Week 3 Assignment

1. State M.P.C section 320 and explain it. How would you describe a wound? State

opinion and inference regarding wounds causing death.

MPC Section 320 – GRIEVOUS HURT

The following kinds of hurt only are designated as "grievous hurt".

First - Emasculation

Secondly - Permanent privation of the sight of either eye

Thirdly - Permanent privation of the hearing of either ear

Fourthly - Privation of any member or joint

Fifthly - Destruction or permanent impairment of the power of any member or joint

Sixthly - Permanent disfiguration of the head or face

Seventhly - Fracture or dislocation of a bone or tooth

Eighthly - Any hurt which endangers life, or which causes the sufferer to be, during the space

of twenty days, in severe bodily pain, or unable to follow his ordinary pursuits.

Definition of a wound

A wound is a solution of any of the tissues of the body with or without external skin being broken

and with or without flow of blood externally.

OPINIONS AND INFERENCES REGARDING WOUNDS CAUSING DEATH

I. Possible Causes of Death

(1) Death from hemorrhage

A rapid loss of over 2 liters of blood (1/3 of the total circulating volume) is dangerous to

life. A small amount of bleeding into a vital area like the brain stem, or the pericardial sac is

also fatal. A sudden loss of blood from an artery has a more serious effect than from a vein.

(2) Death from gross injury to a vital organ

Gross injury to the brain or the heart is sufficient in itself to cause death although there is

very little associated bleeding.

(3) Death from Reflex (Vagal) inhibition

Total inhibition of the cardiac and respiratory centers may occur after slight traumatic

stimuli to certain parts of the body such as: -

- A slight blow to the throat, or testicles or solar plexus;

- Sudden constriction to the neck over the carotid body;

- Passing an instrument into the cervix or urethra without anesthesia.

(4) Death at remote period

In law – the accused is responsible for the death if the fatal result can be traced to the
likely consequences of the injury.

a. Consequences of operation or enforced bed rest.

Death may result from an operation or anesthesia or pneumonia due to enforced bed

rest. The law regards a surgical operation or anesthesia, which has been made necessary

on account of the injury, to be a consequence of that injury, and the accused is held

responsible for all the natural consequences. (Provided that the treatment was done in

good faith and with a reasonable degree of skill and care)

b. Complications of the wound itself

Infection of the wound – bacterial infection, tetanus

Pulmonary embolism

Fat embolism

Air embolism

c. Pre–existing disease accelerated by injury

Death may occur during a struggle with another person from

- bursting of an aneurysm

- cerebral hemorrhage

- rupture myocardial infarct

d. Disease following in injury

Ulceration of the stomach and esophagus may follow head injuries. Curling ulcer may

occur after burns. Acute pancreatitis may develop from a severe blow to the abdomen

after a few days.

II. Is the wound responsible for death?

An obvious stab wound of the heart, for example, would create no difficulty in stating the

cause of death.

But the difficulty may arise when: -

a) Several causes of death exist

b) Other circumstances contribute to death. e.g. - medical treatment

c) A person recovers from the initial effect of the wound and then dies.

d) There is pre-existing bodily disease.

III. Categories of Severity of Bodily Injury Resulting in Death

(1) A wound which is "necessarily fatal"

(2) A wound which is "sufficient in the ordinary course of nature to cause death"

(3) A wound which is "likely to cause death"

(4) A wound which is "not likely to cause death but might possibly cause death"

IV. Type of weapon used

The use of a particular weapon in an assault may affect the amount of punishment given.

A medical witness could seldom say that a particular weapon has been used; he could

only say that the wound was consistent with the use of a particular weapon.

To determine the weapon used the following points should be noted: -

a. Nature of wound
b. Measurement – length, breadth, depth

c. Shape

d. Edges and ends

e. Presence of foreign body

An imprint abrasion represents the pattern of the striking surface of the object.

An incised wound - is produced by a weapon with sharp edges. It indicates the cutting edge

only and not the whole weapon.

A lacerated wound - is caused by a blow with a heavy blunt object or by a fall on a hard

surface.

Bruise- it is often difficult to say whether it results from a blow with a fist, or a weapon or a

fall against a hard surface.

Stab wound - is caused by a pointed instrument with sharp edge (s). The length and breadth

of the wound will indicate the breadth and thickness of the knife; the depth will

indicate the minimum length of the weapon.

V. The amount of force used

Force is expressed in terms of mild, moderate, considerable, or severe.

The degree of force used would be of some indication of: -

a. the intention of the person to cause hurt

b. whether the blow was accidental or not

c. whether he exceeds the Right of Private Defense

The following factors must be considered: -

1. Severity of the wound

The greater the severity of the wound, the greater will be the force used.

2. Nature of the part struck

The severity of the wound may depend upon the type of tissue that is injured. Areas

containing loose subcutaneous tissue like the breast may be easily injured whereas the

palm of the hand, which has firm fibrous tissue, will not be easily injured.

- bone, cartilage, soft tissue

3. Sharpness of the weapon

A sharp weapon will require little force to cause tissue injury compared to a bluntedge weapon.

4. Weight of the weapon

In principle with the same degree of sharpness, the heavier the weapon, the lesser

will be the amount of force required to cause a wound.

5. Amount of clothing

A stab wound that has to penetrate a thick layer of clothing would require a greater

amount of force.

6. Area of striking surface of the weapon

The smaller the striking surface, the greater will be the damage to the tissue. A karate

chop with the edge of the hand to the neck is a good example.
7. Contact time

A very short contact time by a weapon will result in a greater damage.

8. Force at the point of impact

The damage to the tissue will depend upon the velocity of the object that struck a

person. A bullet, although it has a small mass, by virtue of great velocity will penetrate and

injure a large amount of internal tissues. (F = mv2 / 2)

VI. The Position of the Victim and the Assailant

To determine the relative positions of the victim and the assailant, the following points

should be considered:-

1. Exact position of the wound

2. Lie of the wound

3. Direction of the wound

The exact position of the wound must be described in relation to anatomical landmarks.

The Lie of the wound indicates the position of the long axis of the weapon when it strikes

the body. It is described in relation to the figures on the clock.

The Direction of wound is described in terms of -

a) Upwards / Downwards

b) Forwards / Backwards

c) Inwards / Outwards
VII. Volitional Power after Injury

(Volition = the power to act)

The medical opinion on volitional power – i.e. the ability of the injured person to perform

voluntary acts such as movements, speech, resistance, and period of survival, may be helpful to

the court in determining the correctness of a witness's statement, or whether it is consistent with

suicide.

As the volitional power varies a great deal with different cases, an opinion must not be

hastily given. It is safer for the doctor to start the opinion with ---"what might ordinary be

expected ---"

The following features should be considered -

1. Unconsciousness

2. Rapidity of blood loss

3. Injury to structures of locomotion

4. Severity of injury

VIII. Was The Injury Inflicted During Life or After Death?

(Ante-mortem and Post-mortem Injuries)

The body can be injured in a number of ways after death: -

a) The dead skin may be injured in handling by mortuary attendants

b) Resuscitation may mark the skin and cause fracture ribs

c) Soft tissue may be torn or eaten away by rats or fish

d) Passing water craft may dismember a body floating in water

e) A person may have been killed and then placed under a passing train to simulate suicide.

The following features will be helpful in deciding between ante-mortem injuries.

1. Hemorrhage

2. Retraction of the wound edges

3. Signs of vital reaction

IX. Estimation of the age of wounds (When was the injury inflicted?)

In a case where the accused had injuries on his body, - which might have been done by

his victim in defense, this may be of use to check his story.

e.g. scratch marks on the face in rape

In a clean incised wound - healing by first intention:

A wound which is red and swollen - under 12 hours

Formation of vascular buds - by 24 hours

Formation of capillary network - by 36 hours

New vessels grew towards skin surface

fibroblast at right angle to surface - 36 – 48 hours

Epithelium begins to migrate in - 24 - 48 hours

Fibroblast paralleled to surface

repair is well advanced - 3 - 5 days

Firm union with reddish scar - 5 - 6 days

Firm union with pale scar - 14 days

Brown or copper red scar - 2 - 6 months

White and glistening scar - after 6 month

Infection and laceration of tissue - repair by granulation and prolong

the process of repair

Signs of infection is apparent after- - 24 - 48 hours

Granulation tissue - only after one week

No precise time can be given in an infected wound because there are many factors

influencing repair.

X. Differentiation of accident, suicide and homicide

2. How would you differentiate between ante-mortem and post-mortem burn?

Describe burn conflagration and it medicolegal importance.

Ante-mortem Post-mortem
(1) Vesicles contain serum which is rich in Blister contain gases. If there is any
albumen but no gas. fluid, it is poor in albumen.
 (2) A red line is always formed around the margin No red line is found around the margin of the
of the blister. post-mortem blebs.

(3)The base or floor of the vesicle show signs of The base or floor of the vesicle is
congestion and is of dull-red of glistening white appearance
colour.

(4) Signs of inflammatory and reparative changes No sign of inflammation or repair

may be present if the burn is an old one. Pus will never be found in the
formation after 36 hrs. A post-mortem burn.
WBC polymorphs may be seen. WBC-Absent or scanty.

(5) Carbon particles or soot in the Nil

respiratory tract.

(6) Blood for carboxyhaemoglobin detected No carboxy-haemoglobin is CO-60%-80%

The skin may be cherry red colour if CO in the blood.
poisoning is the cause of death.

(7) Cherry red post-mortem staining normal post-mortem staining.

Burns conflagration

1. Possible causes of death from burns

1. Neurogenic shock or pain shock (primary shock) – death within a few hours.

A barrage of pain stimuli will converge on CNS resulting in acute circulatory collapse and

death due to failure of vasomotor centre.

2. Oligaemic shock or hypovolemic shock (secondary shock.) – if patient survive over 24 hours.

- Due to fluid loss

3. Asphyxia – due to inhalation of smoke and irrespirable gases e.g., CO, CO2, CN from fumes.
(Inhalation of fire fumes)

4. Acute oedema of glottis

- Due to inhalation of irritant smoke and irrespirable gases and hot gases.

5. Acute pulmonary oedema

6. Toxaemia – absorption of toxic products from the burnt tissues (e.g., histaminoids, protein-enlage)

7. Infection and septicaemia

8. Acute renal failure – (lower nephron nephrosis.)

- Due to oligaemic shock – renal shut down

9. Electrolyte imbalance

2. Persons removed from a burning building are often found dead from suffocation due to

inhalation of smoke, carbon dioxide and carbon monoxide – the product of combustion.

The larynx and trachea will be congested with deposits of soot along the air passages.

Estimation of the carbon monoxide content of the victim's blood may indicate the cause of

death from carbon monoxide poisoning (60% - 80%). It constitutes proof that the victim was

alive at the time of the fire and usually that death was due to the fire.

3. Although many of the victims of a conflagration die of burns, some of them are killed by falling

masonry, timber or machinery. There are others who die of injuries sustained by a fall when a

vain attempt has been made to escape from the fire by jumping from a window.
4. Complications such as inflammation of serous membranes and internal organs, such as

meningitis, peritonitis, edema of glottis, bronchitis, bronchopneumonia, pneumonia, enteritis

and perforating duodenal ulcer.

5. Shock may also occur from fright before the individual is affected by burns, if his heart is weak or

diseased.