MIDTERMS PHYSICAL INJURIES 1

PART 1
Physical Injury
• Effect of some form of stimulus on the body
• Becomes apparent only if stimulus applied is SUFFICIENT!
• May be acute or delayed depending on the type of applied stimulus

Causes of Physical Injuries

• Barometric trauma or Dysbarism
• Radiation from Radioactive substances
• Heat or Cold (Thermal Injury)
• Electrical Energy
• Chemical Energy
• Infection
• Physical Violence

Physical Violence
• Wound is a natural disruption of the anatomic integrity of a tissue of the living
body.
• Is used synonymously with physical injury however, physical injury does not
always result in a wound.

Legal Classification
• Mutilation (Art 262 RPC)
o Intentionally depriving a person, totally or partially of some of the essential
organs of reproduction
o Intentionally depriving a person, totally or partially of any part other than
that of the essential organs of reproduction
• Serious Physical Injuries (Art 263 RPC)
o Done by:
§ Wounding
§ Beating
§ Assaulting
§ Administering Injurious Substances without the intent to kill
o Serious Physical Injuries (Art 263 RPC)
§ Graduated penalty
§ Prision mayor
§ Person shall become insane, imbecile, impotent or blind
§ Prision correcional (medium to maximum)
§ Loss of the use of speech, power to hear/smell, loss of an
eye, hand, foot, arm and leg
§ Loss of use of any such member
§ Becomes incapacitated for the work in which he was
habitually engaged
§ Prision correcional (minimum to medium)
§ Person shall become deformed
§ Loss of any other member of his body
MIDTERMS PHYSICAL INJURIES 2

§ Loss the use thereof

§ Becomes ill or incapacitated for the performance of work
habitually engaged in for more than 90 days
§ Arresto Mayor (maximum) to Prision correcional (minimum)
§ Becomes ill or incapacitated for the performance of work
habitually engaged in for more than 30 days

• Administering Injurious Substance or Beverages (Art 264 RPC)

o Infliction upon another of any serious physical injury
o It was done knowing that the substance is injurious or took advantage of
the victims weakness or credulity
o No intent to kill

• Less Serious Physical Injuries (Art 265 RPC)

o Incapacitate the offended party from labor for more than 10 days
o Requires medical attendance for more than 10 days
o Qualified by:
§ Manifest intent to insult or offend the injured person
§ Circumstance adding Ignominy
§ Victim is the offender’s parents, ascendants, guardian, curators or
teachers
§ Victim is a person of rank or authority

• Slight Physical Injuries (Art 266 RPC)

o Incapacitate the offended party from labor for 1 to 9 days (arresto menor)
o Causes injury which do not prevent the offended party from working nor
require medical attendance (arresto menor, censure)
o Illtreatment by deed

• Physical Injuries Inflicted in a Tumultuous Affray (Art 252 RPC)

o There is a tumultuous affray
o Participants suffered from serious physical injuries
o Persons who inflicted could not be identified
o All those who appear to have used violence upon the offended party shall
be penalized by arresto from 5 to 15 days

Medicolegal Certificate
• Needed by the Prosecutor to determine which crime to charge the perpetrator
• Contains:
o NOI (Nature of Incident)
o TOI (Time of Incident)
o DOI (Date of Incident)
o POI (Place of Incident)
o List of Injuries
o Conclusion
MIDTERMS PHYSICAL INJURIES 3

• Causes of Injury (or Nature of Incidents)

o Mauling
§ Results from a violent altercation between 2 persons or groups of
persons
§ Injury may be sustained by:
§ The feuding parties
§ Bystanders
§ Domestic Injury and Industrial Accident
§ Usually results from the myriad of combinations of accidents
at home or at work.
§ A physician must note whether there is presence of alcohol
on the patient.

• Vehicular Accident
o Factors responsible in VAs
§ Human Factor
§ Human Factor
§ Mental Attitude
§ Perception Defects
§ Delayed or Sluggish Reaction Times
§ Disease
§ Chemical Factors
§ Environmental Factor
§ Mechanical Factor
§ Social Factor
§ Pedestrian

• Factors Responsible for Passenger and Driver Injury

o Impact within structures
o Ejection
o Direct impact with other vehicle occupants.
o Acceleration-Deceleration Injury (Whiplash)
• Pedestrian-Vehicle Collision
o Primary Impact
§ Causes injuries such as bumper fractures as well as patterned
wounds of the front grills
o Secondary Impact
§ Run Over Injuries
§ Usually results to patterned injuries such as tire tread contusion as
well as patterned abrasions
o Motorcycle Injuries
§ Is a the leading cause of vehicular accidents
§ Reason for increase:
§ Increasing number of motorcycles
§ Relatively small profile of motorcycles
MIDTERMS PHYSICAL INJURIES 4

§ Continued failure to use mandated safety equipment

§ Very little material in a motorcycle to cushion the impact.
§ Sports Injuries
§ Boxing
§ Wrestling
§ Newer sports with attendant risks:
§ Mixed Martial Arts
§ Extreme Games
§ Sky Diving
§ Injuries common in combat sports
§ Lacerations to the eyebrow and malar region (cheek)
§ Hemorrhage secondary to the blood vessel rupture or
fracture of the orbital plate of the frontal bone known
as Spectacle Hematoma
§ Hematoma of pinna with auricular cartilage necrosis
known as Cauliflower ears
§ Cerebral concussion
§ Subdural hemorrhage (most common)
§ Pontine hemorrhage (known as boxer’s hemorrhage)
§ Stabbing Injuries
§ Anything with an edge could be used for injuries of
this type
§ Knives
§ Bolo / Machete
§ Broken bottles
§ Scalpels
§ Sharpened instruments such as shanks
§ Gunshot Injuries

Classification of Wounds
• Severity
o Mortal
o Non- mortal

• Kind of Instrument Used

o Blunt
o Sharp
o Sharp edged Instrument
o Sharp pointed Instrument
o Sharp edged and sharp pointed
o Tearing force

• Manner of Infliction
o Hit
o Thrust/Stab
MIDTERMS PHYSICAL INJURIES 5

o Gunpowder explosion
o Sliding or rubbing

• Depth of the Wound

o Superficial
o Deep
o Penetrating (solid organ)
o Perforating (communication between inner and outer portion of the hollow
organs.

• Relation of the Site of Application of Force and the Location of the Injury
o Coup Injury
§ Injury same site as the application of force
o Contre-Coup Injury
§ Injury opposite site of the application of force
o Coup-Contre Coup Injury
§ Both the site as well as the site opposite has injury
o Locus Minoris Resistencia
§ The site of the injury is at the point of least resistance
o Extensive

• Special Types of wounds

o Defensive wounds
o Patterned wounds
o Self Inflicted wounds

• Type of Wounds
o Closed Wounds
§ No breach in the continuity of the skin
§ May be:
§ Superficial
§ Petechiae
§ Contusion
§ Hematoma
§ Deep
§ Musculoskeletal Injuries
§ Internal Hemorrhage
§ Cerebral Concussion
§ Open Wounds
§ Abrasion
§ Incised Wound
§ Stab Wound
§ Punctured Wound
§ Lacerated Wound
MIDTERMS PHYSICAL INJURIES 6

• Petechiae
o Circumscribed extravasation of blood into the subcutaneous tissues or
beneath the mucous membrane
o Usually from the capillary systems
o Causes:
§ Asphyxia
§ Trauma
§ Coronary occlusion
§ Clotting disorders

• Contusion
o Effusion of blood into the surrounding tissues
o Results from blunt force trauma
o Does not immediately develop after the trauma
o Medicolegal significance:
§ May correspond to the shape of the object causing it.
§ Extent may suggest the degree of force applied
§ Distribution may indicate character and manner of injury
o Age can be estimated by the color
§ Red to purple-recent
§ Green – 4 to 5 days
§ Yellow – 7 to 10 days
§ Gradual resumption of skin tone – 14 to 15 days
o Hematoma
§ Extravasation or effusion of blood in a newly formed cavity
underneath the skin.
§ Usually formed if force is applied where the bone is superficially
located
§ Also known as “bukol”

• Deep Closed Wounds

o Musculoskeletal Injuries
§ Sprain
§ Partial or complete disruption in the continuity of a muscular
or ligamentous support of a joint.
§ Caused by a blow, kick or torsion force
§ Dislocation
§ Displacement of the articular surface of bones entering into a
joint
§ Fracture
§ Fragmentation of bone resulting loss of continuity
§ Strain
§ Subluxation
o Internal Hemorrhage
§ Rupture of blood vessel which may result in hemorrhage
o Cerebral Concussion
MIDTERMS PHYSICAL INJURIES 7

§ Concussion is a trauma-induced change in mental status, with

confusion and amnesia, and with or without a brief loss of
consciousness.
§ Most commonly caused by Vehicular Accidents and Sports Injuries

• Open Wounds
o Abrasion
§ An injury characterized by the removal of the superficial epithelial
layer secondary to friction against a hard rough surface.
§ Usually develops at the precise point of impact
§ May exhibit the pattern of the wounding material
§ Also known as “gasgas”
o Incised Wound
§ Wound produced by a sharp edged instrument
§ May be:
§ Impact cut – like that of a jungle bolo
§ Slice Cut – like that of a knife
§ Stab Wound
§ Wound produced by the penetration of a sharp pointed and
sharp edged instrument.
§ Punctured Wound
§ Injury resulting from the use of a sharp pointed instrument
such as an icepick
§ Lacerated Wound
§ Tear of the skin and underlying tissues due to forcible
contact with a blunt instrument.

PART 2

Firearm
• An instrument used for the propulsion of a projectile using expansive force of
gases coming from the burning of gunpowder
• Includes:
o Rifles
o Muskets
o Shotguns
o Revolvers
o Pistols

Classification of Firearms
• As to wounding power
• Low velocity Firearm (<1,400 fps)
• High power Firearm (>1,400 fps but usually 2,200-2,500 fps)
• As to the Nature of the Bore
• Smooth bore
MIDTERMS PHYSICAL INJURIES 8

• Rifled bore
• As to manner of firing
• Pistol - Single handed weapon
• Rifle - Shoulder fired weapon
• As to the Nature of the Magazine
• Cylindrical Revolving Magazine
• Vertical or Horizontal Magazine
• Components of a Weapon
• The Cartridge
• The Firearm
• Cartridge
• The Cartridge Case or Shell
o Cylindrical structure with a base which houses the different parts of the
ammunition
o May be:
§ Cartridge with a Rim
§ Rimless Cartridge
§ Semi-rimless Cartridge
§ Belted Cartridge
o Primer
§ Functions to transform the mechanical energy of the firing pin to
chemical energy by its rapid combustion
§ Located at the base of the cartridge and covered by a small disc of
soft metal known as percussion cap or primer cap
§ May be:
§ Center fire Cartridge
§ Percussion Cap located at the center
§ Most common
§ Rimfire Cartridge
§ Primer is placed inside the rim of the shell
§ Common in 22 caliber firearm
§ Firearm with a pin
§ No longer in use due to inherent instability
§ Powder or propellant
§ Gunpowder/Propellant
§ Primary propulsive force in the cartridge
§ Types of Propellant
§ Black Powder
§ (80%KNO3, 15%S, 10%C)
§ Smokeless Powder
§ Single base (either cellulose nitrate or
nitroglycerin)
§ Double base (contains both)
§ Semi-smokeless Powder
§ (80%black and 20% smokeless)
§ Bullet or projectile
MIDTERMS PHYSICAL INJURIES 9

§ The projectile attached to the free end of

the cartridge case
§ Classification
§ Shape of the tip
• Conical
• Hemispherical
• Wad cutter (square
nose)
• Hollow point
§ Presence or absence of
jacket
• Naked Lead Bullet
• Jacketed Bullet
• Full Jacketed Bullet
• Semi-jacketed
Bullet
§ Special Bullets
• Armour Piercing
Bullets
• Phosphorus flare or
Tracer Bullet
• Plastic Bullet
• Bullet with Plastic
Sabot
• Bullet with
Secondary
Explosion
• Soft Point Bullets
§ Firearms
§ Parts of the firearm of
medicolegal importance:
• Trigger with firing
pin
• Barrel

• Trigger
• Part of the firearm which causes the firing evolution.
• Classification:
• Relation of cocking and trigger pressure
o Single Action Firearm
o Double Action Firearm
• Number of Shots on Pressure on the Trigger
o Single Shot Firearm
o Automatic Firearm
• Barrel
o Riflings
MIDTERMS PHYSICAL INJURIES 10

§ Series of parallel spiral grooves on the whole length

§ Number – varies from 2-12
§ Twist Rate - expression of 1 complete twist
§ Direction – clockwise or counterclockwise
o Land
§ Space between 2 grooves
§ Determination of caliber
§ Distance of the barrel between 2 lands

• Mechanism of Firearm Action

• The firing pin hits the primer cap which ignites the primer.
• Ignition of the primer initiates ignition of the gunpowder which produces pressure
and this pressure pushes out the bullet out of the barrel.

• Thing which come out of the muzzle after firing

• Bullet
• Flame
• Heated, compressed and expanded gas
• Residue coming from:
o Bullet
o Fragment
o Lubricant
• Primer
• Powder particles
• Powder grains
• Soot
• Graphite
• Rust, Dust
• Scraping from previous fire

• Bullet Movement
• Forward movement
• Spinning Movement
• Tumbling Movement
• Wobbling Movement
• Gravitational Pull

• Factors Responsible for Injurious Effect of the Bullet

• Inherent on the bullet
o Speed of the bullet
o Size and shape of the bullet
o Character of the missile’s momentum in flight
• Nature of the target
• Density of the target
• Length of tissue involvement
• Nature of media Traversed
MIDTERMS PHYSICAL INJURIES 11

• Importance of the Organ Involved

Effects of firing evolution

• Flame
• Brought about by the ignition of the propellant
• Does not usually go beyond a distance of 6 inches and in pistols is often less
than 3 inches
• Causes burning of the skin in contact or near fire
• Heated, Compressed and Expanded Gas
• Brought about by the limited space in the chamber of the firearm
• Responsible for the propulsion of the projectile.
• Responsible for the muzzle blast.
• Smoke
• Product of the complete combustion of the gunpowder and the propellant.
• Light, almost black and only covers the skin.
• May be readily wiped off.
• May be seen up to a distance of 12 inches
• Powder Grains
• Product of the incomplete combustion of the gunpowder and the propellant
together with graphite.
• Relatively heavier than smoke.
• May not be readily wiped off and penetrates the dermal and epidermal layer of
the skin.
• Responsible for the production of tattoing.
• May be seen up to a distance of 24 inches

• Contusion or Abrasion Collar

• Caused by the pressure of the bullet on the elasticity of the skin.

Characteristics of Point of Entry

• Depends upon:
• Caliber of the Wounding Weapon
• Characteristics inherent to entrance wound
• Direction of fire
• Shape and composition of missile
• Range
• Kind of weapon
• Point of Entry – contact fire
• Where bone is superficial
o Wound is large and stellate (star) shaped
o Edges may be everted
o Burns, tattooing, smudging and singeing of hair is present
o Muzzle imprint on the skin
• Where bone is deeply located
o Wound is usually large, circular and without radiating laceration
o Edges may be everted, some tissue may be found in the gun barrel
MIDTERMS PHYSICAL INJURIES 12

o Burns, tattooing, smudging and singeing of hair is present

o Muzzle imprint on the skin present
• Point of Entry – near contact fire
• Wound is usually large and circular depending on the angle of fire
• Abrasion collar distinct
• Burns, tattooing, smudging and singeing of hair is present
• Muzzle imprint on the skin present
• Blackening of the bullet tract
• Point of Entry – short range fire about 1-15 cm distance
• Edges of the wound inverted
• Abrasion collar distinct
• Tattooing and smudging is present
• If within 3 inches, burns may be present
• Point of Entry – medium range fire about 15-60 cm distance
• Edges of the wound inverted
• Abrasion collar distinct
• Tattooing and smudging (if less than 30 cm) is present but of lesser density
• Burns and singeing is absent
• Point of Entry – greater than 60 cm distance
• Edges of the wound inverted
• Abrasion collar distinct
• Tattooing, smudging, burns and singeing is absent

Current forensic usage classifies this more simply under:

• Contact fire
• Intermediate fire
• Distant fire

Point of Exit (Outshoot)

• No characteristic shape
• Edges are usually everted
• Point of Exit (Outshoot)

Special Consideration on Bullets

• Souvenir bullet – when a bullet is left behind in the body
• Bullet migration – bullet is located away from the tract
• Tandem Bullet – 2 bullets are fired at the same time
Shotgun Wounds
• Classes of Shot in a Shotgun Shell
• Birdshot – small and measuring 200-400 shots in the shell
• Buckshot- shot ranges from .24 to .33 inch in diameter. Std 12 gauge = 9 shots
• Single Projectile or rifled slug.

• Types of Shotgun
• As to number of barrels
o Single barrel
MIDTERMS PHYSICAL INJURIES 13

o Double barrel
• As to the manner of firing and reloading
o Bolt Action
o Lever action
o Pump Action
o Autoloading

Chemical Energy
• Causes injury when there is a sudden release of potential energy into kinetic or
thermal energy causing a sudden increase in pressure
• Results in an explosion
• Types of Chemical Explosion
o Diffused Reactant Explosion
§ Caused by a mixture of gas and air and initiated by a flame
§ Examples include:
§ Internal Combustion Engine
§ A leaking Gasul
§ Fuel Air Bomb
§ Condensed Reactant Explosion
§ Caused by a large quantity of heat and gas produced as a
consequence of a rapid chemical reaction in a liquid or solid
§ Radiating in an outward direction thus maximal damage is
sustained nearest the point of origin
§ Subclassified as:
§ Low order Explosive (Deflagrating Explosive)
§ Relies on burning and confinement to produce
explosions
§ Gunpowder is the best known low order
explosive.
§ High Order Explosive
§ Type of explosive which detonates
§ Detonation is a chemical process which results
in the extremely rapid decomposition of
nitrogenous compound releasing heat and gas
as its by-product
§ Damage is caused by the shock wave which
results from the sudden release of heat and
gas
§ Types of High Order Explosive
§ Stable
§ Stable until detonated by
another explosive such as
a blasting cap
§ Example: dynamite and
plastique such as C4 or
Semtex
MIDTERMS PHYSICAL INJURIES 14

§ Unstable
§ Easily detonates from
heat, flame, spark or
percussion
§ Example: Picric Acid and
Nitroglycerin
§ Injury is due to:
§ Primary effects of
detonation
• Occurs when the
body is in contact
with the explosive
• Causes complete
disruption or
fragmentation of the
victim’s body
• Compression-
decompression
effect brought about
by sudden rise and
fall of atmospheric
pressure
§ Secondary to the blast
wave
• Body may be
thrown some
distance and
dismembered
• Hollow organs are
most heavily
damage
§ Peppering of shrapnel
• Secondary to the
effect of blast wave
to small fragments
• May be metallic or
not
§ Other blast wave effects
• May cause fall
related injuries
• Damage to the
respiratory organs
• Damage to the ear
and the tympanic
membrane
MIDTERMS PHYSICAL INJURIES 15

Radiation Related Injuries

• Type of explosive
o Fission type
§ One stage weapons
§ Early weapons such as the Hiroshima and Nagasaki bombs
o Fusion type
§ Two stage weapons
§ Modern thermonuclear devices
o Specialized type of explosive
§ Neutron bomb
§ Primarily a bomb which releases massive amount of
radiation in order kill the populace without destroying useful
structures
§ Salted bomb
§ Nuclear devices to which salts are added which insure long
term radiation would affect the surrounding area
§ Suitcase bomb
§ Man portable nuclear devices
§
§ Dirty Bomb
§ Not a nuclear bomb per se but a conventional explosive
which is mated to nuclear material

• Other Sources of Radiation

o Natural Sources
§ Sun
§ From naturally occurring uranium
o Man made Sources
§ X-ray and CT Scan
o Clinical nuclear medicine
§ Radiotherapy
§ Industrial sources (nuclear power plant)

PART 3

Barometric Trauma
• Hyperbarism
o Injuries caused by rapid increase of atmospheric pressure
o Examples:
§ SCUBA Diving
§ Caisson Mining (mining the seabed or deep riverbed)

• Hypobarism
o Injuries caused by rapid increase of atmospheric pressure
o Example:
§ Alpine climbing (High mountain range)
MIDTERMS PHYSICAL INJURIES 16

§ Rapid Ascent from depth in SCUBA Diving

§ Rapid depressurization of cabin pressure in aircraft travelling at
more than 30,00 ft.
Thermal Injuries
• Caused by appreciable deviation from normal temperature
• either a decrease or an increase
o Cold – frostbite
o Heat – burns or scalds

Death or Injury From Cold

• Unusual in tropical countries
• Frost Bite
• Cause of death
o Decreased ability of the Red Blood Cell to deliver oxygen
o Diminished ability of the tissue to utilize oxygen.
o Vascular effects of cold causes hemostasis and later cell death, necrosis
and infection

Death or Injury From Heat

Either:
• Scalds
• Burns

Local Effects
• Burn
o Dry heat (flame, heated solid, radiant heat)
o Occurs at or above the site of contact
o Singeing of the hair is present
o Unclear boundaries
o Severe
o Clothing involved

• Scalds
o Moist heat or steam
o Occurs at or below the site of contact
o Absent
o Distinct boundaries
o Limited
o Clothing usually uninvolved

• Purposes of Intentional Fire or Arson

o To conceal identity and true cause of death
o To commit homicide
o To commit insurance fraud
o To commit suicide
o To perpetuate a cause.
MIDTERMS PHYSICAL INJURIES 17

• Proof of burning antemortem or while the victim is still living

o Presence of smoke in the air passage
§ Grayish-black to black amorphous material in the mucosa of the
larynx, trachea or bronchii
§ Inflammation of the lung and airway
§ Smoke Inhalation
o Heat Stiffening
§ Exposure to temp >75°C
§ Assumes the pugilistic attitude – lower and upper extremities are
flexed and hands are clenched

• Chemical Burns
o Results from the action of strong acids and alkalis and other irritant
chemicals
o May cause extensive tissue destruction.

Electrical Energy
• Lightning Strikes
• Electrical Current

Lightning
• Electrical charge in the atmosphere
• May reach 1 Gigavolts and 10,000 to 200,000 amperes
• The distribution is variable and unpredictable
• Lichtenberg Figures – characteristic of lightning strikes

Electrical Current
• Main cause of death is shock
• Principal factor is the intensity of the current or the amperage
• Factors affecting Electrical shock
o Personal idiosyncracy
o Disease
§ Heart Disease, presence of pacemakers
o Sleep
§ Increases resistance to electrical current
o Amperage
§ 70-80 in AC
§ 250 in DC
o Resistance of the body
§ Lesser resistance = greater injury
o Nature of the current
§ Ac vs DC
o Grounding
o Duration of contact
o Kind of conductor
MIDTERMS PHYSICAL INJURIES 18

o Point of entry
• Mechanism of death
o Ventricular fibrillation
§ The heart is unable to contract properly leading to loss of cardiac
output and circulation
§ Occurs in Low voltage injury
o Respiratory Failure
§ Paralysis of the nervous system in charge of breathing
§ Occurs in High voltage injury
o Mechanical asphyxia
§ Prolonged convulsions often result from electrical injury

• Electrical Burns
o Other names include:
§ Electrical necrosis
§ Electric marks
§ Current markings
o These may be seen at the point of entry and point of exit
o Metallization
§ A specific feature of electrical injury
§ Metal of the conductor is volatilized or vaporized and the particles
are driven into the epidermis
§ Color depends of the conductor
§ Iron = yellow brown
§ Copper = bluish

PART 4

Asphyxia
• General term
o All Forms of violent death or injury which results from the interference with
the process of respiration
o Condition in which the supply of oxygen to the blood or the tissues or both
has been reduced below normal levels
• Types of Anoxic Death
o Anoxic Death
§ Failure of arterial blood to be saturated with O2
o Anemic Anoxic death
§ Decreased O2 carrying capacity
o Stagnant Anoxic Death
§ Circulatory Failure
o Histotoxic Anoxic Death
§ Failure of oxidative phosphorylation

• Phases of Asphyxial Death

o Dyspneic Phase
MIDTERMS PHYSICAL INJURIES 19

§ Lack of oxygen and retention of CO2

o Convulsive Phase
§ Stimulation of CNS by CO2
§ Presence of Tardieu Spots ( Small Petechial Hemorrhages)
secondary to increased intracapillary pressure
o Apneic Phase
§ Paralysis of the respiratory center of the brain due to cerebral
anoxia
o Classification of Asphyxia
§ Hanging
§ Strangulation
§ By force other than weight of the body
§ Suffocation
§ Drowning or submersion
§ Pressure on the chest (Traumatic Crush Asphyxia)
§ Irrespirable gases
§ Asphyxia by Hanging
§ Need to differentiate Antemortem vs Postmortem
§ Vital reaction or inflammation at site of ligature
§ Classification of Asphyxia by Hanging
§ As to the location of the ligature or knot
§ As to the amount of constricting force
§ As to Symmetry
§ Classification of Asphyxia
§ As to the location of the ligature or knot
§ Typical
§ Runs from midline above the thyroid cartilage
symmetrically encircling the neck
§ Atypical
§ Ligature is noosed along one side of the neck
§ Classification of Asphyxia
§ As to the amount of constricting force
§ Complete
§ Whole body is suspended
§ Partial
§ When body is partially suspended

• Classification of Asphyxia
o As to Symmtery
§ Symmetrical
§ Asymetrical
o Mechanism of Death from Hanging
§ Pressure of the ligature causes airway constriction
o Ligature in Hanging
§ Materials used
§ Noose
MIDTERMS PHYSICAL INJURIES 20

§ Mode of Application
§ Position of the Knot
§ Course of Ligature around the neck
§ Usually deepest opposite the knot
§ Symptomatology
§ Gradual loss of sensibilities
§ Sensation of constriction around the neck
§ Loss of consciousness
§ Numbness of the legs and convulsions
§ Sensation of ringing inside the ear
§ Sensation of flash of light before the eyes
§ Face becomes red with eyes prominent and feeling of heat
in the head
§ Force needed to occlude vital structures (Note that not a lot of force
is needed)
§ Jugular veins – 2 kilos
§ Carotid Artery – 5 kilos
§ Trachea – 15 kilos
§ Vertebral artery – 30 kilos
§ Post vs Antemortem Differentiation
§ Redness or ecchymosis at site of ligature
§ Ecchymosis of the pharynx and epiglottis
§ Line of redness of the carotid artery
§ Subpleura, subepicardial punctiform hemorrhage

• Hanging
o Homicidal
§ Lynching – Southern US
o Suicidal
o Accidental
• Asphyxia by Strangulation
o Strangulation by Ligature
o Force used is other then the weight of the body
• Difference from Hanging
o Hyoid bone injured
o Inverted V-shaped ligature with apex at the site of knot
o Ligature usually at level of hyoid
o Ligature groove deepest opposite the knot
o Vertebral injury is common in hanging
• In Strangulation:
o Hyoid bone is spared
o Ligature is horizontal and knot is on the same plane
o Ligature usually below the larynx
o Ligature is uniform in depth
o Vertebral injury is uncommon
• Manual Strangulation or throttling
MIDTERMS PHYSICAL INJURIES 21

o Form of asphyxia death where the constricting force is applied to the neck
by hand
o Suicidal throttling is not possible
• Asphyxia by Strangulation
o Special Forms of Strangulation
§ Palmar Strangulation
§ Garroting
§ Mugging or Strangle-hold
§ Compression of the neck using a night stick
o Asphyxia by Suffocation
§ Form of asphyxia death where the external respiratory orifices are
closed either by the hand or come other means.
o Asphyxia by Suffocation
§ Smothering
§ Overlaying – most common accident in children
§ Gagging
§ Accidental smothering post-ictal
§ Plastic bag suffocation
§ Choking – foreign body is lodged in the airway
§ Vomit
§ Food - Café Coronary
§ Dentures
§ Asphyxia by Drowning
§ Phases
§ “Respiration de surprise”
§ Phase of resistance
§ Dyspneic phase
§ Another apneic phase
§ Terminal respiration
§ Causes of Death in Drowning
§ Typical
§ Submerged in water and water enters airway
§ Atypical
§ Cardiac inhibition of vagus nerve causing
severe bradycardia
§ Laryngeal Spasm blocking air entry
§ Submersion when unconscious
§ Time required for Death
§ Average time is 2 to 5 min
§ Power of recovery is inversely proportional to
the amount of froth in the air passage and
water in the lungs
§ Post Mortem Finding
§ External
§ Cutis anserine or gooseflesh
§ Penis and Scrotum retracted
MIDTERMS PHYSICAL INJURIES 22

§ Washerwoman’s hands and feet

§ Conjunctival injection
§ Post mortem lividity is in the head, neck
and chest
§ Cadaveric spasm with weeds stone and
sand
§ Post Mortem Finding
§ Internal
§ Emphysema Aquosum
§ Edema Aquosom
§ Champignon d’ocume
§ Congested trachea-bronchial tree with
FB
§ Lungs with bloody froth
§ Asphyxia by Drowning
§ Gettler’s Test
§ Quantitative determination of
plasma chloride in the left and
right ventricle
§ Difference of at least 25 mg
proves death by drowning
§ Asphyxia by Drowning may be:
§ Suicidal
§ Homicidal
§ Accidental
§ Asphyxia by Irrespirable Gas
§ Carbon Monoxide
§ Carbon Dioxide
§ Hydrogen Sulfide
§ Hydrogen Cyanide
§ Lethal at 200-400 ppm
within 30 minutes
§ 2000 ppm – immediately
lethal
§ Carbon Monoxide
§ Level of CO-H causes
death
§ Above 80%
§ Tests
• Kunkel’s Test
• Potassium
Ferrocyanide
• Spectroscopic
Examination
MIDTERMS PHYSICAL INJURIES 23

§ War Gases (or gases

which have been used in
warfare)
• Lacrimator or Tear
Gas such as
Chloroacetophenon
e
• Vesicant or
Blistering Gas such
as Mustard Gas
and Lewisite
• Lung Irritants such
as Chlorine and
Phosgene Gas
• Stermutator
(Vomiting Gas)
• Paralysants (Nerve
Gas)
• Blood Poisons such
as HCN
§ War Gases in World War I
• Mustard Gas,
Chlorine Gas,
Phosgene and Tear
Gas
§ Tokyo Sarin Attack 1995
• Perpetrated by Aum
Shinrikyo
• Released Sarin Gas
which is a nerve
agent to the Tokyo
Subway

Infection
• Caused by a pathogen
• May be:
o Viral
o Bacterial
o Parasitic
o Prions
• Of medicolegal importance:
o Weaponized strains pathogens.
• Historical Implications
o Used since time of antiquity
§ Assyrians – Used fungus to poison enemy wells
§ Hannibal – Used snakes on enemy ships
MIDTERMS PHYSICAL INJURIES 24

§Mongols - animal carcasses to poison enemy wells

§Advent of germ theory
§Weaponization of botulism and brucellosis
o Weaponization
§ Increasing resistance to environmental factors
§ Means:
§ Adding cancer genes to increase the robustness of the
pathogen
§ Combining bacteria with viruses
§ Combining gene enhancers, promoters or suppressors to viruses
§ Using bacterial combinations
§ Usually studied pathogens
§ Small pox
§ Ebola
§ Lassa
§ Anthrax