Lecture Series 1

LEGAL MEDICINE
BY

R H O D O R A LE D ES M A , M .D ., J . D .
Scope and Nature of Legal Medicine

a. Broad and encompassing

b. Medical/Para-Medical Sciences JUSTICE
 Definition of Terms
• a. Legal Medicine
• branch of medicine that deals with the application of medical knowledge to legal problems
and legal proceedings. 
• Synonymous with Forensic Medicine

• b. Medical Jurisprudence
(Juris – Law and Prudentia – Knowledge)
• Application of knowledge of Law in relation to the practice of Medicine

• Medical Jurisprudence - Forensic Medicine - Legal Medicine 

“ That branch of medicine which treats of the application of the principles and
knowledge of medicine to the purposes of the law, both civil and criminal”.
 Definition of Terms
d. Medical Jurist e. Medical Examiner
f. Medico-Legal Officer g. Medico-Legal Expert
PHYSICIANS who specialize or involved primarily with medico-legal duties.
• Such Physician must have sufficient knowledge in Pathology, Surgery,
Obstetrics and Gynecology, Toxicology and such other branches of Medicine
germane to the issues involved.
Ability to acquire facts,
Power to arrange facts in logical order,
Draw conclusion from the facts JUSTICE
 ORDINARY PHYSICIAN
VS MEDICO-LEGAL OFFICER
DISTINCTIONS ORDINARY PHYSICIAN MEDICO-LEGAL
OFFICER
1. POINT OF VIEW 1. TREATMENT 1. CAUSE
2. PURPOSE 2. DEFINITE DIAGNOSIS 2. MEDICO-LEGAL
AND TREATMENT REPORT AND TESTIMONY
IN COURT
3. FOCUS/SIGNIFICANCE 3. MAJOR PROBLEMS 3. INCLUDES MINUTEST
OF P.E FINDINGS DETAILS IN P.E. FINDINGS
 PHYSICAL INJURY
• EFFECT OF SOME FORM OF TRAUMA TO THE BODY
• 3 MAIN CLASSIFICATIONS
1. ORDINARY OR CLASSIC CLASSIFICATION
2. MEDICAL CLASSIFICATION
3. LEGAL CLASSIFICATION
 PHYSICAL INJURY
• ORDINARY OR CLASSIC CLASSIFICATION
• 1. Apparent – Body Resistance > Stimulus (Force) Applied;
Effect hardly visible, e.g., reddening of skin, slight bruise
Real – Body Resistance < Stimulus (Force) Applied;
Effect is visible, e.g., Large hematoma, wound, large bruise
• 2. Immediate e.g., sharp pointed instrument stab wound
Delayed e.g., blunt force trauma delayed contusion
• 3. Classification as to CAUSES
 PHYSICAL INJURY
• CLASSIFICATION AS TO CAUSES
• 1. Physical Violence WOUND
• 2. Heat or Cold BURN / FROSTBITE
• 3. Electrical Energy
• 4. Chemical Energy
• 5. Radiation
• 6. Change in Atmospheric Pressure (Barotrauma)
• 7. Infection
PHYSICAL INJURY DUE TO VIOLENCE 1
• PHYSICAL VIOLENCE WOUND
• WOUND = Disruption of the normal continuity of tissues
• WOUND = KINETIC ENERGY (FORCE) x TIME x AREA x
OTHER FACTORS (SKIN ELASTICITY AND LOCATON)

KINETIC ENERGY = MASS x VELOCITY2 = FORCE

• M16 Rifle - velocity = 3,200 ft/sec

• 0.38 Revolver – velocity = 1100 ft/sec
PHYSICAL INJURY DUE TO VIOLENCE
2
VITAL REACTIONS – SUM TOTAL OF ALL TISSUE REACTIONS
AFTER TRAUMA
1. RUBOR – BLOOD SUPPLY (REPARATIVE PROCESS)
REDNESS/CONGESTION
2. CALOR – HEAT/INCREASE IN TEMPERATURE
3. DOLOR – PAIN/INJURY TO SENSORY NERVES
4. LOSS OF FUNCTION
PHYSICAL INJURY DUE TO VIOLENCE
3
CLASSIFICATION OF WOUNDS
1. AS TO SEVERITY
Mortal /Fatal Wound – capable of causing death immediately or
soon after infliction.
e.g., wounds to vital organs like the heart and great vessels, brain
and upper part of the spinal cord, lungs, liver, spleen, stomach
intestines.
Non-Mortal /Non-Fatal
PHYSICAL INJURY DUE TO VIOLENCE
4
2, As to kind of Instrument used
a. Blunt instrument: contusion, hematoma, laceration
b. Sharp instrument:
- incised: sharp edged
- punctured: sharp pointed
- stab wound: sharp edged and sharp pointed
c. Tearing Force: Laceration
PHYSICAL INJURY DUE TO VIOLENCE
5
3. AS TO MANNER OF INFLICTION
a. Hit: Bolo, Axe, Blunt instrument (e.g. dumbbell)
b. Thrust or stab: Dagger, bayonet, large knife
c. Gun-powder explosion: shrapnel or projectile
d. Sliding, rubbing or Abrasion
PHYSICAL INJURY DUE TO VIOLENCE
6
4. AS TO DEPTH OF WOUND
a. Superficial – only layers of skin involved
b. Deep – goes beyond layers of skin
b-1. Penetrating: skin + solid organ of the body

b-2. Perforating: traverses the body from point of

entry to exit or creates communication
between point of entry and a
hollow organ of the body.
PHYSICAL INJURY DUE TO VIOLENCE
7
5. As regards the relation of the site of application of force to the location of injury
a. Coup Injury – INJURY AT SITE OF FORCE
b. Countre Coup Injury – OPPOSITE SITE OF FORCE
c. Coup Countre Coup Injury – BOTH AT SITE/OPPOSITE
d. Locus Minores Resistencia – NEITHER AT SITE OR
OPPOSITE, INJURY WHERE THERE IS LEAST RESITANCE
e.g. Blow to forehead BLACKEYE
e. Extensive injury - damage to areas > site of force
e.g., multiple fractures, internal organ hemorrhage
Locus Minoris Resistencia
Locus Minoris Resistencia
PHYSICAL INJURY DUE TO VIOLENCE
8
6. SPECIAL KINDS OF WOUNDS
• a. Defense Wounds
• b. Patterned Wounds
• c. Self-Inflicted Wounds
DEFENSE WOUNDS
PHYSICAL INJURY DUE TO VIOLENCE
8
6. SPECIAL KINDS OF WOUNDS
• a. Defense Wounds
• b. Patterned Wounds
• c. Self-Inflicted Wounds
PATTERNED WOUND 1
PATTERNED WOUNDS 2
PATTERNED WOUND 3
PATTERNED WOUND 4
PATTERNED WOUND 5
 PHYSICAL INJURY
EFFECT OF SOME FORM OF TRAUMA TO THE BODY
3 MAIN CLASSIFICATIONS
1. ORDINARY OR CLASSIC CLASSIFICATION
a. Apparent and Real
b. Immediate and Delayed
c. Classification as to CAUSES: VIOLENCE

2. MEDICAL CLASSIFICATION
3. LEGAL CLASSIFICATION
 Medical classification of Wounds 1

1. CLOSED WOUNDS - intact skin and mucous membrane

a. Superficial - wound is just underneath the layers of skin or M.M.
e.g., petechiae, hematoma, contusion
b. Deep – wound goes beyond the layers of skin internally
1. Musculo-skeletal injuries:
e.g., sprain, strain, dislocation, subluxation, closed fracture
2. Internal Hemorrhage
3. Cerebral Concussion
2. OPEN WOUNDS – integrity of skin and M.M. is broken
Medical Classification of Wounds 2
2. OPEN WOUNDS – integrity of skin and mucous
membrane is breached
a. Abrasion
b. Incised wound
c. Stab wound
d. Punctured wound
e. Lacerated wound
OPEN WOUNDS, e.g., Abrasion
OPEN WOUNDS
 PHYSICAL INJURY
EFFECT OF SOME FORM OF TRAUMA TO THE BODY
3 MAIN CLASSIFICATIONS
1. ORDINARY OR CLASSIC CLASSIFICATION
a. Apparent and Real
b. Immediate and Delayed
c. Classification as to CAUSES: VIOLENCE

2. MEDICAL CLASSIFICATION: CLOSED/OPEN

3. LEGAL CLASSIFICATION
 LEGAL CLASSIFICATION
OF
PHYSICAL INJURIES 1
• Reference: THE REVISED PENAL CODE
(Act No. 3815 as Amended)
Effectivity: January 1, 1932

CHAPTER TWO – PHYSICAL INJURIES

 THE REVISED PENAL CODE
Chapter Two – PHYSICAL INJURIES

LEGAL CLASSIFICATION OF PHYSICAL INJURIES

1. Art. 262. – MUTILATION
2. Art 263. – SERIOUS PHYSICAL INJURIES
3. Art. 264. – ADMINISTERING INJURIOUS SUBSTANCES OR
BEVERAGES
4. Art. 265. - LESS SERIOUS PHYSICAL INJURIES
5. Art. 266. – SLIGHT PHYSICAL INJURIES AND
MALTREATMENT
 LEGAL CLASSIFICATION
OF
PHYSICAL INJURIES 2
• Art. 262. Mutilation. The penalty of reclusion temporal or reclusion
perpetua shall be imposed upon any person who shall intentionally
mutilate another by depriving him, either totally or partially, of
some essential organs of reproduction.
• Any other intentional mutilation shall be punished by prision mayor
in its medium and maximum periods.
• RT – 12 yrs + 1DAY – 20 YRS
• RP- 20 yrs + 1day – 40 yrs
• PM- Med- 6 YRS + 1 DAY Max – 12 YRS
 LEGAL CLASSIFICATION
OF
PHYSICAL INJURIES 3
• Art. 263. Serious Physical Injuries. - Any person who shall WOUND, BEAT, OR
ASSAULT ANOTHER, shall be guilty of the crime of serious physical injuries and shall
suffer:
• 1. The penalty of prision mayor, if in consequence of the physical injuries inflicted, the
injured person shall become INSANE, IMBECILE, IMPOTENT, OR BLIND; (PM-6
YRS+1DAY-12 YRS)
• 2. The penalty of prision correccional in its medium and maximum periods, if in consequence
of the physical injury inflicted, the person injured shall have LOST THE USE OF SPEECH,
OR THE POWER TO HEAR OR TO SMELL, OR SHALL HAVE LOST AN EYE, A
HAND, A FOOT, AN ARM, OR A LEG, OR SHALL HAVE LOST THE USE OF ANY
SUCH MEMBER, OR SHALL HAVE BECOME INCAPACITATED FOR THE WORK
IN WHICH HE WAS THEREFOR HABITUALLY ENGAGED;
• (PC – 6 mos + 1 day – 6 yrs)
 LEGAL CLASSIFICATION
OF
PHYSICAL INJURIES 4
• Art. 263. Serious Physical Injuries.
• 3. The penalty of prision correccional in its minimum and medium
periods, if in consequence of the physical injuries inflicted, the person
injured shall have become deformed, or shall have lost any part of
his body, or shall have lost the use thereof, or shall have been ill or
incapacitated for the performance of the work in which he was
habitually engaged for a period of more than 90 days;
• PC – 6 months + 1 day – 6 years
 LEGAL CLASSIFICATION
OF
PHYSICAL INJURIES 5
• Art. 263. Serious Physical Injuries.
• 4. The penalty of arresto mayor in its maximum period to prision
correccional in its minimum period, if the physical injuries inflicted
shall have caused the illness or incapacity for labor of the injured
person for more than 30 days;
• AM – 1 day – 30 days
• PC – 6 months + 1 day – 6 yrs
Persons under Art. 246. Parricide. – FATHER, MOTHER, CHILD
(legitimate or illegitimate), or any ascendant/descendant or spouse.
 LEGAL CLASSIFICATION
OF
PHYSICAL INJURIES 6
• Art. 264. Administering injurious substances or beverages. –
• The penalties established by the next preceding article shall be
applicable in the respective case to any person who, without intent to
kill, shall inflict upon another any serious physical injury, by
knowingly administering to him any injurious substances or beverages
or by taking advantage of his weakness of mind or credulity .
 LEGAL CLASSIFICATION
OF
PHYSICAL INJURIES 7
• Art. 265. Less serious physical injuries. – Any person who shall inflict
upon another physical injuries not described in the preceding articles,
but which shall incapacitate the offended party for labor for ten
days or more, shall require medical attendance for the same period,
shall be guilty of less serious physical injuries and shall suffer the
penalty of arresto mayor.
 LEGAL CLASSIFICATION
OF
PHYSICAL INJURIES 8
• Art. 266.- Slight physical injuries and maltreatment. – The crime of
slight physical injuries shall be punished:
• 1. Arresto menor when the offender has inflicted physical injuries
which shall incapacitate the offended party for labor from 1- 9
days, or shall require medical attendance for the same period;
• 2. xxx
• 3. xxx
 Legal Classification – Summary 1
• Art. 262. Mutilation:
Total or partial deprivation of organ of reproduction.
• Art. 263. Serious physical injuries:
1. Effect: Imbecile, Insane, Impotent, Blind
2. Effect: Loss of speech, hearing, smell; 1 eye, hand, foot, arm,
1 leg or the use thereof + incapacity for habitual work;
3. Effect: Deformed, loss of any organ of the body,
incapacity/medical attendance > 90 days;
4. > 30 days, aggravated if victim is under Art. 246
(father, mother, children, ascendant or descendant;
Legal Classification – Summary 2
• Art. 264. Administering injurious substances or beverages.
- same as serious physical injuries/no intent to kill
• Art. 265. Less serious physical injuries.
- incapacity for labor / medical attendance
10 days or more;
• Art. 266. Slight physical injuries.
- incapacity for labor / medical attendance
1 - 9 days.
 CLASSIFICATION OF PHYSICAL
INJURIES
ORDINARY MEDICAL LEGAL
(Revised Penal Code)

1. Apparent vs Real 1. Closed 1. Mutilation (Art. 262)

2. Immediate vs Delayed a. Superficial 2. Serious Physical Injury
3. As to Cause b. Deep (Art. 263)
a. Violence - Penetrating 3. Administering injurious
b. Heat or Cold - Perforating substances or beverages
c. Electrical Energy 2. Open (Art. 264)
d. Chemical Energy a. Abrasion 4. Less Serious P.I. (Art.
e. Radiation b. Incised wound 265)
f. Change A. Pressure c. Stab wound 5. Slight P.I.or
(Barotrauma) d. Punctured wound Maltreatment (Art. 266)
g. Infection e. Lacerated Wound
THANK YOU
 Lecture Series 2
LEGAL MEDICINE
BY

R H O D O R A LE D ES M A , M .D ., J . D .
 RULES TO BE OBSERVED IN
MEDICO-LEGAL EXAMINATIONS

• 1. Describe all wounds or injuries in detail;

• 2. Description must be comprehensive.
Sketch or Photographs must be taken;
• 3. Examination must be objective
- not influenced by information obtained
from others.
 Outline of Medico-Legal
Investigation of Physical Injuries 1
I. General investigation of the Surroundings
• 1. Examination of the place where the crime occurred;
• 2. Examination of the clothing, stains, cuts, hair, other material found in the
crime scene;
• 3. Investigation of witnesses;
• 4. Investigation of the weapon used;
• 5. Sketches, photographs, description or measurements;
• 6. Degree of hemorrhage; evidence of a struggle;
presence of a suicide note; position of the victim.
 PHYSICAL INJURIES IN
DIFFERENT PARTS OF THE BODY

• 1. Head and Neck Injuries

• 2. Injuries in the Chest
• 3. Abdominal Injuries
• 4. Pelvic Injuries
• 5. Extremities
 Outline of Medico-Legal
Investigation of Physical Injuries 2
II. Examination of the Wounded Body
A. Examination Applicable to Both Living and Dead
1. Age of the wound from the degree of healing;
2. Weapon used;
3. Reason for the multiplicity of wounds;
4. Accidental, homicidal or suicidal
 Outline of Medico-Legal
Investigation of Physical Injuries 3
II. Examination of the Wounded Body
B. Examination Applicable to the Living Victim
1. Determination if injury is life threatening;
2. Determination if there will be permanent damage;
3. Determination if there is shock;
4. Determination of possible complications
 Outline of Medico-Legal
Investigation of Physical Injuries 4
II. Examination of the Wounded Body
C. Examination Applicable to the Dead Victim
1. Ante-Mortem vs Post-Mortem Wound;
2. Fatal vs Non-Fatal Wound;
3. Presence of Existing Diseases or Abnormalities;
4. Accidental, homicidal or suicidal
 Outline of Medico-Legal
Investigation of Physical Injuries 5
III. Examination of the Wound
A. Character
1. Type of wound, e.g. gunshot, incised, laceration,
contusion; stab wound, etc.
2. Size, shape, edges, other characteristic marks;
B. Location – identify the site of injury by relating to a
body landmark
C. Depth
 Outline of Medico-Legal
Investigation of Physical Injuries 5
III. Examination of the Wound
D. Condition of the areas surrounding the wound;
e.g., gunshot at close range – burnt collar;
suicidal attempt – hesitation marks;
E. Extent of the wound – suggests degree of force
applied; e.g., homicidal vs suicidal
C. Direction of the wound – position of the victim in
relation to the assailant
D. Number of wounds
 Outline of Medico-Legal
Investigation of Physical Injuries 4
II. Examination of the Wounded Body
C. Examination Applicable to the Dead Victim
1. Ante-Mortem vs Post-Mortem Wound;
2. Fatal vs Non-Fatal Wound;
3. Presence of Existing Diseases or Abnormalities;
4. Accidental, homicidal or suicidal
 Ante-Mortem vs Post-Mortem Wound;
A N T E- M O RTE M P O S T- M O RT E M

1. Hemorrhage - copious; arterial 1. Hemorrhage – nil, venous

2. Marks of spouting of blood from 2. No spouting of blood
arteries;
3. Blood not clotted, or soft
3. Clotted blood; 4. No staining of tissues or if present,
4. Deep staining of tissues not easily washes off
washed off; 5. No gaping of wounds
5. Gaping wounds 6. No Inflammation or reparative
process
6. Inflammation or reparative process
THANK YOU