Notes on Forensic Medicine

By: Mrs. Enrilen Belaca-ol Laude, R.C.

INTRODUCTION

FORENSIC MEDICINE is a branch of medicine, which deals and applies the medical
science in medico-legal cases. It is then a science, which concerns with the medical
aspects of problems that confronts the court.

FORENSIC MEDICINE is medicine applied in the solution of various problems in

court and legal proceeding.

LEGAL MEDICINE is the branch of medicine that is applied to law and justice
whether to elucidate the crime or not.

MEDICAL JURISPRUDENCE which defines as a branch of law which deals with the
policies, rules or regulations, ethics in the control and in the practice of the medical
profession.

Differentiation between Forensic Medicine and Medical Jurisprudence

Points of Forensic Medicine Medical Jurisprudence

Difference
1. Origin Originates from the Emanate from the Acts of Congress,
development of medical Executive Orders, Administrative
science. Circulars, Customs and Usages.
2. Nature Branch of Medicine Branch of Law
[Link] Deals with medical Deals with the policies, rules, or
and its Applications knowledge that are applied regulations, and other ethics that
to law and administration are applied to the practice of
of justice. medicine.

4. Principle to Coordination Subordination

follow

Differentiation between Physician and Medical Jurist or Medico-Legal Officer

Points of Medical Jurist/Médico-Legal

Difference Physician Expert
1. Line of Specialty Medical Practitioner or specialist Doctor of Medicine who
in other fields of medicine except specializes in Forensic
Forensic Medicine Medicine.
2. Purpose of To find out the cause of illness To determine the cause for the
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Examination and institute treatment sake of law and justice

3. Body Lesions Minor lesions in the body are not All lesion in the body are
significant significant

HISTORY OF FORENSIC MEDICINE IN THE PHILIPPINES

In the Philippines, the practice of Forensic Medicine started several years ago
although the record showed that it started sometime in 1858 during the Spanish
regime. From that time up to the present the following events in the practice of
Forensic Medicine occurred with the corresponding dates:

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 1858 – The first textbook in Legal Medicine and its practice by Dr. Rafael
Genard y Mas who is a Spanish chief army physician was published and is entitled
“Manual de Medicina Domestica”.

1871 – Legal Medicine was included in the curriculum of the College of

Medicine in the University of Santo Tomas.

May 31, 1876 – The “Medico Titulares” which took charge of public
sanitation and medico-legal aid for the purpose of justice was created by the King of
Spain in his Royal Decree No. 188.

1894 – The “Medico Titulares of Forensic” which is about the regulation and
its practice was established.

1895 – Medico-legal laboratory was established in Manila to handle medico-

legal cases.

1898 – During the American Regime, the Spanish Forensic Medicine System
was preserved.

1901 – The provincial, insular and municipal board of health (Acts 157,307,
308) was created by the Philippine Commission which is about the medico-legal
duties of “medico titulares” of the Spanish regime and its assignments to the health
officers of respective areas.

1908 – Legal Medicine was taught in all medical schools in the Philippines.

1919 – The Department of Legal Medicine and Ethics of the University of the
Philippines was created under Dr. Sixto delos Angeles as the chief.

January 10, 1922 – The department of Legal Medicine and Ethics of the
University of the Philippines with its department head was incorporated to the
Philippine General Hospital.
March 10, 1922 – The Philippine Legislature enacted Act No. 1043 which
became incorporated in the Administrative Code as Section 2465 and provides that
the Department of Legal Medicine and Ethics of the University of the Philippines
became branch of the Department of Justice.

December 10, 1937 – The creation of the Division of Investigation under the
Department of Justice was done by the Commonwealth Act 181 in which medico-
legal section is under the division with Dr. Gregorio T. Lantin as the Head.

March 3, 1939 – The Department of Legal Medicine and Ethics of the

University of the Philippines was abolished and its functions was transferred to the
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medico-legal section of the Division of Investigation.

July 4, 1942 – A Medico-Legal section of Manila Police Department was

created under Dr. Pablo Anzures.

1945 – The Provost Marshall of the United States Army created the criminal
investigation laboratory with the Medical Examiner as an integral part under Dr.
Mariano Lara as the Chief Medical Examiner.

June 28, 1945 – The Division of Investigation was reactivated under

Department of Justice.

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 June 19, 1947 – The Bureau of Investigation was created by the Republic Act
157. Then, The Bureau of Investigation was under the National Bureau of
Investigation by the Executive Order from the President of the Philippines. The
Medico-Legal section was created under the National Bureau of Investigation with
its head Dr. Enrique V. de los Santos.

The existence of the medico-legal division in the criminal laboratory of the G-

2 of the Philippine Constabulary also occurred.

At that time, all provincial, municipal and city health officers, physicians of
hospitals, health centers, asylums, penitentiaries, became the ex-officio medico-legal
officers.

In remote places, the service of a “Cirujano Ministrante” or the Sanitary

Inspector may perform the medico-legal work if a registered physician is not
available.

THE MEDICO-LEGAL SYSTEM

The Medico-legal system adopted in a particular country depends upon the

laws of its country. The one commonly used are the Medico-Legal Office System,
Medical Examiner System and the Corner System. Some countries employed the
three systems at the same time but other countries preferred two or a certain
system.

A. MEDICO-LEGAL OFFICE SYSTEM

This is the medico-legal system used in the Philippines at present, which is

handled by a Medical Jurist or Medico-Legal Officer who is a registered physician
duly qualified to practice medicine in the Philippines. The National Bureau of
Investigation, Manila Police Department and the Philippine Constabulary had their
own medico-legal offices with their own Medico-Legal Officers. The Medico-Legal
officer is the one who investigates medico-legal cases of death, physical injuries,
rape and other sexual crimes. His duty is to examine the victim or assailant, to make
a report and to appear in court as expert witness when summoned by the proper
authorities.

In spite of several medico-legal cases in the Philippines, the medico-legal

investigation is still insufficient because of the following reasons:
1. Lack of proficiency by the physician in medico-legal work;
2. Inadequate means of transportation and communication;
3. Lack of sufficient training in medico-legal work by the police investigator and
other law enforcement agent;
a. Law enforcement agent do not appreciate the value of medical
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evidence in the solution of crime;

b. Law enforcement agent rely too much on testimonial evidence;
c. Law enforcement agents do not know in what phase they need the
services of a physician.

4. Insufficient Physician and Personnel to handle medico-legal cases;

5. Inadequate facilities.

B. MEDICAL EXAMINER SYSTEM

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 In some parts of the United States, the Medical Examiner System is the one
preferred although the Coroner System is still used in some states. The Medical
Examiner System is handled b y the Chief Medical Examiner who is a Doctor of
Medicine and appointed by the Mayor from the classified LISTS COMPLIED BY THE
Civil Service on the basis of competitive examination. The Office of the Chief Medical
Examiners on a 24-hour work with clerical staff always present.

The duty of the Medical Examiner is to investigate the cause of death

especially violent death or other circumstances leading to the death of the victim.
The Medical Examiner on-duty after being informed by the police officer of a certain
crime that needs to be investigated will go to the place of the crime, interview the
witnesses, examine the victim and then take specimen if any, for examination.

During trial, the Medical Examiner will then present his medical report to
the court.

C. CORONER SYSTEM

The Coroner System probably originated in England, although there are no

records of its actual origin. In Common Law, the Office of the Coroner is a very
ancient one. The name “Coroner” is probably derived from the title “Custodes
Placitorum Coronae” or “Keeper of the King’s Pleas” as mentioned in Articles of
Eyre of 1194. Magna carta (1215) refers to coroner as “Coronator”. A report of the
Inquest held in 12 65 is one of the oldest reportof an English inquest although there
is evidence that coroners existed in Australia, United States and other colonies of
England.

Coroner System is handled by the Country Coroner or a Borough Coroner

who maybe a barrister, solicitor or legally qualified medical practitioner of not less
than five (5) years standing in his profession and is Elected by the Country Council
or Borough Council.

In spite of the role played by the Coroner, there is a gradual disappearances

or phasing out of this system because of the following reasons:

1. Insufficient medico-legal training of the Coroner;

2. Tenure of office of the Coroner is short;
3. Insufficient payment or salary of the Coroner;
4. Overlapping of duties of the Coroner with Medico-Legal Officer and the
Medical Examiner.

Some Principles Governing the Application and Effects of Law

1. Principle of Stare Decisis

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The principle of law, that, when the court had once laid down the principle of
Law as applied to a certain state of facts, it will adhere to that principle and apply it
to all future cases where the facts are substantially the same.

2. “Ignorancia Legis Nominem Excusat”

Ignorance of the law, excuses no one from the compliance therewith. (Art. 3 Civil
Code)

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5. Customs which are not contrary to law, public order or public policy shall not be
countenanced. (Art. 11, Civil Code)

A Custom is an unwritten law established by long usage and with the

consent of our ancestors. Usage is the legal evidence of custom and is defined as an
established method of dealing, adopted in a particular place, which acquires legal
force because people makes contract in reference to it.

In the Philippines the Civil Code expressly provides that customs should be
applied in case there is no codal provision applicable.

6. Golden Rule

A principle applicable in law which states as: “Don’t do unto others what you
don’t want others do unto you”.

DEFINITION OF TERMS

A. Medical – it is something that refers to medicine pertaining to its origin, nature

and characteristics.
B. Medicine – it is a science and an art which deals with the prevention and
treatment of diseases or illness.
1. Internal Medicine – it is a branch of medicine which deals illnesses that can
be prevented or
cured by the use of drugs or medicines.
2. Surgery – a branch of medicines which deals with affections of the body
that needs drugs and
operative techniques in order to alleviate or remedy the illness or
defects.
3. Pathology – it is the study of diseases affecting the body including the parts
of the body
affected.
4. Gynecology – a branch of medicine pertaining to diseases of woman.
5. Obstetrics – a branch of medicine which deals with the pregnant woman
and her fetus before,
during and after delivery.
C. Legal – It refers to law regards to its origin, nature and its meaning.
D. Law – it is a rule of conduct, just, obligatory, laid down by legitimate power for
the common observance and benefit.

1. Criminal Law – a branch of law which deals with crimes, its nature and
the corresponding
punishments.

2. Civil Law – a mass of precepts that determines or regulates the relation of

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assistance, authority and obedience between members of a family and those that
exist between members of a society for the protection of private interests.

2. Remedial Law – a branch of law which deals with the rules concerning
pleadings, practices and procedures in all courts of the Philippines.

DECEPTION AND DETECTION

Knowledge of truth is important in the administration of justice, lies solely in the

ability to evaluate the statement given by the suspect or witness.

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METHODS OF DECEPTION DETECTION:
1. Devices which record the psycho-physiological response:
a. Use of a polygraph or lie detector machine
b. Word association test
c. Psychological stress evaluator
2. Use of drugs that try to “ inhibit the inhibitor”
a. Administration of the truth serum
b. Narcoanalysis
c. Intoxication
3. Hypnotism
4. By observation
5. Scientific interrogation
6. Confession

IDENTIFICATION OF PERSONS

A. Ordinary methods of identification

1. Characteristics which may easily be changed:
a. Growth of hair, beard d. grade of profession
b. Clothing e. body ornamentation
c. Frequent place of visit
2. Characteristics that may not be easily be changed:
a. Mental memory f. hands and feet
b. Speech g. complexion
c. Gait h. changes in the eyes
d. Mannerism i. faces
e. Handedness-left/right j. degree of nutrition

ANTHROPOMETRY ( BERTILLION SYSTEM) Alphonse Bertillion- utilizes

anthropometrical measurement of the human body for identification.

Basis:
1. Human skeleton is unchangeable after 20 years.
2. No two human beings have exactly the same bones.
3. Use of simple instrument

Portrait Parle ( spoken picture) picturesque description of a person

Extrinsic factors in identification:

1. Ornamentation
2. Personal belongings
3. Wearing apparel
4. Foreign bodies
5. Identification by close friends, police records, photographs
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SCIENTIFIC METHODS OF IDENTIFICATION

1. Fingerprinting
2. Dental identification
3. Handwriting
4. Identification of skeleton
5. Determination of sex, age
6. Identification of blood, blood stains
7. Identification of hair, fibers

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 1. FINGERPRINTING
- Most valuable method of identification
a. No two identical fingerprints 1:64,000,000,000
b. Not changeable – 4th month formed in the fetus

DACTYLOGRAPHY: art and study of recording fingerprints.

DACTYLOSCOPY : comparison of fingerprints

POROSCOPY: study of pores found on the papillary friction ridges of skin

2. DENTAL IDENTIFICATION
- Possibility of 2 persons to have the same is remote

3. DETERMINATION OF SEX OF THE SKELETON :

a. Pelvis( lower trunk) d. femur (thighbone)
b. Skull e. humerus (upper arm)
c. Sternum( the bones to which the ribs are attached)
4. IDENTIFICATION OF SEX
Evidence of sex:
a. Presumptive evidence- general features, hair in some parts
b. Highly probable- vagina, large breast
c. Conclusive evidence- ovary in females
5. DETERMINATION OF AGE
Legal importance
a. Aid to identification
b. Determination of criminal liability
c. Determination of right of suffrage
d. Determination whether a person can exercise civil rights
e. Determination of the capacity to marriage
f. Requisite to certain crimes

6. IDENTIFICATION OF BLOOD AND BLOOD STAINS

Human blood is a reddish liquid portion of the body within the blood vessels and
containing formed elements:
* red blood cells
* white blood cells
* platelets
* Plasma

Medico-legal death refers to the death of which involves in crime or medico-legal

cases to prove or disprove that a foul play had been done. Usually death from
sickness in the hospital or at home is natural death and therefore is not classified
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under medico-legal death because there is no foul play or crime involved.

Medico-legal Importance of Determining Death:

1. Basis for immediate removal of vital organs and for transplantation.
2. Civil personality of natural person is extinguished from death.
3. Property of a person is transferred among the heirs at the time of death.
4. Criminal liability of a person is extinguished by death.
5. Civil case for claim which does not survive is dismissed upon death of the
dependent.

Death – is the termination of life.

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Kinds of Death:

1. Somatic death or Clinical Death

It is complete, continuous, persistent cessation of respiration, circulation and
almost all brain functions of an organism. It is usually pronounce by a physician or
other members of the family.

Clinical types of death

a) Sociological death
It is a type of death wherein the withdrawal and separation from the
patient by the others producing a sense of isolation and abandonment. It can last for
years if the patient is abandoned by the family, unvisited and left alone to die.
b) Psychic death
The condition of death wherein the patient regresses, gives up or
surrender, accepting death prematurely and refuses to continue living. It occurs
prematurely if the patient has excessive fear of his illness and views it as leading to
immediate death.

c) Biologic death
The type of death characterized by the absence of cognitive function
or awareness, although artificial support system may maintain organ functioning.
d) Physiologic death
A type of death when all the vital organs have ceased to function.

2. Molecular Death ( 3 TO 6 hours after cessation of life)

3. Apparent death or state of suspended animation- transient loss of

consciousness in hysteria, uremia and electric shock.

SIGNS THAT DEATH HAS OCCURRED:

 Early Signs of Death
o Cessation of blood flow
o Dilated and un reactive pupil
o Loss of reflexes
o Cessation of breathing
o Loss of ocular tension
o Muscles become flaccid
o Pallor( pale)
o Loss of bladder tone
o Semen may be emitted
o Gastric contents may be regurgitate( reiterate)

 Late Signs of Death

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o Livor mortis
o Algor Mortis ( cooling of the body)
o Rigor Mortis
o Decomposition

@ LIVOR MORTIS
 Settling the blood due to gravity
 Starts 3 to 6 hours after death
 Fully developed at 12 hrs

@ MUSCLES CHANGE AFTER DEATH

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1. Stage of Primary Flaccidity
= occurs immediately after death
= Due to complete relaxation of muscles
2. Rigor Mortis or Stage of Post-Mortem Rigidity
= due to entry of calcium causing contraction of muscles
= most rapid in small facial muscles and follows a head to toe order
3. Stage of Secondary Flaccidity
= muscles start to decompose or putrefy

CONDITIONS SIMULATING RIGOR MORTIS

1. Heat Stiffening
A condition characterized by hardening of the muscles due to coagulation of
muscle proteins when the dead body is exposed to intense heat as burning or
immersion in a hot liquid. The muscle fiber will undergo shortening more than in
rigor mortis and this will result to a pugilistic attitude of the corpse characterized by
flexion of the neck, elbows, thighs, and knees. It is Rigidity of muscles when exposed
to above 75C.

2. Cold Stiffening
A condition characterized by hardening of the muscles due to solidification of
fats, muscles and fluids when the dead body is exposed to extremely cold or freezing
temperature. In freezing temperature, all the body fluids will be frozen, including
those in the joint so that forcible stretching of the flexed limbs will produce a
crackling sound due to breaking of the frozen synovial fluid in the joint spaces.

3. Cadaveric Spasm or Instantaneous Rigor

It is the instant stiffening of the muscle Instantaneous rigidity of the muscles
at the moment of death. It may indicate a struggle during death.

SIGNS OF DEATH
1. Cessation of Respiration
Ordinarily a person is breathing as observed by the upward and downward
movement of the chest and abdomen. It has been observed that when a person is
dying, the breathing becomes irregular and then suddenly in gaps separated by long
periods of interval until a last expiratory movement which is usually accepted as the
outward and visible sign of death which had occurred. A person can hold his breath
not longer than three and a half minutes but persistent, continuous cessation of
breathing and repeated testing for at least two minutes interval at its testing is
considered as a respiratory failure, however, a 12 hour period of treatment with
respirator is required in some cases.

The irregular types of respiration maybe seen in the following conditions:

• Cheney-stokes respiration – a respiration wherein the apnea period or
interval is about 15 to 30 seconds.
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• In drowning and electric shock

• In newly born infants
• In the voluntary act of respiratory suspension

Methods of detecting respiratory failure

1. Observance of the upward and downward movement of the chest and abdomen in
the process of
breathing .No movement observed upon death.
2. Palpation of the respiratory movement by placing the palm of the hand on the
chest and abdomen.
There will be no feel of the movement upon death.

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3. By auscultation with the aid of stethoscope or placing the ear at the region of the
chest to hear the
breath sounds. No breath sounds upon death.
4. Examination with the aid of the mirror
5. Examination with the aid of feathers or fibers
6. Examination during glass of water
7. Examination using a lighted candle, match or any material
8. Winslav Test – test of determining cessation of respiration when there is no
movement of the reflected image on the water or mercury contained in a container
and placed on the chest of a person lying on his back.

2. Cessation of Heart and Circulation

The heart is a muscular organ which performs vital function as a pump organ
and therefore distributed blood to all parts of the body in its contraction and
relaxation. The heartbeat is almost synchronous with the pulse beat although the
heart beating occurs first before the pulse beat in a fraction of a second. Upon death,
the heart stops beating in a persistent and continuous manner which cannot be
revived by cardiac massage and other resuscitative measures for about a period of
five minutes. Subsequently, the pulse beat stopped and also the circulation or blood
flow to different parts of the body. In this condition, the person is pronounced to be
dead. In case of decapitation or cutting of the head and judicial hanging, the heart
beat persist for fifteen minutes to one hour.

Methods of detecting cessation of heart action and circulation

1. Palpation of the pulse and heart beat
2. Auscultation with the aid of stethoscope or placing the ear at the region of the
heart in the left chest to hear the heart sound.
3. Observance of the point of maxim impulse at the region of the left chest
4. Fluoroscopic examination
5. Electrocardiography – EKG
- Tracing of the Living Heart
- Tracing of Dead Heart

3. Cooling of the body

In Post-Mortem Caloricity, there is an increase of temperature due to a fast,

early putrefactive and chemical change in the body, which occurs in about 1-3 hours
after death. Post-mortem caloricity occurs especially in persons who died from
infectious diseases and strychnine poisoning.

LEGAL RECOGNITION OF TWO TYPES OF DEATH

a) CARDIO-RESPIRATORY DEATH
- the continuous, persistent, irreversible cessation of heart action and
respiration (no heartbeat, no breathing)
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b) BRAIN DEATH
- irreversible cessation of all functions of the brain, including the brain
stem (both the cerebrum or the higher brain, and the lower brain or the
brain stem are no longer functional)
- there is absence of electrical brain activity

MEDICO-LEGAL CLASSIFICATION OF CAUSES OF DEATH

1) NATURAL DEATH
- caused by a natural disease or condition in the body

2) VIOLENT DEATH

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 - due to injuries inflicted in the body by some form of outside force
a) accidental
b) negligent
c) suicidal
d) infanticidal
e) parricidal
f) murder
g) homicidal

SIGNS OF DEATH/EARLY CHANGES AFTER DEATH

1) COOLING (ALGOR MORTIS)
- caused by the absence of heat in the blood
- the rate of fall of body temperature averages about 0.9ºC or about 1.8ºF
per hour

2) POST-MORTEM LIVIDITY OR LIVOR MORTIS

- the settling of blood to the lowest part of the body, causing such part to
become dull-red or purplish in color
- becomes apparent after 4-6 hours from the time of death
- becomes fully established after 12 hours

TWO STAGES OF LIVIDITY

a. HYPOSTASIS
o the blood is still in fluid form
b. DIFFUSION
o the blood is no longer in fluid form

3) PRIMARY FLACCIDITY
- immediately after death, there is complete relaxation and softening of all
the muscles of the body
- the muscles are relaxed and capable of contracting when stimulated
- there is incontinence of urination and defecation
- lasts about three to six hours after death

4) RIGOR MORTIS (POST MORTEM RIGIDITY)

- refers to the rigidity of muscles
- the whole body becomes rigid due to the contraction of the muscles
- starts after 3 to 6 hours after death, completed at 12 hours and remains
so for 36 to 48 hours
- caused by heat stiffening (pugilistic attitude of the body), cold stiffening
and cadaveric spasm

CADAVERIC SPASM OR INSTANTANEOUS RIGOR

- The instantaneous rigidity of the muscles which occurs at the moment of
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death due to extreme nervous tension, exhaustion and injury to the

nervous system or injury to the chest
- rare condition where there is the instantaneous rigidity of certain group
of muscles

HEAT STIFFENING/PUGILISTIC ATTITUDE OF THE BODY

- extremities are flexed and hands are clenched
- caused by stiffening and contraction of the muscles
- commonly observed when the body of a person is placed in boiling fluid
or when the body is burned to death

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COLD STIFFENING
- due to the solidification of fat when the body is exposed to freezing
temperature

5) SECONDARY FLACCIDITY
- after the disappearance of rigor mortis, the muscle becomes soft and
flaccid, due to the dissolution of the muscle proteins which have
previously been coagulated during the period of rigor mortis
- the body becomes limp again and the muscles are no longer capable of
responding to mechanical or electrical stimulus
- signals the start of putrefaction or decomposition due to bacteria
- noted about 48 hours after death

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING IN

TROPICAL COUNTRY

Time since Death Condition of the Body

12 hours Rigor mortis present, hypostasis present
24 hours Rigor mortis absent, abdomen distended w/ gases, greenish
48 hours discoloration of abdomen & chest
72 hours Trunk bloated, blister present, Maggots presents
One Week Body grossly smaller and disfigured
Two Weeks Soft tissues putrefied
One Month Soft tissues gone
Skeletonized

POST-MORTEM DECOMPOSITION
1) AUTOLYSIS
- decomposition by enzymes

2) PUTREFACTION
- decomposition by bacteria
- noted after 48 hours after death
- first appears as a greenish discoloration
- generalized swelling and reddish discoloration along the lines of the
superficial veins occur, called MARBLING

3) MUMMIFICATION
- dehydration by extreme dry heat
- the body becomes dry, brittle, dark brown

4) ADIPOCERE FORMATION OR SAPONIFICATION

- noted to occur after several months after death
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- the fatty tissue of the body is replaced with a white greasy product

5) MACERATION
- softening of the body when immersed in the water

6) SKELETONIZATION
- the reduction of the body to the skeletal form

FACTORS OR CONDITIONS ENHANCING DECOMPOSITION

1) Obesity
2) Infection

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3) Moderate moisture in the air
4) Running water
5) Moist, fertile soil
6) Shallow grave
7) Clothing
8) Hot environment
9) Soft or weak coffin
10) Septic air
11) Organic materials in coffin
12) Mass graves
13) Absence of light
14) Free air accessibility

FACTORS OR CONDITIONS DELAYING DECOMPOSITION

1) Skinny or emaciated body
2) sudden/violent death, no infection
3) Excessive moisture in air
4) Still water
5) Dry, sandy soil
6) Deep burial site
7) Tight clothing
8) Frozen
9) Airtight, hard coffin

Presumption of death:
Disputable presumption- not heard in 7 years

Presumption of death:
Absence of 7 years except succession 10 years
Vessel for- 4 years
Armed forces - 4 years
In danger of death 4 years

PRESUMPTION OF SURVIVORSHIP
[Link] 15 y.o.- older survives
[Link] 60 y.o.- younger
3. under 15, above 60 – former
4. over 15 and under 60- male , older
5. under 15, or over 60 y.o, and the other in between- latter

MEDICO-LEGAL INVESTIGATION OF DEATH

Inquest officer- is an official of the state charged with the duty of inquiring into
certain matters.
- In medico –legal examination: manner and cause of death
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The following officials are authorized to make death investigations:

a. Provincial and city prosecutors
b. Judges of the RTC,MTC
c. Director of NBI

AUTOPSY
- a comprehensive study of a dead body performed by a trained physician
using recognized dissection procedures and techniques, primarily to
determine the true cause of death

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 - indicates that, in addition to an external examination, the body is opened
and an internal examination is conducted

POST-MORTEM EXAMINATION
- refers to an external examination of a dead body without incision being
made, although blood and other body fluids may be collected for
examination

KINDS OF AUTOPSIES
1) HOSPITAL OR NON-OFFICIAL
- done on a human body with the consent of the deceased person’s
relatives for the purpose of:
a) determining the cause of death
b) providing correlation of clinical diagnosis and clinical symptoms
c) determining the effectiveness of therapy
d) studying the natural course of disease process
e) educating students and physicians

2) MEDICO-LEGAL OR OFFICIAL
- an examination performed on a dead body for the purpose of:
a) determining the cause, manner or mode and time of death
b) recovering, identifying and preserving evidentiary material
c) providing interpretation and correlation of facts and circumstances
related to death
d) providing a factual, objective medical report for law enforcement,
prosecution and defense agencies
e) separating death due to disease from death due to external cause for
protection of the innocent

NEGATIVE AUTOPSY
- an autopsy which failed to establish cause of death after all efforts have
been exhausted
- an autopsy which after a meticulous examination with the aid of other
examinations does not yield any definite cause of death

NEGLIGENT AUTOPSY
- an autopsy wherein no cause of death is found on account of imprudence,
negligence, lack of skill and lack of foresight of the examiner

METHODS OF DISPOSAL OF DEAD BODIES

1) EMBALMING
- the artificial way of preserving the body after death
2) GROUND BURIAL OR INHUMATION

Sec 91 P.D. 856 Code of Sanitation

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Burial requirement – death certificate issued by physician

The depth of the grave must be at least 1 ½ meters deep , filled well and firmly

3) SEA BURIAL
4) CREMATION –the pulverization of the body into ashes by the
application of heat

EXHUMATION (DISINTERRING)
- refers to the taking out of a body from its tomb or gravesite
- can be done only upon a lawful order, with permission from the
Department of Health

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 - remains of persons who died of non-dangerous, non-communicable
diseases may be disinterred after three (3) years
- remains of persons who died of dangerous communicable diseases may
be disinterred after five (5) years
DEATH BY ASPHYXIA
- a condition resulting from a lack of oxygen in the air or from an
obstructing mechanism to respiration
- the general term applied to all forms of violent death which results
primarily from the interference with the process of respiration or the
condition in which the supply of oxygen to the blood or to the tissues, or
both, has been reduced below normal level

TYPES OF ASPHYXIAL DEATH

1) ANOXIC DEATH
o associated with the failure of the arterial blood to become normally
saturated with oxygen
2) ANEMIC ANOXIC DEATH
o due to a deceased capacity of the blood to carry oxygen
3) STAGNANT ANOXIC DEATH
o brought about by the failure of circulation
4) HISTOTOXIC ANOXIC DEATH
o due to the failure of the cellular oxidative process, although the
oxygen is delivered to the tissues, it cannot be utilized properly

TYPES OF MECHANICAL ASPHYXIA

1) STRANGULATION (THROTTLING)
- may be with the use of hands or a ligature (such as rope)
2) SMOTHERING OR SUFFOCATION
- occurs when the entrance of air through the nose and mouth is blocked or
severely restricted
3) HANGING
- the neck is tied while the body is suspended
- common form of suicide
4) CHOKING
- there is blocking of the internal airway by a foreign object inside or
outside of the victim’s body
5) CRUSH OR TRAUMATIC ASPHYXIA
- brought about by the mechanical compression of the chest by some heavy
object
6) DROWNING
B. POST-MORTEM IDENTIFICATION

OSTEOLOGY
- the study of skeletons
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- the examination of body remains

MEDICO-LEGAL IMPORTANCE OF OSTEOLOGY

1) determination whether the bones are of human origin or not
2) determination of sex
3) determination of race
4) determination of age
5) determination of height
6) determination of the plurality or missing bones
7) determination of the ante-mortem or post-mortem injuries
8) determination of the duration of internment

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ODONTOLOGY
- the examination of dental records in determining the identity of the body
- the possibility of two persons to have the same dentition is quite remote
- the enamel of the teeth is the hardest substance of the human body

Death from starvation- cause may be due to suicidal, homicidal or accidental.

C. PHYSICAL INJURIES

PHYSICAL INJURY
- the effect of some form of stimulus on the body

WOUND
- the solution of the natural continuity of any tissue of the living body
- the disruption of the anatomic integrity of a tissue of the body

CLASSIFICATION OF WOUNDS
1) ACCORDING TO SEVERITY:
a) MORTAL WOUND
o capable of causing death immediately after the infliction or shortly
thereafter
b) NON-MORTAL WOUND
o not capable of causing death immediately after the infliction or shortly
thereafter

2) ACCORDING TO WEAPON OR INSTRUMENT USED:

a) WOUNDS BROUGHT ABOUT BY BLUNT INSTRUMENT/BLUNT
FORCE INJURIES

BRUISE - contusion (pasa)

HEMATOMA - bump (bukol)
ABRASION - grazes, scrape (gasgas)
LACERATED – characterized by irregular or ill-defined edges of the
wound; gash, tear, cut

b) WOUNDS BROUGHT ABOUT BY SHARP INSTRUMENT

INCISED – caused by sharp-edged instrument; incision is longer

PUNCTURED – caused by sharp-pointed instrument; incision is
deeper
STAB – caused by sharp-edged and sharp-pointed instrument
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3) ACCORDING TO RELATION OF THE SITE OF THE APPLICATION OF

FORCE AND THE LOCATION OF THE 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 of force
c) COUP CONTRE-COUP INJURY – physical injury located at the site
and also opposite the site of the application of force
d) LOCUS MINORIS RESISTENCIA – physical injury located not at
the site nor opposite the site of the application of force but in some
areas offering the least resistance to the force applied

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 e) EXTENSIVE INJURY – physical injury involving a greater area of
the body beyond the site of the application of force

SPECIAL TYPES OF WOUNDS

DEFENSE WOUND
- the result of a person’s instinctive reaction of self-protection
- Injuries suffered by a person to avoid or repel potential injury
contemplated by the aggressor.

PATTERNED WOUND
- Wound in the nature and shape of an object or instrument and which
infers the object or instrument causing it.

SELF-INFLICTED WOUND
- produced or caused by a person to his own self
- also called SELF-MUTILATION

GUNSHOT WOUND
- produced by the penetration of a bullet within the tissues of the body

ENTRANCE WOUND
- the wound produced by the entrance of the bullet to the body
- characteristics:
a) usually small and even smaller than the projectile itself due to the
retraction of the skin and tissues at the opening of the wound
b) the edge of the wound is inverted
c) there is the presence of contusion collar or abrasion collar due to the
spinning movement and rough surface of the projectile
d) usually, the shape is round or oval

EXIT WOUND
- the wound produced by the exit of the bullet from the body
- characteristics:
a) usually larger than the entrance wound and the projectile itself
b) the edge of the wound is averted
c) there is no contusion collar or abrasion collar
d) there is no definite shape

FACTORS AFFECTING THE APPEARANCE OF GUNSHOT ENTRANCE AND EXIT

WOUNDS
1) Kind of weapon
2) caliber of the projectile
3) shape and composition of the projectile
4) range of firing
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5) direction of firing
6) part of the body involved

THERMAL INJURIES
- those caused by an appreciable deviation from normal temperature,
capable of producing cellular or tissue changes in the body

TWO TYPES OF INJURY BY HEAT

1) DRY BURN
- when the heat is dry
- also called BURN

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2) WET BURN
- when the heat is caused by liquid
- also called SCALD

CLINICAL CLASSIFICATION OF BURNS

1) FIRST DEGREE BURN
o involves the superficial layer of the skin or tissues
o characterized by redness and pain
o peeling of the skin sets in after a few days
o example is sunburn

2) SECOND DEGREE BURN

o involves the superficial layer of the skin or tissues and nerve endings
o characterized by the formation of blisters containing fluid over the
tissues
o the most painful burn because of the irritation of the nerve endings

3) THIRD DEGREE BURN

o involves the skin, nerves, muscles and bones
o usually encountered in victims of fire
o the most severe burn because the victim usually dies from loss of fluid
and electrolyte in the body and massive infection

LEGAL CLASSIFICATION OF INJURIES ( REVISED PENAL CODE)

1) SERIOUS PHYSICAL INJURIES
o a physical injury wherein the victim is incapacitated for work or
requires medical attendance for more than thirty (30) days
o when as a result of the injury, the victim:
a) becomes insane, impotent or blind
b) loses an organ of sense or locomotion
c) becomes deformed, lost portions or functions of any part of the body

2) LESS SERIOUS PHYSICAL INJURIES

o a physical injury wherein the victim is incapacitated for work or
requires medical attendance for ten days or more but not more
than thirty days

3) SLIGHT PHYSICAL INJURIES

o a physical injury wherein the victim is incapacitated for work or
requires medical attendance for a period of one to nine days

4) MUTILATION
o the intentional act of looping or cutting off any part of the living body
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DEFORMITY
- a temporary or permanent disfigurement of the body or any part of the
body producing physical ugliness

C. SEXUAL OFFENSES AND DEVIATION

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

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KINDS OF VIRGINITY
1) MORAL VIRGINITY
o the state of not knowing the nature of sexual life and not having
experienced sexual relation
o applies to children below the age of puberty and whose sex organs
and secondary sex characteristics are not yet fully developed

2) PHYSICAL VIRGINITY
o a condition whereby a woman is conscious of the nature of the sexual
life but has not experienced sexual intercourse
o applies to women who have reached sexual maturity but have not
experienced sexual intercourse

TRUE PHYSICAL VIRGINITY

o a condition wherein the hymen is intact, with the edges distinct and
regular, and the opening is small to barely admit the tip of the
smallest finger of the examiner even if the thighs are separated

FALSE PHYSICAL VIRGINITY

o a condition wherein the hymen is unruptured but the orifice is wide
and elastic to admit two or more fingers of the examiner with a lesser
degree of resistance

3) DEMI-VIRGINITY
o a condition of a woman who permits any form of sexual liberties as
long as they abstain from rupturing the hymen by sexual act

4) VIRGO INTACTA
o applied to women who have had previous sexual act but had not yet
given birth

DEFLORATION
- the laceration or rupture of the hymen as a result of sexual intercourse

RAPE (RA 8353)

TWO MODES OF COMMITTING RAPE

1) MAN AGAINST WOMAN:

By a man who shall have carnal knowledge of a woman under ANY of the
circumstances:
a) through force, threat or intimidation
b) when the offended party is deprived of reason or unconscious
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c) by means of fraudulent machinations or grave abuse of authority

d) when the offended party is under twelve years of age, or is demented,
even though none of the circumstances mentioned be present
(STATUTORY RAPE)

2) PERSON AGAINST ANOTHER PERSON:

By any person who, under ANY of the circumstances mentioned above

shall commit an act of sexual assault by:
a) inserting his penis into another person’s mouth or anal orifice

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 b) inserting any instrument or object into the genital or anal orifice of
another person

CARNAL KNOWLEDGE
- the act of a man in having sexual bodily connection with a woman
- even the slightest penetration in the sexual organ of the female by the
sexual organ of the male

CRIMES AGAINST CHASTITY

SIMPLE SEDUCTION
ELEMENTS:
1) woman who is single or a widow of good reputation
2) over twelve years but under eighteen years of age
3) committed by means of deceit

QUALIFIED SEDUCTION
ELEMENTS:
1) woman who is a virgin
2) over twelve years but under eighteen years of age
3) committed by any person in public authority, priest, homeservant,
domestic, guardian, teacher or any person entrusted with the
woman’s education or custody

FORCIBLE ABDUCTION
ELEMENTS:
1) the abducted is a woman against her will
2) with lewd designs

CONSENTED ABDUCTION
ELEMENTS:
1) the abducted is a virgin
2) over twelve years and under eighteen years
3) carried out with her consent
4) with lewd designs

SEXUAL DEVIATIONS

HOMOSEXUALITY - sexual desire towards the same sex

INFANTOSEXUALITY – sexual desire towards an immature person; also known as
PEDOPHILIA
BESTOSEXUAL – sexual desire towards animals; also known as BESTIALITY
AUTOSEXUALITY – self-gratification; also known as MASTURBATION
GERONTOPHILIA – sexual desire towards an older person
NECROPHILIA – a sexual perversion characterized by erotic desire or actual sexual
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intercourse with a corpse

INCEST – sexual relations between persons who, by reason of blood relationship
cannot legally marry
SATYRIASIS – excessive sexual urge of men
NYMPHOMANIA – excessive sexual urge of women
FELLATIO – the female agent receives the penis of a man into her mouth and by
friction with the lips and tongue coupled with the act of sucking initiates orgasm
CUNNILINGUS – sexual gratification is attained by licking or sucking the external
female genitalia
ANILINGUS – a form of sexual perversion wherein a person derives excitement by
licking the anus of another person of either sex

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SADISM (ACTIVE ALGOLAGNIA) – a form of sexual perversion in which the
infliction of pain on another is necessary for sexual enjoyment
MASOCHISM (PASSIVE ALGOLAGNIA) – a form of sexual perversion in which the
infliction of pain by another is necessary for sexual enjoyment
FETISHISM – a form of sexual perversion wherein the real or fantasies presence of
an object or bodily part is necessary for sexual stimulation and gratification
PYGMALIONISM – a sexual deviation whereby a person has sexual desire for
statutes
FROTTAGE – a form of sexual gratification characterized by the compulsive desire
of a person to rub his sex organ against some parts of the body of another
VOYEURISM – a form of sexual perversion characterized by a compulsion to peep to
see persons undress or perform other personal activities

T H A N K Y O U

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