WEEKS

Lesson Titles Sections and Titles

AND DATES
Introduction and History of Legal
1 August 19,2023 Module 1
Medicine
2 August 26 , 2023 Module 2 Medical Evidence
Module 3 Deception Detection
Medicolegal Aspect of
3 September 2, 2022 Module 4
Identification
Module 5
4 September 9 & 16, 2023 Forensic Thanatology

Module 6
5 September 23 & 30, 2023 Physical Injuries

Forensic Sexology
6 October 7, 2023 Module 7

Module 8 Paternity and Filiation

7 October 14, 2023

8. October 21,2023 Module 9 Marriage Union and Dissolution

9. November 11 & 18 , 2022 Module 10 Mental Disturbance

10. November 25, 2023 Module 11 Forensic Toxicology

MEDICO-LEGAL
ASPECTS OF
PHYSICAL INJURIES
Catherine Grace Q. Aparece, MD
Objectives

• 1. Describe the classification of wounds

• 2. Differentiate the legal classification of physical
injuries
• 3. Recognize the evidences of physical injuries as
accidental, suicidal or homicidal
Slide Title
• Make Effective Presentations
• Using Awesome Backgrounds
• Engage your Audience
• Capture Audience Attention
• Physical injury is the effect of some forms of
stimulus on the body.
• The effect may only be apparent when the
stimulus applied is insufficient to cause injury
and the body resistance is great
• The effect of the application of stimulus may
be immediate or may be delayed
Causes of Physical Injuries

• A Physical Violence • E. Radiation by Radio-Active

• B. Heat or Cold Substances
• C. Electrical Energy • F. Change of Atmospheric
• D. Chemical Energy Pressure (Barotrauma)
• G. Infection
PHYSICAL INJURIES BROUGHT ABOUT
BY PHYSICAL VIOLENCE

The effect of the

application of physical
violence on a person is
the production of
wound
Wound
– the solution of the natural
continuity of any tissue of the
living body.
– the disruption of the anatomic
integrity of a tissue of the body
Physics of Wound Production
• Time:
• The shorter the period of time needed for
the transfer of energy, the greater the
likelihood of producing damage.
• If a person is hit on the body and the body
moves towards the direction of the force
applied, the injury is less as when the body
is station
Physics of Wound Production
• Time:
• The longer the time of contact between
the object or instrument causing the
injury, the greater will be the dissipation
of energy
Physics of Wound Production
• explains M-16 bullet which has a speed of
3,200 ft/sec will do more damage than a
0.38 caliber bullet which is heavier but has
a much slower velocity
• Area of Transfer:
• The larger the area of contact between
the force applied on the body, the
lesser is the damage to the body
• Area of Transfer:
• By applying an equal force, the damage
caused by stabbing is greater compared
to a blunt instrument
Vital Reaction
• the sum total of all reactions of tissue
or organ to trauma.
• The reaction may be observed
macroscopically and microscopically.
Vital Reaction
• "Rubor" — Redness or congestion of the area
due to an increase of blood supply as a part of
the reparative mechanism.
• "Calor" — Sensation of heat or increase in
temperature.
• "Dolor" — Pain on account of the involvement
of the sensory nerve.
• Loss of function — On account of the trauma,
the tissue may not be able to function normally
CLASSIFICATION OF WOUNDS
As to Severity:

Mortal Wound — caused immediately after infliction or

shortly thereafter that is capable of causing death.
• Parts of the Body where the Wounds Inflicted are Considered
Mortal:
– (1) Heart and big blood vessels.
– (2) Brain and upper portion of the spinal cord.
– (3) Lungs.
– (4) Stomach, liver, spleen and intestine.
As to Severity:

• Non-mortal wound — Wound which is not capable

of producing death immediately after infliction or
shortly thereafter
As to the Kind of Instrument Used

• Wound brought about by blunt instrument (contusion,

hematoma,lacerated wound).
• Wound brought about by sharp instrument:
– (1) Sharp-edged instrument~(incised wound).
– (2) Sharp-pointed instrument (punctured wound).
– (3) Sharp-edged and sharp pointed instrument (stab wound)
As to the Kind of Instrument Used
• Wound brought about by blunt instrument (contusion, hematoma,lacerated
wound).
• Wound brought about by sharp instrument:
– (1) Sharp-edged instrument~(incised wound).
– (2) Sharp-pointed instrument (punctured wound).
– (3) Sharp-edged and sharp pointed instrument (stab wound)
Wound brought about by tearing force (lacerated wound).
Wound brought about by change of atmospheric pressure (barotrauma).
Wound brought about by heat or cold (frostbite, burns or scald).
Wound brought about by chemical explosion (gunshot or shrapnel wound).
Wound brought about by infection
As to the Manner of Infliction

• Hit — by means of bolo, blunt instrument, axe.

• Thrust or stab — bayonet dagger.
• Gunpowder explosion — projectile or shrapnel
wound.
• Sliding or rubbing or abrasion.
As regards to the Depth of the Wound

• Superficial — When the wound involves only the

layers of the skin.
• Deep — When the wound involves the inner
structure beyond the layers of the skin.
As regards to the Depth of the Wound
– Penetrating — one in which the wounding agent enters the body
but did not come out or the mere piercing of a solid organ or tissue
of the body.
– Perforating — When the wounding agent produces communication
between the inner and outer portion of the hollow organs.
As regards to the Relation of the Site of the Application of Force and the Location of
Injury:

• Coup Injury — Physical injury which is located at

the site of the application of force
As regards to the Relation of the Site of the Application of Force and the Location of
Injury:

• Contre-Coup Injury — Physical injury found

opposite the site of the application force.
• Coup Contre-Coup Injury — Physical injury
located at the site and also opposite the site of
application of force
As regards to the Relation of the Site of the Application of Force and the Location of Injury:

• "Locus Minoris Resistencia" — Physical injury located not

at the site nor opposite the site of the application of force
but in some areas offering the least resistance to the force
applied
• Extensive Injury — Physical injury involving a greater
area of the body beyond the site of the application of force.
 Special Types of Wounds:

• Defense Wound — Wound which is the result of a person's

instinctive reaction of self protection
• Patterned Wound — Wound in the nature and shape of an object or
instrument and which infers the object or instrument causing it.
• Self-inflicted Wound—a wound produced on oneself. As
distinguished from suicide, the person has no intention to end his
life
LEGAL CLASSIFICATION OF PHYSICAL
INJURIES
Mutilation
• the act of looping or cutting off any part or parts
of the living body.
• In order to be punishable under the Code, it must
be intentional, otherwise it will be considered as a
physical injury.
"Mayhem "
• the unlawful and violent deprival of another of the
use of a part of the body so as to render him less
able in fighting, either to defend himself or to
annoy his adversary
Serious Physical Injuries

• Any person who shall wound, beat, or assault another, shall be guilty of the
crime of serious physical injuries
• The crime of serious physical injuries may be due to:
• (1) Wounding;
• (2) Beating;
• (3) Assaulting ; or
• (4) Administering injurious substances without the intent to kill
• may be committed through a simple negligence or imprudence.
Serious Physical Injuries: Provision in 4 paragraphs

• P1. the injured person became insane, imbecile,

• impotent, or blind.
– Insanity has not been defined or qualified by the article.
– Imbecility infers that the injured person must be of the preadolescent age and that
on account of the physical injuries inflicted there is an arrest of mental
development.
– Impotency is the inability to grant to the partner sexual gratification.
– Blindness must be total or involvement of both eyes. If only
• one eye became blind, then the physical injury will fall in paragraph 2
Serious Physical Injuries: Provision in 4 paragraphs

• P2 :the following nature and character of the wound or consequences of

the injuries inflicted must be present:
– a. Loss of the use of speech or the power to hear or to smell, or loss of
an eye, a hand, a foot, an arm, or a leg;
– b. Loss of the use of any such member; or
– c. Becomes incapacitated for the work in which he was therefore
habitually engaged.
Serious Physical Injuries: Provision in 4 paragraphs

– There must be a total loss of hearing capacity. If the loss of

power to hear is only in one ear, it is a serious physical injury
under paragraph 3
– For loss of a hand , the prosecution must prove by clear and conclusive
evidence that the offended party actually cannot make use of his hand
and that such impairment is permanent
Serious Physical Injuries: Provision in 4 paragraphs

P3: the following physical injuries or their consequences are included:

– a. Deformity;
– b. Loss of any other member of his body;
– c. Loss the use thereof; or
– d. Becomes ill or incapacitated for the performance of the work
in which he was habitually engaged for more than 90 days, as
a consequence of the physical injuries inflicted.
Serious Physical Injuries: Provision in 4 paragraphs

Deformity
– a condition of physical ugliness.
– must be permanent and conspicuous.
– Ex:
• loss of the front teeth,
• the development of a pigmented scar on the face, or
• loss of the pinna of the ear
Incapacity
--means the inability of the injured person to perform, or engage on a
work or vocation before he sustained injury.
Serious Physical Injuries: Provision in 4 paragraphs

P4: the injured person becomes ill or incapacitated

for labor for more than thirty days and impliedly less than 90
days.
It is noteworthy to mention that in paragraphs 3 and 4 of
article 263 there is no mention of periods of medical attendance
but merely incapacity.
Serious Physical Injuries: Provision in 4 paragraphs

Administering Injurious Substances or Beverages:Art. 264, Revised Penal

Code
The penalties established by the next preceding article shall be
applicable in the respective cases to any person who, without intent
to kill, shall inflict upon another any serious physical injury, by
knowingly administering to him any injurious substances or beverages or
by taking advantages of his weakness of mind or credulity.
Serious Physical Injuries: Provision in 4 paragraphs

Administering Injurious Substances or Beverages:Art. 264, Revised Penal

Code
Elements of the crime:
a. The offender inflicted upon another person any serious physical
b. The infliction of physical injury was done knowing that the substance
or beverage administered is injurious or took advantage of the
victim's weakness or credulity; and
c. There was no intent to kill on the part of the offender
Less Serious Physical Injuries
Art. 265, Revised Penal Code
Any person who shall inflict upon another physical injuries not described
in the preceding articles, but which shall incapacitate the offended party
for labor ten days or more, or shall require medical attendance for the
same period, shall be guilty of less serious physical injuries
Less Serious Physical Injuries

– The basis to determine whether the physical injury is less serious or

not is by either the period of medical attendance or period of
incapacity; both of which is ten days or more but not more than thirty
days.
– There must be proof as to the period of medical attendance.
– In the absence of such proof of medical attendance or incapacity the
crime committed is only slight physical injuries
Less Serious Physical Injuries
• The crime of less serious physical injuries may be qualified
and a fine or a higher penalty is imposed when:
a) a. There is a manifest intent to insult or offend the
injured person;
b) b. There are circumstances adding ignominy to the
offense;
c) c. The victim is the offender's parents, ascendants,
guardian, curators or teachers; or
d) d. The victim is a person of rank or person in
authority, provided that the crime is not direct assault
Slight Physical Injuries and Maltreatment

• Kinds of Slight Physical Injuries Punishable by the Code:

• 1. Physical injuries which incapacitate the victim for labor from one
to nine days, or require medical attendance for the same period.
• 2. Physical injuries which did not prevent the offended party from
engaging in his habitual work or which did not require medical
attendance.
• 3. Ill-treatment of another by deed without causing any injury
 TYP E OF WOUNDS
MEDICAL CLASSIFICATION
CLOSED WOUND

• There is no breach of continuity of the skin or mucous membrane.

• a. Superficial — When the wound is just underneath the layers of
the skin or mucous membrane.
– (1) Petechiae.
– (2) Contusion.
– (3) Hematoma.
CLOSED WOUND

• Petechiae
– a circumscribed extravasation of blood in the
subcutaneous tissue or underneath the mucous
membrane.
CLOSED WOUND

• Contusion:
– the effusion of blood into the tissues underneath
the skin on account of the rupture of the blood
vessels as a result of the application of blunt
force or violence.
 Age of Contusion
• The age of contusion can be appreciated from its color
changes.
• The size tends to become smaller from the periphery to the
center and passes through a series of color changes as a result
of the disintegration of the red blood corpuscles and
liberation of hemoglobin.
• The contusion is red sometimes purple soon after its
complete development.
 Age of Contusion
• In 4 to 5 days, the color changes to green.
• In 7 to 10 days, it becomes yellow and gradually disappears
on the 14th or 15th day.
• The ultimate disappearance of color varies from one to
four weeks depending upon the severity and constitution of
the body.
• The color changes start from the periphery inwards.
• Hematoma (Blood Cyst, Blood Tumor, "Bukol):
– the extravasation or effusion of blood in a newly
formed cavity underneath the skin.
– usually develops when the blunt instrument is
applied in part of the body where bony tissue is
superficially located, like the head, chest and
anterior aspect of the legs.
Distinction Between Contusion and Hematoma

• (a) In contusion the effused blood are accumulated in the interstices of

the tissue underneath the skin, while in hematoma blood accumulates
in a newly formed cavity underneath the skin.
• (b) In contusion, the skin shows no elevation and if ever elevated, the
elevation is slight and is on account of inflammatory changes, while in
hematoma the skin is always elevated.
• (c) In contusion, puncture or aspiration with syringe of the lesion no
blood can be obtained, while in hematoma, aspiration will show
presence of blood and subsequent depression of the elevated lesion.
Musculo-Skeletal Injuries
• Sprain
– Partial or complete disruption in the continuity
of a muscular or ligamentous support of a joint.
– usually caused by a blow, kick or torsion force.
• Strain — The over-stretching, instead of an actual
tearing or the rupture of a muscle or ligament which
may not be associated with the joint.
• (2) Dislocation — Displacement of the articular
surface of bones entering into the formation of a
joint.
• Subluxation — Incomplete
dislocation.
• (3) Fracture — Solution of continuity of bone resulting from
violence or some existing pathology.
– (a) Close or Simple Fracture — Fracture wherein there is
no break in continuity of the overlying skin or where the
external air has no point of access to the site of injury.
– (b) Open or Compound Fracture — The fracture is complicated
by an open wound caused by the broken bone which protruded
with other tissues of the broken skin.
• (c) Comminuted Fracture — the fractured bone is
fragmented into several pieces.
• (d) Greenstick Fracture — A fracture wherein only one side
of the bone is broken while the other side is merely bent.
• (e) Linear Fracture — When the fracture forms a crack
commonly observed in flat bones.
• Spiral Fracture — The break in the bone forms a
spiral manner as observed in long bones.
• Pathologic Fracture — Fracture caused by
weakness of the bone due to disease rather than
violence
Types of Fracture
Internal Hemorrhage

• Rupture of blood vessel which may cause

hemorrhage may be due to the following:
– Traumatic intracranial hemorrhage.
– Rupture of parenchymatous organs.
– Laceration of other parts of the body
Cerebral Concussion (Commotio Cerebri):

• the jarring or stunning of the brain characterized by

more or less complete suspension of its functions, as
a result of injury to the head, which leads to some
commotion of the cerebral substance.
 Cerebral Concussion (Commotio Cerebri):
• Signs and Symptoms: – Pulse is rapid, weak, faltering
– Unconsciousness which is more and scarcely perceptible to
or less complete. the fingers.
– Muscles are relaxed and flaccid. – Temperature is subnormal
– Eyelids are closed and the – Sphincters are relaxed
conjunctivae are insensitive. perhaps with unconscious
– Surface of the body is pale, cold evacuation of the bowel and
and clammy. bladder.
– Respiration is slow, shallow and – Reflexes are present but
sighing. sluggish and in severe cases
may be absent.
 Retrograde amnesia-

• loss of memory for events just before the injury is a

constant effect of cerebral concussion
• is of medico legal importance.
OPEN WOUND
• There is a breach of continuity of the skin or mucous membrane.
– a. Abrasion
– b. Incised Wound
– c. Stab Wound
– d. Punctured
– e. Lacerated
OPEN WOUNDS

• Abrasion- Scratch, Graze, Impression Mark, Friction Mark

– an injury characterized by the removal
of the superficial epithelial layer of the
skin caused by a rub or friction against
a hard rough surface
Characteristic of Abrasions

• develops at the precise point of impact of the force

causing it.
• grossly or with the aid of a hand lens the injury
consists of parallel linear injuries which are in line
with the direction of the rub or friction causing it.
Characteristic of Abrasions

• may exhibit the pattern of the wounding material.

• usually ignored by the attending physician for it
does not require medical treatment but it has far-
reaching importance in the medico-legal
viewpoint.
Characteristic of Abrasions
• (1) Abrasions caused by fingernails may indicate struggle or
assault and are usually located in the face, neck, forearms,and
hands.
• (2) Abrasions resulting from friction on rough surfaces, either
intentional or accidental are located on bony parts of the body and
usually associated with contusion or laceration.
• (3) Nature of the abrasion may infer degree of pressure, nature of the
rubbing object and the direction of movement.
 Forms of Abrasion
• Linear- • Multi-Linear
– An abrasion which – An abrasion which
appears as a single develops when the skin
line. is rubbed on a hard
– may be a straight or rough object thereby
curved line. producing several
linear marks parallel to
one another.
 Forms of Abrasion
• Confluent-An abrasion • Multiple: Several
where the linear marks abrasions of varying
on the skin are almost sizes and shapes may
indistinguishable on
be found in different
account of the severity
of friction and
parts of the body
roughness o the object
Types of Abrasion
• Scratch:This is caused by a sharp-
pointed object which slides across the
skin, like a pin, thorn or fingernail
• Graze:These are usually caused by
forcible contact with rough, hard
objects resulting to irregular removal
of the skin surface
Impact or Imprint Abrasion (Patterned Abrasion,
Stamping Abrasion, "Abrasion A La Signature")
• Those whose pattern and location provides objective
evidence to show cause, nature of the wounding material or
instrument and the manner of assault or death.
– (1) Marks of the grid of the radiator may be imprinted on
the skin.
– (2) Tire thread marks may be seen on the skin in
vehicular accidents.
– (3) Muzzle imprint in contact fire gunshot wound of
entrance.
– (4) Teeth impression mark in skin bites.
Incised Wound (Cut, Slash, Slice):
• produced by a sharp-edged (cutting) or sharp-
linear edge of the instrument, like a knife,
razor, bolo, edge of oyster shell,‘ metal sheet,
glass, etc.
Characteristics of Incised Wound

• Edges are clean- both extremities are sharp, except in

areas where the skin is loose or folded at the time of
infliction.
• The wound is straight and may be shelving if inflicted with
the wounding instrument applied with an acute angle to
the surface of the body involved.
• Usually the wound is shallow near the extremities and
deeper at the middle portion.
Characteristics of Incised Wound

• Because the blood vessels involved are clean-cut,

profuse hemorrhage is invariably a feature.
• Gaping is usually present due to the retraction of
the edges but its presence and degree of retraction
depends on the direction of the incised wound with
the line of cleavage (Langer's line).
Langer Lines
Characteristics of Incised Wound

• If the incised wound is located in parts of the body

covered with clothes, the clothing itself will show
clean-cut of its texture.
• In the absence of complication and/or when there
is deeper involvement present, healing is relatively
fast and the scar may not or may develop
conspicuously
Changes that occur in an Incised Wound
• After 12 hours — Edges are swollen; adherent with
blood and with leucocyte infiltration.
• After 24 hours — Proliferation of the vascular
endothelium and connective-tissue cells.
• After 36-48 hours — Capillary network complete;
fibroblasts running at right angles to the vessels.
• After 3-5 days — Vessels show thickening and
obliteration
Incised Wounds may be Suicidal, Homicidal or Accidental

• Suicidal — Located in peculiar parts of the body, like

the neck, flexor surfaces of the extremities, wrist, and
accessible to the hand in inflicting the injury.
• Homicidal — The incised wounds are deep, multiple
and involve both accessible and non-accessible parts
of the body to the hands of the victim
Incised Wounds may be Suicidal, Homicidal or Accidental

• Accidental — Multiple incised wound is commonly

observed on the passengers and driver of vehicular
accidents on account of the broken windshield and
glass parts of windows
From the movie “Knives Out”, comment on the
nature of cut throat.(suicide, accidental, homicidal)
Distinction Between Suicidal and Homicidal Cut-throat
Distinction Between Suicidal and Homicidal Cut-throat
Stab Wound
• produced by the penetration of a sharp-pointed and
sharp edged instrument, like a knife, saber, dagger,
scissors
• If the sharp edge portion of the wounding instrument is
the first to come in contact with the skin, the wound
produced is an incised wound, but if the sharp-pointed
portion first come in contact, then the wound is a
stab wound
Stab Wound(s) may be Suicidal, Homicidal or Accidental

• Suicidal — Evidences showing that the stab wound is suicidal:

– It is located over the .vital parts of the body.
– It is usually solitary. If multiple, they are located on one part of the
body.
– If located on covered parts of the body, the clothings are not involved.
– The stab wound is accessible to the hand of the victim.
– The hand of the victim is smeared with blood.
– The wounding weapon is firmly grasped by the hand of the victim
(cadaveric spasm).
Stab Wound(s) may be Suicidal, Homicidal or Accidental

• Suicidal — Evidences showing that the stab wound is suicidal:

– It is located over the .vital parts of the body.
– It is usually solitary. If multiple, they are located on one part of the
body.
– If located on covered parts of the body, the clothings are not involved.
– The stab wound is accessible to the hand of the victim.
– The hand of the victim is smeared with blood.
– The wounding weapon is firmly grasped by the hand of the victim
(cadaveric spasm).
Medical evidences showing intent of the offender to kill the victim

• There are more than one stab wounds.

• The stab wounds are located in different parts of
the body or on parts of the body where vital
organs are located.
• Stab wounds are deep
Medical evidences showing intent of the offender to kill the victim

• Stab wound with serrated or zigzag borders infers

alternative thrust and withdrawal of the wounding
weapon to increase internal damages.
• Irregular or stellate shape skin defects may be due to
changing direction of the weapon with the portion of
the instrument at the level of the skin as the lever
Punctured Wound

• the result of a thrust of a sharp pointed instrument.

• the external injury is quite small but the depth is to a
certain degree.
• commonly produced by an icepick,
needle, nail, spear, jointed stick, thorn,
fang of animal and hook
Medical evidences that tend to show it is Homicidal

• It is multiple and usually located in different parts of the

body.
• It may however be found in certain areas of the body.
• The wounds are deep.
• There are defense wounds on the victim.
• There is disturbance in the crime scene (sign of struggle).
Proof to show it is Suicidal
• Located in areas of the body where the vital organs are located.
• Usually singular but may be multiple but located in one area of
the body.
• Parts of the body involved is accessible to the hand of the
victim.
• Clothing usually is not involved
Proof to show it is Suicidal
• Wounding is made by the weapon while the victim is in sitting
or standing position.
• There is bleeding towards the lower part of body or clothing.
• No disturbance of the crime scene.
• Presence of suicide note.
• Wounding instrument found near the body of the victim
Lacerated Wound

• a tear of the skin and the underlying tissues due to

forcible contact with a blunt instrument.
• may be produced by a hit with a
piece of wood, iron bar, fist blow, stone,
butt of firearm, or other objects
without sharp objects
Distinctions Between an Incised Wound and a Lacerated Wound
Practical Ways of Determining How Much of the Skin Surface is Involved in an Injury
or Disease

• The determination of how much skin involvement is

important in the mode of treatment and prognosis
• In cases of burns in children and old age persons, involvement
of more than 70% of the body surface are almost invariably
fatal.
• In the estimation as to how much (by percentage) of the body
surface is involved, the rule of nine is used.
HEALING OF WOUNDS
• Regeneration is the replacement of destroyed tissue by
newly formed similar tissue.
• The more highly specialized the tissue, the less is the
capacity for regeneration.
• Capacity for regeneration decreases as age increases.
• The state of nutrition of the individual affects the
capacity of regeneration
 Regenerates Rapidly • Having No Power or Limited
Capacity to Regenerate
• Connective tissues.
• Highly specialized
• Blood forming tissues.
glandular epithelium.
• Surface epithelium of • Smooth muscles.
the skin • Neurons of the central
nervous system
• The Time of Healing of Wounds is Dependent on the
following:
– a. Vascularity
– b. Age of the Person
– c. Degree of Rest or Immobilization
– d. Nature of the Injury
Kinds of Healing of Wounds
• Healing by Primary (First) Intention
– takes place when there is minimal tissue
loss, more approximation of the edges and
without significant bacterial contamination.
• Healing by Secondary Intention
– takes place when the injury causes a more
extensive loss of cells and tissues
 Aberrated Healing Process

• Formation of
Exuberant Granulation
or "Proud Flesh
• excessive amount of
granulation tissue may
protrude and prevent
closing of the wound.
 Aberrated Healing Process
• Keloid Formation —
abnormal amount of
collagen formed in the
connective tissue thus
producing a large
bulging tumorous scar
 Aberrated Healing Process
• Stricture — due to the  Sinus - tract of
contraction of the infection traversing the
inner part of the body
fibrous tissue of the
scar formed.
 Fistula-communication between an inner
cavity and the outside