LEGAL MEDICINE : GENERAL

CONSIDERATION

CRISBERT I. CUALTEROS, M.D.

http://crisbertcualteros.page.tl
Legal Medicine -is a branch of medicine which deals with the application of
medical knowledge to the purposes of law and in the
administration of justice.

Legal medicine -Application of medicine to legal cases.

Forensic medicine -Application of medical science to elucidate legal problems.

Medical jurisprudence - Knowledge of law In relation to the practice of

medicine.

SCOPE: Application of medical and paramedical sciences as

demanded by law and administration of justice.

NATURE OF THE STUDY OF LEGAL MED:

- The ability to acquire facts, arrange them and draw a conclusion from facts in
the administration of justice.

Medical jurist, Medical examiner, Medicolegal officer, Medicolegal expert

- A physician who specializes primarily with medico-legal duties.
- lmhotep -2980 B.C. earliest rnedico-leqal expert.

DIFFERENCE: ORDINARY PHYSICIAN MEDICO-LEGAL OFFICER

a) Injury/Disease
point of view - Treatment Cause

b) Examine a Diagnose Testify I justice

patient

c) Minor injuries Ignored Records all / qualify crime

PRINCIPLE OF STARE DECISIS:
- When the court has once laid an interpretation of law as applied to certain facts,
it will adhere to and apply to all future cases where the facts are substantially the
same.

BASIC PRINCIPLES GOVERNING APPLICATION AND EFFECTS OF LAWS:

1. "lgnorantia legis nominem excusat " - prevent use as defense In violation

2. Law shall have no retro-active effect.

3. Rights may be waived, unless the waiver is contrary to law, public order,
public policy, morals or good customs, or prejudiced to a third person with a
right recognized by law.

4. Customs which are contrary to law, public order or public policy shall not be
countenanced.

5. Laws are repealed by subsequent ones. and their violation or non-observance

shall not be excused by dis-use, custom or practice to the contrary.

Persons authorized to perform autopsies:

1. Health Officers
2. Medical officer of law enforcement agencies.
3. Members of the medical staff of accredited hospitals.

Autopsies shall be performed in the following cases.

1. Required by special I aws
2. Order of competent court, mayor, tis cal
3. Written request of pol ice officers
4. Sol Gen, fiscal disinter to determine cause of death.
5. Written request of nearest kin to ascertain cause of death.

MEDICAL EVIDENCE
- is the means sanctioned by the rules of court of ascertaining in a
judicial proceeding the truth respect! ng a matter of fact.

Types of evidence:
1. Autoptic or Real evidence - made known to the senses
2. Testimonial evidence - oral under oath
3. Experimental evidence
4. Documentary evidence

Methods of preserving evidence:

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1. Photo, videotape,photocopy 4.Manikin method
2. Sketching 5.ln the mind of the witness
3.Description 6. Special methods: embalming

DECEPTION AND DETECTION

Knowledge of truth is important in the administration of justice, lies solely in the
ability to evaluate the statement given by the suspect or witness.

Methods of deception detection:

1. Devices which record the psycho-physiological response:
a) Use of a polygraph or lie detector machine
b) Word association test
c) Psychological stress evaluator

2. Use of drugs that try to· inhibit the Inhibitor"

a) Administration of the truth serum
b) Narcoanal ysis or Narcosynthesis
c) Intoxication

3. Hypnotism

4. By observation

5. Scientific Interrogation

6. Confession

I. RECORDING OF PSYCHO-PHYSIOLOGICAL RESPONSE

Nervous control - CNS/ANS Sym/ParaS

Sympathetic - Influenced by physical and emotional stimuli, effects

Parasympathetic- works to restore things

A. Use of a Lie Detector or Polygraph

=The fear of the subject when not telling the truth activates the symp.

=To a series of automatic and involuntary physiological changes which are

recorded by the instrument.

=Use of control questions> Most reliable & effective questioning technique.

= Supplemetary tests:

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 a. Peak of tension test - peak of tension on relevant questions
b. Guilt complex test - does not response to added relevant quest.
c. Silent answer test - subject verbal response creates distortion in
the tracing or clearing of the throat.

Reason for admissibility to the court of the result of Polygraph exam :

1. Have not received the degree of standardization of acceptance.
2. Trier of fact is apt to give almost conclusive weight to the experts opinion
3. No way to as sure the a qualified examiner administered the test.
4. May waive right against self-incrimination.
5. ll has many errors.

Factors responsible to 25% errors:

1. Nervousness experienced by a subject who is tel ling the truth
- apprehension by the fact that he is a suspect.
- over-anxiety to cooperate
2. Physiological abnormalities> BP inc. or dee., Cardiac prob.
3. Mental abnormalities
4. Unreponsiveness In a guilty subject - no fear of detection
5. Attempt to beat the machine

Can a person be compelled? No, use of intelligence and other faculties.

B. Word association test:

-Time interval between the words uttered by the examiner and the answer of
the subject is recorded.

C. Psychological Stress Evaluator

- when a person is under stress/lying, the microtremor in the voice utterance
is moderately or completely suppressed.
- degree of suppression varies inversely to degree of psychological stress .

II. USE OF DRUGS THAT INHIBIT THE INHIBITOR

- Not admissible in court

A. Administration of truth serum

- Hyo cine hydrobromi de given hypodermical ly until state of delirium which the
subject feels a compulsion to answer the question truthfully.

B. Narcoanalysis or Narcosynthesis
- Sodium amytal or sodium penthotal

C. Intoxication with alcohol - In wine there is truth

Ill. HYPNOSIS

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 - alteration of consciousness, not all subjects can be hypnotized

IV. OBSERVATION
Physiological and psychological signs and symptoms of guilt:
a) Sweating, color change
b) Dryness of the mouth
c) Excessive activity of adams apple
d) Fidgetting
e) Peculiar feeling Inside
f) Swearing, spotless past record
g) Inability to look at the investigator

V. INTERROGATION
- emotional appeal, mutt and jeff technique

VI. CONFESSION
- expressed acknowledgement of his guilt.

TOKYO DECLARATION
- contains guidelines to be observed by physician concerning torture, inhuman
and degrading punishment.

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MEDICO-LEGAL ASPECTS OF IDENTIFICATION
- determination of the individuality of a person

Importance of identifying a person:

1. In the prosecution of a crime, the identity of the offender and victim.
2. Settlement of estates, retirement, insurance
3. Resolves anxiety of nest of kin.
4. In some transactions - sales, release of dead body

Rules in personal identification:

1. Law of multiplicity of evidence in identification - greater number of similarities
2. Value of different points of identification - flngerpri nts , moles
Visual recognifion of relatives -lesser value than fingerprints/dental
3.The longer interval between death the more experts are needed in establishing
the identity.
4. The team to act in shortest time because It is perishable.
5. No rigid rule in the procedure of identification of the person.

Methods of identification:
1. By comparison - Id found in the crime scene compared with the file.
2. By exclusion

IDENTIFICATION OF PERSONS
A. Ordinary methods of identification

1. Characteri sties which may easily be changed:

a) growth of hair, beard d) grade of profession
b) clothing e) body ornamentations
c) frequent place of visit

2. Characteri sties that may not be easily be changed:

a) mental memory f) hands and feet
b) speech g) complexion
c) gait h) changes in the eyes
d) mannerism i) facies
e) handedness-left /right j) degree of nutrition

Points of identification applicable to both living and dead before onset

of Decomposition:

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 1. 0 ccupational marks - painters have stains
2. Race: Malay:brown, flat nose round face, Round head, Wearing apparel
3. Stature: Tips of middle fingers of both hands extended laterally
4. Tatoo marks
5. Weight- not good point - changes from time to time
6. Deformities, injuries leaving permanent deformities
7. Birth marks moles, scar

Age of Scar:
Recently formed: Slightly elevated, reddish/bluish, tender to touch
Few week-.2 months: Inflammatory redness. soft, sensitive
2 - 6 months: brownish, free from contraction, soft
> 6 months: white, glistening, contracted, tough

Scar formation is delayed by: sepsis, age, depth of wound, mob ii ity
May not develop- mall, superficial, healed by first intention.

8. Tribal marks, Sexual organs, blood exam

ANTHROPOMETRY (BERTILLON SYSTEM) Alphonse Bertillon

- utilizes anthropometri cal measurement of the human body for identification.

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

Information:
1. Descriptive data - color of hair. eyes, shape of nose ...
2. Body marks
3. Anthropometric measurement - height
4. Measurement of the head, limbs

Portait Parle (spoken picture) - picturesque description of a person

Extrinsic factors In identification:

1. ornamentation
2. personal belongings
3. wearing apparel
4. foreign bodies
5. Identification by close friends, police records, photographs

Light as a factor in identification:

1. Clearest moonlight= Less than 16-17 yards Starlight= Less than10-13 yards
2. Broad daylight = Not farther than 1 00 yards not seen before
Almost strangers =recognized at 25 yards

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3. Flash of firearm
= 2 inches letters can be read with the aid of the flash of 22 caliber
at a distance of 2 feet.
4. Flash of lightning - sufficient light to identify
5. Artificial light - relative to the Intensity of light

B. Scientific methods of identification

1. Fingerprinting
2. Dental identification
3. handwriting
4. Identification of skeleton
5. Determination of Sex, Age
6. Identification of blood, blood stains
7. Identification of hair, fibers

1. FINGERPRINTING
= most valuable method of idenUfication.
a) No two identical fingerprints 1 : 64,000, 000, 000
b) Not changeable - 4'" month formed in the fetus

= Practical uses
a) Identity of dead bodies
b) Prints recovered at crime scene
c) Prints on file for comparison
d) Right thumb print is substitute for signature

= DACTYLOGRAPHY : art and study of recording fingerprints as means of id.

= DACTYLOSCOPY: art of id by oomparison of fingerprints

= POROSCOPY: study of pores found on the pappillary friction ridges of skin

Fingerprints can't be effaced:

=as long as the dermis of the bulbs of the finger Is not completely destroyed.

2. DENTAL IDENTIFICATION
= possibility of 2 persons to have the same is remote
= enamel is the hardest substance of the body,
outlast other tissues In putrifaction

3. HANDWRITING

= BIBLIOTIC : Science of handwriting analysis

=GRAPHOLOGY: study of handwriting for the purpose of determining the
writers personality, character and aptitude.

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4. IDENTIFICATION OF THE SKELETON
human - shape, size, general nature
single individual -plurality or excess of bones

Height - add 1 to 1 Y, in. for the soft tissues

Pearson's formula - for the reconstruction of the living stature of long bones

Topinard and Rolle!

= two French anatomist devised a formula for the determination of the
height fro males and females.

Humphrey's table
=Table of different height of bones for different ages and their
corresponding statures.

Manouvrier - made the following co-efficient for the determination of height.

Determination of sex of the skeleton:

a) Pelvis d) Femur
b) Skull e) Humerus
c) Sternum

Difference between Male PELVIS Female

1) Construction Heavier Lighter

Wall More pronounced Less pronounced

2) Height Greater Lesser

3) Pubic arch Narrow & less round Wider/rounder
4) Diameter of the true
pelvis Less Greater

5) Curve of iliac crest Reaches higher level Lower level

6) Greater Sciatic notch Narrow Wide
7) Body of pubis Narrow Wider
8) lliopectineal line Sharp Rounded
9) Obturator foramen Egg-shaped triangular
10) Sacrum Short and narrow Long and wide

CRANIUM MALE FEMALE

1) Shaft less curve more curve

2) Mastoid process larger smaller
3) cranium placed horizontally mastoid process occipital& maxillary bones
rest on
4) Styloid process shorter longer/slender
5).Forehead higher, more oblique less high, more vertical

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6) Superciliary ridges less sharp, more rounded sharper
7) Zygomatic arches more prominent less prominent
8) Lower jaw larger & wider narrower and lighter
9) Face larger in proportion to cranium smaller

Determination of the duration of interment:

- Al I soft tissues in a grave disappear within one year.

Basis of the estimate fro duration of interment:

1) Presence or absence of soft tissue adherent to the bones.
2) Firmness and weight, brittleness, dryness of the bones.
3) Degree of erosion of the surface of the bones.
4) Changes in the clothings, coffin, and painting.

5. IDENTIFICATION OF SEX

Test to determine the sex:

1. Social test
2. Genital test
3. Gonadal test
4. Chromosomal test - barr cells In females

Evidences of sex:
1. Presumptive evidence
= General features, hair in some parts
= Transvestism - sexual deviation by desire to assume the attire and be
accepted as a member of the opposite sex.

2. Highly probabale
=vagina, large breast

3. Con cl us Ive evidence

= ovary In females

6. DETERMINATION OF AGE

Legal importance
a) Aid to identification
b) Determination of criminal liability
c) Determination of right of suffrage
d) Determination whether a person can exercise civil rights
e) Determination of the capacity to marriage
f) Requisite to certain crimes

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Determination of age of fetus:
Hess's rule or Haase's rule
a) Fetus of less than 25 cm long- get square root of length in cm, result in months
b) > 25 cm- divide the length of the fetus by 5 and the res ult is the age in month.

7. IDENTIFICATION OF BLOOD AND BLOOD STAINS

Legal importance :
a) Disputed parentage
b) Circumstantial evidence against perpetrator of a crime
c) Determination of the cause of death
d) Determination of the direction of the escape
e) Determination of the appropriate time crime was committed
f) Determination of the pl ace of the crime
g) Determination of the presence of certain diseases.

Physical examination
a) Solubility test
b) Heat test
c) Luminescence test: 3 amino-phtallc-acid-hydrazide-HCL,
Sodium peroxide • dis ti lied water
> Bluish-white in a dark room

Chemical examination:
a) Saline extract of the blood plus ammonia - brownish> alkaline hematin
b) Benzi dine test - blue color in white filter paper
c) Guaiacum test (Van Deen's Dyas or Schombeln's test)- blue
d) Phenolpthalein test ( Kastle-Meyer test) - pink
e) Leucomalachite Green test

Microscopic examination
- saline extract of stain

Micro-chemical tests:
1. Hemochromogen crystal or Takayama test:
2. Teichmann's blood crystals or Hemin crystal test-
= Sodium chloride- dark brown rhombic prisms of chloride, hematin formed
= best of the micro-chemical test.
3. Acetone-haemin or Wagenhaar test

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Spectrospcopic examination
- blood pigments have the power to absorb light of certain length and produce the
characteristic absorption bands on the spectrum.
=Fresh blood - oxyhgb, Hgb, reduced hematin
= olders stains - methemoglobin, alkaline hematin

Biologic examinations
1. Precipiti n test - blood is human or not
2. Blood grouping

Age of blood stains:

Hgb converted to Methgb of hematin red to red-brown
=warm weather- within 24 hours

8. IDENTIFICATION OF HAIR AND FIBERS

Differences between hair forcibly extracted and naturally shed hair:
- bulb is irregular , undulating surface, excrescence of diff, size and shape

HAIR HUMAN ANIMAL

Medulla
1. Air network In fine grains large or small sacks
2. Cells Invisible w/out tx in H20 Easily visible
3. Fuzz w/out medulla Fuzz w/ medulla

Cortex
1. Looks like a thick muff Fairy thin hollow cylinder
2. Pigments in the form of fine grains lrregul ar grains

Cuticle
I. thin scales thick scale

MEDICO-LEGAL ASPECTS OF DEATH

Importance of Death determination:

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

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 defendant.

Death - is the termination of life.

Kinds of death:
1. Somatic or clinical death - persistence of vital functions
2. Molecular or cellular death - 3 to six hours after cessation of life
3. Apparent death or State of suspended animation -
transient loss of consciousness in hysteria, uremia, electric shock

Signs of death:

1. Cessation of heart action and circulation .• Usually the auricle contract after
somatic death fro a longer period than the ventricle, last to stop so called
ULTIMEN MARIENS.

Methods of detecting the cessation of heart action and circulation:

a) Examination of the heart- pulse, auculta!ion, flouro, ECG

b) Examination of peripheral circulation

= Magnus test - application of ligature around the base of the finger
bloodless area at site of application
dead man - no change

= Opening of small artery- spurting

= !cards test - Injection of flourescein SQ

- greenish yellow discoloration in the whole skin
- dead man only in the area of injection
=Pressure on fingernails
= Diaphanous test - fingers are spread wide through a strong light- Red
= Application of heat on the skin - blister
=Palpation of Radial pulse
= Dropping of melted wax

2. Cessation of respiration - more than 3 Y, minutes

Methods of detecting cessation of respiration:

a) Observance of movement of chest and abdomen
b) With the aid of stet.
c) Examination with a mirror
d) Examination with a feather or cotton fibers
e) Examination with a glass of water
f) Winslow's test - no movement in the image formed by reflecting artificial
light on the water in a saucer and placed in the chest if respiration is
taking place.

3. Cooling of the body ( ALGOR MORTIS)

- After death the metabolic process inside the body ceases.

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 - The progressive fall of the body temp. is one of the most prominent signs.
- First two hours after death the cooling is rapid.
- Fal I of temp. of 15 to 20 degrees Fahrenheit is considered as a
certain sign of death.

POST-MORTEM CALORICITY - is the rise of temp. of the body after death

due to rapid and early putrefactive changes. Usually in the first 2 hours.
= seen in cholera, liver abscess, tetanus, RF,Strynine poisoning, Peritonitis

A. Conditions connected with the body:

Factors delaying the rate of cooling of the body:

1. Acute pyrexial disease
2. Sudden death in good health
3. Obesity of person
4. Death from asphyxia
5. Death of the middle age

Factors accelerating cooling:

1. Leaness of the body
2. Extreme age
3. Long-standing illness
4. Chronic pyrexial disease with wasting

B. Conditions that are connected with the surroundings

Factors delaying cooling:

1. Clothings
2. Want of access of al r to the body
3. Small room
4. Warm surroundings

Factors accelerating cooling:

1. Unclothed body
2. Conditions al lowing the access of air
3. Large room permitting the dissipation of heat
4. Cooling more rapid in water than in air

Methods of estimating how long a person has been dead from the cooling
of the body:

1. If body temp. is normal at the time of death:

= the average rate of fall of the temp. during the first 2 Y, hours is Y, of the
difference of the body temperature and that of the air.
= the body attains the temp. of the surrounding air from 12 to 15 hours after
death in tropical countries.

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2. Chemical Method ( Schourup's formula for the determination of the time of
death of any cadaver whose CSF is examined for the concentrations of L.A .•
NPN,A.A.
= L.A> 15 mg to 200 mg/1 OOcc rapid in 1st 5 hours.
= NPN inc. from 15 to 40 mg/100 cc in 1" 15 hours
= A.A. inc. from 1 mg lo 12 mg% 1" 15 hours.

4. INSENSIBILITY OF THE BODY AND LOSS OF POWER TO MOVE

= may be seen in the living with- apoplexy, epilepsy. trance. catalepsy, hysteria

5. CHANGES IN THE SKIN - opacity, flattening. loss of elasticity

6. CHANGES IN AND ABOUT THE EYE

a) Loss of corneal reflex - seen In live pts: G.A., uremia, narcotic poisoning
b) Clouding of cornea
c) Flaccidity of the eyeball
d) Pupil in the position of rest.
e) TACHE NOIR DE LA SCLEROTIQUE - spot found In the sclera after
death.

7. ACTION OF HEAT ON THE SKIN

= Heat applied while alive - produced blister with serum and redness around
the area.

=Following combinations of signs show death has occurred:

a) Loss of animal heat to a point not compatible with life
b) Absence of response of muscle stimulus
c) Onset of rigor mortls.

CHANGES IN THE BODY FOLLOWING DEA TH

1. CHANGES IN THE MUSCLE- complete relaxation of the whole

muscular system.
Three Stages After Death:
a) Stage of primary flaccidity ( POST-MORTEM IRRITABILITY)
= muscle relax, may contract. dilated pupil, sphincters are relaxed
=presence of molecular life
=warm place: 1 hour and 51 minutes
= chemical reaction of muscle is alkaline

b) Stage of post-mortem rigidity ( CADAVERIC RIGIDITY,

DEATH STRUGGLE OF MUSCLES OR RIGOR MORTIS)
=whole body is rigid due to contraction of the muscles
= starts at muscle of neck, lower jaw
= Reaction is acidic due to Inc. of lactic acid
= develops 3 to 6 hours after death in temperate, earlier in warm
=last from 2 to 3 days in temperate, warm: 24-48H cold weather

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 18-36H summer

c) Stage of Secondary flaccidity or Commencement of putrefaction

(DECAY OF MUSCLES)
= muscle are flaccid, not respond lo stimuli, reaction is alkaline
= due to dissolution of muscle proteins

FACTORS INFLUENCING THE TIME OF ONSET OF RIGOR MORTIS

(1) Internal Factors

a) State of the muscles
= healthy - appears I ate
= Onset is hastened in:
a.1 hunted animal
a.2 prolonged convulsion/lingering illness
a.3 death from- TY, Cholera, Phthisis, typhus

b) Age
= early onset - aged and newborn
=delayed - good health, good muscular development

c) Integrity of nerves
= section of the nerve will delay onset, paralyzed muscle

(2) External factors

a) Temperature
= Hastened by high temperature
= > 75 degrees will produce heat stiffening
b) Moisture
=rapidly but with short duration in moist air

Conditions simulating RIGOR MORTIS:

1. Heat stiffening-> 75 degrees coagulates muscle proteins rasultinq to rigidity.
="Pugilistic attitude" flexed upper and lower limb
= hands clenched, ftexor stronger than extensors, burned to death

2. Cold stiffening
= due to solidification of fats when exposed to cold temp.

3. Cadaveric spasm or Instantaneous Rigor

= instantaneous rigidity due to extreme nervous tension, exhaustion,
injury to the nervous system.
= weapon in hand, weeds

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 RIGOR MORTIS CADAVERIC SPASM
1. Time of appearance 3-6H after death Immediately after death
2. Muscles involved All muscles Certain group
3. Occurrence Natural phenomena May or may not appear
4. Medico-legal signif. Approximates ti me of death Determine nature of death

RIGOR MORTIS MUSCLE CONTRACTION

1. Contracted muscle Losses transparency More or I es s transparent
2. Elasticity Loss elasticity Very elastic
3. Litmus reaction Acidic Neutral or sl. alkaline
4. Contraction Absolute flaccidity Possess inherent
contraction
2. CHANGES IN THE BLOOD
a) Coagulation of blood
= blood may remains fluid inside the blood vessels 6-8H after death.

ANTE-MORTEM CLOT POST-MORTEM CLOT

1. Consistency Firm Soft
2. Surface of blood vessels Raw after clots are removed Smooth, health after
3. Clots Homogenous Can be stripped
can't be stripped off In layers

b) Post-mortem Lividity or Cadaveric Llvidity. or Post-mortem Suggllation

or Post-mortem Hypostasis or Liver Mortis
=Stoppage of heart action and loss of tone of b.v. accumulates in
dependent areas except in bony areas.
=capillaries coalesce >purplish in color called Post-mortem lividity .
=Hasten by death due to cholera, uremia. Typhus fever
= appears 3 - 6 H after death and rully developed 12 H after death.

Physical characteristics of Post-mortem Cadaveric Lividity

1. Occurs in the most dependent areas.
2. Involves the superficial I ayer of the skin
3. Does not appear elevated from the rest of the skin.
4. Color Is uniform.
5. No Injury of the skin

Kinds of Post-mortem Cadaveric Lividity

1. Hypostatic llvidity
2. Diffusion llvidity

Importance of Cadaveric lividity :

1. One of the signs of death.

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 2. Determines the position of the body has been changed after it's
appearance in the body.
3. Color of lividity may indicate the cause of death.
a) asphyxia - llvidity is dark
b) CO poisoning - pink
c) Hemorrhage - less marked
d) Hydrocyanic acid - bright red
e) Phosphorus - dark brown
f) Potassium chlorate - coffee brown
4. Determines how long the person has been dead
5. Gives us an idea as to the time of death.

Points to be considered which may infer the position of the body at the
time of death:
1. Posture of the body when found.
2. Post-mortem hypostasis or lividity
3. Cadaveric spasm

CONTUSSION (BRUISE) POST-MORTEM HYPOSTASIS

1. Small bruises - Below epidermis in true skin In the epidermis or cutis

larger ones - below this

2. Cuticle Abraded by the same violence Unabraded

that produce the bruise.

3. Bruise Appears at the seat or surrounding Always dependent

may or may not be dependent

4. Elevated, inflammatory condition Not elevated, blood in b.v.

CONTUSSION (BRUISE) POST-MORTEM HYPOSTASIS

5. Incision shows blood outside the b.v. Blood Inside the vessels
=most certain test of difference

6. Color variegated Uniform color

Internal hypostasis in Visceral organs:

1. Lungs

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 2. Loops of intestine
3. Brain

POST-MORTEM LIVIDITY OF ORGANS SIMPLE CONGESTION

1. Post-mortem
staining in organs Irregular, most dependent parts Uniform, all organs

2. Mucous membrane Dull ,I usterless Not in congestion

3. Inflammatory exudate Not seen Not seen

Other changes In the blood

1. Hydrogen ion concentration - acid pH C02, L.A., After 24H alkaline ammonia.
2. Breakdown of llverglycogen leads to accumulation of dextrose in the IVC and
the right side of the heart.
3. Rise in NPN and Free A.A.
4. Chemical:
=chloride In the plasma/RSC decrease due to extravascular diffusion, in
72 H only Y. of its content.
= Mg - increases due to diffusion from withoul
= K - increases due to diffusion from the vascular endothelium.

3. AUTOL YTIC OR AUTO DIGESTIVE CHANGES AFTER DEA TH

-After death, proteolytic, glycolytic and lipolytic ferments of the glandular
tissues continue to act which lead to the autodigestion of organs.

4. PUTREFACTION OF THEBODY
- Is the breaking down of complex proteins into simpler components associated
with the evolution of foul smelling gasses and accompanied by the change of
color of the body.

Tissue changes in putrefaction:

1. Changes in the color of the tissue

Hemolysi s of blood within blood vessels > Hgb diffuses through the walls
Reddish-brown In color
In the tissues > Hgb undergo chemical change
Greenish-yellow 1'' seen at R Iliac Iossa

MARB OLIZA TION - prominence of the superficial veins with reddish

discoloration which develops on both flanks of the
abdomen, neck, and shoulder
= look I ike "marbled" reticule of branching veins.

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2. Evolution of gasses in the tissues
C02, ammonia, H2, Suphurated hydrogen, methane.= offensive odor

Effects of pressure of gasses of putrefaction:

a) displacement of the blood- bleeding in open wounds
b) bloating of the body
c) fluid coming out from nostrils, mouth
d) extrusion of the fetus In a gravid uterus
e) floating of the body

3. Liquefaction of the soft tissues

Putrefy rapidly: Eyeball, lining of trachea, larynx, brain, stomach,
intestine, liver, spleen
Putrefy late Highly muscular organs and tissues, Esophagus,
diaphragm, heart, lungs, kidneys, U.B., uterus, P .G.

Factors modifying the RATE of putrefaction:

1. INTERNAL FACTORS
a) age : healthy adults, NB not yet fed, later than Infants
b) condition of body: full grown/obese - rapid , Stillborn- late
c) cause of death : Infection - rapid

2. EXTERNAL FACTORS
a) Free air
a.1 air: tree air hastens decomposition
a.2 moderate moisture - accelerates
a.3 loaded with septic bacteria- early aerobes. later anaerobic
- Clostridium welchi i= decomposition
b) Earth
b.1 dry absorbent soil - retards
b.2 moist fertile soil - accelerates

c) Running water- more rapid than still water

d) Clothings - early it hastens but delays in the later stage.
- tight clothings - delay

Factors influencing the changes in the body after burial:

1. state of the body before death - thin slower, mummify
2. time elapsed between death and burial and environment of the body
3. effect of coffin - later
4. clothings and other coverings on the body when buried - pressure, insects

20
 5. depth at which the body was buried - greater the I ater
6. condition and type of soil
7. inclusion of something in the grave which will hasten decomposition-food
8. access of air to the body after burial
9. mass grave - rapid
1 0. trauma to the body - violent death - slow

CHRONOLOGICAL SEQUENCE OF PUTREFACTIVE CHANGES OCCURING

IN TEMPERATE REGIONS

1-3 DAYS AFTER DEATH - greenish discoloration over iliac fos sa, soft eyeballs
3-5 DAYS - frothy blood from mouth, nostrils
8-10 DAYS - abdominal distention, nails firm
14-20 DAYS - blisters all over the body, maggots
2-5 MONTHS - skull exposed, orbits empty

IN TROPICAL REGION

12 HOURS Rigor mortis all over. hypostasis, greenish-discoloration caecum

24 HOURS Rigor mortis absent all over, abdominal distention
48 H Ova of flies, trunk bloated, face dis colored
72 H Whole body grossly swollen. hairs and nai Is loose
ONE WEEK Soft viscera putrefied
TWO WEEKS Soft tissues largely gone
ONE MONTH Body skeletonized

BEEN SUBMERGED IN WATER

FIRST 4 OR 5 DAYS Cold water little change, in rigor mortis

FROM 5 - 7 DAYS Skin on hands, feet is bleached, race faded white
1 - 2 WEEKS Face swollen and red, skin of hands and feet wrinkled
4 WEEKS Skin wrinkled, nail intact
6 - 8 WEEKS Abdomen distended, skin of hands/ feel come off with nails

Factors influencing the floating of the body in water:

1. age - fully developed. well nourished - rapid
2. sex - females floats sooner
3. conditions of the body - obese float quicker
4. season of the year- moist hot air - putrefaction - floats due to gas
5. water- shallow and stagnant water of creeks, higher specific gravity
- sea water floats sooner than fresh water, higher specific gravity
6. external Influence - heavy-wean ng apparel - slower

Only teeth, bones and hair remain for an indefinite time.

Flat bones disintegrates faster than round bones.

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SPECIAL MODIFICATION OF PUTREFACTION
1. Mummification
=is the dehydration of the whole body which results in the shivering
and preservation of the body.
=usually occurs when buries in a hot, dry with free access of hot air

2. Saponification or Adipocere fromatlon

= a condition where the fatty tissues of the body are transformed to soft
brownish-white substance known as ADIPO CER E at SQ level.

3. Maceration
=softening of the tissues when in fluid medium in the absence of putrefactive
mircro-orq, seen in death in utero
- reddish or greenish color, skin peeling off and arms flaccid and frail.

HOW LONG A PERSON HAS BEEN DEAD? DURATION OF DEATH

1. Presence of rigor rnortis : 2-3 hours after death
12 H fully developed
18-36 H disappears concomitant with putrefaction
2. Presnce of Post-mortem lividity
3-6 H after death
appears as small petechia-like red spots
3. Onset of decomposition
24-48 H after death
manifested watery. foul smelling froth. mouth. nostrils
4. Stage of decomposition

5. Entomology of the cadaver - 24 H before eggs are hatched, maggots

6. Stage of digestion - 3-4 H gastric empty

6-8 distal ileum, cecum
7. Presence of live flies In the clothing in the drowning victim - less than 24H

8. State of clothings - pajama . night

9. Changes In CSF
10. Blood clots Inside the b.v. in 6 -8 Hafter death.
11. Soft tissues of the body may disappear 1 to 2 years after burial.

Post-mortem conditions simulating disease, poisoning or injury:

1. post mortem hypostasi s - contusion, Inflammation , poisoning
2. blisters of the cuticle - seal d and burns
3. swelling, detachment or splitting - Injury

PRESUMPTION OF DEA TH
Disputable presumption - not heard In 7 years

22
Presumption of death
Absence of 7 years except success ion 10 years
Vess el for 4 years
Armed forces 4 years
In danger of death 4 years

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

MEDICO-LEGAL INVESTIGATION OF DEATH

Inquest Officer - is an official of the state charged with the duty of inquiring into
certain matters.
- in medico-legal examination: manner and cause of death

The following officials of the government are authorized to make death

investigations:
1. Provincial and City Prosecutors
2. Judges of the RTC, MTC
3. Director of NBI
4. SolGen

Stages of MEDICO-LEGAL INVESTIGATION:

1.Crime Scene Investigation - investigation of place of commission of the crime
2.Autopsy - investigation of the body of the victim

1. Crime Scene Investigation

- place where the es sen ti al ingredients of the crime took place.
- Person composed the Search T earn:
a) Physician MU trained
b) Photographer
c) Assistant, evidence collector, note taker

2. Autopsy
- comprehensive study of a dead body, in addition to the external examination
. Post-mortem examination- external exam without incision being made.

Purpose of autopsy:
1. Determine cause of death
2. Correlate clinical diagnosis and symptoms
3. Determine effectiveness of treatment
4. Study the natural course of the disease

23
 5. Educate students and physicians

MEDICO-LEGAL OR OFFICIAL AUTOPSY:

1. Determine cause, manner, time of death
2. Recovering, identifying, preserving evidentiary material
3. Provide interpretation and correlation of facts related to death
4. Provide factual, objective medical report
5. Separating death due to disease from external causes.

Dead body belongs to the state for cases that requires medico-legal autopsy.

PATHOLOGICAL AUTOPSY MEDICO-LEGAL AUTOPSY

1. Requirement Consent of next of kin Law that gives the consent

2. Confirmation Clinical findings of research Correlate tissue changes to
criminal act
3. Emphasis Notation at all abnormal findings Effect of wrongful act
4. Conclusion Summation of all abnormal findings Specific to the purpose
5. Minor Need not be mentioned Included if useful

The following manner of death should be autopsied:

1. Death by violence
2. Accidental deaths
3. Suicides
4. Sudden death of persons who are In good health
5. Death unattended by physician
6. D.O.A. with no clinical diagnosis
7. Death occurring in an unnatural manner

Mistakes in autopsy:
1. Error or omission in the collection of evidence for identification
2. Errors or omission in the collection of evidence required fro establishing
the time of death
3. Errors or omission In the collection of evidence required fro the medico-
legal examination.
4. Errors or omission result in the production of undesirable artifacts or in
the destruction of val fd evidence.

Negative autopsies
- If after all efforts Including gross and microscopic studies and toxicological
analysis fall to reveal a cause of death.

Negligent autopsy
No cause of death is found due to Imprudence, negligence, lack of skill, lack of
foresight.

24
CAUSES OF DEATH

Primary purpose of a medico-legal autopsy:

Determination of the cause of death.
Death is the direct and the proximate consequence of the criminal or negligent act.

Defense wounds on the victim: Qualify the crime to homicide.

Series of cuts in the borders of the wound: Multiple trust- intent to kill.

Cause of death: is the injury or disease or both which initiates the physiological
disturbance resulting to a fatal termination.

1. Immediate or Primary cause of death- when injury or disease kills quickly

the victim and no opportunity for complications to develop.
Ex: extensive brain injury
2. Proximate cause or Secondary cause· the injury or disease was survived
for a longer period

Mechanism of death: is the physiologic derangement or biochemical

disturbance incompatible with life which is initiated by the cause of death.
Ex: Hemorrhagic shock, pulmonary depress ion, cardiac arrest,
tamponade metabolic problem.

Manner of death: is the explanation as to how the cause of death arose.

1. Natural death -fatality is cause solely by disease. Ex: pneumonia, cancer
2.Violent or unnatural death - due to injury

Medico-legal masquerade· violent deaths may be accompanied by minimal or

no external evidence of injury or natural death where signs of violence may be
present.

Degree of Certainty to the cause of death:

1. Structural abnormalities established beyond doubt the cause of death. Ex. SW
with H.
2. Degree of probability amounting to the cause of death. Ex: Electrical shock
3. History establishes cause of death and confirmed by anatomic or chemical

25
 findings.
4. When neither history, laboratory and anatomic findings, taken individually or in
combination is sufficient to determine the cause of death but merely speculate
as to the cause of death. Ex. Crib death among Infants.

Steps in the Intellectual Process in the determination of the cause of death:

1. Recognition of the structural organic changes or chemical abnormalities

responsible for the cessation of vital functions.
2. Understanding and exposition of the mechanism by which the anatomic and
other deviations from normal caused the death.

Instantaneous physiologic death or Death from inhibition. death from primary

shock, Syncope with instantaneous exitus.
This is sudden death which is cause within seconds or minute or two after
a minor trauma or peripheral stimulation of relatively simple nature.
The peripheral stimulation initiates the cardlo-vascular inhibitory reflex.
Ex: Vagocardiac slowing or stoppage of the heart.
Blow to the larynx. solar plexus, scrotum, pressure to the carotid sinus.

Diseases with no specific findings of a disease:

1. Sudden infant death syndrome (SIDS) or crib death
2. Sudden unexplained nocturnal death (SUND)

DO A - means actually dead or dying, provided the physician had not been given
ample opportunity to arrive at a working diagnosis as to the cause of death.

Undetermined - if the physician cannot determine the cause of death.

MEDICO-LEGAL CLASSIFICATION OF THE CAUSES OF DEATH

a. Natural death - cause by natural disease condition in the body.

b. Violent death
1. Accidental death
2. Negligent death
3. lnfanticidal death
4. Parricidal death
5. Murder
6. Homicidal death

26
If signs of violence are associated with the natural cause of death:

• Did the person die of a natural cause and were the physical injuries
inflicted immediately after death?
- violence applied in a dead person: Impossible crime.

•Was the victim suffering from a natural disease and the violence only
accelerate the death?
= Offender responsible of the death of the victim.
=Criminal liability shall be incurred by any person committing a felony
although the wrongful act done be different from which he intended.
(Art.4 no. 1 RPC)

• Did the victim die of a natural cause independent of the violence inflicted?
- accused will not be responsible for the death but merely for the physical
injuries he had inflicted. Ex. Slapping a person with heart problem. only
slight physical injury.

- to make the offender liable for the death of the victim, it must be proven that
the death Is the natural consequence of the physical Injuries i nft icted.

The following are deaths due to natural causes:

1. Affection of the CNS
a. Cerebral apoplexy- sudden loss of consciousness followed by paralysis or
death due to Hemorrhage from thrombosis or
embolism in the cerebral vessels.
b. Abscess of the brain
c. Meningitis of the fulminant type

2. Affection of the circulatory system

a. Occlusion of the coronary vessels :
=most common cause of Sudden death due to natural causes.
b. Fatty or myocardial degeneration of the heart.
c. Rupture of the aneurysm of the aorta
d. Valvular heart disease
e. Rupture of the heart

3. Affections of the Respiratory system

a. Acute edema of the larynx
b. Tumor of the larynx
c. Diptheria
d. Edema of the lungs
e. Pulmonary embolism
f. Lobar pneumonia
g. Pulmonary hemorrhage

27
4. Affections of the GIT
a. Ruptured PUD
b. Acute intestinal obstruction

5. Affections of the GUT

a. Acute strangulated hernia
b. Ruptured tubal pregnancy
c. Ovarian cyst with twisted pedicle

6. Affection of the glands

a. Status thymico-lymphaticus
b. Acute hemorrhagic pancreatitis

7. Sudden death in young children

a. Bronchitis
b. Congestions of the lungs
c. Acute broncho-pneumonia
d. Acute gastroenteritis
e. Convulsion
r. Spasm of the larynx

B. Violent death
- are due to injuries inflicted In the body by some forms of outside force.
The physical injury must be the pro xi mate cause of death.
=That the victim at the time the physical injuries were Inflicted was
in normal health.
=That the death may be expected from the physical Injuries inflicted.
= That the death ensued wi thl n a reasonable time.

CLASSIFICATION OF TRAUMA OR INJURIES

1. Physical injury-trauma sustained through the use of physical force.

2. Thermal injury - injury by heat or cold
3. Electrical injury- electrical energy.
4. Atmospheric injury - due to change of atmospheric pressure.
5. Chemical Injury- chemicals
6. Radiation Injury - radiation
7. Infection - microbic lnvasi on

28
PENAL CLASSIFICATION OF VIOLENT DEATHS
1. Accidental deaths - due to misadventure or accident.
Art. 12 no. 4 RPC
Any person who while performing a lawful act with due care, causes an
injury by mere accident without fault or intention of causing it.
Ex. Patient died of ATS injection after proper skin test.

2. Negligent death - felonies may be committed when the wrongful act is due to
reckless imprudence, negligence, lack of skill or foresight.
Ex. Surgeon left a pack - Homicide through reckless imprudence

3. Suicidal death • destruction of one's self

- not punished, unfortunate being.
- Art 253 RPC Giving assistance to suicide. Punishable because he has no
right to destroy or assist in the destruction of life of another.

4. Parricidal deaths
Art. 246 father, mother. child, (leg/illeg) ascendant. descendant, spouse (leg.)

5. tnfanticidal deaths - Art. 255 killing of a child less than 3 days

6. Murder Art. 248

- treachery, consideration, means of inundation. occasion of calamities.
- evident pre-meditation, cruelty

7. Homicidal deaths Art 249

DEATHS UNDER SPECIAL CIRCUMSTANCES

1. Death caused in a tumultuous affray Art 251.
2. Deaths or physical injuries inflicted under exceptional
circumstances. Art 247

2. PATHOLOGICAL CLASSIFICATION OF THE CAUSES OF DEATH

a. Death due to syncope - fatal and sudden cessation of the action of the
heart.

b. Death from asphyxia - a condition In which the supply of oxygen to the

blood or to the tissues or to both has been reduced below normal working
level.
Stage of Increasing dyspnea 1 min
Stage of Expiratory convulsion
Stage of exhaustion 3 min

c. Death from coma

29
SPECIAL DEATHS
l . Judicial deaths -Art. Ill Sec.1 Par. 19 Phil. Const. "cruel and
unusual punishment shall not be inflicted. ; electrocution, hanging,
musketry, gas chamber.
2. Euthanasia or mercy killing
3. Suicide
Automatism - due to drug may be considered as accidental
rather than suicidal.

Evidences that will infer death is suicidal:

1. History of depression, mental disease.

2. Previous attempt
3. Injuries are located in areas accessible to hand.
4. Effects of the act of self-destruction may be found in the victim;. empty
bottle
5. Presence of suicidal note.
6. Secluded, not in public view.
7. Evidences which rule out H,M, P

4. Death from starvation :

Cause may be due to suicidal, homicidal or accidental.

The human body without food losses 1/24'" of its weight daily.
And 40% loss>death

Factors that influence the length of survival: age, condition of the body, sex,
environment.

30
DISPOSAL OF THE DEAD BODY

Sec.1103 Revised Administrative Code : Persons charged with the duty of burial.
1. Deceased was married: the surviving spouse
2. If unmarried: the nearest of kin of the deceased; adults, within the Phil.
And in poss es sion of sufficient means to defray the necessary expenses.
3. If none of the above - municipal authorities.

Sec 1104 RAC Right of custody

Any person charged by law with the study of burying the body of a deceased
person is entitled to the custody of such body for the purpose of burying it, except
when an inquest is required by law for the purpose of determining the cause of
death.
If communicable, the local board of health or local health officer or municipal
council.

Concept of possession - the right of custody over a dead body .. The right of
custody does not mean ownership of the dead body.

Executors right of custody superior to the right of spouse dead body. An executor
is the person mentioned in a will who will carry on the provision of the will. In the
absence of a testamentary disposition. the right of the surviving spouse is
paramount.

METHODS OF DISPOSAL OF THE DEAD BODY

I. Embalming- 6 to 8 quarts of antiseptic solutions of formalin, perchloride
of mercury or arsenic which is carried into the internal carotids and the
femoral arteries.

2. Burial or inhumation
a. Sec 1092 RAC buried within 48 hours if unembalmed.
Within 12 hours, if communicable.

Except: 1. Subject of legal investigation.

2. Authorized by the local health authorities that may be buried
more than 48H.
3. Impliedly when embalmed.

b. Death certificate necessary before burial:

Sec. 1087 RAC Requirement of Death Cert. and the duty of the
physician to issue or the local health officer, or if none by the mayor,
secretary, councilor of the municipality to issue the certificate ..

Sec 91 P .D. 856 Code of Sanitation ; Burial requirement:

- death cert., issued by physician.

3t
 c. Permission from the Provincial fiscal or from the municipal mayor.
Is necessary if death is due to violence or crime.
=Sec. 91 (f) P.O. 856 Code of Sanitation

Sec. 1094 Revised Administrative Code - Disposition of body and

belonging of person dying of dangerous communicable disease.
Ex. Meningococcemia in Bagiuo City
1. The body of a person who died of any dangerous communicable
disease shall not be carried form place to place except for burial or
cremation.
2. Duty of the local health official to disinfect the body before being
prepared for burial; the furniture, house, either disinfect or burned if
capable of conveying infection.

Sec. 91 (h) P.O. 856 Code of Sanitation

1. Remains shall be buried within 12 hours after death. Cause of death is
due to a dangerous communicable disease;
2. Not to be taken any place of public assembly.
3. Only adult members of the deceased are allowed to attend the funeral.

Sec. 1091 RAC Death Certificate must be presented before burial.

Sec. 1099 the placing of the body of any deceased person In an unsealed
overground tomb Is prohibited unless if permanently sealed.

Except: 1. Tombs and vaults which are strictly receiving vaults for bodies or
remains awaiting final disposition.
2. Embalmed bodies awaiting final disposition.

Sec. 1100 of RAC, Sec. 91© of P.O. 856 Code of Sanitation

The depth of the grave must be at least 1 Yi meters deep, rilled well and
firmly.

Sec. 2695 RAC Penalizes the desecration of burial premises; tombstone, plant,
tree, fence, post or wall. P200/ not greater than 6 months.

Sec. 90 code of Sanitation Burial Grounds requirements

1. It shall be unlawful for any person to bury the remains In places other than
those legally authorized .
2. At least 25 meters from any dwelling house and no house s hal I be
constructed within the same distance from any burial ground.
3. Not within 50 meters from any water source.

Other burial requirements:

1. Shipment of remains abroad shall be governed by the rules and
regulations of the Bureau of Quarantine.

32
 2. The burial or remains in city or municipal grounds shall not be pro hi bi ted
due to race, nationality, religious or political reasons.
3. Except when required by legal Investigation or when permitted by the local
health authority, no embalmed remains shall remain unburied longer than
48 hours.

FUNERALS

Art. 305 CC The duty and the right to make arrangements for the funeral of a
relative shall be in accordance with the order of support under Art. 294.

Descendants : Eldest
Ascendants : Paternal

For support as mentioned in Art. 294

1. Spouse
2. The descendants of the nearest degree
3. Ascendant of the nearest degree
4. Brothers and sisters

Art. 306 CC; In keeping with the social position of the deceased.

Art. 307 CC; In accordance to the expressed wishes of the deceased.

Art. 309 CC: Showing of disrespect to the dead shall be liable to the family of
the deceased for damages. materials or moral.

Art. 132 RPC: Interruption ror religious worship.

Art 133 RPC: Offending the religious feeling

Art. 2219 CC: Provides for the moral damages may be recovered for acts
mentioned in Art. 309 CC.

LIMITATIONS TO THE FUNERAL RITES

1. Will of the deceased.
2. Burial of a person sentenced to death must not be held with pomp.
3. Restrictions as to funeral ceremonies In cases of deaths due to
communicable disease.

3. Disposing of the dead body in the sea

Provided the deceased Is not suffering from dangerous communicable
deceased.
Sec. 1093 RAC Permit for conveyance of body to sea for burial.

33
4. Cremation- is the pulverization of the body into ashes
by the application of heat.
First must be identified,
Permit and in a crematory made for the purpose.

NOT GRANTED:
a. If the deceased left a note.
b. Identity of the person is not definite.
c. Exact cause of death cannot be ascertained and the need for
further inquiry or examination.

5. Use of body for scientific purposes

- Corpse of prisoners
- Any person to be buried for public expense and which is unclaimed for 24
hours.

Sec. 98 P .0. 856 Code of Sanitation

Special precautions for safe handling of cadavers containing radioactive
isotopes.

RA 349 as amended by RA 1056 Permission to use Human organs or any

portions of the human body for medical, surgical or scientific purposes
under certain conditions.
- in writing, specific use, signed by the grantor and two disinterested witness.

Sec. 96 Code of Sanitation; Donation of human organs for medical •

surgical and scientific purposes according to the Sanitation Code.

Persons permitted to detach human organs:

1. Licensed physicians
2. Known scientist
3. Medical or scientific Institutions

Requirements for a valid authorization

1. It must be In writing
2. It must specify the person or Institution grated the authorization.
3. Must specify the organ or part to be removed.
4. Signed by the grantor and two disinterested person.
5. Copy of the authorization must bc subrnittcd to the Sccretnryof'Hcalth.
EXHUMATION
The deceased buried may be raised or disinterred upon the lawful order of the
proper authorities.

Sec 1082 RAC Cemetery permits even to NBI agents

Sec. 1097 RAC Exhumation in case of death from dangerous
communicable disease after 5 years from burial.

34
Sec 92 Code of Sanitation
3 years if non-dangerous communicable disease.
Remains shall disinfected before burial.

Requirements to be satisfied in exhumation:

1. Duration of interment as required.
2. Exhumation permit
3. Compliance of sanitary requirements

Procedures followed in Medicolegal Exhumations:

1. A formal request from any of the law enforcement agency or any person
authorized by law.
a. Name of the person, place of interment, date of interment,
suspicion as to cause of death.
b. To determine the cause of death.
c. To determine as to identity of the person.
d. To recover organs or tissues for further examination for:
= Toxicological analysis
= Hi stop a th exams
= Smears from vaginal canal and blood for alcohol determination

2. Set the date and time of exhumation, if physician has a strong reason to
believe that for the justification and strong probability.

3. Written request to the Regional director or Secretary of Health.

4. Grave must be properly identified by the person who was present when
the body was interred.

5. After opening the coffin. the body must be viewed by any person who can
identify the deceased.

6. Actual autopsy and adoption of the procedure is needed to accomplish the

purpose of the exhumation.

7. Dis infection of the body and all areas Involved must be carried out with the
assistance of the local health officer and the return of the body to the
burial place.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES

Physical injury: is the effect of some of stimulus on the body.

Stab wound the effect is immediate but a
blunt object is delayed production on the contusion.

Causes of Physical Injuries

1. Physical violence
2. Heat or cold

35
 3. Electrical energy
4. Chemical energy
5. Radiation by radioactive substances
6. Change of atmospheric pressure
7. Infection

1. PHYSICAL INJURIES BROUGHT ABOUT BY PHYSICAL VIOLENCE

= The effect of the application of physical injury on person is the

production of wound.
= A disruption of the anatomic integrity of the tissues of the body.
= However, not all physical violence will result in the production of wound.

Physics of wound production:

MV2
a. Kinetic energy =
2

Velocity component is the Important factor:

M16 rifle with a velocity of 3200 IV sec causes damage more
than a heavier .38 caliber.

b. Time
= The shorter the period of time needed for the transfer of energy,
the greater the likelihood of producing damage.
= If a person is hit on the body and the body moves towards the
direction of the force applied, the Injury Is less as when the body
Is stationary.
= The longer the time of contact between the object or instrument
causing the injury, the greater will be the dissipation of energy.

c. Area of transfer
=The larger the area of contact between the force applied on the
body, the lesser the damage to the body.
= By applying an equal force, the damage caused by stabbing is
greater compared to a blunt instrument.
d. Other factors
= The less elastic and plastic the tissue > the greater that a
laceration wi II result.

= Elasticity :
Ability of the tissue to return to its normal sizes and shape after
being deformed by a pressure.

= A force transmitted through a tissue containing fluid will force the

fluid away from the area of contact in all directions equally,
frequently causing the tissue to lacerate.

36
VITAL REACTION

= It is the sum total of all reactions of tissue or organ to trauma, either

observed micro or macroscopically.

a. RUBOR- redness or congestion of the area due to an increase of blood

supply as a part of the reparative mechanism.

b. CAL OR - Sensation of heat or increase in temperature.

c. DOLOR - pain due to involvement of the sensory nerve.

d. LOSS OF FUNCTION- due to trauma, the tissue may not function.

The presence of vital reaction difterenUates an ante-mortem from a post-mortem

injury.

EXCEPT: vital reactions not seen even if injury inflicted during life:
1. During agonal state of a living person were cells don't react to the
trauma.
2. Sudden death as in sudden coronary occlusion.

CLASSIFICATION OFWOUNDS:
1. AS TO SEVERITY
a. Mortal wound- caused immediately after Infliction that is capable of
death.
Parts of body that are mortal - heart, vessels, CNS, lungs, other organs.

b. Non-mortal wound - Not capable of producing death after infliction.

2. AS TO KIND OF INSTRUMENT USED

a. Blunt instrument- contusion. hematoma, lacerated wound.

37
 b. Sharp instrument
= Sharp-edge instrument> incised wound
= Sharp pointed > punctured wound
= Sharp edge and sharp-pointed > stab

c. Wounds brought about by tearing force - lacerated wound

d. By change in atmospheric pressure - barotraumas.
e. Wounds brought about by heat or cold - frostbite, scald, burns.

L Wounds brought about by chemical explosion - GSW, shrapnel wound

g. Wounds brought about by infection.

3. AS TO THE MANNER OF INFLICTION

a) HIT - means of bolo, blunt instrument, axe.
b) TRUST or STAB - bayonet dagger
c) GUN POWDER EXPLOSION - Projectile or shrapnel wound.
d) SLIDING or RUBBING or ABRASION

4. AS REGARDS TO THE DEPTH OF THE WOUND

a) Superficial -wound Involves only the layers of the skin.
b) Deep - inner structures beyond the layers of the skin.

PENETRATING WOUND - Wounding agent did not come out or

Piercing a solid organ.

PERFORATING WOUND - Wounding agent produces communication

between the inner and outer portion of the hollow organs.

OR piercing or traversing completely a particular part of the

body causing communication between the points of entry and
exit of the instrument or substance producing it.

5. AS REGARDS TO THE RELA T/ON OF THE SITE OF APPL/CATION OF

FORCE AND THE LOCATION OF INJURY

a. Coup Injury- Physical injury which is located at the site of the

application of force.
b. Contra-coup Injury - opposite the site of the application of force.

c. Coup contra-coup Injury- site and also opposite of application of force.

d. Locus minoris resistencia - Physical injury not located at the site nor
opposite the site of the application of force but In some areas
offering the least resistance to the force appll ed.
Example: Blow in fore head > contusion on the region of the eyeball.

a.Extensive injury- Physical injury involving a greater area of the body

beyond the site of the application of force.

38
 Example: Fall or MVA

6. AS TO REGIONS OR ORGANS OF THE BODY INVOLVED

Injuries in various parts of the body

7. SPECIAL TYPES OF WOUNDS

a) DEFENSE WOUNDS - Instinctive reaction of self-preservation.>
hands/fractures

b)PA TIERNED WOUND - Wound in the nature and shape of the

instrument. > Wheels .abrasions from rope.

c)SELF-INFLICTED WOUNDS - Wound produced on oneself but no

intention to end his life.

Motive of producing self-inflicted wounds:

1. To create or deliberately magnify an existing injury or disease for
pension or workman's compensation.
2. To escape certain obi igations or punishment.
3. To create a new identity.
4. Gain attention or sympathy.
5. Psychotic behaviour.

Some ways of self-mutilation:

1. Head banging or bumping
2. Exposure of body to heat radiation from open fires, radiators
3. Penetrating nail to chest wall
4. Castration by amputation of the penis
5. Trichotillomania- pulling of body hair

LEGAL CLASSIFICATION OF PHYSICAL INJURIES

1. MUTILATION
=Art. 262 RPC Kinds of mutilation:
a. Intentionally depriving a person, totally or partially of some of
the essential organs for reproduction.
b. Intentionally depriving a person of any part or parts of the
human body other than the organs for reproduction.
Mutilation to be punishable It must be intentional or not physical Injury.

MAYHEM - is the unlawful and violent deprival of another of the use of a

part of the body so as to render him less able In fighting, either
to defend himself or to annoy his adversary.

Vasectomy/Tubal ligation are not mutilation and a legitimate method of

contraception despite the fact that it is done intentionally and deprives a person
of his power of reproduction.

39
SERIOUS PHYSICAL INJURIES Art. 263 RPC

Any person who s hal I wound, beat or assault another Art. 263 and
administering injurious substance, without intent to kill Art. 264.

The main purpose of dividing the provision into four paragraphs

a) Is to graduate the penalties depending upon the nature and character of
the wound Inflicted
b) Their consequences on the person of the victim.

1. Prison mayor- because of the physical injuries Inflicted, the injured person
becomes insane, imbecile, impotent or blind.

2. Pris ion correctional in its medium and maximum periods

- loss of speech, hear or smell
- loss of eye, hand, foot, arm, leg
= loss of the use or incapacitated for the habitual work he used to do.

3. Pris ion oorrectional in its minimum and medium periods.

- person injured shall be deformed.
- lost any other part of the body, incapacitated for more than 90 days.

4. Arresto mayor in its maximum period to prision correctional

- If the physical injuries shall have cause the illness or incapacity for
labor for more than 30 days.

Is the offense shall be committed against any of the persons enumerated in

Art. 246 Or with attendance of any of the circumstances mentioned in Art. 248

=The case covered by subdivision number 1 of this art. Will be punished by

reclusion temporal in Its medium and maximum periods.
= Subdivision number 2 by Prlsion correctional in its maximum period to
prisi on mayor in its mi nl mum period.
=Subdivision number 3 by prision correctional In Its medium and maximum
=Subdivision number 4 prision correctional in its minimum and medium periods.

The provisions of the preceding paragraph shall not be applicable to a parent

who shall inflict physical injuries upon his child by excessive chastisement.
RA 7610.

It may be com mi tied through a simple negligence or imprudence.

ADMINISTERING INJURIOUS SUBSTANCE OR BEVERAGES Art 264 RPC

Elements:
1. The offender inflicted upon another any serious physical injury,

40
 2. There is knowledge that the substance or beverage administered is
injurious Or took advantage of the victims weakness of credulity.
3. There is no intent to kill in the part of the offender.
If intentional so> frustrated murder. Treachery is inherent in Art. 264 RPC

LESS SERIOUS PHYSICAL INJURIES Art. 265 RPC

Any person who s hal I inflict upon another physical injuries not described in the
preceding articles,

= But which shall incapacitate the offended party for labor 10 days or more

= 0 r shall require medical attendance for the same period

Both of which is 10 days but not more than 30 days and
there must be proof to it..

The crime of less serious physical injuries may be qualified and a fine of a higher
penalty is imposed when:

1. There is a manifest intent to insult or offend the injured person.

2. There are circumstances adding ignominy to the offense.
3. The victims is the offender's parents, ascendants, guardian, curators,
teachers.
4. The victim is a person of rank or person of authority, provided the crime
Is not direct assault.

P.O. 169 Obligation imposed on Physicians treating persons suffering serious

and less serious physical Injuries required to report to law enforcement agencies.

SLIGHT PHYSICAL INJURIES AND MAL TREATMENT Art 266 RPC

1. Arresto me nor- when the offender has lnfl lcted physical injuries which
shall incapacitate the offended party for labor form 1 to 9 days or shall
require medical attendance of the same period

2. Aresto menor or fine not exceeding P200 and censure when the offender
has cause physical injuries which do not prevent the offended party
from engaging in his habitual work nor require medical attendance.

3. Arresto me nor in its minimum period or a fine not exceeding P50 when the
offender shall ill treat another by deed without causing any injury.

If there is no evidence to show actual injury or incapacity for labor or

period of medical attendance, the accused can only be guilty of slight physical
injuries.

41
 So a tender slap on the face, holding the arm tighdy, application of
pressure in some parts of the body or mild blow which show no sign of physical
violence may still be considered slight physical injuries or maltreatment.
( Parag 3)

PHYSICAL INJURIES INFLICTED IN A TUMULTOUS AFFRAY Art 252 RPC

Elements:

1. There Is a tumultuous affray

2. Participants s uttered from serious physical injuries.
3. The person who inflicted serious physical injuries cannot be identified.
4. All those who appear to have used violence upon the person of the
offended party shall be penalized by arrest from 5 to 15 days.

TYPES OF WOUNDS (MEDICAL CLASSIFICATION)

1. CLOSED WOUND- no breach of continuity of the skin or mucous membrane.

a. Superficial - When the wound is just underneath the layers of the skin
or mucous membrane.

a.1 -PETECHIAE - Is a circumscribed extravasation of blood In the

subcutaneous tissue or underneath the mucous membrane.
Example : mosquito bite, blood disease, hanging

a.2 - CONTUSSION - is the effusion of blood into the tissues

underneath the skin on account of the rupture of the blood
vessels as a result of the application of blunt force or violence.
=size of contusion greater than the size of the object.
= Location of the contusion is not always the site of
application of the force. Example: Black eye> Forehead

Medico-legal point of view:

A contusion as indicated by its external pattern may correspond to the
> shape of the object or weapon used.
Extent > the possible degree of violence applied.
Distribution> indicates the character and manner of injury as in manual
strangulation around the neck.

42
 Age of Contusion: appreciated from its color change

The size tends to become smaller from the periphery to the center
and passes through a series of color changes as a result of the
> Disintegration of the RBC and liberation of hemoglobin.

The contusion is red, purple soon after its complete development.

4 to 5 days > green
7 to 1 0 days > yellow and gradually disappears on the 14•• or 15~ day.

The ultimate disappearance of color varies from 1 to 4 weeks

depending upon the severity and constitution of the body.

The color changes starts at the periphery.

CONTUSION VS. POST-MORTEM HYPOSTASIS

Contusion
Below the epidermis in the true skin In small bruises or extravasations,
below this in larger ones and often much deeper still.
The epidermis has no blood vessels to be ruptured.

Post mortem Hypostasis

In the epidermis or in the cutis as a simple stain or a showing through the
epidermis of the underlying engorged capillaries.

Contusion
Cuticle was probably abraded by the same violence that produced the
bruise. In small punctures such as fleas bites, this Is not observed.

Post-mortem hypostasis
Cuticle unabraded, because the hypostasis Is a mere sinking of the blood,
there is no trauma.

Contusion
A bruise appears at the seat of and surrounding the injury. This may or may
not be a dependent part.

Post-mortem hypostasis
Always in a part which for the ti me of information Is dependent.

43
Contusion
Often elevated because elevated blood and subsequent inflammation swell
the tissues.

Post-mortem hypostasis
Not elevated, because either the blood is still in the vessels or at most has
simply soaked into and stained the tissues.

Contusion
Incision shows blood outside the vessels. This is the most certain test of
difference and can be observed even in very small bruises.

Post-mortem hypostasis
Incision shows the blood is still In its vessels and if any oozing occurs drops
can be seen issuing from the cut mouths of the vessels.

Contusion
Color variegated. This is only true of bruises that are the same days old due
to the changes in the hemoglobin produced during life.
Post-mortem hypostasis
Color is uniform. The well known change in color produced in blood
Extravasated Into living tissues does not occur in dead tissues with the
same regularity.

Contusion
If the body happens to be constricted at or supported on a bruised pl ace,
the actual surface of contact may be a little lighter than the rest of the bruise
but will not be white.

Post-mortem hypostasis
In a place which would otherwise be the seat of hypostasis pressure of any
kind even simple support is sufficient to obliterate the lumen of the venules
and capillaries and so to prevent their filling with blood.

White lines or patches of pressure bordered by the dark color of hypostasis

are produced and marks of Hoggings, strangulation, etc. are thus
sometimes simulated.

FACTORS INFLUENCING THE DEGREE AND EXTENT OF CONTUSSION

1. General condition of the patient.

2. Part of the body affected. Fatty tissues, bloody parts> contused easily
Fibrous areas, muscle >less
3. Amount of force applied - The greater the force, the more effusion of blood.
4. Disease - Contusion may develop with or without application of force.
Example: Aplastic anemia, whooping cough

44
 5. Age - Children and old age tend to bruise easily.
6. Sex - women, obese easily develops unlike boxers.
7. Application of heat and cold

The distinction between ante-mortem and post-mortem contusions in an

undecomposed body is that in ;

1. Ante-mortem bruising: there is swe lllng, damage to epithell um,

extravasation,
coagulation and infiltration of the tissues with blood
2. Post-mortem bruising there are no such findings.

a.3 HEMATOMA
is the extravasation or effusion of blood in a newly formed cavity
underneath the skin. When the blunt instrument hit a hard part of the body
like a bony part which is superficially located.
Force causes the subcutaneous tissue to rupture on account of the
presence of a hard structure underneath ..

DISTINCTION BETWEEN CONTUSION AND HEMATOMA

1. In contusion- the effused blood are accumulated in the Interstices of the

tissues underneath the skin
In hematoma blood accumulates in a newly formed cavity underneath the
skin.

1. In contusion, theskin shows no elevation and is ever elevated, the

elevation is slight and Is on account of i nH ammatory changes
In hematoma - the skin is always eelevated.

2. In contusion, puncture or aspiration with syringe of the lesion, no blood

can be obtained.
In hematoma - shows presence of blood and subsequent depression of
the elevated lesion.

Abscess, gangrene, hypertrophy, fibroid thickening and even malignancy

are potential complications of hematoma.

MUSCULO·SKELETAL INJURIES

1. Sprain - partial or complete disruption in the continuity os a muscular or

ligamentous support of a joint, due to a blow, kick or torsion force.
2. Dis location - displacement of the articular surface of bones entering into
the formation of a joint.
3. Fracture - solution of continuity of bone resulting from violence or some
existing pathology.

45
 a. Close or Simple Fx - no break in continuity of the overlying skin.
b. Open or Compound Fx - Fx is complicated by an open wound
caused by the broken bone which protruded with other tissues of the
broken skin.
c. Comminuted Fx - Fractured bone is fragmented into several pieces.
d. Greenstick Fx - Fx wherein only one side of the bone is broken
while the other is merely bent.
e. Linear Fx - when the Fx forms a crack usually in flat bones.
f. Spiral F x - break in the bones forms a spiral manner as seen in long
bones.
g. Pathologic F x - F x caused by weakness of the bone due to disease.

4. Strain - the over-stretching instead of an actual tearing or the rupture of a

muscle or ligament which may not be associated with the joint.

5. Sublaxation - Incomplete or partial dislocation.

INTERNAL HEMORRHAGE
rupture of blood vessels which may cause hemorrhage due to the
following:
a. Traumatic intracranial hemorrhage.
b. Rupture of parenchymatous organs.
c. Laceration of other part of the body.

CEREBRAL CONCUSSION ( COMMOTIO CEREBRI)

- THE JARRING OR STUNNING OF THE BRAIN CHARACTERIZED BY
MORE OR LESS COMPLETE SUSPENSION OF ITS FUNCTIONS AS A
RESULT OF INJURY TO THE HEAD WHICH LEADS TO SOME COMMOTION
OF THE CEREBRAL SUBSTANCE.

- is more severe when the moving or mobile head struck a fixed hard object
as compared when the head Is fixed and struck by a hard moving object.

Signs and Symptoms

1. unconsciousness which Is more or less complete.
2. muscles are relax and flaccid.
3. eyelids are closed and the conjunctivae are insensitive.
4. surface of the body is pale, cold and clammy.
5. respiration Is slow and sighing.
6. pulse Is rapid, weak, faltering and scarcely perceptible to the fingers.
7. temperature is subnormal.
8. sphincters are relaxed with unconscious evacuation of the bowel and
bladder.
9. reflexes are present but sluggish and In severe cases may be absent.

Loss of memory for events just before the injury is a constant effect of
cerebral concussion and is of medico-legal Importance.

2. OPEN WOUNDS

46
 a. Abrasion (Scratch, graze, impression mark, friction mark )
- it is an Injury characterized by the removal of the superficial epithelial
layer of the skin caused by a rub r friction against a hard rough object.
- Contussion with abrasion = forcible contact before friction occurs.
- the shape varies and the raw surface exudes blood and lymph which later
dries and forms a protective covering as SCAB or CRUST.

Characteristics of abrasion:
1. It develops at the precise point of the force causing it.
2. Grossly or with the aid of a hand lens the injury consists of
parallel linear injuries which are in line with the direction of rub or
friction causing it.
3. It may exhibit the pattern of the wounding material.
4. Usually ignored by attending physician. Medico-legal viewpoint
= abrasions caused by fingernails may indicate struggle or assault
and are usually located in the face, neck, forearms and hands.
= abrasions resulting from friction on rough surfaces are located in
bony parts and are usually associated with contusion or
laceration.
= nature of the abrasion may infer degree of pressure, nature of
the rubbing object and the direction of movement.

5. Abrasion heals in a short time and leaves no scar unless if not

infected or if the whole thickness of the skin is involved.

Forms of abrasion
1. Linear abrasion - appears as a single line. straight or curve.
= pinching with fingernails = curve a.
=sliding the point of a needle= straight linear ab.

2. Multi-linear - develops when the skin is rubbed on a hard rough

object producing several linear marks parallel to one another.
Example: MVA

3. Confluent - linear marks in the skin are almost Indistinguishable

on account of the severity of friction and roughness of the object.

4. Multiple - several abrasions of varying sizes and shapes may be

found In different parts of the body.

Types of abrasion
1. Scratch - caused by sharp pointed object which slides across the skin,
like pin, thorn or fingernail.
- Injury usually parallel to the direction of slide.
= Fingernail scratch > broad at point of commencement with
tailing at the end.
2. Graze - usually caused by forcible contact with rough, hard objects

47
 resulting to irregular removal of the skin surface.
= course indicated by a clean commencement and tags on the end.
3. Impact or imprint abrasion ( patterned abrasion, stamping abrasion,
abrasion a la signature)
- those whose pattern and location provides objective evidence to
show cause, nature of the wounding instrument and !he manner
of assault or death.
= marks of grid of radiator, thread marks of wheel, teeth marks.
4. Pressure or friction abrasion - caused by pressure accompanied by
movement usually observed in hanging or strangulation.
= spiral strands of the rope as seen in the skin in hanging.

Differential diagnosis:
1. Dermal erosion - gradual breakdown or very shallow ulceration of the
skin which Involves only the epidermis and heals without scarring.

2. Marks of insects and fishes bites - skin injury is irregular with no vital
reaction and usually found on angles of the mouth, margins of
nose, eyelids and forehead.

3. Excoriation of the skin by excreta - found in infants and the skin

lesions heals when the cause is removed.
No apparent hi story of rubbing trauma on the affected area.

4. Pressure sore - usually found at the back at the region of bony

prominence. History of longstanding illness, bed ridden.

ANTEMORTEM ABRASION POSTMORTEM ABRASION

COLOR reddish-bronze due to slight yellowish and transparent

exudation of blood

LOCATION any area over bony prominence

Rough handling of the cadaver

VITAL with intravital reaction shows not vital reaction and

REACTION may show remains of damaged is characterized by a separation
Epithelium of the epidermis from
Complete loss of the former.

b, Incised wound ( cut, slash, slice)

- produced by a sharp-edged ( cutting)

- or sharp-linear edge of the instrument like a knife, razor, bolo,

glass etc.

48
 = Impact cut> when there is forcible contact of the cutting instrument
with the body surface.
= Slice cut> when cutting injury is due to the pressure accompanied
with movement of the instrument
= Chopped or Hacked wound > when the wounding instrument is a
heavy cutting instrument like saber
> Injury is severe

Characteristics of incised wound:

1. Edges are clean cut.
2. The wound is straight
3. Usually the wound is shallow near the extremities and deep at the middle
portion.
4. Profuse hemorrhage because of the clean cut on the vessels.
5. Gaping is usually present due to the retraction of the edges.
6. Clothes will also show a clean cut if cut by the instrument.
7. Faster healing if without complications.
8. Incised wound made by broken glasses maybe irregular. needs to be
removed.

Changes that occur in an incised wound:

1. After 12 hours - edges are swollen, adherent with blood and with
leukocyte Infiltration.
2. After 24 hours - proliferation of the vascular endothelium and connective
tissue cells.
3. After 36 to 48 hours -capillary network complete, fibroblasts running at
right angles to the vessels.
4. After 3 to 5 days - vessels show thickening and obliteration.

Why a person suffers from incised wound:

1. As a therapeutic procedure.
2. As a consequence of self-defense
3. Masochist may self-Inflict incised wounds for self-gratification.
4. Addicts and mental patients.

Suicidal wounds - usually located In peculiar parts of the body, accessible to the
hand.
the most common site is the wrist, radial artery and the neck.

Homicidal wounds - usually deep, multiple and involves both accessible and
non-accessible parts.
clothing are usually Involved
Defense and other forms of wounds are present.

49
Accidental wounds - multiple incised wounds observed on the passenger and
driver of MVA due to broken windshields.
kitchen knives in the preparation of food.

SUICIDAL WOUNDS HOMICIDAL WOUNDS

DIRECTION Oblique from below left ear, Usually horizontal below

downwards across front neck the adams apple
just above Adams apple

SEVERITY Usually not so deep and Usually deep and may cause
may only involve trachea, involvement of the carti I age
carotid and esophagus and bones.

SUPERF'L Usually present before the Practically absent but may

CUT commencement of deeper rarely be present when the
wound. victim struggled when attacked

POSIT'N OF May be sitting or facing a Usually victim I ying on bed

THE BODY mirror or standing or In other place.

WOUNDING Firmly grasp (cadaveric spasm) Weapon Is absent

WEAPON or found lying beside the
victim.

BLOOD Bid found in front part of body Bid found at the back of neck.
DISTRIBUTION Hand smeared with blood. Hands are clean.

MOTIVE History of mental depression, Absence of such history

Financial, social problems, alcoholism

PREVIOUS Hx May be present Always absent

Of SELF-DESTRUCT'N

3. STAB WOUNDS - Is produced by the penetration of a sharp and a sharp

edged Instrument like a knife, scissors.
If the sharp edge Is the one that comes in contact with the skin then It is an
Incised wound.
If the sharp pointed portion first come in contact, It is a stab wound.

= surface length may reflect !he width of !he wounding instrument.

50
 = smaller when the wound is not so deep.

= wider if upon withdrawal is not in the same direction as seen in

slashing movement. The presence of an abrasion from the extremity of
the skin defect is In line with direction of the slashing movement.

The extremities of stab wound may show the nature of the instrument used.
a doubled bladed weapon shows both extremities to be sharp.
A single bladed weapon - one of its extremities as rounded and contused,
not seen if instrument is quite thin.

The direction of the surface defect may be useful in the determination of the
possible relative position of the offender and the victim when the wound was
inflicted.

As to whether the wound is slit-like or gaping depends on the direction of the

wound to the Langers I ine.

The depth of the wound may be influence by:

1. size and sharpness of the instrument.
2. area of the body involved
3. the degree of force applied

Hemorrhage is always the most serious oonsequence of stab wound due to

the severance of blood vessels or involvement of bloody organs.

How to describe stab wound:

1. length of the skin defect - edges must be coaptated first

Tailing - the direction of withdrawal of the wounding weapon.
2. condition of the extremities
= sharp extremity > sharpness of the instrument used.
=If Both extremity are sharp> double bladed weapon Is used.
3. condition of the edges.
=edges are regular and clean cut> due to one stabbing act
= serrated or zigzag in appearance > several stabbing wounds ( series
of thrust
and withdrawal.)
4. linear direction of the wound - it may be running vertically, horizontally, or
upward medially or laterally.
5. location of the stab wound - to include exact measurement from
anatomical landmarks.
6. direction of the penetration - must be tridimentional
7. depth of the penetration
8. tissue and organs involved

51
 Stab wounds may be:
A.Suicidal
1. Located over vital parts of the body.
2. Usually solitary
3. Located over covered parts of the body, the clothing is not involved
4. Stab wound is accessible to the hand of the victim
5. Hand of victim is smeared with blood
6. Wounding weapon is firmly grasp by the hand of the victim.
7. If stabbing is accompanied with slashing movement
> the wound tailing a bras ion is seen towards the hand Intl icting
the injury.
8. Suicide not may be present
9. Presence of a motive for self destruction.
1 0. No disturbance in the death scene with wounding instrument found
near the victim.

B. Homicidal - stabbing with homicidal intent is the most oommon

Characteristics:1. Injuries other than stab wound may be present.
2. Stab wound may be located In any part of the body.
3. Usually more than one stab wound
4. A motive for stabbing, if none then the offender either
insane/drugs
5. Disturbance in the crime scene

Medical evidence showing the intent of the offender to kill the victim:
1. there are more than one stab wounds
2. stab wounds located in different parts of the body
3. stab wounds are deep
4. serrated stab wounds means thrust and withdrawal of the wounding
weapon to increase Internal damages.
5. irregular or stellate shape skin defects> due to changing direction of the
weapon with the portion of the Instrument at the level of the skin as the
lever.

52
4. PUNCTURED WOUND - is the result of a thrust of a sharp pointed
instrument.

= External injury is quite small but the depth is to a certain degree.; ice-pick, nail

- Nature of the external Injury depends on the sharpness of the end of the
wounding instrument:
= contusion of the edges> if end is not sharp
= opening may be> round, elliptical, diamond shaped or cruciate.

- External hemorrhage Is limited although internal injuries may be severe.> blood

vessels and bloody organs is fatal if no intervention applied.

- Site of external wound can be easily sealed by dried bid, serum, or clotted bid.
- Punctured wounds are usually accidental

Characteristics:
1. The opening of the skin is very small, wound Is much deeper than it
ls wide.
2. External hemorrhage is limited than intemall y may be severe.
3. Sealing of external opening is favorable for the growth and
multiplication of anaerobic organism like bacillus tetani.

Homicidal -
1. multiple and usually located in different parts of the body.
2. wound are deep
3. there are defense wounds on the victim.
4. signs of struggle In the crime scene.

Suicidal -
1. located In areas of the body where the vital organs are located.
2. usually singular, if multiple located in one area.
3. parts of body involved is accessible by the hand of the victim.
4. clothing usually not Involved.
5. wounding is made while the victim is in sitting or standing position,
bleeding is towards the lower part of the body or clothing.
6. no disturbance in the crime scene.
7. wounding instrument found near the body.

Puncturing wound with puncturing instrument loaded with poison:

1. poison dart - cyanide or nicotine
2. fish spines
3. dog bites with hydrophobia virus
4. Injection of air and poison as a way of euthanasia.

53
5.LACERATED WOUNDS (TEAR, RUPTURE, STRETCH "PUTOK'/
is a tear of the skin and the underlying tis sues due to forcible contact with
a blunt instrument.
May be produced by a hit with a piece of wood, iron bar, fist, stone, butt.
If the force Is applied to a tissue is greater than its cohesive force and
elasficity> the tissue tears and a laceration is produced.

Characteristic:
1. shape and size of the Injury does not correspond to the wounding
instrument
2. tear on the skin is rugged with extremities irregular, ill-defined.
3. injury developed where the blunt force is applied.
4. borders of the wound are contused and swollen.
5. developed in areas where the bone Is superficially I ocated.l ike scalp.
6. examination with the aid of hand I ens shows bridging tissue joining
the edges and hairs bulbs are intact.
7. bleeding is not extensive due to blood vessels are not severed
evenly.
8. heal Ing process is delayed and has a tendency to develop a scar.

Classification of lacerated wounds:

1. Splitting caused by crushing of the skin between two hard objects.

Ex: laceration of scalp hit by a bunt Instrument, cut eyebrow of a boxer.

2. Overslretching of the skin

When pressure is applied on one side of the bone> the skin over the area
will be stretched up to a breaking point to cause laceration and exposure
of the fractured bone.
In avulsion: the edges of the remaining tissue is that of I aceration.

3. Grinding compression
the weight and the grlndl ng movement may cause separation of the skin
with the underlying tissues.

4. Tearing
this may be produced by a semi-sharped edged instrument which causes
irregular edges on the wound like hatchet and choppers.

Lacerated wounds are rarely suicidal.

INCISED WOUNDS LACERATED WOUNDS

54
Edges are clean cut, regular, well defined edges are roughly cut, irregular, ii I-
defined

No contusion or swelling around the swelling and contusion around the

Incised wounds I a cerated wounds

Extremities of the wound are sharp, may be extremities are ill-defined and
irregular
Round, or contused

Examination by means of a hand lens hair bulbs are preserved

Shows that hair bulbs are cut

Healing is faster healing is delayed

Caused by sharp edged instrument caused by a blunt instrument

GAPING OF WOUND
- Separation of the edges especially in deep wound may be due to the
following:
1. mechanical stretching or dilatation
the presence of a mechanical device on the edges to prevent coaptation
will cause separation. Example: drain in an abscess, retractor during
operation.

2. loss of tissue due to:

a. Destruction due to pressure, inftion, cell lysis. burning, chemical reaction.
b. Avulsion or physical or mechanical stretching resulting to separation of a
portion of the tissue.
c. Trimming of the edges - debridement of the skin which come in contact
with the bullet at the entrance and exit of GSW and removal of necrotic materials.

3. retraction of the edges

underneath the skin are dense networks of fibrous and elastic connective
tissue fibers running on the same direction and forming a pattern more or
less present in all persons.
This pattern of fiber arrangement is called cleavage direction or lines of
cleavage of the skin and their linear representation on the skin is called
Langers line.

Practical ways of determining how much of the skin surface is involved in

an injury or disease:

skin functions as a mechanical protection of the body, storage of water.

55
 Determination of how much skin is involved is important in lhe mode of
treatment and prognosis especially in burns, contusion ..
=burns of 70% in children and older age group are fatal.

= rule of nine is used. Head and neck 9% 9%

one upper extremity 9% 18%
front chest and abdomen 18% 18%
posterior chest and abdo 18% 18%
one I ower extremity front 9% 18%
one lower ext(back) 9% 18%
pudendum 1% 1%

Factors responsible for the severity of the wound:

1. Hemorrhage may inti uence the severity of wound by:

a. loss of blood incompatible with life

- blood constitutes 1 /20 of the body weight of an adult.
- 5 to 6 quarts of blood ( one quart is 946 cc)
- loss of 1 /1 O" of its volume will cause no significant change.
- loss of one quart> fainting
- loss of 113"' to 2/5~ > irreversible shock
- males can wilhstand more loss of blood than females.
- hypertension causes more excessive and rapid bleeding.

b. Hemorrhage may result in an increase in pressure in or on the vital

organs to affect the normal function.
- i ntracranial hemorrhage cause compression of the vital centers of
the brain.
- hemopericardium > pericardia! tamp
- hemorrhage to the chest> diminution of the respiratory output>anoxia.

c .. Hemorrhage may cause mechanical barriers to the function of organs.

- into tracheo-bronchial I umi na> asphyxia
- into muscles> disturbance in their contractility.

Causes of hemorrhage:
a. trauma - destruction of its blood vessel wall
b. natural causes
- lntracerebral hemorrhage(apoplexy)> lenticulostraite br. MCA
- Spontaneous subarachnoid hemorrhage> saccular berry aneurysm
- rupture of arteriosclerotic aneurysm

56
 - rupture of esophageal varices
- pulmonary hemorrhage due to PTB, lung abscess, bronchiectasis
- ruptured ectopic pregnancy

2. Size of injury - burns greater than 1/3"' of the body are fatal

3. Organs involved - usually fatal to heart, brain, lungs.

4. Shock - blow to genitalia, slight burns to young and old.

5. Foreign body or substance introduced into the body - bacterial, viral, foreign
body, chemical,

TOXIN.
I. snake bites> 2 punctured wds at the center of the reddened affected area.
The venom is Injected through its fangs which is connected to the poison
gland.

Snake venom toxicity will depend on:

1. potency of venom injected
2. amount of venom lnj acted by the fang wll I depend on
- season of the year
- the length of time the snake has eaten.
- if a snake has just killed its prey> toxic content Is smaller.
3. size of the patient
4. immediate treatment instituted.

Snake venoms are two principal classes:

1. Neurotoxic - primarily paralysis the respiratory and cardiac center of the brain.
- may cause N,V. ascending paralysis, coma, convulsion. c/p arrest

2. Hematoxic - affects particularly the blood

- manifestations are pain, swelling on the affected area, tV hemolysis,
N,V, pulmonary and cardiac edema.

Emergency treatment may be:

1. Incision of the wound to promote more external hemorrhage to drain the
venom.
2. tourniquette above the site of the wound
3. placing ice on the bite site
4. sucking the wound to drain venom with the mouth
5. administration of anti-snake venom serum.

57
 2. Scorpion venom
- venom has toxic, hemolytic, hemorrhagic
- one punctured wound on the center of a reddened area
- pain, edema and reddening

3. Coelenterate sting (jellyfish )

- tentacles penetrate Into the skin and cause explosion of the nematocyst
and liberation of the venom.
- extreme pain. Urticaria! rash, dilated pupils, paleness, labored breathing

6. Absence of medical or surgical intervention - wound may not be fatal but

due to neglect or ignorance of its management, may be serious and fatal.

FATAL EFFECT OF WOUNDS:

1. Wounds may be directly fatal by reason of:
a. hemorrhage - neck due to carotid bleed.
b. Mechanical Injuries on vital organs
c. shock

2. Wounds may be indirectly fatal by reason of:

a. secondary hemorrhage following sepsis
b. specific infection
c. scarring effect
d. secondary shock

NATURE OF DEA TH DUE TO SECONDARY CAUSES

1. Changes whose natural sequence are direct & obvious - sepsis, tetanus
2. Changes producing separate pathological I esions which In turn proves to
be fatal
Ex: operation to ligate vessel but died of peritonitis despite diligence/skill
3. Changes where a definite pathological condition was present before the
injury. Ex. Person with tumor and stabbed . stab is not capable of death
but accused Is responsible for his death.
4. Changes where a definite pathological condition of totally different nature
arises after the wounding and the consequential sequence Is doubtful.
Ex. TB meningitis ffg blow to the head

COMPLICATIONS OF TRAUMA OR INJURY

1. Shock due to injury to nervous system, anoxemia, endothelial damage
2. Hemorrhage
3. Infection
a. from the instrument
b. from the organs involved in trauma ex. Bowels Injured
c. injury may depress general vitality
d. deliberate Intro of micro-organism
4. Embolism

58
HEALING OF WOUNDS
1. Power of the human tissue to regenerate - replaced the destroyed tissue
by newly formed similar tissue.

Regenerates rapidly: C.T., blood forming tissues.surface epith. skin

Slow to regenrate:sm. Muscles, neurons of CNS, highly specialized
glandular tis s.

Time or healing is dependent on:

a. vascularity
b. age of person
c. degree of rest or immobilization
d. nature of the Injury

2. Aberrated healing process:

a. formation of exuberant granulation or proud flesh
b. keloid formation
c. stricture
d. fistula or sinus formation

MEDICO-LEGAL INVESTIGATION OF WOUNDS

Rule to follow by a physician:

1. all injuries must be described
2. description of wound must be comprehensive, sketch/photograph
3. examination must be influenced be any other information obtained from
others in making a report or a conclusion.

Outline of the medico-legal investigation of physical injuries:

1. General investigation of the surroundings:
a. examination of place where crime is committed.
b. Examination of clothing, stains, cuts, hair, f.b. in the crime scene
c. Investigations on possible witnesses to the incident
d. Examination of the wounding instrument
e. Photography, sketching, accurate description of the crime scene.

2. Examination of the wounded body

a. examinations applicable to living or the dead
- age of the wound rrom the degree of healing
- determination of the weapon used

59
 - reasons for the multiplicity of wounds
- determination if the wound is accidental, suicidal or homicidal

b. examination applicable only to the living

- determination if injury is fatal
- determination if injury will produce permanent deformity
- determination if wound produces shock
- determination if wound produces complications

c. examination applicable to a dead victim only

- determination if wound is pre-mortem or post-mortem
- determination whether wound is mortal or not
- determination whether death is accelerated by a disease present at time
of injury.
- determination whether wound cause by A,S, H

3. Examinations of wound
- character of wound : abrasion, hematoma, laceration etc
- location of wound : from some fixed area
> to determine trajectory/course
- depth of wound : not in the living , only if the outer and inner are fixed
- condi lions of the s urroundlngs of the wound -
= near GSW- burning, tattooing
= suicidal cuts - superficial tentative cuts or hesitation cuts
= lacerated wounds - contusion on neighboring skin
- extent of the wound
= extensive injury- marked degree of force applied in the
production of the wound.
= homicidal cutthroats are deeper, extensive, numerous than
suicide
- direction of the wound> lmpt. in the position of the victim to the offender
- number of wounds - several> homicidal

- condi lions of locality

a. degree of hemorrhage
b. evidence of struggle
c. information as to the position of the body
d. presence of suicide note
e. condition of the weapon

ANTE-MORTEM WOUNDS POST-MORTEM WOUNDS

HEMORRHAGE More profuse, arterial SI ight or none, venous

due to loss of tone of vessels,
Absence of heart action
Post-mortem clotting of

60
 blood inside b.v.

Marks of spouting of blood No spouting of blood

from arteries

Clotted blood Bid not clotted.or soft clot

SIGNS OF Inflammation & reparative None

INFLAMMATION process
Swelling in the area,
Effusion of lymph, pus
Adhesion of the edges
Unless if victim is weakened

SIGNS OF Fibrin formation No time of repair

REPAIR growth of epithelium
Scab or scar formation

RETRACTION Deep staining of the edges Not deeply stained

OF THE EDGES and cellular tissues can be removed by washing
OF THE WOUND which is not removed by washing

Edges gape owing to the reaction
of the skin and muscle fibers
Edges do not gape, but are
closely approximated to
Each other unless if the
wound is 1 to 2 hrs
after death

DETERMINATIONS IF WOUND IS:

HOMICIDAL SUICIDAL ACCIDENTAL

ABRASIONS Not common unless Rarely observed Extensive

If dragged abrasions WNA
Or If victim res isled

CONTUSION Rare except when Found in any portion

jumping from a height of the body - Fall

INCISED Commonly observed Commonly observed Frequent but rarely

WOUNDS •depth, location and surroundings cause of death

Points to consider in the determinat'n as to whether the wounds is A, S, H.

61
 1. external signs and circumstances related to the position and attitude of the
body when found.
2. location of the weapon or the manner in which it was held
3. the motive in the commission of the crime
4. the personal character of the deceased
5. the possibility for the offender to have purposely changed the truth of the
condition.
6. other information
a. signs of struggle
b. number and direction of wounds
c. direction of wound
d. nature and extent of the wound
e. slate of clothing

LENGTH OF TIME OF SURVIVAL OF THE VICTIM AFTER INFLICTION OF

THE WOUND

1. degree or healing> signs of repair of wound appear in less than a day after
the infliction of injury.
2. changes In the body in relation to the time of death >systematic changes
a
In the body = was ng, anemia, bed sore.
3. age of blood stain - not reliable
4. testimony of witness when the wound was inflicted.

POSSIBLE INSTRUMENTS WHEN USED BY THE ASSAILANT IN

INFLICTING THE INJURIES

1. contusion - blunt
2. lncls ed wound - sharp-edged instrument
3. lacerated wounds- blunt
4. punctured wounds - sharp pointed
5. abrasion - body surface is rubbed on a hard surface
6. GSW - the diameter of the wound of entrance may approximate the
caliber of the wounding Instrument.

Could the injury have been inflicted by a special weapon?

A physician cant determine that a specific weapon was used in innicting a
wound.
It is possible that it is caused by a certain Instrument presented.
He must be cautious In giving categoric statements

Which of the injuries sustained by the victim caused death?

Ir with conspiracy - no need coz the act of one Is the act of all.

62
 If none- offenders are only responsible for their individual acts.

Ir multiple injuries: which of the wound injured a vital organ.

Or if same organ which caused the degree of damage.

Which of the wounds was inflicted first?

If multiple for the qualification of the offense committed.
First - treachery , murder
Last - homicide
Consider:
1. relative position of the assailant and the victim when the first injury was
inflicted on the latter.
2. trajectory/course of the wound inside the body of the victim
3. organs Involved and the degree of injury
4. testimony of witness
5. presence of defense wounds - inflicted fl rst.

Effect of medical and surgical intervention on the death:

If death fol lowed after operation> offender Is responsible if death was
inevitable and that even with operation death is normal and direct oonsequence
of the injury, and the physician Is competent and in spite of exercise of degree of
diligence still death Is the outcome.

If death ensued even the wounds are minor, and death due to the negligence
or incompetence of the physician then !he offender cant be responsible.

Effect of negligence of the injured person on the death

If death occurred from oompl ications arising from a simple injury owing to the
negligence of the injured person In its proper care and treatment
= the offender is responsible for the death
= a person is not bound to submit himself to medical tx for the injuries
received during the assault.
=unless ir it is proven that the negligence of the victim is deliberate so
offender is not responsible but only for physical lnj uries.

Power of volitional acts of the victim after receiving a fatal injury:

= dying declaration, attempt to kill the offender after the first blow of the offender

Relative position of the victim and assailant when injury was inflicted:
1. location of the wound
2. direction of the wound
3. nature of Instrument used In infllcti ng the lnj ury
4. testimony of the witness

63
EXTRINSIC EVIDENCES OF THE WOUNDS

1. evidences from the wounding weapon

= position of the weapon - near or grasp by victim
=blood on weapon - may be stained with blood
= hair and other substance on weapon

2. evidences in the clothing of the victim

= soaked with blood - hemorrhage
= gunpowder - distance
= tears - struggle

3. evidences derived from the examination of the assailant

=paraffin test, tears In clothing, blood stains, intoxication etc.

4. evidences derived from the crime scene

= amount of hemorrhage. wounding Instrument etc.

PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY

1. HEADANDNECK
= not be underestimated
= bleeding from ears, nose, mouth > basal fractures
= may have normal x-rays yet with severe head injury

Factors influencing the degree and extent of head injuries :

a. nature of the wounding weapon> degree of violence applied
depends on the thickness of the scalp and the weight of the
weapon.
b. Intensity if the force > intensity and heavy agent
c. point of impact >extensive in fx of vaults at side or back
d. mob ii ity of the skull at the application of force
if head is mobile, free> effect on the brain is due to the shearing
movement imparted to the brain.
> may produce contusion, laceration without fx.

If head is fixed and unsupported> jarring movement of the brain is absenl

but the fracture Is extensive.

Head injuries are classified as to the site of the appllcation of force:

64
1. Direct or Coup injuries
2. Indirect injuries
a. contr-coup injuries
b. remote Injuries - fall hitting buttocks> basal fx
c. locus minoris resistencia - injury in areas with less resistance
3. Coup-contra-coup Injuries (direct and indirect injuries)

Wounds in the Scalp:

1. it is difficult to prevent the spread of infection
2. there is proximity of the scalp to the brain
3. there are free vascular connection between the structures inside and
outside the brain
4. it is frequently difficult to determine the extent of damage of the skull.

FRACTURES OF THE SKULL p. 302

GUNSHOT WOUNDS

Death or physical injuries brought about by powdered propelled

substances:
1. Firearm shot
= the injury is caused by the missile propelled by the explosion of the
gunpowder located in the cartridge shell and the rear of the missile.

2. detonation of high explosives - grenades

=explosion inside the metallic container will cause fragmentation of the
oontainer.

I. FIREARM WOUND

= Firearm : is an instrument used for the propulsion of a projectile by the

expansive force of gasses coming from the burning of gunpowder.
(technical definition)

=Includes rifles, muskets, shotguns, revolvers, pistols, other deadly weapons

which a bullet. ball, shell or other missile may be discharged by means of
gunpowder or other explosives.

=includes air ritle except of small calibers and limited range.

= the barrel of any firearm shall be considered as a complete firearm for all

65
 purposes thereof.

Penal provisions of laws relative to firearm:

a. Sec. 2692 RAC - unlawful manufacture, dealing in acquisition,

disposition or possession of firearms or ammunitions therefore or
Instrument used or intended lo be used in the manufacture of
firearms or ammunition.

b. Sec. 2690 RAC - selling of firearms to unlicensed purchaser.

c. Sec. 2691 RAC - failure of personal representative of deceased

licensee to surrender firearm.

d. Arl 155 RPC - Alarms and Scandals

e.Arl. 254 RPC - Discharge of firearms

CLASSIFICATION OF SMALL FIREARMS:

Small firearms - are those which propel projectile of less than 1 inch in diameter.
1. as to wounding power:
= low velocity firearm >muzzle velocity of not more than 1400 ft per sec.
Ex. Revolver
= high power firearm > muzzle velocity more than 1400 ft. per second
> usual Is 2200 to 2500 ft per second or more.

2.as to nature of the bore:

= smooth bore weapon >inside portion of the barrel that is perfectly smooth
from the firing chamber to the muzzle. Ex. shotgun
= rifled bore firearm > the bore of the barrel with a number of spiral lands
and grooves which run parallel with one another but twisted spirally from
breech to muzzle. Ex. Military rifle

3. as to manner of firing
=pistol - fired with a single shot Ex. Revolver
= rifle - may be fired from the shoulder Ex. Shotgun

4. As to the nature of the magazine

=cylindrical revolving magazine - the cartridge is located in a cylindrical
magazine which rotates at the rear portion of the barrel
Ex. Revolver
=vertical or horizontal magazine - the cartridge is held one after another
vertically or horizontally and also held in place by a spring side to
side or end to end. Ex. Automatic pistol

66
Types of small firearms which are of medico-legal interest:
1. revolver - usual muzzle velocity is 600 feet per second
2. automatic pistol - self-loading firearm, muzzle velocity of 1200 feet per
second
3. rifle - muzzle velocity of 2500 feet per second and a range of 3000 feet.
4. shotgun - projectile is a collection of pellets

A weapon in order to cause injury must have two principal component

parts:
1. the cartridge or ammunition - bullet primer, cartridge case, powder charge
2. firearm -instrument for the propulsion of a projectile force of gases from a
burning powder.

ENTRANCE WOUND EXIT WOUND

Appears to be smaller than the missile Always bigger than the missile
Owing to the elasticity of the tissue

Edges are Inverted Edges are averted

Usually oval or round depending upon Does not manifest any definite
the angle of approach of the bullet shape

Contusion collar or contact ring is present Absent

due to invagination of the skin
and spinning of the missile

Tattooing or smudging may be present when Absent

when firing Is near

Underlying tis sues are not protruding Underlying tissues may be

seen
Protruding from the wound

Always present after fire May be absent, if missile is

lodged in the body

Paraffin test may be positive Negative

67
INSTANCES WHEN THE SIZE OF THE WOUND OF ENTRANCE DO NOT
APPROXIMATE THE CALIBER OF THE FIREARM
In distant fire, the rule is that the diameter of the GSW of entrance is almost the
same as the caliber of the wounding firearm except:

1. Factors which make the wound of entrance bigger than the caliber:
a. In contact or near fire
b. deformity of the bullet which entered
c. bullet might have entered the skin sidewise
d. acute angular approach of the bullet

2. Factors which make the wound of entrance smaller than the caliber
a. fragmentation of the bull et before penetrating the skin
b. contraction of the elastic tis sues of the skin

Other evidences or findings used to determine entrance of GSW

1. examination of the clothing, if involved in the course of the bullet
a. fabric shows punch in destruction
b. particle of gunpowder

2. examination of the internal injuries caused by the bullet

a. bone fragments, cartilage. soft tissues are driven away from entrance
wound
b. destruction of the bone Is oval, with sharp edges
at the exit it Is irregular, bigger and bevelled
c. testimony of witness

Determination of the trajectory of the bullet inside the body of the victim
1. external examination
a. shape of wound of entrance
= when bullet is fired at right angle with the skin> the wound of entrance Is
circular except In case of near fire.
= if fired at another angle • it is oval
=when the bullet is deformed no such characteristics findings will be
observed.

b. shape and distribution of the contusion collar

= contusion collar Is widest at the side of the acute angle of approach of
the bullet.
= if the bullet hits the skin perpendicularly> collar will have a uniform
width around the GSW except when bullet is deformed or In near fire.

c. difference In level between the entrance and exit wounds

d. by probing the wound of entrance - not with too much force

68
2. internal examination
a. actual dissection and tracing the course of the wound at autopsy
b. fracture of bones and course In visceral organs
c. location of bone fragments and lead particle
d. x-ray exam

3. other evidences to show trajectory

a. relative difference in the vertical location of entrance and exit in the clothing
b. relative position and distance of the assailant from the victim in the
reconstruction of re-enactment of the crime.
c. testimony of witness

EXIT WOUNDS OR OFFSHOOT WOUND

Does not show characteristic shape unlike the entrance wound due to the
absence of external support beyond the skin so the bullet tends to tear or shatter
the skin.

Shored GSW of exit: if pressed on a hard object like when victim is lying:
Wound of exit is circular or nearly circular with abrasion.

ODD AND EVEN RULE IN GSW

=If the number of entrance and exit wound is even so presumption that no
bullet is lodge in the body.
= verified by x-ray

How to determine the number of fires made by the offender:

1. determination of the number of spent shells

2. determination of entrance wounds in the body of the victim - number of
entrance wounds may not show the exact number of fire:
a. not all fire made may hit the body of the victim
b. the bullet may in the course of Its Hight hit a hard object thereby
splitting It and each fragment may produce separate wounds of
entrance.
c. Bullet may have perforated a part of the body and then made
another wound in some other parts of the body.
3. number of shots heard by the witness

Instances when the number of GSW of entrance is less than the number of
GSW of exit in the body of the victim:

69
 1. a bullet might have entered the body but split into several fragments. each
of which made separate exit.
2. one of the bullets might have entered a natural orifice of the body. Ex.
nose
3. there might be two or more bullets which entered the body through a
common entrance and later making individual exit wounds .
4. in near shot with a shotgun, the pellets might have entered in a common
wound and later dispersed while inside the body and making separate
wounds of exit.

Instances when the number of GSW of entrance is more than the number of
GSW of exit in the body of the victim:

1. when one or more of the bullet is not through and through and the bullet is
lodged in the body.
2.when all of the bullets produce through and through wounds but one or
more made an exit in the natural orifices of the body.
3. when different shots produced different wounds of entrance but two or
more shots produced a common exit wound.

Instances when there is no GSW of exit but the bullet is not found in the
body of the victim:

1. when the bullet is lodged in the GIT and expel led through the bowel or
lodged in the pharynx and expelled through the mouth.
2. near fire with a blank cartridge produced a wound of entrance but no slug
may be recovered.
3. the bullet may enter the wound of entrance and upon hitting the bone the
course is deflected to have the wound of entrance as the wound of exit.

Antemortem GSW- hemorrhage, swelling, vital reaction.

- microscopically: congestion and leucocytic infiltration.

Problems confronting Forensic Physician in the identification of GSW:

1. alteration of the lesion due to natural process:drying of wound, lnfn,

healing proc ..
2. medical and surgical Intervention: refer to clinical record of patient
3. embalming
4. problems inherent to the Injury itself.
5. x-ray exam - migratory, external souvenirs

70
The effects of the clothing on the movement of the bullet depend on:

1. number of layers of fabric between the muzzle and subjacent skin

2. nature of the fabric; closely woven
3. muzzle- clothing distance

Examination of the external wearing apparel of the victim of GSW may be

significant in investigation because:

1. it may establish the possible range of the fire:

a.contact fire
=tear in the cloth Ing covering the skin, fibers turn outward away from body
= soot deposit, gunpowder tattooing, burning of fibers around the turned
fiber
= muzzle imprint
=dirt and greasy deposit may be wipe out and visible in the tom clothing

b.not contact but near shot

=same with (a) except tor absence of muzzle imprint and beyond flame
range

c. far fire
=there Is a hole tear with inward direction of the thread

2. it may be useful in the determination as to which Is the point of entry and of

exit of the bullet. Entry- the fiber are inverted.

3. it may be useful in locating the bullet

Special consideration on bullets

1. souvenir bullet
2. bullet migration
3. tandem bullet

EVIDENCES SHOWING THAT THE GUNSHOT WOUNDS MAY BE SUICIDAL

1. shot fired In a closed locked room, or open uninhabited place.

2. death open near the place victim was found
3. shot fired with the muzzle of the gun in contact with the part of body
Involved
4. location of entrance wound accessible part of body
5. shot usually solitary
6. direction of fire is compatible with the trajectory of bullet

7t
 7. personal history may reveal social, economic, business or marital problem
which cannot be solve.
8. gunpowder presence in the hand of the victim
9. entrance wound usually does not contain clothing
1 0. fingerprints of victim on the butt
11.suicide note at the vicinity
12. no disturbance in the pl ace of death

Russian roulette = unfortunate victim has no predetermined desire of self-

destruction

EVIDENCES THAT GSW IS HOMICIDAL

1. site of wound of entrance has no point of election

2. fire is made when the victim is at some distance
3. signs of struggle or defense wounds
4. disturbance in the surroundings
5. wounding firearm usually not found in the scene of the crime
6. testimony of witness

EVIDENCES TO SHOW THAT GSW IS ACCIDENTAL

1. usually one shot

2. no special area of body Involved
3. consideration on the testimony of the ass ai I ant and determination as to
whether it is possible by knowing the relative position of the victim
4. testimony of the witness

POINTS TO BE CONSIDERED AND INCLUDED IN THE REPORT OF THE

PHYSICIAN

1. complete description of the wound of entrance and exit

2. location of the wound; part of body involved. distance of wound from
midline, distance of wound from heel or buttock.
3. direction and length of the bullet track
4. organs or tissues involved in Its course
5. location of the missile, if lodged in the body
6. diagram. Photograph, sketch or drawing showing the location and number
of wounds.

QUESTIONS THAT A PHYSICIAN IS EXPECTED TO ANSWER IN COURT;

1. COULD WOUND THE WOUND BE INFLICTED BY THE WEAPON

PRESENTED TO HIM?
2. AT WHAT RANGE WAS IT FIRED?
3. WHAT WAS THE DIRECTION OF THE FIRE?
4. IS rr SELF-INFLICTED?

72
 5. ARE THERE SIGNS OF STRUGGLE?
6. DID THE VICTIM DIE INSTANTANEOUSLY?
7. IS IT POSSIBLE FOR THE VICTIM TO FIRE OR RESIST THE ATTACK
AFTE THE INJURY WAS SUSTAINED?
8. WHERE WAS THE POSTION OF THE ASSAILANT AND THE VICTIM
WHEN THE SHOT WAS FIRED?

The caliber may be inferred from the diameter of the wound of entrance.

Determination of the length of survival of the victim:

1. nature of the GSW
2. organs involved
3. presence or absence of infection
4. amount of blood loss
5. physical condition of the patient

Capacity of a victim to perform volitional acts - depends upon the area of the
body involved, involvement of vital organs and the resistance of the victim.

DETERMINATION AS TO THE LENGTH OF TIME A FIREARM HAD BEEN

FIRED
1. odor of the gas inside the barrel
2. chemical changes inside the barrel
3. evidences that may be deduced from the wound

DETERMINING WHETHER THE WOUNDING WEAPON IS AN AUTOMATIC

PISTOL OR A REVOLVER
1. location of the empty shells - revolver the empty shells are found In the
cylindrical magazine chamber after the fire
2. nature of the spent shell - automatic firearm= bullet is copper jacketed
3. nature of the base of the cartridge or spent shell = base of a revolver
has a wider diameter than that of the cylindrical body to keep the
cartridge stay in the magazine chamber.

It may be possible for a person who is accustomed to the sounds of firearms of

different calibers to identify the firearm by the sound produced.

It is not possible to determine the direction of the shot by determining the

direction of the sound except when the flash or the person firing the shot is seen
at the time the shot was fired.

GSW may not be a near fire or may not appear to be near fire:
1. when a device Is set up to hold the firearm and to enable it to be
discharged at a long range by the victim.
2. when the GSW of entrance does not show characteristics of a near shot
because the clothing are interposed between the victim and the firearm.

73
 3. when the examining physician failed to distinguish between a near or far
shot wound
4. when the product of a near shot has been washed out of the wound.

X-ray
1. facilitate the location and extraction of the wound
2. reveals fragmentation and its location
3. shows bone involvement like fracture
4. reveal trajectory of the bullet
5. shows effect of the bullet wound, like hemorrhage, escape of air,
laceration

SHOTGUN WOUNDS
Is a shoulder fired firearm having a barrel that is smooth-bored and is intended
for the firing of a changed compound of one or more bal Is or pellets.

Measure the distance between the two farthest shot(pellets) in inches and
subtract one, the number obtained will give the muzzle-target distance in
yards.

Determination of the presence of gunpowder and primer components:

Importance:
1. Determination of the distance of the gun muzzle from the victim's body
when fired. Usually not more than 24 inches when fired.
2. Determining whether a person has fired a firearm. - dorsum of the hand
= metallic residues. burning and unburned gunpowder
= in suicide found in the palm

Procedures in determining the presence of gunpowder:

1. Gross examination use of hand lens- Fine black powder- not conclusive
2. Microscopic examination
3. Chemical test

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Tests for the Presence of Powder residues
J. On the skin - Dorsum of the hand or Wound of entrance

Dermal nitrate test (Paraffin test, Diphenylamine test, Lung's test

Gonzales' test)
= melted paraffin heated at 150 degrees fahrenheit - Lung's reagent
= small particles with nitrate or nitrite > blue reaction
= not conclusive: fertilizers, cos me(ics, cigarettes, urine
= Negative is not conclusive: thorough washing

2. On clothings
Walker's test ( c-acld test, H-acid test)
= glossy photographic paper fixed in hyposolution for 20 min to
remove the silver salts and washed for 45 min. and dries.

Tests for the presence of Primer Components - metallic primer residues like
barium, antimony, and lead.
1. Harrison and Gilroy test :Cotton swab moistened with 0.1 molar HCI to
gather the primer component.
= Reagent sodium rhodisonate yields red color with the pri mer oomponents.
= Add 1.5 H Cl to the red area> blue-violet or pink in lead or barium
=lacks specificity, sensitivity

2. Neutron Activation Analysis (NAA)

= Sample obtained by paraffin or by washing with dilute acid
= Extremely sensitive, even with small quantity

3. Flameless Atomic Absorption Spectroscopy (FAAS)

4. Use of Scanning electron microscope with a Linked X-ray analyzer

75
THERMAL INJURIES OR DEATHS
- are those caused by deviation from normal temperature, capable of producing
cellular or tissue changes in the body.

- Exposure to severe cold =Frost bite

- exposure to high temperature = burning scalding

1. DEATH OR INJURY FROM COLD

- not common in the Philippines
- Primary cause of death: Decrease dissociation of 02 from Hgb in the RSC
: Diminished power of the tissue to utilize 0 2
- Cold damp air is more fatal than cold dry air.
- Women are more resistant to cold > greater deposits of SQ fats.

Effects of CO LO:
A. Local effect ( Frostbite, Immersion foot, Trench foot)
1~ -Blanching. paleness of the skin due to vascular spasm.
2"' - Erthyma, edema, swelling due to vascular dilatation, paralysis and
increased cap ii lary permeability.
3"' - Blister formation
4~ - Necrosis, vascular occlusion, thrombosis and gangrene.

Microscopically: Vacuolization, degeneration of epidermal cells

Necrosis of the collage of the SQ tissue
Occlusion of the vessels due to clumping of RSC

B. Systemic effects:
- Reflex in nature due to the stimulation and paralysis of the nerves
- Pulmonary .Cardiac action is slowed down due to cerebral anoxia>
resulting to lethargy, delirium, convulsions. coma or death.

2. DEATH OR INJURY FROM HEAT - effect may be local or general

Classifications of Heat Injury:

a) General or Systemic effects:
a.1 Heat cramps
a.2 Heat exhaus lion
a.3 Heat stroke

b) Local effects:
b.1 Scalding
b.2 Burns
=Thermal
=Chemical
= Electrical, lightning
=Radiation
GENERAL OR SYSTEMIC EFFECT: death usually accidental
1. Heat cramps( Miner's Camp, Firemans Camp, Stroker's camp)

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 - Involuntary spasmodic painful contraction of muscles due to dehydration and
excessive loss of chlorides by sweating
- Tx: Fluids with chlorides

2. Heat Exhaustion ( Heat collapse, Syncopal Fever, Heat syncope,

Heat prostration)
- Due to heart failure, cause:Heat precipitated by exertion/warm clothes
=Sudden syncope, face turns pale, dim vision
- T x: removal from the heated area

3. Heat stroke(Sunstroke,Heat Hyperpyrexia,Comatous form,Thermic Fever)

- Working in ill-ventilated places with dry temperature or exposure to the sun

LOCAL EFFECTS OF HEAT

1. Scald: Caused by hot liquid
The injury by scalding is not severe as burns:
a. Scalding liquid runs on the body surface - distributing the heat
b. Easily cools off
c. Temperature not as high except : oils and molten metals

2. Thermal burns: Caused by heat or chemical substances like fire, radiant heat,
friction, solid substances, electricity.
: Classification of burns/ DUPUYTREN'S CLASSIFCATION
1 ~ Degree -erythema
2°• - vesicle formation
3•• - destruction of the cuticle, part of true skin, painful
4" - whole skin is destroyed, ulceration, not painful
s~ - deep fascia, muscles
6" - charring of the Ii mbs

BURNS SCALDS

1. CAUSE Dry heat - flame. heated soBd Moist heat - /}quid. steam
radiant heat

2. LOCATION At or above the site of contact Occurs at or below

3. SINGEING of hair is present Absent

4. BOUNDARY OF NORMAL Not clear Distinct

5. INJURY Severe Limited

6. CLOTHINGS Involved Not burned

Proofs that the victim was ALIVE BEFORE burned to DEATH:

1. Presence of carbon particles in the air passage.
2. Increase carboxy-hemoglobin blood level.

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 3. Dermal erythema, edema and vesicle formation.
4. Subendocardial left ventricular hemorrhage.

BURNS ANTE-MORTEM BURNS POST MORTEM BURNS

1. BUSTERS Abundant albumin/chlorides Scanty albumin/chlorides

2. AREA OF Around the antemortem burn Absent

INFLAMMATION

3. BASE OF Red Not much change In color

THE VESICLE

4. TRACHEO- Particles of soot or carbon No findings

BRONCHIAL
LUMEN

5. BLOOD Abundance of carboxy-Hgb Absent

Differential diagnosis of blisters:

1. Due to putrefaction -fluid content is blood stained watery fluid
- asso. with putrefactive changes In other parts of body.

2. Due to disease - heat by the size. distribution

3. Due to friction - Hx of application of heat

3. Chemical bums

Characteristics of lesions:
a. Absence of vesication
b. Staining of the skin or clothing by the chemical
c. Presence of the chemical substance
d. Ulcerative patches of the skin
e. Inflammatory redness of the skin surface
f. Delayed healing

CHEMICAL BURNS THERMAL BURNS

1. BLISTERS Absent Present

2. SKIN/CLOTHINGS Stained by chemicals No staining
3. ANALYSIS OF Shows chemical cause of corrosion Absent

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SUBSTANCE
4. LESION Borders are disti net Diffused

Characteristic lesions by different chemicals:

a. Sulphuric acid ( Oil of Vitriol)
= most intense action, considerable destruction
=ulcerations where acid flowed, clothings destroyed
=blackish-brown sloughs

b. Nitric acid
=Clothing is destroyed, brown
=yellow or yellowish brown slough

c. Hydrocloric acid
= not so destructive
=intense irritation, localized ulceration red or reddish-gray.

d. Caustic soda and Potash

= Corrosive action on the tissues with bleached appearance

4. Electrical burns - Contact burns. spark bums. Flash burns

5. Radiation bums - x-ray, UV light burns

PHYSICAL INJURIES OR DEATH BY

LIGHTNING AND ELECTRICITY

Lightning - is an electrical charge from the atmosphere.

- 1 mill ion volts/ 2000 amperes

Elements of lightning that produces injury:

79
 1. Direct effect from the electrical charge.
2. Surface flash burns from the discharge - electrical into heat energy.
3. Mechanical effect - expansion of air > laceration
4. Compression effect - "sledgehammer blow"

Spasmodic contraction of cerebral vessels > shock

Electricity - main cause of death is shock

-Above 300 volts are like the effect of lightning,

Factors which influence the effect of electrical shock:

1. Personal idiosyncracy- personal condition
2. Disease- cardiac dis. Is prone
3. Anticipation of shock- Can withstand
4. Sleep - increases resistance
5. Amperage or intensity of the electrical current - principal factor
= 70-80 in AC and 250 in DC.
6. Resistance of the body
7. Nature of current - AC is more dangerous
8. Earthing- shock is enhanced
9. Duration of contact
10. Point of entry- left more dangerous than the right

Mechanism of death in electrical shock:

1.Ventricular fib - leads to rupture of muscle fibers
2. Respiratory failure due to bulbar paralysis
3. Mechanical asphyxia due to violent and prolonged convulsion.

Metallization: - specific feature of electrical injury.

= the metal of the conductor Is volatilized and particles of the metal are driven
into the epidermis causing darkening of the skin

Delayed effects of electrical injuries:

=necrosis of the area develops Into gangrene
=Damaged arteries becomes brittle. friable and liable to rupture
=Nervous Injuries - retrograde amnesia, hemiplegia
= May enter the head > cataract

DEATH OR PHYSICAL INJURIES DUE TO CHANGE AF

ATMOSPHERIC PRESSURE ( BAROTRAUMA)

Increase of atmospheric pressure ( Hyperbarism)

-Normal atmospheric pressure at sea level is 760 millimeters of Hg.

- Henry's Law= "At constant temperature, the amount of gas dissolved in

a liquid is directly proportional to the pressure"

80
= As he goes deeper there will be an increase in the amount
of gas dissolved in the blood and other body fluids.

= If ascent is made rapidly, the diver will suffer from the effects of the sudden
release of the gasses from the body fluids.

= released of air bubbles in the circulation and act as emboli in different parts of
the body causing interstitial emphysema, pulmonary embolism, in big joints
called bends.

Decrease of atmospheri c pressure (Decompression)

1. Hypobarism - at high altitudes the atmospheric pressure is lower and
more gas will be liberated by the body fluid.
= release of gasses results to:
a) Bends - joint and muscular pain
b) Chokes - Substernal distress, non-productive coughing
c) Substernal emphysema -
d) Trapped gas

2. Anoxia- Hypoxia felt at 8000-15,000 feet level

- Aircrafts greater than 34,000 feet be provided with 02.

AIRCRAFT INJURIES AND FATALITIES

1. During the flight
a) Altitude: Hypobarism ( Decompression)
b) Speed - spatial disorientation ; sudden change of direction at a speed of
500 miles drains brain from blood to the lower parts> unconsciousness
c) Toxins - CO, C02 saturates cabin resulting to asphyxia
d) Temperature - At 25,000 feet 40 degree below zero: frost bite . freezing
e) Pre-existing disease - Coronary dis./Hpn fatal due to sudden change env.

2. During crash - fatalities occur us. during take-off and landing.

- Fx, Rupture of the heart due to cmpression.

DEATH BY ASPHYXIA

Asphyxia -Applied to all forms of violent death due to interference with process
of respiration
- Conditions in which the supply of 02 to the blood or tissues or both
has been reduced below normal level.

Types of asphyxia! death:

1. Anoxic death
Failure of arterial blood to be normally saturated with 0.2 due to:
a) Breathing in an atmosphere with insufficient 02- High altitude

81
 b) External obstruction of the air passage - traumatic crush asphyxia
c) Paralysis of the respiratory center - poisoning, injury, anesthesia
d) Mechanical interference of the passage of air- drowning, asthma
e) Shunting of blood

2. Anemic anoxic death

Decrease capacity of lhe blood to carry 02 due to Hge. CO poisoning. Low Hgb

3. Stagnant anoxic death

Failure of circulation due to Heart failure. shock, arterial venous obstruction

4.Histotoxic anoxic death

Failure of the cellular oxidative process, cannot be utilized in the tissues. Cyanide

Phases of asphyxial death:

1.Dyspneic phase - Breathing is rapid and deep, PR inc., Rise of BP
- due to I ack of 02 and retention of C02

2. Convulsive phase - Cyanosis more pronounced, pupils dilated, unconscious

- Tardieu spots =petechia /hges in the visceral organs
- due to s tlmulation of CNS by C02

3. Apneic phase - Breathing is shallow, gasping

- Due to para I ysis of respiratory center

Classification of Asphyxia:
1. Hanging
2. Strangulations: by ligature, manual strangulation, spl forms -palmar
3. Suffocation: choking
4. Asphyxia by drowning
5. Asphyxia by pressure on the chest
6. Asphyxia by irrespirabl e gasses

A. ASPHYXIA BY HANGING
= Not necessary the whole body is suspended: Pressure at side of neck
= Mechanism of death: Air passage Is constricted by pressure of the rope
; Compression of carotids, jugs, Sup, Laryng nerve> Cereb. anoxia

Causes of death in hanging:

1. Simple asphyxia by blocking lhe air passage.
2. Congestion of the venous blood vessels in the brain.
3. Lack of arterial blood In the brain.
4. Syncope due to pressure on the vagus and carotid sinus.
5. Injury In the spinal column
6. Combination of the above.

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 Hanging is ante-mortem: Vital reaction= principal criterion
1. Redness or ecchymosi s at the si le of I igature.
2. Ecchymosis of the pharynx and epiglottis.
3. Line of redness or rupture of the inti ma of the carotid artery
4. Subpleural hges.

B. ASPHYXIA BY STRANGULATION - Tightened by force not the weight

HANGING STRANGULATION WITH LIGATURE

1.HYOID BONE Frequently injured Frequently spared

2.DIRECTION Inverted V-shape Usually horizontal

OF LIGATURE
MARK

3. LIGATURE At level of Hyoid bone Below larynx

LOCATION

4. LIGATURE Deepest opposite the knot Uniform depth

GROOVE

5. VERTEBRAL Frequently observed Not observed

INJURY

Manual strangulation or throttling:

- form of asphyxia! death where the oonstrictlng force Is the hand.

C. ASPHYXIA BY SUFFOCATION
- Occlusion of air from the lungs by closure of air openings
or obstruction of the air passageway from the external openings to the air
sacs.

Smothering:
- A form of asphyxia! death cause by closing the external respiratory orifices.

Overlaying - most common in children: pressure of pillows

Gagging - application of materials to prevent air to have access to mouth and

nostrils.

Plastic bag suffocation

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Choking- Form of suffocation by the impaction of F.B. in the respiratory
passage.

D. ASPHYXIA BY SUBMERSION OR DROWINING

- Form of asphyxia where the nostrils and mouth has submerged in watery fluid.

Time required for death in drowning:

- Submersion for 1 Y, mi nut es considered fatal.
- Average time required for death In drowning is 2 to 5 minutes.

Emergency treatment in Drowning

1. Schaefer's method-Face down, prone position:operator exerts pressure In ribs
2. Sylvester's method- Lying on his back, astride over body, swinging arms

Post-mortem findings:
1. External findings

a) Wet clothes, pale face, F.B. clinging on skin surface

b) ·cutis anserlne" or "qoose flesh" - skin Is pale, contracted NOT Dxtic
c) Washerwoman's hands and feet - skin of hands & feet:bleached NOT Ox tic
d) Postmortem lividity - marked in the head, neck and chest
e) Presence of firmly-clenched hands with objects - Person was alive at first
f) Physical injuries for struggle
g) Suicidal drowning - Pieces of stone

2. Internal findings
A. RESPIRATORY SYSTEM

1. "Emphysema aquosum" - Lungs are distended overlapping the heart

= 0 ue to irritation made by the inhaled water on the muoous membrane of
the air passage which stimulate the secretion of mucous.

2. "Edema aquosum"- Oue:Entrance of water Into air sacs, Lungs are doughy

3. "Champignon d'ocume" -whitish foam accumulates in the mouth/nostrils

= 0 ue: abundance of mucous secretion
= One of the Indications that death was due to drowning.

4. Tracheo-bronchial lumen - congested, filled with froth

5. Blood stained fluid found inside chest cavity.
6. Section lungs shows fluid with bloody froth.

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B. HEART
1. Both sides of heart may be filled or emptied with blood.
2. Salt water drowning - Blood chloride content is greater than left side.
Fresh water- Blood chloride is more I the right side. FRESH- RIGHT

Gettler's Test
- Quantitative determination of the chloride content of the blood in the right and
left ventricle of the heart. : Difference of at least 25 mg.

C. STOMACH
- Presence food in the stomach but absence of water.> Death is rapid or
submersion made after death. Impossible for water to get into the stomach if
body is submerged after death.

FINDINGS CONCLUSIVE THAT THE PERSON DIED OF DROWNING

1. The presence of F .B. in the hands of the victim.
The clenching of the hands Is a manifestation of cadaveric spasm in the
effort of the victim to save himself from drowning.

2. Increase in volume (emphysema aquosum)

edema of the lungs ( edema aquosum)

3. Presence of water In the stomach

4. Presence of froth, foam. F.B. in the air passage found in the medium
where the victim was found.
5. Presence of water In the middle ear due to violent Inspiration when the
mouth is full of water.

Floating of the body in drowning:

-Within 24 H due to the decomposition which causes the accumulation of gas in
the body, the body floats.
- Body is flexed bee a use of the dominance of the flexor muscles
-"tete de negri" - bronze color of head and neck; face as the most dependent
portion of the body.

Homicidal D. =struggle, motive, articles found near the place, phys. injuries
Suicidal D.= note, heavy objects, mentality, Hx of previous attempt
Accidental =Absence of violence in the body., exclusion of suicide, witnesses

E. COMPRESSION ASPHYXIA (TRAUMATIC CRUSH ASPHYXIA)

- Form of asphyxia where the free exchange of air In the lungs is prevented by
the immobility of the chest and abdomen due to external pressure or crush Injury.
- Homicidal =offender kneels on the chest
- Accidental = pinned between two big objects

Burking - invented by Burke and Hare= murder for the sale to medical schools

85
 - Kneels or sits on the chest and the hands close the mouth and nostrils

Death by crucifixion- alternative raising and lowering of the body leads to

exhaustion, unconsciousness and death from asphyxia = IC mm are stretched

F. ASPHYXIA BY BREATHING llRESPIRABLE GASES

1. Carbon monoxide" silent killer", colorless, insoluble in water and alcohol.
- formed by the incomplete combustion of carbon fuel.
-Main action is 02 deprivation

Qualitative test for CO in the blood

a) Kunkel's test -4 volume of water+ 3x its volume of 1 % lannic acid
- crimson red if positive

b) Potassium Ferrocyanide test - bright red

c) Spectroscope exam
d) Gas chromatograph
e) Infra-red analysis

2. Carbon dioxide - C02, Carbonic acid gas

- Blown out of the lungs during respiration
- Product of complete combustion of carbon containing compounds
- End result of fermentation & decomposi lion of organic matters. - septic tank
=The inhalation of pure C02 may cause immediate vagal inhibition with
spasm of the glottis and death.= manhole, poorly ventilated rooms

Tests for the presence of C02

1. Barium nitrate - white precipitate of Barium carbonate with carbonic acid
2. silvernitrate - white ppt. of silver carbonate when carbonic acid is added.

3. Hydrogen sulfide ( H2S, Sulphuretted hydrogen) =rotten egg odor

- Formed during decomposition process of organic substances containing
sulphur
- Causes titanic convulsion, delirium, coma, death

4. Hydrogen cyanide - one of the most toxic, rapid acting gas

- Formed by the addition of acid to potassium or sodium salt of cyanide
- Found in plants; leaves of cherry laurel, bitter almond, kernels of common
cherry, plum, peaches, ordinary bamboo shoots, certain oil seed and beans
- Contains AMYGDALIN which in the presence of water and natural enyzme
EMULSIN is readily decomposed to HYDRO CYANIC ACID, glucose and
benzaldehyde.
= 60-90 mg of Hydrogen cyanide is fatal, death in 2 to 10 min.

5. Sulfur dioxide - Heavier than air, pungent odor

- employed as disinfectant, bleaching agent,

86
 - found in eruption of volcano

WAR GASES
Classification based on the physiological action
1. Lacrimator or Tear gas - causes irritation with copious flow of tears
a) Chloracetphene (C.A.P.)
b) Bromobenzyl cyanide (B.B.C.)
c) Ethyl lodoacetate ( K.S.K.)

High concentration - irritation of respiratory passages, lungs, V .N

2. Vesicant of Blistering Gas - contact with skin cause bleb or blister formation
a) Mustard gas ( Dlchlordiethyl sulfide, yellow cross, Yperite)
b) Lewisite ( Chlorovinyl-dichlorarsine)

3. Lung irritants ( Asphyxiant or choking gas)

- Dysnea, lightness of the chest, coughing, coma • death
a) Chlorine ( Cl2) - yellowish green gas
b) Phosgene (COCl2)
c) Chloropicrln
d) Diphosgene

4. Sternutator - nasal irritants of vomiting gases

5. Paralysants - Nerve gas - like organophosphates
6. Blood poisons - CO, H2S, Hydrogen cyanide
DEATH OR PHYSICAL INJURIES DUE TO
AUTOMOTIVE CRASH OR ACCIDENT

Factors responsible to an Automotive Crash

A. HUMAN FACTOR (DRIVER)

1. Mental attitude: reckless driving, fatigue, inexperience
2. Perceptive defect
3. Delayed reaction time
4. Disease
5. Chemical factor
2. ENVIRONMENTAL FACTOR
- Poor visibility, poorly maintained roads, rain, blind intersection
3. MECHANICAL FACTOR: Poor brake, worn out tires

4. SOCIAL FACTOR: Speed, insurance

5. PEDESTRIAN

Injuries and Death on the Driver and Passengers:

1. First collision: the impact of the moving vehicle with another or fixed object
=The MOVING VEHICLE -rapidly decelerates and stops after impact.
= The degree of damage depends: a) speed b) part of vehicle involved

87
2. Second collision: Impact of unrestrained occupants with the vehicle interior
=1st Col., Occupants move same direction/velocity towards point of impact
a) Front impact> Occupants move forward.
b) Side impact (severe)> moves to the side that was involved in the 1" Col.
>The passenger nearest to it will suffer the most.
c) Rear impact crash-Acceleration-deceleration injury or whiplash
d) Roll over crash (Turn turtle impact)

= If vehicle is not put into a stop after the 1" Col. > the unrestrained
occupants will continue to strike to some parts of the vehicle interior.

Pedestrian-Vehicle Collision:
Death or Physical Injuries to pedestrian
1.Primary impact - Contact with vehicle
2. Secondary impact - Subsequent impact of the pedestrian to the ground
- Accounts for the multiple injuries
3. Run over Injuries
4. Hit and run Injuries

88