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Forensic medicine

HISTORY OF LEGAL MEDICINE

 2980 B.C.: IMHOTEP: earliest medico-legal expert; chief

physician and architect of King Zoser of the third dynasty in
Egypt; first to record a report of a murder trial written on clay
tablet
 460-355 B.C. HIPPOCRATES: discussed the lethality of
wounds in Greece. Also known as the Father of Medicine
 384-322 B.C. ARISTOTLE: fixed animation of fetus at the 40th
day after conception
 600 B.C. NUMA POMPILIUS: (In ROME) all women dying
during confinement should immediately be opened in order to save
the child's life.
 ANTISTIUS: was the first “Police Surgeon” or Forensic
pathologist, who conducted the autopsy of the dead body Julius
Caesar. In his 23 stab wounds, only one is fatal.
 483-565 B.C. JUSTINIAN: in his Digest, he made that a
physician is not an ordinary witness and that a physiciangives
judgment rather than testimony. This led to the reorganization of
expert witness in court.
 1209 POPE INNOCENT III: issued an edict providing for
appointment of doctors to the court for determination of the nature
of wounds.
 1234 POPE GREGORY IX: the preparation of Nova
CompilatioDecretalium which concerns medical evidence
 1575 AMBROISE PARE: considered legal medicine as separate
discipline and he discussed in his book, abortion, infanticide, death
by hanging, lighting, drowning, distinction between ante-mortem
and post-mortem wound and poisoning by carbon monoxide and
by corrosives.
 Paulus Zacchias – “Father of Forensic Medicine” he published
“Questiones Medico Legales” which dealt with the legal aspects of
wound and the first two chapter dealt with the detection of secret
homicide.
 MathiewOrfila – introduced chemical method in toxicology.
“Father of Modern Toxicology”
HISTORY OF LEGAL MEDICINE IN THE PHILIPPINES
 1858 The first medical textbook "Manual De MedicinaDomestica"
which includes pertinent instructions in the practice of forensic
medicine was written by Dr. Rafael Genard y Mas, a chief army
physician.

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 1895 Medico-legal laboratory was established in the City of

Manila
 The legal medicine was taught in all medical schools in the
Philipines.
 1919- The Department of legal medicine and ethics of the
University of the Philippines was created under Dr. Sixtodelos
Angeles as the chief.
 1945-after the liberation of the city of manila, criminal
investigation Laboratory Division was created with Dr. Mariano
Lara as chief.
 Dr. Gregorio T. Lantin– CA No. 181 was passed creating the
division of investigation under the DOJ. He was the chief of the
medico legal section.
 Dr. Enrique Delos Santos – RA 157 creating the Bureau of
Investigation. It was created by virtue of an executive order of the
President. Under the bureau, a medico legal office is created and
he was the chief.
LAW- is a rule of conduct, just, obligatory, laid by legitimate power for
common observance and benefit.
Forms of Law
 Lex Scripta- written or statutory law
 Lex non Scripta- Unwritten or Common Law
 Forensic- It denotes anything belonging to the court of law or used
in court or legal proceedings.
 Legal – is that which pertains to law, arising of, by virtue of
included in law.
 Jurisprudence- it is practical science which investigates the nature,
origin, development and function of law.
 Legal medicineis the branch of medicine which deals with the
application of medical knowledge to the purpose of law and in the
administration of justice.
 Forensic Medicinethe use of medical science to elucidate legal
problems in general without specific reference or application to a
particular case
 Medical Jurisprudence branch of law which concern with aspects
of law and legal concepts to medical practice. It includes rights,
duties, liabilities of physician, patient and health institution.(Juris-
law; Prudentia - knowledge) - denotes knowledge of law in relation
to the practice of medicine.
The Principle of Stare Decisis
 When the court has once laid down a principle of law or
interpretation as applied to a certain state of facts, it well adhere to

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and apply to all future cases where the facts are substantially the
same.
Types of Medical Evidence
 Autoptic or Real Evidence – evidence made is known or addressed
to the senses of the court.
 Testimonial Evidence - Ordinary/Expert Witness
 Experimental Evidence – a medical witness may be allowed by the
court to confirm his allegation or as a corroborated proof to an
opinion he was previously stated.
 Documentary Evidence – an instrument on which is recorded by
means of letters, figures, marks, intended to be used for the
purpose of recording that matter which may be evidentially used.
(Medical Cert.,Medical Expert, Deposition)
 Physical Evidence – articles and materials 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 criminal.
KINDS OF WITNESSES
 Expert witnesses - opinion of a witness regarding a question of
science, art or trade, when he is skilled therein, may be received in
evidence.
 Ordinary Witnesses - all persons who, having organs of sense, can
perceive, and perceiving, can make their perception to others, may
be witnesses.
Law of Multiplicity of Evidence in Identification Greater the number
of points of similarities and dissimilarities of 2 person compared,
there is greater probability of the conclusion to be correct.
 Identification of Persons
• By comparison– identification criteria recovered during
investigation are compared with records available in the file or post
mortem finding are compared with ante-mortem records
• By exclusion– if 2 or more persons have to be identified, then the
one whose identity has not been established may be known by
process of elimination
The Medico-Legal System
1. Medico-legal Office 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 PNP and the
NBI has their own medical jurist who handles their medico-legal
cases. His duties are to investigate the victim or the assailant and to
make reports and to appear in court as expert witness.
2. Medical Examiner System
-In some parts of the United States

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-is handled by the Chief Medical Examiner who is a Doctor of

Medicine and appointed by the Mayor from the classified lists
compiled by the Civil Medical Examiner is on a 24-hour work with
clerical staff always present.
3. 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 “CustodesPlacitorumCoronne” or “Keeper of the King’s
Pleas” as mentioned in Articles of Eyre of 1194.
 Coroner- not less than five years standing in his position. The
coroner is an inquest officer whose duty is to inquire into the
circumstances of certain medico-legal cases within his jurisdiction.
Unlike the medico-legal examiner and medico legal officer whose
duties are practically the same, the coroner has investigative and
judicial function.
Ordinary Methods of Identification
Characteristic that may easily changed
 Growth of hair, beard or mustache
 Clothing
 Frequent place of habit
 Grade of profession
 Body ornamentations
Characteristic that may not easily changed
• Mental memory changes in the eye
• Speech facies
• Gait – manner of walking left or right handedness
• Mannerism – habit peculiar to the individual degree of nutrition
• Hands and feet
• Complexion
Gait patterns
 Is the series foot marks of a person by running or walking
 Note: when the distance between the center points in two
successive heel prints of the two feet exceeds 40 inches-
presumption the person is running.
 Ataxic gait- foot is raised high, thrown forward and brought
downward.
 Cerebellar- staggering movement
 cow’s gait- swaying movement due to knock knee.
 Paretic gait- the steps are short, the feet dragged, and the legs are
more or less widely apart.
 Spastic gait- walks like a robot the legs are held together and
moves in stiff manner and the toes to drag and catch.
 Waddling gait- a gait resembling a duck.
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 Frog gait- hopping gait due to infantile paralysis.

 Gait line- the straight line connecting the center of the succeeding
steps
 Footline- the longitudinal line drawn on each foot mark.
Points of Identification applicable to both living and dead before onset
of decomposition
 Occupational marks injuries leaving
permanent result
 Race – Color of skin, shape of skull moles
 Stature scars
 Teeth tribal marks
 Tattoo Marks sexual organ
 Weight blood group
 Deformities fingerprint
 Birth Marks
Facies- facial expression
 Hippocratic facies- nose pinched, temple hallow, eyes sunken,
ears cold, lips relaxed and skin vivid. The appearance of the face
isindicative of approaching death.
 Mongolian Facies– almond eyes, pale complexion, prominence of
cheek bones
 Facies leonine a peculiar, deeply furrowed, lion like appearance of
the face. This may be observed in leprosy, elephantiasis and
leontiasis ossia.
 Myxedemic facies– Pale, face, edematous swelling which does not
pit on pressure, associated with dullness of ontellect, slow
monotonous speech, muscular weakness and tremor
STATURE- a person ceases to increase height after 25 years.
 The growth of a person rarely exceeds 5 cm after the age of 18 yrs
 The rate of growth is most active in the age of 5- 7 and 13-16 yrs
of age
 The growth of a person rarely exceeds 5 cm after the age of 18 yrs
 The rate of growth is most active in the age of 5- 7 and 13-16 yrs
of age
Methods of approximating the height of a person.
 The distance between tips of the middle finger of both hands with
the arms extended laterally and it will approximately equal to th
height.
 2x the length of 1 arm + 12 inches from the clavicle and 1.5 inches
from sternum is the height
 Approximately 8 times the size of the head equals the height of the
person.

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 The length of the forearm measured from the tip of olecranon

process to the tip of the middle finger is 5/19 of the height.
 8x the length of the head is approximately equal to the height of
the person.
TATTOO MARKS- introduction of coloring pigment in the layers of
the skins by multiple puncture
PORTRAIT PARLE (spoken picture) is verbal, accurate and
picturesque description of the person identified.
Light as a factor in identification
Clearest moonlight - person cannot be recognized at greater distance of
16-17 yards
Starlight- not further than10-13 yards
Broad Daylight- a person is hardly recognized at a distance farther than
100 yards if the person has never been seen before.
Person who are almost strangers may be recognized as a distance of
25 yrds
Flash of firearms- letter two inches high can be read with the aid of the
flash of cal.22 firearm at the distance of 2 feet
• Dental identification- adult has 32 teeth
PD 1575- requiring the dentist to keep records of their patients
Ambidextrous- people can use their right hand and left hand with equal
skill
Identification of the skeleton
 The oval or round shape of the skull and the less prominent lower
jaw and nasal bone are suggestive of human remains.
 The female’s pelvic bone is wider and rounder than the male’s to
permit child-bearing.
Points to consider in the Determination of AGE
 Pubic hair appear- age 13 in female and 14 in male
 Mustache and beard- 16-18 yrs
 Breast commences- 13-14 yrs
 Male develop low tone voice- bet. Age of 16-18yrs
 Hair turn to gray- after 40 yrs
 Pubic hair may turn gray at the age of 50 yrs
BLOOD is the circulating tissue of the body, which refers to a high
complex mixture of cells.
Globin- a kind of protein found in the blood.
Hematin- is an organic compound of iron.
 hemoglobin found in the red blood cells is responsible for
transporting oxygen to tissues and carbon dioxide to the lungs. The
substance responsible for the reddish color of the blood.
 Serology is a science, which deals with the study of human body
fluid, which are the result of secretion and excretion.

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 Plasma the liquid portion of the blood that contains, in the

suspension, the blood cells and platelets along with the water,
glucose, protein and other chemical compounds.
 The normal amount of hemoglobin for an adult is 14 to 17 grams
for each 100 cc of blood.
Physical test for blood
 PHYSICAL EXAMINATION
 Solubility Test – recent blood shed is soluble in saline solution
and imparts a bright red color
 Heat Test – solution of the blood stain when heated will impart a
muddy precipitate.
 Luminescene Test – stains on dark fabric mixed with mud, paint,
etc. emit bluish white luminescene in a dark room when sprayed
with solution
 Thrombocytes- components of the solid part of the blood that
assists in the clotting process, they are commonly called platelets.
 Agglutination- the joining or clumping of antigen-bearing red
blood cells and the antibodies specific to that antigen.
 Antigen- in blood are inherited from substances on the red blood
which are responsible for eliciting a blood group reaction to
specific antibodies.
 Erythrocytes (red blood cells) –they carry the supply of oxygen
throughout the body.
 Leukocytes- they serve as the fighting mechanism of the body
against unwanted foreign microorganism e.g virus and bacteria
Blood examination
 PRELIMINARY TEST - determine whether the stain contains
blood or another substance. Determines whether visible stains do
or do not contain blood. It is used to demonstrate the presence of
blood.
 CONFIRMATORY TEST - determines whether bloodstain really
contains blood. Test that positively identifies blood.
 PRECIPITIN TEST- determines whether blood is a human or
non-human origin, and if non human, the specific animal family
from which it originated.
 BLOOD GROUPING TEST - determines the blood group of
human

CHEMICAL EXAMINATIONS
1. Saline extract of the bloodstain plus ammonia will give a brownish
tinge due to the formation of alkaline hematin.
2. Benzidine test – positive result color blue (1:300,000 dilution)
This is an extremely sensitive test that can be applied to minute

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stain. The Benzidine test never fails to detect blood even when
very old, decomposed stain with all shorts of contamination is
examined.
3. Gualacum Test (Van Deen’sDya’s or Schombein’s Test) –
positive result color blue (1:5,000 dilution)The test also reacts with
saliva, pus, bile, milk, rust, iron salts, cheese, gluten, potatoes,
perspiration and other oxidizing substances.
4. Phenolphthalein Test (katle-Meyer Test) – positive result will
show pink color (1:80,000 dilution) This is an alternative test to
benzidine test. It can detect blood in a dilution of 1:80,000,000
parts. A positive results with this test is highly indicative of blood.
The negative result is, therefore, valuable and is conclusive as to
the absence of blood.
5. Leucomlachite Green Test by Adler in 1904 – positive result will
peacock blue or bluish green
Micro chemical tests for blood
 Hemochromogen Crystal or Takayama Test – positive result
will show salmon color to dark brown and pink
 Teichman’s or Hemin Crystal Test
 Acetone hemin of Wagenhaar Test - positive result will show
small dark, dichroic acicular crystal of acetone haeminare seen.
Grouping test for blood
 These are based on the ability of blood serum of one person to
clump or bring together the red blood cells of certain individuals.
 If a suspension of human red cells is mixed with its own serum, or
the serum of similar group, the cells remain even. But if they
mixed with the serum of another group, the cells clump or
agglutinate
 This process is called AGGLUTINATION, which was first
observed by Landsteiner in 1900. This was explained on the basis
that the red blood cells (RBC) contain an antigen or Agglutinogen,
and that the serum contains antibodies or agglutinins (ablution-
elution technique.)
SEMEN AND SEMINAL STAINS
 Semen fresh is a viscid, gelatinous, sticky, whitish fluid,
which has a fish-like odor and is slightly alkaline. It is ejaculated
by male species. It appears grayish-white in color.
 The seminal fluid contains certain substance called flavins
which help give a yellowish color to semen and cause it to
fluoresce under ultra violet lights.
 Normal quantity of seminal fluid in a single ejaculated is from 1.5
to 3.5 cc.

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Types of Examination Conducted for Semen and Seminal Stains:

 A. Physical Examination
It is also visible to the ultra violet rays and it exhibit bright bluish
fluorescence.
 B.Microscopic Examination – to detect the presence of
spermatozoa
The only specific test for semen is the identification of a sperm cell
under the microscope.
 The presence of sperm cells proves that the stain is of semen.
However, with the absence of sperm cells it cannot be concluded
that the stain is not of seminal origin. These are some conditions
which may be lead tonon detection of semen, like
ASPERMIA, a disorder produced by male organ which produces
semen without sperm cells and
OLIGOSPERPIA, a semen with a very few sperm cell.
 a. Florence test – it has the characteristics and a formation of
choline periodide crystals are observed under the microscope.
 b. Barberio test – it appear as slender yellow-tinted rhomboid
needles with obtuse angles almost the same the Florence test result.
 c. Acid phosphates test – is an enzymes found in both animal and
plant cells, but in large concenttion of human cells.
 d. P30 test- a test conducted using a protein called P30.
Medico-legal Aspects of Death
- termination of life. It is a complete cessation of all vital functions
without possibility of resuscitation and it is irreversible loss of the
properties of living matter.
 Dying – is a continuing process of cessation of organs and cells
TYPES OF DEATH
 Brain death - death occurs when there is deep irreversible comma,
absences of electrical brain activity and complete absence of all
vital function of body without the possibility of resuscitation
 Cardio-respiratory death - death occurs when there is a
continuous and persistent cessation of heart action and respiration.
 Biological death- type of death characterized by the absence of
cognitive function or awareness, although artificial support system
may maintain organs functioning.
 Physiologic Death- type of death when all vital organs ceases to
function.
 Molecular or Cellular Death – cessation of life of the individual
cell in the body which occurs one at a time after somatic death.
The death of the individual cell within 3-6 hours
 SOMATIC OR CLINICAL DEATH – there is complete, persistent
and continous cessation of the vital functions of the brain, heart
and lungs which maintains life and health.

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 APPARENT DEATH/ STATE OF SUSPENDED ANIMATION

 not really death but merely a transient loss of consciousness or
temporary cessation of the vital functions of the body on account
of a disease, external stimuli or other forms of influence. Usually
seen in newly born infants, with diseases such as catalepsy, uremia
and hysteria.
Signs of death.
 CESSATION OF HEART ACTION AND CIRCULATION -
there must be entire and continuous cessation of the heart action
and flow of blood in the whole vascular system.
General rules – no heart action for 5 min death is regarded as certain
Methods of Detecting the Cessation of heart Action and Circulation:
EXAMINATION OF HEART
 Palpation of the heart
 Auscultation for heart sound at the precordial area
 I card’s test – by application of injection of a solution of
fluorescence subcutaneously. If dead man, the solution will just
remain at the site of injection.
 Pressure in fingernails – pressure is applied on the fingernails
intermittently. There will be a zone of paleness at the site of
application of pressure which becomes livid on release.
 Diaphanous test – fingers are spread wide and finger webs are
viewed through a strong light. Finger webs are red, if living and
yellow if dead.
 Magnus test- a ligature is applied in the finger with moderate
tightness.
 Application of heat on the skin – a dead man, it will not produce
true bluster and there is no sign of congestion, or vital reaction and
in living person there are bluster reaction and other vital part will
injured.
 Palpation of radial pulse – palpation of radial artery with the
finger and absence of pulsation area will observe as dead man.
CESSATION OF RESPIRATION -cessation of respiration in order to
be considered as a sign of death must be continuous and persistent.
note: A person can hold his breath for a period not longer than
of1/2minutes
Method of Detecting Cessation of Respiration
 Expose the chest and abdomen and observe the movement during
inspiration and expiration.
 Examine the person with the aid of stethoscope.
 Examination with a mirror - a cold-looking glass is held in front
of the mouth and nostrils.
 Examination with a feather or cotton fibbers - living, if the
feather or cotton will move, without intervention or external air.
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 Examination with glass of water - places glass half water at the

region of the chest. If the surface of water will move, respirations
take in place.
 Winslow’s test - if there is no movement of image formed from by
using artificial light or sunlight on a water or mercury in a saucer
placed on the chest or abdomen
Post-mortem cooling of the body (algor mortis)
 the cooling of the body after death at approximately 1.5 degrees F/
hr. under normal conditions and assuming the body’s temperature
at death is 98.6 F (37 C)
 The rate of cooling depends on certain conditions such as the
gender, age, weight, clothing and humidity of the place.
 Note: if the temperature of the body falls under 20 0F, death is
presumed.
Post mortem rigidity
 3 to 6 hours after death the muscles gradually stiffen. It usually
starts at the muscles of the neck and lower jaw and spreads
downwards to the chest, arms, and lower limbs.
Factors simulating post mortem rigidity
 Heat stiffening- stiffening of the muscles due to coagulation of
muscle proteins when exposed to intense heat usually in more than
75 degrees Celsius which will coagulate muscle proteins.
 Cold stiffening- hardening of muscles due to solidification of fats
when exposed to extremely low temperature.
 Cadaveric spasm or instantaneous rigor- instant stiffening of
certain muscles perhaps due to extreme nervous tension associated
with violent death.
Post mortem lividity
 Livor mortis- discoloration of the body; setting of blood in the
dependent regions following death.
 Starts in about 20-30 and becomes fixed in approx. 12 hrs.
Two types of lividity (stages)
 Hypostatic- blood is still in fluid form inside the blood vessels. It
changes as the position of the body change.
 Blood remains fluid in the body in about 6-8 hrs.
 Diffusion lividity- fixed or permanent discoloration due to
coagulated blood inside the blood vessels or has diffused to
different parts of the body.
Post mortem caloricity
 is the rise of temperature of the body after death due to rapid and
early putrefactive changes or some internal changes. Usually
observed in the first 2 hours after death.

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CHANGES IN THE EYES

 Loss of corneal and light reflex- the cornea will not respond to the
light stimulus
 Haziness or clouding of the cornea- a whte patch may be seen at
the cornea when the eyes are exposed to dry atmosphere after
death.
 Fixation of the Pupil- the pupil will be fixed and diluted and
assume a middle position in the eye.
 Flaccidity of the eyeball-inter-ocular tension falls to zero because
of less muscle tone
 Tache noir sclerotique- (spot in the sclera)- described by Sommer
in 1833 in a brownish triangular spot in the sclera.
Stage of primary Flaccidity – immediately after death, there is
complete relaxation and softening of all muscles of the body. The
extremities may be reflexed, the lower jaw falls, the eyeball loses
its tensions and there may be inconsistencies of urination and
defecation. This stage usually last about 3-6 hours after death. In
warm countries, the average duration is only 1 hour and 51 minutes.
(Mackenzie cited by Modi, p.122)
STAGE OF SECONDARY FLACCIDITY OR SECONDARY
RELAXATION
 After the dissapearance of rigor mortis, the muscles become soft
and flaccid. It does not respond to mechanical and electrica
stimulus.
Putrefaction
breaking down of the complex protein into simpler component
-the dissolution of tissue by its enzymes and bacteria that result to
softening and liquefaction, usually accompanied with liberation of
putrid gases and change of color of tissues, appears on the 2nd day.
 Decomposition - the action of bacteria on the dead body. gases:
ammonia, co2, methane, phosphorus, merceptans- offensive odor
 Temperature for specific decomposition is 70 oC to 100 oC
 Decompostion does not occur at the temperature below 32 oF or
about 212oF
 Tropical countries decomposition set in 24-48 hrs after death.
FACTORS INFLUENCING DECOMPOSITION
Internal factors:
1. Body temperature - warm temperature is conducive to
decomposition
2. Condition of the body – robust or stout bodies has faster
putrefaction than thin ones.
External factors:
1. Air & moisture – sufficient air and moisture enhance putrefaction
2. Condition of type of soil – moist fertile soil enhance putrefaction
3. Presence of water

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4. Clothing - prevents or delays putrefaction because it protects the

body from ravages of flies and other insects
5. Effect of coffin – delayed especially if it is airtight
6. Depth of burial – the deeper, the more delayed
7. Mass grave – faster putrefaction if 2 or more dead bodies are
placed
SAPONIFICATION ADIPOCERE FORMATION
 formation of soft, greasy substance in the soft, fatty tissues of the
body after death formed by the hydrolysis and hydrogenation of
body fats.
MACERATION
softening of tissues due to the action of autolytic and proteolytic
enzymes in the absence of bacteria.
-frequently observed in the death of the fetus in the uterus
 Marbolization – prominence of the superficial veins with reddish
discoloration during the process of decomposition.
Stage of digestion of food
 Normally 3-4 hrs for the stomach to evacuate its contents after
meals
 Size of the last meal- stomach usually starts to empty within 10
min. after the first mouthful has entered.
Presence of live fleas in the clothing in drowning cases.
 Flea can survive for approximately 24 hrs submerged in water, if
more than that period no longer can revived.
 If the fleas still move, then the body has been in water for a period
less than 24 hrs
Presumption of Death
Disputable presumption – the person does not heard for 7 years
 if for purpose of succession – 10 years
 Disapeared after the age of 75 years old – 5 years
 The ff. shall be presumed dead for all purpose
 A person on board a vessel lost during a sea voyage,or an
aeroplane which is missing, who has not been heard of for 4 years
since the loss of the vessel or aeroplane
 A person in the Armed Forces who takes part in war, and has been
missing for 4 years.
 A person who has been in danger of death under circumstances and
his existence has not been known for 4 years.
Presumption of Survivorship (Sec.5(jj) Rule 131 Rules of Court
 if both were under the age of 15 years, theolder is presumed to
survived
 If both were above the age of 60, the younger is presumed to
survived.

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 If one is under 15 and the other is above 60, the former is

presumed to survived
 If both be over 15 and under 60, and the sexes, the male is
presumed, if sexes be the same, then the older
 If one be under 15 or over sixty, and the other between those
ages, the latter is presumed to survived.
AUTOPSY – comprehensive study of a dead body, performed by a
trained physician employing recognized dissection procedure and
technique . It includes removal and tissues for further examination.
 Post mortem examination – refers to external examination of a
dead body without incision being made, although blood and other
body fluids may be collected for further examination is conducted.
Two kinds of autopsy
A. Hospital or Non-official autopsy – done w/ the consent of the
deceased person’s relative for the purpose of 1.) determining
cause of death 2.) provide correlation of clinical diagnosis and
clinical symptoms; 3.) determining the effectiveness of therapy 4.)
studying the natural course of disease process 5.) educating
students and physicians.
B. Medico legal or Official Autopsy – examination performed on a
dead body for the purpose of
1.) determining cause, manner and time of death 2.) recovering,
identifying and preserving evidentiary materials
3.) providing interpretation and correlation of facts and
circumstances relating to death.
Cause of Death
1. Immediate (Primary) cause of death – applies to cases when
trauma or disease kill quickly that thre is no opportunity for sequel
or complication to develop.
2. Proximate (Secondary) cause of death – injury or disease was
survived for a sufficiently prolonged interval wc permitted the
devlopment of serious sequel or complication to develop.
Pathological classification of death
 Death of syncope- loss of consciousness, fall of blood pressure
cardiac standstill cerebral metabolism hyperventilation cardiac
disease tussive syncope, hysterical syncope.
 Death of asphyxia- respiratory obstruction and circulatory arrest,
inhalation of obnoxious gases and fumes, drowning and electric
shock compression of the neck and strangulation, compression of
the chest and asphyxia in brain injury.
 Death of coma- profound stupor in sickness or after severe injury.

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DISPOSAL OF DEAD BODIES

 Embalming – is an artificial way of preserving the body after
death by injecting 6 to 8 quarts of antiseptic solutions of formalin,
per chloride of mercury or arsenic.
 Burial or Inhumation – the body must be buried within forty-
eight hours after death. (Sec. 1092 Revised Adm. Code) (1-1 ½
meters depth of grave)
 If the person died w/ communicable disease, it shall be buried
within 12 hours
 Disposing of the Dead body in the sea – dead body thrown over
board in an open sea provided that the deceased is not suffering
from dangerous communicable disease. (Sec. 1095 Revised Adm.
Code)
 Cremation – is the pulverization of the body into ashes by the
application of heat.
 Use of the body for scientific purposes (Sec. 97 P.D. 856 Code of
Sanitation) & (Sec. 1107 RAC.)
DONATION OF PARTS OF HUMAN BODY
 Permission to use human organ or portion of human body for
medical for medical or scientific purposes under certain conditions.
(R.A. No. 349 as amended by R.A. 1056)
PERIOD OF EXHUMATION
 The DECEASED buried may be raised or disinterred upon the
lawful order of the proper authorities and the body is exhumed for
the purpose of performing post-mortem examination.
 If the person died with communicable disease, he can only be
exhumed after 5 of years interment.
 If the person died with incommunicable disease, he can only be
exhumed 3 years after interment.
 A burial ground shall at least 25 meters distant from any dwelling
place and no house shall be constructed within the same distance
from any burials ground
 No burial ground shall be located within 50 meters from any
source of water supply
 Starvation – deprivation of a regular and constant supply of food
and water wc is necessary to normal health of a person
 LENGTH OF SURVIVAL
 Human body without food loses 1/24th of its weight daily
 Loss of 40% of weight result to death
 Without food and water, person cannot survived fir more than 10
days
 With water, person can survived without food for 50-60 days.

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Physical Injuries - effects of the application of stimulus to the body

The effect may only be apparent when the stimulus applied is
insufficient to cause injury and body resistance is great. It may be real
when the effect is visible.
 Kinetic energy – in as much as kinetic energy is based on the mass
and velocity factors and that the velocity is squared, the velocity
component is the important factor KE=MV(2)/2
 Time – the shorter the time needed for the transfer of energy, the
greater the likelihood of producing damage.
 Area of transfer – the larger the area of contact between the force
applied on the body, the lesser is the damage to the body. By
applying an equal force, damage caused by stabbing is greater
compared to a blunt instrument
CAUSES OF PHYSICAL INJURIES
 Physical Violence chemical energy
 Heat or cold electrical energy

VITAL REACTIONS
 sum total of all reactions of tissue or organ to trauma/injury/wound.
• Rubor – redness or congestion of the area due to an increase of
blood supply as part of the reperativemechanism .
• Calor – sensation of heat or increase in temperature
• Dolor – pain on account of the involvement of sensory nerve.
• Loss of function – on account of trauma, the tissue may not be able
to function normally.
Legal classifications of wound
 Mutilation (Art. 262 RPC) – is the act of looping cutting off any
part or parts of the living body.
 Serious physical injuries (Art 263 RPC)- injury that will
incapacitate the subject for more than 90 days or Deformity – is a
condition of physical ugliness.
 Less Serious physical injuries (Art. 265 RPC)- Injury that will
require medical attendance for 10 days or more but not more than
30 days
 Slight physical injuries and maltreatment (Art. 266 RPC) -
Injury that will incapacitate subject and require medical attendance
from 1 to 9 days
 Physical injuries inflicted in a tumultuous affray (Art. 252)
INJURIES AS TO THE SITE OF APPLICATION OF FORCE
AND TO THE LOCTION OF THE WOUND
 Coup injury – P.I. located at the site of application of of force.
 Contre coup injury – P.I. found opposite the site of application of
force

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 Coup contre coup injury – P.I. located at the site of the

application and also at the opposite
 Locus minorisresistencia– P.I. not at the site of application but in
the some areas offering least resistance to the force applied
 Extensive Injury – physical injury involving a great area of the
body beyond the site of the application of force.
CLASSIFICATION OF WOUNDS AS TO SEVERITY
 Mortal wound – wound which is caused immediately after
infliction or shortly there after that is capable of causing death
 Non-mortal wound – wound which is not capable of producing
death immediately after infliction or shortly there after.
WOUND AS TO THE INSTRUMENT USED
 Incised wound – sharp edge instrument. It is longer as much as it is
deeper.
 Stab wound – sharp pointed and sharp edge instrument. It is deeper
as much as it is longer.
 Lacerated wound – caused by blunt instrument
 Barotrauma – brought about by change of atmospheric pressure.
Note: normal atmospheric pressure is about 760 mm/Hg
 Shrapnel wound - brought by chemical explosion.
 Abrasion wound - caused by superficial damage to the skin, no
deeper than the epidermis.
FORMS OF ABRASION
 Linear abrasion- there is singe line which may be curved or
straight.
 Multi Linear abrasion- several lines of injuries which are parallel
to one another.
 Confluent abrasion the lines of injury are arranged in haphazardly
manner.
 Multiple abrasion- abrasion in the body surface located in
different parts of the body.
Other types of wounds
 Contusion- wound in the skin and subcutaneous tissue
characterized by swelling and discoloration of tissues.
 Hematoma- extravasation of blood in a newly formed cavity
secondary to trauma characterized by swelling, discoloration of
tissues swelling and effusion pf blood underneath the tissues.
Musculo-skeletal injury
 Sprain –partial or complete disruption of a muscular ligamentous
support of a joint
 Dislocation displacement of articular bone resulting from violence
 Fracture solution of continuity of bone resulting from violence or
some existing pathology.

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 Strain over stretching

 Subluxation incomplete or partial dislocation
INJURIES CAUSED BY EXPOSURE TO EXTREME
TEMPERATURES
 Frostbite- exposure of certain parts of the body to cold temperature
causing cold stiffening, necrosis, gangrene and pallor.
 Trench foot- condtition usually seen among those seen walking
over the snow wherein the feet is exposed to extreme cold.
 Immersion foot- the foot is submerged in cold freezing liquid
STAGES OF ASPHYXIAL DEATH
 Dyspneic stage- due to lack of oxygen and retention of carbon
dioxide, breathing becomes rapid and deep. Blood pressure is
elevated and pulse rate increased.
 Convulsive stage- retention of carbon dioxide sstimulates the
central nervous system. Eyes become starring and pupils dilated.
 Apneic stage- there is paralysis of the respiratory center. The
breathing becomes shallow, slow and gasping. The victim dies of
heart failure.
Other forms of asphyxial death
 Manual strangulation or throttling- form of strangulation whereby
hands are used.
 Palmar strangulation- palms of the hands are used in applying
force in the neck to obstruct the passage or airway.
 Garroting- form of strangulation wherein a metal collar or strap is
placed around the neck and tightened to compress the neck.
 Mugging- the assailant stands at the back of the victim and the
forearm is applied in front of the neck.
 Burking- invented by Burke wherein the assailant will stand or
kneel at the chest of the victim then cover the nostrils.
 Smothering- closing of external respiratory orifices.
 Gagging- application of materials usually handkerchiefs and
clothing in the mouth or nostrils.
 Overlaying- most common accidental smotheing in children
suffocated either from beddings or pillows.
Asphyxia by drowning
 Cutis anserina- also known as gooseflesh, pale puckered and
contracted skin due to contraction of erector pili muscles.
 Champignon de ocume- a whitish form which accumulates at the
nostrils and mouth which increases in amount when pressure on
the chest increases.
 Washer woman’s hands and feet- bleached and corrugated.

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Medico legal aspects of sexual crimes

 Defloration – is the laceration or rupture of the hymen as a result
of sexual intercourse.
 Pregnancy – is a state of a woman who has within her body the
going product of conception.
 Delivery -is the process by which in a woman gives birth to her
offspring.
 Puerperium – is the interval between the termination of labor
(delivery) to the complete return of the reproductive organ its
normal pregnant state-last from 6 to 8 weeks.
 The Good Bacteria found in the vagina is called Vaginal Flora or
vaginal microbiota. More popularly known as Doderiein Bacilli
which was discovered by Albert Doderlein.
 Fourchette- the v- shaped structure formed by the anion of labia
majora posturing and vaginal orifice.

Spurious children- Illegitimate who are not natural are considered

spurious children may be
 Adulterous Children – conceived in an act of adultery or
concubinage.
 Sacrilegious Children – children born of parents who have been
ordained in sacris.
 Incestuous Children – children born by parents who are legally
incapable of contracting valid marriage because of their blood
relations as marriage between brothers and sisters, father and
daughter, etc.
 Manceres– children conceived by prostitute. It is very difficult to
determine the father because of the nature of the work.

Sexual deviations
• Homosexual – sexual desire towards the same sex
• Infantosexual – sexual desire towards an immature person
(pedophilia)
• Gerontophilia – sexual desire to old person
• Bestosexual – sexual desire towards animal (zoophilia)
• Autosexual - form of self abuse or solitary vice (masturbation
• Necrophilia – sexual perversion with a corpse
• Incest – sexual relation between relatives
• Dyspareunia – painful spasm of the vagina during sexual act
• Satyriasis – excessive sexual desire of men
• Nymphomania – excessive sexual desire of women
• Sexual anesthesia –absence of sexual deisre or arousal during
sexual act of women (arousal insufficiency)

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• Fellatio – female receives the penis of a man into her mouth

• Cunnlingus – sexual gratification by licking or sucking female
genitalia
• Anilism – sexual desire by licking the anus of another by either
sex
• Flaggellation - a sexual deviation associated specifically with
the act of whipping or being whipped
• Sadism – infliction of pain on another for sexualenjoyment
• Masochsim – pain and humiliation from the opposite sex is the
primary factor for sexual gratification.
• Ospresiophilia – fetish whose stimulus is pleasant odor or foul
odor for sexual satisfaction
• Urolagnia – sexual deviation by seeing women urinating
• Coprolalnia – sexual deviation by seeing women defecate
• Fetishism – real or imaginary fantasied presence of an object or
bodily part is necessary for sexual stimulation
• Mysophilia – A sexual dependency on
something soiled or filthy, usually a kind of undergarment after
use.
• Pygmalionism – sexual deviation whereby a person has sexual
desire for statutes
• Mannikinism – sexual desire for mannikins
• Narcissism – sexualf gratification is attained by looking at the
mirror and appreciating one self
• negative fetish – the marked dislike for things like eyeglasses,
beard, hair cut as the sole stimulus for gratification
• Saboteur fetish – a deviate does damage while he gets
satisfaction like cutting clothes or hair
• Vampirism – sexual satisfaction at the sight of blood
• Sodomy – sexual act through the anus of another person
• Uranism – sexual satisfaction is attained by fingering, fondling
with the breast, licking parts of the body etc
• Frottage – by rubbing his sex organ against some part of the
body of another
• Partialism – person has special affinity to certain parts of the
female body
• Voyeurism - by seeing a person undress “peeping tom”
• Mixoscopia (scoptophilia) – watching the couple undress or
during their sexual intimacies
• Troilism – three person participate in a sexual orgies
• Pluralism – group of person in sexual orgies
• Coprolalia – use of obscene language to satisfy sexual
gratification

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• Don juanism – making seduction of many women as a part of

his career. Characterized by promiscuity.
• Exhibitionism – willful exposure in the public places of one’s
genital organ
• Transvestism – by wearing opposite apparel. Women/ male
wear opposite dress

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