1. LECTURER , FORENSIC MEDICINE,MCST
RAPE
Medicolegal view
Dr. Aly Samy Somaa
MB.ChB,Msc,ABFMD,MD
LECTURER , FORENSIC MEDICINE,MCST
4Dr. Aly Samy 2014
Dr. Aly Samy ,PSMCHS

2. Rape defined as unlawful sexual intercourse by a man with a woman:
Against her will; without her consent;
With her consent, when;
Her consent has been obtained by putting her or any other person in whom she is interested in fear of death or hurt
With her consent, when the man knows that he is not her husband and that her consent is given because she believes that he herself to be lawfully married.
With her consent, when at time of giving such consent, by reason of unsoundness of mind or intoxication .
4Dr. Aly Samy 2014

3. TYPES OF RAPE:
Statutory Rape: It is a forcible sexual intercourse by a man with a woman, who is less than 16 years of age.
Marital Rape. Also called as spousal rape.it is a forcible sexual intercourse by a man with his wife without her consent if the Wife is living separately from him under a decreeo f separation .
Custodial Rape (CustodyRape). It is done by persons taking advantage of their custodial positions and has forceful sexual intercourse with woman in their custody.
Gang Rape. Also called as group rape or pack rape. When rape is committed on a female by more than one person acting in furtherance of their common intention,
it is called as gang rape.
Date Rape. It is a forcible sexual intercourse by a boyfriend withgirl friend when they are on date (for stay or vacation).In such cases, the girl may allege that her boyfriend had given her some intoxicant and proceed with the act
Stranger Rape: It is the rape committed by a male on a female who had no previous contact
4Dr. Aly Samy 2014

4. MEDICAL EXAMINATION OF RAPE VICTIM
Doctors, examining a victim of rape are shouldered with dual responsibilities,
Firstly they have to treat the patient and provide support and
Secondly they have to examine the victim and collect material evidences to
facilitate and aid the justice.
 . A female nurse or attendant should be present while examining victim.
whenever female has to be examined it should be done by (or under supervision) of a lady doctor.
4Dr. Aly Samy 2014

5. THE MEDICAL EXAMINATION CONSISTS OF:
1. Recording history
2. Examination of clothes
3. Physical examination
4. Collection of material evidence.
CONSENT
Written informed consent of a victim is a must without which a doctor cannot proceed with medical examination.
A victim of and over 12 years of age can give consent.
If she is child under 12 years of age or of unsound mind, the consent of parent or guardian should be taken.
4Dr. Aly Samy 2014

6. HISTORY
VICTIM
CONDITION
ASSILANT
4Dr. Aly Samy 2014

7. Medicolegal classification-cont
Contused wounds
Stab wounds
Firearm wounds
4Dr. Aly Samy 2014

8. 1-Abrasions
Destruction of the superficial layers of the skin following contact with rough object. Bleeding is minimum, it heals rapidly in few days. Abrasions are usually localized at the site of trauma
4Dr. Aly Samy 2014

9. 1-Abrasions Blunt force applied perpendicular to the body surface
Scrape.
dragging: Dragging of the body as in street accidents, broad and multiple and may take the shape of the causative instrument.
Sliding: sliding semi sharp object as finger nails leading to parallel lines
Impact abrasion
Blunt force applied perpendicular to the
body surface
Overlying bony prominence
pattern/imprint abrasion
finger nail
ligature or rope abrasion
4Dr. Aly Samy 2014

10. Medicolegal importance of abrasion
It may be the only evidence of a crime
1. Type of the crime from its site. e.g.
smothering. Abrasions around mouth
throttling .Abrasions around neck
strangulation
Hanging or
rape.
4Dr. Aly Samy 2014

11. Medicolegal importance of abrasion- cont
2. The instrument used:
Finger nail
Bite
Rope
dragging
3,Direction of the injury and position of the assailant
4. Identify the assailant
5.Differentiate incised and contused wounds.
4Dr. Aly Samy 2014

12. The age of abrasion
The age of abrasion gives an idea about the date of the crime:
1st day: It is reddish, tender, oozing serosanguinous .
2nd day: soft yellow scab
3rd day, it is covered with brown red soft
scab. Gradually the scab dries up and
4TH DAY become dark brown.
7-10 days : Fallen of the dry scab occurred
from leaving a red colored area.
Disappearance of the abrasion occurred in three weeks
4Dr. Aly Samy 2014

13. DIFRENCES BETWEEN AM &PM ABRASIONS
AM ABRASIONS
PM ABRASIONS
A-Reddish, swollen.
ABSENT
B-May be accompanied by bruises
C. On microscopic exam.  Vital tissue reaction
D. Some remnants of the damaged epithelium.
E. Occur anywhere
4Dr. Aly Samy 2014

14. 2-Contusions or burises
1. Definition:-
Extravasations of blood in
the tissues following rupture of
blood vessels as a result of
application of blunt force.
It varies in size from a small
pin head ecchymosis to a large
collection of blood, known as
hematoma
4Dr. Aly Samy 2014

15. first bright red (oxy HB)  violet, then  bluish (reduced HB)
The color of a bruise
first bright red (oxy HB) 
violet, then 
bluish (reduced HB)
green (biliverdin) 
yellow (bilirubin)
It gradually disappears in 15 days
(range from 2-4 weeks).
The color changes occur from the periphery inwards
4Dr. Aly Samy 2014

16. Danger of the bruises 1. Neurogenic shock.
2. Injury to internal organs and hematoma.
3. Liability to sepsis and death from septicemia.
4Dr. Aly Samy 2014

17. Medicolegal importance of the bruises
1. evidence of crime or violence.
2. evidence of signs of resistance.
3. The date of the crime can be
estimated from its age.
4. instrument used (from its shape).
5. Differentiate between incised and
contused wound.
6. May be the cause of death.
7. It should be differentiated from hypostasis
8. Site : usually at the same site or may be shift as black eyes
4Dr. Aly Samy 2014

18. DIFRENCES BETWEEN AM &PM BRUISES
AM BRUISES
PM BRUISES
SWELLING NO
CHANGE OF COLOR
CELLULAR REACTION
BLOOD CLOTING
4Dr. Aly Samy 2014

19. DIFFERENCE BETWEEN HYPOSTASIS AND BRUISES
BRRUSIES
HYPOSTASIS
SWELLING AT AGES NO
ANY SITE OF THE BODY
DEPENDENT AREA
NO BLANCHED BY PRESSURE
YES
CUTTING OVER SHOWS BLOOD CLOT
COULDN’T BE WASHED OUT
Accompanied by abrasions
4Dr. Aly Samy 2014

20. Hypostasis: 1. A postmortem change. 2. Site: dependent parts.
3. Intact Skin.
4. No swelling, no color changes and no marked edges.
5. By pressure the color disappear.
6.The blood is intravascular, and fluidly.
7. No cellular infiltration
4Dr. Aly Samy 2014

21. 3- Contused wound 3. contused wound Definition:
An open injury produced by the impact of blunt force against the body.
It is caused by a stick, stone, or fall from a height.
The edges are usually abraded with contusions around, and the angles may be multiple and irregular.
4Dr. Aly Samy 2014

22. 4-Lacerated wound Definition
It is a contused wound where the edges are severely damaged and highly irregular, with multiple angles.
4Dr. Aly Samy 2014

23. Medicolegal importance of contused wound
1.It indicates the type of injury and causal instrument.
2.Could simulate incised
wound in the skin
stretched over bone
e.g. scalp.
3.If in the head it may
accompanied by fracture.
4Dr. Aly Samy 2014

24. Danger of Contused wound
1.Liability to sepsis.
2.Neurogenic shock.
3.Crush syndrome. Myoglobinuria  Renal failure.
4.Fat embolism (fracture of long bones).
5.On healing a scar is produced  may leave permanent infirmity.
4Dr. Aly Samy 2014

25. 5-Incised wound (cut wound)
Definition:
It is produced by drawing the sharp edge of a sharp instrument along the surface of the skin with sufficient pressure e.g. of sharp instrument, knife, razor, and broken glass.
Manner of incised wound
suicidal
homicidal
accidental
defense
Hesitation
Therapeutic
4Dr. Aly Samy 2014

26. 6-Incised wound (cut wound)
4Dr. Aly Samy 2014

27. Danger of incised wound
1. Severe bleeding.
2. Cutting of important nerves and tendons.
3. Air embolism.
4. Infection
4Dr. Aly Samy 2014

28. Medicolegal importance of incised wound
1. It indicates the type of instrument used.
2. Its site indicates the type of crime whether homicidal or suicidal.
3. Could simulate contused wound.
4Dr. Aly Samy 2014

29. Antemortem or post mortem cut wound
Edge gap widely
No gapping hg
No hg
Blood clot at the base
No blood clot
Swollen edges
No swelling
Evidence of sepsis of healing
Cellular reaction no
4Dr. Aly Samy 2014

30. 6- Stab wound Definition:-
A wound caused by thrusting or forcing sharp pointed instrument into the body, having a sharp edged blade e.g. knife, scissors.
4Dr. Aly Samy 2014

31. Wounds similar to stab Punctured Wound:
Caused by thrusting an instrument
with a blunt edge and pointed end e.g. nail.
4Dr. Aly Samy 2014

32. Wounds similar to stab Penetrating Wound:
These are stab or punctured wounds
reaching a body cavity eg: chest (pleura, pericardium), abdomen (peritoneum), joint cavity.
Transfixing Wound = Perforating Wound:
These are stab or punctured wounds transfixing a limb or even the whole body.
4Dr. Aly Samy 2014

33. Characters of stab wound
1. More deep than long.
2. The edges :
are cleanly cut without surrounding abrasions or contusions.
3. The shape:
- Bibladed knife(double dladed)  Two pointed sharp angle.
- Monobladed knife(single bladed)  One end is sharp pointed, the other is transverse
4Dr. Aly Samy 2014

34. Danger of stab wound 1. Neurogenic shock. 2. Injury to vital organs.
3. Internal hemorrhage.
4. Sepsis.
4Dr. Aly Samy 2014

35. DEFENSE WOUNDS = SELF PROTECTION WOUNDS
These results from the victim's spontaneous reaction of self protection when he is attacked.
He may either grasp the weapon to prevent it injuring a vital part, or may raise his arm or hand to ward off an attack.
4Dr. Aly Samy 2014

36. DEFENSE WOUNDS = SELF PROTECTION WOUNDS
4Dr. Aly Samy 2014

37. Fabricated wound
They are usually done by the person himself (self inflicted wounds) to give suspicious of self defense or by the aid of another person in agreement with him.
They are usually superficial,
consists of a series of parallel
or crossing incisions.
4Dr. Aly Samy 2014

38. Fabricated wound
Commonly seen over accessible parts e.g. top of the head, forehead, neck, front of chest or abdomen.
Usually there is no corresponding cuts on the clothes.
4Dr. Aly Samy 2014

39. Causes of death from wound
I. TRAUMATIC SHOCK
A. Primary or neurogenic shock:
i. Death from reflex vagal inhibition of the heart i.e. parasympathetic stimulation  slowing of the heart  instantaneous death.
ii. Death from sympathetic stimulation of the cardiovascular system .
B-Secondary or hemorrhagic shock
4Dr. Aly Samy 2014

40. Causes of death from wound cont
II. HEMORRHAGE:
Types of hemorrhage:
1. Primary hemorrhage follow immediately after injury.
2. Reactionary hemorrhage is usually delayed for several hours up to 24 hours after injury.
3. Secondary hemorrhage is due to infection of a wound, it occurs between days after injury
4Dr. Aly Samy 2014

41. Causes of death from wound
III. INFECTION OF THE WOUND.
IV. EMBOLISM:
A. Air embolism
The minimum amount of air to cause air embolism is 60 ml.
B. Pulmonary embolism due to deep vein thrombosis.
C. Fat embolism.
4Dr. Aly Samy 2014

42. CASES- I. A PHOTO showing: ORGAN:----------- Causative instruments 
against a rough
surface AS
Victim died soon after the injury
(absence of any evidence of healing
or sepsis)
4Dr. Aly Samy 2014

43. CASES- II. A PHOTO showing: -------------------- Causative instruments
their colour points to there A, M. nature absence of any evidence of healing or sepsis indicates that death
happened soon after the injury.
 Cause of death:
Neurogenic shock.
4Dr. Aly Samy 2014

44. CASES- III. A PHOTO showing: the anterior ----------chest wall
showing lesion:
SIZE .5X1.5 cm
Site: about
Elliptical in shape i.e.
caused by single
4Dr. Aly Samy 2014

45. CASES- III. A.M. wound (presence of hg.)
Death occurred soon after the injury (absence of any evidence of healing or sepsis of surgical interference.
Causes of Death:
Haemorrhage
4Dr. Aly Samy 2014

46. IV A PHOTO showing: --------------------------
wound
instrument.
DESCRIPTION  
Possible cause (s) of death:
Brain laceration
Interacranial Haemorrhage.
4Dr. Aly Samy 2014

47. 4Dr. Aly Samy 2014