Professional Documents
Culture Documents
General Considerations:
I. Definition:
Legal Medicine is a branch of Medicine, which deals with the application of
medical knowledge to the purposes of law and in the administration of justice.
It is the application of basic clinical and paramedical sciences to elucidate legal
matters.
Legal Medicine, Forensic Medicine and Medical Jurisprudence are all
synonymous with each other and in common practice, are used interchangeably.in
ordinary parlance. Schools of Medicine, hospitals and government entities adopt
either name, representing one of its departments or divisions in its organizational
setup.
However there are subtle differences as pointed out by Dr. Pedro Solis, the
author of our official textbook:
Strictly speaking, Legal Medicine is primarily the application of medicine to
legal cases while Forensic Medicine concerns with the application of medical
knowledge to elucidate legal problems.
William J. Curran, a prominent Harvard professor of legal medicine, defines
legal medicine as encompassing those specialty areas of medicine concerned with
relations to substantive law and legal institutions. Forensic medicine, on the other
hand, deals with investigation , preparation, preservation and presentation of evidence
and medical opinion in courts and other legal, correctional and other law-enforcement
settings.
Then again, according to Dr. Henry C. Lee, an eminent U.S. forensic expert,
forensic medicine has a broader definition than legal medicine. It encompasses a
variety of fields in forensic science such as, pathology, anthropology, odontology,
toxicology, entomology, et al. Its application is limited not only to legal issues but
also covers historical, environmental and social political issues. This may be further
elucidated by stating that Legal Medicine refers to substantive law defining the
relationship between and among hospitals, doctors, patients, whereas Forensic
Medicine deals with activities or acts punishable under our local laws.
Medical Jurisprudence denotes the knowledge of law in relation to the
practice of medicine. It concerns with the study of the rights, duties and obligations of
a medical practitioner with particular reference to those arising from a doctor-patient
relationship.
According to Sec. 5 Rule 138, one of the requirements to be admitted to
the Bar examination is Medical Jurisprudence as a subject in the law course. Actually,
Medical Jurisprudence is more properly referring to the course taken in the College of
Medicine but fit purposes of the College of Law it should be the study of legal
medicine.
The expertise needed in Forensic Medicine encompasses practically every branch
of Medicine. It is a subspecialty of a medical specialty. So that before a doctor can go
into the field of Legal Psychiatry, he must first specialize in Psychiatry; before he can
go into Forensic Gynecology, he must have first been trained in basic Gynecology,
and the same is true for the other fields of medicine.
Any branch science so long as it is involved with the collection, preservation and
presentation of evidence to be presented in a legal forum is covered by the practice of
Forensic Medicine. So that now we have experts in different areas of forensic science
such as serology, chemistry, toxicology. etc.
I.
E.g. The knowledge of the nature of the extent and nature of wounds as
applied in surgery would involve not only knowledge of medical science but also
physics, physiology, pharmacology, etc.
Formula: Physics of Wound Production:
Wound = Kinetic Energy x Time x Area x other factors
Kinetic Energy= MV2 M=Mass V= Velocity
2
Kinetic Energy:
Kinetic energy is based on mass and velocity factors and that velocity is squared,
the velocity component is the important factor. This explains why an M-16 bullet which has a
velocity of 3,200 ft/sec will do more damage than a .38 caliber bullet which is heavier but has a
much slower velocity.
Time:
The shorter the period of time needed for the transfer of energy, the greater the likelihood
of producing damage. If a person is hit on the body and the body moves towards the direction of
the force applied, the injury is less as when the body is stationary. The longer the time contact
between the object and instrument causing the injury, the greater will be the dissipation of
energy.
Area of Transfer:
The larger the area of contact between the force applied on the body, the lesser is the
damage to the body. By applying an equal force, the damage caused by stabbing is greater
compared to a blunt instrument.
Other Factors:
The less elastic and plastic the tissue, the greater the likelihood that a laceration will
result. Elasticity and plasticity refer to the ability of tissue to return to its normal size and
shape after being deformed by a pressure.
The movement of the parts of the body as a result of the force being applied to them and
the local stretching of tissue during acceleration had deceleration cause most of the internal
injuries seen in traumatized individuals.
A force transmitted through a tissue containing fluid will force the fluid away from the
area of a contact in all directions equally, frequently causing the tissue to lacerate (Legal
Medicine Annual 1980, Cyril Wecht ed., p. 36).
IV.
Common also among the public is the belief that one has to be a pathologist to be
involved in this line of work. Again, this is not true because victims can be both living or dead.
When victims survive the trauma and are admitted to hospitals, they are referred to practitioners
in Forensic Medicine. But when they eventually die or is dead at the onset, autopsy must be doen
to document officially the cause of death and this is now in the realm of the Forensic Pathologist.
A physician who specializes or is involved primarily with medico-legal duties is known
as a Medical Jurist (also called Medical Examiner, Medico-legal Officer, Medico-legal
Expert).
[e.g. Dr V.V. Villasenor (PNP Crime Laboratory), Dr. Ronaldo Bandonill (NBI)]
On the other hand, Atty. Molly Cr. Abiog, M.D. is only a doctor and a lawyer, but
not a Medico-legal Officer.
Medicolegal practitioners can either be in the service of the government or in private
practice. In government , they are connected with law enforcement agencies such as thw police
departments or with legitimate investigative bodies such as those with the PNP Crime
Laboratory or with the Medicolegal division of the National Bureau of Investigation.
They may also be physicians employed by the government either as Municipal or
Provincial Health Officers as they are mandated by law to perform autopsies on medicolegal
cases.
As private practitioners, they are consultants in private hospitals to whom are referred
medicolegal patients. They become part of the Hospital Team that monitors the patients
condition while confined at the Hospital. When the patients case goes to court, the medicolegal
practitioner is called to testify on the fact of the injury, the treatment the patient received in the
Hospital, his expert opinion as to the cause of the patienty
Vl. Who are authorized by law to perform autopsies?
Sec. 95, P.D. 856, Code of Sanitation:
1. Health Officers
2. Medical Officers of Law enforcement agencies
3. Members of the Medical Staff of Accredited hospitals
4. Code of Medical Ethics of the Medical Profession of the Philippines. Sec. 2.
Art. III states:
However, it is the duty of every physician, when called upon by the
judicial authorities, to assist in the administration of justice on matters which are
medico-legal in character.
VII. Distinction between an ordinary physician and a medical jurist:
Ordinary Physician
1.
Medical Jurist
Point of view of treatment from the point of
view of CAUSE
3.
proofs
act.
Medical jurists must record all bodily injuries
even if they because these injuries may be
4.
5.
Cases of child abuse, domestic violence, rape, alcoholism and drug addiction;
6.
7.
4.
5.
6.
7.
X.
XI.
Remedial Law
1. Rules on evidence
2. Proceedings for hospitalization
3. Physical/mental examination of a person
XII.
DNA Analysis
Forensic Anthropology
Forensic Archaeology
Forensic Pathology
Forensic Odontology
Questioned Document analysis
Forensic Psychiatry and Psychology
Blood Splatter Analysis
LECTURE 2:
MEDICAL EVIDENCE:
A good lawyer wants you to find out the TRUTH, and he/she wants to
know ahead of time so he/she is not caught by surprise later on.
If an experts opinion opinion is contrary to what the lawyer expects to
prove his case, all is not lost. He might want to settle rather than go to
trial.
2.
3.
4.
5.
6.
Methods:
1. The answer to the question may be yes or no.
2. The answer of the subject is to be recorded.
3. When the subject is asked questions with reference to his name, address, civil
status, nationality, etc. that has no relation with the subject-matter of the
investigation, the tendency is to answer quickly.
4. When the question bear some words which have to do with the criminal act
the subject allegedly committed, like knife, gun or hammer which is used in
the killing, the tendency is to delay the answer.
5. The test is not concerned with the answer, be it a yes or a no. the
important factor is the time of response in relation to stimulus or non-stimulus
words.
6. The subject cannot be compelled to be subject to the test without his consent.
C. Use of the Psychological Stress Evaluator (PSE)
When a person speaks, there are audible voice frequencies, and superimposed on
these are the inaudible frequency modulations, which are products of minute oscillation
of the muscles of the voice mechanism. Such oscillation of the muscles or microtremor
occurs at the rate of 8 to14 cycles per second and controlled by the nervous system.
When a person is lying, the microtremor in the voice utterance is moderately or
completely suppressed. The degree of suppression varies inversely to the degree of
psychological stress in the speaker.
PSE detects, measures and graphically displays the voice modulation that we
cannot bear.
II. USE OF DRUGS THAT INHIBIT THE INHIBITOR
A. Use of Truth Serum,-misnomer
The procedure does not make someone tell the truth and the thing
administered is not a serum but is actually a drug.
-Hyoscine hydrobromide-by injection
-Repeated doses state of delirium
-Is needed questioning begins
-Patient feels the compulsion to tell the truth, forgets his alibi.
-Drug depressant of CNS- (cortex, diencephalons)
-Admissibility as evidence
B. Narcoanalysis or Narcosynthesis:
-Use of Sodium amytal/ Sodium penthotal
-Drug causes the depression of the inhibitory mechanism of the brain and the
subject talks freely.
C. Alcohol Intoxication: In Vino Veritas
-The ability of alcohol to reveal the real person behind the mask which all of us
are said to wear (mask of sanity) is reflected in the age-old masim.
Methods:
1. The person whose statement is to be taken is allowed to take alcoholic
beverages to almost intoxication. At this point the power to control diminishes
and the investigator starts pounding questions and recording answers
2. The questioning must start during the executor state when the subject has the
sensation of his ell-being and when his action, speech and emotion are less
strained due to the lowering of the inhibition normally exercised by the higher
brain centers. When the subject is already in depressive state, he will no
longer be able to answer any question.
3. Confessions made by the subject while under the influence of alcohol may be
admissible if he is physically capable to recollect the facts that he uttered after
the effects pf alcohol have disappeared.
Legal Medicine page 11
4. Subject may not recall everything that he has mentioned or he may refuse to
admit the truth of the statement given.
III. HYPNOSIS: the alteration of consciousness and concentration in which the subject
manifests a heightened of suggestibility while awareness is maintained.
Not all person are susceptible to hypnotic induction, subjects who are compulsivedepressive type, strong-willed like lawyers, accountants, physicians and other professionals are
usually non-hypnotizable.
Reasons why Hypnotism is not Admissible in Court
1. It lacks the general scientific acceptance of reliability of hypnosis per se in
ascertaining the truth from falsity.
2. The fear that the truer of fact will give uncritical and absolute reliability to a scientific
device without consideration of its flaws in ascertaining veracity.
3. The possibility that the hypnotized subject will deliberately fabricate.
4. The prospect that the state of heightened suggestibility in which the hypnotize subject
as suspended will produce distortion of the fact rather than the truth
5. The state of the mind, skill and professionalism of the examiner are too subjective to
permit admissibility of the expert testimony
6. Confession while under hypnotic spell is not admissible as evidence because such
psychiatric treatment is involuntary and mentally coercive.
7. Although hypnosis may not yield admissibility evidence it may be pf some use during
investigation.
IV. OBSERVATION: A good criminal investigator must be a keen observer and a good
psychologist. A subject under stress on account of the stimulation of the sympathetic
nervous system may exhibit changes that may be used as a potential clue of deception. And
since just one or a combination of the following signs and symptoms are not conclusive pr a
reliable proof of guilt of the subject, their presence infers further investigation to ascertain
the truth of the impression.
A. Physiological and Psychological Sign and Symptoms of Guilt:
1.
Sweating-Sweating accompanied by a flushed face indicate anger,
embarrassment or extreme nervousness. Sweating with a pallid face
may indicate shock or fear. Sweating hands indicate tension.
2.
Color Change-Flushed face: anger, embarrassment and shame
-Pale face: sign of guilt
3.
Dryness of the Mouth- Swallowing and licking of the lips
4.
Excessive Activity of the Adams Apple
5.
Fidgeting-subject is constantly moving about in the chair, pulling his
ears, rubbing his face, picking and tweaking the nose, crossing and
uncrossing his legs, rubbing the hair, eyes, eyebrows, beating and
snapping fingernails, etc. These are indicative of nervous tension.
6.
Peculiar feeling inside- There is a tension of lightness of the head and
the subject is confused. This is the result of his troubled conscience.
7.
Swearing to the truthfulness of his assertion- Usually a guilty subject
frequently utters such expression. I swear to god I am telling the
truth or I hope my mother drops dead of a, lying, I swear to
Godetc. Such expressions are made to make forceful and
convincing his assertion of innocence.
8.
Spotless past records-Religious man-The subject may assert that it is
not nor possible for him to do anything like that inasmuch as he is a
religious man and that he has a spotless record.
9.
Inability to look at the investigator-subject does not look into the
investigators eyes for the fear that his guilt may be seen in his eyes. He
will rather look at the floor or at the ceiling.
10.
Not that I remember expression- the subject will resort to the use of
not that I remember expression when answering to be evasive or to
avoid committing something prejudicial to him.
1.
2.
3.
2.
2.
By exclusion- if two or more persons have to be identified and all but one is not
yet identified, then the one whose identity has not been established may be known by the
process of elimination.
IDENTIFICATION OF PERSONS:
I. Ordinary Methods of Identification: those which laymen use to prove identity.
1.
Characteristics which may easily be changed:
a.
Growth of hair, beard and mustache
b.
Clothing
c.
Frequent place of visit
d.
Grade of profession
e.
Body ornamentations
3. Characteristics which may NOT easily be changed:
a.
Mental memory
b.
Speech
c.
Gait
d.
Mannerism stereotype movement or habit peculiar to an individual.
e.
Hands and feet
f.
Complexion
g.
Changes in the eyes
h.
Facies
i.
Left or right handedness
j.
Degree of Nutrition
Points of Identification Applicable to both living and dead before decomposition sets in:
1. Occupational Marks:
2. Race
a. color of skin
Legal Medicine page 16
b. features of face
c. features of skull
d. wearing apparel
3. Stature: a person ceases to increase in height after the age of 25.
Methods of Approximating the Height of a Person:
1.
Measures distance between the tips pf the middle fingers of both hands
extended laterally equals to height;
2.
2X length of one arm plus 12.5 inches from the clavicle and 1.5 inches
from the sternum is the approximate height.
3.
2X the length from the vertex of the skull to the public symphysis is the
height.
4.
The distance between the supra-sternal notch and the publish symphesis is
about one-third of the height.
5.
The distance from the base of the base of the skull to the coccyx is about
44% of the height.
6.
Length of forearm from tip of olecranon process to the tip middle finger is
5/9 of the height.
7.
8X the length of the head is approximately equal to the height of the
person.
4. Tattoo marks-- introduction of coloring pigments in the layers of the skin by
multiple puncture.
Importance:
1. Helps in identifying a person.
2. Indicates memorable events in his life.
3. Indicate the social stratum to which the person belongs.
4. Implies previous commitment in previous or membership in a criminal gang.
5. Weight- easily changes from time to time.
6. Deformities- congenital or acquired
7. Birth marks- spot naevi, port wine, or a mongolian blue spot.
c.
described as to shape. Location, dimension, color, or degree of
pigmentation.
8. Injuries leaving permanent results- amputation, improper union of fractured bones.
9. Moles
10. Scar
i.
iv.
vi.
vii.
Ornamentaions
Personal belongings
Wearing apparel
Foreign bodies
Identification by close relatives
Identification records on file at the police department, immigration bureau,
hospitals, etc.
7. Identification photograph
LIGHT AS A FACTOR IN IDENTIFICATION:
Particularly important when there is an eye witness to a crime:
1. Clearest Moonlight or starlight:
Experiments have shown that the best-known person cannot be recognized by the
clearest moonlight at a distance greater than 16 to 17 yards and by starlight any
farther than 10-13 yards.
a.
Broad daylight:
A person can hardly recognize another person at a distance farther
than 100 yards if the person has never been seen before, but persons who are
almost strangers may be recognized at a distance of twenty-five yards.
b.
Flash of firearms:
By experiment, letters 2 inches high can be read with the aid of the flash
of caliber .22 firearms at a distance of two feet,
BUT it is hardly possible for a witness to see the assailant in case of a hold-up
pr a murder because:
1. Usually the assailant is hidden.
2. The assault is unexpected and attention of witness is at its minimum.
c.
Flash of lightning:
Legal Medicine page 18
Artificial light:
Identity is relative to the kind and intensity of the light. Experiments
maybe made for every particular artificial light concerned.
Uses of Fingerprints:
1. Help establish identification in cases of dead bodies and
unknown or missing persons.
2. Fingerprints recovered for scne of crimes are associative
evidence, associative persons are weapons
3. Fingerprints on file are useful for comparative purposes
and for the knowledge of previous criminal records.
4. Among illiterate, right thumb printing is recognized as a
substitute for signature on legal documents (Philippines),
left thumb (India) and right pointing finger (Spain).
1. Plain method
2. Rolled method
Kinds:
1. Real Impressions
2. Chance Impressions
a. Visible print- visible without previous treatment. Visible
immediately after impression.
b. Plastic print- printed on paraffin, putty, resin, cellophane, plastic,
tape, butter, soap, and etch.
c. Latent print- prints that are not visible after impression but made
visible by the addition of some substances.
B. DENTAL IDENTIFICATION:
Dental identification is important in the following reasons
1. The possibility of two (2) persons to have the same dentition is quite remote. Why?
-32 teeth (Adult) have five (5) surfaces. . Some of the teeth may be missing, carious,
with filling materials, and with abnormality in shape and other peculiarities.
2. The enamel of the teeth is the hardest substance of the human body
3. After the death, the greater the degree of the tissue destruction, the greater is the
importance of dental characteristics as means of identification.
4. The more recent the ante-mortem records of the person to be identified, the more
reliable is the comparative or exclusionary mode of identification that can be done.
P.D. 1575 requires that practitioners of dentistry to keep records for 10 years of their
patients to make accurate dental records available for purposes of comparison or
exclusionary mode of identification. Upon the lapse of ten years, they shall turn over the
dental records to the NBI.
Forensic Odontologist- dentist specializing in dental identification
Sex- examination for the presence of Barr bodies (sex identification) from palatal
scrapping.
HANDWRITING:
5.
DETERMINATION OF SEX:
Legal importance of determination of Sex Determination
1. As an aid in identification
2. To determine whether an individual can exercise certain obligations vested by
law on one sex only.
3. Marriage or the union of a man and a woman
4. Rights granted by law are different to different sexes.
5. There are certain crimes wherein a specific sex can only be the offender or
victim.
How to determine sex:
1.
Social tests
2.
Genital tests
3.
Gonadal tests
4.
Chromosomal test
Problems in Sex Determination
1. Gonadal agenesis- (testes or ovaries) have never developed
2. Tue hermaphrodism- A state if bisexuality
DETERMINATION OF AGE:
Legal importance of Determination of Age:
1. As an aid in identification
2. Determination of criminal liability
3. Determination of suffrage
4. Determination of exercise of civil rights
5. Determine the capacity to contract marriage.
6. As a right to certain crimes- rape, infanticide, seduction (qualified, simple),
consented abduction.
Determination of the age of a fetus:
1. Application of the Hesss Rule or Haasses Rule:
a. Fetus less than 25 cm. long (Crown to feet length)- get the square root
of the length in cm. and the result is the age of the fetus in months.
b. Fetus more than 25 cm. long or more- divide the length of the fetus
by 5, and the result is the age of fetus in months.
2. Examination of the product conception.
IDENTIFICATION OF BLOOD AND BLOOD STAINS:
Legal importance of the study:
1. For disputed parentage (maternity and paternity)
2. Disputed maternity may arise
a. Alleged switching of babies the nursery of the hospital;
Legal Medicine page 23
Prescriptin test:
If a positive result is obtained, more or less conclusive way that the blood stains is
of human origin although anthropoid ape may give the same result.
Blood Grouping:
Value of Test- it may solve disputed parentage (paternity and maternity)
- A positive result is not conclusive but a negative is conclusive that he is
not the child of the alleged parents.
Inheritance Patterns of ABO Blood Groups:
Group of Parents
Group of Children
Exclusion Case
OxO
O
A, B, AB
OxA
O, A
B, AB
OxB
O, B
A, AB
AxA
O, A
B, AB
AxB
O, A, B, AB
BxB
O, B
A, AB
O x AB
A, B
O, AB
A x AB
A, B, AB
O
B x AB
A, B, AB
O
AB x AB
A, B, AB
O
Differential Characteristics of Blood from different Sources
1. Artificial Blood
a.
Bright scarlet in color
b. Leaves blood vessel with pressures
c.
High oxygen content
2. Venous Blood
Legal Medicine page 24
Theoretically, wherever a person is, he is continually shedding off his DNA in some form
of biological specimen such as saliva, blood, urine, sweat, and even semen and vaginal fluid. No
matter how minute the amount, this can be collected and because of its uniqueness will identify
the source from whence it came.
It is such a powerful tool that, theoretically, it can prove that a particular group of people
had been together in one room or one place. If a suspects DNA is collected from a particular
area, it can at the very least put the suspect in the vicinity of the crime. It is so sensitive that if the
specimen is not properly handled, even the DNA of the collector may contaminate the specimen.
Briefly, the procedure involves taking a DNA pattern sequence from a human cell,
cutting it with an enzyme that recognizes a distinctive site. Through electrophoresis, there is
separation of these fragments by size. Then this is probed with a piece of radioactive DNA as a
result of which bands will appear, corresponding to the length of these fragments, appearing like
a bar code like the commercial products sold in supermarkets.
But how can this help in identifying a dead body? Through its mitochondrial DNA which
can only be passed on in the egg and so only from the mother, identification can readily be
accomplished. By comparing the dead bodys DNA with any female or male relative on the
maternal side, one can be sure with certainty that the body is that of someone related to them.
DNA typing is a well-established tool for the identification of human remains. It is such a
powerful tool that it is resorted to regularly and especially when the traditional methods of
identification have not yielded positive results. Since DNA is relatively resistant to
decomposition, especially in bones, this method can be useful in conditions of incineration,
fragmentation or decomposition where ideal specimens can no longer be obtained.
Of the many techniques of DNA analysis, the mitochondrial DNA (mt DNA) analysis is
the most effective identification although technically the most challenging. In difficult cases, the
possibility of extracting useful DNA is far better that nuclear DNA. This involves the study of a
relatively small amount of DNA found in the cytoplasm of human cell. It consists of a single
strand present in each mitochondrion, which is responsible for aerobic metabolism of the cell. In
contrast to a single copy of nuclear DNA per cell, there are hundreds to thousands of copies of
mitochondrial DNA per cell.
Irrespective of other methods of identification, the trend in the States is for the medical
examiner to retain a small specimen such as blood from an autopsied body. This is preserved as a
card on file for easy reference, especially when the identification should later be questioned.
Locally there are several agencies that can do this competently. What appears to be a
major stumbling block to its widespread use is its a relatively expensive procedure. As with other
modern technology, it is hoped that one day the procedure will be cheap enough to allow a DNA
file for everybody.
A.
What is DNA?
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
The four building blocks and their sequence in DNA makes up the letters
of the genetic code;
An individuals DNA remains the same throughout his life;
In specific regions on a DNA strand each person has a unique sequence of
building blocks or genetic code;
It is a persons unique genetic code that allows scientists to identify an
individual to the exclusion of all others.
B. Characteristics of DNA:
Each person has a unique DNA profile;
Each persons DNA is the same in every cell;
An individuals DNA profile remains the same throughout life;
Most DNA is the same from person to person;
Some DNA varies from person to person
C. How does DNA solve crimes?
DNA profiling:
Sexual assault;
Homicidal and violent crimes;
Exculpate wrongly accused suspects;
Identify serial crimes;
Identify human remains;
Sex offender tracking;
Parentage testing.
E.
F.
H.
Paternity:
Fresh blood cord
blood abortus,
prenatal samples
saliva (buccal swabs)
Possible results of DNA Analysis:
Maternity:
abandoned, switched,
kidnapped infants
1.
2.
3.
I.
Exclusion the DNA profile from the evidence sample does not
match the profile of the suspects reference sample; the suspect
is excluded as a source of the evidence;
Inclusion the DNA profile of the reference sample matches that
of the evidence sample; the suspect is included `as a potential
source of the evidentiary DNA;
Inconclusive not possible to determine if the samples are the
same; may arise from sample degredation; contamination, or
failure to observe some part of the protocol.
Admissibility;
Evidentiary weight;
Reading and understanding DNA analysis Report;
Presenting and making the report admissible.
J.
K.
Likelihood Ratio:
L.
M.
If the law made you a witness remain a man of science. You have no victim to avenge,
no guilty or innocent person to ruin or save. You must bear within the limits of science. (Paul
H. Broussard, Chair of Forensic Medicine , Sorbonne, 1897)
LECTURE V
Death: is the termination of life. It is the complete cessation of all the vital functions
without possibility of resuscitation.
Distinguishing death vs. dying
The ascertainment of death is clinical and nor legal
Previously, complete and persistent cessation of cardio-respiratory function is the standard
criteria in the determination of death. Scientific development and advancement lead to
development of uncertainty of death
1. Increasing use of mechanical resuscitation devices, which can maintain
reparation and cardiac function almost indefinitely. Technological Imperative
2. There is an increasing demand of organs for transplantation
3. Coma- Following administration of excessive doses of modern sedatives and
hypnotics could be mistaken for death.
Brain Death- is the most ideal criteria, however, Electro-encephalogram (EEG), which
is the most reliable machine to determine brain activities, is not available in many places and
number of component persons to apply the instrument is and the interpretation of the results is
quite limited.
The use of the criteria of brain death may be applied to potential organ
donors.
Kinds of Death
1. Somatic death or clinical death
2. Molecular or cellular death- 3-6 hours later.
3. Apparent death or state of suspended animation.
Legal Medicine page 30
Signs of Death
1. Cessation of heart action and circulation-As a general rule: if there is no heart action for 5 minutes, death is regarded as certain.
2. Cessation of respiration- a person can hold his breath no longer than 3 minutes.
Following conditions where there is suspension of respiration without death:
a. Purely voluntary act- swimmers, divers, cannot be longer than 2
minutes.
b. Chyne-Strokes conditions- diabetic complication
-The apneic interval cannot be longer than fifteen to twenty (15-20)
seconds.
c. Apparent drowning
d. Newly born infants
CRITERIA: Stages of COMA
General rule: the body attains the temperature of the surrounding air for 12
to 15 hours after death in tropical countries.
b. Approximate estimate of duration of death from body temperature; (Normal
temperature) 98.4 F - (Rectal temperature)
15
=Approximate number of hours after death
c. Chemical Method:
Schourups formula- for the determination of the time of death of any
cadaver whose cerebro-spinal fluid is examined for the concentration of
lactic acid (L.A.), non-protein nitrogen (N.P.N.) and amino acid (A.A) and
whose axillary temperature has been taken the time the cerebro-spinal
fluid has been removed.
-Skin of dead person when exposed to translucent light will allow the red color of
circulation to be seen underneath the skin. The skin of a dead person is opaque
due to the absence of circulation.
d. Effect of application of heat: (Melted Sealing Wax)
-Will not produce blisters or inflammatory reaction.
1. Soft in Consistency
Post-mortem Hypostasis
1. In the epidermis
2. Cuticle-unabraided because
there is no trauma.
3. Forms at the most dependent
portion because of gravity.
4. Not elevated
5. Incision-blood still inside vessels
6. Color is uniform
7. White lines or patches of
Pressure
35
LECTURE VI
MEDICO-LEGAL INVESTIGATION OF DEATH
The following officials of the government are authorized to make death investigation:
1. Provincial and City Fiscals
2. Judge of Regional Trial Court (RTC)
3. Judge of Municipal Trial Court (MTC)
4. Division of National Bureau of Investigation (NBI)
5. Chief Police of City of Manila
6. Solicitor General
36
Kinds of Autopsies:
a. Hospital or Non-official Autopsy
b. Medico-legal or Official Autopsy
Death by violence
Accidental Death
Suicides
Sudden death of persons who are apparently in good health
Death unattended by physician
Death in hospitals or clinics (D.O.A) wherein a physician was not able to arrive at a
clinical diagnosis as the cause of death
7. Death occurring in an unnatural manner.
a. Natural Death
- caused by natural disease condition in the body
-in natural deaths with concomitant physical injuries, it is necessary for the physician
to determine whether the physical injuries would accelerate death, or the injuries
itself developed independently and produced/death or that the person died absolutely
of a natural cause.
b. Violent Death:
-are those due to injuries inflicted in the body in some forms of outside force.
The physical injury must be the proximate cause of death.
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38
Sometimes social death comes ahead of biological death. When the person who is dying is
abandoned he or she has died already, although physically there is life
Guidelines for Physicians to aid this in cases where a decision to withhold or withdraw
nutrition and hydration is to be made
1. Unconscious, imminently dying patient (progressive and rapid
deterioration)
-the dying process has begun and cannot be reversed.
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40
2
Ex. M-16 Machine gun Speed of bullet 3,200ft/sec.
.38 cal. bullet heavier, slower V= 600 ft/sec
2. Time- the longer time of impact, the lesser injury
3. Area of transfer the larger the area the lesser injury
4. Other factors skin elasticity, prox. Of base/hard
Classification of Wounds:
1. As to severity
a. mortal wound
b. non-mortal wound
2. As to kind of instrument used/agent
a. blunt instrument contusion, hematoma, lacerated wound
b. sharp instrument
1.1 sharp edged incised wound
1.2 sharp pointed punctured wound
1.3 sharp-edged pointed stab
c. tearing of force lacerated wound
d. change of atmospheric pressure barotraumas
e. heat of cold
f. chemical explosion gunshot or shrapnel
3. As to the manner of Infliction
a. hit bolo, blunt instrument, axe
b. thrust or stub bayonet, dagger
c. gunpowder explosion projectile or shrapnel wound
d. sliding or rubbing abrasion
4. As regards to depth of wound:
a. superficial includes only layers of the skin
b. Deep beyond layers of the skin;
Penetrating 2 meanings:
1.a. wounding agent enters the body but did not come out
1.b. the mere piercing of a solid organ or tissue of the body
c. Perforating
1.a. Wounding agent produces communication between
inner and outer portion of the hollow organs.
1.b. piercing or traversing completely as particular part of the body causing
communication between the points of entry and exit of the instrument or
substance producing it.
5. As regards to the Relation of the Site of the Application of Force and the
Location of Injury:
a. Coup Injury Physical Injury which is located at the site
of the application of force.
b. Contre-Coup Injury Physical injury found opposite
the site of the application force.
c. Coup Contre-Coup Injury Physical Injury located at
the site and also opposite the site of application of force.
d. Locus Minoris Resistencia Physical injury located not al the site nor
opposite the site of the application of force but in some areas offering the least
resistance to the force applied. A blow on the forehead may cause contusion at
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the region of the eyeball because of the fracture on the papyraceous bone
forming the roof of the orbit.
e. Extensive Injury Physical injury involving a greater area of the body
beyond the site of the application of force. (e.g. fall from a height; run-over
victim of vehicular accident may suffer from multiple fractures, laceration of
organs, and all types of skin injuries.
6. As to the Regions or organs of the Body involved:
7. Special types of Wounds:
a. Defense Wound result of a persons instinctive reaction of selfprotection/preservation.
b. Patterned Wound wound in the nature/shape of an object or instrument and
which infers the object or instrument causing it.
e.g. hanging rope, plastic cord,
c. Self-inflicted wounds wound produce on one-self as distinguished from
suicide; person has no intention to end his life.
Motive of producing Self-inflicted Wounds:
1. deliberately magnify an existing injury or disease for pension
or workmans compensation
2. escape certain obligation or punishment.
3. create a new identity or destroy the existing one.
4. gain attention or sympathy
5. psychotic behavior.
Mutilations:
Maylem is the unlawful and violent deprival of another of the use of
a part of the body so as to render him able in fighting either to defend himself
or to annoy his adversary.
Therefore Mutilation of other parts of the body other than the organ of
reproduction. May be classified as maylem.
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Kinds:
1. Physical Injuries which incapacitate victim for labor from 1-9 days or require med.
Attendance for the same period.
This kind will require med. Cert. As to the duration of medical attendance, or
period of incapacity. Incase of divergency in the duration of medical attendance and
incapacity, the physician must always consider the best interest of the victim in the
determination of the period.
2. Physical Injuries which did not incapacitate or require medical attention.
3. Ill-treatment of another by deed.
Review Physical Injuries inflicted in Tumultous Affray Art. 252
Types of Wounds
A. Closed Wounds no breach in continuity of skin
Superficial wound is within skin / mucous membrane
a. Petechiae circumstancial extravasation of blood subcutaneous tissue
c. Contusion effusion of blood into the tissues underneath the skin on
account of the rupture of the blood vessels as a result of the application of
blunt force or violence.
b. Hematoma extravasation or effusion of blood in a newly formed cavity
underneath the skin.
Distinction between Contusion and Hematoma:
i. In contusion the effused blood are accumulated in the interstices of the
tissue underneath the skin.
ii. In hematoma blood accumulates in a newly formed cavity underneath
the skin.
c. Contusion - skin shows no elevated if only slight acct. of inflammatory,
while in hematoma skin always slunted
Contusion aspiration with syringe no blood can be obtained
Abscess, gangrene, hypertrophy, fibroid, thickening, and even
malignancy are potential complications of hematoma.
Ecchymosis kiss mark, a type of hematoma
Deep:
Musculo-Skeletal Injuries:
1. sprain partial or complete disruption in the continuity of a muscular
or ligamentous support of a joint. Caused by blow, kick or torsion
force.
2. Dislocation displacement of the articular surface of bones entering
into the formation of a joint.
3. Fracture solutions of continuity of bone resulting from violence or
existing pathology
Types: a. closed or simple
b. open or compound
c. Comminuted Fracture
d. Greenstick Fracture
e. Linear Fracture
f. Spiral fracture
g. Pathological Fracture
4. strain the over stretching of muscle a ligament which may not be
properly associated with a joint.
5. subluxation Incomplete or partial dislocation
Internal Hemorrhage : caused by rupture of blood vessel due to
Traumatic intracranial hemorrhage
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B. Open Wound there is breach in the continuity of the skin or mucous membrane.
1. Abrasion (scratch, graze, Impression Mark, Friction Marck)
-Injury characterized by the removal of the superficial epithelial
layer of the skin caused by a rub or friction against hard, rough
surface.
-May be associated with contusion if there is forcible contact
CHARACTERISTICS:
develops at the precise point of impact
injury consist of parallel linear of the rub or friction causing it.
may exhibit the pattern of the wounding material
usually ignored by attending physician for it does not require medical treatment but it has
far-reaching importance in the medico legal viewpoint.
-abrasions caused by fingernails
-usually located in bony parts of the body associated with contusions and laceration
-nature of abrasions may infer degree of pressure, nature of rubbing object and the
direction of movement.
abrasion heals in a short time and leaves no scar.
FORMS OF ABRASION:
a.
b.
c.
d.
Linear
multi-linear
confluent
multiple
TYPES:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Incised wound (cut, slash, slice) - produced by a sharp edged or sharp linear edged
of the instrument. (e.g. knife, razor, bolo, glass, metal sheet)
impact cut
slice cut
CHARACTERISITICS:
1. edges clean cut, both extremities are sharp
2. wound straight or shelving acute to body
3. wound shallow near extremities; deeper at middle position
4. because clean cut; profuse huge is a features.
5. Gaping
6. If incised wound is covered are = even clothing show clean cert texture
7. Healing by 10 intention
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Characteristics:
a.
b.
c.
d.
Punctured wound:
1. produced by a thrust of a sharp pointed instrument
2. external injury small depth is usually deep
3. produced by ice pick, needle, nail, spear, pointed stick, thorn, fang of
animal hook
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4. nature of external injury depends on sharpness and shape of the end of the
wounding instrument
5. contusion of edges may be present of end not so sharp
6. external injuries minimal internal injuries severe.
7. site of the external wound can be easily sealed by the dried blood,
8. serum or clotted so that introduction of anaerobes e.g. tetanus secondary
infection
Characteristics:
1. shape and size of injury does not correspond to wounding
instrument.
2. tear of skin rugged with extremities irregular and ill-defined
3. injury at the site where blunt force is applied
4. borders of wound contused and swollen
5. usually develop in areas where bone is superficially located. Scalp,
dorsum of foot, front leg.
6. exam with hard lens bridging tissues and instant hair bulbs
7. heeding not extensive because Blood usual are not severed evenly
8. healing process delayed scars usually develop.
Lacerated Wound
Edges are roughly cut, irregular and
ill-defined
There is swelling and contusion
around the lacerated wound
Extremities of the wound are illdefined and irregular
Examination with a magnifying lens
shows that the hair bulbs are preserved
Healing is delayed
Scar is irregular
It is caused by a blunt instrument
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character
location
depth of the wound
condition of the surrounding
extent of the wound
direction of the wound
number of wounds
condition of the surroundings
a. degree of hemorrhage
b. evidence of struggle
c. position of body
d. presence of letter or suicide note
e. condition of the wound
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Relative position of assailant and victim when the first injury was inflicted to latter.
Trajectory or course of the wound inside the body
Organs involved and degree of injury sustained
Testimony of witness
Presence of defense wounds of victim.
defense wound must be inflicted first before fatal wound
LECTURE VIII:
GUNSHOT WOUNDS
b. Shotgun
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length, has a high muzzle velocity of about 1,0004,000 ft/sec. assuring accuracy at a considerable range
Pistol- has a short barrel of about one to twelve inches
in length; it has a low muzzle velocity of about 6001,000 ft/sec and is accurate only at a very short range.
2 types of pistol:
1. Revolver the ammunition is put in chambers in a metal cylinder which
revolves before each shot to bring the next live round opposite the
barrel
After the bullet has been fired, the brass case which contained the
explosive, remains in the cylinder and must be removed by hand
2. Automatic pistol The ammunition is found in a magazine which is attached to the butt
or handle of a gun
B. Detonation of high explosives e.g. grenades, bombs and mine explosion
i. Explosion of gunpowder inside the metallic container
ii. Each fragment/shrapnel is moving with a certain velocity with out any
predetermined direction
iii. The detonation of high explosives can be very destructive not only to
property but also to the people nearby, causing death instantaneously
iv. When the victim is very near the source of explosion (arms length),
the damage can be so devastating that there is complete disruption or
fragmentation of the body due to displacement, distortion and bursting
of body parts.
v. When the victim is a few meters away, he may still be fatally injured
but the body remains in one piece
vi. Shrapnels and other flying objects resulting from the blast may strike a
vital part of the persons body and cause death
vii. Asphyxia due to the inhalation of the b y-products of combustion such
as carbon Monoxide, nitrous or nitric gas, hydrogen sulfide, sulfur
dioxide or hydrocyanic gas may be lethal
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2. Creation of a temporary cavity-the greater the velocity, the larger the temporary
cavity formed
3. Hydrostatic force- when bullet traverses organs with fluid, the liquid contents
are displaced radially away from the bullet path producing extensive laceration
in the fluid path
4. Shock wave- when the bullet velocity is greater than 1,087 feet/sec, the
destruction caused by kinetic energy is a radial direction perpendicular to the
path of the bullet
5. Fragmentation or disintegration of the bullet- when the bullet hits a hard object,
(bone), it fragments to several pieces each with an energy like the mothe bullet
causing laceration, fracture and shocking effect (shocking power or
knockdown power)
6. Fragmentation of hard brittle object in the trajectory- Bone fracture in the
trajectory may cause additional damage on the surrounding tissues and even in
the wound of exit
7. Muzzle blast in contact fire- when the gun muzzle in pressed in contact with the
skin when fired, all of the products of combustion primarily the muzzle blast will
penetrate the tissues causing severe mechanical destruction on account of
pressure. The explosive effect will cause laceration of soft tissues and fracture of
bones.
8. Other consequential effects on the body of the victim- hemorrhage, infection,
paralysis, shock, loss of function may cause diability or death on the victim
General Rule the higher the caliber of the wounding bullet, the
greater will be the size of the wound of entrance
Manner of approach of the bullet to the skin
Distance of the muzzle of firearm to skin surface
Deformity or splitting of the bullet
Surface of the skin involved are factors which modifies the size and
shape of the wound of entrance
How produced:
Bullet comes in contact of the skin causes indentation of skin
surface extreme pressure skin tissues give way rough surface of
bullet comes in contact with the skin contusion or abrasion collar is
produced.
1. in most cases, the size of wound of entrance is smaller than the caliber of the
wounding bullet on account of the retractions of the connective tissues of skin.
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missile is deformed
contact firing/near
acute angle approach wound of exit is oval
Contusion a abrasion collar widest on the side of the
acute angle approach
close range fire injury not only due to the missile but also due to
the pressure of the expanded gases, flame and other solid products of
combustion
distant fire usually produces the characteristics effect of the
bullet alone
7. Kind of weapon:
High powered weapon has more destructive effect as compared
with low powered one
8. Shape of bullet
Conical shape free end bullets have more piercing
power without marked tissue destruction
Bullets with hemispherical free ends are more
destructive
CONTACT FIRE- the nature and extent of injury is caused not only by the force of
bullet but also by the gas of muzzle blast and part of body involved.
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o soft or hollow point bullet has tendency to flatten and causes none damage
o Part of body involved:
a. when the bone is superficially located under skin
b. when the bone is deeply located in loose soft parts of the body
PRESSED and FIRM CONTACT FIRE:
1. On parts of body when bone is superficial: Commonly observed on the
head where the skull is just beneath the skin.
CHARACTERISTICS;
1. Wound of entrance is large, frequently star-shaped secondary
to tear radiating from the entrance wound caused by the blast
effect which ff. the sudden release of gases into a confined area
between skin and underlying bone.
2. edges of wound are everted creeping of gases between scalp
and bone skin moves toward muzzle
3. entrance wound is blackened by
a. burns,
b. tattooing and smudging
c. singeing of the hair
4. Muzzle imprint on the skin- iron-like effect on pressed skin
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Medium range fire more than 15 cm. but less than 60 cm.
1.
2.
3.
4.
Gunshot wound with inverted edges and with abrasion collar is present
burning effects
smudging may be present if less than 30 cm. distance
gunpowder tattooing is present but of lesser density and has a wider area of
distribution
5. contact ring is present
Instances when the size of the wound of entrance do not approximate the
caliber of the firearm:
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B. Factors which make the wound of entrance smaller than the caliber
a. fragmentation of the bullet before penetrating the skin
b. contracting of the elastic tissues of the skin
3. Testimony of witnesses:
The testimony of the witness as to the position of the victim and the
assailant when the firearm was fired may determine which of the wounds is the entrance
wound.
External examination
a. Shape of wound of entrance: oval? Circular? Deformed bullet?
b. Shape and distribution of contression or abrasion collar?
c. Difference in level between entrance and exit wound how? Reference point (sole
of foot)
d. By probing the wound
2.
Internal examination
a. actual dissection and tracing the course of the wound at autopsy.
b. Fracture of bones and course in visceral organs
c. Location of bone fragments and lead particles
d. X-ray examination
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3.
Characteristics:
1. Does not show characteristic shape like wound of entrance
2. may be slit-like, stellate, irregular or even similar to wound of entrance due to
absence of external support beyond skin bullet tear or shatter skin
3. edges of wound are everted and occasionally portions of inner tissues protruding
4. aside from bone, skin is one of most resistant so that
tight fitting clothes, waist band, belt collar, brassiere may also
support the skin to enhance formation of a circular wound of exit.
This is known as a shored gunshot wound of exit.
How produced?
Outstretched skin is impaled, sandwiched and crushed between the outgoing
bullet and the unyielding object is over the exit site, thus making the wound to be circular
with abrasion collar at its margin. Proper coaptation of the wound margin is impossible
because of the loss of skin just like those observed in the entrance wound. In contrast
with the entrance wound, the supported exit wound shows a scalloped or punched-out
abrasion collar and sharply contused skin in between the radiating skin lacerations
marginating the abrasion.
DISTINCTION BETWEEN GUNSHOT W ENTRANCE vs. EXIT:
Size
Edges
Shape
Contusion
Collar
Tattooing/
smudging
Underlying Not protruding
Always bigger
Everted
Definite shape
Absent
Absent
May be seen protruding from the
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tissues
Always present after fire
Paraffin test may be positive
Smudging Present always if near/contact fire
Singing of Contact fire
hair
wound
Maybe absent if missile is lodged in
the body
Paraffin test always negative
Present or absent
6 inches
If the number of gunshot wounds of entrance and exit found in the body of the victim
is even, presumption is that no bullet is lodged in the body.
If the number of the gunshot wounds of entrance and exit is odd, the presumption is
that one or more bullets might have been lodged in the body
Instances when the number of GSW of entrance is less than the # of GSW
of exit in the body of victim:
1. bullet-entered body split into several fragments, each of which made a
separate exit
2. one bullet entered natural orifice of body -> producing wound of exit
3. 2 or more bullets entering the body through a common entrance and
later making individual exit wounds.
4. near shot w/ gunshot entered common wound disperse separate
wound exit.
one or more bullets not through and through and the bullet is
lodged in the body
exit of bullets in natural orifices of body
different shots prod. diff. GSW of entrance but prod. a
common exit.
Instances when there is no GSW of exit but the bullet is not found in the
body of the victim:
1. bullet gastro-intestinal tract expelled through mouth by coughing
2. near fire with blank cartridge produced a wound of entrance but no slug may be
recovered
3. bullet may enter the wound of Entrance and upon hitting the bone the course is
deflected to have the wound of entrance as the wound of exit.
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b. The bullet may in the course of the flight hit a hard object, thereby splitting it and
each fragment may produce separate wounds of entrance.
c. The bullet may have perforated apart of the body and then made another wound
of entrance.
3. Number of shots heard by witnesses:
The witnesses might be able to count the number of shots especially if the
shots were made at sufficient intervals of succession. However in cases of machine gun fire,
there is difficulty in ascertaining the number heard and the testimony of witness as to the
number of shots must be admitted with caution.
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3.
4.
5.
6.
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59
- spared
- ligature mark horizontal
- lig. Usually below larynx
- lig. Groove is uniform in depth in its
whole course
- vert. Injuries not present
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6.
Post-Mortem;
Internal Findings:
a. Respiratory System:
1. Emphysema aquosum- remedial air - balloons
2. Edema Aquosum - H2O is air sacs
3. Champignon docume whitish foam nostrils mouth
Gettlers Test quantitative determination of the chlorise content of the blood in the
right and left ventricle of the heart.
- difference if of at least 25 mcg. Proves that death occurred in fresh
salt H2O and drowning is the cause of the death
- salt H2O Cl content of right side vert is less than lt. = fresh H2O
CL- lt of right side less than lt.
2.
3.
4.
5.
6.
b.
c.
d.
e.
f.
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1.
2.
3.
4.
Kinds of Virginity:
Moral virgin state of not knowing the nature of sexual life and not having experienced sexual
relation.
- applies to children < age of puberty sex organs and secondary char. not developed
Physical Virgin condition where a female is conscious of the nature of the sexual life byt has
not experienced sexual intercourse.
There is no conclusive medical finding that a woman is physically virgin. Reliance
is made as absence of laceration of the hymen
a) True physical virgin
b) False physical virgin
Demi-virginity this term refers to a condition of a female who permits any form of sexual
liberties as long as they abstain from rupturing the hymen by sexual act
Virgo Intacta literally term refers to a truly virgin female, no structural changes in her organ
to infer previous sexual intercourse and that she is a virtous female.
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1. degree of laceration
a. incomplete laceration
1. superficial does not go beyond width of hymen
2. deep laceration involve more than width but
does not reach bone
b. complete involves whole width of hymen but does not reach base
c. compound or complicated laceration involves hymen and surr.
Tiss. Eg. Perineum,vaginal canal, urethra or rectum
2. location of laceration relate to face of watch
3. duration of laceration may be approximated by changes observed in the
macerated tissues
a. fresh bleeding recent ___ than 24 hours
b. fresh healing with fibrin formation and with edema of the surroung
tissue usually 24 hours
c. healed laceration with congested edges and with sharp coaptible
borders
depending on degree of laceration and the presence or
absence of Cx
- 4-10 days old
- called also recently healed
d. healed laceration with sharp coaptible borders without congestion
- laceration took place > 10 days or 2-3 weeks
e. healed laceration with rounded non-coaptible borders and retraction
of the edges
depending on degree of laceration
laceration took place more than a months time
4. Complications of laceration
a. secondary infection bacterial:
b. hemorrhage present in severe cpd. laceration of hymen surgery
may be necessary
c. fistulae formation recto-vaginal or vesico-vaginal fistula;
correction surgey
d. stricture laceration involving vaginal wall scar formation/healing
narrowing of vaginal canal
e. sterility secondary infection uterus fallopian tube
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Masters and Johnson have described sexual response cycles for men and women 4
stages:
1. excitement phase
2. plateau
3. orgasm
4. resolution
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