FORENSIC PATHOLOGY

PETER P. NG, M.D.,Ph.D., LL.B.

UST FACULTY OF MEDICINE AND SURGERY
UST FACULTY OF CIVIL LAW
UST GRADUATE SCHOOL
PETER NG, UST
FORENSIC PATHOLOGY
• FORENSIC SCIENCE
– FORENSIC SEROLOGY
– FORENSIC CHEMISTRY
– FORENSIC GENETICS
– FORENSIC BIOCHEMISTRY/MOLECULAR
BIOLOGY
– FORENSIC ANTHROPOLOGY
– FORENSIC ODONTOLOGY
– FORENSIC ENTOMOLOGY
– FORENSIC BOTANY

PETER NG, UST

FORENSIC PATHOLOGY
• FORENSIC MEDICINE
– FORENSIC PATHOLOGY
– FORENSIC OBSTETRICS
– FORENSIC GYNECOLOGY
– FORENSIC PEDIATRICS
– FORENSIC PSYCHIATRY
– FORENSIC PHARMACOLOGY
– FORENSIC ENT/OPTHA
• MEDICAL JURISPRUDENCE
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“CSI – Crime Scene Investigation”

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 Fold down or cross-
projection sketch.
Room is unfolded as if
it is a cardboard box.
Each wall is represented
as a flap extending from
the floor.

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PHYSICAL EVIDENCE
TRIANGLE

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Person of Historical Significance
Edmond Locard (1877-1966)
ƒ French professor
ƒ Considered the father of
criminalistics
ƒ Built the world’s first
forensic laboratory in
France in 1910

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The Locard Exchange Principle
• Every time an object comes into contact with
another object, it either leaves a portion of itself
or takes a portion of the other object with it

– Every contact leaves its trace

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PETER NG, UST
 CRIME SCENE TEAM
ƒ A group of professional investigators, each
trained in a variety of special disciplines.
ƒ Team Members
ƒ First Police Officer on the scene
ƒ Medics (if necessary)
ƒ Investigator(s)
ƒ Medicolegal Officer Or Forensic Pathologist
(if necessary)
ƒ Photographer and/or Field Evidence Technician
ƒ Lab Experts
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Processing a body
1. Obtain victim’s clothing for more
thorough analysis in lab
2. Fingernail scrapings
3. Hair sample
4. Blood sample
5. Other bio-samples
6. Hand swab (for GSR)

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Forensic Pathologists
• Perform autopsies and diagnose
circumstances surrounding the cause
and manner of death

• Determine whether death was

• Accidental
• Suicidal
• Homicidal

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MEDICOLEGAL OFFICER’S
RESPONSIBILITIES
ƒ Identify the deceased
ƒ Establish the TOD and DOD
ƒ Determine a medical COD —the injury or disease that
resulted in the person dying
ƒ Determine the MEOD—the physiological reason that the
person died
ƒ Classify the MOD
ƒ Natural
ƒ Accidental
ƒ Suicide
ƒ Homicide
ƒ Undetermined
ƒ Notify the next of kin
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 AUTOPSY anatomical pathology

Rembrandt 1632
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Autopsy Examination

• Autopsy means to look at oneself

• Necropsy means to look at the dead
• Autopsies have been practiced since
the middle ages
• Term autopsy generally used in
Philippines

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Purposes of Autopsy
1. determine or confirm the cause of death
2. improve the diagnosis of a specific disease
3. advance medical and scientific knowledge
4. aid in the evaluation of new techniques,
procedure or medications
5. help clinicians avoid repeating errors in
diagnosis and therapy in future cases
6. aid in medical education
7. may absolve guilt and remove concern about
possible genetic defects.

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Autopsy Under the Philippine
System

• MEDICOLEGAL AUTOPSIES

• NON-MEDICOLEGAL AUTOPSIES OR HOSPITAL

CASES

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Autopsy Process
• Incisions created in chest, abdomen
and head
• Removal of organs from those areas
of the body
• Y or T-shaped incision is typically
used, because it facilitates
examination of tongue and neck

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Autopsy Process
• Brain is removed via incision from
behind one ear to behind other ear
• Scalp is pulled upward and backward
• Skull is sawed circularly or in a
tonsorial manner
• Brain may be dissected immediately, or
placed in formaldehyde to preserve
tissue for better examination

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Autopsy Process
• Other internal organs are removed and
weighed
• Organs are also dissected to determine
disease or injury
• In certain cases such as child abuse,
spinal injury, and subtle blunt trauma
more extensive dissection and removal
may be completed

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Obtaining Appropriate
Specimens
• Toxicology requires adequate
specimens for testing
• Blood is usually taken from aorta
• Bile taken from gall bladder
• continued….

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Obtaining Appropriate
Specimens
• Blood, urine, liver, kidney and brain
used to determine presence of drugs
• Blood- alcohol or Urine- drugs
• Information from medical history,
witness statements, scene
examination, and autopsy may be
used to search for other drugs or
poisons

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Microscopic Examination

• Small portions of organs are put into

a solution of formaldehyde to
preserve them for study
• Diseased or injured sections of
tissue are taken, as is normal tissue
• Tissue is encased in paraffin and
mounted on slides with H&E dye for
examination under light microscope

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DNA Analysis
• Preserve one specimen of tissue for
DNA analysis
• If tissue sits in formaldehyde for too
long, DNA becomes hydrolyzed and
unsuitable for study
• DNA embedded in paraffin blocks or
cut into sections and made into
slides will not further decompose

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DNA Collection

• Methods to accomplish this:

– Blood spotted on absorbent paper
allowed to dry then stored in envelope
– Pull head hairs, including bulbs, and
place in envelope
– Cut hair has mitochondrial DNA, bulbs
include nuclear DNA

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Photography

• Both film and digital photography are

both used, depending on law
enforcement jurisdiction

• Multiple photographs must be taken

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JFK - AUTOPSY

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JFK - AUTOPSY

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Che - AUTOPSY

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 Autopsy

Y incision

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DEATH
•Complete

•Irreversible

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DEATH
• The Organ Donation Act of 1991
(RA7170), as amended, defines death
as “the irreversible cessation of
circulatory and respiratory functions or
the irreversible cessation of all functions
of the entire brain, including the brain
stem.”

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DEATH
• Cardiopulmonary Death.
– there is an absence of natural respiratory
and cardiac functions and, attempts at
resuscitation would not be successful in
restoring those functions.
– In this case, death shall be deemed to
have occurred at the time these functions
ceased; or

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DEATH
• Brain Death.
– there is an irreversible cessation of all
brain functions; and considering the
absence of such functions, further attempts
at resuscitation or continued supportive
maintenance would not be successful in
resorting such natural functions.
– In this case, death shall be deemed to
have occurred at the time when these
conditions first appeared.

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POSTMORTEM CHANGES AND
TIME OF DEATH

1. ALGOR MORTIS (BODY COOLING)

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POSTMORTEM CHANGES AND
TIME OF DEATH
2. RIGOR MORTIS.

Body warm not stiff less than 3 hours

Body warm stiff 3-8 hours
Body cool stiff 8-36 hours
Body cool not stiff more than 36 hours

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POSTMORTEM CHANGES AND
TIME OF DEATH
3. LIVOR MORTIS (HYPOSTASIS, POST
MORTEM LIVIDITY, POSTMORTEM
SUGGILLATIONS)

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POSTMORTEM CHANGES AND
TIME OF DEATH
• 4. POSTMORTEM DECOMPOSITION (PUTREFACTION)

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POSTMORTEM CHANGES AND
TIME OF DEATH

• 5. ADIPOCERE

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POSTMORTEM CHANGES AND
TIME OF DEATH

• 6. MUMMIFICATION

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POSTMORTEM CHANGES AND
TIME OF DEATH

• 7. MACERATION

• 8. AQUEOUS HUMOUR POTASSIUM

• 9. STOMACH CONTENTS

• 10. Forensic Entomology

• 11. last known activity (last sighting,

newspaper/mail)
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INDIVIDUAL OBSERVATIONS USED
TO ESTIMATE TIME OF DEATH
• When used together the following
individual observations of a body may
be used to estimate the time of death
– body temperature
– rigor mortis
– livor mortis
– decomposition changes
– stomach contents

PETER NG, UST

Cause of Death and Manner of
Death
• The Cause and Mechanism of Death
is the physiological incident which
started the physical progression of
death in the body.
• The Manner of Death,
Death on the other
hand, is which category the death falls
into. The Manner of Death can be one
of five categories: Homicide, Suicide,
Natural, Accidental, or Undetermined.
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 Forensic
Pathology

EVIDENCE
FROM
WOUNDS

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COMMON TYPES OF WOUNDS
GUNSHOT WOUNDS
Type of Wound Characteristics

Firearm:
Contact (muzzle against No blackening around entry; star-shaped, often with flaps
body) directed outward

Close (less than 18 Blackening around entry; grains of powder and deposits of
inches) powder residue

Distant (18 inches or None of the above characteristics appear

more)

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BULLET WOUNDS
• Point of Entry and Exit
• Bullet is spinning as it hits the body the entry
area is usually smaller than the exit wound.
• Bullet may ricochet inside the tissue &
travels a path which is not a straight line.
• Powder burns - near range hits.
• contusion ring (abrasion collar) around the
bullet wound usually indicates the angle and
close range.

PETER NG, UST

A BULLET PENETRATING
THE SKIN
• When a bullet
penetrates the skin:
– the skin is pressed
inward
– the skin is stretched
and perforated
– the skin then returns
to its original
position
(Source: Barry A. J. Fisher, Techniques of Crime Scene Investigation,
© 1992, reproduced with permission of copyright owner, CRC Press,
Boca Raton, Florida)
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9-13
Bullet Entry wound

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Bullet Entry wound – contact
range

star-shaped laceration

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Abrasion ring – contact range

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Powder tattooing:

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Powder tattooing: close range.

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Slit like Exit wound:

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Slit like Exit wound:

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COMMON TYPES OF WOUNDS
GUNSHOT WOUNDS
Type of Wound Characteristics

Firearm:
Contact (muzzle against No blackening around entry; star-shaped, often with flaps
body) directed outward

Close (less than 18 Blackening around entry; grains of powder and deposits of
inches) powder residue

Distant (18 inches or None of the above characteristics appear

more)

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Ninoy Aquino Assasination

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Ninoy Aquino Assasination

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Ronald Reagan Assasination

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Bullet Trajectory - Murder

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COMMON TYPES OF WOUNDS
• CLOSE WOUND
– Petechiae
– Contusion
– Hematoma
• OPEN WOUND
– Incised
– Stab
– Punctured
– Laceration

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Contusions

Color changes a bruise goes

through can give rough
estimate of time of injury
• Dark blue/purple (1-18 hours)
•Blue/brown (~1 to 2days)
•Green (~ 2 to 3 days)
•Yellow (~3 to 7 days)

Assumes person is healthy.

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BLUNT trauma:
• The blow produces a crushing effect
• Resulting in contusions, abrasions,
lacerations, fractures, or rupture of
vital organs.
• Red-blue contusions are always
present, but this varies by the weight of
the individual (obese people bruise
easier than lean people).

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Contusion: 1 week. (Yellow
green)

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Blunt injury- Liver rupture.

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COMMON TYPES OF WOUNDS
Type of Wound Characteristics
Incised Cutting wound inflicted with sharp-edged instrument,
wound typically narrow at ends and gaping in middle with a
great deal of blood
Stab As above; manner in which knife is thrust into and pulled
out of body can result in wounds of different shapes made
with same knife
Puncture Can be caused by ice picks, leather punches, and
screwdrivers; result in small wounds with little or no blood
Lacerations Open, irregularly shaped wounds, caused by clubs, pipes,
pistols and other blunt instrument wounds accompanied by
bruising or bleeding
Defenses Commonly found on palms of hands, fingers, forearms

Strangulation: Mark encircling neck in a horizontal plane overlying larynx

Ligature or upper trachea; sometimes broken at back of neck where
hand grasped ligature; abrasions and contusions of skin
Manual not usually present
Abrasions, contusions and fingernail marks on skin
PETER NG, UST
STAB WOUNDS
• Slash wounds: cuts are as wide and they
are long. look like superficial bullet wounds.
Other types of slash wounds are called
"hesitation marks" commonly found in
suicide cases.
• Incision wounds: lengths greater than their
depth, greater amount of subsurface tissue
is exposed in an almost oval fashion.
• Puncture wound: Stab or shive wound.
distinguishable by its clean-cut edges.
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Abrasion:

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Abrasions

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INCISED WOUNDS
• Typically bleed a lot
• Are inflicted with
knives or razors
• Are narrow at the
edges and gaping in
the middle

(Courtesy Federal Bureau of Investigation)

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 Incised Wounds
Slash Stab

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Laceration:

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Lacerations

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Stab wound – hilt mark.

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Laceration: Defense wound

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Defense wound – how?

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Laceration: Defense wound

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STRANGULATION
• Homicidal, suicidal, or accidental.
• PM Features:
– Intensive heart congestion (enlarged
heart; right side ventricle)
– venous engorgement (enlarged veins
above point of injury)
– cyanosis (blue discoloration of lips
and fingertips).

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Asphyxia - Strangulation

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Brain – Hemorrhages & edema

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Brain – Hemorrhages & edema

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Fat Embolism in Pulm art.

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AUTOEROTIC DEATH
• In autoerotic death cases
the investigator will
typically find:
– a white male partially
suspended and nude
– dressed in women's
clothing or undergarments
– or with his penis exposed

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DROWNING
• Rapid formation of mucus block - Bronchi.
– "foam cone" covering the mouth and nostrils.
– "dry drowning" - edema of Larynx - no fluid
• Stages in drowning:
– Surprise - Inhales water.
– Holding breath - while struggling
– Pink foam – exhalation of fluid.
– Respiratory arrest - Pupils dilate.
– Final struggle - 3-4 quick attempts to breath.

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SMOTHERING
• Obstruction of airway. If soft object e.g.
pillow or blanket. No trauma.
• Injury on the inner lips.
• Cyanosis may or may not.
• Petechial hemorrhage on the face,
typically around the area of the eyes.

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BURN wounds
• may be caused by heat, a chemical, or
electricity.
• Fire victims often are found in a
"pugilistic" position with clenched fists,
resembling the pose of a boxer.
• Heat generally causes the protein in
the body to contract.
• Blood and lung samples are often
taken for various reasons.
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Burns:

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RAPE
• Art. 266-A. Rape is committed –
– 1. By a man who shall have knowledge of a
woman under any of the following circumstances:
a. through force, threat or intimidation;
b. when the offended party is deprived of reason
or is otherwise unconscious;
c. by means of fraudulent machination or grave
abuse of authority
d. when the offended party is less than (12)
years of age or is demented.

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RAPE
• Art. 266-A. Rape is committed –
– 2. By any person who, under any of the
circumstances mentioned in para (1)
hereof, shall commit an act of sexual
assault be inserting his penis into another
person’s mouth or anal orifice, or any
instrument or object, into the genital or anal
orifice of another person.

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History and physical
examination
• A brief description of the assault indicates areas for
medical investigation and treatment; recounting the
events is often frightening for the patient, and a
complete description may have to be deferred until
immediate needs have been met.
• The reasons for the questions and for the
examination procedure are not always clear to
patients; eg, the female patient may need to be told
that knowing when her last menstrual period was or if
she uses a contraceptive helps determine the risk of
pregnancy or that information about the time of the
previous coitus helps establish the validity of sperm
testing.

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History and physical
examination
• Because these patients have experienced
coercion, enlisting their cooperation and
requesting permission for the examination are
important.
• Details of the pelvic examination should be
described and explained as it proceeds, and
the results should be reviewed with the
patient. Because being examined by a
physician of the opposite sex may make the
patient feel anxious, a nurse or volunteer of
the patient's sex should be present to give
support and to corroborate the procedures.

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Female Organ

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Hymen

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Vaginal Penetration

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• The slide
demonstrates one of
the best positions to
examine younger
children. This child
is sitting on the
mothers lap with the
mother holding her.

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Hymenal Laceration at 5 o’clock

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 Female aged 8 years.
Dilated hymenal
opening,
bumps (3 + 9 o’clock)
and deep rounded
notch posteriorly.

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 4 year old: reddening,
transsection at 9 o’clock
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 Female aged 2 yrs.
Reddening, tag,
healing fissures,
gaping sphincter,
visible mucosa.

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DRUG FACILITATED
SEXUAL ASSAULTS
• Rohypnol (street name Roofies), known as the drug
flunitrazepam, belongs to a class of drugs called
benzodiazepines
– It produces a spectrum of effects including skeletal
muscle relaxation, sedation, and reductions in
anxiety
• GHB. Gamma hydroxybutyrate or GHB (also known
as Gamma-OH, Liquid Ecstasy, Georgia Home Boy,
or Goop)
– It is another central nervous system depressant
that is used to perpetrate sexual assaults

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ROHYPNOL
• Drug used by sex offenders at:
– parties
– bars
– clubs
– social drinking
locations

(Courtesy Sergeant Christopher McKissick and Detective Tyler Parks, Port

Orange, Florida, Police Department)

PETER NG, UST

COLLECTION OF EVIDENCE DURING
THE MEDICAL EXAMINATION OF THE
RAPE VICTIM

• Physical evidence to
be collected:
– vaginal swabs,
– oral and anal swabs,
– pubic combing,
– head and pubic hair
controls,
– saliva sample,
– blood sample,
– fingerprint scrapings,
– all clothing.
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ITEMS ROUTINELY
COLLECTED FROM
SUSPECTS

• All clothing,
• pubic hair combing,
• forcibly removed head and pubic hair
controls,
• saliva and blood samples.

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FORENSIC SEROLOGY
• An analysis must be performed on a stain to
determine whether or not it is actually blood. If the
sample is blood, the species must then be
determined.
• Conventional serological analysis analyzes the
proteins, enzymes, and antigens that are found in
blood.
• If the blood sample is human, it goes on to further
identification and then individualization.
• Blood analysis is a comparison analysis. The
victim’s blood and the suspect’s blood must be
compared to the blood found at the crime scene.
• Restriction fragment length polymorphism (RFLP)
DNA analysis directly analyzes certain DNA
sequences found in white blood cells.
• Polymerase Chain Reaction (PCR) DNA analysis
analyzes DNA sequences that have been replicated
numerous times. This procedure works well with
small samples of blood. It, however, cannot
individualize a blood sample.

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IS THE RED STAIN BLOOD?

– Benzidine color
test,
– Phenophthalein
test,
– Leukomylokite
test,
– Luminol test,
– Microcrystalline
test.

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SEMINAL STAINS
• Seminal stains found at a crime scene are collected with
cotton swab and placed in an airtight container so that they
may not be contaminated.
• A spermatozoa search is a microscopic analysis where
sperm cells are visually observed.
• The acid phospatase is a presumptive analysis that test for
the general existence of semen.
• Anti P-30 is a quantitative and qualitative test that identifies
the presence of protein P-30 (found only in human semen).
This test may also serve to individualize seminal evidence.
• DNA analysis to determine if the DNA pattern extracted
from a crime scene semen stain matches the DNA pattern
of the suspect:
– RFLP,
– PCR.
PETER NG, UST
 Maximum Reported Time Intervals For Sperm
Recovery in Living Sexual Assault Victims
Body cavity Motile sperm Non-Motile

Vagina 6 – 28 Hours 14 Hours – 10 Days

Cervix 3 – 7.5 Days 7.5 – 19 Days

Mouth ---------------- 2 – 31 Hours

Rectum ---------------- 4 – 113 Hours

Anus ---------------- 2 – 44 Hours

PETER NG, UST
 Sources of Biological Evidence
Blood
Semen
Saliva
Urine
Hair
Teeth
Bone
Tissue
Perspiration
Vaginal secretions

Source: http://www.cstl.nist.gov/biotech/strbase/ppt/intro.ppt PETER NG, UST

 The Cell
• Smallest unit of life
• Compose all living things
• The “nucleus” (one of
many organelles) contains
genetic information the
cell needs to exist and
reproduce
- most cells organize
genetic information into
chromosomes

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 DNA in the Cell Nucleus
chromosome

cell nucleus

Double stranded
DNA molecule Target Region for PCR

Individual
nucleotides

Source: http://www.cstl.nist.gov/biotech/strbase/ppt/intro.ppt PETER NG, UST

PETER NG, UST
DNA Extraction

• DNA analysis begins with DNA extraction from

biological evidence
• DNA extraction is:
– A chemical process by which DNA is released from
cell(s)
– Other cellular components are removed leaving a
pure sample of DNA in an aqueous (liquid) solution

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 DNA Amplification
• After DNA extraction DNA is amplified using the
Polymerase Chain Reaction (PCR)
• PCR amplification makes many copies of the DNA to
allow for detection (think photocopies)

PCR

DNA strand Amplified DNA

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PETER NG, UST
 Gel Electrophoresis
• Gel with different sized pores
agarose and acrylamide are common materials
• Load DNA samples into wells at top of gel
• Run electric current through the gel
• DNA moves due to negative charge
• Smaller bands run “faster”

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 DNA Detection
• Amplified DNA fragments are labeled with a fluorescent tag
• DNA fragments are separated by electrophoresis (electric current)
• The size of the fluorescent DNA fragment is determined by a
machine which displays the information graphically.
• Analysts read the graph to determine the DNA type

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DNA Analysis
• Short Tandem Repeats (STRs) are short stretches of
DNA that are repeated several times at a particular
location on a chromosome
• The number of repeats and, therefore, the length of
the Short Tandem Repeat DNA varies from person to
person
• Each individual has two different (or two equal) length
repeats at the same location on a chromosome
• STR DNA testing determines the length of the STR
DNA at 13 different chromosomal locations
• STR DNA testing analysis is the most commonly
used forensic DNA analysis method

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 13 CODIS Core STR Loci with Chromosomal Positions
A listing of all lengths at each
location (loci) is called a DNA
TPOX
profile
D3S1358

TH01
D8S1179
D5S818 VWA
FGA D7S820
CSF1PO

AMEL

D13S317
D16S539 D18S51 D21S11 AMEL

Source: http://www.cstl.nist.gov/biotech/strbase/ppt/intro.ppt PETER NG, UST

At a single STR locus:

(5) CAG CAG CAG CAG CAG CAG CAG CAG CAG (4)
(6) CAG CAG CAG CAG CAG CAG CAG CAG CAG CAG CAG CAG CAG (7)
Father’s Type: 5, 6 Mother’s Type: 4, 7

(6) CAG CAG CAG CAG CAG CAG

CAG CAG CAG CAG (4)
Baby’s Type: 4, 6
*(Other possibilities: 4, 5 or 5, 7 or 6, 7)
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Statistics

• The 13 STR DNA tests produce exceedingly

rare DNA profiles
• A STR DNA profile might be found in 1 person
out of a quadrillion (that is, a billion million)
people
• A match between two DNA samples, say, a
crime scene stain and the DNA of a suspect,
can link a subject to a crime
• A non-match may shift the focus away from a
particular suspect
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Philippine Cases - DNA

• People vs. Vallejo. 2002

• People vs. Yatar, 2004
• Agustin vs. CA, 2005
• Herrera vs. Alba, 2005

PETER NG, UST

That’s all folks!

PETER NG, UST