1. Forensic medicine as a medical specialty.

Types of forensic medical examinations and expert

reports.

Forensic Medicine:
is a branch of medicine where principles and knowledge of medicine is used for the purpose of the
law, both civil and criminal

Branches:
- Forensic Pathology
- finding COD as result of trauma
- finding COD as result of sudden unexpected death
- interpreting mechanism of injuries and giving medico legal opinions
- Clinical Forensic Medicine
- medicolegal examination of rape cases
- determination of age
- assessment of degree of permanent disabilities e.g for compensation
- Psychiatric Assessment
- insanity in murder case
- competency as witness
- Forensic Toxicology
- Forensic Entomologist
- estimation of time of death through examination of various insects that have invaded
body

Examinations
- examination of scene of death
- record relationship of victim to surroundings
- estimating post mortem interval at scene
- autopsy: external examination
- age, race, gender, body length, body weight, skin colour (hypostasis), personal hygiene,
congenital deformities, external marks for identification, hands, fluids from orifices,
RM, injuries
- autopsy: internal examination
- incising body
- inspecting organs
- examining cavity
- checking for pathology
- putting organs back, padding and suturing
- samples for toxicology and histology

Expert reports:
- living
- dead
- written data
 2. General characteristics and classification of mechanical injuries.
- intensity of applied force exceeding capability of tissues to adapt, therefore wound occurs
- kinetic energy = ½ mass x velocity2
- area over which force acts. e.g greater damage from varrow edge of wood plank than flat
surface
- causes: compression, traction, torsion and leverage stresses
- depends on the nature of target tissue. e.g. torsion more damaging to bone than soft tissue
- tangential impact (glancing blow): only part of kinetic energy transferred

a. abrasions
b. contusions
c. lacerations
d. incised wounds
e. stab wounds
f. firearm
g. fracture and dislocation

Incised wounds:
- caused by sharp objects
- clean division of skin and underlying tissue, therefore margins free from damage
- often meaning wounds that are longer than it is deep (cuts/slashes)
- inflicted by swiping action
- seen in suicide
- normally deeper on entry than exit point
- less dangerous than stab wounds
Stab wounds:
- can be classified as subcategory of incised wounds
- common in homicide
- deeper that it is wide
- weapon identifiers
- length, width, single vs double edged, grooving
- direction of thrust
- amount of force used
 3. Blunt force trauma – abrasion, contusion, laceration.

Blunt Force Trauma (BFT):

A moving object striking the body and or moving body striking fixed object
Blunt object: no sharp edges or points

Factors Determining the type of damage

- kinetic energy, characteristics of blunt object and angle of impact
- characteristics of human body
- objects between blunt object and human body
Types of surfaces of blunt objects
- wide flat, small flat, rough, spherical, cylindrical, edges
Mechanisms of BFT
- hit (impact)
- compression
- extension
- friction
BFT Injuries classification
- abrasions
- contusions-bruises
- lacerations
- bone fx
- internal organ injuries
Abrasions
- superficial layers of skin are damaged (sliding motions, firm downward pressure on skin)
- superficial injury: does not extend through skin full thickness
- am - reddish/brown: PM after 6hrs so AM abrasion can be seen
- pm - yellowish (from drying): apply H2O will go pink, differentiates from AM abrasions
- present at point of impact
- may exhibit a pattern of the object
- may show direction: curled skin tags and terminal skin tag
- may suggest sever internal inj
- heals w/o scarring
Contusion-Bruises
- force applied to skin sufficient to rupture veins, leading to escape of blood into surrounding
loose connective tissue
- site does not always correspond to impact point, may migrate along tissue plane w/ gravity
- rarely exhibit pattern: some are characteristic e.g. police batton (2 parallel lines of bruise)
- DDx from PM lividities: cut it. Contusions is extravascular
- special areas of interest: neck, inner aspect of arms (restraints), inner thigh, scrotum
- intradermal bruises: negative imprinting from car

* soft tissue contusions are dark red

*heparin cream can speed up healing
Lacerations
- irregular shape: full thickness skin penetrated
- ragged edges with bruising and abrasions
- bridging tissues inside: connective tissues and nerves differentiate from cut. (if covered with
hair, hairs will bross wound)
- always scars
- smashed vessels: debris at base of wound
- lacerations originating from inside will not have abrasion and bruising (e.g compound Fx)
 4. Blunt force trauma – bone fractures and internal organ injuries.

Bone Fx:
- bones more vulnerable to pulling then pressure
- direct vs indirect
- direct: occurs at point of impact
- indirect: occurs at distance away from force application but at time of impact
Types:
- single and multiple
- open and closed
- unilateral/bilateral
- Fx by bending
- compression Fx
- complete/incomplete
- oblique
- transverse
- longitudinal
- spiral
- epiphyseal
- metaphyseal
- diaphyseal
- avulsion

Fx face: Le Forte
I - Fx across maxilla
II - pyramidal shaped Fx
III- craniofacial separation

Coup - contrecoup injury (brain)

- cerebral contusions and traumatic SAH pattern of injury at site of impact (mild) and injury at
opposite side maximal, where it accelerates or recoils away from impact and hits other side of
skull
- often temporal poles
Flail Chest
- segment of rib cage breaks
- moves independently in opposite direction to rest of chest
- “paradoxical breathing” and pul. contusion
Solid organs:
- more commonly injured in BFT
- spleen, liver, kidneys, bladder
Inertia:
- internal organ trauma
- dark red contusions
- differentiate aspiration
- traumatic emphysema
- pneumothorax
- flail chest
- organ rupture: heart, spleen, liver, lungs
- contra coop
- brain edema
 5. Blunt force trauma – fall from height.

Fall from height:

- accidental/suicidal/homicidal
- from: balcony/window/ roof/scaffolding/tree etc..
Types of fall:
- direct fall: ends with single hit of the body on the ground
- stair like fall: body hits different objects before it falls on ground
- free fall: only the body falls
- jointed fall: with other objects
- active: body falls due to previous acceleration (homicide or suicide)
- passive: w/o acceleration
Types of falling:
- on legs, gluts, head, side, back, front (dictate injury pattern)
factors affecting severity:
- height, surface, age (osteoporosis), BW, clothes, type of fall, alcohol (transverse laceration on
back point of head common in drunks)
Mechanism of injuries:
- primary direct: at place of impact
- primary indirect: at place distant from direct impact
- secondary: secondary impact on ground
Types of injuries:
- typical: laceration on one side, minor external and massive internal signs of body concussion
- nonspecific: Fx, contusion, bruises
- 1 straight leg: primary foot, secondary hand or lateral side
- 2 straight legs: primary both feet, secondary drop lumbar, back, neck, elbows
- gluteal area: primary gluteal, secondary back/neck (fractured coccyx)
- head: primary head, secondary side/rear surface body
- polifragment fx of skull
- ring fx around foramen magnum
- compression fx vertebral column (atlanto occipital joint)
- fx sternum and ribs
- back: delamination of skin with blood pocket formation, pelvic trauma, side (transverse
skull fx/ ribs: 3 lines on side, 1 line on opposite)

Falling from own height v falling from high places:

- own height:
- can sustain multiple fx depending on bw and contact surface
- injuries on top of head (vertex) are suspicious and rare from falling
- examine for suspicious bruises under axillae
- signs of altercation (ex. nail marks)
- high places:
- concussion signs on body: increased ruptures, lung injuries, pelvic fractures

COD from falls:

● head trauma
● polytrauma
● septic MODS
● PE
● Blood loss
Long term causes of death from skull fx
● traumatic epilepsy
● infection
● epidural haemorrhage
 6. Motor vehicle accidents – trauma to pedestrians.

Trauma to pedestrians
- most common road fatality
- acceleration process
Injuries:
- primary injuries: first impact on victim,
- secondary injuries: subsequent contact with ground
- characteristic injuries: not themselves proof of RTA but corresponding to RTA
- specific injuries: specific to vehicle (tire tread, emblem with unique identifier)
- nonspecific injuries: laceration, fx, abrasion, contusion
- 4 Phases:
- impacting phase
- upper body going over bonnet → depends on impacting phase hitting below
center of gravity
- rejection phase and falling on ground → can be second phase if victim falls
forward, may then be run over
- sliding of body → terrain abrasions
*increased speed of impact can throw body high in air and increase severity of
injuries “scooping up effect”
- Most common trauma is to legs→ bumper contact (butterfly fx)
- transverse tibial tx if lifted (walking)
- oblique tibial fx if height bearing
- older cars have smaller bumpers therefore more damage as surface area decrease
- if fx seems too low - consider rapid breaking lowers frot of car as it descends on suspension
- sudden overstretching - superficial stretching on opposite side of impact
- SC injuries - thoracolumbar junctions, cervicothoracic
- Axial overload - smashing several vertebrae
- head injuries are most common cause of death
- RTA most common cause of skull fx (often basal)
- dragging by car - Carbonised epidermis and bone from heat

Running Over by Car

- active wheels: skidding on human body
- passive wheels: climb on body
- flaying injury.: tearing skin and muscle from limb or head
- maybe great internal damage and little surface damage
- 4 Stages:
- 1. impact
- 2. climbing:
- traumatic pocket formation
- fills with fat, can embolize
- can fill with blood
- 3. vehicle on top
- 4. climbing down
- liver and mesentery can be divided over vertebral column
- flail chest
- intradermal bruising
- negative pattern as skin and blood forced into grooves of tire tread
- Dirt pattern on clothes will be positive pattern
 7. Motor vehicle accidents – trauma inside the motor vehicle.
pattern of injury varies according to position of the occupant

The Driver
- unrestrained driver first slides forward so legs hit parcel shelf then body flexes across steering
wheel and head goes forwards and strikes windscreen
- the whole body then ejected through broken glass to land on the bonnet.
- engine maybe forced back into seating area and A frame may impinge driver
- rear impact→ whiplash hyperextension
Characteristic lesions:
- impact abrasions, lacerations and fx of legs around knee
- pressure on foot from pedal - lacerations and fx
- post hip dislocation
- rupture of liver and spleen on steering wheel and fx ribs and sternum
- upper limb injuries less common
- injuries to face and head: lacerations, incisions, fx, intracranial haemorrhage, ocular
injuries
- hyperflexion and hyperextension of [Link] → fx or dislocation. often atlanto-occipital
dislocation
- pendulum effect of heart → aortic rupture or dissection
- ejection in. - usually multiple and can be of any kind (being struck by other vehicles,
contact with road)

Front Seat Passenger

- drivers more commonly killed (because often there is only the driver)
- passenger seat slightly more dangerous
- less likely to have warning about crash
- less steering wheel protection
- often skull fx
Rear seat occupant
- strike back of front seat
- or thrown over seats and ejected

Seatbelts
- reduce death by 25%
- most are 3 point attachment belt
- shoulder harness used in racing cars
Seat Belt injuries
- can hinder escape from burning vehicle
- if person too small for belt → garotte neck
- bruising in diagonal or transverse component
- lap strap: - SI or LI rupture
- bladder rupture
Airbags
- speed of >200mph
- facial bruising, partial-complete amputation fingers
- dislocated - fx arms, [Link] and fatal head injuries
- eye inj. corneal abrasions and chemical burns from unburned NA acid in airbag release to blow
out fx and globe rupture
Motorcyclist
- high speed
- no restraint of body
- knee trauma
- femoral condyle explosion fx
- hinge fx of skull
- ring fx
 8. Railway trauma.
- small children can be sucked towards fast moving train
- suicides: look for alcohol and drugs in toxicology
- level crossing accidents

injuries are not very specific:

- typically: severe mutilation (often found naked as clothes thrown off)
- amputations
- decapitation
- crushed decapitation
- squeezing zone/wiping zone : dust, oil and abrasions seen. lateral to squeezing zone of
injury
- search for unusual injuries in case of homicide
- rail workers may be trapped between trucks (flail chest)
- electrically charged railways of underground/metro
- complicate injuries with electrical burns
 9. Injuries caused by sharp objects – stab and stab-incised wounds.
shram object have pointed tips/cutting edges - do not cause wounds with tissue bridges

Classifications:
- stabbing objects → stab wounds
- cutting objects → incised wounds (cuts)
- stabbing and cutting objects → stab-incised wounds
- chopping objects → chop wounds
Stabbing objects pointed tips
- pointed tip punctures skin/mucosa and body of injuring object separates tissues in the depth
- injuries are called stab wounds: deeper than they are wide
shapes
- smooth edges
- pointed angles
- no abrasions
- depending on features of inuring object, edges might be inverted
- blunt body leaves laceration lines but stab incised will have even edges through all layers
stab wounds
- entrance wound
- wound channel
- exit wound
- slits in different planes due to langers lines
- natural alignment of collagen fingers within the dermis
- skin, fusion, [Link], deep muscle
Stab incised wounds
- triangular or slit like depending on shape and taper of blade: with one or two pointed angles
correlating to 1 or 2 cutting edges of blade
- tissues in depth are cut in single plane (examine wound layer by layer, no bridges)
- smouth wound edges
- injuries from handle - imprings, suffusions, abrasions
- superficial or deep additional cuts - twisting of knife, movements of victim
COD
- air embolism
- acute haemorrhage → renal failure, thyroid pallor, decreased lividity, pale cortex kidney,
decrease in blood
- organ trauma
- infection
- pneumothorax
 10. Injuries caused by sharp objects – incised and chop wounds.

Incised wounds
- might have different depth along length of the injury: also called slashes or cuts
- In the common case, deeper at the beginning of the cut and become more shallow at exit.
- superficial tail may be present - shallow scratch running from termination of slash
- less dangerous than stab wound as more shallow, therefore less likely to compromise organs or
blood vessel
- most common on arms and legs
- neck is most dangerous site: as superficial vessel
- bleeding is most serious complication-will be external and easier to treat than treat hidden
internal bleeding of stab wound
- glassing gives characteristic slash wound: [Link] edges and glass spikes

chopping wounds
- cutting edge: axe
- higher kinetic force - acceleration prior impact

wounds-smooth edges
- pointed angles
- wedge-like cross section
- chopping of bones
- traces → identification of injuring object

defence injuries
- attempts of the victim to protect the head and other body areas
- mechanisms:
- carving area
- grasping blade of injury object
- arms, forearms, hands, palms

survival period after wounding and discussion of victim ability to feel pain requires investigation of
blood loss, defence injuries, injured area,age, intoxication, gender etc
- may be requested by police/courts
 11. Injuries caused by firearms – general characteristics.
- firearm injuries are mechanical traumatic injuries
- their features depend on;
- features of firearm
- type of jnuring shell
- additional injuring factors
- action of secondary formed projectiles
- projectile ejection and movement are provided by energy of burning gunpowder

Types of Firearm:
- long barreled
- [Link]
- short barreled
- smooth barreled
- with grooves (rifled)
- caliber= diameter of barrel
- small 5-6mm
- med. 7-9mm
- large >10mm
Cartridges
- projectile gunpowder capsule/case
- disbalanced bullets increase damage
- steel heart bullets
- superficial cuttings - bullet opens on impact
- naked lead - tip is smashed
- hollow point - stays in body
- projectile ejected from the muzzle due to action of gases formed in
the process of burning gunpowder. very high pressure.
gun fingerprint:
- on bullet - traces barrel imprints on surface. bullet is slightly larger
than barrel, therefore in contact and grooves of barrel put spin on
bullet and leave traces
- on cases - hollows at bottom unique
Mechanism
- projectile passes through tissues → pulsing cavity formed due to
changes of pressure causing injury in distant from wound canal
- additional injuring factors:
- fire, gases, soot, gunpowder and metal particles
- secondary formed projectiles:
- metal particles, fx bones
Entrance wound:
- minus tissue - cannot be repaired as there is missing tissue
- smaller than bullet as skin is stretched
- inverted edges
Exit wound:
- variable appearance - usually laceration/can be fissure
- additional projectiles can make it wider (e.g bone fragment)
- usually bigger and irregular
- without wiping and powder marks
- everted edges
transitory injury - entrance and exit wound
blind injury - entrant and wound canal
central zone - projectile
contusion peripheral - kinetic energy impact
concussion zone - necrosis takes time
 12. Contact and close range shots.

Contact Wounds - muzzle touching skin

- depends on tight or loose contact
- bubble of injected gases
- radial lacerations
- additional factors inside wound canal
- local reddening from heat and CO
- very little tattooing
Death through:
- haemorrhage
- brain tissue damage
- thrombosis
- infection
- hypostatic pneumonia
- SAH - thoracic shot increase. BP
Short range
- no radial lacerations
- symmetrical wound
- additional factors on skin - heavier weight of additional factors travels furthest. eg. metal
particles travel further than soot
- ring of wiping - of dirt from bullet
- ring of abrasion
- small burns from tattooing
- little CO in tissues
- burnt hair
 13. Long range shots.
- injuries cause only by projectile
- no additional factors
- ring of wiping at inner margin of ring of abrasion (frayed keratin ring)
- if shotgun - diffuse pellet pattern

14. Injuries caused by rifles and explosives

Hunting Rifles
- cartridges
- pellets
- less kinetic energy individually
- separate or act together depending on distance
- no wound canal
- just entrant wound
- if very long range, bullet may tumble in air and strike sideways → rectangular entrance wound

Explosions
- an explosions is a rapid increase in volume and energy release in an extreme manner, with
generation of increased temperatures and release of gases
- enclosed explosion increase injury effect as greater gas pressure
explosion zone - at epicenter
- frontal zone of compressed air
- zone of vacuum - explodes human body
- shock wave zone - massive blunt force
- zone of impact
- projectiles and objects causing injury
- chemical agents → inhalation
Injuries:
close range: disintegration of body, massive burns and fx, 10 rupture, bright red tissues (CO)
medium range: shock wave injuries, falling of body cause injury, primary and secondary
projectiles
distant range: projectiles in body

*lungs greatest affected

- subpleural haemorrhages
- intrapulmonary haemorrhages
- internal ear rupture
*GI - pressure changes → haemorrhage and rupture

Forensic examination
- trace evidence
- DNA analysis
- x ray examinations
 15. Cause of death and genesis of death caused by mechanical injuries.

Cause of death:
- the reason or event precipitates death
Manner of death:
- the fashion of circumstances that result in death
- natural vs unnatural (accidental/suicidal/homicidal/undetermined)
Mechanism of death
- process that causes one or more vital organs or organ systems to fail
Genesis of death
- chain of processes that lead to fatal outcome
Traumatic causes of death
- early primary + (postponed secondary complications of primary injury)
- More than one cause of death

Primary Causes
- severe traumatic injuries of body part, incompatible with life
(head/neck/thorax/abdomen/detachments)
- blood loss
- quantity of blood loss
- period of blood loss → anemia of cadaver
- type of injured BV
- internal vs external haemorrhage
- compressions syndrome
- hemopericardium, haemothorax, pneumothorax, IC haemorrhages
- concussion of internal organs
- brain concussion
- heart concussion: angina pectoris traumatica/heart rhythm disorders
- blood aspiration
- MA
- DDx blood aspiration (good border between parenchyma) and lung contusion
(parenchyma is masked)
- embolic complications
- air embolism
- fill pericardium with H2O and puncture heart (bubbles will escape if air
present)
- or bore a needle into RV with 50ml H2O (bubble in H2O). Must do at
beginning of PM
- gas embolisation
- thrombotic embolism
- fatty embolism: from bone fx or traumatic pocket
- tissue embolism
- traumatic shock
- decreased volume
- increased peripheral resistance as vasoconstriction
- reflexory inhibition of heart
- vagal
Late (secondary) causes of death
- infections: pneumonia/meningitis/sepsis/abscess
- noninfectious: adhesions/strictures/traumatic toxicosis (crush syn), thromboembolism
 16. Thermal trauma – injuries caused by extreme temperatures.
- tissue injury due to application of heat in any form to the external or internal body surfaces

Classification
- high temperature injuries
- dry heat (combustions): flames/hot surfaces/objects = burns
- moist heat (ambustions): hot liquids/hot gases =scalds
- cold injuries
- general (hypothermia) and local (frostbite)
- electric contact
- radiation burns: X rays, UV rays

High Temperature Injuries:

- 44C can burn if in contact for 5h
- 60C takes 3 seconds
Hyperthermia
Causes:
- field work
- factory work
- overexposure and overdressing (esp. young children)
Pathophysiology:
- high temperature, impaired metabolic proteins → degradation and renal failure
- drop in blood pressure, hypoxia, metabolic acidosis, increased vascular permeability
- stress releasing substances - biogenic amine → produce further heat
Clinical Manifestation
- fever/erythema/tachycardia/tachypnea/HA/dizziness/adynamia/decreased LOC/ irritability
Autopsy
- liquid blood/stasis/thrombosis/brain edema

Burns
1°- combustio erythematosa: redness and inflammation (not PM as vital reaction)
2°- combustio bullosa: blisters due to exudation (involves partial dermis)
3° - comsutio ascharotica: heels with rough scars (all skin layers involved, analgesia)
4° - reaches muscles and bones (carbonization)

Rule of 9 for body% (30-50%=death)

● Head/neck - 9% TBSA
● Each arm - 9% TBSA
● Anterior thorax - 18% TBSA
● Posterior thorax - 18% TBSA
● Each leg - 18% TBSA
● Perineum - 1% TBSA
Age of burn
- immediate redness
- 2-3 hours vesication
- 36-72 hours purulent inflammation
- 1-2 weeks sloughing
- >2 weeks granulation
- scar formation
Carbonisation = prolonged action of high temperature
- charred tissues → black
- corpse is position of boxer (contractions as flex bulkier protein degradation)
- skin splits (as it contracts worse on extensors)
- brittle bones
- skin charred
 - heat haematoma
Death form burn
- 1° shock: from fear or pain
- 2° shock: hypovolemia
- toxaemia
- septicaemia
- asphyxia: CO, CO2 and smoke
- spasm and edema of glottis
- determining if victim was alive at the time of fire by CO + carbon particle in the lungs
- antemortem burns usually reddened and blistered with erythematous ring/basse
Scalds
- horizontal fluid level
- uniform skin damage with sharp demarcation
- when poured from height - scalds more severe in areas of initial contact
- do not cause carbonization or singing of hairs
- old and young px at rik
- death through shock, fluid and electrolyte disturbance and secondary chest infection.

Local Cold Injuries

- frostbite: exposure to dry cold
- 35.5C - 37.5C = normal
- 1° congelation erythematosa
- 2°congelation bullosa
- 3°congelation gangrenosa
- 4°congelation necrotica
Hypothermia (<35C)
- <25C = absolute death: loss of tissue vitality/respiratory arrest/arrhythmia
- compensation: vasoconstriction, shivering, heat production
- decompensation: hypoxia/ 1° stoppage of breathing
- autopsy findings: due to vasoconstriction and stagnant anoxia
- pink skin
- gangrene fingers and toes
- red colour of blood
- congestions of internal organs
- hemorrhagic erosion of GI mucosa (vishnevsky spots)
 17. Injuries caused by electricity.
- electrical current may be DC or AC
- AC is more dangerous than direct current; as there is “hold on” effect stronger flexors go into
spasm involuntary AC also more likely to cause AF
- 24 volt current is domestic supply→ usually enough to cause death

Fatal electrocutions - 3 Mechanisms (electrons crossing vital structures)

- current passage across heart - hand (live) → hand/foot (earthed)
- causes cardiac dysrhythmia, usual VF→ asystole
- most common
- current across chest → respiratory paralysis from spasm of IC muscles and diaphragm
- body will have severe congestions and hypoxia
- current through head and neck
- overhead contact→ direct brainstem effect: cardiac/respiratory paralysis
- victims may be thrown from height → death

Severity depends on
- current 50-80mA=death
- voltage 240V=death
- resistance→skin pads most resistant, less resistance by sweat
- time of exposure

Cutaneous electrical marks

- electrical/joule burns: sites of entry of current
*fatal electrocution in bath may not leave mark as low resistance and increased SA
- contact burn: heating of tissue fluids → steam → splitting of epidermal-dermal
junction→blister
- spark lesion :less firm contact → air gap→current jumps → outer keratin melting and fusing
into hard raised brown nodule
- the lesions often combined due to movement
- lesions have areola of blanched skin at periphery (from arteriolar spasm) *pathognomonic
- high voltage lesions
- multiple spark lesions → crocodile skin effect
- earthing (exit) lesions
- less severe, not always seen
- puncture wounds
- charring if long contact
- metalization: metallic ions and tissue anions from metallic salts, may be seen grossly
 18. Mechanical asphyxia – definition, classification, mechanisms of death.
- acute hypoxic state caused by a mechanical factor causing disturbances in the breathing process
in upper respiratory tract, trachea and bronchi

Classifications
MA due to pressure
- strangulation (pressure to neck)
- hanging/ligature strangulation/manual strangulation
- obturational asphyxiations
- pressure over nose and mouth (smothering)
- stuffing of airways with FBs (gagging)
- drowning (fulfilling of airways with liquid substances)
Stages of MA
- preasphytic stage: 15s-1min holding breath
- stage of dyspneoae and convulsion 1-2min
- stage of peace (apnea)
- stage of terminal breathing movements (1min)
- stage of autonomic cardiac activity (3-10min) (20-30 min in cold water)

Morphological signs of quickly occurring death

- external signs
- facial cyanosis (due to congestions from obstructed venous return)
- petechial haemorrhages (conjunctiva)
- exophthalmia and facial edema
- nose and ear haemorrhages
- massive intensive lividity
- internal signs
- visceral cyanosis
- petechial haemorrhages on visceral pleura (tardieu spots), epicardium, kidney mucosa
- lung and brain edema
- acute alveolar emphysema
- classic signs= now considered unreliable
- congestion
- petechiae
- edema
 19. Mechanical asphyxia - strangulations.

MA due to pressure of the neck

- hanging
- ligature strangulation
- manual strangulation

Mechanism of death
- disturbance in brain circulation
- occlusion of jugular return → causes classic signs and symptoms of asphyxia
- occlusion of carotid aa → requires greater force. immediate loss of consciousness
- disturbing respiration
- pressure of [Link]
- pressure on baroreceptors → bradycardia and total cardiac arrest
Hanging
- strangulation due to pressure of the neck by mechanical factor
when the ligature is tightened by weight of the body or body parts
- strangulation mark
- negative imprint from the strangulation object: abrasions and bruising
- deep to strangulation mark: soft tissues are bruised (dark red)
- look for fx to hyoid bone +/- thyroid cartilage
Ligature strangulation
- strangulation due to pressure to enck by mechanical factor
when ligature tightened by some external force
- might be suicide
- strangulation mark
- deeper than in cases of hanging and more perpendicular
- towards the long axis of the neck
Manual strangulation
- due to pressure of the neck by someone else's hands, knees, feet, forearms etc. (ex. George
Floyd)
- homicide in all cases
- traumatic injuries caused by fingers
- abrasions, scratches, oval or elongated, positive or negative bruises with paler central
zone
- deep traumatic injuries are more massive b/c high force of pressure
 20. Mechanical asphyxia – positional and traumatic.

traumatic asphyxia
- restricts respiratory movements and thus prevents inspiration
- gross mechanical forces are usually the reason for thoracic cage fixation
2 main conditions
- 1. chest and abdomen compression by object, preventing chest expansion and diaphragmatic
lowering. ex:
- burying in excavation collapse
- avalanche
- pinning under tractor
- 2. crushing in crowds
- hillsborough, heisl
Features
- degree of congestion and cyanosis ↑↑↑
- conjunctiva haemorrhage
- hemorrhagic tissue may bulge out through lids (whites of eyes obliterated)
- swollen face
- bleeding from ears and nose
- extends below neck
- lungs dark and heavy (tardieu spots present)
- Right heart and veins distended
- pressure on the chest forces blood back into great veins and subclavian valves
prevent blood from going to the arm, therefore engorgement in the head.

Positional/postural asphyxia
- obstruction of the respiratory movements of chest, abdomen and diaphragm due to the
particular posture of the patient body.
- there is no mechanical obstruction, compression ot lack of air
- seen in prisoners, mentally ill or alcoholics with hands tied behind body whilst lying on front
- hyperextension or hyperflexion of body limiting respiratory movements
- factors facilitating asphyxia
- fatigue (frome struggle)
- alcohol
- drugs
- mental status
 21. Drowning.

Stages of Drowning
- preasphytic stage
- 15-20s to 1 min
- holding breath with motor resistance
- stage of dyspnoea and convulsions
- apnoea
- slowing of HR and low BP
- stage of terminal respiratory movements
- unregulated depper and short breaths with passive exhalation
- stage of autonomic function of the heart
- 3-10 mins after breathing stops

Examination of body
white froth in air passages
- edematous fluid from lungs containing proteinaceous exudate and surfactant mixed with H2O.
- pressing chest can cause foam to come out of nose and mouth, can be pink if admixed with
haemorrhage
internal organs
- lung highly bloated with imprints from ribs. obliterate [Link]. “emphysema
aquosum”
- subpleural haemorrhages
- tardieu spots: pinpoint haemorrhage (drowning in salt H2O)
- haemorrhages of rasskazov: large spills with vague borders from drowning in fresh
H2O
- sign of svetshtnikoc: fluid in the sinus of sphenoid bone

fresh water drowning

- H2O can enter the bloodstream through lungs as it has lower solute conc. than plasma →
haemolysis
- PM: “washer woman’s skin” on hands after prolonged immersion
 22. Suffocation/smothering, aspiration (gagging, choking).

suffocation
- general term used to indicate death from O2 deprivations, from lack of gas or obstruction of
airways
smothering
- is more specific, in that it indicates blockage of the external air passages, usually by hand or
soft fabric.
gagging
- where fabric or adhesive tape occludes the mouth to prevent speaking or shouting
- while the nasal passages remain patent, air can enter, but later blockage by mucus or edema
may lead to death
choking
- refers to blockage of the upper airways by some FB, but is also used for manual strangulation.
smothering
- mechanical occlusion of mouth and nose
- usually fabric
- could be mobile solid (eg. sand or mud)
- death through occluding substance pressing down on facial orifices
- deliberate homicide is seen in old, debilitated and in infants
- pressure marks on face difficult to distinguish from PM changes
- if has been struggle - may be signs of facial petechiae
Plastic bag suffocation
- often leaves no signs of asphyxia or petechial haemorrhages

Autopsy signs of suffocation/smothering

- bruising over mouth, chin and nose
- buccal abrasions from pressure
gagging
- originally airway may be patent
- later obstruction from edema and mucous or movement of gag backwards into NP → death
(robbery upgraded to homicide)
choking
- blockage of airways between pharynx and bifurcation of trachea
- death from pure hypoxia - struggle will lead to classical asphyxia signs
- death can occur from neurogenic cardiac arrest (before hypoxia occurs)
causes:
- FB, denture, haemorrhage, food material (from mouth/regurgitated from stomach)
- obstructive lesions: epiglottitis,edema of hypersensitivity
 23. Forensic identification of toxemia. Pharmacodynamics and pharmacokinetics of poisons.
Classification of poisons.
intoxication
- the pathological process which develops as a result of the action of a poison
- poisons are substances which cause disturbances in the organism in relatively small doses
Factors
- features of substance: dose/purity/conc.
- route: PO/IV/rectal/inhalation ect
- organism features: age/sex/smi/tolerance
- environmental conditions: temperature/air movement/humidity/medical help
toxicodynamics
- interaction between poison and organism, leading to functional and morphological changes,
pathological processes and death
toxicokinetics
- changes of poison in organism: absorption, distribution, metabolism, elimination
identification of intoxication
- medical and investigational data
- signs and symptoms
- autopsy
- additional examination - toxicological analysis

Classification of poisons - according to site and more of action:

Local action
- corrosive:
- strong acid (mineral acid)
- metallic (mercuric chloride)
- irritant: mechanical - glass powder
- chemical: inorganic
- metals: arsenic/lead/mercury
- organic : chemical presentations
Remote action
- neurotics: CNS poisons
- opioids/[Link]/belladonna

Samples
- blood:
- femoral or iliac veins
- never from body cavity as will be contaminated from urine, feces, gi contents
- urine 20-30mL
- vomit and stomach contents
- feces:
- in suspected heavy metal poisoning
- arsenic, mercury, elad
- liver and other organs
- liver
- bile
- lung - for solvent abuse
- hair and nails
- heavy metals
- vitreous humour
- in bodies with increased decomposition
- zone of tissue if injection of poison into muscle
 24. Corrosive agents.
- acids are rare in suicide nowadays
- mineral acids (vitriol throwing) are used in homicide
- penolic acids - carbolic acid and lysol occasionally seen in suicide
- damage is structural rather than poisonous

Features
- spillage of fluid on exterior → corroding skin in pattern (allowing posture determination rickle
marks)
- interior mouth erosion, tongue swollen, pharynx and larynx eroded
- if aspiration : pul edema and haemorrhages
- lower esophagus and stomach: desquamation to perforation and discoloration
- COD: pul edema from spillage to lungs, if lasts >1day bronchopneumonia
Acids
- dehydrate tissues
- coagulate proteins→coagulative necrosis
- convert H6 to haematin
- sulphuric acid : general heat → black tissues
- nitric acid: brown/yellow mucosal damage
- HCL: greyish sloughing stomach
- peholic acid: stiffens tissues
- Alkalis: liquifications. colliquatine necrosis
- NaOH: dirty white discolouration
Oxalic acids and salts
- not as corrosive as mineral acids
- cause death within an hour from shock or hypocalcaemia
- calcium oxalate crystals seen in stomach
- death through R+N if survive acute stage
 25. Carbon monoxide intoxication.

sources:
- exhaust gas
- faulty gas appliances
- burning timber and fabric
- steel works (industrial
could be:
- suicide
- homicide
- accident

Carbon Monoxide
- heavy, colourless, odourless gas
- 250x affinity for H6
- even in small concentrations can displace O2 from RBC and diminish O2 transport
- high concentration can kill in minutes
- carboxyhemoglobin > 50-60% fatal in adults
- varies in individuals sensitivity

Signs and symptoms

- insidious headache → come and death
- N/V
- vertigo
- muscle weakness

External signs
- pink colouration of skin “cherry pink lividity”
- nail beds and lips may show this colour also
Internal signs
- carboxyHb and myoglobin render all organs pink
- pulmonary edema
- bilateral cystic degeneration of basal ganglia if individual survived for a time
 26. Illicit drugs intoxications.

illicit drugs
- substances prohibited by law
- illegal manufacture, possession and use
- varies country to country

classification
opioids natural opioids morphine/codeine/papaverin

semi synthetic heroin

stimulants natural cocaine

khat

ephedrine

amphetamines

synthetic methamphetamines

ecstasy

hallucinogens natural mescaline/muscarine/psilocin

semisynthetic

LSD

synthetic PCP,ketamine

atypical cannabis

hashish

tranquiliser BZD, barbiturates, antihistamines

inhalants ether poppers
Designer
drugs

COD:
- OD
- combined poisonings
- last intake dose in combo with low tolerance (heroin users post-rehab)

specific complications of drug abuse:

- heroin:
pul. edema, track marks, crystals in lung, pneumonia, hepatic steatosis, hepatitis, myocardial
fibrosis, atherosclerosis, cerebral edema, finger burns (smoking), yellow discolouration
- stimulants:
crack thumb, CAD, CA spasm, myocardial hypertrophy, MI, valvular heart dz, perforated nasal
septum
 27. Ethyl alcohol intoxication.
- ethyl alcohol most widely used drug in world
- depressant
- H2O soluble

Absorption
- 20% stomach
- 80% intestines: mucosa contains alcohol dehydrogenase
- fatty food delays pylorus opening and blocks contact of EtOH with mucosa
Elimination
- metabolized by liver 90%
- 5-8% excreted unchanged by kidneys
- rate depends on the individual. Chronic alcoholics have ↑CP450 enzymes, therefore rapid
metabolism
- average rate: 11-25mg/100mL/h. 8g (1 unit) per hour
Measurement
- milligrams per 100 millilitres (mg/100mL)
- BAC (Blood alcohol conc)
- 0.2-0.5% subclinical
- 0.5-1.5% light degree
- 1.5-2.5% medium degree
- 2.5-3% heavy (severe) degree
- 3-5% fatal alcohol poisoning
- 5-6% absolutely fatal intoxication
Phases
- agitation
- inhibition
- paralytic
- withdrawal signs and symptoms
- metatoxic phase (hangover)

Dangers
- respiratory paralysis
- falling
- aspirating vomit
- RTAs
- violence
- burns
- drowning
- liver issues
- liver failure
- PHT - esophageal varices
- HCC
- wernicke encephalopathy
- DT
 28. Forensic examination in cases of physical assaults.

Anamnesis
- data from victim, parent, witness
- includes
- what happened
- when did it happen
- how did it happen
- which objects caused the injuries
- who was perpetrator
- must be tactful if interviewing child
- help from psychologist often needed
Examination of victim
- specify circumstances
- time at beginning of examination
- surrounding conditions: day/night
- standard clinical examination techniques with additional elements
- check clothing
- stains/slashings/burns/traces
- advice for preservation of clothing samples
- body traces
- including under nails
- properly described and collected for additional tests
- samples should be properly labelled and dates
Description of injuries by “verbal photography”
- localization
- anatomical area
- position in relation to anatomical points (nose, umbilicus, articulations, etc.)
- distance from anatomical lines (medical clavicle, axilar etc.)
- direction/position
- towards anatomical lines (medium line of body, head, neck, etc)
- shape
- nails
- knuckles - DNA swabbing
- size
- at least in 2 perpendicular planes
- size specific elements (if there are any)
- more complex shapes should be measure in planes for each
- edges, wall, angles of wounds
- colour, surface, depth of injury
- soiling, FB, biological and non-biological traces
- status ands tage of reparative processes
Drawing location and type of injuries on schemes.
Schematic visualization.
Taking photos.
 29. Forensic examination in cases of sexual assaults.

Anamnesis
- data from victim, parent, witness
- includes
- what happened
- when did it happen
- how did it happen
- which objects caused the injuries
- who was perpetrator
- must be tactful if interviewing child
- help from psychologist often needed

Additional questions
- sexual contacts before or after
- age of first sexual contact
- age of first menstruation
- Hx of abortions
- complaints, signs and symptoms
- details:
- how many times
- how long
- specific anatomical features of abuser
- condom
- ajaculation
- anal involvement
- questions should be apporpriate for the age of the victim and his/her ability to understant what
happened in the incident

Examination
- genital system
- no medical tools that can cause further trauma
- in gtinecological position
- the hymen should be examined by stretching labia downward
- swab from back of hymen to identify perforation
- hymern types:
- tubiformis angular (most common), semilunar, fimbratis,carinatus, denticularis,
spinalis, crivriformis, pseudocribiformis, subseptius, imperforates
- true perforation - dent reaching fibrous ring
- 14-20 days for penetration to heal
- initially bleeds → edema → whitish
- some may appear fragmented, difficult to identify perforation
- possible for intact hymen if sexually active
- Anus examination
- knee to elbow positions
- anus has possibility to stay open without any traumatic injuries in area
- features of anal and genital areas must be described in details including:
- presence of biological traces
- injuries (linear lacerations)
- inflammation
- obtaining samples from biological traces from areas
- labia majora
- vestibule
- vagina
- perianal areas
- anus an drectum
- lips
- face
- neck
- breast area
- hips
- Description of injuries by “verbal photography”
- localization
- anatomical area
- position in relation to anatomical points (nose, umbilicus, articulations, etc.)
- distance from anatomical lines (medical clavicle, axilar etc.)
- direction/position
- towards anatomical lines (medium line of body, head, neck, etc)
- shape
- nails
- knuckles - DNA swabbing
- size
- at least in 2 perpendicular planes
- size specific elements (if there are any)
- more complex shapes should be measure in planes for each
- edges, wall, angles of wounds
- colour, surface, depth of injury
- soiling, FB, biological and non-biological traces
- status ands tage of reparative processes
- Drawing location and type of injuries on schemes.
- Schematic visualization.
- Taking photos.
- pregnancy and STI testing
- light microscopy for spermatozoa (1 day)
- PSA detectable for 3 days (nonspecific)
 30. Diagnosis of death. Forensic classification of death.

somatic death
- person loses consciousness and unable to carry out voluntary movement
- may still have reflex activity
- cardiorespiratory functions persist with or without support
- brain death/vegetatice state
cellular death
- tissues and cells are dead
- no metabolism
- process: as different tissues die at different rates
indications of death
- cardiorespiratory arrest
- irreversible brain damage
- 7-9 mins anoxia
- if hypothermia may be extended as decreased O2 requirement
- unconscious and loss of reflexes
- muscle flaccidity
- loss of corneal nd light reflexes
- beloglazov sign “sign og cats eye
- squeeze eye→pupil goes oval (10-15 mins after death)
Autopsy requested for different reasons
- death occurring in Sx
- suspected unnatural death
- potential poisoning or industrial dz
- unknown COD
- deceased had not been seen by doctor either after death or >14days before
- deceased was not attended in his last illness by doctor completing the certificate

phases of terminal state:

can be rapid or slow. rapid = acute death, slow=agenic death
- pregnancy
- falling of BP, loc, decreased metabolism
- terminal pause
- drop in BP and breathing
- agony
- cessation of breathing and “spark of life” sudden return to life
- somatic death
- reversible cessation of vital functions
- biological/cellular death
- irreversible cessation of vital functions and cell death
 31. Early postmortem changes.

rapid primary flaccidity of muscles

- complete loss of tone
- may respond to some stimulation hours after CA
- discharges of dying motor neurons may cause some twitching
pallor and loss of skin elasticity
- decrease in BP and cessation of circulation causes pallor
- skin of lips and face may remain blue in cases of congestive deaths
loss of muscle tone in sphincters
- voiding of urine
- sometimes semen
- gastric content regurgitation
rigor mortis
- lack of O2 → stopping aerobic respiration and therefore ↓ATP
- anaerobic respiration takes over → lactic acid
- therefore ↓ATP and ↑acidity = actin myosin fibers to bind together and form gel → muscle
stiffness. flexion prevails as ↑ muscle mass
- estimation
- appears 2-6 hours
- peak 12 hours
- decreases by 24 hours
- first detectable in smaller muscle groups
- less pronounced in small children and cachexic patients
- delayed by cold and sped up by warmth
cadaveric rigidity
- forensic rarity
- stiffness of muscles immediately after death
- eg. grass found gripped in hand
- neurogenic phenomenon occurring with patients at high emotional stress at death
hypostasis/lividity
- 30-40 min starts, but variable
- passive setting of RBC under influence of gravity
- maybe reduced in anaemic, hypovolemic (mass hemorrhage) or very young persons
- variable in colour
- cherry pink in CO poisoning
- brick red in cyanide poisoning
- c. perfringens bronze hypostasis
- areas of contact with ground will be pale
- can indicate movement of body
- stages:
- hypostasis: disappears with pressure
- stasis: fades to pressure
- imbibition: no change to pressure
cooling of body
- can be used to estimate time of death
- henssges nomogram
- depends on rectal temperature
- ambient temperature
- body weight
Tache noire
- drying of sclera when body found with eyes open
 32. Late postmortem changes.

putrefaction
- liquefaction of soft tissues
- most common route of decomposition
- warmer temperature increase speed of puterfication
- 3 days
- right iliac region stains green as ccum is superficial
- abdominal and secretal distention due to gas
- colorize venous system
- marbling: haemolysed blood stained vessels and greenish brown skin
- blister and sloughing of skin
- eyes and tongue protrude due to increase pressure and fluid will be forces out of nose and
mouth “purge”
- prostate and uterus may survive months

mummification
- natural/artificial
- dry decomposition
- brown leathery tissue
- desiccates rather than putrefying
- part of the body can be mummified

adipocere
- conversion of body into waxy substance
- seen in wet conditions: buried in wet ground or found in water
- anaerobic bacteria hydrolyze fat and combine it with Na and K, forming saponified substance
- early-greasy semifluid → whiter →brittle grey compound
- takes weeks to months
 33. Inspection at a crime scene/accident scene.
34. Sudden death.
- very rapid death is almost inevitably cardiovascular
- virtually no other COD operates so suddenly

CAD
- stenosis, narrowing of lumen by atheroma → ischemia (exacerbated by large meal, stres,
exercise) →arrhythmia
- bleeding into plaque → rupture and blockage
- MI
- Healed MI fibrosis → cardiac aneurysms
Hypertensive heart disease
- SUD from LVH
AS
- elderly
- [Link] valve
- →LVH
Senile myocardial degeneration
- small heart
- brown myocardium from lipofusions in cells
primary myocardial disease
- myocarditis
- HOCM
- brugada sun
- long QT syn
Artery disease
- atheromatous aneurysm of aorta
- abdominal region often elderly males
- lumen line with thromb
- dissecting aneurysm of aorta
- syphilitic aneurysms
- thin walled and often thoracic
Intracranial vascular lesions
- rupture berry aneurysm SAH
- SAH due to trauma
Cerebral haemorrhage
Cerebral thrombosis and infarction
Respiratory system
- pulmonary embolism
GIT
- severe duodenal peptic ulcer bleed
- perforation
gynecological conditions
- pregnancy
- ruptured ectopic gestation
- PE
- rupture cerebral aneurysm
Asthma
- status asthmaticus
Epilepsy
 35. Sudden death in infancy and infanticide.

traumatic injuries in childhood are not accidental

- child abuse
- battered baby syndrome
- non-accidental injury in childhood
- sexual abuse
- emotional
- psychological abuse

Child abuse
- fatal → cause of death → BFT/MA/Injuries by sharp objects/Other
- sixpenny bruises - finger pads
- bruises with different ages
- abrasions, bites, rib fx, scars, skull fx, limb fx, intracranial haemorrhages, internal organ injury
- xray
- retinal hemorrhages - may be significant

Sudden Death in Children

- sudden infant death syndrome
- 5-20% infant mortality
- ⅓ in age period between 1st month and 1st year of life
Causes:
- usually due to severe abnormality
- 70-80% due to respiratory pathology
- NRDS, epiglottitis, laryngeal spasm, congenital malformation lungs, pneumonia
- cardiovascular pathology and abnormalities
- GI pathology
- dehydration, enterocolitis, bacterial toxic syndromes
- meningitis → WHF syndrome
- tumours: nephroblastoma, neuroblastoma, retinoblastoma eetc

Sudden infant death syndrome

- the sudden death of any infant or young child which is unexpected by Hx and in whom a
necropsy fails to demonstrate adequate CoD
- peak 2-7 months
- no specific gross or histological changes
- CoD cannot be determined aetiologically
- note sleeping position of baby
 36. Personal identification.
- identification of human remains
- identification of persons of unknown ID
- ID of trace evidence

Personal Id based on:

- criminalistic data
- expert reports: medical/biological → forensic examination

Personal features
- constant features
- gender/age/height/blood/DNA/race/Physique type
- variable features
- inherited disease/tattoos/scars/fingerprints/[Link] (eg. blue marks - coal workers)
- accompanying features
- personal objects/ jewels/ sticks/ shoes/ clothes/ glasses

Forensic Methods for personal ID

- comparative methods
- comparison between infro for missing person and feature found during examination
- reconstructive methods
- reconstruction by determination of basic features (constant/variable/accompanying)
Process of ID
3 main stages
- 1. detailed establishment and fixation of the findings
- first the constant, second variable and accompanying objects
- 2. collection of materials for comparison
- [Link] between object of examination and obtain material

external examination
- many features will be observable
- internal examination
- additional features may be detectable
- eg. prior surgery, pacemakers, healed fx, etc.

Other:
- dactiloscopy
- fingerprints
- unique and quite resistant to decomposition
- poroscopy - sweat glands
- chelioscopy - lips
- foot print
- rugoscopy - palate

ID of decomposed body
- loss of soft tissues
- uterus and prostate survive for months → gender determination

Bones
- antrhopology
- long bones - stature
- skull - gender (male more prominent ridges)/ ethnicity
- pelvis - gender/gynaecological pelvis
- ages teeth/ ossification center and cranial suture/ degeneration of articulation surfaces
- hair - ethnicity
 37. Trace evidence examination.
trace evidence
- physical evidence found in small but measurable amounts such as fibers, hair etc
non-biological evidence:
- items: water, glasses, clothes
- materials found in environment: carpet fibers, bullets, tablets
biological evidence:
- body fluids: blood, semen, saliva
- tissues
- stains
- hair
- scrapings from nails
Collection
- appropriate labelling and sealing
preservation
- dry form, wet form, mixed form, freezing, dehydration → fixing formulation for Hx
examination, anti-coagulants
dispatch of specimen to analytical lab
- with instructions

Classic examples:
sexual assault:
- biological material
- assailant → victim
- victim → assailant
- assailant and victim to scene of crime
- non biological material from both to scene of crime

gun crime
- ballistics
- fingerprinting on bullet
- fingerprinting on base of case
- gunpowder on back of hand
- additional factors
chop hand
- axe leaving fragments in wound
electrocution
- metalization

Note:
- compare injuries and suspected weapons
- verbal photography
- photography: measure shape and size
- check surfaces
 38. DNA-analysis.

DNA analysis = DNA fingerprinting = DNA profiling

- DNA can be left by tough
- any nucleated cellular material
- smallest samples can be used
- amplified by PCR
- denaturation
- hybridization
- synthesis
- care in collection to avoid contamination
- should be stored at -20C or swabs can be dried

Chromosomal DNA
Mitochondrial DNA
- lasts longer
- can be obtained from hair shafts and old bones/teeth
short tandem repeats (STRs) for ID
- highly polymorphic
- non coding regions → respect medical privacy
- short enough to survive degradation in subpar conditions and long enough to avoid artifactism
in preferential PCR amplification
SNP (single nucleotide polymorphism)
- phased out as STRs now favourable
- useful when v low amounts of material available

Uses:
- sexual crimes
- unkown ID
- maternal/paternal identification, genetic relation

*Px should eat before DNA profiling → physiological leukocytosis