LEGAL MEDICINE

Law- defined as a rule of conduct, just and obligatory, land down by legitimate authority for the common observance and benefit.

Medicine- A science and art of dealing with prevention, cure and alleviation of disease. It is that part of science and art of
restoring and preserving health.

Legal- Refers to anything conformable to the letters or rules of law as it is administered by the court.

Jurisprudence- A science of giving wise interpretation of the Laws.

Legal Medicine = is that branch of medicine which deals with the application of medical knowledge to the purposes of law and
in the administration of justice.

Forensic Medicine = use of medical science to elucidate legal problems in general without specific reference or application to a
particular case.

= it encompasses a variety of fields in forensic science such as pathology, anthropology, odontology, toxicology,
entomology, and others.

Medical Jurisprudence = a branch of law which concerns with the aspects of law and legal concepts to medical practice. It
includes rights, duties, and liabilities of physician, patient and health institution.

Medico-Legal Cases
1. Injuries or deaths involving persons who have no means of being identified.
2. Persons pronounced as “dead on arrival”
3. Death under the following circumstances:
a. Death occurring within twenty-four (24 hrs.) of admission when the clinical cause of death is unknown or
indeterminate:
b. Unexpected sudden death especially when the deceased was in apparent good health;
c. Death due to natural diseases but associated with physical evidence suspicious of foul play;
d. Death as a result of violence, accident, suicide or poisoning; and
e. Death due to improper or negligent act of another persons.
4. Physical injuries caused by:
a. gunshot wound, stab wound etc.,
b. Vehicular accident;
c. Asphyxia
d. Electrocution, Chemical or thermal insult;
e. Accident, Attempted homicide or suicide; and
f. Poisoning
5. Cases of child abuse, domestic violence, rape alcoholism and drug addiction.
6. Cases involving the mental in competency of the patient.
Difference between a medical jurist and an ordinary physician
1. An ordinary physician ignores trivial injuries not needing treatment which a medical jurist records all injuries to qualify
the crime or justify the act.
2. An ordinary physician sees injury or disease to be able to treat while a medical jurist sees injury or disease in order to
find out the cause.
3. The purpose of an ordinary physician is to arrive at a definite diagnosis and institute proper treatment while a medical
jurist testifies on bodily lesion seen for justice.

Difference Between Legal Medicine and Medical Jurisprudence

1. Legal medicine is a branch of medical 1. Medical jurisprudence is a branch of law

science

2. It is a medicine applied to law and 2. It is a law applied to the practice of medicine

administration of justice

252
 3. It originates from the development of 3. It emanates from the act of congress, executive orders,
medical science administrative circulars customs and usages and decisions of
tribunals which have relation to the practice of medicine

4.It is based on the principle of 4. it is based on the principle of subordination; that is the duty of the
coordination; that legal medicine physician to obey the laws in as much as our government is
coordinate medicine to law and justice established on the principle of government of laws and not of men
and that no one is considered above the law.

The Medico-legal System

1. Medico-Legal Office System
The system used in the Philippines, which is handled by a medical jurist who is a registered physician duly qualified
to practice medicine in the Phils. The National Bureau of Investigation and the Phil. National Police have their own medical
jurist who handles medicol-lagal cases. His duty is to examine the victim or assailant, to make report, and to appear in court
as an expert witness when summoned by the proper authorities.

2. Medical Examiner System

This is a system under the control of the Chief medical Examiner that is a doctor of medicine and appointed by the
mayor from the classified lists compiled by the civil service by the basis of competitive examination. The office of the chief
medical examiner is on 24 hours work with clerical staff always present. His duty is to investigate the cause of death especially
violent death of the victim.

3. Coroner System
The coroner system is headed by a country coroner or borough coroner who may be a barrister, solicitor or a legally
qualified practitioner of not less than five (5) years standing in his profession and is elected by the county council or borough
council.

The coroner is an inquest officer whose duty is to inquire into the circumstances of certain medico-legal deaths within
his jurisdiction. Unlike the medico-legal officer or the medical examiner whose qualifications, duties, and powers are
practically the same, the coroner has investigative and judicial functions.

Medical Evidence

Evidence is the means, sanctioned by the Rules of the Court, of ascertaining in a judicial proceeding the truth respecting
a matter of fact

Types of Medical Evidence:

I. Autoptic or Real Evidence:

This is an evidence made known or addressed to the senses of the court. It is not limited to that which is known
through the sense of vision but is extended to what the sense of hearing, taste, smell, and touch is perceived.

Limitations to the presentation of Autoptic:

a. Indecency and Impropriety – Presentation of an evidence may be necessary to serve the best interest of justice
but notion of decency and delicacy may cause inhibition of its presentation.
b. Repulsive Objects to those Offensive to Sensibilities- Foul Smelling objects, persons suffering from highly
infectious and communicable disease, or objects which when touch may mean potential danger to the life and
health of the judge may not be presented.

II. Testimonial Evidence:

A physician may be commanded to appear before a court to give his testimony. While in the witness stand, he is obligated
to answer the question propounded by the counsel and presiding officer of the court. His testimony must be given orally
and under oath or affirmation.

a. Ordinary Witness:

A physician: who testifies in court on matters be perceived from his patient in the course of physician-patient
relationship is considered as an ordinary witness.

253
 b. Expert Witness:

A physician on account of his training and experience can give his opinion on a set of medical facts. He can
deduce of infer something, determine the cause of death or render opinion pertinent to the issue and medical
in nature.

III. 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.

IV. Documentary Evidence:

A document is an instrument on which is recorded by means of letters, figures or marks intended to be used
for purpose of recording that matter which may be evidentially used. The term applies to writings, to words printed,
lithographed or photographed; to seals, plates or stones on which inscriptions are cut or engraved; to photographs and
pictures; to maps or plans.

V. Physical Evidence:

These are articles and materials which are found in connection with the investigation and which aid in
establishing the identity of the perpetrator or the circumstances under which the crime was committed, or in general
assist in the prosecution of a criminal.

Types of Physical Evidences:

a. Corpus Delicti Evidence- Objects or substance which may be a part of the body of the crime.
b. Associative Evidence- These are physical evidences which link a suspect to the crime.
c. Tracing Evidence- These are physical evidences which may assist the investigator in locating the suspect.

MEDICO-LEGAL ASPECTS OF IDENTIFICATION

= Law of Municipality of Evidence (is true in the case of identification.)

The greater the number of similarities or dissimilarities, the greater is the probability for the conclusion to be
correct.

= The value of the different points of identification varies in the formulation of conclusion.

= The longer the interval between the death and the examination of the remains for purposes of identification, the
greater is the need for experts in establishing identity.

= 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.

Importance of Identification of Persons:

1. In Criminal case, the identity of the offender and that of the victim must be established, otherwise it will be a ground
for the dismissal of the charge or acquittal of the accused.
2. Identification of missing person or presumed dead will facilitate settlement of the estate, retirement, insurance and
other social benefits. It vests on the heirs the right over the properties of the identified person.
3. Identification resolves the anxiety of the next-of-kin, other relatives and friends as to the whereabouts of a missing
person or victim of calamity or crime.
4. Identification may be needed in some transaction, like cashing of check, entering a premise, delivery of parcels or
registered mail in post office, sale of property, release of dead bodies to relatives, parties to a contract, etc.

Methods of Identification:
1. By comparison – with the used of standard specimen, evidence under question can be compared in order
to effect identification.

254
 2. By exclusion = is two or more persons have to be identified and all but one is not yet identified, then the
one whose identity has not been established may be known by the process of elimination.

Ordinary methods of Identification

I. Points of Identification applicable to the living only:

a) Characteristic that may easily be changed:

- Growth of chair, beard or mustache
- Clothing
- Frequent place of Visit
- Grade of profession
- Body ornamentation
b. Characteristic that may not easily be changed:
- Mental memory
- Speech
- Gait a manner of walking or moving on food (Webster dic.)
1. Ataxic Gait- a gait which the foot is raised high, thrown forward and brought down suddenly.
2. Cerebellar gait- a gait associated with staggering movement.
3. Cow’s Gait- a swaying movement due to knock-knee.
4. Paretic gait- a gait in which the steps are short, the feet dragged, the legs held more or less
widely apart.
5. Spastic gait- a gait in which the legs are held together and moves in stiff manner, and the
toes to drag and catch.
6. Waddling gait- a gait resembling duck
7. Frog gait- a hoping gait in infantile paralysis.

Gait line = the straight line connecting the center of the succeeding steps. It is more or less in zigzag fashion especially
when the legs are far apart while walking

Foot line = the longitudinal line drawn on each foot mark.

- Mannerisms- These are the characteristic movement of the body peculiar to a person.
1. Way of sitting
2. Movement of the hands
3. Movement of the body
4. Movement of the facial muscles
5. Expression of the mouth while articulating
6. Manner of learning
- Hands and feet

- Facies
- Left or right handedness
- Degree of nutrition (thin, medium built or stout)
- Changes in the eye

II. Points of identification applicable to both living and dead before onset of decomposition:

1. Occupational Marks
2. Race- In the living, race may be presumed on:
a. Color of the skin
Caucasians- fair

Malayans- brown

Negroes- Black

b. feature of face:

Caucasian- prominent sharp nose

255
 Malayan- flat nose with round face

Mongolian- almond eyes such and prominent cheek bones.

Negroes- thick spreading lips

c. Shape of Skull

Red Indians- Flat head

Malayan- Round head

3. Stature (height)
Methods of approximating the height of a person

a. measure the distance between the height of a person fingers of both hands with the arms
extended laterally and it will be equal to the height of the person.
b. Two time the length of one arm plus 12 inches for the clavicle and 1.5inches for the sternum
is the approximate height.
c. Two times the length from the vertex of the skull to the public symphyses.

c.1. The distance from the sternal netch and the public symphyses is about one-hand
of the height.
c.2 The distance from the base of the skull to the coccyx is about 44% of the height.

4- Teeth

The following points must be considered in the study of the teeth for identification process:

d. Determine whether it is temporary or permanent set;

e. Number of teeth present;
f. Number of teeth lost, including evidence of length of time lost;
g. Nature of the teeth present, whether reverse, crooked, mal-aligned or straight;
h. Condition of those present, whether carious, colored, presence of cavities, erosion, filling and
cleanliness;
i. Presence of supernumenary teeth;
j. Odontoid gum; and
k. Extraction, dental fitting, permanent bridge work, fitting of crown and filling cavities.
= the most convenient way of identifying a person by means of the teeth is the use of dental
diagram or chart.

5- Tattoo marks

Importance of Tattoo marks

a. It may help in the identification of the person

b. It may indicate memorable events in his life
c. It may indicate the coial stratum to which the person belongs
d. It implies previous commitment in prison or membership in a gang

Methods of Tattoo Removal

A. Excision = involves an injection of a local anesthetic to numb the area after which the tattoo is
removed surgically. The edges are then brought together and sutured.
B. Dermabrasion = a small portion of the tattoo is sprayed with a solution that freezes the area. The
tattoo is then “sanded” with rotary abrasive instrument causing the skin to peel. Because some
bleeding is likely to occur, a dressing is immediately applied to the area.
C. Laser = Laser surgery is considered to be one of the best methods of tattoo removal. The Q-
switched Nd: Yag, Q-switched Alexandrite and the Q-switched Ruby are among the most frequently
used lasers. If necessary, a cream to numb the skin can be applied prior to the treatment. Pulse of
light from the laser are directed unto the tattoo breaking up the tattoo pigment. Over the next

256
 several weeks the body’s scavenger cells remove the treated pigmented areas. More than one
treatment is usually necessary to remove all of the tattoo.
D. Salabrasion = a centuries old procedure using local anesthetic applied around the tattoo area after
which a solution of ordinary tap water dipped in table salt is applied and an abrading apparatus
such as the one used in dermabrasion or even a simplier device is used such as a wooden block
wrapped in gauze.
6- Deformities

7- Birth marks

8- Injuries leaving permanent result

9- Moles

10-Scars = They are composed of fibrous tissues which take the place of the original tissues which have been
injured or destroyed. They are devoid of specialized tissue so they do not contain pigment layers,
sweat or sebaceous glands.

a. Recent scars of two to three weeks old are vascular with red or pink color.
b. Contracted bloodless scars with white and glistering surfaces are usually more than six months old;
c. Scars resulting from superficial wounds and from wounds healing by first intention develop earlier.

SOME SCARS MAY SHOW CHARACTERISTICS APPEARANCE SUCH AS:

A. Surgical Operation = regular form and location with stitch marks.
B. Burns and sealds = scars are large, irregular in shape and may be keloid.
C. Gunshot wounds = disc like with depressed center. They may be adherent to the underlying tissues.
D. Tuberculous sinus = irregular in shape, furrowed, with edges hardened and uneven.
E. Gumma = depressed scar following loss of tissue
F. Venesection = located at bend of elbow, dorsum of feet, or at the temporal region.
G. Lupus = bluish –white scar
H. Wetcupping = short parallel scars on the lower part of the back and loin.

11- Tribal marks

A common practice of some tribes in Africa is to place some marks on the exposed parts of the body.

12- Sexual organs

Circumcision may help in identification. The uterus and breast may indicate previous
pregnancy. The best evidence of sexuality is the presence of Testes in Male and Ovaries in the Female.

13- Blood examination ( ABO grouping and MN typing)

Extrinsic Factors in Identification:

b) Identification of ornamental wearing apparel

c) Personal Belongings
d) Clothing’s
e) Dust
f) Identification by close friend
g) Criminal Records
h) Photograph

Methods of Identification

1. Portrait Parle (Personal description) “speaking likeness” Is a verbal, accurate and picturesque description of the person
identified.

257
 2. Photography
3. Anthropometry (Bertillion System)

A system of identification based on the measurements of the various bony structure of the human body came
to be known when it was introduced in the police department in Paris, France in 1882 by Alphonse Bertillon.

Bases of the Bertillion’s method of identification

a. Human skeleton does not change after 20 years.

b. It is impossible for two human beings to have bones alike.
c. Measurement easily taken with the aid of simple instrument.

West case:

In 1903, Will West arrived at the US Petretentiary at the Leavenworth, kaneas. While West was being processed in
through identification, a staff member said that there was already a photograph and Bertillon measurement for him on
the file. But a comparison on fingerprints showed that despite identical appearances and nearly identical Bertillon
measurements, the identification card on file belonged to a Willian West, who had been in Leavenworth since 1901.
4. Fingerprint Identification
5. Handwriting Identification
6. Blood Grouping and Blood Typing
7. DNA Testing (Deoxyribonucleic acid) (A-adenine, C- cytosine, T- thymine, and G- guamine Sequence)

LIGHT AS A FACTOR IN IDENTIFICATION

1. Clearest moonlight or starlight

= experiments have shown that the best known person cannot be recognized under the clearest moonlight at
a distance greater than 16 to 17 yards and by Starlight any further than 10 to 13 yards.

2. Broad Daylight
= a person can hardly recognized another person at a distance further than 100 yards if the person has never
been seen before; but person who are almost stranger may be recognized at a distance of 25 yards.

3. Flash of Firearm
= Although by experiment by experiment letters of two inches high can be read with the aid of the flash of a
caliber.22 firearm at a distance of two (2) feet it is hardly possible for a witness to see the assailant in case of a holdup
or a murder because:

a. Usually the assailant is hidden

b. The assault is unexpected and the intention of the person or witness is at its minimum.
4. The flash of Lighting

= produces sufficient light from the identification of individual provided that the person’s eye is focused
towards the individual he wishes to identify during the flash.

5. In case of artificial light. The identification is relative to the kind and intensity of the light.

IDENTIFICATION OF THE SKELETON

Following points can be determined

Whether the remains are of human origin or not.

- oval or round shape of the skull
- less prominent lower jaw and nasal bone
Whether the remains come from a single individual or not
- complete layout of the bones on a table in their exact locations in the human body is necessary.
- Any plurality denotes that the remains belong to more than one (1) person.
k) Height

258
 l) Determination of the Sex of the skeleton
- the following bones must be studied
a. pelvis
b. skull
c. sternum
d. femur
e. humerous

DETERMINATION OF AGE
Legal Importance of Age Determination
1. For Identification
2. To Determine Criminal Liability
3. For Right of Suffarage or in the exercise of other political rights
4. For the exercise of civil rights
5. Determination of the capacity to contract marriage
6. Age is a factor by which the crime of rape is committed
7. The crime of infanticide can only be committed when the child killed is less than three days old.
8. Seduction is committed on a woman over twelve and under eighteen years of age

Determination of Age of the Fetus:

1. For fetus less than 25 cm. Long
Find the square root of the length in centimeters and the result is the age of the fetus in month.
2. For fetus 25 cm. Long or more
Divide the length of the fetus in centimeters by 5, and the result will be the age in months.

(Age as referred in this rule is lunar month, not calendar month. One lunar month is equivalent to 28 days)

Nature of the Intra-uterine product of conception corresponding

to the age in months:
1 month - The Ovum is about 1.0 cm with limb buds only present.
2 months - The ovum has a length of 2.5cm with an embryo about 1.0cm long with head, ears and hands well
formed.
3 months - The length is 9.0 cm. With nails beginning to appear and the placenta can be differentiated.
4 months - The length is 16.0 cm. And the sex can be differentiated, with the fingers beginning to open and hair
beginning to appear on the head.
5 months - Fetus processes hair on the head and Lanugo over body surfaces. Nails are distinct. Skin shows
sebaceous secretion. Dental gum appears at the mandible.
6 months - Fetus weighs 2.5 kg. Lanugo and vernix present in the skin are dark and wrinkled. Meconium is present
in the small intestine and at the beginning of the large intestine. Brain shows convolutions. The
testis is found in the abdominal cavity. Hair of eyebrow and eye-lashes begin to appear.
7 months - The body is dark red and plump, with hair on the scalp. The testis begins to descend towards the
scrotum.
8 months - Fetus has rosy skin, and nails reach the end of the finger-tips. Convolutions of the brain are more
distinct. Second piece of sternum ossified Papillary membrane disappears.
9 months - Brain convolutions reach the gray matter. The scrotum is occupied by the testis. The body surface is
now pale. Sebaceous secretion is formed at the flexures of joints. Nails fully formed and
developed.

Medico-Legal Aspects of Death

259
Life – is the sum total of all vital processes by which the physical integrity of the body is maintained.
Death- is the state of complete persistent cessation of the vital function of the body such as the function of the heart, the lings
and the brain.

A. Importance of Death Determination

1. The civil personality of a natural person is extinguished by death;

The civil personality is extinguished by death. The effect of death upon the rights and obligations of the
deceased is determined by law, by contract and by will.

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 extinguishments 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.

B. Kinds of Death

1. Clinical Death or Somatic Death

Is a type of death usually declare by members of the immediate family of the diseased or by the physician.
Immediate signs of the in a person are; Sudden cessation of the upward and downward movement of the chest in the
process of respiration (10-15 minutes), sudden pale color of the faces and lips, pulse and heart beat stops, the jaw or head
drops down and flaccidity of muscles occur; presence of dilated pupil as well as loss of corneal and light reflexes. Clinical
types of death can either be: Sociologic, Psychic, Biologic or Physiologic.

2. Molecular or Cellular Death

Is the type of death characterized by death of individual cells ( one at a time ) after the somatic death. The nerve
cells and brain cells die earlier at about 5 minutes due to loss of food and oxygen while the muscles live longer until the
onset of the rigor mortis which about two to three hours after death.

3. Apparent Death/ State of Suspended Animation

A transient loss of consciousness of temporary cessation of the vital function of the body on account of disease,
external stimulus other forms of influence.

C. Signs of Death

A. Cessation of Respiration
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 no longer than 3 – ½ minutes. In case of electrical shock, respiration may
cease for some time but maybe restored by continuous artificial respiration.

Irregular Types of Respiration

a. Cheyne-Strokes respiration – interval is about fifteen to thirty seconds

c. In drowning and electric shock

d. In new born infants
e. In the voluntary act of respiratory suspension.
Methods of Detecting Cessation of Respiration:

a. Expose the chest and abdomen and observe the movement during inspiration and expiration.
b. Examine the person with the aid of stethoscope which is placed at the base of the anterior aspects of the
neck and hear sound of the current of air passing through the trachea during each phase of respiration.
c. Examination with a Mirror
d. Examination with a Feather or Cotton Fibers
e. Examination with a glass of water
f. Winslow’s test

D. Cessation of Heart and Circulation

260
 There must be an entire and continuous cessation of the heart action and flow of blood in the whole vascular
system,. A temporary suspension of the heart action is still compatible with life. The length of time the heart may cease to
function and life is still maintained depends upon the length of time it is readily reestablished and upon the oxygenation of blood
at the time of the suspension. As a general rule, if there is no heart action for a period of five minutes death is regarded as
certain.

Methods of Detecting the Cessation of heart Action and circulation:

A. Examination of the heart:

-Palpation of the pulse and heartbeat.

- Auscultation with the aid of stethoscope or placing the ear at the region of the heart.
- Observation of the point of maximum impulse.
- Electrocardiography or ECG.
- Fluoroscopic Examination

B. Examination of the Peripheral Circulation:

- Magnus’ Test
- Opening of Small Artery
- Icard’s test
- Pressure on the fingernails
- Diaphanous Test
- Application of heat on the Skin
- Palpation of the radial pulse
- Dropping of Melted Wax
C. 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. The progressive fall of the body
temperature is one of the most prominent signs of death.
Gradual decreasing of the body temperature until such time it assumes the temperature of the environment
which is faster during the first two (2) hours after death and slower during the next 6 to 9 hours and equal to the
environmental temperature beyond 12 hours.
The fall of temperature of 15 to 20 degrees Fahrenheit is considered s a certain sign of death.
Post Mortem Caloricity is the rise of temperature of the body after death due to rapid and early putrefactive
changes or some internal changes. It is usually observed in the first two hours of death. Occur in the following
condition:
a. Cholera b. Tetanus c. Small pox d. Peritonitis
D. Insensibility of the body and loss of power to move.
No kind of stimulus is capable to letting the body have voluntary movement.
E. Changes in the Eyes

a. Loss of Corneal and light reflexes

b. Haziness of the cornea

c. Flaccidity of the eyeball

d. Finding inside the eye.
(Ophthalmoscopic finding)

F. Changes in skin

A. Change of color
B. Loss of the elasticity of the skin
C. Opacity of the skin

261
 D. Absence of reaction to injury
CHANGES OF THE BODY AFTER DEATH
1. Primary Flaccidity ( period of the muscle irritability )
-muscles are relaxed and capable of contracting when stimulated

- pupil are dilated, incontinence of urination and defection.

- Lasts 3- 6 hours after death.
2. Stage of Post Mortem Rigidity (Rigor Mortis)
- 3-6 hours after death and may last 24 to 36 hours
- body becomes rigid due to contraction of the muscles

Conditions Simulating Rigor Mortis

1. Heat Stiffening
- body is exposed to temperature above 77 degree Celsius
- Pugilistic attitude
- More or less permanent
2. Cold Stiffening

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

3.
Cadaveric Spasm or Instantaneous rigor.
- rigidity of the muscles which occurs at the moment of death due to nervous tension,
exhaustion and injury to the nervous system.
-
DISTINCTION BETWEEN RIGOR MORTIS AND CADAVERIC SPASM

Rigor Mortis Cadaveric spasm

Time of Appearance 3- 6 hours after death Immediately after death
Occurrence Natural May or may not appear
Medico-legal Time of death Cause of death
significance
Muscle Involved All the muscles Certain muscle,
asymmetric

4. Stages of Secondary Flaccidity or secondary relaxation

- due to the dissolution of the muscles protein
- onset of putrefaction
- the body become limp again and the muscles are no longer capable of responding to mechanical or electrical
stimulus.
- Noted about 48 hours after death

CHANGES IN THE BLOOD

a. Coagulation of the blood

The stasis of the blood due to the cessation of circulation enhances the coagulation of blood inside the blood
vessel. Blood clothing is accelerated in cases of death by infectious fevers and delayed in cases of asphyxia, poisoning by
opium, hydrocyanic acid or carbon monoxide poisoning.

Blood may remain fluid inside the blood vessel after death for 6 to 8 hours.

Distinction Between Ante-Mortem from Post-Mortem Clot:

Ante-Mortem Clot Post-mortem Clot

1. Firm in consistency 1. Soft in consistency.

262
 2. Surface of the blood vessel raw after the 2. Surface of the blood vessels smooth and
clots are removed. healthy after the clots are removed.
3. Clots homogenous in construction so it 3. Clots can be stripped off in layers.
cannot be stripped into layers. 4. Clot with distinct layer.
4. Clot with uniform color.

b. MOST MORTEM LIVIDITY

It is the discoloration of the body after death when the blood tens to pool in the blood vessels for the most
dependent portion to the pool in the blood vessels for the most dependent portion of the body. The blood remains
fluid in the body after for 6-8 hours and gradually clot until it is fully developed at about 12 hrs., The appearance of
Post Mortem lividity usually stars about 20-30 minutes after death, thus, it can also be a means in approximating the
time of death of the person. But is more useful in determining the position of the body after death. The discoloration
of the bloody may varies in color. Usually it is dull-red or Reddish-purple with some bluish-black petechiae due to
rupture of small engorged capillaries. In carbon monoxide and cyanide poisoning as well as exposure to cold
temperature, the color is pink while lead color asphyxia. Although the color will become darker and permanent as it
completes.

Stages of Lividity or Livor Mortis

1. Hypostatic Lividity

It is the lividity when the discoloration is due to the blood pooled in the most dependent areas of the
body.

2. Diffusion Lividity

It is a fixed or permanent discoloration when the blood clotted, inside the blood vessels or has diffused
to different parts of the body.

Importance of Cadaveric Lividity

• It is one of the signs of death

• It may determine the position of the body after death or whether it was changes after its appearance
in the body.
• The color of the lividity may indicate the cause of death
e.g. Asphyxia – dark

CO poisoning – bright pink

• It gives us an idea as to the time of death.

263
 Points to be considered which may infer the position of the body at the time of death:

1. Posture of the body when found

The body may become rigid in the position in which he died. Post-mortem lividity may develop in the
assumed position.

2. Post-mortem hypostasis
Hypostatic lividity will be found in areas of the body in contact with the surface where the body lies.

3. Cadaveric Spasm
In violent death, the attitude of the body may infer position on account of the spasm of the muscles. e.g. In
drowning the victim may be holding the seaweeds.

POST- MORTEM DECOMPOSITION

1.) Autolysis or autodigestive changes after death

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

= This is also seen in the maceration of the dead fetus inside the uterus. The stomach may be perforated,
glandular tissues become soft after death due to auto digestion and the action of autolytic enzymes.

=decomposition by enzymes

2.) Putrefaction

- It is the breaking down of the complex protein into simpler components associated with the evolution of foul
smelling gases and accompanied by the change of color of the body.

-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.

Principal changes undergone by the soft tissues of the body during putrefaction:

a. Changes in the Color of the Tissue

A few hours after death, there is hemolysis of the blood within the blood vessel and as a result of
which hemoglobin is liberated. The hemoglobin diffuses through the walls of the blood vessels and stains the
surrounding tissues thereby imparting a reddish-brown color.

Tissue color gradually changed to greenish-yellow, greenish brown or greenish black color due to
chemical changes in hemoglobin.

b. Evolution of gases in the Tissues

Carbon dioxide, ammonia, hydrogen, sulphurated hydrogen, phosphoretted hydrogen, and methane
gases are formed. The offensive odor is due to these gases and also due to a small quantity of mercaptans.

The formation of gases causes the distention of the abdomen and bloating of the whole body. Gases
formed in the subcutaneous tissues and in the face and neck cause swelling of the whole body. Small gas bubbles are
found in solid visceral organs and give rise to the “foamy” appearance of the organs.

Effects of the pressure of gases of Putrefaction:

1. Displacement of the Blood

264
 2. Bloating of the Body

3. Fluid Coming Out of Both Nostrils and Mouth

4. Extrusion of the Fetus in a Gravid Uterus

5. Floating of the Body

c. Liquefication of the Soft Tissues

As decomposition progresses, the soft tissues of the body undergo softening and liquefication. The
eyeballs, brain, stomach, intestine, liver and spleen putrefy rapidly while highly muscular organs and tissues relatively
putrefy late.

Factors Affecting rate of Purification

I. Internal Factors

m) Age
n) Cause of Death
o) Condition of the body
II. External Factors

p) Air and Moisture

q) Condition and type of Soil
r) Presence of Water
s) Effect of Clothing
t) Effect of Coffin
u) Depth of Burial
v) Mass Grave

Special forms of Putrefaction

1. Mummification- a condition at which the body fluids is removed before decomposition sets in resulting to
shrunkening and preservation of the dead body. Mummification can be either natural of artificial (embalming).
Natural for the forces of nature such as sunlight, warm climate and hot dry soil influence the dead body. Artificial
when the preservation is done with the introduction of some chemical like formalin, alcohol, phenol, mercury,
arsenic and glycerin and covering the skin with the Vaseline or plaster of paris before decomposition sets in.
2. Saponification (Adipocere formation)- is the formation of a soft, friable and brownish- white greasy substance
in the soft fatty tissues of the body after death. This substance is called adipocere that is formed by
hydrogenation of the body fats. It can be possibly be seen in the buttocks, trunk, limbs, breast and cheeks. It
prevents or delays the putrefaction of the body.
3. Maceration- It is a condition of the dead body, usually the fetus, characterized by the softening and discoloration
of the tissues as well as formation of blisters in the skin due to the action of autolytic or proteolytic enzymes in
the absence of utero is important in the consideration of legal live-birth which shows evidence of maceration by
the following manifestations: 1) Reddish green to reddish-brown discoloration of skin; 2) Softness and limpness
of the body; and 3) Blebs formation and separation of the epidermis from the underlying tissues.

Classification of Death
I. Medico-legal classification of Death:

1. Natural Death- Due to disease or ailment.

2. Violent Death- Due to injuries of some outside force.
a) Accident Death- Art 12, Par 4, RPC
b) Negligent Death
c) Infanticidal Death
d) Parricidal Death- Art 247, RPC
e) Homicidal Death- Art. 249, RPC’
f) Murder- Art 248, RPC
g) Euthanasia ( mercy Killing )
h) Suicidal Death- Art. 253, RP

265
 Pathological Classification
1. Death of Syncope (loos of consciousness, fall of blood pressure, Cardiac Standstill, cerebral metabolism,
hyperventilation, cardiac disease, Tussive Syncope Hysterical syncope
2. Death of Asphyxia (Respiratory Obstruction and Circulatory Arrest, Inhalation of obnoxious gases fumes,
drowning and electric shock, Compression of the neck and strangulation, Compression of the chest and
asphyxia in brain injury)
3. Death of Coma (Is a profound stupor in sickness or after severe injury)

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 primary 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 ASPHYXIA

1) ANOXIC DEATH associated with the failure of the arterial blood to become normally saturated with oxygen.

2) ANEMIC ANOXIC DEATH due to a deceased capacity of the blood to carry oxygen

3) STAGNANT ANOXIC DEATH brought about by the failure of circulation.

4) HISTOTOXIC ANOXIC DEATH due to the failure of the cellular oxidative process, although the oxygen is delivered to the tissues, it
cannot be utilized properly.

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 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 from 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

Death as Punishment

1. Death by Lethal Injection

2. Death by Electrocution (used of about 2,00 to 5,000 voltages)
3. Death by Gas chamber
4. Death by hanging
5. Death by Musketry

AUTOPSY

- a comprehensive study of a dead body performed by trained physician using recognized dissection procedures and techniques,
primary to determine the true cause of death
- indicates that, in addition to an external examination, the body is opened and internal examination is conducted.

POST MORTEM EXAMINATION

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

KINDS OF AUTOPSIES
266
 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 purpose of:

a) determining the cause, manner or mode and time of death

b) recovering, identifying and preserving evidentiary material
c) providing 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 examination 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.
Method of Disposal of the Dead Body
1. Embalming- Artificial Mummification
2. Burial- Inhumation or Interment
Is a method of placing the dead body in the grave.

Funeral- it is the procession of the dead body followed by grieving relatives, friends and other persons
to the place of burial in accordance with the religion, custom and traditions.

Persons in-charge; The Spouse(if married), The descendant of the nearest degree and brother and
sisters.

3. Cremation- Is the burning of the dead body into ashes or pulverization of the body into ashes by the
application of heat or flames. Requirement: permit for cremation, Exact identification of the deceased and
exact cause of death has been ascertained.
4. Disposal of the dead body to the Sea.
5. Use of the Dead body for Scientific Purpose.
Exhumation- It is the raising or disinterring of the Dead body or remains from the grave.

EXHUMANTION (DESINTERRING)

- 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.
- remains of persons who died of non- dangerous, non-communicate diseases may be disinterred after three (3) years.

- remains of persons who died of dangerous communicable diseases may be disinterred after five (5) years.

Physical Injury

Injury- Is the scientific impairment of the body structure or function caused by outside force or agent.

Physical Injury- is an injury of the body caused by physical agents which is the application of stimulus to the body producing
damage or injury to the tissue.

267
 Wound- is a break or solution in the continuity of the skin or tissues of the body.

Inflammation- Is a specific tissue response to injury by the living or inanimate agents, or to electrical, chemical etc.,
characterized by vascular dilatation, fluid exudation and accumulation of leukocytes in the tissues.

Classification of Wound or Physical injury

A. As to Severity

1. Mortal Wound
2. Non-Mortal Wound
B. As to Kind Instrument used
1. Blunt instrument – lacerated
2. Sharp-edge instrument – incised
3. Sharp-pointed instrument – punctured
4. Sharp-Edge and Sharp-Pointed – stab
5. Rough object – abrasion

C. As to Manner of Infliction

D. As to the depth of the Wound

E. As to the relation of the site of application of force and injury

a) Coup Injury- Injury at the side of application.

b) Contre coup- injury found opposite the side of application.
c) Coup Contre Coup- injury both at the side and opposite side of application.
d) Locus Minoris Resistencia- Injury is found on some area offering the least resistance to the force applied.
e) Extensive Injury- involves a greater area of damage.

F. Medico-legal Classification

A. Mutilation
B. Slight Physical Injury (1-9 days)
C. Less Serious Physical Injury (10-30days)
D. Serious Physical Injury (more than 30 days)
E. Administration of injurious substance or beverages.

G. As to the type of the Wound

1. Closed Wound: superficial Closed wound and deep closed wound, petechiae,
contusion or bruise, hematoma or blood cyst, sprain, fracture, discoloration,
Concussion, and Internal Hemorrhage
2. Open Wound: Incised, Lacerated, Punctured, Stab Wound, Avulsion, and Gunshot
and shotgun Wound.
Petechiae- Are minute, pin point, circumscribed extravasation of blood in the subcutaneous tissues or underneath
the mucous membrane.

Contusion (Bruise)- Wound in the substance of the true skin and in the subcutaneous cellular tissues characterized by
swelling and discoloration of tissue due to extravasation of blood.

Hematoma- large extravation of blood in a newly formed cavity secondary to trauma characterized by swelling, discoloration
and effusion of blood underneath the tissues.

Sprain- The straining or tearing of the articular tendons, ligaments and muscles characterized by swelling, discoloration of
tissues involve and extreme pain.

Fracture- It is a break or solution in the continuity of the bone tissues resulting from violence. (it can be either simple,
compound or comminuted).

268
 Dislocation- Is the displacement of the articular surfaces of the bones forming the joints usually secondary to trauma. (simple
or compound)

Cerebral Concussion- Condition of the brain resulting from a sudden jarring or stunning of the brain which follows a blow
on the head characterized by headache or dizziness, unconsciousness or semi-unconsciousness, relaxed and
flaccid muscles, slow and shallow respiration and rapid but weak pulse

Internal Hemorrhage- It is the bleeding usually in the cavity or organs inside the body. (intra-cranial, Rupture of organ and
Laceration of Organ).

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.

Kinds of Virginity

1. MORAL VIRGINITY = state of not knowing the nature of sexual life and not having experienced sexual relation.

2. PHYSICAL VIRGINITY = a condition whereby a woman is conscious of the nature of the sexual life but not experienced sexual
intercourse. Applies to women who have reached sexual maturity but not experienced sexual intercourse.

TRUE PHYSICAL VIRGINITY

= 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

= 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

= 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

= applied to women who have had previous sexual act but not yet given birth.

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

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 intercourse with a corpse.
INCEST = sexual relations between person who, by reason of blood relationship cannot legally marry.
SATYRIASIS = excessive sexual urge of men.
NYMPHOMANIA = excessive sexual urge of women.
FELATTIO = 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 sexual excitement by licking the anus of another person of
either sex.
SADISM =(Active Algolagnia) = A form of sexual perversion in which the infliction of pain on another is necessary for sexual
enjoyment

269
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 fantasied 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
part 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.

270