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

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

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

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

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

HISTORY VICTIM CONDITION ASSILANT 4Dr. Aly Samy 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 10-16 days after injury 4Dr. Aly Samy 2014

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

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

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

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

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

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

4Dr. Aly Samy 2014