LEARNING RESOURCE ON

LEGAL MEDICINE

LEARNING RESOURCE

START DISCUSSION
GENERAL PROVISIONS
CHAPTER 1
DEFINITION AND NATURE OF LEGAL MEDICINE

LEGAL MEDICINE is a branch of medicine which deals with the application of

medical knowledge for the purpose of law and in the administration of justice.

A knowledge of legal medicine means the ability to acquire facts, the power to
arrange those facts in their logical order, and to draw a conclusion from the
facts, which may be useful in the administration of justice.

A physician who specializes or is involved in medico-legal duties is known as a

medical jurist (a.k.a. medical examiner, medico-legal officer, medico-legal
expert). They are mostly in the service of the government and should posses
the power to impart to others what he/she has observed verbally or in writing.
LEGAL PROVISIONS RELATED TO LEGAL MEDICINE

• Sec. 95, PD 856 [Code of Sanitation]

“Health officers, medical officers of law enforcement agencies and members of the
medical staff of accredited hospitals are authorized by law to perform autopsies”

AUTOPSY –

• Sec. 2, Art III of Code of Medical Ethics

“It is the duty of every physician, when called upon by the judicial authorities, to assist in
the administration of justice on matters which are medico-legal in nature”

NOTE: To be involved in Medico-Legal duties, a physician must posses sufficient

knowledge in pathology, surgery, gynecology, toxicology and such other branches of
medicine germane to the issue at hand.
DISTINCTION BETWEEN AN ORDINARY PHYSICIAN
AND A MEDICAL JURIST
• An ordinary physician sees injury or disease on the point of view of treatment, but a
medico-legal expert sees an injury or disease on the point of view of the cause.

• The purpose of an ordinary physician in examining a patient is to arrive at a definite

diagnosis so that appropriate treatment can be instituted, while the purpose of a
medical jurist in examining a patient is to include those bodily lesions in his report and
testify before the court or before an investigative body, thus giving justice to whom it
is due.

• Trivial injuries are usually ignored by ordinary physicians, but a medical jurist records
all injuries, even minor ones, because these injuries may be proofs to qualify the
crime or to justify an criminal act.
DISTINCTION BETWEEN AN LEGAL MEDICINE AND
OTHER RELATED SCIENCES
LEGAL MEDICINE is closely related to FORENSIC MEDICINE and MEDICAL JURISPRUDENCE

• FORENSIC MEDICINE – concerns with the application of medical science to elucidate

legal problems.

• MEDICAL JURISPRUDENCE – the knowledge of law in relation to the practice of

medicine

THE PRINCIPLE OF STARE DECISIS

STARE DECISIS is a principle in law which states that once the court laid down a principle
of law, or interpretation is applied to a certain state of fact, it will adhere to and apply to
all future cases where the facts are substantially the same.
BRANCHES OF LAW WHERE LEGAL MEDICINE
MAY BE APPLIED
I. CIVIL LAW
• Determination and Termination of Legal Personality
• The limitation or restriction of a natural person’s capacity to act
• The marriage and legal separation
• The paternity and filiation
• The testamentary capacity of a person making a will

II. CRIMINAL LAW

• Circumstances affecting criminal liability
• Crimes against persons
• Crimes against chastity

III. REMEDIAL LAW

• Physical and mental examination of a person
• Proceedings for the hospitalization of an insane person
• Rules on evidence
BRANCHES OF LAW WHERE LEGAL MEDICINE
MAY BE APPLIED
IV. SPECIAL LAWS
• Dangerous Drug Act (RA 6425 as amended)
• Youth and Child Welfare Code (PD 603 as amended)
• Insurance Law (Act No.2427, as amended)
• Code of Sanitation (PD 856)
• Labor Code (PD 442)
• Employee’s Compensation Law

WHEN AUTOPSIES MAY BE PERFORMED

• Whenever required by special laws
• Upon order of a competent court, a mayor, or a provincial or city fiscal
• Upon written request of police authorities
• In the determination of the cause of death if the fiscal deems in necessary
• Whenever requested in writing by the nearest kin to determine the cause of death
MEDICAL EVIDENCE

EVIDENCE – the means, sanctioned by the Rules of Court, of ascertaining in a judicial

proceeding the truth respecting a matter of fact. An evidence is admissible in court if it is
relevant to the issue and is not excluded by the rules of court.

TYPES OF MEDICAL EVIDENCE

• REAL OR AUTOPTIC EVIDENCE

- evidence made known or addressed to the senses of the court.
- as to Legal Medicine, the court may require the physician to present the skeleton of
victim of a criminal act exhumed and examined before the judge to see the presence
and degree of ante-mortem fracture

LIMITATIONS:
a) Indecency and impropriety (the court may not allow the exposure of the
genitals of the victim of an alleged sexual offense)
b) Repulsive objects (objects which are offensive to the sensibilities)
MEDICAL EVIDENCE

• TESTIMONIAL EVIDENCE
- a physician may be commanded to appear before a court to give his testimony. He
may be an ordinary or an expert witness

Ordinary Witness - if the physician testified in court on matters that he perceived

from his patient in the course of patient-physician relationship.
Expert Witness – if the physician, on account of his training and experience, can give
his opinion om a set of medical facts.

LIMITATIONS:
(Ordinary)
1) Privilege Communication (Sec 21, Rule 130 of Rules of Court)
2) Hearsay Rule (Sec 30, Rule 130, Rules of Court) except Dying Declaration
(Expert)
1) Opinion Rule (Sec 42 and 43, Rule 130, Rules of Court)
MEDICAL EVIDENCE

• EXPERIMENTAL EVIDENCE
- a medical witness may be allowed by the court to confirm his allegation or as a
corroborated proof to an opinion he previously stated

Example:
1) Issue on how long a person can survive after administration of poison
2) Issue on how long a body decomposes under extreme weather conditions

• PHYSICAL EVIDENCE
- articles and materials which are found to be in connection with an investigation and
which can aid in establishing the identity of the perpetrator or the circumstance
under which the crime was committed, or in general, assist in the prosecution of the
criminal.
1) Corpus Delicti Evidence
2) Tracing Evidence
3) Associative Evidence
MEDICAL EVIDENCE

• DOCUMENTARY EVIDENCE
- the term applies to writings, words printed, lithographed, or photographed symbols

Examples of Medical Documentary Evidence

1) Medical Examination Result
2) Physical Examination Result
3) Necropsy Report
4) Laboratory Results
5) Exhumation
6) Birth and Death Certificates
7) Medical Expert Opinion
8) Deposition – written record of evidence given orally and transcribed in writing
in the form of questions by the interrogator and the answers of the deponent
MEDICAL EVIDENCE

PRESERVATION OF EVIDENCE

Evidences recovered during medico-legal investigation must be preserved to maintain

their value when presented as exhibit in court.

Methods of Preservation

1) Photographs, audio/video clips, micro-film, Photostat, Xerox or voice tracing

2) Sketching
3) Description
4) Manikin Method
5) Memory
6) Other special methods such as embalming, use of formalin solution for soft
tissues, refrigeration for blood, drying for stains, and sealing on containers
MEDICAL EVIDENCE

KINDS OF EVIDENCE NECESSARY FOR CONVICTION

• DIRECT EVIDENCE – that which proves the fact in dispute without the aid of
presumptions.

• CIRCUMSTANTIAL EVIDENCE – the proof of a fact or facts from which, if taken singly
or collectively, the existence of a particular fact in dispute may be inferred as a
necessary or probable consequence

To be sufficient:

1. There should be more than one circumstance

2. The facts from which the inferences are derived are proven
3. The combination of all the circumstances is such as to produce guilt beyond
reasonable doubt
MEDICAL EVIDENCE

WEIGHT AND SUFFICIENCY OF EVIDENCE

• ON CIVIL CASES: Preponderance of Evidence

The party who presented evidences of superior weight wins
the case

• ON CRIMINAL CASES: Guilt Beyond Reasonable Doubt

Moral certainty is required, or that degree of proof which
produces conviction in an unprejudiced mind
DECEPTION DETECTION
CHAPTER 2
GENERAL NATURE OF DETECTING DECEPTION

The knowledge of truth is an essential requirement for the administration of

justice. Modern scientific methods of detecting deception such as physiology,
psychology, pharmacology, toxicology, etc. has been utilized to know if a
subject is telling the truth or not. Although most these scientific methods have
not yet attained legal recognition, they are very much useful in investigation.
METHODS OF DETECTING DECEPTION

 Devices which record the psycho-physiological response

- Use of Lie Detector machine
- Use of word association test
- Use of psychological stress evaluator

 Use of drugs that inhibit the inhibitor

- Use of truth serum
- Narcoanalysis or narcosynthesis
- Intoxication

 Hypnotism

 Observation

 Scientific Interrogation

 Confession
RECORD OF PSYCHO-PHYSIOLOGICAL RESPONSE

The nervous system of the human body is composed of the central nervous
system (brain, spinal cord) and the autonomic nervous system (sympathetic,
parasympathetic). Between the two, the autonomic nervous system acts as a
self-regulating response of the body. It is composed of two elements acting
opposite each other. Thus, when a person is under the influence of physical or
emotional stimuli, the sympathetic will dominate and override the
parasympathetic which will result to changes in the heart rate, pulse rate,
blood pressure, respiratory tracing, psychogalvanic reflex, and even time of
response.

 Lie Detector Test – subject is seated on a chair where his responses to yes
or no questions are recorded in a machine which records heart beat,
respiratory rate, and psychogalvanic responses helpful in detecting if the
subject is lying or not.
RECORD OF PSYCHO-PHYSIOLOGICAL RESPONSE

REASON FOR INADMISSIBILITY IN COURT

1. Polygraph techniques are still in the experimental stage and have not
received the degree of standardization of acceptance among scientists
2. The trier of fact is apt to give almost conclusive weight to the
polygraph’s expert opinion.
3. No way to assure that a qualified examiner administered the test
4. The test itself cannot be relied upon due to errors
5. Waiver of right against self-incrimination

 Word Association Test – a list of stimulus and non-stimulus words are

read to the subject who is instructed to answer as quickly as possible.
Like the lie detector test, the subject is not compelled to the test
without his consent
RECORD OF PSYCHO-PHYSIOLOGICAL RESPONSE

 Psychological Stress Evaluator (PSE) – when a person speaks, there are

audible voice frequencies, and superimposed on these are the
inaudible frequency modulations which are products of minute
oscillations of the muscles of the voice. Thus, when a person lies, the
microtremor in the voice utterance is moderately or completely
suppressed. The degree of suppression varies as to the degree of
psychological stress
DRUGS THAT INHIBIT THE INHIBITOR

 Truth Serum Test – in this test, a drug known as hyoscine hydrobromide is

given hypodermically in repeated doses until a state of delirium is induced.
When the proper point is reached, the questioning begins and the subject
feels a compulsion to answer the question truthfully.

 Narcoanalysis / Narcosynthesis – practically the same with the truth

serum test except that a different kind of drug is used (sodium amytal or
sodium penthotal. Like the previous one, results of this test is not
admissible in court.

 Intoxication – the ability of alcohol to induce a person to speak the truth is

embodied in the maxim “In Vino Veritas”.
HYPNOSIS

Hypnosis is the alteration of consciousness and concentration in which the

subject manifests a heightened of suggestibility while awareness is
maintained.
OBSERVATION

A subject under stress on account of stimulation of the sympathetic

nervous system may exhibit changes which may be used as potential clue
of deception.

SIGNS AND SYMPTOMS OF GUILT

1. Sweating
2. Color Change
3. Dryness of Mouth
4. Excessive activity of the Adam’s Apple
5. Fidgetting
6. Peculiar Internal Feeling
7. Swearing to the truthfulness of his assertion
8. Spotless Past
9. Not able to look straight to the eye
10. Not that I remember
SCIENTIFIC INTERROGATION

INTERROGATION – the skilful questioning of a person suspected to having

committed an offense or of a person who are reluctant to make a full
disclosure of information in his possession which is pertinent to the
investigation.

REQUIREMENT FOR ADMISSIBILITY

Sec. 20, Art. IV, Bill of Rights, Phil. Constitution
- If a person is to be interrogated, he must be first warned and advised
that, (1) he has the right to remain silent, (2) he has the right to counsel.
(3) if he cannot afford his own attorney, one will be appointed to him. After
mentioning these and in order to secure a waiver, he should be asked; (1)
Do you understand these rights that I have explained to you? , and (2)
Having these rights in mind, do you wish to speak to us now?
CONFESSION

CONFESSION – an expressed acknowledgment by the accused in a criminal

case of the truth of his guilt as to the crime charged, or of some essential
elements thereof

NOTE:

• Maltreatment of persons in order to extract confession is a crime

TOKYO DECLARATION – contains guidelines to be observed by physicians

concerning torture and other cruel, inhumane, and degrading treatment or
punishment in relation to detention and imprisonment.
MEDICO-LEGAL ASPECT OF
IDENTIFICATION
CHAPTER 3
DEFINITION, IMPORTANCE, RULES
AND GENERAL METHODS OF IDENTIFICATION
IDENTIFICATION is the determination of the individuality of a person or a
thing.

IMPORTANCE
1. In the prosecution of the criminal offense, the identity of the offender and that of the
victim must be established, if not it could be grounds for dismissal
2. The identification of persons missing or presumed dead will facilitate settlement of
estate, retirement, insurance, and other social benefits
3. Identification resolves issues of kinship
4. Identification is need in some public and private transactions.

RULES IN PERSONAL IDENTIFICATION

• Law of Multiplicity – greater number of similarities/dissimilarities, the
greater the possibility of the conclusion to be correct
DEFINITION, IMPORTANCE, RULES
AND GENERAL METHODS OF IDENTIFICATION
• The value of the different points of identification varies in the formulation
of conclusion. In a fresh cadaver, if the fingerprints on file are the same as
those recovered from the crime scene, they will positively establish the
person’s identity while bodily marks, scars, moles, complexion, shape of
nose etc. are merely corroborative.
• The longer the interval between death and the examination of the remains
for the purposes of identification, the greater is the need for experts to
establish identity.
• Inasmuch as the object to be identified is highly perishable, it is necessary
for the team to act in the shortest possible time specially in cases of mass
disaster.
• There is no rigid rule to be observed in the procedure of identification of
persons.
DEFINITION, IMPORTANCE, RULES
AND GENERAL METHODS OF IDENTIFICATION
GENERAL METHODS OF IDENTIFICATION
1. By comparison – identification criteria recovered during investigation are
compared with records available on file, or post-mortem finding are
compared with ante-mortem
2. By exclusion – two or more persons have to be identified and all but one is
not yet identified, then one whose identity has not been established may
be known by the process of elimination
ORDINARY METHODS OF IDENTIFICATION OF PERSONS

CHARACTERISTICS THAT MAY BE EASILY CHANGED CHARACTERISTICS THAT MAY NOT BE EASILY
CHANGED
Hair, Beard, Moustache Mental Memory
Clothing Speech
Frequent Place of Visit Gait – manner of walking brought by disease
Grade of profession Mannerism
Body ornaments Hands and Feet
Complexion
Changes in the Eyes
Facies – facial expression brought about by race
Hand usage in writing
Degree of Nutrition

• ANTHROPOMETRY

• PORTRAIT PARLE
POINTS OF IDENTIFICATION APPLICABLE
TO BOTH LIVING AND DEAD
• OCCUPATIONAL MARKS – marks acquired from performance of a person’s
profession

• RACE – color of the skin, feature of the face, shape of the skull, and wearing
apparel

• STATURE – a person ceases to increase in height after the age of 25. Likewise,
there is actual shrinkage in old age.

• TATTOO MARKS, BIRTH MARKS, MOLES, TRIBAL MARKS

• DEFORMITIES, INJURIES, SCARS

• SEXUAL ORGAN / BLOOD EXAMINATION

SCIENTIFIC METHODS OF IDENTIFICATION

•FINGERPRINT

• DENTAL IDENTIFICATION

• HANDWRITING

• IDENTIFICATION OF SKELETON

• DETERMINATION OF SEX AND AGE

• DETERMINATION OF BLOOD AND BLOOD STAINS

• IDENTIFICATION OF HAIRS AND FIBERS

FINGERPRINTING

FINGERPRINTING – considered as the most valuable method of identification.

It is universally used because;
a) There are no two identical fingerprints
b) Fingerprints are not changeable

PRACTICAL USES OF FINGERPRINT:

1) Establish identity of dead bodies and unknown or missing persons
2) Associates persons and weapons
3) Used for comparisons and knowledge of previous criminal records
4) Works as a substitute for signature among illiterates

METHODS OF PRODUCING FINGERPRINTS

• Plain Method – pressing on ink pad
• Rolled Method – rolling on the ink plate with printing ink
FINGERPRINTING

KINDS OF IMPRESSION:
1) Real Impressions – involves the use inks and pressing on the paper
2) Chance Impressions – impressed by mere chance without any intention
of producing it, they could be:
• Visible Prints – visible without previous treatment
• Plastic Prints – made by chance by pressing the finger tips on
melted paraffin, putty, resin, cellophane, plastic tape, butter, soap
• Latent Print – made visible by addition of some substances

HOW TO DEVELOP LATENT PRINTS

• Application of fine powder (graphite, aluminum powder, plaster of paris,
copper powder, metallic antimony)
• Chemical development by fuming and immersion – use of iodine or
arsenic acid, use of silver nitrate
FINGERPRINTING

HOW TO GET FINGERPRINT IMPRESSIONS ON DEAD

BODIES:

In case of dead bodies, the fingers are unclenched

and each one is inked individually with the aid of a
small rubber roller. The paper where the print will
be placed will be impressed will be placed in a
spoon-shaped piece of wood and slowly and evenly
rolled over the pattern.

If the fist is too tightly clenched, a small incision

may be made or the fist may be drenched in hot
water to open.
 FINGERPRINTING

HOW TO GET FINGERPRINT IMPRESSIONS ON DEAD

BODIES:

If the so-called washerwoman’s skin is not too marked on

the fingerprints of dead bodies recovered shortly from
bodies of water, the fingers may be dried off with a towel
and glycerin is injected under the skin of finger tips to
smoothen the surface.

If the floater has been in water for a long period of time

and friction ridges has disappeared, the skin of the
fingertips is cut away, placed in a test tube concerning
formaldehyde solution. This same procedure may be
applied to putrefied or burned bodies.
FINGERPRINTING

POROSCOPY
Examination of the ridges the hands and fingers reveal to be studded with minute pores
which are the openings of ducts of sweat glands. These pores are permanent as the
ridges are and differ in number and shapes in a giver area in each person. If only a part
of the fingerprint is available for proper means of identification, Poroscopy is utilized.

Can fingerprints be effaced?

As long as the dermis of the bulbs of the finger is not completely destroyed,
the fingerprints will always remain unchanged and indestructible.

Can fingerprints be forged?

There is still no record of successfully forged fingerprint
DENTAL IDENTIFICATION

REASONS WHY TEETH CAN BE USED AS MEANS FOR IDENTIFICATION

1. The possibility of two persons having the same dentition is quire remote.
2. The enamel of the teeth is the hardest substance of the human body. It
may outlast all other tissues during putrefaction or physical destruction.
3. After death, the greater degree of tissue destruction, the greater the
importance of dental characteristics as a means of identification.
4. The more recent the ante-mortem records of a person to be identified,
the more reliable is the comparative and exclusionary mode of
identification that can be done.
DENTAL IDENTIFICATION

DENTAL FEATURES WHICH MAY BE INCLUDED IN THE DESCRIPTION FOR

IDENTIFICATION

1. Malposition. overlapping, crowding, and spacing teeth

2. Number and location of deciduous or permanent teeth
3. Missing (unerupted or extracted) or supernumerary
4. Peculiar shape, size, direction, of growth of individual teeth
5. Restoration, prosthesis
6. Root canal therapy
7. Bone pattern
8. Relationship of bite
9. Oral Pathology
DENTAL IDENTIFICATION

OTHER ASPECT OF IDENTIFICATION REFLECTED IN DENTITION

1. Personal, Occupational, and Cultural Traits

- Smokers (smoke marks)
- Groves on seamstress, carpenters, cobblers
- Altered teeth position for wind instrument users
- Poor oral hygiene with many decayed teeth (indication of economic
status)
- Dissolution of enamel (fruit drinkers, carbonated drinks)
2. Age – different in number for different ages
3. Sex – examination for the presence of Barr bodies from palatal scrappings
HANDWRITING

A person may also be identified through his handwriting, handprinting or

handnumbering. Section 23, Rule 32 of Rules of Court states that the
handwriting of a person may be proved under the following:

1. Acknowledgment of the writer that he wrote a disputed writing

2. Statement of a witness who saw the writing made and is able to
identify it as such
3. By the opinion of persons familiar with the handwriting of the alleged
writer
4. By the opinion of an expert who compares the questioned handwriting
with the other writing which are admitted or treated to be genuine by the
party against whom the evidence is offered
HANDWRITING

PRACTICAL USES OF HANDWRITING EXAMINATION

1. Financial Crimes
2. Death Investigation
3. Robberies
4. Kidnapping with Ransom
5. Anonymous Threats
6. Falsification of Document

BIBLIOTICS – science of handwriting analysis

GRAPHOLOGY – study of handwriting for the purpose of determination of

writer’s personality, character and aptitude
HANDWRITING

PURPOSE OF HANDWRITING EXAMINATION

1. Whether the document was written by the suspect

2. Whether the document was written by the person whose signature it
bears
3. Whether the writing contains additions or deletions
4. Whether the document such as bills, receipts, suicide notes or checks are
genuine or forged

In general, to determine whether a certain instrument or document has been

written by a certain person, it is necessary to compare the writing from
known standards for the purpose of comparison.
HANDWRITING

DISGUISED WRITING – the deliberate attempt on the part of the writer to

alter his writing habit by endeavoring to invent a new writing style or by
imitating the writing of other person

FORGED SIGNATURE – the intentional faking of another person’s signature

done either through tracing, simulation, or writing the signature spuriously
for the purpose of deceiving another
IDENTIFICATION OF THE SKELETON

In some cases, before a physician is called to examine a dead body,

the soft tissues have already disappeared and only the skeletal
system remains. In these instances, experts resort to the study of the
bones.

In the examination of the bones, the following points can be

approximately determined:
1. Whether the remains are of human origin or not
2. Whether the remains belong to a single person or not
3. Height, Sex, Race, and Age
4. Length of interment or length of time from date of death
5. Presence or absence of ante-mortem or post-mortem bone
injuries
6. Congenital deformities and acquired injuries on hard tissues
IDENTIFICATION OF THE SKELETON

How to determine if the remains is of human origin or not:

The shape, size, and general nature of the remains, especially that of the head, must be studied.
The oval round shape of the skull, and the less prominent lower jay and nasal bones are
indications of human remains. A complete layout of the whole bones is also helpful. Presence of
dental fixtures, rings on the fingers, earrings, hair and other wearing apparel are strong
presumptions.

How to determine if the remains belong to a single person:

A complete layout is necessary and any plurality or excess of bones after lay out indicates that
the remains belong to more than one person.

How to determine duration of interment:

The period from the time of death to the time of examination may be determined by the nature
and presence of soft tissues and degree of erosion of the bones.
IDENTIFICATION OF THE SKELETON

How to determine presence or absence of Ante-Mortem or

Post-Mortem injuries:

Individual bones must be examined in detail. Importance

must be laid on whether these fractures or injuries
occurred during life or in the process of exhumation. Note
the presence of vital reactions, principally signs of repairs.

SUPERIMPOSE PHOTOGRAPHY – a special

method of determining the whom a skull
belongs. In this process, the negatives of the
picture of the skull and the suspected
individuals are superimposed and printed. This
will show whether the contour of the skull
matches the contour of the suspected person.
DETERMINATION OF SEX

LEGAL IMPORTANCE OF SEX DETERMINATION

1. As an aid in identification
2. To determine whether an individual can exercise certain obligations
vested by law to one sex only
3. Marriage or the union of man and woman
4. Different rights granted by law to different sexes
5. Certain crimes based on the sexuality of the person

TESTS TO DETERMINE SEX

• SOCIAL TEST – dress, hair style, general body shape

• GENITAL TEST – presence of penis or vaginal opening
DETERMINATION OF SEX

• GONADAL TEST – presence of testes in male

and ovary in female (this is considered to be
a conclusive evidence of sexuality)
• CHROMOSOMAL TEST – testing the
Chromosomes X and Y

PROBLEMS IN SEX DETERMINATION

1. Gonadal Agenesis – sex organs (testes and

ovaries) have never developed.
2. True Hermaphrodism – a state of
bisexuality. The gonads of both sexes are
present which may be separated or
GONADS combined as ovotestis.
DETERMINATION OF SEX

PRESUMPTIVE CHARACTERISTICS BETWEEN TWO SEXES

FEMALES MALES
Hips are broader in relation to shoulders Shoulders are broader than hips
Generally small build Generally large build
Breasts developed Generally not developed except on cases such as
Gynaecomazia
Thyroid Cartilage (Adam’s Apple) not developed Adam’s apple prominent
Pubic hair straight and stop short above the monsveneris Pubic hair thick, curved upward extending to umbilicus
Hair absent on face, abdomen, and chest Hair present on chest, face
Skull is smaller and lighter and has smooth thin bones Male skull is longer, heavier and of thick bones
Trunk abdominal segment is larger Trunk abdominal segment is smaller
Thighs are conical Thighs cyclindrical
DETERMINATION OF AGE

LEGAL IMPORTANCE OF AGE DETERMINATION

1. As an aid in identification
2. Determination of criminal liability
3. Determination of right of suffrage
4. Determination of the exercise of civil right
5. Determination of capacity to contract marriage
6. Requisite of certain crimes

POINTS TO CONSIDER IN AGE DETERMINATION

• Growth of pubic hair, beard, mustache

• Changes of breast
• Voice development
• Degree of mental development, etc
IDENTIFICATION OF BLOOD AND BLOOD STAINS

LEGAL IMPORTANCE OF STUDY OF BLOOD

1. Disputed parentage
2. Circumstantial or corroborative evidence
against or in favor of the perpetrator of a
crime
3. Determination of the cause of death
4. Determination of the direction of escape of
the victim or assailant
5. Determination of the approximate time the
crime was committed
6. Determination of the place of the commission
of the crime
7. Determination of the presence of certain
diseases
IDENTIFICATION OF BLOOD AND BLOOD STAINS

PROBLEMS TO BE ANSWERED IN THE EXAMINATION OF BLOOD:

• Whether the stain is due to blood

• If due to blood, determination whether the blood is of human origin or not
• If of human origin, determination of which group does it belong
• Determination if the blood came from the person in question
• The manner, degree, and condition of the article which have been stained
• Age of stain

PHYSICAL EXAMINATIONS
• SOLUBILITY TEST – recent blood test is soluble in saline solution and
imparts a bright red color. Blood stains exposed to air becomes dry;
hemoglobin is transformed to meth-hemoglobin or hematin. If the stain
has been kept in damp places for a long time, it transforms to hematin.
IDENTIFICATION OF BLOOD AND BLOOD STAINS

• HEAT TEST – solution of a blood stain when heated will impart a muddy
precipitate
• LUMINISCENCE TEST – stains on dark fabrics mixed with mud, paint, etc
emit a bluish white luminescence in a dark room when sprayed with some
chemicals and water

CHEMICAL EXAMINATIONS:
• Saline extract of the blood stain + ammonia will give a brownish tinge due
to the formation of alkaline hematin
• Benzidine Test – a piece of white filter paper is pressed on the suspected
stain and applied with a benzidine reagent and drops of hydrogen
peroxide. A positive result will produce a bluish color. This is considered to
be the best chemical test.
BENZIDINE SOLUTION – benzidine sulphate is dissolved in glacial acetic acid to form a
10% solution
IDENTIFICATION OF BLOOD AND BLOOD STAINS

• Guaiacum Test – a piece of white filter paper is pressed on the suspected

stain and applied with a guaiacum alcoholic solution and then hydrogen
peroxide or ozonic ether. If blood is present, a blue color will show.
• Phenolphthalein Test – a drop of Kastle-Meyer reagent is dropped on a white
filter paper with the stain and left for 10 seconds. A positive result will show a
pink color after drop of hydrogen peroxide
• Leucomalachite Green Test
• Takayama Test (micro-chemical) – a fragment of suspected material is placed
on a slide glass ad applied with a drop of hemochromogen reagent. Under a
microscope, it should produce crystals varying from salmon color to dark-
brown and pink.
• Hemin Crystal Test (micro-chemical) – fragment of the stain is added with
water with traces of sodium chloride. After adding glacial acetic acid and
evaporated to dryness, dark brown crystals are formed. This is considered to
be the best microscopic test.
IDENTIFICATION OF BLOOD AND BLOOD STAINS

BIOLOGIC EXAMINATIONS:
• PRICIPITIN TEST – test to determine whether the blood is of human origin
or not.
• BLOOD GROUPING
GROUP OF PARENTS GROUP OF CHILDREN EXCLUSION CASES
O and O O A, B, AB
O and A O and A B and AB
O and B O and B A and AB
A and A O and A B and AB
A and B O, A, B and AB None
B and B O and B A and AB
O and AB A and B O, AB
A and AB A, B, AB O
B and AB A, B, AB O
AB and AB A, B, AB O
IDENTIFICATION OF BLOOD AND BLOOD STAINS

AGE OF BLOOD STAINS

When blood is exposed to the atmosphere

or some other influences, its hemoglobin is
changed to meth-hemoglobin or hematin
(if also with presence of acids). Its natural
color changes from red to reddish-brown.
These changes take place in warm weather
within 24 hours. Stains of one week and
that of six weeks may not present a
difference in the physical or chemical
properties.
IDENTIFICATION OF HAIRS AND FIBERS

How the hair and fibers change color;

1. Addition of substances that will coat the outer surface of the hair or fiber
so as to impart a different color (bismuth salt, lead, silver, and pyrogallic
acid)
2. Addition of substances which bleaches or change the hair’s natural color
(hydrogen peroxide, chlorine and diluted nitric acid)

OTHER POINTS OF IDENTIFICATION OF HAIR:

• CHARACTERISTICS – hair on body surface are fine while those from the
beard, mustache, scalp are thick.
• LENGTH
• COLOR
• DOES THE HAIR BELONG TO A MALE OR FEMALE
IDENTIFICATION OF HAIRS AND FIBERS

DIFFERENCES BETWEEN HAIR FORCIBLY EXTRACTED AND NATURALLY SHED HAIR

If a hair root has been extracted forcibly, the bulb is irregular in form due to rupture
of the sheath and shows an undulating surface, together with excrescences of
different shapes and sizes. A naturally shed bulb has a rounded extremity, a smooth
surface, and most probably show signs of atrophic or fatty degeneration, especially
in an elderly person.

DISTINCTION BETWEEN ANIMAL AND HUMAN HAIR

MEDULLA
In human hair, air network in fine grains In animal hair, air network forms of large or small sacks.
Cells are invisible without treatment in water Cells easily visible
Fuzz without medulla Fuzz with medulla
IDENTIFICATION OF HAIRS AND FIBERS

CORTEX
Human hair looks Animal hair looks
like thick muff like a fairly thin
hollow cyclinder
Pigments of Pigments of
human hair are in animal hair in the
the form of fine form of irregular
grains grains larger than
that of human hair

CUTICLE
Thin scales not Thick scales and
protruding, protruding, do not
covering one cover one another
another to about
4/5
MEDICO-LEGAL ASPECT OF DEATH
CHAPTER 4
AREAS OF STUDY

• IMPORTANCE OF DEATH DETERMINATION

• GENERAL CLASSIFICATION OF DEATH

• KINDS OF DEATH

• SIGNS OF DEATH

• CHANGES IN THE BODY FOLLOWING DEATH

• DURATION OF DEATH

• PRESUMPTION OF DEATH
IMPORTANCE OF DEATH DETERMINATION

1. Civil personality of a natural person is extinguished by death.

2. The property of a person is transmitted to his heirs at the time of death.
3. The death of a partner is one of the causes of dissolution of partnership
agreement.
4. The death of either the principal or agent is a mode of extinguishment of
agency.
5. The criminal liability of a person is extinguished by death
6. The civil case for claims which does not survive is dismissed upon death of the
defendant

DEATH – the termination of life. The complete cessation of all the vital functions
without possibility of resuscitation. It is an irreversible loss of the properties of living
matter. Previously, complete and persistent cessation of the heart action and
respiration is the standard criteria in the determination of death, but due to recent
technology this has been put in question.
GENERAL CLASSIFICATION OF DEATH

 BRAIN DEATH – death occurs when there is deep irreversible coma, absence of
electrical brain activity and complete cessation of all the vital functions without
possibility of resuscitation.

a) No response / No Reception
b) No movement or breathing
c) No reflexes
d) Flat electro-encephalogram

 CARDIO-RESPIRATORY DEATH – death occurs when there is a continuous and

persistent cessation of the heart function and respiration. (Based on common
sense and intuition)

 ALTERNATIVE / ECLECTIC DETERMINATION OF DEATH - the use of combined brain

and cardio-respiratory death
KINDS OF DEATH

 SOMATIC DEATH or CLINICAL DEATH – the state of the body when there is complete,
persistent, and continuous cessation of vital functions of the brain, heart, and lungs which
maintain life and health. Determination of the time of death is possible.

Immediately after death the face and lips becomes pale, the muscles becomes flaccid,
sphincters are relaxed, the lower jaw tends to drop, the eyelids remain open, pupils dilate
and the skin losses elasticity. The body fluids tends to gravitate to the most dependent
portions of the body and the body heat gradually assumes the temperature of the
surroundings.

 MOLECULAR or CELLULAR DEATH - After cessation of the vital functions of the body, there is
still animal life among individual cells. This is evidenced by the presence of excitability of
muscles and ciliary movements and other functions of individual cells.

About 3-6 hours later, death of individual cells occurs. Its exact time of appearance cannot be
determined due to influence of factors such as; state of health, infection, climate, etc.
KINDS OF DEATH

 APPARENT DEATH OR STATE OF SUSPENDED ANIMATION

This condition is not really death but merely a transient loss of consciousness or temporary
cessation of the vital functions of the body on account of disease, external stimulus or other
forms of influence. It may arise specially in hysteria, uremia, catalepsy, and electric shock.

It is important to determine the condition of suspended animation to prevent premature burial.

There are records of cases wherein a person was pronounced dead, placed in a coffin and later
angrily rise from it and walk unaided.
SIGNS OF DEATH

 CESSATION OF HEART ACTION AND CIRCULATION

There must be an entire and continuous cessation of the heart

and flow of blood in the whole vascular system. As a general
rule, if there is no heart action in a period of 5 minutes, death
is regarded as certain. Respiration ceases frequently before the
stoppage of the heart and circulation.

METHODS OF DETECTION:
A. EXAMINATION OF THE HEART
1. Palpation of pulse – pulsation of blood vessels may be made
on the regions of the neck or wrist.
2. Auscultation for the Heart Sound at the Precordial Area –
use of stethoscope to hear heart sound
3. Fluoroscopic Examination – this examination will reveal the
shadow of the heart in its rhythmic contraction and relaxation
4. Electrocardiograph – a machine that records electrical
charges coming from the heart
SIGNS OF DEATH

 CESSATION OF HEART ACTION AND CIRCULATION

B. EXAMINATION OF THE PERIPHERAL CIRCULATION

1.Magnus Test – a ligature is applied around the base of the finger with moderate tightness. In a
living person, there appears a bloodless zone at the site of the application of the ligature and a
livid area distal to the ligature.
2. Opening of Small Artery – in the living, once an artery is ruptured, blood escapes in jerks at a
distance. In a dead man, blood vessel is white and there is no jerking escape of blood but may
only ooze towards the nearby skin,
3. Icard’s Test – consists of the injection of a solution of fluorescein subcutaneously. If circulation
is present, the dye will spread all over the body and the whole skin will have a greenish-yellow
discoloration.
4. Pressure on Fingernails – zone of paleness will develop at the site where pressure is applied.
5. Diaphanous Test – the fingers are spread wide and the finger webs are viewed through a
strong light. Red color is viewed in the living, yellow in the dead.
6. Application of Heat on Skin – in a dead man, no blister is produced.
7. Palpation of the Radial Pulse
8. Dropping of Melted Wax – dropped on the breast. If dead, no inflammation will ensue.
SIGNS OF DEATH

 CESSATION OF RESPIRATION

Like heart action, cessation of respiration in order to be considered as a sign of death must be
continuous and persistent. A person can hold his breath for a period of not longer than 3 and ½
minutes. In case of electric shock, respiration may cease for sometime but may be restored by
continuous artificial respiration.

METHODS OF DETECTING CESSATION OF RESPIRATION

1. Expose chest and abdomen

2. Examine with the aid of stethoscope
3. Examination with a mirror (in front of mouth and nostrils)
4. Examination with a feather or cotton fibers
5. Examination with a glass of water
6. Wislow’s Test – no movement on mercury on saucer placed on top of chest
SIGNS OF DEATH

 COOLING OF THE BODY (ALGOR MORTIS)

After death, the metabolic process inside the body ceases. No more heat
is produced but the body loses slowly its temperature by evaporation or
by conduction to the surrounding atmosphere. This progressive fall of
body temperature is a prominent sign of death.

The rate of cooling of the body is not uniform. It is rapid in the first two
hours and as the temperature of the body approaches the temperature
of the surroundings, the rate becomes slower. The fall of temperature
of 15-20 degrees Fahrenheit is considered as a certain sign of death.

Post-mortem Caloricity – the rise of temperature of the body after death

due to rapid and early putrefactive changes or some internal changes.
Usually observed on the first two hours after death. It may occur in
people suffering from cholera, yellow fever, peritonitis, rheumatic fever,
tetanus, small pox, liver abscess.
SIGNS OF DEATH

Factors Influencing the Rate of Cooling

A. Factors inside the Body

Delayed Cooling: Accelerated Cooling:
- sudden death in good health - leanness of the body
- obesity - extreme age
- death from asphyxia - long standing illness
- death of middle age - chronic pyrexial disease

B. Factors in the surrounding

Delayed Cooling: Accelerated Cooling:
- clothings - unclothed body
- conditions denying access of air - conditions allowing access of air
- small room - large room
- warm surroundings - cooling more rapid in water than in air
SIGNS OF DEATH

 INSENSIBILITY OF THE BODY AND THE LOSS OF POWER TO MOVE

After death, the entire body becomes insensible. No kind of stimulus is capable of
letting the body move voluntarily. This condition must be observed in conjunction
with cessation of heart beat and circulation, and cessation of respiration.

However, there are certain conditions that shows insensibility even in a living state.
Among which are; (1) Apoplexy, (2) Epilepsy, (3) Trance, (4) Catalepsy, (5) Cerebral
Concussion, and (6)Hysteria

 CHANGES IN THE SKIN

A. Livid Discoloration - The skin may be observed to be pale and waxy-looking due
to the absences of circulation. Areas of the skin, especially the most dependent
portions will develop livid discoloration on account of the gravitation of blood.
B. Loss of Elasticity – after death, the application of pressure to the skin surface
will make the surface flattened.
Post-mortem Contact Flattening – on account of post-mortem flaccidity of
muscles, the body becomes flattened over areas which are in contact with the
surface it rests.
SIGNS OF DEATH

C. Opacity of the Skin - The skin of a dead person is opaque due to absence
of circulation
D. Effect of Application of Heat – no inflammatory reaction is seen when wax
is applied to the skin

 CHANGES IN AND ABOUT THE EYE

A. Loss of Corneal Reflex – cornea has no reaction to light stimulus

B. Clouding of the cornea
C. Flaccidity of the Eyeball
D. Pupil in position of rest – no reaction to light
E. Tache Noir De La Sclerotique – oval/round spot in the sclera of the eyes
due to the thinning of the sclera after death

 ACTION OF HEAT ON THE SKIN

If death is real, there is no redness of the surrounding skin after heat

application.
CHANGES IN THE BODY FOLLOWING DEATH

 CHANGES IN THE MUSCLE

The entire muscular tissue passes three stages after death;

A. Stage of Primary Flaccidity (Post-mortem Muscular Irritability)

- muscles are relaxed and capable of contracting. There is incontinence of urination and
defecation, lasts normally around 3-6 hours but in temperate countries, the duration is averaged at
one to two hours.
- during this stage, the muscle still reacts to external stimuli owing to the presence of
molecular life after somatic death.

B. Stage of Post-mortem Rigidity (Cadaveric Rigidity or Rigor Mortis)

- whole body becomes rigid due to the contraction of muscles, develops 3-6 hours after death
and may last 24-36 hours; but on warm countries, it may develop and last sooner; in temperate
countries, it may last two to three days but in tropical countries, 24-48 hours in cold weather, 18-36
hours on summers.
- rigor mortis appears late and lasts longer in cases where the muscles have been healthy and
at rest before death, has early on-set in the aged and the new-born, and develops rapidly on both
high and low temperatures.
CHANGES IN THE BODY FOLLOWING DEATH

Cadaveric Spasm (Instantaneous Rigor) – occurs at the moment of death due to extreme
nervous tension, exhaustion, and injury to the nervous system or injury to the chest.

Cadaveric Spasm VS Rigor Mortis

1. In Rigor, the appearance is 3-6 hours;
in spasm, the appearance is instant.
2. In Rigor, all muscles are involved; in spasm,
only a certain muscle group or region
3. Rigor is a natural phenomenon that occurs
after death, spasm may or may not appear
4. Rigor may be utilized by a medical jurist to
determine the time of death, while spasm may
be useful to determine the nature of crime

C. Stage of Secondary Flaccidity or On-set of Putrefaction

- after the disappearance of rigor mortis , the muscles becomes soft and flaccid.
- muscles start to decay
CHANGES IN THE BODY FOLLOWING DEATH

 CHANGES IN THE BLOOD

A. Coagulation of Blood

- blood clotting is accelerated in cases of death by infectious fevers and delayed in cases of
poisoning especially of opium or carbon monoxide.
- blood may remain fluid inside the blood vessels after death for 6-8 hours

B. Post-mortem Lividity (a.k.a. cadaveric lividity, post-mortem suggillation, pot-mortem

hypostasis, livor mortis)

- stoppage of heart action and loss of tone

of blood vessels causes the blood to be under the
influence of gravity. Blood begins to accumulate in the
most dependent portions of the body causing the area
to be dull-red or purplish color.
- usually appears 3-6 hours after death
CHANGES IN THE BODY FOLLOWING DEATH

 AUTOLYTIC OR AUTODIGESTIVE CHANGES AFTER DEATH

After death, proteolytic, glycotic, and lipolytic ferments of glandular tissues continue to act
which lead to the autodigestion of organs. This action is facilitated by weak acid and higher
temperature.

 PUTREFACTION OF THE BODY

PUTREFACTION is the breaking down of the complex proteins into simpler components
associated with the evolution of foul smelling gasses and accompanied by the changes in color.

A. Changes in the color of tissues – chemical changes on the tissue color from greenish yellow
to greenish blue or greenish black.
MARBOLIZATION – prominence of superficial veins
with reddish discoloration during the process of
decomposition which develops on both flanks of the
abdomen, root of the neck, and shoulders which
makes these areas look like marble.
CHANGES IN THE BODY FOLLOWING DEATH

B. Evolution of gasses in the tissues – gases such as

carbon dioxide, ammonia, hydrogen, sulphurated
hydrogen and methane gases are formed and
contributes to foul smelling odor.

Effects of Pressure Gasses of Putrefaction:

1. Displacement of blood
2. Bloating of the body
3. Fluid coming out of both nostrils and mouth
4. Floating of the body

C. Liquifaction of the Soft Tissues – the eyeballs, brain,

stomach, intestine, liver, and spleen putrefy rapidly while
higher muscular organs putrefy late.
CHANGES IN THE BODY FOLLOWING DEATH

SUMMARY OF PUTREFACTIVE CHANGES OCCURING IN TEMPERATE REGIONS

PUTREFACTIVE CHANGES TIME
Greenish discoloration, eyeballs soft and yielding 1-3 days after death

Greenish discoloration spreading all over the abdomen, external genitals and other part of the body. Froth 3-5 days after death
(liquid) blood coming out of nostrils
Abdomen distended with gases, cornea fallen, purplish red streaks of veins prominent on the extremities, 8-10 days after death
sphincters relaxed
Soft parts changes into thick semi-fluid black mass. Skull is exposed. 2-5 months after death

SUMMARY OF PUTERFACTIVE CHANGES OCCURING IN TROPICAL REGIONS

PUTREFACTIVE CHANGES TIME
Rigor mortis present all over. Hypostasis well-developed and fixed, greenish discoloration starts 12 hours

Rigor mortis absent. Greenish discoloration over whole abdomen to the chest, gasses distends 24 hours

Ova flies seen. Trunk is bloated. Face discolored and swollen. Maggots present. 48 hours

Soft viscera putrefied. Soft tissues gone. 1-2 weeks after death

Body Skeletonized One month

CHANGES IN THE BODY FOLLOWING DEATH

INFLUENCE OF BACTERIA IN DECOMPOSITION

Decomposition is due to the action of bacteria in various tissues of the body. It is the Clostridium
Welchii which plays an important role in the body decomposition. It is responsible for the
destruction of cytoplasm, destruction of nuclei and generation of gases in cells.

Other Destructive Agents:

1. Maggots
2. Reptiles
3. Rodents
4. Fishes and Crabs
5. Molds
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:
CONDITION CONSIDERATION
Presence of RIGOR MORTIS In warm countries, 2-3 hours after death, fully developed in 12 hours. Lasts 18-36 hours.

Presence of Post-mortem Lividity Develops 3-6 hours after death, appears first as red spots which coalesce with each other to involve
bigger areas in the most dependent portion of the body
Onset of Decomposition In warm countries, decomposition is early and the average time is 24-48 hours after death.
Manifested by presence of watery, foul-smelling froth coming out of the nostrils and mouth,
softness of the body.

Stage of Decomposition See previous tables

Entomology of the Cadaver Know the life cycle of flies. If there are maggots, the body may have been dead for 24 hours.

Stage of digestion of food in stomach It normally takes 3-4 hours for the stomach to evacuate its contents after a meal. The approximate
time of death may be deduced from the amount of food in the stomach in relation to his last meal.
Post-mortem clotting Blood clots inside the blood vessels in 6-8 hours after death
PRESUMPTION OF DEATH

Art 390, Civil Code and Sec 5, Rule 131, Rules of Court:

After an absence of seven years, it being unknown whether or not the absentee still lives, he
shall be presumed dead for all purposes, except for those of succession (10 years).

Art. 391, Civil Code

The following are considered dead:

(1) A person on board a vessel lost during voyage, or an aeroplane which is missing, who has
not been heard of for four years since the loss of the vessel.
(2) A person in the armed forces who has taken part in war, and has been missing for four years.
(3) A person who has been in danger of death
MEDICO-LEGAL INVESTIGATION OF
DEATH
CHAPTER 5
WHO CONDUCTS DEATH INVESTIGATION

In a medico-legal investigation, the inquest officer is the one charged with the duty of investigating the
manner and cause of death. He is authorized by law to summon witnesses and direct any person to
perform or assist in the conduct of investigation whenever necessary.

WHO ARE AUTHORIZED TO MAKE DEATH INVESTIGATION

1. Provincial or City Fiscals [Sec 983, Revised Administrative Code]
2. Judges of Regional Trial Court
3. Judges of Municipal Trial Court
4. Director of National Bureau of Investigation
5. Chief of Police Manila
6. Solicitor General
STAGES OF MEDICO LEGAL INVESTIGATION

 CRIME SCENE INVESTIGATION

The investigation of the place where the crime was committed or when the essential ingredients
of the crime took place. Especially in the medico-legal point of view, crime scene investigation
includes the appreciation of its conditions and drawing inferences from it. It also includes the
collection of physical evidence that may lead to the identity of the perpetrator, the manner the
criminal act was executed, and such other things that may be useful in the prosecution of the
case.

IMPORTANCE OF CRIME SCENE INVESTIGATION

- a great amount of physical evidence may be lost or unrecovered if the investigation merely
starts at the autopsy table or in the medical examining room. In violent death cases, the manner
and cause of death may be inferred from the condition of the crime scene. The investigator has
the earliest possible opportunity to interview persons who have knowledge of the circumstances
of actual events. The proximity of such narrations to the actual occurrence makes it more
reliable than those given after the lapse of time.
STAGES OF MEDICO LEGAL INVESTIGATION

EXAMINATION OF DEAD BODY IN THE CRIME SCENE:

After a complete search, the investigating physician must make a thorough inspection of the
dead body. Special consideration must be made on the following:

a. Evidences which will prove identity

b. Position of the victim
c. Condition of the apparel worn
d. Approximate time of death
e. Presence of wounding instrument and its approximate distance from the body
f. Potential cause of death.

In death by gunshot, the clothing must be left undisturbed since a lot of information may be
gathered from it. Examination “in situ” may be useful in the determination of the site of
entrance and exit bullet, and the trajectory of the shot.
STAGES OF MEDICO LEGAL INVESTIGATION

 AUTOPSIES

An autopsy is a comprehensive study of a dead body, performed by a trained physician

employing recognized dissection procedure and techniques. It includes removal of tissues for
further examination.

AUTOPSY VS POST-MORTEM EXAMINATION

POST-MORTEM EXAMINATION
– external examination of a dead body
without the need for incision, although
blood and other fluids may be collected
for further examination.
AUTOPSY
– indicates that in addition to the external
examination, the body is opened and an
internal examination is conducted.
STAGES OF MEDICO LEGAL INVESTIGATION

KINDS OF AUTOPSIES:

A. Pathological / Hospital / Non-Official Autopsy

B. Medico-Legal / Official Autopsy

PATHOLOGICAL AUTOPSY MEDICO-LEGAL AUTOPSY

REQUIREMENT Must have consent by next of kin Law gives consent. Relatives approval not necessary.
PURPOSE Confirmation of clinical findings of research Correlate tissue changes to a criminal act
EMPHASIS Notation of all abnormal findings Effect of wrongful act on the body. Other findings
may only be noted in mitigation of criminal liability
CONCLUSION Summation of all abnormal findings Must be specific for the purpose of determining
irrespective of its correlation with clinical whether it is in relation to a criminal act
findings

MINOR MATTERS Need not to be mentioned in report If investigator thinks it will be useful in the
administration of justice, it must be included.
STAGES OF MEDICO LEGAL INVESTIGATION

OTHER FEATURES UNIQUE TO MEDICO-LEGAL AUTOPSIES:

• Clinical history of the deceased in most instances absent. Sketchy or doubtful.

• The identity of the deceased is the responsibility of the forensic pathologist
• The time of death and the timing of tissue injuries must be answered by the forensic
pathologist
• Careful examination of the external surface for possible trauma including the clothings to
determine the pattern of injuries in relation to the injurious agent

DEATHS THAT REQUIRE AUTOPSY:

 Death by Violence
 Accidental Death
 Suicides
 Sudden death of persons apparently in good health
 Death unattended by physicians
 Death in hospitals / clinics [DOA] wherein a physician wasn’t’ able to arrive at a cause of death
 Death occuring in unnatural manner
STAGES OF MEDICO LEGAL INVESTIGATION

GUIDELINES IN PERFORMING AUTOPSIES:

• Be it official or unofficial, the pathologist must be properly guided by the purpose to which
the autopsy is to be performed.
• The autopsy must be comprehensive and must not leave some parts of the body
unexamined.
• Bodies severely mutilated, decomposing or damaged by fire, are still suitable for autopsy
• A dead body must not be embalmed before autopsy
• The body must be autopsied at the same condition when it was found at the crime scene.
CAUSES OF DEATH and SPECIAL
DEATHS
CHAPTER 6
AREAS OF STUDY

• IMPORTANCE OF CAUSE OF DEATH DETERMINATION

• MEDICO-LEGAL CLASSIFICATION OF THE CAUSE OF DEATH

• PATHOLOGICAL CLASSIFICATION OF THE CAUSE OF DEATH

• SPECIAL DEATHS
IMPORTANCE OF CAUSE OF DEATH DETERMINATION

The primary purpose of a medico-legal autopsy is to determine the cause of death. It must be further
shown that the death is the direct and approximate consequence of the criminal or negligent act of
someone. If death developed independent of an unlawful act, then the person who committed the
unlawful act cannot be held responsible for the death.

The CAUSE OF DEATH is the injury, disease, or the combination of both, responsible for initiating the
trend or physiological disturbance, brief or prolonged, which produces fatal termination. Thus, the
cause of death may be immediate or approximate.

 IMMEDIATE (Primary Cause) – this applies to cases when trauma or disease kill quickly that there
is no opportunity for complications to develop.

 APPROXIMATE (Secondary Cause) – the injury or disease was survived for a sufficiently
prolonged interval which permitted the development of serious complications which actually
caused the death.

MECHANISM OF DEATH – the physiologic derangement or biochemical disturbance incompatible with

life which is initiated by the cause of death.
IMPORTANCE OF CAUSE OF DEATH DETERMINATION

DEGREE OF CERTAINTY TO THE CAUSE OF DEATH

1. When the structural abnormalities established beyond doubt the identity of the cause of death.
2. When there is that degree of probability amounting to almost certainty the cause of death
3. When cause of death is established by historical facts which are confirmed or supported by positive or
negative anatomic or chemical findings
4. When neither history, laboratory, or anatomic findings, taken individually or in combination is sufficient
to determine the cause of death, but merely speculate to the cause of death

INSTANTANEOUS PHYSIOLOGIC DEATH (DEATH BY INHIBITION) - a sudden death which occurs within
seconds or a minute or two after a minor trauma or peripheral stimulation. The peripheral irritation initiates
cardio-vascular inhibitory reflex which causes slowing or stoppage of the heart, reflex dilatation with
profound fall in blood pressure or a combination of both mechanisms.

Death by inhibition can be made only by exclusion and is completely dependent on the availability of
accurate information. After elimination of natural causes by autopsy and toxicological analyses are non-
contributory, then only physiologic death may be entertained.

• CRIB DEATH
• SUND (Sudden Unexpected Nocturnal Death)
MEDICO-LEGAL CLASSIFICATION OF CAUSES OF DEATH

 NATURAL DEATH – death caused by natural disease condition in the body. The disease may develop
spontaneously or it might have been a consequence of physical injury inflicted prior to its
development. Natural death may or may not be associated with violence. Although history and
external findings may show that death is due to natural causes, a complete autopsy must be made to
determine exactly the cause of death and exclude the possibility of violent cause.

If signs of violence are associated with the natural cause of death, the physician must be able to
answer the following questions:

1. Did the person die of a natural cause and were the physical injuries inflicted immediately after
death?
2. Was the victim suffering from a natural disease and the violence only accelerated his death?
3. Did the victim die of a natural cause independent of the violence inflicted?

To make an offender liable for the death of a victim, it must be proven that the death is natural
consequence of the physical injuries inflicted. Proximate cause is that cause, which in natural and
continuous sequence, would produce death, and without which the result would not have occurred.
MEDICO-LEGAL CLASSIFICATION OF CAUSE OF DEATH

 VIOLENT DEATH – are those due to injuries inflicted in the body by some forms of outside force. The
physical injury must be the proximate cause of death. To ascertain that the death is the natural cause of the
injury inflicted;

A. The victim should be proven to be in normal health prior to the injury

B. The death may be expected from the physical injuries inflicted
C. Death ensued within a reasonable period of time

PENAL CLASSIFICATIONS OF VIOLENT DEATH

• Accidental Death – death due to misadventure or something that happened outside the sway of our
will, and although it comes about through some act of will, lies beyond bounds of human’s foreseeable
consequences. In a pure accidental death, the offender is EXEMPT from criminal liability.

• Negligent Death – death due to reckless imprudence, negligence, lack of skill, lack of foresight. If
death occurred due to the recklessness of someone, he may be charged for homicide through reckless
imprudence.

• Suicidal Death – a person committing suicide is not punished but someone assisting a person in
committing suicide is
MEDICO-LEGAL CLASSIFICATION OF CAUSE OF DEATH

• Parricidal Death – Article 246, Revised Penal Code – killing of a father, mother, or child, whether
legitimate or illegitimate, or any of his ascendants or descendants, or his spouse.

• Infanticidal Death – Article 255, RPC – killing of a child less than 3 days old

• Murder – Article 248, RPC – Homicide attended with qualifying circumstances such as but not limited
to; (1) treachery, (2) consideration of price, reward or promise, (3) on occasion of calamities, or (5)
with evident premeditation, etc.

• Homicide – Article 249, RPC

• Death under Special Circumstances

- Tumultuous Affray – Art 251, RPC

- Exceptional Circumstances – Art 247, RPC
PATHOLOGICAL CLASSIFICATIONS OF CAUSES OF DEATH

 DEATH FROM SYNCOPE – death due to the sudden and fatal cessation of the action of the heart
with circulation included:
(1) Coronary disease
(2) Myocardial Degeneration
(3) Valvular disease
(4) Rupture of the aortic or aneurysm
(5) Deficiency of blood as in profused hemorrhage, especially if sudden

 DEATH FROM ASPHYXIA – death due to reduction of oxygen supply to the blood or tissues:
(1) Respiratory diseases such as pneumonia, bronchitis, rupture of blood vessels due to
pulmonary tuberculosis
(2) Strangulation, suffocation, hanging, drowning. Inhalation of irritant gases
(3) Pulmonary embolism

 DEATH FROM COMA – death due to the sudden and fatal cessation of the action of the brain
(1) Gross lesions of the brain (apoplexy, tumor, abscess)
(2) Poisons such as ingested alcohol
SPECIAL DEATHS

 JUDICIAL DEATH – death caused the decisions of judges after a criminal proceeding.
(1) Death by electrocution
(2) Death by hanging
(3) Death by musketry
(4) Death by gas chamber

 EUTHANASIA – also known as mercy killing, it is the deliberate and painless acceleration of death of a
person usually suffering from an incurable distressing disease

 SUICIDE – self-destruction, usually unfortunate consequence of mental illness and social disorganization.

EVIDENCES WHICH WILL INFER THAT DEATH IS SUICIDAL

1. History of depression, unresolved personal problems, mental disease
2. Previous attempt of self-destruction
3. If committed through infliction of injuries, wounds are located on areas accessible to the hand
4. Presence of suicide note of genuine character
5. Place not susceptible to public view

 DEATH BY STARVATION – deprivation of a regular and constant supply of food and water necessary to
normal health (loss of 40% of weight results to death, without water and food, 10 days maximum)
MEDICO-LEGAL ASPECT OF
PHYSICAL INJURIES
CHAPTER 7
CAUSES OF PHYSICAL INJURIES

PHYSICAL INJURIES - the effect of some forms of stimulus to the body which could be immediately visible
or delayed.

CAUSES:

 PHYSICAL VIOLENCE
 HEAT OR COLD
 ELECTRICAL ENERGY
 CHEMICAL ENERGY
 RADIATION BY RADIOACTIVE SUBSTANCES
 CHANGE IN THE ATMOSPHERIC PRESSURE (BAROTRAUMA)
 INFECTION
PHYSICAL VIOLENCE

The effect of the application of physical violence on a person is the production of wound.

WOUND – the solution of the natural continuity of any tissue of the living body. It is the disruption of
the anatomic integrity of a tissue. It most cases, wound and physical violence is used interchangeably;
but physical violence may not always result to wound, but the wound is always a result of physical
violence.

VITAL REACTION – the sum total of all the reactions of tissue or organ to trauma or the application of
physical violence which can be any of the following:

 RUBOR – redness or congestion of the area due to an increase of blood supply as a part of a
reparative mechanism
 CALOR – sensation of heat or increase in temperature
 DOLOR – pain on account of the involvement of the sensory nerve
 LOSS OF FUNCTION – on account of trauma, the tissue may not be able to function normally

The presence of the vital reaction differentiates an ante-mortem from a post-mortem injury.
PHYSICAL INJURIES

CLASSIFICATION OF WOUNDS

 As to Severity

1. MORTAL WOUND – wound which is caused immediately after infliction or shortly thereafter that is
capable of causing death.
PARTS OF THE BODY WHERE THE WOUND INFLICTED ARE CONSIDERED MORTAL
a. Heart and big blood vessels
b. Brain and upper portion of spinal cord
c. Lungs
d. Stomach, liver, spleen, and intestine

2. NON-MORTAL WOUND – wound which is not capable of producing death immediately after infliction or
shortly thereafter.

 As to Kind of Instrument Used

1. Wound brought about by blunt instrument. (contusion, hematoma, laceration)

2. Wound brought about by sharp instrument. (incised, punctured, stab)
3. Wound brought about by a tearing force (laceration)
PHYSICAL INJURIES

4. Wound brought about by change of atmospheric pressure (barotrauma)

5. Wound brought about by heat or cold (frostbite, burns, scalds)
6. Wound brought about by chemical explosion (gunshot, shrapnel wound)
7. Wound brought about by infection

CONTUSION (Bruise) HEMATOMA (Clot) Laceration Incision

Puncture Stab Frostbite Burns

PHYSICAL INJURIES

 As to Manner of Infliction

1. Hit- by means of bolo, blunt instrument, axe

2. Thrust or Stab – bayonet dagger
3. Gunpowder Explosion – projectile of shrapnel wound
4. Sliding or Rubbing or Abrasion

 As regards to the depth of wound

1. Superficial – involves only the layers of the skin

2. Deep
a. Penetrating – enters the body but did not come out
b. Perforating – enters the body and came out

 As regards to the relation of the site of the application of force and the location of the injury

1. COUP INJURY – injury is located at the site of the application of force

2. CONTRE-COUP – injury is located opposite the site of the application of force
3. COUP CONTRE-COUP - injury is located at the site and also at the opposite site of the application
4. LOCUS MINORIS RESISTENCIA – not on the site nor the opposite but in areas offering the least
resistance to the force applied
PHYSICAL INJURIES

5. EXTENSIVE – injury involves a greater area of the body beyond the site of the application of force.

 Special Types of Wounds

1. Defense Wound – resulted from a person’s instinctive reaction of self-protection.

2. Patterned Wound – wound in the nature and shape of an object or instrument, and which infers the
object or instrument causing it.
3. Self-Inflicted Wound – produced on oneself. As distinguished from suicide, the person has no intention to
end his life.

LEGAL CLASSIFICATION OF WOUNDS

 MUTILATION – the intentional act of looping or cutting off any part of the living body. MAYHEM – the
unlawful and violent deprival of another use of a part of the body so as to render him less able in
fighting either to defend himself or to annoy his adversary.

Reclusion temporal to reclusion perpetua – if the organs removed are for reproduction
Prison Mayor – if the organ removed is any other part of the body

 SERIOUS PHYSICAL INJURY – any crime due to wounding, beating, assaulting, or administering injurious
substance, without the intent to kill.
PHYSICAL INJURIES

The main purpose of dividing the provision into four categories is for graduated penalty;

Paragraph 1 – If injury results to insanity, imbecility, impotency, or blindness

PENALTY: Prison Mayor
Paragraph 2 – If injury results to loss of speech or the power to hear or smell, loss of an eye, a hand, a
foot, an arm, or a leg; loss of any use of any such member; and incapacitation for work in which he was
therefore habitually engaged
PENALTY: Prision Correcional (medium and maximum)
Paragraph 3 – If injury results to deformity, loss of any other member of the body, loss of the use
thereof, or victim becomes ill or incapacitated for the performance of the work in which he was
habitually engaged for more than 90 days, as a consequence of the physical injuries inflicted.
PENALTY: Prision Correcional (minimum and medium period)
Paragraph 4 – If injury results to illness or incapacity to work for labor for more than 30 days
PENALTY: Arresto Mayor (max) to Prision Correcional (minimum)

Administering Injurious Substances

Elements:
1. The offender inflicted upon another person any serious physical injury
2. The infliction of physical injury was done knowing that the substance or beverage
administered is injurious, or took advantage of weakness or credulity
3. There is no intent to kill on the part of the offender
PHYSICAL INJURIES

 LESS SERIOUS PHYSICAL INJURY – incapacitation for labor for 10 days or more, requiring medical
attendance for the same period.
 SLIGHT PHYSICAL INJURY – those which incapacitated victim for labor for 1-9 days, those that did not
prevent victim from engaging in his habitual work nor requires medical attention, and ill-treatment of
another by deed without causing any injury

Physical Injuries Inflicted in a Tumultuous Affray

Elements:
1. There is tumultuous affray [a commotion in a confused manner to an extent that it would not be
possible to identify who the killer is if death results, or who inflicted the serious physical injury, but the
person or. persons who used violence are known]
2. Participant suffered from serious physical injuries
3. Persons who inflicted injury cannot be identified
PENALTY: If injury is serious - Next lower than the serious physical.
If injury is less serious – Arresto for 5 to 15 days
MEDICO-LEGAL INVESTIGATION OF
PHYSICAL INJURIES
CHAPTER 8
RULES TO BE OBSERVED IN WOUND EXAMINATION

 All injuries should be described, however small the injury is.

 The description of the wound must be comprehensive, and if possible, as sketch or photograph
must be taken.

 The examination must not be influenced by any other information obtained from others in making
a report or a conclusion.

OUTLINE OF THE MEDICO-LEGAL INVESTIGATION OF WOUNDS

 GENERAL INVESTIGATION OF THE SURROUNDINGS

- Examination of the place where the crime was committed

- Examination of the clothing, stains, cuts, hair, and other foreign bodies that can be found in the
scene of the crime
- Investigation of persons who may be witnesses to the incident
- Examination of the wounding instrument
- Photography, sketching, or accurate description of the scene of the crime for the purpose of
preservation
OUTLINE OF THE MEDICO-LEGAL INVESTIGATION OF WOUND

 EXAMINATION OF THE WOUNDED BODY

APPLICABLE TO BOTH LIVING AND DEAD

- Age of the wound from the degree of healing

- Determination of the weapon used in the commission of the offense
- Reasons for the multiplicity of wounds in cases where there are more than one wound
- Determination whether the injury is accidental, suicidal, or homicidal

APPLICABLE ONLY TO THE LIVING

- Determination whether the injury is dangerous to life

- Determination whether the injury will produce permanent deformity
- Determination whether the would produce shock
- Determination whether the injury will produce complications as a consequence

APPLICABLE ONLY TO THE DEAD

- Determination whether the wound is post or ante mortem, mortal or not

- Determination whether death is accelerated by a disease or some abnormal developments
OUTLINE OF THE MEDICO-LEGAL INVESTIGATION OF WOUND

 EXAMINATION OF THE WOUND

- Character of the wound

- Location of the wound
- Depth of the wound
- Condition of the surroundings
- Extent of the wound
- Direction of the wound
- Number of wounds
- Conditions of the locality
POST MORTEM VS ANTE MORTEM WOUND

 HEMORRHAGE

Much profuse when the wound was inflicted during the lifetime.

 INFLAMMATORY SIGNS

Swelling on the area surrounding the wound, effusion of lymph or pus and adhesion of the edges if the
wound was inflicted during life. Vital reaction may also indicate time of infliction.

 SIGNS OF REPAIR

Scab, scar, fibrin formation conclusively show that the wound was inflicted during life.

 RETRACTION OF EDGES

Owing to the vital reactions, edges of the wound inflicted during life gapes and retract
POST MORTEM VS ANTE MORTEM WOUND

DISTINCTION BETWEEN ANTE MORTEM AND POST MORTEM WOUND

ANTE-MORTEM POST-MORTEM
Haemorrhage more or less copious and generally Haemorrhage slight or none at all and always venous
arterial
Marks of spouting of blood from arteries No spouting of blood
Clotted blood Not clotted at all
Deep staining on the edges If there are stains, it can be easily removed by water
Edges gape owing to the skin reaction and muscle Edges do not gape
fibers
Presence of inflammation or reparative processes No inflammation
HOMICIDAL, ACCIDENTAL, OR SUICIDAL WOUNDS

 AS TO THE NATURE OF THE WOUND INFLICTED

ABRASIONS

Accidental – extensive in the body particularly on traffic accident

Suicidal – rarely observed or nothing at all
Homicidal – not common except when victim is dragged on the ground

CONTUSION

Suicidal – rarely observed except when person jumped from a high location
Accidental – may be found in any portion of the body due to contact with some hard object
Homicidal – rare

INCISIONS

Suicide – commonly observed

Homicide – commonly observed
Homicidal – rare
HOMICIDAL, ACCIDENTAL, OR SUICIDAL WOUNDS

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 weapon or manner in which it was held
3. Motive underlying the commission of the crime and the likes.
4. Personal character of the deceased
5. Possibility of purposely changing the truth of the condition
6. Other information such as:

- signs of struggle
- number of wounds
- direction of wounds
- nature and extent of wounds
- state of the clothing
LENGTH OF TIME: VICTIM SURVIVAL

In the approximation of the length of survival of the victim after receipt of the physical injury, the following
factors must be taken into consideration:

 DEGREE OF HEALING

The injured portions of the body undergoes certain chemical and physical changes as a normal course
repair. Signs of repair appears in less than a day after infliction of injury. Age of wound may be
estimated using the degree of granulation tissue formation and other reparative changes.

 CHANGES IN THE BODY IN RELATION TO TIME OF DEATH

The degree of wasting, anemia, condition of the face, and bed sore formation may be basis as to how
long as person survived.

 AGE OF BLOOD STAIN

 WITNESS TESTIMONY
INSTRUMENTS USED

Determination of the wounding instrument may be inferred from the nature of the wound in the body of
the victim.

CONTUSION – blunt instrument

INCISED – sharped-edged instrument inflicted by hitting
LACERATED - blunt instrument (strong force)
PUNCTURED - sharp-pointed instrument
ABRASION - body surface is rubbed on a rough surface
GUNSHOT - diameter of entrance wound approximates the caliber

DETERMINATION AS TO WHICH INJURY SUSTAINED PRODUCED DEATH

If there are several offenders who conspired with one another in the commission of an offense, it is not
necessary to determine who among them gave the fatal blow. But if there is no conspiracy, it is necessary to
determine who among them gave the fatal injury because one is only responsible for his individual act.

The determination as to which injury sustained produced fatality relies heavily on the testimony of the
examining physician. This can be ascertained by individually examining the wounds and noting which
among them are involved in the injury to some vital organs or large blood vessels.
INSTRUMENTS USED

DETERMINATION AS TO WHICH INJURY WAS INFLICTED FIRST

When there are several wounds present on the body of the victim, it is important to determine which of
them was inflicted first because it may be necessary for the qualification of the offense committed. The
following factors must be taken into consideration:

1. Relative position of the assailant and the victim when the first inflicted.

- Location of the wound in the body

- Direction of the wound
- Nature of the instrument
- Testimonies

2. Trajectory or course of the wound inside the body of the victim.

3. Organs involved and degree of injury sustained
4. Testimony of witnesses
5. Presence of defense wounds on the victim.
EXTRINSIC EVIDENCES IN WOUNDS

 EVIDENCES FROM THE WOUNDING WEAPON

1. Position of the weapon

2. Blood on the weapon
3. Hair and other substance on the weapon

 EVIDENCES IN THE CLOTHING

- holes and presence of gunpowder from gunshot wound

- tears

 EVIDENCES DERIVED FROM THE EXAMINATION OF THE ASSAILANT

 EVIDENCES DERIVED FROM THE SCENE OF THE CRIME