Legal Medicine Lecture Series 2nd Ed
Legal Medicine Lecture Series 2nd Ed
Legal Medicine Lecture Series 2nd Ed
General Considerations:
I. Definition:
Legal Medicine is a branch of Medicine, which deals with the application of
medical knowledge to the purposes of law and in the administration of justice.
Kinetic Energy:
Kinetic energy is based on mass and velocity factors and that velocity is squared,
the velocity component is the important factor. This explains why an M-16 bullet which has a
velocity of 3,200 ft/sec will do more damage than a .38 caliber bullet which is heavier but has a
much slower velocity.
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 stationary. The longer the time contact
between the object and instrument causing the injury, the greater will be the dissipation of
energy.
Area of Transfer:
The larger the area of contact between the force applied on the body, the lesser is the
damage to the body. By applying an equal force, the damage caused by stabbing is greater
compared to a blunt instrument.
“Other Factors”:
The less elastic and plastic the tissue, the greater the likelihood that a laceration will
result. Elasticity and plasticity refer to the ability of tissue to return to its “normal” size and
shape after being deformed by a pressure.
The movement of the parts of the body as a result of the force being applied to them and
the local stretching of tissue during acceleration had deceleration cause most of the internal
injuries seen in traumatized individuals.
A force transmitted through a tissue containing fluid will force the fluid away from the
area of a contact in all directions equally, frequently causing the tissue to lacerate (Legal
Medicine Annual 1980, Cyril Wecht ed., p. 36).
On the other hand, Atty. Molly Cr. Abiog, M.D. is only a doctor and a lawyer, but
not a Medico-legal Officer.
1. Sees an injury or illness on the Point of view of treatment from the point of
point of view of view of CAUSE
treatment sees injury
or illness from the
5. Cases of child abuse, domestic violence, rape, alcoholism and drug addiction;
If the Hospital has the authority to conduct autopsy but the relatives refuse to
cooperate, the death certificate is merely filled up by putting as the cause of death
“undetermined”. In effect, it is also as if no death certificate has been issued because legally
the body cannot be buried without a cause of death.
1. conducts autopsy
2. conducts examination of victims of sexual crimes
3. conducts examination of victims of Physical injuries
C. Remedial Law
1. Rules on evidence
2. Proceedings for hospitalization
3. Physical/mental examination of a person
Case Demonstration:
An 18 year old female, single, came to a medical clinic complaining that she has been
raped.
History of the Present Complaint:
One (1) month PTC, Mr. X by use of force and intimidation had carnal
knowledge with her at Burnham Park @ 2:00 p.m. For fear of her parent’s
wrath, she kept what happened to herself and came for medical examination
only today.
Examination results:
1. Recently healed hymeneal lacerations at 4 and 6 o’clock;
2. No signs of recent application of force at the perineal area;
3. Internal Examination, admits 2 examining fingers with ease; shallow vaginal
rugosities;
4. Laboratory Examinations: Positive for spermatozoa, no gram negative cocci.
1. Autoptic or Real Evidence- made known or addressed to the senses of the court, not
limited to vision.
3. Experimental Evidence: Example: A doctor may come to court and give lethal injection
of poison to a rat to demonstrate its effect on human beings.
5. Physical Evidence:
These are articles or materials that are found in connection with the investigation
and which aid in establishing the identity of the perpetrator or the circumstances under
which the crime was committed, or in general assist in the prosecution of the criminal.
Types:
a. Corpus Delicti Evidence: Objects or substances, which may be part of
the body of the crime.
b. Associative Evidence: Physical Evidence which link a suspect to a
crime. e.g. broken headlights of a car wearing apparel of offender in the
crime scene of rape.
“A good lawyer wants you to find out the TRUTH, and he/she wants to
know ahead of time so he/she is not caught by surprise later on.
Methods of deception detection, which are currently being used or applied by law
enforcement agencies:
1. Devices which record psycho-physiological responses
a. Use of a polygraph or lie detector machine
b. Use of the word association test
B. Narcoanalysis or Narcosynthesis:
-Use of Sodium amytal/ Sodium penthotal
-Drug causes the depression of the inhibitory mechanism of the brain and the
subject talks freely.
Methods:
1. The person whose statement is to be taken is allowed to take alcoholic
beverages to almost intoxication. At this point the power to control diminishes
and the investigator starts pounding questions and recording answers
2. The questioning must start during the executor state when the subject has the
sensation of his ell-being and when his action, speech and emotion are less
strained due to the lowering of the inhibition normally exercised by the higher
brain centers. When the subject is already in depressive state, he will no
longer be able to answer any question.
3. Confessions made by the subject while under the influence of alcohol may be
admissible if he is physically capable to recollect the facts that he uttered after
the effects pf alcohol have disappeared.
III. HYPNOSIS: the alteration of consciousness and concentration in which the subject
manifests a heightened of suggestibility while awareness is maintained.
Not all person are susceptible to hypnotic induction, subjects who are compulsive-
depressive type, strong-willed like lawyers, accountants, physicians and other professionals are
usually non-hypnotizable.
Reasons why Hypnotism is not Admissible in Court
1. It lacks the general scientific acceptance of reliability of hypnosis per se in
ascertaining the truth from falsity.
2. The fear that the truer of fact will give uncritical and absolute reliability to a scientific
device without consideration of its flaws in ascertaining veracity.
3. The possibility that the hypnotized subject will deliberately fabricate.
4. The prospect that the state of heightened suggestibility in which the hypnotize subject
as suspended will produce distortion of the fact rather than the truth
5. The state of the mind, skill and professionalism of the examiner are too subjective to
permit admissibility of the expert testimony
6. Confession while under hypnotic spell is not admissible as evidence because such
“psychiatric treatment” is involuntary and mentally coercive.
7. Although hypnosis may not yield admissibility evidence it may be pf some use during
investigation.
IV. OBSERVATION: A good criminal investigator must be a keen observer and a good
psychologist. A subject under stress on account of the stimulation of the sympathetic
nervous system may exhibit changes that may be used as a potential clue of deception. And
since just one or a combination of the following signs and symptoms are not conclusive pr a
reliable proof of guilt of the subject, their presence infers further investigation to ascertain
the truth of the impression.
A. Physiological and Psychological Sign and Symptoms of Guilt:
1. Sweating-Sweating accompanied by a flushed face indicate anger,
embarrassment or extreme nervousness. Sweating with a pallid face
may indicate shock or fear. Sweating hands indicate tension.
2. Color Change-
-Flushed face: anger, embarrassment and shame
-Pale face: sign of guilt
3. Dryness of the Mouth- Swallowing and licking of the lips
4. Excessive Activity of the Adam’s Apple
5. Fidgeting-subject is constantly moving about in the chair, pulling his
ears, rubbing his face, picking and tweaking the nose, crossing and
uncrossing his legs, rubbing the hair, eyes, eyebrows, beating and
snapping fingernails, etc. These are indicative of nervous tension.
6. “Peculiar feeling inside”- There is a tension of lightness of the head and
the subject is confused. This is the result of his troubled conscience.
7. Swearing to the truthfulness of his assertion- Usually a guilty subject
frequently utters such expression. “I swear to god I am telling the
truth” or “I hope my mother drops dead of a, lying”, ”I swear to
God”…etc. Such expressions are made to make forceful and
convincing his assertion of innocence.
8. Spotless past records-“Religious man”-The subject may assert that it is
not nor possible for him to do “anything like that” inasmuch as he is a
religious man and that he has a spotless record.
9. Inability to look at the investigator-subject does not look into the
investigators eyes for the fear that his guilt may be seen in his eyes. He
will rather look at the floor or at the ceiling.
For purposes of investigation, the following are the different types of Criminal Offenders:
1. Based on behavioral attitude:
a. Active aggressive offenders- impulsive manner
-Aggressive behavior e.g. crimes of passion,
revenge and
resentments.
b. Passive inadequate offenders
2. Based on the state of the mind:
a. Rational offenders: Those who commit crime with motive or
intention and with full possessing of their mental faculties.
E.g.: Killing with evident premeditation
b. Irrational offenders: Those who commit crime without knowing the
nature and quality of his act.
Example: Mad killer
3. Based on proficiency:
a. Ordinary offenders- they are engaged in crimes which require limited
skill.
b. Professional offenders-they are highly skilled and able to perform
criminal acts with the least chance of being detected. They require skill
rather than violaence.
Example: Pick-pocketing and shoplifting
4. Psychological classification:
a. Emotional offenders-Persons who commit crimes in the heat of passion,
anger or revenge, and also who commit offenses of accidental nature.
They usually have a feeling of remorse, mental anguish or compunction
as a result of their acts. They have a sense of moral guilt. The most
effective interrogation: sympathetic approach
b. Non-emotional offenders: persons who commit crimes for financial gain
Usually recidivist or repeaters.
Interrogation technique: Appeal to his common-sense and reasoning rather
than to his emotion.
Techniques of Interrogation:
1. EMOTIONAL Appeal— The interrogator must create a mood that is
conducive to confession. He must be sympathetic and friendly to the subject.
Basis of investigator’s Inference that the subject is not telling the truth:
Kinds of Confession:
Methods of Identification:
2. By exclusion- if two or more persons have to be identified and all but one is not
yet identified, then the one whose identity has not been established may be known by the
process of elimination.
IDENTIFICATION OF PERSONS:
Points of Identification Applicable to both living and dead before decomposition sets in:
1. Occupational Marks:
2. Race
a. color of skin
Basis:
1. The human skeleton is unchangeable after the twentieth year.
2. It is impossible to find two human beings having bones exactly alike.
3. The necessary can easily be taken with the aid of a simple instrument.
In many instances the investigator does not have a picture of the wanted or missing
person. The only way to have an idea of the prominent physical features is for the witnesses or
someone who has knowledge of the identity to tell him.
If a skilled investigative illustrator is available, a picture of the person to be identified
may be drawn or sketched. As a check to the sketch or drawing made, it must be shown to the
person(s) who gave the information to see wethwer it tallies wioth the person to be identified.
1. Ornamentaions
2. Personal belongings
3. Wearing apparel
4. Foreign bodies
5. Identification by close relatives
6. Identification records on file at the police department, immigration bureau,
hospitals, etc.
7. Identification photograph
a. Broad daylight:
A person can hardly recognize another person at a distance farther
than 100 yards if the person has never been seen before, but persons who are
almost strangers may be recognized at a distance of twenty-five yards.
b. Flash of firearms:
By experiment, letters 2 inches high can be read with the aid of the flash
of caliber .22 firearms at a distance of two feet,
BUT it is hardly possible for a witness to see the assailant in case of a hold-up
pr a murder because:
c. Flash of lightning:
d. Artificial light:
Identity is relative to the kind and intensity of the light. Experiments
maybe made for every particular artificial light concerned.
Uses of Fingerprints:
Poroscopy- type study of identification of the pores found on the papillary or friction ridges
of the skin for purposes of identification. It is also called as the Locards’ Method
of Identification.
Kinds:
1. Real Impressions
2. Chance Impressions
a. Visible print- visible without previous treatment. Visible
immediately after impression.
b. Plastic print- printed on paraffin, putty, resin, cellophane, plastic,
tape, butter, soap, and etch.
c. Latent print- prints that are not visible after impression but made
visible by the addition of some substances.
B. DENTAL IDENTIFICATION:
P.D. 1575 requires that practitioners of dentistry to keep records for 10 years of their
patients to make accurate dental records available for purposes of comparison or
exclusionary mode of identification. Upon the lapse of ten years, they shall turn over the
dental records to the NBI.
Sex- examination for the presence of Barr bodies (sex identification) from palatal
scrapping.
HANDWRITING:
The Sec.22, Rule 132 of Court: the genuineness of any disputed handwriting may be
probed by:
1. Acknowledgement of the alleged writer that he wrote it.
2. Statement of the witness who saw the writing made and is able to identify it as
such.
3. By the opinion of persons who are familiar with the handwriting of the alleged
writer.
4. By the opinion of an expert who compares the questionable writing with that
of other writings which are admitted or treated to be genuine by the party
against whom the evidence is offered.
Two (2) types if handwriting examination done by comparison with known standards:
1. Collected (procured) standard- These consist of handwriting by a person suspected
to have written the questioned document. It may be found in public or private records
of the person or from other sources. Provided it is clear and sufficient, it is a most
appropriuate standard.
- 15 handwriting specimens (used as standards)
2. Requested standard- These are standards made by the alleged writer of the
document in question upon the request of the examiner or persons interested in the
examination. Inasmuch as one of the characteristics of a good exemplar is that it must
b contemporaneous with the date of the questioned document was made, the use of
the requested standards is applicable only or recently written questioned documents,
like extortion or “poison” notes or letter of threat or ransom, etc.
* Please review the following: Handwriting Characteristics of Illiterates, Old Aged Persons
and Disguised Writing, pp.71-73 of your book, Forensic Medicine by Solis, 1988 ed.
IDENTIFICATION OF SKELETON:
In the identification of bones, the following points should be determined approximately:
1. Whether remains are of human origin or not
2. Whether remains belong to a single person or not.
3. Height
4. Sex
5. Race
6. Age
7. Length of interment or length of time from date of death
8. Presence or absence of anti-mortem or post-mortem bone injuries.
9. Congenial deformities and acquired injuries in the hard tissues causing permanent
deformities.
-Superimposed photography
How to determine whether the remains comes from a single individual or not:
1. A complete lay-out of the bones on a table in their exact locations in the human
body is necessary.
2. Any plurality or excess of the bones after a complete lay-out denotes that the
remains belong to more than one person.
3. However, congenital deformities must not be forgotten.
4. The unequality in sizes, specially in the limbs may be antemortem.
DETERMINATION OF SEX:
Legal importance of determination of Sex Determination
1. As an aid in identification
2. To determine whether an individual can exercise certain obligations vested by
law on one sex only.
3. Marriage or the union of a man and a woman
4. Rights granted by law are different to different sexes.
5. There are certain crimes wherein a specific sex can only be the offender or
victim.
DETERMINATION OF AGE:
Prescriptin test:
If a positive result is obtained, more or less conclusive way that the blood stains is
of human origin although anthropoid ape may give the same result.
Blood Grouping:
2. Venous Blood
I. DNA FINGERPRINTING
Unless two people are identical twins or clones, the chance that any two individuals
would have the same DNA fingerprint is one in several billion. So reliable is this method that if
the DNA sequence from a suspect doesn’t match, with the specimen, the suspect is excluded
from having left that specimen.
In rape cases, there would be no need for the rape victim to testify as to whether the
sexual act took place with a particular suspect since the vaginal fluid or the semen obtained from
the woman’s vagina can contain the suspect’s DNA.
It is such a powerful tool that, theoretically, it can prove that a particular group of people
had been together in one room or one place. If a suspect’s DNA is collected from a particular
area, it can at the very least put the suspect in the vicinity of the crime. It is so sensitive that if the
specimen is not properly handled, even the DNA of the collector may contaminate the specimen.
Briefly, the procedure involves taking a DNA pattern sequence from a human cell,
cutting it with an enzyme that recognizes a distinctive site. Through electrophoresis, there is
separation of these fragments by size. Then this is probed with a piece of radioactive DNA as a
result of which bands will appear, corresponding to the length of these fragments, appearing like
a bar code like the commercial products sold in supermarkets.
But how can this help in identifying a dead body? Through its mitochondrial DNA which
can only be passed on in the egg and so only from the mother, identification can readily be
accomplished. By comparing the dead body’s DNA with any female or male relative on the
maternal side, one can be sure with certainty that the body is that of someone related to them.
DNA typing is a well-established tool for the identification of human remains. It is such a
powerful tool that it is resorted to regularly and especially when the traditional methods of
identification have not yielded positive results. Since DNA is relatively resistant to
decomposition, especially in bones, this method can be useful in conditions of incineration,
fragmentation or decomposition where ideal specimens can no longer be obtained.
Of the many techniques of DNA analysis, the mitochondrial DNA (mt DNA) analysis is
the most effective identification although technically the most challenging. In difficult cases, the
possibility of extracting useful DNA is far better that nuclear DNA. This involves the study of a
relatively small amount of DNA found in the cytoplasm of human cell. It consists of a single
strand present in each mitochondrion, which is responsible for aerobic metabolism of the cell. In
contrast to a single copy of nuclear DNA per cell, there are hundreds to thousands of copies of
mitochondrial DNA per cell.
Irrespective of other methods of identification, the trend in the States is for the medical
examiner to retain a small specimen such as blood from an autopsied body. This is preserved as a
card on file for easy reference, especially when the identification should later be questioned.
Locally there are several agencies that can do this competently. What appears to be a
major stumbling block to its widespread use is its a relatively expensive procedure. As with other
modern technology, it is hoped that one day the procedure will be cheap enough to allow a DNA
file for everybody.
A. What is DNA?
B. Characteristics of DNA:
Each person has a unique DNA profile;
Each person’s DNA is the same in every cell;
An individual’s DNA profile remains the same throughout life;
Most DNA is the same from person to person;
Some DNA varies from person to person
Sexual assault;
Homicidal and violent crimes;
Exculpate wrongly accused suspects;
Identify serial crimes;
Identify human remains;
Sex offender tracking;
Parentage testing.
Paternity: Maternity:
Fresh blood cord abandoned, switched,
blood abortus, kidnapped infants
prenatal samples
saliva (buccal swabs)
H. Possible results of DNA Analysis:
Admissibility;
Evidentiary weight;
Reading and understanding DNA analysis Report;
Presenting and making the report admissible.
K. Likelihood Ratio:
“If the law made you a witness remain a man of science. You have no victim to avenge,
no guilty or innocent person to ruin or save. You must bear within the limits of science.” (Paul
H. Broussard, Chair of Forensic Medicine , Sorbonne, 1897)
Brain Death- is the most ideal criteria, however, Electro-encephalogram (EEG), which
is the most reliable machine to determine brain activities, is not available in many places and
number of component persons to apply the instrument is and the interpretation of the results is
quite limited.
The use of the criteria of brain death may be applied to potential organ
donors.
Kinds of Death
1. Somatic death or clinical death
2. Molecular or cellular death- 3-6 hours later.
3. Apparent death or state of suspended animation.
Methods of estimating how long a person has been from the cooling of the body:
a. When the body temperature is normal at the time of death, the average rate of
fall of the temperature during the first 2 hours.
= ½ of the difference between body temperature and that of the air.
-Next 2 hours = ½ of the previous rate
-Next 2 hours= ½ of the previous rate
General rule: the body attains the temperature of the surrounding air for 12
to 15 hours after death in tropical countries.
b. Approximate estimate of duration of death from body temperature; (Normal
temperature) 98.4 °F - (Rectal temperature)
15
=Approximate number of hours after death
c. Chemical Method:
Schourup’s formula- for the determination of the time of death of any
cadaver whose cerebro-spinal fluid is examined for the concentration of
lactic acid (L.A.), non-protein nitrogen (N.P.N.) and amino acid (A.A) and
whose axillary temperature has been taken the time the cerebro-spinal
fluid has been removed.
7. Action of heat in the skin: Useful to determine whether the application of heat
occurred before of after death.
-If after death-dry blisters is produced
*Epidermis is raised, no fluid on pricking
*No redness of surrounding of the skin
-If before death (living person)= blister is wet with vital reaction (Inflammation and
congestion)
2. External Factor
a. Temperature: accurate by high temperature but a
temperature above 75 °C will produce heat stiffening.
b. Moisture: High R.M. onset rapid and duration is short.
If the body is lying on his back, the lividity will develop on the back. Areas of the
bone prominence may not show lividity on account of the pressure.
If the body is moved during early stage- initial lividity may disappear and develop
again in the new position assumed.
BUT if the position of the body is moved after clotting has set in or when blood
has already differed into the tissues of the body, a change in position will not alter the
location of post-mortem lividity.
Example: (12 hrs. fully developed) Lividity begins to appear 3 to 6 hrs, after death
and the condition increase until blood coagulation for 12 hrs.
Kinds:
1. Hypnostatic
2. Diffusion lividity
Putrefaction of the body- is the breakdown of complex proteins into simpler components
associated with evolution of foul smelling gasses and accompanied by a change in color of
the body.
1. Presence of Rigor Mortis- 2 to 3 hours after death. Complete after 12 hours and
lasts for 18 to 36 hours.
-disappears with onset of decomposition.
2. Presence of Post-mortem lividity.
-Develops in 3 to 6 hrs, after death.
-Found on most dependent portion of the body.
.
3. Onset of Decomposition:
-Decomposition early in Philippines, average time of onset is 24 to 48 hrs,
after death
-Manifested by watery, foul-smelling froth coming out of the nostrils and
mouth, softness of the body and presence of crepitations, when pressure is
applied on the skin.
4. Stage of Decomposition:
-Degree of decomposition (refer tabulation in the Book p. 143)
5. Entomology of Cadaver:
-The usual time for an egg to be hatch into larva is 24 hrs.
-Presence of maggots implies that death has occurred more 24 hrs.
6. Stage of Food Digestion in the Stomach:
- It takes 3-4 hrs, for stomach to evacuate food contents after a meal.
7. Presence of live fleas:
-Flea can survive for 24 hours even if submerged in water.
LECTURE VI
MEDICO-LEGAL INVESTIGATION OF DEATH
The following officials of the government are authorized to make death investigation:
1. Provincial and City Fiscals
2. Judge of Regional Trial Court (RTC)
3. Judge of Municipal Trial Court (MTC)
4. Division of National Bureau of Investigation (NBI)
condition
physicianof the or medico
5. Chief Police of City of Manila
6. Solicitor General
crimecscene
legal officermay
Stages of Medico-Legal Investigation
include
photographer
1.strugglle,
Crime Scene Investigation
handgun
assistant
2. firmly
Autopsy-investigation
grasped
Crime in the
Scene- is thepalm ofessential ingredients of the criminal act took place.
place where
-It includes the setting of the crime and also the adjoining places of entry and
hand of deceased exit of both offender and victim.
In violent death cases, the manner and cause of death may be inferred from the
condition of the crime scene.
Kinds of Autopsies:
a. Hospital or Non-official Autopsy
b. Medico-legal or Official Autopsy
Purposes: consent
1.
2.
determining the cause of death
providing correlation of clinical diagnosis and clinical symptoms
comeing
3. determining the effectiveness of theraphy from the next
4. studying the natural course of disease process
5. educating students and physicians of kin
Medico-Legal or Official Autopsy: spouse
descendants
Purposes:
1. Determining the cause, manner (mode), and time of death;
2. Recovering, identifying, and preserving evidentiary material;
3. providing interpretation and correlation of facts and circumstances related to death;
4. providing a factual, objective medical report for law enforcement, prosecution, and
defense agencies;
5. Separating death due to disease from death due to external cause for protection of
the innocent
The following Manner of Death should be Autopsied:
1. Death by violence
2. Accidental Death
3. Suicides
4. Sudden death of persons who are apparently in good health
5. Death unattended by physician
6. Death in hospitals or clinics (D.O.A) wherein a physician was not able to arrive at a
clinical diagnosis as the cause of death
7. Death occurring in an unnatural manner.
a. Natural Death
- caused by natural disease condition in the body
-in natural deaths with concomitant physical injuries, it is necessary for the physician
to determine whether the physical injuries would accelerate death, or the injuries
itself developed independently and produced/death or that the person died absolutely
of a natural cause.
immeduate
b. Violent Death: mechanism
-are those due to injuries inflicted in the body in some forms of outside force.
cause of of death
The physical injury must be the proximate cause of death.
SPECIAL DEATHS
2.2 Permission from the Provincial Fiscal or from the Municipal Mayor is Necessary
if Death is Due to Violence Crime:
Sec. 1090: Burial and Transfer Permit
Sec. 1091: Burial permit (death certificate) must be
presented before burial
Sec. 1094: Disposition of body and belonging of person dying of
dangerous communicable disease
methods of disposal of dead body
Limitations to the Funeral Rites:
a. Will of Deceased
b. Burial of the person sentenced to death must not be held with pomp:
c. Restrictions as to funeral ceremonies in cases of deaths due to communicable
disease:
Sometimes social death comes ahead of biological death. When the person who is dying is
abandoned he or she has died already, although physically there is life
Guidelines for Physicians to aid this in cases where a decision to withhold or withdraw
nutrition and hydration is to be made
1. Unconscious, imminently dying patient (progressive and rapid
deterioration)
-the dying process has begun and cannot be reversed.
Classification of Wounds:
1. As to severity
a. mortal wound
b. non-mortal wound
2. As to kind of instrument used/agent
a. blunt instrument – contusion, hematoma, lacerated wound
b. sharp instrument
1.1 sharp edged – incised wound
1.2 sharp pointed – punctured wound
1.3 sharp-edged – pointed – stab
c. tearing of force – lacerated wound
d. change of atmospheric pressure – barotraumas
e. heat of cold
f. chemical explosion – gunshot or shrapnel
3. As to the manner of Infliction
a. hit – bolo, blunt instrument, axe
b. thrust or stub – bayonet, dagger
c. gunpowder explosion – projectile or shrapnel wound
d. sliding or rubbing – abrasion
4. As regards to depth of wound:
a. superficial – includes only layers of the skin
b. Deep – beyond layers of the skin;
Penetrating – 2 meanings:
1.a. wounding agent enters the body but did not come out
1.b. the mere piercing of a solid organ or tissue of the body
c. Perforating –
1.a. Wounding agent produces communication between
inner and outer portion of the hollow organs.
1.b. piercing or traversing completely as particular part of the body causing
communication between the points of entry and exit of the instrument or
substance producing it.
5. As regards to the Relation of the Site of the Application of Force and the
Location of Injury:
a. Coup Injury – Physical Injury which is located at the site
of the application of force.
b. Contre-Coup Injury – Physical injury found opposite
the site of the application force.
c. Coup Contre-Coup Injury – Physical Injury located at
the site and also opposite the site of application of force.
d. “Locus Minoris Resistencia” – Physical injury located not al the site nor
opposite the site of the application of force but in some areas offering the least
resistance to the force applied. A blow on the forehead may cause contusion at
Mutilations:
Maylem – is the unlawful and violent deprival of another of the use of
a part of the body so as to render him able in fighting either to defend himself
or to annoy his adversary.
Therefore Mutilation of other parts of the body other than the organ of
reproduction. May be classified as maylem.
Types of Wounds
A. Closed Wounds – no breach in continuity of skin
Superficial – wound is within skin / mucous membrane
a. Petechiae – circumstancial extravasation of blood subcutaneous tissue
c. Contusion – 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.
b. Hematoma – extravasation or effusion of blood in a newly formed cavity
underneath the skin.
Distinction between Contusion and Hematoma:
i. In contusion the effused blood are accumulated in the interstices of the
tissue underneath the skin.
ii. In hematoma blood accumulates in a newly formed cavity underneath
the skin.
c. Contusion - skin shows no elevated – if only slight acct. of inflammatory,
while in hematoma – skin always slunted
Contusion – aspiration with syringe – no blood can be obtained
Abscess, gangrene, hypertrophy, fibroid, thickening, and even
malignancy are potential complications of hematoma.
Ecchymosis – “kiss mark”, a type of hematoma
Deep:
Musculo-Skeletal Injuries:
1. sprain – partial or complete disruption in the continuity of a muscular
or ligamentous support of a joint. Caused by blow, kick or torsion
force.
2. Dislocation – displacement of the articular surface of bones entering
into the formation of a joint.
3. Fracture – solutions of continuity of bone resulting from violence or
existing pathology
Types: a. closed or simple
b. open or compound
c. Comminuted Fracture
d. Greenstick Fracture
e. Linear Fracture
f. Spiral fracture
g. Pathological Fracture
B. Open Wound – there is breach in the continuity of the skin or mucous membrane.
1. Abrasion (scratch, graze, Impression Mark, Friction Marck)
-Injury characterized by the removal of the superficial epithelial
layer of the skin caused by a rub or friction against hard, rough
surface.
-May be associated with contusion if there is forcible contact
CHARACTERISTICS:
develops at the precise point of impact
injury consist of parallel linear of the rub or friction causing it.
may exhibit the pattern of the wounding material
usually ignored by attending physician for it does not require medical treatment but it has
far-reaching importance in the medico legal viewpoint.
-abrasions caused by fingernails
-usually located in bony parts of the body associated with contusions and laceration
-nature of abrasions may infer degree of pressure, nature of rubbing object and the
direction of movement.
abrasion heals in a short time and leaves no scar.
FORMS OF ABRASION:
a. Linear
b. multi-linear
c. confluent
d. multiple
TYPES:
1. Scratch – sharp pointed object which slides over skin
2. Graze – forcible contact
3. Impact or Imprint Abrasion
4. (Pattern abrasion, stamping abrasion or “abrasion a la signature”)
5. marks of the grid of radiator
6. tire thread marks
7. muzzle imprint – contact fiercing
8. teeth impression – skin bites
9. pressure or Friction Abrasions – hanging or strangulation
Incised wound – (cut, slash, slice) - produced by a sharp edged or sharp linear edged
of the instrument. (e.g. knife, razor, bolo, glass, metal sheet)
impact cut
slice cut
CHARACTERISITICS:
1. edges – clean cut, both extremities are sharp
2. wound straight or shelving – acute to body
3. wound shallow near extremities; deeper at middle position
4. because clean cut; profuse huge is a features.
5. Gaping
6. If incised wound is covered are = even clothing show clean cert texture
7. Healing by 10 intention
Characteristics:
a. presence of other injuries
b. location – any part of body
c. more than one stab wound – gradually
d. + motive for stabbing if w/o motive, the offender must be insane or under the
influence of drugs
e. + disturbance in the crime scene
Punctured wound:
1. produced by a thrust of a sharp – pointed instrument
2. external injury small – depth is usually deep
3. produced by ice pick, needle, nail, spear, pointed stick, thorn, fang of
animal – hook
Characteristics:
1. shape and size of injury does not correspond to wounding
instrument.
2. tear of skin – rugged with extremities irregular and ill-defined
3. injury at the site where blunt force is applied
4. borders of wound – contused and swollen
5. usually develop in areas where bone is superficially located. Scalp,
dorsum of foot, front leg.
6. exam with hard lens – bridging tissues and instant hair bulbs
7. heeding not extensive because Blood usual are not severed evenly
8. healing process delayed – scars usually develop.
Contusion age:
1. Relative position of assailant and victim when the first injury was inflicted to latter.
2. Trajectory or course of the wound inside the body
3. Organs involved and degree of injury sustained
4. Testimony of witness
5. Presence of defense wounds of victim.
defense wound must be inflicted first before fatal wound
A. Firearm shot – injury caused by the missile propelled by the explosion of the
gunpowder located in the cartridge shell and at the rear of the missile.
i. In the Philippines, it is unlawful to carry a firearm without a license.
ii. The barrel alone is considered a complete firearm.
iii. There are basically two (2) types of firearms, namely:
iv.
a. Rifled weapon so called due to the spiral grooving on the inside
of the barrel imparting a spinning or gyroscopic effect to the bullet as the
missile is fired.
b. Shotgun
Blackening is due to :
1. Smoke effect of smudging
2. Combined effects - gunpowder tatooing
- to certain extent –> burning of wound margin
The pressure of the bullet on the skin will cause the depressed portion -->
rubbed by the rough surface of the bullet.
Perpendicular approach – prod. Even width of collar acute angle approach –
abrasion collar wider at the acute angle of approach
General Rule – the higher the caliber of the wounding bullet, the
greater will be the size of the wound of entrance
Manner of approach of the bullet to the skin
Distance of the muzzle of firearm to skin surface
Deformity or splitting of the bullet
Surface of the skin involved are factors which modifies the size and
shape of the wound of entrance
How produced:
1. in most cases, the size of wound of entrance is smaller than the caliber of the
wounding bullet on account of the retractions of the connective tissues of skin.
6. Range:
close range fire – injury not only due to the missile but also due to
the pressure of the expanded gases, flame and other solid products of
combustion
distant fire – usually produces the characteristics effect of the
bullet alone
7. Kind of weapon:
8. Shape of bullet
CONTACT FIRE- the nature and extent of injury is caused not only by the force of
bullet but also by the gas of muzzle blast and part of body involved.
o Effectiveness of the sealing between the gun muzzle and the skin
o Amount of gas liberated by the combustion of the propellant
o Nature of the bullet: bigger cal. Bullet the more destructive
CHARACTERISTICS;
Metal Fouling – when bullet travels the whole length of the tight fitting barrel, it is rotated
by the lands and grooves its surface is scraped by the lands is ejected from the barrel
and strikes the target. It may lodge on the clothing or may cause small abrasions or
superficial lacerations on the skin around the main wound.
9. Singeing of hair
Medium range fire more than 15 cm. but less than 60 cm.
1. Gunshot wound with inverted edges and with abrasion collar is present
2. burning effects
3. smudging may be present if less than 30 cm. distance
4. gunpowder tattooing is present but of lesser density and has a wider area of
distribution
5. contact ring is present
1. Gunshot wound is circular or oval depending on the angle of approach with abrasion
collar.
2. wound of entrance has no burning, smudging or tattooing
3. contact ring is present
Instances when the size of the wound of entrance do not approximate the
caliber of the firearm:
When course of bullet is through and through and there is difficulty in the determination as to
which is the entrance because it does not show characteristic findings, or it has been modified
by healing, infection or surgical intervention, the medical examiner must resort to the
following:
1. External examination
a. Shape of wound of entrance: oval? Circular? Deformed bullet?
b. Shape and distribution of contression or abrasion collar?
c. Difference in level between entrance and exit wound how? Reference point (sole
of foot)
d. By probing the wound
2. Internal examination
a. actual dissection and tracing the course of the wound at autopsy.
b. Fracture of bones and course in visceral organs
c. Location of bone fragments and lead particles
d. X-ray examination
Characteristics:
How produced?
Outstretched skin is impaled, sandwiched and crushed between the outgoing
bullet and the unyielding object is over the exit site, thus making the wound to be circular
with abrasion collar at its margin. Proper coaptation of the wound margin is impossible
because of the loss of skin just like those observed in the entrance wound. In contrast
with the entrance wound, the supported exit wound shows a scalloped or punched-out
abrasion collar and sharply contused skin in between the radiating skin lacerations
marginating the abrasion.
If the number of gunshot wounds of entrance and exit found in the body of the victim
is even, presumption is that no bullet is lodged in the body.
If the number of the gunshot wounds of entrance and exit is odd, the presumption is
that one or more bullets might have been lodged in the body
Instances when the number of GSW of entrance is less than the # of GSW
of exit in the body of victim:
Instances when there is no GSW of exit but the bullet is not found in the
body of the victim:
1. bullet – gastro-intestinal tract – expelled through mouth by coughing
2. near fire with blank cartridge produced a wound of entrance but no slug may be
recovered
3. bullet may enter the wound of Entrance and upon hitting the bone the course is
deflected to have the wound of entrance as the wound of exit.
Types:
4. Anoxic Death – associated with the failure of the arterial blood to become normally
saturated with oxygen. Due to:
a. Breathing in an atmosphere without or with insufficient oxygen, as in high
altitude
b. Obstruction of the air passage due to pressure from outside, as in traumatic crush
asphyxia
c. Paralysis of the respiratory center due to poisoning, injury or anesthesia, etc.
d. Mechanical interference with the passage of air into or down the respiratory tract
due to:
closure of the external respiratory orifice, like in smothering and
overlaying
obstruction of the air passage, as in drowning, choking with foreign
body impact, etc.
respiratory abnormalities, like pneumonia, asthma, emphysema and
pulmonary edema
5. Anemic Anoxic Death – due to a decreased capacity of the blood to carry oxygen. Due to:
a. Severe hemorrhage
b. Poisoning like carbon monoxide
c. Low hemoglobin level in the blood
6. Stagnant Anoxic death – brought by the failure of circulation. Due to
a. heart failure
b. shock
c. arterial and venous obstruction, incident to embolism, vacular spasm, varicose
vains, or the use of tourniquet
7. Histotoxic Anoxic death – due to the failure of the cellular oxidative process, although the
oxygen is delivered to the tissues, it cannot be utilized properly.
CLASIFFICATION OF ASPHYXIA:
1. Hanging
2. Strangulations:
a. strangulation by ligature
b. manual strangulation or trottling
c. Special forms of strangulations:
- palmar
- garroting
- mugging or yoking
- compression of the neck with stick
3. Suffocation
a. smothering or closing of the mouth and nostrils by solid objects
b. choking or closing of the air passage by obstruction of its lumen
4. Asphyxia by submersion or drowning
5. Asphyxia by pressure on the chest
Legal Medicine page 59
6. Asphyxia by irrespirable gases.
Mechanism of drowning:
Person- (does not know how to swim)--- falls into a deep body of water – body sinks bec. Of
momentum of fall – and sp. Grav. Of body > than H2O
- body will be buoyed up – because of instinctive movement of
individual and air under clothings
- while under H2O – breath is held – but upon reading surface – there
is an attempt to breath – air and H2O gets into mouth and nostrils
- subj. will raise his hard – will cause him to sink
- subj. alt. Appears and disappears on surface – everytime he attempts
to breath H2o and air gets in
- violent coughing occurs – which will expel air in the lungs – greater
desire to breath – more H2o is drawn in lungs and stomach
- H2O files bronchioles – push residual air – surface of lungs –
ballooning soggy and edematous.
- Death 2-5 minutes (average time)
If dead body recovered in H2O – physician must answer the ff. questions:
2. Did death occur prior to entry in H2O? If so what was the cause of death?
3. Did drowning cause death? If so is it fresh/salty H2O pool?
4. Any ante-mortem injuries? If so did they play any part in the death
5. Any post-mortem injuries?
Post-Mortem;
Internal Findings:
a. Respiratory System:
1. “Emphysema aquosum”- remedial air - balloons
2. “Edema Aquosum” - H2O is air sacs
3. “Champignon d’ocume” – whitish foam – nostrils mouth
Gettler’s Test – quantitative determination of the chlorise content of the blood in the
right and left ventricle of the heart.
- difference if of at least 25 mcg. Proves that death occurred in fresh
salt H2O and drowning is the cause of the death
- salt H2O – Cl content of right side vert is less than lt. = fresh H2O –
CL- lt of right side less than lt.
Virginity – is a condition of a female who has not experienced sexual intercourse and whose
genital organs have not been altered by canal connection
Kinds of Virginity:
1. Moral virgin – state of not knowing the nature of sexual life and not having experienced sexual
relation.
- applies to children < age of puberty sex organs and secondary char. not developed
2. Physical Virgin – condition where a female is conscious of the nature of the sexual life byt has
not experienced sexual intercourse.
There is no conclusive medical finding that a woman is physically virgin. Reliance
is made as absence of laceration of the hymen
a) True physical virgin
b) False physical virgin
3. Demi-virginity – this term refers to a condition of a female who permits any form of sexual
liberties as long as they abstain from rupturing the hymen by sexual act
4. Virgo Intacta – literally term refers to a truly virgin female, no structural changes in her organ
to infer previous sexual intercourse and that she is a virtous female.
4. Complications of laceration
a. secondary infection – bacterial:
b. hemorrhage – present in severe cpd. laceration of hymen – surgery
may be necessary
c. fistulae formation – recto-vaginal or vesico-vaginal fistula;
correction surgey
d. stricture – laceration involving vaginal wall – scar formation/healing
– narrowing of vaginal canal
e. sterility – secondary infection – uterus – fallopian tube
Criminal Characteristics:
1. It is one of the ancient and universal crime.
2. there is close physical contract between the offender and the victim. Murder and
homicide may be committed at a distance. Estafa and other crimes may be committed
even w/o physical presence
3. As a gen. Rule, it is a crime committed by one sex against the opposite sex
4. Sex is an inborn instinct. Any person with out sex drive is considered abnormal.
- anti-social means of attaining sexual gratification is one punished
5. Seduction and consisted abduction are considered as crimes in the Philippines but not
in other countries
6. Many sex crimes are committed but not reported if reported, not investigated, if
investigate, not prosecuted. Why?
- under publicly may be prejudicial to the reputation of the victim