Forensicmedicine.pdf

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What is Forensic Medicine?

Forensic Medicine - branch of medicine that deals with the application of medical knowledge of the purpose of law and in the administration of justice.

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What is Medical Evidence? Medical Evidence - species of proof, or probative matter, legally presented at the trial of an issue by the act of the parties, and through the medium of witnesses, records, documents, concrete objects, etc. for the purpose of inducing belief in the minds of the court as their contention. - must be preserved to maintain their value when presented as exhibits in court. knip

What is Death? Death - termination of life. It is the complete cessation of all vital functions without possibility of resuscitation. Categories of Death 1. Brain Death - when there is irreversible coma, absence of electrical brain activity and complete cessation of all the vital functions without possibility of resuscitation. 2. Cardio - Respiratory Death - continuous and persistent cessation of heart action and respiration. knip 3. Others

Kinds of Death 1. Somatic Death or Clinical Death - complete and irreversible cessation of vital function of brain followed by cessation of functions of heart and lungs. 2. Molecular or Cellular Death - happens after somatic death (3-6 hours later) when tissues and cell die. 3. Apparent Death or State of Suspended Animation - transient loss of consciousness or temporary cessation of vital functions of the body. knip

Signs of Death

1. Cessation of Heart Action and Circulation 2. Cessation of Respiration 3. Cooling of the Body-Algor Mortis 4. Insensibility of the Body and Loss of Power to Move knip

Signs of Death

5. Changes in the Skin a. Discoloration - skin may be observed to be pale and waxy-looking due to absence of circulation. b. Loss of Elasticity of the Skin - skin surface is flattened, application with fingertip will produce impression. c. Opacity of the Skin - opaque when expose to translucent light. d. Effect of the Application of Heat - absence of inflammatory reaction to the skin after application of melted sealing wax. knip

Signs of Death

6. Changes in and About the Eye a. Loss of Corneal Reflex b. Clouding of the Cornea c. Flaccidity of the Eyeball d. The Pupil is in the Position of Rest - pupil cannot react to light. e. Opthalmoscopic Findings - optic disc and retina became pale, fundus may have yellow tinge which later changes to a brown-gray or slate color, no evidence of blood and retinal vessels and arteries are indistinguishable. knip

Signs of Death f. Tache Noir dela Sclerotique - spot may be found in the sclera (oval, round or may be triangular).

7. Action of Heat on the Skin - this test is useful to determine whether death occurred before or after the application of heat. Heat is applied to a portion of the leg and arm. If death is real, only blister is produced, no fluid is present and no redness of the surrounding. knip

Changes in the Body Following Death

1. Changes in the Muscle 2. Changes in the Blood 3. Autolytic or Autodigestive Changes after Death 4. Putrefacation of the Body knip

Changes in the Body Following Death 1. Changes in the Muscle - complete relaxation of the muscular system. It is contractile for 3-6 hours after death and later rigidity sets in. Stages of the entire muscular tissue after death: a. Primary Flaccidity or Post-Mortem Muscular Irritability b. Post-Mortem Rigidity or Cadaveric Rigidity or Death Stiffening or Death Struggle of the Muscles or Rigor Mortis knip

Conditions Stimulating Rigor Mortis • Heat Stiffening • Cold Stiffening • Cadaveric Spasm or Instantaneous Rigor c. State of Secondary Flaccidity or Secondary Relaxation

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Changes in the Body Following Death 2. Changes in the Blood a. Coagulation of the Blood b. Post-mortem Lividity or Cadaveric Lividity or PostMortem Suggilation or Post Mortem Hypostasis or Livor Mortis 3. Autolytic or Autodigestive Changes after Death 4. Putrefacation of the Body

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Duration of Death - in the determination as to how long a person has been dead from the condition of the cadaver and other external evidences, the ff. points must be taken into consideration: 1. Presence of Rigor Mortis - sets from 2-3 hours after death. Fully developed after 12 hours and last from 1836 hours. 2. Presence of Post-Mortem Lividity - usually develops 36 hours after death.

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Duration of Death 3. Onset of Decomposition - average time is 24-48 hours for tropical countries. Manifested by presence of watery, foul smelling coming out from the nostrils and mouth, softness of the body and presence of crepitation when pressure is applied on the skin. 4. Stage of Decomposition - approximate time of death may be inferred from the degree of decomposition. 5. Entomology of the Cadaver - maggot in the cadaver means death has occurred more than 24 hours. knip

Duration of Death 6. Stage of Digestion of Food in the Stomach - it takes 3-4 hours for the stomach to evacuate its content after meal. 7. Presence of Live Fleas in drowning Cases - flea can only survive for approximately 24 hours submerged in the water. If flea presence in the body can still move then the body has been in water for a period less than 24 hours. 8. Amount of Urine in the Bladder - may indicate the time of death when taken into consideration ; he was last seen voiding his urine. knip

Duration of Death 9. State of Clothing 10. Chemical Changes in the Cerebro-Spinal Fluid Fifteen Hours After Death - lactic acid increases from 15 200 mg/100 cc, non-protein nitrogen increases from 1540mg and amino acid concentration rises from 1% to 12% following death. 11. Post-Mortem Clotting and Decoagualtion of Blood 12. Presence or Absence of Soft Tissue in Skeletal Remains 13. Conditions f the Bone knip

Stages of Medico-Legal Investigation of Death 1. Crime Scene Investigation - place where the essential ingredients of the criminal act took place. 2. Autopsy - comprehensive study of dead body, performed by a trained physician employing recognized dissection procedure and techniques. 2 kinds of Autopsy a. Hospital or Non-Official Autopsy b. Medico-Legal or Official Examination knip

Causes of Death

1. Immediate or Primary Cause of Death - cases when trauma or disease kill quickly and no opportunity for sequelae or complications to develop. 2. Proximate or Secondary Cause of Death - injury or disease was survived for a sufficiently prolonged interval which permitted the development of serious sequelae w/ch actually caused the death. knip

Medico-Legal Classifications of Death

1. Natural Death - caused by natural disease condition in the body. 2. Violent or Unnatural Death - are those due to injuries inflicted in the body by some forms of outside force.

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Pathological Classification of the Causes of Death

1. Death from Syncope - due to sudden and fatal cessation of the action of the heart with circulation included. 2. Death from Asphyxia - supply of oxygen to the blood, tissues or both reduced below. 3. Death from Coma

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Medico-Legal Aspects of Physical Injuries Physical injury - is the effect of some forms of stimulus on the body . Causes of Physical Injuries: A. Physical Violence B. Heat or Cold C. Electrical Energy D. Chemical Energy E. Radiation by Radio-Active Substances F. Change of Atmospheric Pressure (Barotrauma) G. Infection

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Vital Reaction: sum total of all reactions of tissue or organ to trauma.

Common reactions of a living tissue to trauma: a. Rubor – redness b. Calor – heat c. Dolor – pain d. Loss of function – not able to function normally knip

Classification of wounds As to Severity a. Mortal Wound b. Non-mortal wound

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Classification of Wounds As to the Kind of Instrument Used a. Wound brought about by blunt instrument ( contusion, hematoma, lacerated wound) b. Wound brought about by sharp instrument: 1. Sharped-edged instrument (incised wound) 2. Sharped-pointed instrument (punctured wound) 3. Sharped-edged and sharp pointed instrument (stab wound) c. Wound brought about by tearing force (lacerated wound)

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Classification of Wounds d. Wound brought about by change of atmospheric pressure (barotrauma) e. Wound brought about by heat or cold (frostbite, burns or scald) f. Wound brought about by chemical explosion (gunshot or shrapnel wound) g. Wound brought about by infection knip

Classification of Wounds As to the Manner of Infliction: a. Hit b. Thrust or stab c. Gunpowder explosion d. Sliding or rubbing or abrasion.

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Classification of Wounds As regards to the Depth of the Wound: a. Superficial – only layers of the skin b. Deep – inner structure beyond the layers of the skin 1. Penetrating 2. Perforating

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Classification of Wounds 5. As regards to the Relation of the Site of the Application of Force and the Location of Injury: a. Coup Injury- site of the application of force b. Contre-Coup Injury- opposite c. Coup Contre-Coup- site and opposite d. “Locus Minoris Resistencia”- not at the site nor opposite but in some areas offering the least resistance to the force applied e. Extensive Injury- greater area of the body beyond the site of application of force knip

Classification of Wounds 6. As to the Regions or Organs of Body Involved: 7. Special Types of Wounds: a. Defense Wound- self-protection b. Patterned Wound- wound in the nature and shape of an object or instrument and w/ch infers the object or instrument causing it c. Self-Inflicted Wound- produced on oneself knip

Type of wounds (Medical Calssification) 1. Closed Wound – no breach of continuity of the skin or mucous membrane. a. Superficial- just underneath the layers of the skin or mucous membrane. - Petechiae- circumscribed extravasation of blood - Contusion- effusion of blood into the tissues underneath the skin - Hematoma-extravasation or effusion of blood in a newly formed cavity underneath the skin.

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Layers of the Skin

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Petechiae

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Hematoma

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Type of wounds (Medical Classification) b. Deep - Musculoskeletal Injuries >sprain- disruption in the continuity of muscular or ligamentous support of a joint >dislocation- displacement of the articular surface of bones >strain- over-stretching of a muscle or ligament >subluxation- incomplete or partial dislocation >fracture- solution of continuity of bone knip

Types of Fracture a. Close or Simple Fracture – no break in continuity of the skin b. Open or Compound Fracture – with open wound caused by the broken bone c. Comminuted Fracture - fragmented in several pieces d. Greenstick Fracture – crack e. Spiral Fracture – spiral f. Pathologic Fracture – weakness of bone due to disease

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Types of Fracture

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- Internal Hemorrhage- rupture of blood vessel which may be due to: >Traumatic intracranial hemorrhage >Rupture of parenchymatous organs >Laceration of other parts of the body

- Cerebral Concussion- jarring or stunning of the brain knip

Type of wounds (Medical Classification) 2. Open Wounds – there is a breach of continuity of the skin or mucous membrane.

a. Abrasion (Scatch Graze Impression Mark, Friction Mark) – removal of superficial epithelial layer of the skin

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Point of Distinction Color

Ante-mortem Abrasion Reddish-bronze

Location

Any area

Post-mortem Abrasion Yellowish & translucent

Bony prominence (elbow, & attributed to rough handling of the cadaver) Vital Reaction W/ intravital reaction No vital reaction & and may show characterized by a separation remains of damaged of epidermis from complete epithelium. loss of the former. knip

b. Incised Wound ( Cut, Slash, Slice) – produced by a sharp-edged (cutting) or sharp-linear edge of the instrument Changes that occur in an Incised Wound: No. of Hours & Days

Characteristics

After 12 hours

Edges are swollen; adherent w/ blood and w/ 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 3-5days

Vessels show thickening and obliteration knip

Why a Person Suffers from Incised Wound:

a. As a therapeutic procedure. b. As a consequence of self-defense. c. Masochist may self-inflict incised wound as a means of sexual gratification. d. Addicts and mental patients may suffer from incised wound irrationally.

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Incised Wounds may be: a. Suicidal b. Homicidal c. Accidental

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Suicidal

Homicidal

Direction

Oblique, from below left ear, downwards, across front neck just above Adam’s apple

Usually horizontal below the Adam’s apple

Severity

Usually not so deep and may only Usually deep and may cause involve trachea carotid and involvement of the cartilage sometimes the esophagus is involved and bones

Superficial Cut

Usually present before the commencement of deeper wound

Practically absent but may rarely be present when the victim struggled when attacked.

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Suicidal

Homicidal

Position of the body

May be sitting facing a mirror or standing

Wounding weapon

Firmly grasped (Cadaveric Weapon is absent spasm) or found lying beside victim Blood found in front part of the Blood found at the back of body. Hand generally smeared the neck. Hands clean with blood

Blood distribution

Usually victim ling on bed or in other place

Motive

History of mental depression, domestic, financial problems, alcoholism etc.

Absence of such history

Previous history of self destruction

May be present

Always absent knip

c. Stab Wound – penetration of a sharp edged instrument (knife, saber, dagger, scissors). It may involve the skin or mucous surface. It may be: Suicidal, Homicidal, Accidental

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a. Suicidal – Evidences showing hat the stab wound is suicidal: • Located over the vital parts of the body. • Usually solitary. If multiple, they are located on one part of the body. • If located on covered parts of the body, the clothing are not involved. • The stab wound is accessible to the hand of the victim. • The hand of the victim is smeared with blood. knip

• The wounding weapon is firmly grasped by the hand of the victim (cadaveric spasm) • If stabbing is accompanied with slashing movement, the wound tailing abrasion is seen towards the hand inflicting the injury. • A suicide note may be present. • There is the presence of a motive for self-destruction. • No disturbance in the death scene, wounding instrument is found near the victim. knip

In the Description of a Stab Wound, the following must be included : a. Length of the skin defect b. Condition of the extremities c. Condition of the edges d. Linear direction of the surface wound e. Location of the stub wound f. Direction of penetration g. Depth f penetration h. Tissue and organs involved knip

b. Homicidal – stabbing with homicidal intent is the most common. Characteristics: • Injuries other than stab wound may be present. • Stab wound may be located in any part of the body. • Usually there are more than one stab wound. • There is motive for the stabbing. If w/out , the offender must be insane or under the influence of drugs. • There is disturbance in the crime scene. knip

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 the parts of the body where vital organs are located. • Stub wounds are deep. • Stab wound w/ 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 knip level of the skin as the lever.

d. Punctured Wound – result of a thrust of a sharp pointed instrument. The external injury is quite small but the depth is to a certain degree. (icepick, needle, nail, spear, pointed stick, thorn, etc.) Usually accidental but in rare instances its may be homicidal or suicidal.

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e. Lacerated - a tear of the skin and the underlying tissues due to forcible contact with a blunt instrument. It may be homicidal or accidental but rarely suicidal. Classification of Lacerated Wound: a. Splitting caused by crushing of the skin between 2 hard objects. b. Overstretching of the skin. c. Grinding compression. d. Tearing knip

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GAPING OF WOUND: The separation of the edges especially in deep wound may be due to the following: 1. Mechanical stretching or dilatation 2. Loss of tissue a. Destruction b. Avulsion c. Trimming of the edges 3. Retraction of the edges Cleavage direction or lines of cleavage of the skin- dense networks of fibrous and elastic connective tissue fibers running on the same direction and forming a pattern more or less present in all persons. Langer’s line- linear presentation on the skin knip

Complications of trauma or Injury 1. Shock – disturbance of fluid balance resulting to peripheral deficiency Kinds of Shock: a. Primary Shock – immediate nerve impulse set up at the injured area b. Delayed or Secondary Shock – develop sometime after the infliction of injury knip

2. Hemorrhage – extravasation r loss of blood from the circulation brought about by wounds in the cardiovascular system. Kinds of Hemorrhage a. Primary Hemorrhage b. Secondary Hemorrhage 3. Infection – appearance of growth and development of microorganism at the site of injury. knip

Medico-Legal Aspects of Wounds 1. The following rules must always be observed by the physician in the examination of wounds: a. All injuries must be described, however small for it may be important later. b. The description of the wounds must be comprehensive, and if possible a sketch or photograph must be taken. c. The examination must not be influenced by any other information obtained rom others in making a report or a conclusion. knip

Medico-Legal Aspects of Wounds

2. Examinations of the Wounded Body: a. Examinations that are applicable to the living and dead victim:  age of the wound from the degree of healing  Determination of the weapon used in the commission of the offense  Determination whether the injury is accidental, suicidal or homicidal.  Reasons for the multiplicity of wounds in cases where there are more than one wound knip

Medico-Legal Aspects of Wounds

b. Examinations that are applicable only to living:  Determination whether the injury is dangerous to life.  Will produce permanent deformity.  Produced shock.  Will produce complication as a consequence.

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Medico-Legal Aspects of Wounds

c. Examinations that are applicable to the dead victim:  Determination whether the wound is ante-mortem or post-mortem.  The wound is mortal or not.  Death is accelerated by a disease or some abnormal developments which are present at the time of the infliction of the wound.  Wound was caused by accident, suicide or homicide. knip

Medico-Legal Aspects of Wounds

3. Examination of the Wound: a. Character of the Wound – description of the wound (type, size, shape, nature of edges) b. Location of the Wound – region of the body c. Depth of the Wound d. Condition of the Surroundings e. Extent of the Wound f. Direction of the Wound g. Number of Wounds knip

Medico-Legal Aspects of Wounds h. Conditions of the Locality degree of hemorrhage evidence of struggle information as to the position of the body presence of letter or suicide note condition of the weapon

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Distinction between Ante-Mortem and Post-Mortem Wounds Ante-mortem Wound

Postmortem Wound

1. Hemorrhage more or less copious and generally arterial.

1. Hemorrhage slight or none at all and always venous.

2. Marks of spouting of blood from arteries.

2. No spouting of blood.

3. Clotted blood.

3. Blood is not clotted; if at all, it is a soft clot.

4. Deep staining of the edges and cellular tissues, which is not removed by washing.

4. The edges and cellular tissues are not deeply stained. The staining can be removed by washing.

5. The edges gape owing to the reaction of the skin and muscle fibers.

5. The edges do not gape, but are closely approximated to each other, unless the wound is caused within one or two hours after death.

6. Inflammation and reparative processes.

6. No inflammation or reparative processes. knip

Determinnation Whether the Wounds were Inflected During Life or After Death During Life

After Death

Hemorrhage

more profuse

amount of bleeding iscomparatively less

Signs of Inflammation

swelling of the area sorrounding wound and other signs of vital reactions

do not show any manifesting signs of vital reactions

Signs of Repair

fibri formation, growth of epithelium, scab or scar formation

absence of signs of repair

Retraction of the Edges of the Wound

retract and cause gaping

do not gape and are closely aprroximated to each other knip

Points to be considered in the determination as to whether the wound is homicidal, suicidal, or accidental

1. External signs and circumstances related to the position and attitude of the body when found. 2. Location of the weapon or the manner in which it was held. 3. The motive underlying he commission of the crime and the like. 4. The personal character of the deceased. 5. The possibility for the offender to have purposely changed the truth of the condition knip

Points to be considered in the determination as to whether the wound is homicidal, suicidal, or accidental

6. Other information. a. Signs of Struggle b. Number and Direction of Wounds c. Direction of the Wound d. Nature and Extent of the Wound e. State of the Clothing

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Length of Time of survival of the victim after infliction of the wound

1. 2. 3. 4.

Degree of Healing Changes in the Body in Relation to the Time of Death Age of Blood Stain Testimony of the Witness when the Wound was Inflicted

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Possible Instruments Used by the Assailant in Inflicting the Injuries:

The determination of the wounding instrument maybe made from the nature of the wound found in the body of the victim. 1.Contusion- produced by the blunt instrument. 2.Incised wound- produced by sharp-edged instrument inflicted by hitting. 3.Lacerated wound- produced by the blunt instrument. 4.Punctured wound- produced by the sharped-pointed instrument. 5.Abrasion- body surfaces rubbed on rough hard surface. 6.Gunshot wound- the diameter of the wound of entrance may approximate of the caliber of the wounding firearm. knip

Which of the Injuries Sustained by the Victim Caused Death

This can be ascertained by examining individually the wounds and noting which of them involved injury to some vital organs or large vessels or led to secondary result causing death.

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Which of the wound was inflicted first?

When the several wounds present on the body of the victim, it is important to determine which of them was inflicted first because it maybe necessary for the qualification of the offense committed. If the first wound was inflicted in a treacherous way that the victim after receipt is incapable of defense, then murder is committed, but if the fatal wound was inflicted last, it is possible that the crime committed is only homicide. knip

Relative Position of Victim and Assailant when Injury was inflicted

The ff. has to be considered: 1. Location of the wound in the body of the victim. 2. Directio of the wound. 3. Nature of the instrument used in inflicting the injury. 4. Testimony of the witnesses.

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Death or Physical Injuries Brought About by Powder Propelled Substances

1. Production of Combustions: a) Bullet - Gunshot Wound b) Flame - Singeing c) Smoke - Smudging d) Gun powder residue - tatooing e) Grime - tatooing 2. Firearms Wounds a) Gunshot Wound knip

Difference Between Entrance and Exit ENTRANCE Appears to be smaller than missile owing to elasticity of tissue except contact fire Edges inverterd

EXIT Always bigger than missile

Usually ovaloid or rounded

Variable shape

Contusion collar present

Contusion collar absent

Other product of combustions when firing is near

Always absent

Paraffin test may be positive

Always negative

Edges everted

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Determination of Relative Position of Victim & Assailant

a. Contusion collar - the wider side points to the source of the missile b. Smudging and Tattooing - the side with more or intense deposit to the source of the missile. Determination of the probable caliber of the firearm used in the infliction - measure in centimeter of the cross diameter of the gunshot wound from collar to collar - the shortest is the probable caliber. knip

Determination of the distance of fire: a) Contact Fire - intense laceration and undermining of the point entrance. No bigger than exit. b) Distance of six (6) inches presence of smudging, singeing and tattooing. c) Beyond six (6) inches but within (36) inches - presence of the tattooing. d) Beyond thirt six (36) inches only the gunshot wound will be present.

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Shotgun Wound 1. Kinds of Shotgun Wound a) Unchoked bore or straight bore b) Choked bore - improved cylinder - narrowing of the bore from rear to the muzzle is 3-5 thousandth of an inch. - Half Chock - narrowing of the barrel is 15-20 thousandth of an inch. - Full Chock - narrowing of the barrel is 35-5thousandth of an inch. knip

Shotgun Wound 2. Characteristics of shotgun wounds a. Contact fire - entrance of wound is irregular with severe destruction of the underlying tissue. there is singeing and smudging. b. Near shot up to 6 inches      

mark laceration of skin gunpowder maybe driven into the deeper area of wound mark surrounding of skin and deeper portion of the wound of entrance mark tattooing hair is singe wad may be found inside the wound entrance knip

Shotgun Wound c. Distance of about 1 yard  Pellets enter as one mass thus making entrance wound with irregular edges.  Surrounding skin ay be blacken with light burning and tattooing. d. Distance of 2-3 yards  The wound of entrance has big central hole with rugged edges with few stray wound of entrance wound.  Smudging & tattooing - no longer evident. e. Distance of 4 yards - pellets may enter skin area of about 6-8 inches diameter although there may be a central care where a knip group might have entered.

Death by Asphyxia - all forms of violent death which results primarily from the interference with the process of respiration or to condition in which the supply of oxygen to the blood or tissue or both has been reduced below normal level. 1. Hanging 2. Strangulation a) by ligature b) manual or throtting c) special forms of strangulation (palmer, garroting, mugging or yoking, compression of neck with stick knip

Death by Asphyxia 3. Suffocation a) smothering - closing mouth and nostrils by solid objects b) choking 4. Asphyxia by submersion in water (drowning) 5. Asphyxia by pressure on the chest 6. Asphyxia by irrespirable gases

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Death or Physical Injuries Due to Vehicular Accidents

1. Kinds of injuries in VA cases  sustained by the pedestrian a) impact injuries • •

primary impact injuries secondary impact injuries

b) Secondary injuries c) Run over injuries  sustained by driver and passengers a) impact injuries b) turn-turtle injuries knip

Death or Physical Injuries Due to Vehicular Accidents 2. Medical Evidence in VA Cases  Evidence from victim a) Crash injury b) Tire thread marks c) Abrasion prints d) Blood e) Physical defects f) Inebriation of the victim  Evidence from the driver a)Physical defects b) Under the influence of alcohol or drugs c) History of grudge

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Medico-Legal Aspects of Sex Crimes

Virginity - condition of a female who has not experienced sexual intercourse and whose genital organs have not been altered by carnal connection.

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Kinds of Virginity 1. Moral Virginity - state of not knowing the nature of sexual life and not having experienced sexual relation (children below puberty and whose sex organs and secondary characteristics are not yet fully developed). 2. Physical Virginity - woman is conscious the nature of sexual life and not having experienced sexual relation. 3. Demi-Virginity - woman who permits any form of sexual liberties as long as they abstain from rupturing the hymen by sexual act. 4. Virgo Intacta - truly virgin woman. knip

Parts of the Female Body to be Considered in the Determination of the Conditions of Virginity

1. Breasts 2. Vaginal Canal 3. Labia Majora and Labia Minora 4. Fourchette 5. Hymen

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Defloration - laceration or rupture of the hymenas a result of sexual intercourse.

Parts of Female Genetalia that Must be Examined to Determine Defloration 1. Condition of the Vulva 2. Fourchette 3. Vaginal Canal knip