Complete recovery:
- No organic structural damage
- Regains consciousness
- Complains of headache, amnesia, restlessness and returns
normal
2) Post-concussion (PC) syndrome: (remains few days)

C/P:
- Headache
- Drowsiness
- Irritability
Cause:
Cerebral oedema
MLI Fabricated
3) Fatal concussion
Death due to arrest of Resp. and CVS functions
The cause is unknown ( Temporary arrest permanent)
PMP pet. Hge and congestion
Depressed fractrue blood
- Lucid interval
4) Concussion compression
+ lucid interval
lucid interval:
1- Definition
Period of consciousness between unconsciousness of concussion and
unconsciousness of compression .
2- Time interval
Secs 1 week (as the he has to strip the Dura from the skull →brain
compression)
3- Amount of blood 150-160 ml.
80 Head injury
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4- Mechanism
concussion Lucid interval compression

Bl.V torn Bl.V torn Big hematoma
Bp ↓↓ BP normal
Bleeding
↓
Stripping of the Dura
→ hematoma
5- MLI Of concussion compression with lucid interval
1-Name of the assailant

2- Defense vital signs examination
3- 48 hrs Hospitalization x-ray
signs of lateralization localize lesion

CT scan
Decompression operation done
when pulse < 60
Medical responsibility
♦ Treatment of concussion
1- Hospitalization
2- Investigation bed rest
3- Conservative care Nutrition
Medical observation
Avoid morphine
Masks signs of lateralization

In the pupil
• MLI of concussion compression without lucid interval:
1- Negligence (Doctor) medical responsibility
2- Not witness(patient)due to retrograde amnesia for events prior to
injury
81 Head injury
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Compression
Def. : state of ↑ intra cranial tension
Mechanism:
1- Stage of stimulation ( irritation)
↑ ICT close veins congestion & edema
Miosis
Irritation signs ↑↑ reflex
Twitches
↑Bp & slow pulse
2- Stage of paralysis :
↑↑ ICT close arteries ischemia
Mydriasis
Loss of reflexes
Paralytic signs Muscle paralysis
Fever
82 Head injury
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Clinical pic :
Signs & symptoms Signs of local neurological affection Investigations
Signs of lateralization
3 V ↑↑↑↑ ↓↓↓↓ EEG
1-Vibration loss of 1-Pupil

(unequal)
consciousness
Ipsilateral
gradual miosis followed Contraction Paralysis
by the other ↓
2- Vomiting side Dilatation
Projectile +
headache +
Papilloedema + ↑↑ ↓↓
conjugate deviation 2-motor power
of the globe . (contralateral
side due to
3- Vital signs: extrapyramidal
decussation)
BP ↑↑↑
TEMP↑ cerebral
fever ↑↑ ↓↓
PULSE ↓slow full 3- reflexes
RESP slow , deep (contralateral
side )
Causes of death:
Through foramen magnum
(tonsillar herniation)
Cerebellum
Herniation of medulla is compressed against the edge of

Temporal lobe the foramen magnum
Through tentorial opening ischemic necrosis central asphyxia

(Tentorial or uncal herniation)
83 Head injury
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Treatment of compression:
Surgical "trephine operation"
1- Removing depressed piece of bone & for
2- Removing the haematoma after ligating the bleeding B.V
84 Head injury
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Causes or Aetiology of compression: Depressed Fracture(bone) explained before

Hemorrage
Traumatic Pathological
Extradura Hge Subdural Hge Subarachinid Hge Intracerebral Hge Intraretinal Hge
1- Defenition: Several types Aneurysm 1) Pathologial 1) Extensive

Dura & skull Extension from subarachnoid 1) Pathological extension from Cerebral apoplexy intracerebal hge
or intracerebral Hge under intracerebral hge • BP Heart
2- Causes the dura (versus) slower Kideny 2) Trauma
Fissur fracture &may even stop if compressed 2) Rapture of aneurysm
(traumatic) tear of on veins occur • Atherosclerosis Tearing of choroid
extradural blood vessels Congenital Mycotic Cerebral vessels
plexus especially
Subacute Mostly at corpus
Traumatic B.V in children
3- C/P: Cause bacterial striatum rupture of
Types: due to sever weakness
concussion compression endocarditis lentcinlo-striate artery
i) Acute trauma tearing
liquid internal ii) Subacute subdural vessels
Character Single Multiple 2) Traumatic
iii) Chronic (Pachy meningitis a) Coup injury side of
4- P.M.P
interna hgica) trauma
i- Scalp wound
Causes: Site Base Vertex
ii- Skull fracture b) Contra coup oppsite
a- Repeated minior of trauma
iii- Extradural Hge side
b- Diabetus/old /alcoholics
iv- Brain comprssion due to
c- Laminated Circle of
willis
i) lagging
movement
of brain in skull
ii)Accel. deceleration
theroy
85 Head injuries
injuries
NMT11
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-Causes of death from head injuries
Immediate Late
1- Concussion → fatal type 1- Convulsions → Jacksonian epilepsy

(hge)
Blood
2- Compression 2- Causative organ 1- meningitis
Bone(fracture) → infection 2- encephalitis
3-brain scars
3- Cutting / laceration 4- cavernous sinus
Thrombosis
3- Permanent infirmity 1- infection

→complications 2-weather
3-trauma
4-jacksonian
epilepsy
-Sequelae of head injuries : 4 A & 4 P
1- Amnesia →retrograde
2- Automatism→antrograde
4A 3- Adhesions → Jacksonian epilepsy
4- Abcess→ infection(sepsis)
5- Permanent infirmity "see before"
6- Post traumatic neurosis →vagal symptom
4P 7- P-C syndrome
8- Post concussion syndrome
86 Head injury
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Brain injuries
‫آ ا ر‬
Coma
except except
Fissure fracture frontal lobe
Lucid interval Broca`s area
Aphasia
© Go through the table: diff between concussion and compression
87 Head injury
NMT1
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Firearm injuries
injuries
Cartridge:
1- Classification of Weapons
a- Mechanism of Loading b- Cycle of firing
88 Firearm
NMT1
NMT11
Mechanism of loading Cycle of firing

Slow action 1- Automatic
2- Non Automatic
1- Muzzle Difficult loading
3- Semi Automatic
Near
Non-Rifled
2- Breach
Rifled Riflings
V.Imp
Riflings
a- Def: Ridges & Grooves

b- Direction: ))))))) or ((((((((
c- Function: 1-Spinning Range of firing by Resistance
2- Stability (Gyroscopic effect)
89 Firearm
NMT1
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d- MLI:
To be compared with Primary rifling (preliminary)
experimentally fired
bullet to identify the
suspected weapon Secondary rifling (confirmatory)
Straches of rust & dust depend on

Frequency of cleaning & using
V.Imp
Percussion cap
Antimony sulphate Aiming Firing
Fulminate
1- Def : cylinder Base in the cartridge
2- Function: Paste
Percussion P Heat
Cap C O2
Aiming A Catalyst
Firing F Spark
Other types: lead stephnate
3- MLI:
a- Fired or Not.
b- Identification of weapon.
c- Compensation claims by workers of cartridge factories as Mercury

Fulminate causes Dermatitis.
90 Firearm
NMT1
NMT11
Rifled
3. Service Rifled ‫ب‬
( ) (
)

‫ه‬ ‫ر أ‬

Automatic Non-Automatic 2.Revolver 1.Pistol
Non-Automatic Automatic
Old Recent
V.Imp (In the exam do not write them in Table form)
Cartridge Bullet Powder

• Copper
1- Pistol • Short • Jacketed • Smokeless
• Automatic
(Groove)
2- Revolver • Copper • Jacketed • Smokeless

• Short (Old Revolver (Old Revolver
• Non-Automatic Non-jacketed) Black powder)
(Rim)
3- Service • Copper
• Jacketed • Smokeless
rifle • Long
• Auto or Non-
Automatic
91 Firearm
NMT1
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Non-Rifled
N.B: Missile = Shots & Wads.
Non-Rifled Weapons
Ghaffier Sporting gun
Greener Schneider Remington Black Smokeless Powder
Smokeless Black Powder
Shots:
1- Sporting Small Rounded
2- Greener Gross Rounded
3- Schneider Slugs
4- Remington
V.Imp
Non-Rifled Weapons
Cartridge Ext. Shots Int. Powder

wad wad
1- Sporting * Long Small Black
* Non-Automatic √ & √ &
(Rim) Rounded Smokeless
* Carton or plastic
2- Ghaffier
G * Cu Gross round Smokeless
S * Long X Slugs √ Black
R * Non-Automatic Slugs Black
92 Firearm
NMT1
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Chocking (Non-Rifled weapons)
Increase range of firing.
Practical
Firearm injuries
• Missiles
Bullets Shots
1- Non-jacketed -Small Sporting
-Gross Greener
-Slugs S & R
2- Jacketed (Fur Fragmentation)

Prevents fragmentation
93 Firearm
NMT1
NMT11
3- Partially jacketed
4- Dum Dum Bullet
5- Devastator
N.B: Composite, Partially jacketed, Dumdum

& Devastator bullets are Forbidden/ Illegal
by international law
94 Firearm
NMT1
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V.V.Imp
• Wads & MLI
Internal wad External wad

1. ‫ ا‬1 cm Thick 1. 1 mm Thick
2. ‫ ا‬Felt 2. Carton
3. ‫ ا‬3-10 m (Distance of travelling) 3. 1-3 m

- From 1-3 m penetrates you - >1m penetrates you
- From 3-10 m strikes you - 1-3 m strikes you
4. Site Between Shots & powder 4. Above Shots
5. Function a. Piston 5. Keeps the shots in place

b. Barrier prevents
Leakage of gases bet.
Shots
c. Cleans the barrel
6. MLI 6 Ds
a. Diagnosis of firearm inj. ~~~~~
b. Diagnosis of weapon (non-rifled) ~~~~~
c. Diff. bet. Inlet & exit ~~~~~
d. Distance of firing ~~~~~
e. Diameter of the barrel ~~~~~
f. Direction of firing ~~~~~
• Gun powder:
Black Smokeless (Non-Black)

1. Composed C, S, K nitrate Nitrocellulose + Nitroglycerin
of
300 V of gases Nine” 900 V of gases
2. On ignition:
Carbonate & Bicarbonate Nitrates & Nitrites
3. Residue: (Alkaline) (Neutral)
-Old revolver -All the other types:

4. Present in: -Sporting Pistol , sporting , service rifle ,
-Schneider & Remington Greener , new revolver
5. Shapes
95 Firearm
NMT1
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6. Powder B B T B B T
marks: Burning (fire) ~~~~~
Blackening (smoke) ~~~~~
Tattooing (unburned ~~~~~
powder under skin)
Long Weapon B & B 1.5 m Far
T3m Injuries ~~~~~
~~~~~
Short Weapon B & B 25 cm Near ~~~~~
T 50 cm Injuries
7.MLI: 1. Diagnosis of firearm

(similar to wads inj.
except no. 5) 2. Diagnosis of weapon
3. Diff. bet. Inlet & exit ~~~~~
4. Distance of firing ~~~~~
5. Date of firing ~~~~~
(only Black) ~~~~~
1w Carbonate > ~~~~~
Bicarbonate ~~~~~
2w Bicarbonate > ~~~~~
Carbonate ~~~~~
6. Duration of firing ~~~~~
~~~~~
~~~~~
~~~~~
96 Firearm
NMT1
NMT11
Read
• Fabricated wounds:
1- Circumstantial evidence
2- Clothes
3- Superficial / safe area
Read
• Physical activity:
1- Medulla
2- Broca’s area
3- Spine
• Sequence of events of firing:

Rifled Non-rifled
1- Flash of light 1- Flash
2- Bullet + BBT 2- Wad + Shots + BBT

Write Distance of traveling of wads +
3- Hot explosive gases (15cm) Distance of traveling of shots:
distorts the edges of the inlet
(irregular, everted & wider)
1m 2 cm
2m 4 cm
3m 9 cm
4m Full dispersion 16 cm
Four
Twenty meter Total body with no

penetration
97 Firearm
NMT1
NMT11
• Characters of firearm:
1- Loss of tissue/substance Oral
2- Inlet & Exit

Inlet Exit
3- Powder marks BBT 1. √ X
2. X (Natural orifice) X (orifice)
4- Bevelling. 3. Thorough & thorough ~~~~~
4. Tandem ~~~~~
98 Firearm
NMT1
NMT11
• Distance of firing:
Near Far
< 3m >3m
1- Powder Marks 1- Dispersion of Shots
2- Hot Explosive Gases 2- Bullets Penetration
3- Wads & Shots
OR
Rifled Non-Rifled
- Bullets - Shots
- Powder - Wads
- Powder
99 Firearm
NMT1
NMT11
• Diff. bet. Inlet & Exit:
Inlet Exit
1. Bevelling Internal External
2. Burning √ (Near) X
3. Bruises & marginal √ X

abrasions
4. Powder marks √√ XX
Except:
1. Far>3m
2. Clothes
3. Contact firing
4. Ricochette
(Reflected Bullet)
5. Pink color -Carbon effect Carboxy Hb. X
6. Palisade appearance -Longitudinal with long nuclei X

(M/P)
7. Soiling ring √ X
8. Size -Small, Except: NESR -Large

Near Explosive
Shots Ricochette
9. Substance > loss of substance < loss of substance

10. Edge -Inverted, Except: FAN -Everted
Fatty area Autolysis Near
-Regular, Except: NESR+W -Irregular

11. Regularity Wrinkled area
100 Firearm
NMT1
NMT11
• Factors affecting shape of inlet :

3-Distance
1- ‫ُب‬ 2- ‫ــِِـِب‬
4-Direction
a. Bullet or / Shots
Black
b. Powder
Smokeless
Suicidal / Homicidal / or Accidental
Firearm injury Suicidal Homicidal Accidental

1- Circumstantial
evidence:
1- Door Close from inside Closed from outside or +
not Ceremonies
2- Disturbance of X √ Cleaning
furniture Children
3- Daily note √ X
4- Depression √ Threatening
5- Dactylography Victim Assailant
2- Victim:
1- Burning & √ X
blackening
2- Clothes No tear May be torn
3- Sex Male Male or female
4- Spasm Weapon Anything belonging to
assailant
5- Sign of struggle X √
101 Firearm
NMT1
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3- Wound: (TEN SAD)

-No. 1 >1
-Site Within reach + vital Anywhere
organ
-Shape Irregular, lacerated, Anything
everted
-Direction Upward √
-Distance Near Any distance
4- Assailant:
Search for skin residue X √
Nitrates, Nitrites/Metals
5- Weapon:
-Where √√ XXX
-Witness Finger prints of victim Finger prints of assailant
-Which type Rifled Any type
-Defects X X √√√
102 Firearm
NMT11
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Thermal injuries
1- Heat disease 2- Burns 3- Scalds

4- Corrosives 5- Radiation 6-Flash burns (electrocution)
I- Heat Diseases
Heat diseases Causes C/P Treatment P.M.P
-
1) Heat cramps Excessive loss Cramps Cl supply
of NaCl tablets,
Striated muscles NaCl , Cl- IV saline
2) Heat syncope BP Treatment of

(heat exhaustion) Heat Heart Temp. shock shock
muscle Resp.
Heart vascular Pulse
collapse
Foments
3) Heat Dry ,flushed - Putrefaction
hyperpyrexia skin ,anorexia • Ice
(heat stroke) Hypothalamus ,thirst, - R.M
(sun stroke) = HRC XX convulsions, Enema
Head Coma & Death - Cooling
• Cold room - Congested
viscera &
brain
• Predisposing factors:
1- Non-acclimatized
2- Fatigue, old age & humidity
3- Drugs e.g. Alcohol & anti cholinergic
Oral
N.B:
• Heat syncope body temperature is low due to shock
• Sun stroke occurs only in sun exposure No, it can occur also in
shadow because it depends on high temperature not the sun
103 Thermal injuries

NMT11
NMT11
Scheme II- Burns: (due to dry heat)

1- Definition 1- Definition: Heat injury due to dry heat
2- Condition of burn 2- Condition of burn:
3- Classification Workers
• Accidents
4- Factors affecting Children
prognosis of burn Car & airplane crashes
5- P.M.P
6- AM or PM • Suicidal female mainly
7- Characters of burn • Homicidal rare…
8- Causes of death
9- Age of burn
10- D/D 1- After death ( ‫)ء ا‬
2- Child abuse
3- Classification:
Dupuytreu Hebra Wilson According to ttt

st
1- reddnen &'() 1- Epidermal 1 self healing
1 Epidermis
2- vesicles Erythma
3- Superficial *+, 2- Dermoepidermal 2nd surgical graft

2
4- Deep skin
-'
5- S.C *+‫ا‬ 3- S.C 3rd surgical
3 amputation
6- Charring
(carbonization
Muscle, bone)

NMT11
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4- Factors affecting severity or prognosis of burn:
a) Surface area Wallace’s rule of “9”

• > 60% fatal
• Rule of nine
Surface area is more

dangerous than
‫ ام‬ 9
degree
‫ ورا‬ 9
Water Loss
Infections
Neurogenic shock
b) Time severity
2T
c) Temp severity

d) Strong (health)

e) Small or old age
5S f) Site of burn
head & neck & trunk more dangerous
g) Superficial or deep

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5- P.M.P:
Body &Organ Passages Blood Bone

A) ‫ ة‬/ Soot 1- Concentrated “Thermal fracture
in the skull”
1- Degree (Any degree) ‫رد‬ Due to eruption
‫ن‬/ ‫آ‬ of plasma as
2- Red ( ) carboxy Hb effusion in Fissured fracture
organs
3- Pugilistic attitude
i.e. Boxer’ attitude 2- Red Due to:
“generalized flexion” “carboxy Hb”
“CO” 1- Brain losses
Coagulated ptn water in the
ms form of vapour
4- Heat rupture(skin split)
Due to coagulation of ICT
skin protein
fracture of
inner table
B) ‫ة‬,
2- Outer table
1- Coagulated organ
losses H2O
Effusion
dissection of
2- Rupture
bone
similar to
3- Coagulation 0+1
errosion
6- AM or PM:
A.M P.M
1- P.M.P table ×××
except:
• Boxer attitude
• Heat rupture
• Thermal Fracture

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AM PM
• N.E Healing or sepsis ××
Leucocytic infiltration
• M.E ××
“Tissue reaction”
• Cause of death Burn Anything except burn
7- Characters of burn:
P.M.P 1 Soot in air passages

2 COHb in blood
3 Singed hair & comma shaped
4 Degree of burn + vesichels
V.V.IMP.
5 Spread from down to upwards
8- Causes of death: 3×3
1st six hours 6hs 2 days > 2 days
3C * Sepsis
1-* CVS or sympathetic 1-* Plasma Oligaenic shock 1- Inflammation &
neurogenic shock due to “hypovolemic degeneration of organs
fear of pain -evaporation shock”
- ____vesicle
- perfusion Edema of
into tissue glottis
when they are trying to
escape
2-* CNS Head injuries 2-* Fat embolism (pulmonary) 2- Supra-renal failure
a on 5th day
1
Hge
3-* Resp. Traumatic 3-* Histamine VD 3- Stress ulcer “curling ulcer”
asphyxia
a
falling or ppl
VR CO 12th day
step on chest
and abdomen
during escaping Toxaemic shock
or
2 Haematogenic shock
Choking due
to inhalation of
fumes or nitrous
gasses

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• “Curling ulcer” acute duodenal ulcer
Perforate in 12th day Death

with bile in
duodenum
a- Burn toxins “from not detoxified toxins of burns by liver”

Excreted
b- Bact. Toxins
c- Adrenaline with nervous vc BL. necrosis (due to

stress)
12th day
9- D/D: ( if you are asked give an acc. on scold or corrosives write these
columns only)
Burn III- Scold IV- Corrosive

1- Soot in air × ×
2- Hair Singed Wet Eaten
3- CO in blood
COHb × ×
(COHb)
May be 2nd degree ×× (never due to
4- Vesicles
around burnt area hygroscopic effect)
5- Cause Dry heat Moist heat Chemical subst.
6- Clothes Burnt Wet Eaten + discolored
1st, 3rd, 4th
1st + 2nd erythema
7- Classify (degree) 1st 6th no 2nd no
vesicles
vesicles degree
8- Charring ×
Below
9- Spread Channels é gravity é gravity
upward

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V.V.IMP.
10- Age of burn: MCQ
Start (when did the burn start)
Hestochemical reaction Sepsis

(Microscopically)
36 hours
Esterase enzymes 45 minutes
Amino peptidase 2 hours
3A Acid phosphatase 3 hours 2×3=6
Alkaline phosphatase 6 hours

& RNA & DNA + leucocytic infiltration
• END (Heals after)
Vesicles Red (erythema)
Heal Disappears
1 weak 2 days

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V- Electrocusion “Flash burns”

• Condition of electrocusion:
Acc. Hospital
Bathroom
Factories
Suc. Psychiatric problems
Hom: Child abuse
USA electric chair
• Factors affecting severity “6D”

or factors influencing the effect of electric shock:
1- AC or DC current AC is more dangerous cause more

3 related to
physical damage & has tetanoid effect

the current
2- Duration of contact
3- Degree AMPERE 60 AMP 100 AMP
for 1sec 1/5 sec (fatal)
Volt 22 vol. is not dangerous > is dangerous
4- Diseases cardiac, pl, ventricular fibrillation
related
to the host
death
5- Dry or wet skin wet skin resistance
severity
6- Dangerous areas of body heart, brain … etc.
3

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• C/P "3S" of Electric/Flash burn
1. Spasm Tetanoid spasm

Dark black from inside
2. Skin ulcers Joul's burn White from inside
SSS
Superficial ring of hypaeremia
At the inlet &
exit of current
3. Shock Blood vessels Rupture
Petichial Hge
4. Delayed effect or late effect MS. Contraction Spasm
Haemeplegi… aphasia Break down
(MS.)
Personality changes
(MS.)
(electrophopia) Paralysis of ocular ms.
(Blood)
Hge in inner ear and Skin Hge + ulcers
tympanic membrane
(Blood)
Hge + Congestion (MS.)
& edema Spasm Closure of
coronary angina
pectoris electrica
(Blood)
Petechial Hge + Cong
(MS.)
Acute renal failure
due to myoglobin
from breakdown of
muscles
(MS.)
Haemolysis Blood Bone Contraction of muscles
fracture

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• Cause of death from Electric / Flash burn:
CVS Resp. Brain Skin

Heart 1- Central asphyxia 1- Brain anoxia Burn
(Brain)
2- Peripheral
asphyxia Jule's burn
1- Ventricular
(Chest)
Fibrillation
Below level of Infection enters
2- Vagal shock
heart through the inlet
or exit
ttt by artificial
ttt by fibrillator +
ventilation +
cardiac stimulant
cardiac stimulant
Continue ttt until R.M or survival occurs

because of fear of apparent death
• P.M.P of flash burn / Electric:
1- Microscopic picture:
Skin Brain
Horny layer atrophy 1- Swelling
Softing of all neuron tissue
Corneum Honey comb Tearing
appearance + Hge
2- Ballooning of myelin sheath
Basal cell layer elongation

3- Petechial Hge Medulla
Spinal cord
2- Skin Coagulation necrosis

Joule burn
Body
R.M.H
3- Body Organs Generalized congestion
Well marked hypostasis
Viscera
Generalized congestion with dark fluidy blood
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4- Metalization
• Metal deposition on skin ( superficial layers& some hair follicles)
Iron Cu
M.P Brown M.P. Yellow
• Gives +ve reaction until onset of putrefaction
N.B:
Boehm → describe use of scanning electron Microscope to detect metallic particles
Radium
VI-
VI- Radiation: Cobalt
Radiation
Radiotherapy
A) Ionizing radiation: Radioactive chemicals
Nuclear
1) Skin 2) Eyes 3) Gonads 4) Blood

• Pigmentation Cataract ♂ Sterility
• Leukemia
(hyperkeratosis) mainly Impotence
• Cancer • Cancer
Atrophy ♀ Sterility
• Dermatitis ulcer
& burns Still birth
• Alpastic anemia
Abortion
• Loss Hair & Congenital
nail & finger anomalies
print

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A) Ionizing radiation:
C/P
5) Bone 6) Bone Marrow 7)
7 Acute radiation
syndrome (ARS)
• Leukemia “Whole body exposure”
Osteogenic sarcoma Aplastic anemia Nausea
Thrompocytopenia Vomiting Very
common
Agranulocytosis Diarrhea
Melena Rare
Dehydration
UVR
B) Non-ionizing
ionizing radiation: US
Acute Chronic & prolonged

1- UV • Skin sun burns • Pigmentation of skin
Aging of the skin
Cancer
• Eye temporary
blindness or dazzing
2- US & Laser • Pregnant ♀ specially in • Eye Corneal keratitis

3rd trimester affection Retinal damage
Light Amplification
mplification of the fetus Macular burns
by Stimulated
Emission of Radiation
adiation
N.B: Identification of burnt bodies

bodies:
1) Fragments of clothing
races of jewellery
2) Traces
3) Dental marks in the mouth
ray
4) X-ray Old deformity of bones
Compare with other old x-rays

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Asphyxia
1. Def.
2. Causes
3. Stages
4. PMP
• Def.:↓ O2 ( Hypoxia) ↑ CO2 ( Hypercapnia )
• Causes:
‫(د‬1) ‫( ض‬2)
(3)
Accident Pathology Poison
RP RM poliomyelitis RM Strychnine-oxalic
Anything interferes with RP Diphteria acid
respiration RC Pontine RP Gases, CO2, CO…
hemorrhage RC Morphine
4- Environmental” NO2 & ↓O2” e.g. High altitude

5- Iatrogenic Dr. (Mainly with anaesthesia)
115 Asphyxia
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Written
• Stages:
body CVS respiration

3C
Cyanosis & dyspnea Blue ↑ BP ↑ Rate & Depth
↑ Pulse ( Dyspnea )
Convulsions Blue ↑ AP (Arterial Pr.) ↑ AP (Alveolar pr.)

Tardieu spots Silvery spots
(Refer to book) (Refer to book)
Chyne stokes Blue ↓ BP

breathing ↓ Pulse
= irregular Breathing
Gasping Gaps of
Apnea
• PM.P: ‫زم‬

‫اآ‬
External signs of asphyxia: 4B (2 Blue & 2 Bulging)
- Blue body (face- lip- nail mm). ‫
رق ام‬CO2 ‫ن‬
- Blue hypostasis. ‫ آ اات‬
- Bulging eye (conjunctival edema & congestion).
- Bulging tongue (with blood froth).
Internal signs of asphyxia(2 Congestion & Blood & 2 spots)

- Congestion All organs
- Congestion lungs ‫ي هم‬
- Spots organ(Tardieu spots)
- Spots lung (Silvery spots)
- Blood: Dark blue fluid due to ↑ fibrinolysin ‫ "! ؟‬# $‫ د‬:‫س‬
Due to ↑CO2 damage of endothelium release of fibrinolysin ‫ )( و زا؟‬:‫س‬
Tardieu spots:
Petechiae due to:
-Simple mechanical obstruction of its venous return of blood from the parts ↑
capillary pressure to bursting point
-Suboxia ↑ capillary permeability escape of blood into tissue spaces
*+‫ زي ا‬-. "
116 Asphyxia
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Silvery spots: Subplueral air vesicles

-Are due to expiratory dyspnea ↑ intra_ alveolar pressure
rupture of unsupported alveoli
Violent asphyxia:
Neck ٍSuffocation Drowning
1-Throttling 1-Smothering
‫ي‬6Throat ‫ ال‬89
Mouth & Nose +F 8."‫آ‬
ONLY
2-Strangulation
‫ اي‬C9.. ?@A ‫> او اي‬: ";<= 2-Choking
">D‫ ر‬#". Air passages ‫ ال‬+D...‫ّق‬HI
‫ ?ا‬C
3-Hanging
">D‫ ر‬C "; E 3-Traumatic asphyxia
‫ ال‬K E 8? ).. @J‫" ! ا‬F
Chest or Abdomen
Resp. Movement ‫ ال‬8L<
Scheme for Neck & Suffocation:

uffocation:
1. Def.
2. Condition : accidental-suicidal-homicidal
3. Cause of death : CNSCA cerebral ischemia
CVS vagal shock
Closing of airways
4. PM.P : General: external & internal signs
Local:
1.
e.g.: -Throttling >DH‫ ا‬K E -‫ا‬J
-Smothering Mouth & Nose ‫ ال‬C A -‫ا‬J
-Strangulation or Hanging >DH‫ ا‬K E >A ME
2. !" (Bruises- Lacerations – Rupture- Congestion)
+ In Neck: 1-Phayrnx
2-Larynx Hge
3-Carotid Artery
4-Trachea NO Hge.
117 Asphyxia
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3.# H9"" K ‫ ا‬.OL‫ا‬
4. " Signs of Struggle & Resistance

Except -Hanging %96 ‫@ر‬:"F‫> ا‬F ‫ن‬
-Choking ‫ق وه @آ‬HI A‫وا‬
Overlying ‫*زم اآ '& ال‬

‫ ه‬+ &,overlying ‫** )(ال‬
smothering ‫ال‬
Throttling Smothering
1-Def. Neck/ Hands Mouth & Nose/ Hands
2-Conditions:
-Accidental Quarrels- Jokes- Sports Children- Overlying
-Suicidal Rare Cadaveric spasm Rare May be Cad. Spasm
-Homicidal Weak RLS‫ن ا‬9 ‫زم‬ Common : Old – Infants-

Narcotized
3-Causes of death:
- CNS
√ X No CA
- CVS
√ X No Vagus
- Closing of air
√ √
passages
4-PM.P:
General : External √ √
Internal √ √
Local:
1- -Semi lunar & linear nail -Hand & Nail abrasions
abrasions & bruises & Bruises
-Around the Neck -Around Mouth & Nose
May be Absent
MU ‫ة‬W. +F 8."‫ آ‬
2-# Fracture INWARD of X Nasal Septum
Hyoid bone & Teeth
‫ا !ا‬H C @ E T*‫ن ا‬
118 Asphyxia
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3-!" Neck muscles Facial muscles
4-" Signs of Struggle & Signs of Struggle &

Resistance Resistance
+ In Neck:
1-Phayrnx
2-Larynx Hge
3-Carotid Artery
4-Trachea NO Hge.
Burking‫زم اآ 'ه ال‬
Choking Traumatic
Asphyxia
-Occlusion of air ‫هم‬ -On resp. muscles(Chest)

1-Def.
passages/INSIDE Pressure on chest
preventing resp. movement
2-Condition:
1-Solid .: "A -X Y ‫رة‬Z 1-Crowd ً MU \:‫ ا‬$]
- Accidental:
2-LiquidBl. in cut throat 2-Collapse of building
3-GasesEdema of passage 3-Car accident
Mainly ‫ر‬,.‫"ء و‬.
4-Pathological e.g.
Diphteric Membrane
- Suicidal: -Rare X
- Homicidal: -Infanticide by gagging Burking : Sitting on chest

e.g. piece of cotton Was 1st done by guy called
(Rare) Burke therefore was called
by his name. Oral
3-Causes of death:
CNS: X No CA X
CVS:
√ X
Closing of air passages:
√ √√
+ Contraction of larynx
Death
119 Asphyxia
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4-PM.P: √ √
General : External √ √
Internal ‫ا‬,@ ‫هم‬
‫ا‬,@ ‫هم‬
Local: -Foreign body 1-Line of demarcation:

1- In air passages ‫
ام‬:‫ زي ا‬Compression ‫@ن ال‬9
... <YD – .: "A – X Y ‫رة‬Z _ ‫ ق‬-.!" `M=.. ‫
ول ام‬F -<
2-Cyanosis in upper part:
3-Petechial Hge in upper
part of body “Face, Neck
&Chest”
X -Sternum & ribs

2-#
X -Chest muscles
3-!"
X -If Burking (Homicidal)
4-" Mainly Accident No Signs of struggle &
signs of Struggle & resistance
Resistance
120 Asphyxia
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Strangulation Hanging
1-Def. Neck / Ligature Constriction of Neck by Body
K E +D K ‫ه ا‬ ...>:‫ا‬ weight using Ligature
">D‫ر‬ Types :
1-Typical ‫ ورا‬C ‫;ة‬L‫ا‬
2-Atypical (<!‫ ا‬C ‫ام او‬D C ‫;ة‬L‫ا‬
Or:
‫ اي‬H a ?@A ‫ اي‬1-Complete
?H ‫ ارض‬#. @
2-Incomplete
‫ ه‬..6 ‫آ>" او‬H ‫_ ارض‬
C9. ‫@ن‬.‫ آ‬Head Only‫"@ج وزن ال‬:
Air passages ‫ ال‬+; ‫ را‬F@ -?H
( Refer to book)
2-Condition:
- Accidental -Children -Children
-UC( umbilical cord) -Falling from scaffolding
psuedostrangulation
- Suicidal -Rare may be in Multiple Commonest

turns or tightened rope
- Homicidal Commonest -Postmortem suspension8

< RLS‫ن ا‬9 ‫ط‬HI _ -Narcotized A@J
3-Causes of death:
√ √
CNs
√ √
CVS
√ √
Closing of air passages
+ Cervical vertebrae
fracture in Judicial
Hanging
4-P.M.P.
General
-External signs √ √
-Internal signs √ √
121 Asphyxia
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‫ي هم‬
Local 1-Ligature marks: 1-Ligature marks:
1. a-Symmetrical around a- Deepest at part of
neck suspension & Tails &
b-Equal force all around disappears as it raise
c-Transverse b-Forces are not equal all
d-Below the larynx around
e-Complete c-Oblique
Except in: d-Above the larynx
1-Garothing: e-Incomplete
Victim attacked from ‫؟؟؟‬Complete
, -.: ‫ي هم‬$*
behind without warn Double /"‫ ا‬0. " ‫ا‬
‫ا ف
وا ورا‬
‫وا
ارض‬
2-Mugging
Holding neck of victim
in the bind of elbow
Forearm ‫ ورا ل‬
3-Palmer strangulation
(when the assailant
right hand was
horizontally placed
across the victim mouth
& then reinforced the
pr. By placing the left
hand on top at right
angle to the other)
‫ وه‬
2. 2-Fracture INWARD in 2-Fracture OUTWARD in

hyoid hyoid
3. 3-Neck Ms. + 3-Neck Ms.
4. " 4-Signs of struggle & 4-×××

resistance
**NB: 5-
-In putrified body Submandibular glands
look at bone !
"‫ ا‬# "‫ ا‬Dried saliva (dribbling) ّ#
$%& 78&9 .. 2# 345# /"‫ا‬
Salivation
122 Asphyxia
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-Throttling Fracture 6-

of thyroid cartilage Carotid artery (Transverse
tears)
#&‫< دم آ‬#.‫ آ‬78#‫ =ود اوي و‬
7-
Hypostasis in lower limb
Overlying: ‫ا‬,@ ‫هم‬

Def: Accidental smothering
Condition: - Prone Position in Infant.
-Breast feeding
-Building (fallen houses) 8LD‫@رة و‬.E
Causes: -Closing of resp. orifices.
PM.P: -Hypostasis in Ventral aspect of the body “Prone Position”
-Flattening of nose
‫ا‬,@ ‫هم‬
Ligature marks (V.Imp.)
Strangulation Hanging
Transverse & lower Oblique & higher
Symmetrical Not symmetrical deepest at site
of suspension & disappear on raise
Equal force Not equal force all around the neck
Complete Not complete
Below Larynx Above larynx
123 Asphyxia
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Drowning
1-Def.: Mouth & Nose under H2O (Most common cause of mechanical asphyxia)
2-Condition of death:
a- Accidental (Most common) No injuries ‫! وح‬#$ ‫ ن‬... &> !
Naked (epileptic & drunken person)
b- Suicidal (common) Not naked

Ties + stones
c- Homicidal (less common) infanticide

PM injuries
Another cause of death
3-Causes of death (CM)
1-Clossing of air passages
2-CNS (head injury - fatal)
4C 3-CVS (vagus) → cardiac arrest → reflex vagal inhibition
4-Contraction of larynx (laryngeospasm) (dry drowning)
M 5-Murder
Putrefaction
↓ ↑
↓Temp. ↑Temp
↓ Air ↑ Air↓↓
↓ Boot ↑ Boot
↓ Water ↑Water
Diagnosis:
PMP: N.B.: Q. Sure signs → don’t write possible
Q. external signs ext. Possible
Ext. Sure
1-Probable signs :
- External (chapter 3)
1-hypostasis stasis of blood in dependent areas
Head, neck, face
Pale (water dilutes the blood)
2-cooling → normal within 12 hrs., but here its faster (9 hrs.)
3-RM → goose skin (cutis anserine)
4-putrefaction → peeling of epidermis (gloves → hands &feet)
Finger prints remains on dermis
124 Asphyxia
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5-adiposcere
6-washer women skin
(.... skin) of hands & feet 24 hrs after submersion
2-Sure signs: a-external

b-internal
A-External:
-<-.E
(cadaveric spasm)
Hands firmly grasping weeds, sands, etc.
-<#
(froth)
- Site: around mouth & nose
- Formation: air + H2O + mucous + forcible respiration → froth
- D.D: drowning putrefaction (offensive, dark brown bloody & coarse bubbles)
drowning putrefaction
Size Fine particles coarse
color white Brownish, blackish
smell ××× offensive
Pressure on chest reappears ×××
B-Internal:
G=,
Air passages → P.T.D
1-air passages: -Froth <#

-Foreign bodies + Planktons Active Resp. .‫ و‬H I ‫ل‬J
-Congested mucosa
• Distance in Bronchioles
The more distance, the more sure that dead was due to drowning
• Differentiate: Pulmonary Edema
Pulmonary ‫ن‬-, -. ! ‫<؟‬# <# <K 0$* : ‫ى هم‬
‫>ن ؟؟؟‬L ! Edema
! O ‫>ن‬4"‫ ا‬H9 ‫ن‬-# FB ‫ ان ال‬# "‫ق ا‬$"‫ ا‬:‫ج‬
125 Asphyxia
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2-lungs: (emphysema aquosum)

a- Pale lung: H2O expells blood from pulmonary capillaries
b- Balooning of lung (emphysema aqueous): bulky voluminous with ribs
indentation on the over distended surface
c- Petichial hge (sub-pleural)
d- Bubbles or oozing froth on cut section
3-spleen: CC Contracted
Coregated capsule (wrinkled)
4-Stomach:
-
Salty muddy
/ #
-)
Foreign body
+ve limited value (can occur after death)
-ve drowning (rapid)
Dead at time of submersion
5-heart Tardieu spots (sub-pericardial hge)

Lt side of heart (more than rt.)
Hypovolemia diluted blood because it receives bl.

From lungs
Chemical
Tests
<#
G <#
Chloride Diluted
( Blood chloride imbalance)
6-skull:
Temporal bone hge due to barotrauma
Aspiration of fluid into eustichian tube
126 Asphyxia
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7-planktons (diatons):
- Def.: unicellular algae (microscopic*
- Found in: all (organs – blood – tissues) except spleen
- MLE:
1-sure sign of drowning
2-sure sign of drowning even after putrefaction → bones → plankton's
3-nature of water → site of drowning
Where the algae (planktons) came from
4-type of death (large) → prolonged submersion
127 Asphyxia
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Sexual offenses
Unnatural:
1. Buccal coitus:
Penis Mouth (child)

‫را‬ Child
Penis (Teeth Marks) Mouth (Semen)
2. Frotteauism
Friction
3. Feticulism
‫
ت اأة‬
4. Exhibitionism Exposure of Genitalia in front of others.
5. Sadism inflection of pain on the other partner to get sexual

gratification. It may be death.
6. Masochism The male obtain sexual enjoyment by receiving pain stimuli

from the female partner.
Man
7. Necrophilia Neaophagia.
Sexual intercourse with Dead Body
‫ رح‬
8. Transvertism Sexual perversion where male finds sexual pleasure on

weaning female clothes & vice versa.
9. Bestiality Human & Animal:

Male & Animal.
Female & Animal.
128 Sexual offenses

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10. Sodomy: Male Male (Male Homosexuality)

Female (Buggery) Ground for Divorce
Child
Sailors
• Causes: Prisoners
Psychological Disturbance or Endocrinal Disturbance.
• Examination:
A. Passive Sodomist ( Habitual):
o General: Feminine gate & speech & Clothes.
Knee-Elbow position (Done quickly & in front of
any one)
o Local: Anus:
Open Wide & Funnel shape
Skin Lost wrinkle & fissures
Most Imp. Sphincter Reflex Lost
Mucosa Wide & lost ruge “Smooth”
Semen in Anal canal A proof of Sodomy
B. Active Sodomist:
o Penis:
Elongated, Narrowing & kinking Due to Anal
changes of the 2nd Male
Fecal Matters
11. Tribadism (Lesbianism)
Female & Female (Female Homosexuality)

Nymphomania “Uncontrolled Sexual Desire”
Hate Men “Repulsion for Males”
Consent Not Punishable
129 Sexual offenses

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N.B. Sexual Asphyxia:

Definition:
o It is self-inflected, Sexual pleasures induced by Hypoxia.
o Naked or with Feminine clothes.
o In front of Mirror.
Using:
o Rope.
o Mirror.
o Feminine Cloths.
o It’s Accidental NOT Suicidal should tell the parents.
‫ا اف‬:
o Feminine Cloths.
o Masochism.
o Martidism.
Natural:
Natural:
I- Incest: Sexual intercourse between persons of forbidden degree of
relationship, e.g.: father é daughter
Consent of ♀ is not accepted.
II-
II- Rape:
1- Definition: Sexual intercourse with female without her consent.
V. IMP. 2- Conditions of consent of female: ( A P C D )
Below 7 yrs = Max punishment
A • Age >18
• Afraid Under fear Physical violence
Submission
Moral violence
P • Powerful physically
• Powerful mentally
C • Consciousness Narcosis Opium or Barbiturates
Alcohol
Anesthesia Exotic dreams therefore it’s always
recommended to have
3rd party
D • Deception (Fraud) Impersonate of husband during sleep
Misrepresentation of act as a method of ttt of
diseases as sterility
130 Sexual offenses

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+ ‫اوح‬
‫ ر ا‬
3- Examination of the victim:
Clinical examination Investigation
1- Consent 1- General violence: 1- Pregnancy
APCD
> 21 yrs ‫
وح‬ Assailant
1.Age 2- Venereal disease
2.Afraid Hair, a) C/P discharge
Tears
2- Conduct 1)Clothes blood,
3.P.P Lost button b) Culture
semen
4.P.M Gonorrhea
3- Condition 5.Consciousness Abrasions c) Serological
of attack 6. Deception 2)Body * Bruises
Bite marks 3- Semen
Disarrange- Clothes
3)Hair ×
ment Body
Skin + Hair
4)Nail × Vaginal swab
epithelium
(1w)
2- Local violence:
‫
وح‬ Assailant Semen
semen, remains
1) Vulva A, B, B in vagina
blood
2) Pubic Sever for 1w
××
hair matting
3) Hymen Rupture ×× Analysis
* 1- General violence 3 Preliminary
2- Body: A, B, B 1- UV (blue
Aging, Age factor, florescence)
Anatomical site, 2- Florescence
Another look test
• Face & around 3- Barbories test
mouth Deep Bruises
3 Confirmatory
• Neck, breast,
1- M/P
arm, leg
2- Acid
• Inner aspect of phosphatase E
thighs
3- Lactic
Age Factor
dehydrogenase
Adult Adult
Child
virgin married
3 Specific
1- General 1- Precipitation
violence × ×
test
*Deep
seated 2- Group test
2- Local 3- DNA typing
violence
hymen ××
*dispropor-
tion
131 Sexual offenses

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NMT11
4- Examination of Assailant:
Clinical examination Investigation
1- General Violence
From the
1- Consent APCD Wounds 1-Venereal Diseases
victem
1.Age >14yrs * C/P discharge
2.Afraid Tears Hair,
2- Conduct 1)Clothes
Lost button blood * Culture
3.P.P
3- Condition 4.P.M 2)Body A, B, B Gonorrhea.
of attack 5. Consciousness Vaginal
6.Deception * Serological.
epith
3)Penis A, B, B +
Vaginal
discharge
Impotence ♂
1- Definition: Erection
2- Is ask in:
‫ه‬ 1) Devorce
‫ه‬ 2) Defence (Rape)
‫ه‬ 3) Compensation
3- Causes:
a) Physical <14Yr
b) Pathological Inguinal
hernia
c) Psych erection after
anal message
Impotence ♀
1- Fragidity
2- Dysparonia
132 Sexual offenses

NMT11
NMT11
Virginity
1- Definition: No sex intercourse
2- Is asked in:
‫ه‬ Impotence
‫ه‬ Rape
‫ه‬ No Virginity (Laylet el dokhla)
3- Signs Of Virginity:
1. Breast Firm, small nipple , rosy areola
2. Labia Majora (next to it) Fourchette – intact
3. Labia Minora (next to it) Post. comissure intact

“pinkish”
4. Vagina (next to it) Hymen
5. Causes of rupture of hymen:
6. Types of hymen:
1- Semilunar (Cresentic)
2- Annular
3- Imperforate
4- Cribriform
5- Septal
6- Dental
7- Fimbriate
133 Sexual offenses

NMT11
NMT11
MLI:
1- Imperforate
2- Annular & dental “Elastic hymen” allow intercourse without any rupture
3- Dental & Fimbriate
D&F Ruptured (deflorated hymen)

1) Symmetrical 1) Irregular (Asymmetrical)
2) Folds 2) Tear
3) α Vaginal Wall 3) Reach the vaginal wall
4) Pink 4) White, Opaque
4- Recent Or Old Rupture
Recent Old
• Painful
• Tender
• Bleeding edges
• Swelling • Covered with scar which is opaque
• Membrane on transillumination.
134 Sexual offenses

NMT1
NMT11
Pregnancy
1) MLI:
1- Divorced (Alimony ‫)زدة ا

ن ا‬.
2- Inheritance (widow ‫)ار‬.
3- Capital of sentence for death (‫)ا‬.
If she is pregnant there they have to delay her sentence for death
until 2 years after delivery.
4- Rape.
5- Illegal pregnancy .
2) Probable signs of pregnancy:
Pigmented / Dark / Secretions
A. Breast Dark areola + colostrums

B. Abdomen Enlarged + linea nigra (striae graviderum)
stretch collagen fibers
C. Vulva Dark Vs
D. Vagina Dark Vs +secretions
E. Cervix secretion
135 Pregnancy
NMT1
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3) Sure signs of pregnancy:
Sure signs of
of pregnancy
Fetus Films Fertilization tests
1) Inspection Depends on:

‫ف‬ X-ray Sonar 1) HCG in urine
2) Palpation 2) +ve 2nd after
"#
3) Auscultation - delivery
$%‫إ‬ of fetal skeleton - abortion
Of fetal heart sound by the end of 5th m. - 1stmissing
120/min period
(Tic-Tac rhythm)
(In the 4th month and Twins Intra - Pregnancy
Not before that) uterine 3) HCG:
Death - vesicular mole
Pregnancy - chorio carcinoma
Fetal
Period of gestation malformation 4) Biological Fertilization
tests.
Presentation A) A.I.T (gravindex test)
Agglutination inhibition test
B) Friedman test (rabbit)
C) Ascheim index (rat)
D) Male frog test (frog)
136 Pregnancy
NMT1
NMT11
4) Period of gestation:
Living Dead
Fundal level
1st m. Size of small orange
2nd m. Size of large orange
3rd m. Symphysis pubis from mother from the Fetus
% ‫('ة‬ herself
(Umbilicus) uterus ‫*ل‬ chapter 1
+,- ./- 4th m. 6"
(Xiphoid) +2
Full term (Xiphoid./- 5th m. 7"
by 3 fingers)
6th m. 9"
+3
7th m. 10"
8th m. 12"
+4
9th m. 13"
Diagnosis of fetal sex

1) Sex chromatin test fetal epithelial cells in the amniotic fluid hazardous
2) Ultrasonography safe & reliable
*AHI* Artificial Human Insemination

Def: instillation of semen genital tract of female without sexual intercourse
Indication: Male impotence

vaginismus
Female Dysparunia
Hostile vaginal discharge
Types:
1) Homologous:
a) Semen of husband No legal problem.
b) Done in front of husband
2) Heterogonous or donor:
a) Semen of donor illegal child
b) Illegal by law
137 Pregnancy
NMT1
NMT11
Delivery
1) MLI:
1) Inheritance
2) Interchange
3) Infanticide V.V.IMP
.
2) Signs of recent delivery (living):
1) General exhaustion
2) Breast Dark areola + colostrums
3) Abdomen (Lax/ Flabby /redundant/ striae)

Uterus level:
*Above umbilicus 0
after delivery ‫ *ل‬0
*Between umbilicus & pubis 12‫ ا‬03 1‫وا‬ week ‫وان‬

*Pelvis ./- Ten days
*Size =Normal Six weeks
4) Tears:
Perineal
Fourchette (connects the two labia majora)
Hymen
Exception some times occurs in female with elastic hymen doesn't

Rupture in the 1st intercourse but rupture at delivery
5) Vagina: "Lochial discharge"
- Sanguineous (Red bloody) 1st 5 days
- Sero sanguineous (Yellowish red) 5 days
- Serous (Yellowish) 5 days
- Disappears after 15 days
6) Cervix: ( external cervical os)
2 fingers immediately after delivery

1 finger 1 week after delivery
XXX 2 weeks after delivery
7) HCG positive
138 Pregnancy
NMT1
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3) Signs of old delivery in living:

1) Breast Dark areola
2) Abdomen Feebly
Striae
3) Vulva Old scars
4) Vagina Lax
Smooth wall
5) Cervix Old scars

Transverse slit
4) In dead The same + uterine examination

V.V.IMP
.
Difference
♦ Diff Nulliparous::
erence bet. Parous & Nulliparous
Item Nulliparous Parous
Uterus
• Length 2" 3"
• Body / cervix 1 >2
• Cavity globular
• Mucosa rugae smooth (+raised blood
tinged area at the
placenta site)
• Wall thick thin
Cervix - Opening "round& - Transverse slit
small"
- No lacerations - Lacerated with no
mucosa "arbor vitae" mucosa "arbor
vitae"
Oral
N.B:
In nulliparous:
Cervix Mucosa Arbor vitae
(Similar to arborization that occur in putrefaction)
139 Pregnancy
NMT1
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5) Diagnosis
Dead Living
1- 5# .‫ اول إ آ‬.78‫;زم أ‬
*Signs of pregnancy later
2-.<% ‫ إ‬.78‫;زم أ‬
‫هم‬
General Local Drugs
1) Bruises in abdomen 1) Bruises in genital organ - By laboratory analysis
"Vulva, vagina..." Blood
2) Infection, sepsis & yellowish urine
Discharge stool
‫ ا? اه وآن‬drug‫
ن ا
'ف ال‬-
pregnancy test ‫
ن ال‬-
Bacteriological cause of abortion‫
ن ا
'ف ال‬-
But in dead:
Cause of death ‫;زم أل ال‬
140 Pregnancy
NMT1
NMT11
Abortion
1) MLI:
Female Male
1) Quarrel <A 03 A'@ -‫ر‬B @ 1) License ‫او‬D 2‫ ر‬E/%‫ا‬
(/2 $3'-) E<‫ا‬
2) Doctor ‫@ اآر‬ 2) Discover 0B ‫ إ‬0, A 1‫أآ‬
(/2 $3'-) <% .‫وآ‬
3) Concealing E< ‫زه‬B‫ و‬5/‫' ا‬F- 3) Doctor "collogues"
1FA # .7G ‫ دآر ز
ن‬EH
(‫)@ه‬ 4) No death certificate
'B 0+ .... # 3
2)Types:
1) Spontaneous mother CHD ‫ ا'اض‬5‫ 'ط آ‬K
‫ء ور‬ CRF
Fetal Disease B# ‫أى‬
Placental Separation
2) Therapeutic "Legal" A /% ‫ان‬ to save mothers life

• Mother T.B, CHD, Mania, CRF, Rubella
• Fetal Intrauterine fetal death
• Pregnancy Bleeding, eclapsia, hyperansine graviderum disease $B'A
Diseases
Mechanism of action:
1) Metals ovum death
2) Purgative Reflexelly
3C + J (contraction to stomach + reflex contraction to uterus)
3) PG. Ecbolic direct stimulation to uterine muscles
Plumbism
Plants uterine contraction
Pituitary
‫ي هم‬ How does Pb cause abortion?
1) ovum death
2) ecbolic
141 Pregnancy
NMT1
NMT11
3) Criminal "Illegal" 'B any thing but not save mother's life
‫هم ا ا ا‬
Methods cause of death
Therapeutic Criminal
1) Capsules "Vaginal" eg: General Local Drugs
Prostaglandins Violence Violence
Contraction ‫ اا أو اآر‬،‫ت‬,‫ا‬ • Professional 3Ps:
-Exercise ‫(اآر‬similar to • Prostaglandins
2) Curettage operation -Weight therapeutic ecbolic direct
(D&C) 8 ‫ت‬B# 5- method) ./‫آ‬ action &
(Dilatation & Curettage) -Height ‫أو‬ contraction
./‫آ‬ ‫ ع‬-‫ إر‬P O- • Mid wife / - Pituitary
-Blow Nonprofessional extraction
3) Catheter & aspiration <A 03 "‫آ‬A ‫ دا‬،‫ت‬,‫ا‬ - Plants
Ovum ‫ ال‬O - • Only in Solid ‫أ
اد‬ - Plumbum
predisposed F'- ‫'ة‬A‫أو إ‬ • Purgative
Late period of pregnancy: females (its Knitting needle (Reflex) 3c+J
1) Abdominal effective) Perforation to - Colocynth
hysterectomy ‫ أى‬O,- ‫ت دى‬B/‫ ا‬:‫س‬ amniotic mem. - Castor oil
Baby ‫ا ال‬+ <‫ و‬P<7‫ا ا‬/ ‫؟‬.% Rupture 5+A - Croton oil
O3 P@'+‫ا‬..:‫ج‬ Liquid - Jalap
B# ‫ أى‬P ‫ط‬, Antiseptic solution • Metals
e.g.: (Poisons)
‫ي هم‬ Iodine , glycerin - Lead
K 2/ ‫ى
ن‬FA - Mercury
sepsis - Arsenic
Plugs < ، - Antimony
: </A‫و‬
- Arsenic
- Mercury
(Irritation &
contraction)
Cause of death:
Wounds ‫' ال‬A P
(Stab, cut throat, abortion)
1) Shock
2) Sepsis
3) Hemorrhage
4) Embolism
5) Poisoning "From drugs"
6) Hepato_renal Failure Aloes
ONLY
Senna
142 Pregnancy
NMT1
NMT11
1) Shock: Sympathetic shock due to perforation of uterus "severe pain"
Parasympathetic shock Blow in vaginal area
2) Hemorrhage: Primary ;
ً # ‫ت‬- IU. Hge. Retained fetal content
EU. Hge. Dye to perforation of uterus
Secondary Y
ً G ‫ع‬7%‫ إ‬+A 'Z due to sepsis
3) Sepsis: Instrumental causes
Non_instrumental Y
ً G + K @‫او‬
4) Embolism: Air embolism in injection
Fluid embolism
‫ى هم‬
May be Fat embolism

0‫[<ء ده‬A \# A‫ ر‬5 <‫ ن ا‬Baby‫ ال‬P
143 Pregnancy
NMT1
NMT11
Infanticide
1) Definition: Murder of Newly born (1st 2 weeks) Viable
iable (>7ms. IU)
Live birth
Report "6 items"
‫
ي‬ 1) Identification (as before)
2) Maturity (9ms = full term
term)
3) Live & still birth ‫
زل
و‬
4) Age? How long he lived? ‫`
ش إ‬
5) Causes of death
6) P.M interval (as before) "chapter 2" Written
aturity:
2) Signs of ‘aturity:
‫ دوا‬3 ‫ ا ال‬2 ‫ ا ال‬2 ‫ أوزان‬2
Osific Knee + cuboid Hair 50 cm Wt. of
center fetus
= 3.5kg
Testes scrotum Nail ‫!ا‬ 50 cm Wt. of
If male ‫ل‬ placenta
Umbilical cord = 600 gm
Circumference 13
P.F closed
A.F opened
3) Live Or Still birth:
External Internal
1) Umbilical
mbilical cord 12
12 L I V
2) A.M wound
Lactate nspiration
Inspiration Vascular
kin
3) Skin Maceration "
Desquamation #
$
Start after 2 ds. Stop after 2 wks.

4) Stool (yellowish)
conium %&‫) أ‬
(D.D Meconium
144 Infanticide
NMT1
NMT11
Hyperemia * Vascular:
Ulceration
Umbilical cord Fall "raw area" d m Obliterate
a) Umbilical vessels 2 1 2 1
d d w w Ligamentum
1 2 1 2 w teres
Form "healed wound"
)‫*ا و‬
Normal ‫زي ال‬ Organization starts & end 2 wks.
V ‫ ال‬/ C ‫ال‬ b) Foramen ovale 1 wk.

Umbilical Cord & Umbilical (Between 2 atrium)
Vessels c) Ductus arteriosus 1 m.
So, (Pulmonary & aorta ‫ ال‬,*) (anatomical)
21 ‫ ال‬12 ‫ال‬ After 6 hrs.
functional ligamentum
closure arteriosus
Inspiration

Non Resp. Resp.

1) N.E of lung
aFull the chest cavity

• Chest cavity -X & completely covered the
heart
-Mottled/Mosaic-./
• Color -Pinkish ‫ن )
هاء‬5.. 0‫زي ا"ز‬
-Crepitations O2
)
• Consistency -Firm No O2
-Rounded edge
• Contour -Sharp
)‫ آ و‬78%* ‫ن ا)اء‬9
(edge)
• Compress
under water -X -Bubbling
145 Infanticide
NMT1
NMT11
2) M.P of lung
Columnar epith.
Squamous epith.
Salivary gl. ‫زي ال‬

)..* ‫ن ا)اء‬5
Collapsed alveoli
Distended alveoli
3) Test: “Fourty 40”

a) Static "Fodere's test": Wt. of respired lung doubles that of non.respired
lung due to blood
Spasm Ductus arteriosum ‫ ال‬:;*‫ و‬Spasm $<* =: &
*
"
40×2 ‫ي ه
م‬:
40 gm (non.respired) & 80 gm (respired)
b) Hydrostatic flow:
- Principles: Air specific gravity floatation in water
- Procedure: Lung cut into small pieces squeeze these pieces if floated
- Results:
1) All parts sink Non respiration
2) All floated but some pieces sink Partial floatation
(Consider dead because this air causes partial flow is due to blow of
doctor in the child's mouth)
3) All lung parts float full respiration
146 Infanticide
NMT1
NMT11
- Objections = false results:

1) Non respired lung: float due to putrefaction or artificial
Respiration
Putrefactive gas C.D
) .8E
78%‫ ا‬G/H* C.
" /.‫ ا)اء ا‬,F
2) Respired lung
lung: sink due to disease
Hydrostatic test not used in: ‫ااااا‬I ‫ي ه
م‬:
1. Maceration
2. Milk in stomach
ultiple congenital anomalies
3. Multiple
4. Mother can'tt live without mother "5 Or 6 months"
c) Stomach: Bowel test:

- Principles:: Air swallowed on respiration
!‫ )@ ؟‬A As 97% not swallow air No
o mouth breath
4) Age? How long he lived?
External Internal
a aa L I V
a S S X X aa aa
147 Infanticide
NMT1
NMT11
Causes of death:
1) Accidental:
• Heading precipitant labor
‫رض وه‬9‫)
ا‬L C; /‫ وا<ض آ‬8 :.‫ا‬
Difficult labor M
‫ د‬7/OD‫ل إ‬P
" ‫ا‬I -<D‫ وإ‬/‫ آ‬:.‫ا‬
• Asphyxia Acc. Strangulation “by U.C”
Suffocation "by muocus"
• Birth injuries
• Blood group & RH incompatibility
• Congenital syphilis
• Diseases of unknown etiology
• Infections
• Congenital anomalies
2) Act of emission: Clothes (Neglecting clothes)

‫إه"
ل‬ Colostrum (Neglecting feeding) EQ* A
Cord (not tied) ‫ي‬H‫ ا‬/<‫ ا‬C.;Q* A
‫
ي‬ ‫ إ ؟؟‬, ‫ "ت‬:‫س‬
‫هم‬ Hge A Infection , ‫ "ت‬:‫ج‬
Except: in partial nasal obstruction =‫= آ‬:LQ ‫ *ف‬A
Umbilical cord vessels :;‫ ه‬A
N.B: Not hge as the umbilical vessels reflexly contract on respiration
3) Act of commission: ‫ ووان‬WL

Smothering, throttling, strangulation, drowning, chocking, cut throat,
Head injuries, burning, electrocution & poisoning
N.B:
When is the test for live birth not necessary?
1) Macerated fetus
2) Monster baby (babies with multiple anomalies)
148 Infanticide
NMT1
NMT11
Child abuse
(Battered baby syndrome/ Caffey syndrome)
1) Definition.
2) Variants.
3) Types of injuries.
4) Radiological Evidences.
5) Recognition (Diagnosis) ‫إزاى‬.
6) DD.
7) Role of forensic pathologist.
1) Definition:
Definition (By parents) ‫أو أى‬
Non_accidental physical,emotional or sexual injury inflicted on children by
persons caring for them with males > females ‫دا"!ً اب وام ا آ‬
2) Variants:
a) Non_accidental
• Physical abuse ‫ق‬%&"‫"&*ب و"&)(' و‬
• Emotional abuse ‫ أو إه&!م‬+" ‫' أى ر‬-
• Sexual abuse
3) Types of injuries: (2) Rupture of

1) Bruises Abd. Organs
2B 2) Burns
3) Hge (retinal) / 0‫آ‬

2H 4) Hge (Subdural) 1‫( أو د‬1) causes of death
5) Fracture
2F 6) Fremulum of lips torn + (2 +-34‫ا‬
1) Bruises: - Site Face (cheeks) ‫زم‬5

Trunk
Upper hand 6!
Upper leg
- Character Multiple
Different color
(Donates different times +-)&7 ‫ت‬9‫)*ب أو‬
149 Child abuse

NMT1
NMT11
2) Burns: - Cigarette "spared areas"

(Involuntary Flexion of knee & hips
- Scalds when lowered in hot water)
4) Radiological: - Fracture: - Extremities

- Clavicle (Torsion & traction) "‫&)ى ا‬...!=‫>ا دا‬4 ?4‫ا‬
- Ribs Lat. & post. Compression -)A‫> و‬BC ?‫آ‬
- Skull "Most frequent" (Cause of death)
- Extremities:
1) Epiphyseal Metaphyseal cornea ‫ة زى ال‬FG +&
Buckets handle ‫ زى ال‬x-ray ‫ آ>ة إ?ت &>ن‬+&
Indicate Abuse ‫)ي‬4‫ وا‬3)4 +J&B
2) Diaphyseal (May be accidental) "abuse ‫"
ط ن‬
5) Recognition:
Recognition: “Diagnosis”:
Children Parents
1) Character - Illegal K 1 6‫ا‬ - Mentally
- Unwanted +%%N4‫ ا‬+&4‫ إن دى ا‬+-"K ‫س‬B
LFK ‫ أو‬2 +J&B ‫ب‬1 1 - Financial troubles
‫ام‬ (Money) +"‫ د‬L‫آ‬3
- Abnormalities 2M
ً)2 M)7&
- 1-3 yrs. ‫ًا‬C FG
2) Evidence 2D 2D
a) Diff. inj.+ Hospitality a) Delay in seeking ttt
b) Deprivation ‫ وه !ت‬L4‫>ا ا‬J
0>)4‫ ا‬6 +C L‫ آ‬6 ‫ن‬%4‫ا‬ b) Discrepancy
2> L-(4‫ وا‬+C L‫ وآ‬L‫واآ‬ "Dis-explanation"
ً"‫ د‬6?"‫ آ‬6".. 6- )K R)1?- ‫&ى‬،، ‫م‬4‫ ا‬P9/
‫وق دى‬%4‫وح أو ا‬J4‫ ا‬4T? !4
‫ إ"؟؟‬6
150 Child abuse

NMT1
NMT11
6) Role of forensic pathologist:
1) scene 2) Dissection 3) Histological 4) Laboratory

‫ ا ن‬ ‫ ا‬
- History J4 ‫ ا‬6 - Bruises - Toxicological
1) External: Healing ‫ا‬3" ‫ن‬3 examination
Child parent ‫ آم "م‬42
Features Clothes
Medical Wound Electrolyte
+ "TEN SAD" Imbalance
Social ‫ة‬V ‫ة‬V‫أ‬ 2) Internal especially
‫ ؟‬5‫و‬ Wound Vitrous humour
* Osteogenic 3) X-ray
imperfection in 4) Dactylography
children or
hemophilia
* Psychiatry ttt for
adult
- House
- Health of child
- P.M changes
7) DD:
1) SIDS "Sudden Infant Death Syndrome"

2) Shaken Baby Syndrome "Sub type of child abuse"
IMP ‫ &&ج‬J‫ &وح و‬1‫را ن د‬4 XC)‫ام و‬24 ‫ وح‬L*- 1‫ د‬L-(4‫ ا‬M/ ‫ء‬/Z‫أ‬
MCQ
• Cause of death:
1) Subdural Hge
2) Subarachnoid Hge
3) Retinal Hge
• Due to:
1) Whiplash action: of the child heavy head over weak neck
2) Immature partially membranous skull
3) Soft immature brain
4) Relatively large subarachnoid space
N.B: Not brain injury ‫غ‬4‫ ) ا‬+(>A ‫زم‬5

Vein injury L! 64 brain injury ')!& ‫ دى‬+C4‫ا‬
151 Child abuse

NMT1
NMT11
Medical Ethics
Physician -patient Physician- Physician-society
physician
1) Consent: 1) Should not 1) Registration:
(Except in case of creticise syndicate of medical
emergency) 0‫ ز‬12!3 4 practice
- Informative 2) Should not refuse ‫او‬6 *7) 8# 0,‫ج ا‬:;‫ ا‬$* ‫زم‬
‫زم ا ف‬ 3) % of fees for !‫ا‬
- Invalid referral to other 2) Erasion: <=
colleague is a Refraining
e.g.: misconduct ( Discontinuity
- Mentally ‫ن‬ Dichotomy) Conviction
- Mind <21 yrs 3) XX Commission > ?@;
- Malprocedure 2C $%A;*‫ أو دآ;ر و‬$
‫ت‬ B)
(Abortion) Commercial jobs
- Misrepresentation .....‫ل‬7* ، 8B‫آ‬3 ‫اق‬,
Or Fraud False data G ‫ت‬2H ‫أل‬
3F
2) Medical certificate: False report ‫م‬I‫أآ;< آ‬
‫!دة‬ G
- No fees ‫س‬# $%‫ع أ‬ Fraudulent method
- No false data (% ‫*)ت‬ ‫ذة‬.‫ وا‬K2$* ‫دع‬:‫ج ا‬I‫ا‬
- Finger prints Advertise in press
- Photo Age 4) Malpractice:
estimation ‫هم ا ى‬..
‫اء ا‬
recent (physical damage
3) Professional
secrecy: Incompetence Negligence
!‫ار ا‬,‫أ‬ ‫ه‬2 !
Disclosure/ Disvulge
‫ار‬,‫ أ‬-.‫آ‬ e.g.: - Transfusion of ICBT
However professional G ‫ دم‬K7)
secrecy is disclosed in - Transmission of
the following condition: disease(syringes)
Court
Nerve paralysis
I
ً N O 7* 0;$
-Toxic dose of drug
- Thermal injuries
(Over dose LASER)
- Towel ‫ ا‬P=* 8# #
152 Medical ethics

NMT1
NMT11
Written &
oral v.imp.
Court
1) Malpractice if he is a caused for Q)‫ أ‬1!3‫آ;ر أ‬$‫ا‬

2) Medical expert witness give court all information revealed on
examination of the person ‫ة‬% ‫ ذو‬$‫ه‬.‫ آ‬R‫ ا‬8# S
3) For patient QB@) ‫ ان‬% ‫ن‬. Mentally & Minor.
4) Medical certificate ‫ < !دة‬T* ‫ن ان‬.
5) Community Crimes "Illegal abortion"
‫ اس‬% ‫ن‬.
Communicable diseases
153 Medical ethics

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NMT11

Bones 1.Age 4. Animal or human?

⇒ (NAS) 2.Sex 5.Stature

3.Negroid or not 6. No of persons?

Q1: Animal or Human Bone ?

Anatomical features Precipitation test

Antiglobulin inhibition test

Q2: Number of persons >>>>>3

3 3. Rt Male & left Female

& Diff.age and sex

Diff. Age of bones

1. Traumatic Skull Head injury

Bullet Flat bones only

Hyoid bone Asphyxia

Direct by hand NOT by hands

3. Poisoning Metallic poisoning

Hair, nail, teeth & bone

Q3: Death (MCQ + Practical)

Why? When? (P.M. Interval)

1. Soft tissue Six month

3. >1 year only bone

It may also depend on place of burial Preservation

Q4: Deformity (MCQ + Practical)

Acquired Malunion of fracture

Occupational Shoe Maker Depressed sternum

Q5: Stature (Written) >>>>>>>> Karl Pearson's Formula

Q6: Negroid or not ? Or Identification of race from

1. Metopic suture 1. Depressed nasal

Anatomical neck Surgicl neck

Epiphyseal lines UL, L.L., Clavicle

2. Trochlea+ capitulum +shaft

3. ‫ آــــ‬see in your palm

4. Watch & bag 20 yrs.

mental foramen Mental foramen Mental foramen

3. Skull discussed before

Same (-2yrs) in growth

1) Personal 2) Bite marks 3) Poisoning

3- Bone ORAL 1- long bones In

2- Flat bones order

3 – Skull 95% accurate from

4- Sternum 70% accurate up to

5- Pelvis 98% accurate “most accurate " down

ORAL: always choose according to the seq. of most accurate

- body < 2 × manubrium ♀

In female wide & broader

*Pelvis Rem. Delivery

5 – Firearm singed at inlet.

Type of wound from Hair :-

Cut wound hair Sharply cut

Contused wound Hair brushed tip

1 - Hair or Fibre 4 – Site of hair .

1 – Cotton Curved & twisted ribbons

2 – Silk Shiny + No segments

3 – Linen Segments or Swellings " similar to animal hair "

" Bamboo-like " .

1 – Cuticle 1 layer of cells > 1 layer

3 – Medulla Man only

C- Hair tip & Root :-

Bulky healthy root + Flattened atrophied root

Tip of hair Date of cutting

Type of Instrument (Type of Wound)

Sharply cut Crushed

Certain person or Not :-

Anatomical neck Surgicl neck

3. ‫ آــــ‬see in your palm

Davidson body called ‫دم‬ Barr body called

1- Suspended animation: ( ‫)إ