LECTURE

Forensic Medical Examination of Alive persons

Examination of living persons is carried out at the department of forensic medical examination of victims, accused and other persons or in regional departments of Regional Bureau of Forensic Medical Examination (FME). Method of FME of living persons as for definition of Degree of Gravity of physical injuries Acquaintance with the decision on the purpose of FME or referral to forensic examination and documents certifying identity (their presence is obligatory). Filling in the register and the introductory part of Conclusion of Expert or Act of Forensic Medical Examination . Finding out the circumstances of the case and filling in the corresponding part of Conclusion of Expert , Act of Forensic Medical Examination . Features of Medico-Legal Anamnesis: When (date, time)? Where (at home, in a street, etc.)? Who (number of attackers, their sex, age, etc.)? What was done and what instrument with? How many times was the damage inflicted? ( he was struck on the head with a stick 2 times , etc.); When and where did the victim address for medical aid? Complaints in process of examination. The expert particularly and consistently describes the injuries from top to bottom and from the right to the left according to the following scheme: Location of injury Character of injury (abrasion, bruise, wound, fracture) Form of injury Size of injury in centimetres

Characteristics of injury Number of physical injuries, their interposition, and height relative to the person s body height Conclusions of FME: 1. Character of damages, their location and features; 2. The kind of object or ways by which damages are inflicted; the mechanism of their formation; 3. Time of inflicting damages, whether it corresponds to the facts of the matter; 4. Degree of gravity of physical injuries with definition of the qualifying sign. According to the degree of gravity physical injuries are subdivided into: grave; moderate; mild. The criteria characterizing grave physical injuries: danger to life, loss of organ or its function, abortion due to trauma, development of mental disease due to trauma, indelible disfiguration of face, loss of the general work capacity by more than 1/3. The criteria for injuries of moderate degree of gravity: absence of danger to life, absence of consequences specified for grave physical injuries, a long disorder of health for a term over 21 days, a stable loss of general work capacity from 10 % to 33 %. The criteria for mild physical injuries: which caused short-term health disorder and insignificant persistent loss of general work capacity (a shortterm disorder of health for a period of 7 to 21 days, insignificant persistent loss of general work capacity up to 10 %). which did not cause a short-term disorder of health (up to 6 days) and insignificant persistent disability.

DISPUTABLE SEXUAL CONDITIONS AND SEXUAL CRIMES Features and method of carrying out FME as for disputable sexual conditions and sexual crimes are stated in Rules of forensic medical examinations (investigations) concerning sexual conditions in the Bureau of forensic medical examination (1995). Medicolegal examination concerning disputable sexual conditions and at sexual crimes should be carried out with attraction of doctors of different clinical specialities. Examination of a female: 1. A sexual maturity. 2. Rupture of virgin hymen. 3. Attributes of the former sexual act. 4. Character and the mechanism of formation of damages and changes at fulfillment of dissolute actions. 5. Abilities to sexual relations and fertilization. 6. Pregnancy and former delivery. 7. Connections of interruption of pregnancy with a trauma. 8. Artificial interruption of pregnancy. 9. A sexual belonging. 10. Conditions of genitals in case of an establishment of a degree of proof disability or ability to physical work. Examination of male carry out for an establishment: 1. 2. 3. 4. 5. Abilities to sexual relations. Abilities to fertilization. A sexual maturity. Venereal disease. Attributes of the former sexual act. The establishment of sexual maturity Sexual maturity of Females is the degree of sexual and physical development at which all sexual functions of woman can be fulfilled without any harm to her health, i.e. sexual intercourse, pregnancy, delivery, and breast-feeding of the child. 1. Anthropometric data with definition of general physical development.

2. Data of special gynaecologic examination. 3. Parameters of development of external and internal genitals. 4. Parameters of functioning of sexual glands. Examination is carried out for Males at the age of 14-17 years in cases connected with sexual crimes. Sexual maturity of males is characterized by such a condition of general physical development and formation of sexual glands at which the physiological functions of sexual life do not cause disorder of health and do not do harm further development of organism. 1. Parameters of general development of organism. 2. Parameters of development of external and internal genitals. 3. Ability to sexual intercourse and fertilization. The establishment of rupture of hymen A virgin (virgo intacta) is a female who has not experienced sexual intercourse. Defloration means loss of virginity. Hymen Causes of Rupture of Hymen: (1) An accident, e.g., a fall on a projecting substance or by slipping on the furniture or fence or while playing at seesaw. (2) Masturbation. (3) Surgical operation and gynaecological examination. (4) Foreign body (aptae viris). (5) Ulceration from diphtheria, fungus or other diseases. (6) Scratching due to irritation of the parts from lack of Cleanliness. (7) Sanitary tampon may sometimes rupture the hymen. In women who are used to coitus, and in those who have borne children, the hymen is destroyed and small, round, fleshy projections or tags, known as carunculae hymenales or myrtiformes are formed round the hymenal ring.

Fimbriated (wavy or undulating) hymen shows multiple notches which may be mistaken for artificial tears. Natural notches are usually symmetrical, occur anteriorly, do not extend to the vaginal wall and are covered with mucous membrane. Tears caused by sexual intercourse or by foreign body are usually situated posteriori; at one or both sides, or in the midline, and usually extend to the vaginal wall and are not covered with mucous membrane.

Hemorrhage in Hymen ( - , .200) Reaction in place of rupture of Hymen ( - , .100) Leukostases in Hymen ( - , .200) Medico-Legal Aspects: The presence of unruptured hymen is a presumption, but is not an absolute proof of virginity. The diagnosis of virginity is difficult and in many cases a physical examination of the genital organs may not be helpful. With an intact hymen, there are true virgins and false virgins. The hymen is present always in a virgin in some form or other, but very rarely may be absent congenitally. The principal signs of virginity are: (1) An intact hymen. (2) A normal condition of the fourchette and posterior commissure. (3) A narrow vagina with rugose walls. These signs taken together, may be regarded as evidence of virginity but taken singly they cannot be so regarded. Sexual crimes Sexual crimes stipulated by criminal legislation of Ukraine are socially dangerous actions encroaching on sexual freedom of citizens, normal way of sexual relations, normal physical, moral and sexual development of minors. Forensic medical examination 1. The fact of a past copulation based on revealing the rupture of hymen, establishment of its time and mechanism of damage; presence of spermatozoa in the vagina and the sperm group; pregnancy; infection with venereal disease or HIV. 2. Presence of signs of physical injuries with definition of their character, mechanism and time of occurrence. 3. Establishment of medical consequences of signs of violent actions with obligatory definition of degree of gravity of physical injuries. 4. Establishment of signs of a helpless condition which may be caused by age, health state, inflicted damages, toxic effect. Collection of laboratory specimens 1) clothing stained, torn, foreign matter; 2) scrapings of dried blood stains -grouping, DNA; 3) scrapings of dried seminal stains - grouping, sperms, P30 glycoprotein, DNA characteristics;

4) hairs matted pubic hair, combed foreign hair, plucked hair; 5) broken nails and debris from under the nails; 6) blood - grouping, alcohol, drugs, VDRL, T- cells; 7) saliva secretor status; (8) swabs from any soiled area of skin; from bite marks for saliva; and from mouth, pharynx, vagina, cervix, and anus for spermatozoa, microorganisms, P30 glycoprotein, and sexually transmitted disease. Semen ( - , - ,

. 400)

Establishment of Artificial Abortion Legally, abortion (miscarriage) means the premature expulsion of the foetus from the mother's womb at any time of pregnancy, before full term of pregnancy is completed. Classification: (1) Natural: (a) Spontaneous. (b) Accidental. (2) Artificial: (a) Justifiable. (b) Criminal. Causes of Natural Abortion : (1) Defect in the ova, including chromosomal defect. (2) Developmental defect of the foetus (common cause). (3) Low implantation of zygote. (4) Disease of decidua or placenta. (5) Rh incompatibility. (6) Retroverted uterus. (7) Submucous uterine fibroid. (8) Malformed uterus. (9) Uterine hypoplasia. (10) Hypertension. (11) Diabetes mellitus. (12) Hormonal deficiency. (13) Sudden shock, emotional disturbances. (14) Syphilis.

(15) Nephritis. (16) Arsenic or lead toxicity. (17) Drug toxicity. The differences between natural and criminal abortion from a medicolegal point of view. THE METHODS OF PROCURING CRIMINAL ABORTION The two methods in common use to procure abortion are: (1) the administration of drugs, (2) the application of mechanical violence.

A proportion of abortions are a result of combination of these methods. The pointers to criminal abortion are: (1) sudden death of a pregnant woman, (2) disturbed underclothing, (3) presence of abortifacient drugs or instruments, (4) fluid, soapy, or haemorrhagic discharge from the vagina. Complications from criminal abortion: Death may occur from: shock, haemorrhage, air or fat embolism, sepsis, action of poisonous substances, renal failure, disseminated intravascular coagulopathy (DIG) and cerebral damage.