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LEGAL MEDICINE : GENERAL CONSIDERATION

Legal Medicine – is a branch of medicine which deals with the appication 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.
- Imhotep – 2980 B.C. earliest medico-legal expert.

DIFFERENCE : ORDINARY PHYSICIAN MEDICO-LEGAL OFFICER

a) Injury/Disease
point of view - Treatment Cause
b) Examine a Diagnose Testify / justice
patient
c) Minor in juries 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 GOVERN ING APPLICATION AND EFFECTS OF LAWS:

1 . “Ignorantia 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 Laws are repealed by subsequent ones, and their violation or non-observance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 d is-use, custom or practice to the contrary.

____________________
Persons authorized to perform autopsies:
1 . Health Officers
2. Med ical officer of law enforcement agencies.
3. Members of the medical staff of accredited hospita ls.

Autopsies shall be performed in the following cases.

1 . Required by special laws
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2. Order of competent court, mayor, fiscal

3. Written request of police officers
4. SolGen , 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
jud icial proceeding the truth respecting 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:

1 . Photo, videotape,photocopy 4.Manikin method
2. Sketching 5. In 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) Narcoanalysis 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 wh ich are
recorded by the instrument.
= Use of control questions > Most reliable & effective questioning technique.
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= Supplemetary tests:__________________
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 standard ization of acceptance.
2. Trier of fact is apt to give a lmost conclusive weight to the experts opinion
3. No way to assure the a qualified examiner administered the test.
4. May waive right against self-incrimination .
5. It has many errors.

Factors responsible to 25% errors:

1 . Nervousness experienced by a subject who is telling the truth
- apprehension by the fact that he is a suspect.
- over-anxiety to cooperate
2. Physiological abnormalities > BP inc. or dec. , 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
- Hyocine hydrobromide given hypodermically until state of delirium which the
subject feels a compulsion to answer the question truthfully.

B. Narcoana lysis or Narcosynthesis

- Sodium amytal or sodium penthotal

C. Intoxication with alcohol - In wine there is truth

III. HYPNOSIS
- alteration of consciousness, not all subjects can be hypnotized

IV. OBSERVATION
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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. SCIENTIFIC INTERROGATION
Causes of Criminal behavior
To understand the thought pattern behind a criminal mind, it is important to
consider all possibilities. There is no single cause of criminal behavior. A
combination of both genetic and environmental factors contributes to the thought
process of a criminal. Some criminals will be motivated to engage in deeply immoral
and illegal actions, while others simply break or bend the laws on a smaller but still
significant scale. Examining the history of the person and the supporting facts of
the crime lead to insight about similar criminals and their methods.
1. Psychological Disorders
o Some criminals suffer from psychological disorders
People with psychological disorders often have altered thoughts that
can cause inappropriate reactions. Delusions, impulses or other
abnormal considerations can prompt a person to behave irrationally.
While a mentally ill criminal's explanation for illegal behaviors may
seem completely ludicrous to a normal person, it makes sense to the
person committing the crime. Despite the apparent irrational nature of
a particular senseless crime, psychological disorders are not able to
explain all criminal behaviors.
2. Poverty
o Some researchers believe that poverty causes people to engage in
criminal thinking
Studies suggest that there is a direct link to poverty and crime, despite
the controversial nature of this debatable topic. While many researchers
believe that there is no obvious link between the two, most people will
agree that poverty-stricken regions tend to have a significantly higher
crime rate. High levels of poverty can also force people to engage in
criminal behaviors, such as stealing, when no alternative seems to be
available.
3. Addiction
o Drug addicts typically have a higher chance of thinking criminally
Addiction can fuel criminal thinking in a person without the proper
resources to obtain the drug of choice. If a drug addict or alcoholic
lacks funds to purchase the substance they are addicted to, criminal
thoughts enter the mind. A severely addicted individual will do whatever
it takes to get the drug, including steal, prostitute themselves or engage
in other illegal activities. A study published in 2009 in Criminology and
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Criminal Justice suggests that in addition to addiction, criminal

thinking is also associated with specific patterns of age and self-control.
4. Social Pressure
o Gang members are prone to criminal thinking
Research revealed information supporting the correlation between gang
membership and criminal thinking. Gang members are encouraged to
engage in criminal activities as a way of not only participating in the
gang but also supporting it financially. Younger members are even more
susceptible to criminal thinking as they attempt to prove themselves to
other members. Older, more experienced members avoid participating
in illegal actions for fear of repercussions, but easily manipulate young
recruits using peer pressure and intimidation tactics.
5. Familial Influence
o A negative home environment supports criminal thinking in children.
Partaking in illegal activity is easier when an individual grows up in a
household where criminal thinking is the norm. Even if illegal or violent
activity does not go on directly in the home, a generally dysfunctional
environment can create the perfect breeding ground for criminal
thinking, as reported in 2009 by Yale. Children who do not receive
discipline for their inappropriate actions learn that they can get away
with doing the wrong thing, even if they know it is indeed wrong.
Furthermore, a lack of supervision can also have a dramatic effect on a
child.

Types of Criminal Offender

1.Based on behavioral attitude
a. Active Aggressive Offenders -those who act in an impulsive manner,
those who commit the crimes of passion

b. Passive Inadequate Offenders

-those who act because of their thought that they are being manipulated,
crimes that are petty
2. based on the State of mind

a.Rational Offenders
-thinking criminals, commit crimes with motive or intention and
possess full control of their mental faculties: i.e.murder with evident premeditation.

b. Irrational Offenders
-commit crime without knowing the nature and quality of their crimes;
non-thinking criminals-act impulsively-mad killers

3.Based on Proficiency
a.Ordinary offenders
-commit crimes that does not require skill or intelligence, i.e.Physical
injuries

b.Professional Offender
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-highly skilled and able to perform crimes with the least chance of being
detected,pickpocketing,usually violence is not required

d.Psychological Classification
a.Emotional offenders
-commit crimes in the heat of passion; anger or revenge, or through
negligence or imprudence
-manifest remorse, mental anguish or guilty conscience
- they have the sense of moral guilt

b.Non-emotional
-commit crimes more for financial gain, recidivists or repeaters

Techniques of interrogation

There are a number of different ways to conduct an interrogation of a suspect.

The selection of an interrogation method often is based on the background of the
suspect, amount of evidence available, and possible response of the suspect to the
interrogation.
Preparing for the interrogation requires that the interrogator had sufficient rooms,
interrogators, witnesses, and resources to handle the number of suspects involved
in the incident. In larger cases, such as organized theft rings, this may become as
much of an administrative problem as an interrogational issue

1.Emotional appeal
-interrogator must create a mood that is conducive to confession, may be
sympathetic and friendly

The classic emotional approach to an interrogation does not require the

presentation of evidence. In
this approach it generally begins with the use of a direct accusation, which accuses
the suspect of involvement in a specific issue.

Also called Psychological approach.

-designed to focus the thoughts and emotions of the suspect on the moral aspects of
the crime and thus bring about a realization that a wrong has been committed.
Great care should be taken in using this approach to make sure that the suspect
does not become so emotional as to render any statement made inadmissible.
You may begin this type of interrogation by discussing:
the moral seriousness of the offense;
by appealing to the suspect's civic-mindedness or to responsibilities of citizenship;
or by emphasizing the effects of his or her acts on the suspect's family or close
relatives.
From this beginning, proceed to such matters as the sorrows and suffering of the
victim and the victim's relatives and friends.
The suspect may tend to become emotional when discussing a mother or father; a
childhood and childhood associations; early moral and religious training; and
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persons held in very high esteem, such as school teachers, religious instructors,
athletic coaches, neighbors, or friends.
This tendency is particularly true when a suspect is guilty of a crime that he or she
feels violates the moral values that are associated with these people.
-often successful with a young person and with a first offender who has not had
time to become a hardened criminal or to develop a thinking pattern typical of a
hardened criminal.

2. Mutt and Jeff Technique

-involves at least 2 investigators with opposite characters, 1 displays an
arrogant and relentless stunt who would rather do drastic measures, other
manifests himself as being sympathetic and friendly

3.Bluff on split pair technique

-applicable when there are 2 or more persons subject to interrogation

-puts the subjects against each other (bluffs)

one suspect is played against another by purposely encouraging the belief of one
suspect that a companion in the crime is cooperating or has talked about the crime
and has laid the blame on the suspect you are interrogating.
-assigned to different rooms, interrogator tries to set up the offender that 1 has
broken his/her silenceThe suspects normally are separated and are not allowed to
communicate with each other.
Periodically, they may be allowed to glimpse or to observe each other from a
distance, preferably when one is doing something that the other may construe as
cooperation and as prejudicial to the observer's interests.

4.Stern Approach
-interrogator demands for a swift, clear answer and uses a harsh language,
demands immediate answer and information

*points that subject is not telling the truth

1.when subject’s statements have many improbabilities and gaps
2. if statements are inconsistent with material date
3.If statements are incoherent or are conflicting with one another.

5.Free flowing technique

-accused narrates, recorded, may or may not be admissible, depends on
whether the subject was afforded Miranda rights at the time of interrogation-form of
extra-judicial confession

*Inconsistencies-to test credibility of the witness

-more important if matter is already in court

**incoherent-specially in its material points

-show that the subject does not have knowledge of the truth
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6. The hypothetical story.

Relate a story of a fictitious crime that varies only in minute details from the offense
that the suspect is believed to have committed.
After a lapse of time, request that the suspect write the details of the crime that
have been related.
If guilty, the suspect may include details that are identical with the actual offense
and that were not mentioned in the fictitious crime.
When confronted with this fact, the suspect may be influenced to make an
admission or confession or may be forced to lie some more to extricate himself from
a difficult position.

7. The "cold shoulder".

Invite the suspect to your office. If the suspect accepts the invitation, he or she is
taken to the crime scene.
The investigators accompanying the suspect say nothing to the suspect or to each
other; they simply await a reaction.
This technique permits the suspect, if guilty, to surmise that you may have
adequate evidence to prove guilt, and may induce him or her to make an admission
or confession.
If witnesses whose identities are known to the suspect are available, they may be
requested to walk past the crime scene without saying or doing anything to indicate
to the suspect that they are aware of his or her presence.
This procedure serves to intensify the suggestion that the facts of guilt are already
established.

Backing Out
There may be instances where the suspect will not confess to the incident under
investigation. The interrogator should be prepared to back out of the interrogation
without obtaining an admission.
Prior to backing out the interrogator should present the evidence discovered during
the investigation.
On occasion the individual may be able to explain the evidence or provide proof of
their innocence.
If the suspect cannot provide an adequate explanation for the evidence the
interrogation could
continue using one of the emotional appeals. Sometimes presenting evidence at this
point will cause
the suspect to confess or to lie when confronted with it, which may prove damning
at some later point.
If the suspect still refuses to acknowledge his involvement after presenting the
evidence, the interrogation
shifts to the suspect’s knowledge or suspicion of who was involved. From there the
interrogator
either will discuss the individual’s suspicion or talk about why he does not believe
why the
others were involved.
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Another way of backing out of the interrogation is to use the behavioral interview,
which allows the suspect to begin to talk. The interrogator asks the questions
included in the interview and then
slowly draws the encounter to a close.

VI. CONFESSION
- expressed acknowledgement of the accused of the truth of his guilt to the
crime charged or on its essential part or portions.
Vs.
Admission- statement of a fact by the accused which does not directly involve an
acknowledgment of guilt of the accused

Judicial Confession-admissible as against him during trial

Extra-judicial confession-not enough to sustain conviction unless corroborated by
the corpus delicti

Maltreatment
-deliberate, systematic or wanton infliction of physical or mental suffering acting
alone or with others to yield a person to make a confession
1.by overdoing in the correction or handling of prisoner either by:
a.imposition of punishment not authorized by the regulation,or
b.inflicting such punishment in a cruel and humiliating manner,or
2.by maltrateing such prisoner to extort a confession or to obtain some
information.

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

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 nearest 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
and dissimilarities, the greater the probability of conclusion to be correct.
2. Value of different points of identification – fingerprints , moles
Visual recognition of relatives –lesser value than fingerprints/dental ,marks
may establish positively or are simply corroborative
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.
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5. No rigid rule in the procedure of identification of the person .What is important is

you are able to establish identity

Methods of identification :
1 . By comparison – Id found in the crime scene compared with the file.,post-
mortem findings are compared with the ante-mortem record
Ex.Latent fingerprints recovered from crime scene are compared with those on
record of files of investigating agencies; dental date
2. By exclusion-evidence or date are removed from what is on file to establish
identity; if two or more persons have to be identified and all but 1 is not yet
identified, then the one whose identity is not yet established may be known by the
process of elimination

IDENTIFICATION OF PERSONS
A. Ordinary methods of identification, need to consider certain characteristics:
1 . Characteristics 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. Characteristics that may not be easily be changed :

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

Points of identification applicable to both living and dead before onset of

Decomposition:

1 . Occupational 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:
-Remaining marks after healing of wounds, characterized by presence of
lesions which may cause a person to be identified and we may know their cause.

Kinds:
1.surgical operations-scars that remains are usually of regular forms and
stitch marks
2.burns and scalds-usualy large,irregular in shape and there is adherence of
the skin with the underlying tissue
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-development of keloids-usually smooth on the surface

3.gunshot wounds-bears hole in a person’s body, irregularity of size if shot at
long distance-if short distance- surrounding of the wound would develop a tattoo-
blackening of surrounding tissue of a gunshot wound
4.Tuberculosis sinus-irregular shape, furrowed and with edges
5.Flogging-development of fine white lines usually diagonal across the skin,
there may be depression of the skin and development of spot, accident where bodies
are rubbed against rough surfaces
6.Gumma-depressed scar following loss of tissue
7.wet cupping-short parallel scars usually found at the lower part of the back
and loin.

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 , mobility

May not develop – mall , superficial , healed by first intention .

8. Tribal marks, Sexual organs, blood exam

ANTHROPOMETRY ( BERTILLON SYSTEM) Alphonse Bertillon

- utilizes anthropometrical measurement of the human body for identification .

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

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

(Specialized method of identification)
-spoken pictures,description of a person whose picture as such is produced on one’s
identification of him trhough verbal manner, skilled investigative illustrator
sketches the picture of the suspect-cartographic sketch
-rougue’s gallery, photograph-collection of pictures of persons previously arrested
and put to trial-pictures of persons placed in a gallery.

Extrinsic factors in identification :

1 . ornamentation
2. personal belongings
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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 (14-15meters) Starlight = Less
than10-13 yards (9-11m)
2. Broad daylight = Not farther than 100 yards (91m)not seen before
Almost strangers =recognized at 25 yards (22m)
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 -requires expertise in the field, investigator is

an expert witness-testimony is given great weight, allowed to give opinion as
answers in evidence

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 identification .
a) No two identical fingerprints 1 : 64,000, 000, 000
b) Not changeable - 4th month formed in the fetus and remains unchanged
throughout life until the final stage of decomposition after death.
c. almost every police and law enforcing agencies throughout the world
accept, adapt and utilized the fingerprint system as a means of absolute
identification of person, and taken cognizance of its importance and reliability as a
means of identification

= 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 comparison of fingerprints
= POROSCOPY : study of pores found on the pappillary friction ridges of skin
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Fingerprints can’t be effaced :

=as long as the derm is of the bulbs of the finger is not completely destroyed .

Types
1.Arch
a.Plain arch
b.Tinted Arch
2.Loops
a.Radial loop
b.Ulnar loop
3.Whorl
a.Plain whorl
b.Central pocket loop
c.Double loop
d.Accidental whorl

BIFURCATION-forking or dividing of one line into two or more branches

DIVERGENCE- spreading apart two lines which have been running parallel or
nearly parallel
DELTA- point on a ridge at or in front of and nearest the center of the divergence of
the type line.

Advantages of Fingerprinting as a means of identification:

1.not much training is necessary in the taking, classification and comparison of the
fingerprint
2.No expensive instruments are required in the operation.
3.The system is easy to classify, and
4. Actual prints are always available for reference in any suspected error that can be
checked.

Methods of producing impressions

Plain method
-the bulbs of the last phalanges of the fingers and thumb are pressed on the surface
of the paper after pressing them on an ink plate with printing ink.

Rolled method(accepted)
-the bulb of the thumb and other fingers are rolled on the surface of the paper after
being rolled in an inkpad with the printing ink.

Kinds of impression
Real- impressions of the finger bulbs with the use of the printing ink on the surface
of the paper. any other coloring material may be used but less visible and indelible.

chance impression-finger prints which are imprinted by mere chance or without any
intention to produce the print. It may be:
a.Plastic impression- made by chance on cellophane tapes or any plastic materials
b.visible prints-impressions made by chance and visible without chemical treatment
c.latent prints- visible grossly but made visible by the addition of some substance
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-may be developed by:

a.spraying with graphite
b.use of aluminum powder
c..use of plaster of paris
d.copper powder may be used for latent prints on leather
e.use of metallic antimony
f.use with silver nitrate with acetic acid may be used for latent prints on
clothes
g.use of iodine fumes
-the choice of material to develop latent fingerprints depends on the color and
texture of material where the print is suspiciously located.

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
putrefaction
= dental records are compared with the dental state of the victim

PD 1575- requirement among dental practitioners to keep records of their patientrs

for purposes of comparison or exclusion, to make accurate their records for a period
of 10 years

3. HANDWRITING
-a person may be identified through his handwriting by his intimate friends.
-governed by physical and mental factors
-worry, anxiety, anger and feelings of insecurity are some of the mental factors
which influence the handwriting.
-physical factors-age, drunkenness..
-identified by general appearance, form, style, connections, line quality, slant and
spacing.

= BIBLIOTIC : Science of handwriting analysis

= GRAPHOLOGY : study of handwriting for the purpose of determining the writers
personality, character and aptitude.
Sec. 22, Rule 132, Rules of Court
How to prove genuineness of any disputed handwriting
1. acknowledgement of the alleged writer that he wrote it
2. statement of a witness who saw the writing made and is able to identify it
as such
3. by the opinion of persons who are familiar with the handwriting of the
alleged writer,or
4. by the opinion of person expert who is tasked to compare the questioned
writing withthat of other writings
Bibliotics-science of handwriting analysis, thew study of documents and writing
materials to determine the genuineness or authorship
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Admissible if person gives his consent

-defendant cant be compelled to give sample of handwriting- entails intelligence and
not mechanical in nature-may violate right against self-incrimination.

Two-Types
1.Procured/collected standard
consists of handwriting by a person suspected to have written the questioned
document
-found in the private or public records of the person or from other possible
sources
-require 15 handwriting specimens
2.Requested standard
-writer of document is asked to produce 7 specimens in comparing the
questioned document

may be availed or used at the same time and admissible in evidence

Signature Forgery
Classifications
1.Traced Forgery
-outlining of a genuine signature from one document to another
-basically considered a drawing
-lacks free natural movement inherent in a persons normal writing

Ways:
1.paper wherein signature is to be copied is placed on top of the document
containing the signature
2.by placing original document on top, write on top of original signature to
have a mark on the document

2.Simulated Forgery
-attempt to copy in a freehand manner, the characteristics of the original
signature either from memory or from a model.
-characteristics by free natural movement inherent in writing

3.Spurious Forgery
-siganture is that of forge’s own handwriting wherein little or no attempt has
been made to copy the characteristics of the genuine handwriting

4. IDENTIFICATION OF THE SKELETON

-usually done in cases of exhumation; bones or remains are given emphasis

*points
1.whether the remains are of human origin or not.
a. there must be determination of size, shape and general features; head
must be studied.
b.if there is complete set of bones, there must be undertaken a complete
lay-out-arranging bones in their anatomical places.
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c.Examination of presence or absence of identifying features: dental

fixtures, presence of rings, hair and other weatring apparels-indicate the sex of a
person
d. important to establish duration in which interment would have set in.-
length of time on how long the cadaver is dead.

Indicia of interment
1.presence or absence of soft tissue still adherent to the bones
flesh of humans buried without coffin or preservatives such as formalinme takes
about 8 days for the skin to shred off and about 43 days for the soft tissues to
decompose.
2.firmness and weight; brittleness and dryness of the bones
3.degree of erosion on the surface of the bones
4.extrinsic factor:changes in the clothing or other wearing apparels of the cadaver
-may include determination as to changes in the coffin or in its painting.

human – shape, size, general nature

single individual – plurality or excess of bones
Height – add 1 to 1 ½ in . for the soft tissues
Pearson ’s formula – for the reconstruction of the living stature of long bones

Topinard and Rollet

= two French anatomist devised a formula for the determination of the height
for 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) Iliopectinealline Sharp Rounded
 17

9) Obturator foramen Egg-shaped triangular

1 0) 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

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:

- All soft tissues in a grave disappear within one year.

Basis of the estimate for 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.

Methods of Approximation of one’s height

1.measure the distance between the tips of the middle fingers of both hands with
the arms extended laterally and it will approximately be equal to the height
2.two times the length of 1 arm + 12.5 inches from the clavicle and 1.5 inches from
the sternum is the approximate height.
3.Two times the length of the vortex of the skull to the pubic symphisis is the height
4.the distance between the supra-sternal notch and the pubic symphisis is about
1/3 of the height
5.the distance from the base of the skull to the coccyx is about 44% of the height.
6.The length of the forearm, up to the top middle finger is 5/9 of the height
7.eight times the length of the head is approximately equal to the height

5. IDENTIFICATION OF SEX
a. aid in the identification of a person
b. if able to be identified based on sex, gives rise to exercise of certain rights that
the heirs may enjoy
- may refer to second marriage; custoidial rights of children’ rights granted by
special laws only given to particular sexes.
c. to determine what crime or offense was committed.

Test to determine the sex:

1 . Social test
 18

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 probable
= vagina, large breast
3. Conclusive 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

Determination of age of fetus:

Hess’s ru le or Haase’s ru le
-approximates the age of the fetus
-measurement of the fetus from crown to the feet; length (tip to tip)
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 result 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 place of the crime
g) Determination of the presence of certain diseases.

-to determine blood type,parasitic infection of toxic substances present which may
be utilized to distinguish one person from another.Ex.CBC; helpful by knowing
inheritance patterns of blood group

Inheritance patterns
1.F & M = O child = O exclude: A,B, AB
2.O & A O,A B,AB
3. O & B O,B A, AB
 19

4.A,& A O,A B,AB

5.A& B O,A,B,AB -
6.B&B O,B A, AB
7.O&AB A,B O, AB
8.A &AB A,B AB O
9.B &AB A,B AB O
10.AB & AB A,B AB O

Characteristics
1.Artificial Blood-usually bright,scarlet in color, high O2 content and blood
vessels are usually left with pressure
2.Venous blood(poison blood)-dark red in color,low O2 content and do not
spill far from the ground
3.Menstrual blood-does not clot,acidic in reaction owing to the mixture with
vaginal mucus, if examined under microscope there may be presence of vaginal
epithelial cells,contains larger number of Deoderleins bacillus
4.Man’s or Woman’s blood-no method of determination except menstrual
blood
5.child’s blood-thin and soft as compared with an adult, the red blood cells
count more than in adult

*Animal-blood taken exhibit characteristic of artificial blood, darker than that of

human, dry up easily due to high O2 content, leave their marks
Physical examination
a) Solubility test
b) Heat test
c) Luminescence test: 3 amino-phtalic-acid-hydrazide-HCL,
Sodium peroxide , distilled water
> Bluish-white in a dark room
Chemical examination:
a) Saline extract of the blood plus ammonia – brownish > alkaline hematin
b) Benzidine test – blue color in white filter paper
c) Guaiacum test ( Van Deen’s Dyas or Schombein’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-haem in or Wagenhaar test

Spectrospcopic examination
- blood pigments have the power to absorb light of certain length and produce the
characteristic absorption bands on the spectrum.
 20

= Fresh blood – oxyhgb, Hgb, reduced hematin

= olders stains – methemoglobin , alkaline hematin

Biologic examinations
1 . Precipitin 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

-important in post mortem identification

Important parts that are examined

1.cuticle-outer layer of hair
2.cortex/middle layer-longitudinal fibers bearing pigments
3.medulla/core- contains air bubbles and some pigments taken from medulla-
specific only to a person
-1 in a million that 2 individuals will have the same results

aid to estimate the age of a person

-by knowing characteristics of differences in generations referring to:
a.children- usually fine, short and deficient of pigments in the middle layer
-as a rule: hair of children are without medulla/core
b. adolescent-hair on scalp becomes long, thick and whity
c.elderly- white or gray, there is marked absorption of pigments in
degenerative stage.,there is joining of cortex with cuticle-middle layer of hair starts
to shed off

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 H2O 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 irregular grains
Cuticle
1. thin scales thick scale

Medico-Legal Aspects of Sexual Crimes

-crime of rape,acts of lasciviousness,seduction,abduction-offenses against
women(usually victims)
 21

virginity-condition in women who has not yet experienced any sexual intercourse
and whose genital organ has not yet encountered carnal connection

4 Kinds of virginity
1.moral virgin- woman in a state of not knowing nature of sexual life and not
experienced any sexual relation
-applicable only to children less than the age of puberty and secondary
characteristics of womanhood has not yet developed.

2.physical virgin-female is already conscious of nature of sexual life but has not yet
experienced any sexual relations
-presence or absence of laceration- tears in the sexual organ.
characteristics of women (2 classes)
1.true physical virgin – no lacerations in the hymen and who has not truly
experienced intercourse
2. false physical virgin-already experienced sexual intercourse – caused by
strenuous activities-horseback riding, gymnastics…

3. demi-virgin – female who permits any form of sexual liberties as long as partner
abstains from rupturing hymen – no insertion
state in person where they experience pleasure bu rubbing genitalia against any
part of the partners body instead of insertion.

4. virgo intact – truly virgin female

-no structural changes in organ to infer sexual intercourse – truly virtuous female.

statement of victim + physical evidence

1. to determine whether calim is possible
2. to determine state of virginity

Examination of Woman (taken individually as a whole

virginity is determined by:
a. breast-not that reliable
areaola is already about the size of 5 peso coin- suggestive of fact that
woman is not a virgin – possibility of lactation
nipples- bulged- suggestive of non-virginity
b.vaginal canal- space between majora and minora
gen rule: tight and robusities (inside labia) are sharp and prominent
upon examination there is insertion of foreign bodies ( instrument or finger )
and they will be after the degree of resistance, if virgin – resistance is high – pain , if
non- physical virgin – robusities( blood clot, insertion of instruments, manipulation
by woman herself) – diminished – lose character of sharpness and prominence
c. examination of labia majora or labia minora – not reliable
state may be affected depending on the physique of the woman to be
examined,
labia of fat and skinny differ,
fat ladies – firm, plump, coaptated- opening not obvious
skinny ladies – gaping labia
 22

d. fourchette – base, y shaped – virgins, non- virgins – round (giving birth,

insertion of foreign objects)
e. hymen- determines virginity except few
-lacerated if there is sexual intercourse
* chastity not symonymous with virginity
* defloration- rupture of hymen due to sexual intercourse.

Facts to be included:
1. general conditions of the hymen- report or width, thickness, vascularity and
laxity
-other pathological condition
-inflammatory changes/signs of previous trauma, development of
abnormalities, presence or absence of foreign bodies.
2.original shape of the orifice
3. it must be noted: a. degree of laceration-incomplete, complete,
compound/complicated
-incomplete laceration-
a. superficial incomplete laceration- tera that does not go beyond ½ of the
width of the hymen
b. deep laceration – more than ½ the width of the hymen but it does not reach
the base (edges)

-complete laceration- involve whole width of the hymen but does not reach the
base

-compound/complicated – involves hymen and surrounding tissues –

perenum or vaginal canal, urethra, rectum, characteristic found in gang rape

2. location of laceration –related to the face of the watch , to be notes in hours

3. duration of the laceration-age, may be approximated by the changes that are
observed in the macerated tissues
-fresh bleeding-suggest that insertion is less than 24 hours before examination
-after 24 hours- absent any complication, healingprocess start-fibrim formation,
edema
-healed laceration with congested edges and with sharp coaptible edges – 4-10
days old, recently healed lacerations
-with sharp coaptible borders without congestion – more than 10 days old –
between 2-3 weeks old
-healed with rounded non-coaptible borders and retraction of borders – more than
a month old
-placedin the report upon examination where there are lacerations observed

4.presence or absence of complications – where there is infection caused by

bacterial infection or hemorrhage – requires surgery, undertaken the soonest
possible to correct damage
-blood clots-abnormality caused in vesico vaginal-must be corrected by surgery
-stricture-involves vaginal wall ( scar formation) – narrowing of vaginal canal –leads
to death
 23

-sterility-incapacity to bear children – secondary to infection

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
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 an imation –
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, aucultation , flouro, ECG

b) Examination of peripheral circulation

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

= Opening of small artery- spurting

= Icards 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 Radia l pulse
= Dropping of melted wax
2. Cessation of respiration – more than 3 ½ m inutes
Methods of detecting cessation of respiration :
a) Observance of movement of chest and abdomen
 24

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.
- The progressive fall of the body temp. is one of the most prominent signs.
- First two hours after death the cooling is rapid .
- Fall of temp. of 1 5 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,Stryn ine 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 d isease with wasting

B. Conditions that are connected with the surroundings

Factors delaying cooling :
1 . Clothings
2. Want of access of air to the body
3. Small room
4. Warm surroundings

Factors accelerating cooling :

1 . Unclothed body
2. Conditions allowing 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 :
 25

= the average rate of fall of the temp. during the first 2 ½ hours is ½ 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.
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 00cc rapid in 1st 5 hours.
= NPN inc. from 1 5 to 40 mg/1 00 cc in 1st 15 hours
= A.A. inc. from 1 mg to 1 2 mg% 1 st 1 5 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 l ive 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 mortis.

CHANGES IN THE BODY FOLLOWING DEATH

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
1 8-36H summer
 26

c) Stage of Secondary flaccidity or Commencement of putrefaction

( DECAY OF MUSCLES)
= muscle are flaccid , not respond to 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 late
= 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 resulting to rigidity.
= “ Pugilistic attitude” flexed upper and lower limb
= hands clenched , flexor 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

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 sign if. Approximates time of death Determine nature of death

RIGOR MORTIS MUSCLE CONTRACTION

1 . Contracted muscle Losses transparency More or less transparent
2. Elasticity Loss elasticity Very elastic
3. Litmus reaction Acidic Neutral or sl. alkaline
 27

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 Lividity , or Post-mortem Suggilation
or Post-mortem Hypostasis or Livor 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, urem ia, Typhus fever
= appears 3 – 6 H after death and fully developed 12 H after death .

Physical characteristics of Post-mortem Cadaveric Lividity

1 . Occurs in the most dependent areas.
2. Involves the superficial layer 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 lividity
2. Diffusion lividity

Importance of Cadaveric lividity:

1 . One of the signs of death .
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 – lividity 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 .
 28

2. Post-mortem hypostasis or lividity

3. Cadaveric spasm

CONTUSSION (BRUISE) POST-MORTEM HYPOSTASIS

1 . Small bruises – Below epiderm is in true skin In the epiderm is 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 (BRU ISE) 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
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 , lusterless Not in congestion
3. Inflammatory exudate Not seen Not seen

Other changes in the blood

1 . Hydrogen ion concentration – acid pH CO2, L.A. , After 24H alkaline ammonia.
2. Breakdown of liver glycogen leads to accumulation of dextrose in the IVC and
the right side of the heart.
3. Rise in NPN and Free A.A.
4. Chemica l :
= chloride in the plasma/RBC decrease due to extravascular d iffusion , in
72 H on ly ½ of its content.
= Mg – increases due to diffusion from without.
= K – increases due to diffusion from the vascular endothelium.

3. AUTOLYTIC OR AUTODIGESTIVE CHANGES AFTER DEATH

- 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.
 29

Tissue changes in putrefaction :

1 . Changes in the color of the tissue
Hemolysis of blood with in blood vessels > Hgb diffuses through the walls
Reddish-brown in color
In the tissues > Hgb undergo chemical change
Greenish-yellow 1st seen at RI liac fossa

MARBOLIZATION – prominence of the superficial veins with reddish

discoloration which develops on both flanks of the
abdomen , neck, and shoulder
= look like “marbled” reticule of branching veins.

2. Evolution of gasses in the tissues

CO2, ammon ia, 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 muscu lar 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 : free air hastens decomposition
a.2 moderate moisture - accelerates
a.3 loaded with septic bacteria – early aerobes, later anaerobic
- Clostrid ium welchii= 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
 30

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
5. depth at which the body was buried - greater the later
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 fossa, soft eyeballs
3-5 DAYS - frothy blood from mouth , nostrils
8-1 0 DAYS - abdominal distention , nails firm
1 4-20 DAYS - blisters all over the body, maggots
2-5 MONTHS - skull exposed , orbits empty

IN TROPICAL REGION
1 2 HOURS Rigor mortis all over, hypostasis, greenish-discoloration caecum
24 HOURS Rigor mortis absent all over, abdom inal distention
48 H Ova of flies, trunk bloated , face discolored
72 H Whole body grossly swollen , hairs and nails loose
ONE WEEK Soft viscera putrefied
TWO WEEKS Soft tissues largely gone
ONE MONTH Body skeleton ized

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 , face 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/ feet 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-wearing apparel - slower

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

Flat bones disintegrates faster than round bones.

SPECIAL MODIFICATION OF PUTREFACTION

1 . Mummification
 31

= 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 a ir
2. Saponification or Adipocere fromation
= a condition where the fatty tissues of the body are transformed to soft
brownish-white substance known as ADIPOCERE at SQ level .
3. Maceration
= softening of the tissues when in fluid medium in the absence of putrefactive
m ircro-org , 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 mortis : 2-3 hours after death
1 2 H fully developed
1 8-36 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 distalileum, 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
1 0. Blood clots inside the b.v. in 6 –8 H after death .
1 1 . Soft tissues of the body may disappear 1 to 2 years after burial.

Post-mortem conditions simulating disease, poisoning or injury:

1 . post mortem hypostasis – contusion , inflammation , poisoning
2. blisters of the cuticle – scald and burns
3. swelling , detachment or splitting - injury

PRESUMPTION OF DEATH
Disputable presumption - not heard in 7 years
Presumption of death
Absence of 7 years except succession 1 0 years
Vessel for 4 years
Armed forces 4 years
In danger of death 4 years

PRESUMPTION OF SURVIVORSH IP
1 . under 1 5 y.o. – older survives
2. above 60 y.o.- younger
3. under 15, above 60 - former
 32

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 essential ingredients of the crime took place.

- Person composed the Search Team:

a) Physician MLI 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
5. Educate students and physicians

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 laws
2. Order of competent court, mayor, fiscal
3. Written request of police officers
4. SolGen , fiscal disinter to determine cause of death .
5. Written request of nearest kin to ascertain cause of death .
 33

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 for establishing
the time of death
3. Errors or omission in the collection of evidence required for the medico-
legal examination .
4. Errors or omission result in the production of undesirable artifacts or in
the destruction of valid evidence.

Negative autopsies
- if after all efforts including gross and microscopic studies and toxicological
analysis fail to reveal a cause of death .

Negligent autopsy
No cause of death is found due to imprudence, negligence, lack of skill , lack of
Foresight

CAUSES OF DEATH
Primary purpose of a medico-legal autopsy:
Determination of the cause of
death.
 34

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 depression , 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 in jury
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
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 with in seconds or minute or two after
a minor trauma or peripheral stimulation of relatively simple nature.
- The peripheral stimulation initiates the cardio-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
 35

2. Sudden unexpla ined nocturnal death (SUND)

DOA – 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. Infanticidal death
4. Parricidal death
5. Murder
6. Homicidal death

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 in juries inflicted .

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
 36

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
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
f. 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 proximate 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 in juries inflicted .
= That the death ensued with in 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 in jury – due to change of atmospheric pressure.
5. Chemical injury – chemicals
6. Radiation injury – radiation
7. Infection – microbic invasion

PENAL CLASSIFICATION OF VIOLENT DEATHS

1 . Accidental deaths – due to misadventure or accident.
Art. 1 2 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
 37

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/i l leg) ascendant, descendant, spouse (leg .)
5. Infanticidal 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

SPECIAL DEATHS
1 . Judicial deaths – Art. III 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.
 38

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 th of its weight daily.
And 40% loss>death
Factors that influence the length of survival: age, cond ition of the body, sex,
environment.

DISPOSAL OF THE DEAD BODY

Sec.1 103 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 possession of sufficient means to defray the necessary expenses.
3. If none of the above – municipal authorities.

Sec 1 104 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 d isposition , the right of the surviving spouse is
paramount.

METHODS OF DISPOSAL OF THE DEAD BODY

1 . Embalming – 6 to 8 quarts of antiseptic solutions of formalin , perch loride
of mercury or arsenic which is carried into the internal carotids and the
femoral arteries.
2. Burial or inhumation
a. Sec 1 092 RAC buried with in 48 hours if unembalmed .
With in 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. 1 087 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:

 39

- death cert. , issued by physician .

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.D. 856 Code of Sanitation
Sec. 1094 Revised Administrative Code – Disposition of body and
belonging of person dying of dangerous communicable disease.
Ex. Men ingococcemia 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.D. 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. 1 100 of RAC, Sec. 91© of P.D. 856 Code of Sanitation
The depth of the grave must be at least 1 ½ meters deep, filled 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 shall be
constructed within the same distance from any burial ground .
3. Not with in 50 meters from any water source.

Other burial requ irements:

1 . Shipment of remains abroad shall be governed by the rules and
regulations of the Bureau of Quarantine.
2. The burial or remains in city or municipal grounds shall not be prohibited
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.
 40

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 for 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.
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.D. 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.
 41

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 be submitted to the Secretary of Health.

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
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
= Histopath 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 Hea lth .
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 .
 42

7. Disinfection of the body and all areas involved must be carried out with the
assistance of the local hea lth 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
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:

M1 6 rifle with a velocity of 3200 ft/ 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
 43

laceration will 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.

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. CALOR – 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 differentiates 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 OF WOUNDS:
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. B lunt instrument – contusion , hematoma, lacerated wound .
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.
f. 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.
 44

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 RELATION OF THE SITE OF APPLICATION OF

FORCE AND THE LOCATION OF INJURY

a. Coup In jury – Physical injury which is located at the site of the

application of force.
b. Contre-coup in jury – opposite the site of the application of force.

c. Coup contre-coup in jury – 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 applied .
Example: B low in forehead > contusion on the region of the eyeball .

e.Extensive injury – Physical injury involving a greater area of the body

beyond the site of the application of force.
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)PATTERNED 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 h is life.
Motive of producing self-inflicted wounds:
1 . To create or deliberately magnify an existing injury or disease for
 45

pension or workman ’s compensation .

2. To escape certain obligations 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 un lawfu l and violent depriva l of another of the use of a

part of the body so as to render h im less able in fighting , either
to defend h imself or to annoy h is adversary.
Vasectomy/Tuba l l igation are not muti lation and a leg itimate method of
contraception despite the fact that it is done intentiona l ly and deprives a person
of h is power of reproduction .

SERIOUS PHYSICAL INJURIES Art. 263 RPC

Any person who sha l l wound , beat or assau lt another Art. 263 and
adm in istering in jurious substance, without intent to ki l l Art. 264.
The ma in purpose of d ivid ing the provision into four paragraphs
a) Is to graduate the pena lties depend ing upon the nature and character of
the wound infl icted
b) Their consequences on the person of the victim.
1 . Prison mayor – because of the physica l in juries infl icted , the in jured person
becomes insane, imbeci le, impotent or bl ind .
2. Prision correctiona l in its med ium and maximum periods
- loss of speech , hear or smel l
- loss of eye, hand , foot, arm, leg
= loss of the use or incapacitated for the habitua l work he used to do.
3. Prision correctiona l in its m in imum and med ium periods.
- person in jured sha l l be deformed .
- lost any other part of the body, incapacitated for more than 90 days.
4. Arresto mayor in its maximum period to prision correctiona l
 46

- If the physica l in juries sha l l have cause the i l lness or incapacity for
labor for more than 30 days.

Is the offense sha l l be comm itted aga inst any of the persons enumerated in
Art. 246 Or with attendance of any of the circumstances mentioned in Art. 248
= The case covered by subd ivision number 1 of th is art. Wi l l be pun ished by
reclusion tempora l in its med ium and maximum periods.
= Subd ivision number 2 by Prision correctiona l in its maximum period to
prision mayor in its m in imum period .
= Subd ivision number 3 by prision correctiona l in its med ium and maximum
= Subd ivision number 4 prision correctiona l in its m in imum and med ium
periods.
The provisions of the preced ing paragraph sha l l not be appl icable to a parent
who sha l l infl ict physica l in juries upon h is ch i ld by excessive
chastisement.
RA 761 0.
I t may be comm itted through a simple neg l igence or imprudence.

ADM IN ISTERING INJURIOUS SUBSTANCE OR BEVERAGES Art 264 RPC

Elements:
1 . The offender infl icted upon another any serious physica l in jury,
2. There is knowledge that the substance or beverage adm in istered is
in jurious Or took advantage of the victims weakness of credu l ity.
3. There is no intent to ki l l in the part of the offender.
If intentiona l so> frustrated murder. Treachery is inherent in Art. 264 RPC

LESS SERIOUS PHYSICAL INJURIES Art. 265 RPC

Any person who sha l l infl ict upon another physica l in juries not described in the
preced ing articles,
= But wh ich sha l l incapacitate the offended party for labor 1 0 days or more
= Or sha l l requ ire med ica l attendance for the same period
Both of wh ich is 1 0 days but not more than 30 days and
there must be proof to it. .
The crime of less serious physica l in juries may be qua l ified and a fine of a h igher
pena lty is imposed when :
1 . There is a man ifest intent to insu lt or offend the in jured person .
2. There are circumstances add ing ignom iny to the offense.
3. The victims is the offender’s parents, ascendants, guard ian , curators,
teachers.
4. The victim is a person of rank or person of authority, provided the crime
is not d irect assau lt.
P.D. 1 69 Obl igation imposed on Physicians treating persons suffering serious
and less serious physica l in juries requ ired to report to law enforcement agencies.

SLIGHT PHYSICAL INJURIES AND MALTREATMENT Art 266 RPC

1 . Arresto menor- when the offender has infl icted physica l in juries wh ich
sha l l incapacitate the offended party for labor form 1 to 9 days or sha l l
requ ire med ica l attendance of the same period
 47

2. Aresto menor or fine not exceed ing P200 and censure when the offender
has cause physica l in juries wh ich do not prevent the offended party
from engag ing in h is habitua l work nor requ ire med ica l attendance.
3. Arresto menor in its m in imum period or a fine not exceed ing P50 when the
offender sha l l i l l treat another by deed without causing any in jury.
If there is no evidence to show actua l in jury or incapacity for labor or
period of med ica l attendance, the accused can on ly be gu i lty of sl ight physica l
in juries.
So a tender slap on the face, hold ing the arm tightly, appl ication of
pressure in some parts of the body or m i ld blow wh ich show no sign of physica l
violence may sti l l be considered sl ight physica l in juries or ma ltreatment.
( Parag 3 )

PHYSICAL INJURIES INFLICTED IN A TUMULTOUS AFFRAY Art 252 RPC

Elements:
1 . There is a tumu ltuous affray
2. Participants suffered from serious physica l in juries.
3. The person who infl icted serious physica l in juries cannot be identified .
4. Al l those who appear to have used violence upon the person of the
offended party sha l l be pena l ized by arrest from 5 to 1 5 days.
TYPES OF WOUNDS ( MEDICAL CLASSIFICATION)
1. CLOSED WOUND – no breach of continu ity of the skin or mucous membrane.
a. Superficial – When the wound is just underneath the layers of the skin
or mucous membrane.

a.1 –PETECH IAE – is a circumscribed extravasation of blood in the

subcutaneous tissue or underneath the mucous membrane.
Example : mosqu ito bite, blood d isease, hang ing
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 resu lt of the appl ication of blunt force or violence.
= size of contusion greater than the size of the object.
= Location of the contusion is not a lways the site of
appl ication of the force. Example: Black eye> Forehead
Medico-legal point of view:
A contusion as ind icated by its externa l pattern may correspond to the
> shape of the object or weapon used .
Extent > the possible degree of violence appl ied .
Distribution> ind icates the character and manner of in jury as in manua
l
strangu lation around the neck.
Age of Contusion: appreciated from its color change
The size tends to become sma l ler from the periphery to the center
and passes through a series of color changes as a resu lt of the
> Disintegration of the RBC and l iberation of hemog lobin .
The contusion is red , purple soon after its complete development.
4 to 5 days > green
 48

7 to 1 0 days > yel low and gradua l ly d isappears on the 1 4th or 1 5th
day.
The u ltimate d isappearance of color varies from 1 to 4 weeks
depend ing upon the severity and constitution of the body.

The color changes starts at the periphery.

CONTUSION VS. POST-MORTEM HYPOSTASIS

Contusion
Below the epiderm is in the true skin in sma l l bru ises or extravasations,
below th is in larger ones and often much deeper sti l l .
The epiderm is has no blood vessels to be ruptured .
Post mortem Hypostasis
In the epiderm is or in the cutis as a simple sta in or a showing through the
epiderm is of the underlying engorged capi l laries.
Contusion
Cuticle was probably abraded by the same violence that produced the
bru ise. In sma l l punctures such as fleas bites, th is is not observed .
Post-mortem hypostasis
Cuticle unabraded , because the hypostasis is a mere sinking of the blood ,
there is no trauma.
Contusion
A bru ise appears at the seat of and surround ing the in jury. Th is may or
may
not be a dependent part.
Post-mortem hypostasis
Always in a part wh ich for the time of information is dependent.
Contusion
Often elevated because elevated blood and subsequent inflammation swel l
the tissues.
Post-mortem hypostasis
Not elevated , because either the blood is sti l l in the vessels or at most has
simply soaked into and sta ined the tissues.
Contusion
Incision shows blood outside the vessels. Th is is the most certa in test of
d ifference and can be observed even in very sma l l bru ises.

Post-mortem hypostasis
Incision shows the blood is sti l l in its vessels and if any oozing occurs drops
can be seen issu ing from the cut mouths of the vessels.
Contusion
Color variegated . Th is is on ly true of bru ises that are the same days old due
to the changes in the hemog lobin produced during l ife.
Post-mortem hypostasis
Color is un iform. The wel l known change in color produced in blood
Extravasated Into l iving tissues does not occur in dead tissues with the
same regu larity.
Contusion
 49

If the body happens to be constricted at or supported on a bru ised place,

the actua l surface of contact may be a l ittle l ighter than the rest of the bru
ise
but wi l l not be wh ite.
Post-mortem hypostasis
In a place wh ich wou ld otherwise be the seat of hypostasis pressure of any
kind even simple support is sufficient to obl iterate the lumen of the venu les
and capi l laries and so to prevent their fi l l ing with blood .
Wh ite l ines or patches of pressure bordered by the dark color of hypostasis
are produced and marks of flogg ings, strangu lation , etc. are thus
sometimes simu lated .

FACTORS INFLUENCING THE DEGREE AND EXTENT OF CONTUSSION

1 . Genera l cond ition of the patient.
2. Part of the body affected . Fatty tissues, bloody parts > contused easi ly
Fibrous areas, muscle > less
3. Amount of force appl ied –The greater the force, the more effusion of blood .
4. Disease – Contusion may develop with or without appl ication of force.
Example: Aplastic anemia , whooping cough
5. Age – Ch i ldren and old age tend to bru ise easi ly.
6. Sex – women , obese easi ly develops un l ike boxers.
7. Appl ication of heat and cold
The distinction between ante-mortem and post-mortem contusions in an
undecomposed body is that in ;
1 . Ante-mortem bru ising : there is swel l ing , damage to epithel ium,
extravasation ,
coagu lation and infi ltration of the tissues with blood
2. Post-mortem bru ising there are no such find ings.
a.3 HEMATOMA
- is the extravasation or effusion of blood in a newly formed cavity
underneath the skin . When the blunt instrument h it a hard part of the body
l ike a bony part wh ich is superficia l ly 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 accumu lated in the interstices of the
tissues underneath the skin
In hematoma blood accumu lates in a newly formed cavity underneath the
skin .
1 . in contusion , theskin shows no elevation and is ever elevated , the
elevation is sl ight and is on account of inflammatory changes
In hematoma – the skin is a lways eelevated .
2. In contusion , puncture or aspiration with syringe of the lesion , no blood
can be obta ined .
In hematoma – shows presence of blood and subsequent depression of
the elevated lesion .
Abscess, gangrene, hypertrophy, fibroid th icken ing and even ma l ignancy
 50

are potentia l compl ications of hematoma.

MUSCULO-SKELETAL INJURIES
1 . Spra in - partia l or complete d isruption in the continu ity os a muscu lar or
l igamentous support of a joint, due to a blow, kick or torsion force.
2. D islocation – d isplacement of the articu lar surface of bones entering into
the formation of a joint.
3. Fracture – solution of continu ity of bone resu lting from violence or some
existing pathology.
a. Close or S imple Fx – no break in continu ity of the overlying skin.
b. Open or Compound Fx – Fx is compl icated by an open wound
caused by the broken bone wh ich protruded with other tissues of the
broken skin .
c. Comm inuted Fx – Fractured bone is fragmented into severa l pieces.
d . Greenstick Fx – Fx wherein on ly one side of the bone is broken
wh i le the other is merely bent.
e. Linear Fx – when the Fx forms a crack usua l ly in flat bones.
f. Spira l Fx – break in the bones forms a spira l manner as seen in long
bones.
g . Patholog ic Fx – Fx caused by weakness of the bone due to d isease.

4. Stra in – the over-stretch ing instead of an actua l tearing or the rupture of a

muscle or l igament wh ich may not be associated with the joint.
5. Sublaxation – Incomplete or partia l d islocation .

INTERNAL HEMORRHAGE
- rupture of blood vessels wh ich may cause hemorrhage due to the
fol lowing :
a. Traumatic intracran ia l hemorrhage.
b. Rupture of parenchymatous organs.
c. Laceration of other part of the body.

CEREBRAL CONCUSSION ( COMMOTIO CEREBRI )

- THE JARRING OR STUNN ING OF THE BRAIN CHARACTERIZED BY
MORE OR LESS COMPLETE SUSPENSION OF ITS FUNCTIONS AS A
RESULT OF INJURY TO THE HEAD WH ICH LEADS TO SOME COMMOTION
OF THE CEREBRAL SUBSTANCE.
- is more severe when the moving or mobi le head struck a fixed hard object
as compared when the head is fixed and struck by a hard moving object.
S igns and Symptoms
1 . unconsciousness wh ich is more or less complete.
2. muscles are relax and flaccid .
3. eyel ids are closed and the con junctivae are insensitive.
4. surface of the body is pa le, cold and clammy.
5. respiration is slow and sigh ing .
6. pu lse is rapid , weak, fa ltering and scarcely perceptible to the fingers.
7. temperature is subnorma l .
8. sph incters are relaxed with unconscious evacuation of the bowel and
 51

bladder.
9. reflexes are present but slugg ish and in severe cases may be absent.
Loss of memory for events just before the in jury is a constant effect of
cerebra l concussion and is of med ico-lega l importance.

2. OPEN WOUNDS
a. Abrasion ( Scratch , graze, impression mark, friction mark )
- it is an in jury characterized by the remova l of the superficia l epithel ia l
layer of the skin caused by a rub r friction aga inst a hard rough object.
- Contussion with abrasion = forcible contact before friction occurs.
- the shape varies and the raw surface exudes blood and lymph wh ich later
dries and forms a protective covering as SCAB or CRUST.

Characteristics of abrasion:
1 . I t develops at the precise point of the force causing it.
2. Grossly or with the a id of a hand lens the in jury consists of
para l lel l inear in juries wh ich are in l ine with the d irection of rub or
friction causing it.
3. I t may exh ibit the pattern of the wound ing materia l .
4. Usua l ly ignored by attend ing physician . Med ico-lega l viewpoint
= abrasions caused by fingerna i ls may ind icate strugg le or assau
lt
and are usua l ly located in the face, neck, forearms and hands.
= abrasions resu lting from friction on rough surfaces are located in
bony parts and are usua l ly associated with contusion or
laceration .
= nature of the abrasion may infer degree of pressure, nature of
the rubbing object and the d irection of movement.
5. Abrasion hea ls in a short time and leaves no scar un less if not
infected or if the whole th ickness of the skin is involved .

Forms of abrasion
1 . Linear abrasion – appears as a sing le l ine, straight or curve.
= pinch ing with fingerna i ls = curve a.
= sl id ing the point of a need le = stra ight l inear
ab.
2. Mu lti-l inear – develops when the skin is rubbed on a hard rough
object producing severa l l inear marks para l lel to one another.
Example: MVA
3. Confluent – l inear marks in the skin are a lmost ind istingu ishable
on account of the severity of friction and roughness of the object.

4. Mu ltiple – severa l abrasions of varying sizes and shapes may be

found in d ifferent parts of the body.

Types of abrasion
1 . Scratch – caused by sharp pointed object wh ich sl ides across the skin ,
l ike pin , thorn or fingerna i l .
 52

- In jury usua l ly para l lel to the d irection of sl ide.

= Fingerna i l scratch > broad at point of commencement with
ta i l ing at the end .
2. Graze – usua l ly caused by forcible contact with rough , hard objects
resu lting to irregu lar remova l of the skin surface.
= course ind icated 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 wound ing instrument and the manner
of assau lt or death .
= marks of grid of rad iator, thread marks of wheel , teeth marks.
4. Pressure or friction abrasion – caused by pressure accompan ied by
movement usua l ly observed in hang ing or strangu lation .
= spira l strands of the rope as seen in the skin in hang ing .

Differential diagnosis:
1 . Derma l erosion - gradua l breakdown or very sha l low u lceration of the
skin wh ich involves on ly the epiderm is and hea ls without scarring .
2. Marks of insects and fishes bites – skin in jury is irregu lar with no vita l
reaction and usua l ly found on ang les of the mouth , marg ins of
nose, eyel ids and forehead .
3. Excoriation of the skin by excreta – found in infants and the skin
lesions hea ls when the cause is removed .
No apparent h istory of rubbing trauma on the affected area.

4. Pressure sore – usua l ly found at the back at the reg ion of bony
prom inence. H istory of longstand ing i l lness, bed ridden .
ANTEMORTEM ABRASION POSTMORTEM ABRASION
COLOR redd ish-bronze due to sl ight yel lowish and transparent
exudation of blood
LOCATION any area over bony prom inence
Rough hand l ing of the cadaver
VITAL with intravita l reaction shows not vita l reaction and
REACTION may show rema ins of damaged is characterized by a separation
Epithel ium of the epiderm is from
Complete loss of the former.
b. Incised wound ( cut, slash, sl ice)
– produced by a sharp-edged ( cutting)
– or sharp-l inear edge of the instrument l ike a kn ife, razor, bolo,
g lass etc.

= Impact cut > when there is forcible contact of the cutting instrument
with the body surface.
= S l ice cut > when cutting in jury is due to the pressure accompan ied
with movement of the instrument
= Chopped or Hacked wound > when the wound ing instrument is a
heavy cutting instrument l ike saber
 53

> in jury is severe

Characteristics of incised wound:

1 . Edges are clean cut.
2. The wound is stra ight
3. Usua l ly the wound is sha l low near the extrem ities and deep at the m idd le
portion .
4. Profuse hemorrhage because of the clean cut on the vessels.
5. Gaping is usua l ly present due to the retraction of the edges.
6. Clothes wi l l a lso show a clean cut if cut by the instrument.
7. Faster hea l ing if without compl ications.
8. Incised wound made by broken g lasses maybe irregu lar, needs to be
removed .

Changes that occur in an incised wound:

1 . After 1 2 hours – edges are swol len , adherent with blood and with
leukocyte infi ltration .
2. After 24 hours – prol iferation of the vascu lar endothel ium and connective
tissue cel ls.
3. After 36 to 48 hours –capi l lary network complete, fibroblasts runn ing at
right ang les to the vessels.
4. After 3 to 5 days – vessels show th icken ing and obl iteration .

Why a person suffers from incised wound:

1 . As a therapeutic procedure.
2. As a consequence of self-defense
3. Masoch ist may self-infl ict incised wounds for self-gratification .
4. Add icts and menta l patients.

Su icida l wounds – usua l ly located in pecu l iar parts of the body, accessible to
the
hand .
- the most common site is the wrist, rad ia l artery and the neck.
Hom icida l wounds – usua l ly deep, mu ltiple and involves both accessible and
non-accessible parts.
- cloth ing are usua l ly involved
- Defense and other forms of wounds are present.
Accidenta l wounds – mu ltiple incised wounds observed on the passenger and
driver of MVA due to broken windsh ields.
- kitchen kn ives in the preparation of food .

SU ICIDAL WOUNDS HOM ICIDAL WOUNDS

DIRECTION Obl ique from below left ear, Usua l ly horizonta l below
downwards across front neck the adams apple
just above Adams apple
SEVERITY Usua l ly not so deep and Usua l ly deep and may cause
may on ly involve trachea, involvement of the carti lage
 54

carotid and esophagus and bones.

SUPERF’L Usua l ly present before the Practica l ly absent but may

CUT commencement of deeper rarely be present when the
wound . victim strugg led when attacked
POSIT’N OF May be sitting or facing a Usua l ly victim lying on bed
THE BODY m irror or stand ing or in other place.
WOUNDING Firm ly grasp (cadaveric spasm) Weapon is absent
WEAPON or found lying beside the
victim.
BLOOD B ld found in front part of body B ld found at the back of neck.
DISTRIBUTION Hand smeared with blood . Hands are clean .
MOTIVE H istory of menta l depression , Absence of such h istory
Financia l , socia l problems, a lcohol ism
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 l ike a kn ife, 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 the width of the wound ing instrument.
= smal ler when the wound is not so deep.
= wider if upon withdrawa l is not in the same d irection as seen in
slash ing movement. The presence of an abrasion from the extrem ity of
the skin defect is in l ine with d irection of the slash ing movement.

The extrem ities of stab wound may show the nature of the instrument used .
- a doubled bladed weapon shows both extrem ities to be sharp.
- A sing le bladed weapon – one of its extrem ities as rounded and contused ,
not seen if instrument is qu ite th in .
The d irection of the surface defect may be usefu l in the determ ination of the
possible relative position of the offender and the victim when the wound was
infl icted .

As to whether the wound is sl it-l ike or gaping depends on the d irection of the
wound to the Langers l 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 appl ied
Hemorrhage is a lways the most serious consequence of stab wound due to
the severance of blood vessels or involvement of bloody organs.

How to describe stab wound:

 55

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

Ta i l ing – the d irection of withdrawa l of the wound ing weapon .
2. cond ition of the extrem ities
= sharp extrem ity > sharpness of the instrument used .
= If Both extrem ity are sharp > double bladed weapon is used .
3. cond ition of the edges.
= edges are regu lar and clean cut> due to one stabbing act.
= serrated or zigzag in appearance > severa l stabbing wounds ( series
of thrust
and withdrawa l .)
4. l inear d irection of the wound – it may be runn ing vertica l ly, horizonta l ly, or
upward med ia l ly or latera l ly.
5. location of the stab wound – to include exact measurement from
anatom ica l landmarks.
6. d irection of the penetration – must be trid imentiona l
7. depth of the penetration
8. tissue and organs involved

Stab wounds may be:

A.Suicidal
1 . Located over vita l parts of the body.
2. Usua l ly sol itary
3. Located over covered parts of the body, the cloth ing is not involved
4. Stab wound is accessible to the hand of the victim
5. Hand of victim is smeared with blood
6. Wound ing weapon is firm ly grasp by the hand of the victim.
7. If stabbing is accompan ied with slash ing movement
> the wound ta i l ing abrasion is seen towards the hand infl icting
the in jury.
8. Su icide not may be present
9. Presence of a motive for self destruction .
1 0. No d isturbance in the death scene with wound ing instrument found
near the victim.
B. Homicidal – stabbing with hom icida l intent is the most common

Characteristics:1 . In juries other than stab wound may be present .

2. Stab wound may be located in any part of the body.
3. Usua l ly 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 kil l the victim:
1 . there are more than one stab wounds
2. stab wounds located in d ifferent parts of the body
3. stab wounds are deep
4. serrated stab wounds means thrust and withdrawa l of the wound ing
weapon to increase interna l damages.
5. irregu lar or stel late shape skin defects> due to chang ing d irection of the
 56

weapon with the portion of the instrument at the level of the skin as the
lever.

4. PUNCTURED WOUND - is the resu lt of a thrust of a sharp pointed

instrument.

= Externa l in jury is qu ite sma l l but the depth is to a certain degree. ; ice-pick, na
il
- Nature of the externa l in jury depends on the sharpness of the end of the
wound ing instrument:
= contusion of the edges> if end is not sharp
= open ing may be> round , el l iptica l , d iamond shaped or cruciate.
- Externa l hemorrhage is l im ited a lthough interna l in juries may be severe.>
blood
vessels and bloody organs is fata l if no intervention appl ied .
- Site of externa l wound can be easi ly sea led by dried bld , serum, or clotted bld .
- Punctured wounds are usua l ly accidenta l

Characteristics:
1 . The open ing of the skin is very sma l l , wound is much deeper than it
is wide.
2. Externa l hemorrhage is l im ited than interna l ly may be severe.
3. Sea l ing of externa l open ing is favorable for the growth and
mu ltipl ication of anaerobic organ ism l ike baci l lus tetan i .

Homicidal -
1 . mu ltiple and usua l ly located in d ifferent parts of the body.
2. wound are deep
3. there are defense wounds on the victim.
4. signs of strugg le in the crime scene.

Su icidal -
1 . located in areas of the body where the vita l organs are located .
2. usua l ly singu lar, if mu ltiple located in one area.
3. parts of body involved is accessible by the hand of the victim.
4. cloth ing usua l ly not involved .
5. wound ing is made wh i le the victim is in sitting or stand ing position ,
bleed ing is towards the lower part of the body or cloth ing .
6. no d isturbance in the crime scene.
7. wound ing instrument found near the body.
Puncturing wound with puncturing instrument loaded with poison :
1 . poison dart – cyan ide or n icotine
2. fish spines
3. dog bites with hydrophobia virus
4. in jection of a ir and poison as a way of euthanasia.

5.LACERATED WOUNDS ( TEAR, RUPTURE, STRETCH “PUTOK”)

- is a tear of the skin and the underlying tissues due to forcible contact with
 57

a blunt instrument.
- May be produced by a h it with a piece of wood , iron bar, fist, stone, butt.
- If the force is appl ied to a tissue is greater than its cohesive force and
elasticity> the tissue tears and a laceration is produced .

Characteristic:
1 . shape and size of the in jury does not correspond to the wound ing
instrument
2. tear on the skin is rugged with extrem ities irregu lar, i l l-defined .
3. in jury developed where the blunt force is appl ied .
4. borders of the wound are contused and swol len .
5. developed in areas where the bone is superficia l ly located . l ike sca lp.
6. exam ination with the a id of hand lens shows bridg ing tissue join ing
the edges and ha irs bu lbs are intact.
7. bleed ing is not extensive due to blood vessels are not severed
even ly.
8. hea l ing process is delayed and has a tendency to develop a scar.
Classification of lacerated wounds:
1 . Spl itting caused by crush ing of the skin between two hard objects.
Ex: laceration of sca lp h it by a bunt instrument, cut eyebrow of a boxer.
2. Overstretch ing of the skin
- When pressure is appl ied on one side of the bone> the skin over the area
wi l l be stretched up to a breaking point to cause laceration and exposure
of the fractured bone.
- In avu lsion : the edges of the rema in ing tissue is that of laceration .
3. Grind ing compression
- the weight and the grind ing movement may cause separation of the skin
with the underlying tissues.
4. Tearing
- th is may be produced by a sem i-sharped edged instrument wh ich causes
irregu lar edges on the wound l ike hatchet and choppers.

Lacerated wounds are rarely su icida l .

INCISED WOUNDS LACERATED WOUNDS

Edges are clean cut, regu lar, wel l defined edges are rough ly cut, irregu lar, i l
l-
defined
No contusion or swel l ing around the swel l ing and contusion around the
Incised wounds lacerated wounds
Extrem ities of the wound are sharp, may be extrem ities are i l l-defined and
irregu lar
Round , or contused
Exam ination by means of a hand lens ha ir bu lbs are preserved
Shows that ha ir bu lbs are cut
Hea l ing is faster hea l ing is delayed
Caused by sharp edged instrument caused by a blunt instrument
 58

GAPING OF WOUND
- Separation of the edges especia l ly in deep wound may be due to the
fol lowing :
1 . mechan ical stretching or dilatation
- the presence of a mechan ica l device on the edges to prevent coaptation
wi l l cause separation . Example: dra in in an abscess, retractor during
operation .
2. loss of tissue due to:
a. Destruction due to pressure, inf’tion , cel l lysis, burn ing , chem ica l
reaction .
b. Avu lsion or physica l or mechan ica l stretch ing resu lting to separation of a
portion of the tissue.
c. Trimm ing of the edges – debridement of the skin wh ich come in contact
with the bu l let at the entrance and exit of GSW and remova l of necrotic materia ls.
3. retraction of the edges
- underneath the skin are dense networks of fibrous and elastic connective
tissue fibers runn ing on the same d irection and form ing a pattern more or
less present in a l l persons.
- Th is pattern of fiber arrangement is ca l led cleavage d irection or l ines of
cleavage of the skin and their l inear representation on the skin is ca l led
Langers l ine.
Practical ways of determin ing how much of the skin surface is involved in
an injury or disease:
- skin functions as a mechan ica l protection of the body, storage of water.
- Determ ination of how much skin is involved is important in the mode of
treatment and prognosis especia l ly in burns, contusion . .
= burns of 70% in ch i ldren and older age group are fata l .
= rule of n ine is used. Head and neck 9% 9%
one upper extrem ity 9% 1 8%
front chest and abdomen 1 8% 1 8%
posterior chest and abdo 1 8% 1 8%
one lower extrem ity front 9% 1 8%
one lower ext(back) 9% 1 8%
pudendum 1% 1%

Factors responsible for the severity of the wound:

1 . Hemorrhage may influence the severity of wound by:
a. loss of blood incompatible with l ife
- blood constitutes 1 /20 of the body weight of an adu lt.
- 5 to 6 quarts of blood ( one quart is 946 cc)
- loss of 1 /1 0th of its volume wi l l cause no sign ificant change.
- loss of one quart> fa inting
- loss of 1 /3rd to 2/5th > irreversible shock
- ma les can withstand more loss of blood than fema les.
- hypertension causes more excessive and rapid bleed ing .

b. Hemorrhage may resu lt in an increase in pressure in or on the vita l

organs to affect the norma l function .
 59

- intracran ia l hemorrhage cause compression of the vita l centers of

the bra in .
- hemopericard ium > pericard ia l tamp
- hemorrhage to the chest> d im inution of the respiratory output>anoxia.
c. . Hemorrhage may cause mechan ica l barriers to the function of organs.
- into tracheo-bronch ia l lum ina> asphyxia
- into muscles > d isturbance in their contracti l ity.

Causes of hemorrhage:
a. trauma - destruction of its blood vessel wa l l
b. natura l causes
- intracerebra l hemorrhage(apoplexy)> lenticu lostra ite br. MCA
- Spontaneous subarachnoid hemorrhage > saccu lar berry aneurysm
- rupture of arteriosclerotic aneurysm
- rupture of esophagea l varices
- pu lmonary hemorrhage due to PTB, lung abscess, bronch iectasis
- ruptured ectopic pregnancy

2. Size of in jury - burns greater than 1 /3rd of the body are fata l
3. Organs involved – usua l ly fata l to heart, bra in , lungs.
4. Shock – blow to gen ita l ia, sl ight burns to young and old .
5. Foreign body or substance introduced into the body - bacteria l , vira l , foreign
body, chem ica l ,

TOXIN .
1 . snake bites> 2 punctured wds at the center of the reddened affected area.
The venom is in jected through its fangs wh ich is connected to the poison
g land .

Snake venom toxicity wi ll depend on:

1 . potency of venom in jected
2. amount of venom in jected by the fang wi l l depend on
- season of the year
- the length of time the snake has eaten .
- if a snake has just ki l led its prey> toxic content is sma l ler.
3. size of the patient
4. immed iate treatment instituted .
Snake venoms are two principal classes:
1 . Neurotoxic – primari ly para lysis the respiratory and card iac center of the bra in
.
- may cause N ,V, ascend ing para lysis, coma, convu lsion , c/p
arrest
2. Hematoxic - affects particu larly the blood
- man ifestations are pa in , swel l ing on the affected area, IV hemolysis,
N ,V, pu lmonary and card iac edema.
Emergency treatment may be:
1 . incision of the wound to promote more externa l hemorrhage to dra in the
venom.
 60

2. tourn iquette above the site of the wound

3. placing ice on the bite site
4. sucking the wound to dra in venom with the mouth
5. adm in istration of anti-snake venom serum.
2. Scorpion venom
- venom has toxic, hemolytic, hemorrhag ic
- one punctured wound on the center of a reddened area
- pa in , edema and redden ing
3. Coelenterate sting ( jel lyfish )
- tentacles penetrate into the skin and cause explosion of the nematocyst
and l iberation of the venom.
- extreme pa in . Urticaria l rash , d i lated pupi ls, pa leness, labored breath
ing
6. Absence of med ica l or surg ica l intervention – wound may not be fata l but
due to neg lect or ignorance of its management, may be serious and fata l .

FATAL EFFECT OF WOUNDS:

1 . Wounds may be d irectly fata l by reason of:
a. hemorrhage – neck due to carotid bleed .
b. Mechan ica l in juries on vita l organs
c. shock
2. Wounds may be ind irectly fata l by reason of:
a. secondary hemorrhage fol lowing sepsis
b. specific infection
c. scarring effect
d . secondary shock

NATURE OF DEATH DUE TO SECONDARY CAUSES

1 . Changes whose natura l sequence are d irect & obvious – sepsis, tetanus
2. Changes producing separate patholog ica l lesions wh ich in turn proves to
be fata l
Ex: operation to l igate vessel but d ied of periton itis despite d i l igence/ski l
l
3. Changes where a defin ite patholog ica l cond ition was present before the
in jury. Ex. Person with tumor and stabbed , stab is not capable of death
but accused is responsible for h is death .
4. Changes where a defin ite patholog ica l cond ition of tota l ly d ifferent nature
arises after the wound ing and the consequentia l sequence is doubtfu l .
Ex. TB men ing itis ffg blow to the head

COMPLICATIONS OF TRAUMA OR INJURY

1 . Shock due to in jury to nervous system, anoxem ia, endothel ia l damage
2. Hemorrhage
3. Infection
a. from the instrument
b. from the organs involved in trauma ex. Bowels in jured
c. in jury may depress genera l vita l ity
d . del iberate intro of m icro-organ ism
 61

4. Embol ism

HEALING OF WOUNDS
1 . Power of the human tissue to regenerate – replaced the destroyed tissue
by newly formed sim i lar tissue.
Regenerates rapid ly : C.T. , blood form ing tissues,surface epith . skin
S low to regenrate:sm. Muscles, neurons of CNS, h igh ly specia l ized
g landu lar tiss.
Time of hea l ing is dependent on :
a. vascu larity
b. age of person
c. degree of rest or immobi l ization
d . nature of the in jury
2. Aberrated hea l ing process:
a. formation of exuberant granu lation or proud flesh
b. keloid formation
c. stricture
d . fistu la or sinus formation

MEDICO-LEGAL INVESTIGATION OF WOUNDS

Rule to follow by a physician :
1 . a l l in juries must be described
2. description of wound must be comprehensive, sketch/photograph
3. exam ination must be influenced be any other information obta ined from
others in making a report or a conclusion .

Outl ine of the medico-legal investigation of physical in juries:

1 . General investigation of the surroundings:
a. exam ination of place where crime is comm itted .
b. Exam ination of cloth ing , sta ins, cuts, ha ir, f.b. in the crime scene
c. Investigations on possible witnesses to the incident
d . Exam ination of the wound ing instrument
e. Photography, sketch ing , accurate description of the crime scene.
2. Examination of the wounded body
a. exam inations appl icable to l iving or the dead
- age of the wound from the degree of hea l ing
- determ ination of the weapon used
- reasons for the mu ltipl icity of wounds
- determ ination if the wound is accidenta l , su icida l or hom icida l
b. exam ination appl icable on ly to the l iving
- determ ination if in jury is fata l
- determ ination if in jury wi l l produce permanent deform ity
- determ ination if wound produces shock
- determ ination if wound produces compl ications

c. exam ination appl icable to a dead victim on ly

- determ ination if wound is pre-mortem or post-mortem
- determ ination whether wound is morta l or not
 62

- determ ination whether death is accelerated by a d isease present at time

of in jury.
- determ ination 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 determ ine tra jectory/course
- depth of wound : not in the l iving , on ly if the outer and inner are fixed
- cond itions of the surround ings of the wound -
= near GSW – burn ing , tattooing
= su icida l cuts – superficia l tentative cuts or hesitation cuts
= lacerated wounds – contusion on neighboring skin
- extent of the wound
= extensive in jury – marked degree of force appl ied in the
production of the wound .
= hom icida l cutthroats are deeper, extensive, numerous than
su icide
- d irection of the wound > impt. in the position of the victim to the offender
- number of wounds – severa l> hom icida l
- cond itions of loca l ity
a. degree of hemorrhage
b. evidence of strugg le
c. information as to the position of the body
d . presence of su icide note
e. cond ition of the weapon

ANTE-MORTEM WOUNDS POST-MORTEM WOUNDS

HEMORRHAGE More profuse, arteria l S l ight or none, venous
due to loss of tone of vessels,
Absence of heart action
Post-mortem clotting of
blood inside b.v.
Marks of spouting of blood No spouting of blood
from arteries

Clotted blood B ld not clotted ,or soft clot

SIGNS OF Inflammation & reparative None
INFLAMMATION process
Swel l ing in the area,
Effusion of lymph , pus
Adhesion of the edges
Un less if victim is weakened
SIGNS OF Fibrin formation No time of repa ir
REPAIR growth of epithel ium
Scab or scar formation
RETRACTION Deep sta in ing of the edges Not deeply sta ined
OF THE EDGES and cel lu lar tissues can be removed by wash ing
OF THE WOUND wh ich is not removed by wash ing
 63

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

after death

DETERMINATIONS IF WOUND IS:

HOMICIDAL SU ICIDAL ACCIDENTAL
ABRASIONS Not common un less Rarely observed Extensive
If dragged abrasions MVA
Or if victim resisted
CONTUSION Rare except when Found in any portion
jumping from a height of the body - Fa l l
INCISED Common ly observed Common ly observed Frequent but rarely
WOUNDS * depth , location and surround ings cause of death
Points to consider in the determinat’n as to whether the wounds is A, S, H .
1 . externa l signs and circumstances related to the position and attitude of the
body when found .
2. location of the weapon or the manner in wh ich it was held
3. the motive in the comm ission of the crime
4. the persona l character of the deceased
5. the possibi l ity for the offender to have purposely changed the truth of the
cond ition .
6. other information
a. signs of strugg le
b. number and d irection of wounds
c. d irection of wound
d . nature and extent of the wound
e. state of cloth ing

LENGTH OF TIME OF SURVIVAL OF THE VICTIM AFTER INFLICTION OF

THE WOUND
1 . degree of hea l ing> signs of repa ir of wound appear in less than a day after
the infl iction of in jury.
2. changes in the body in relation to the time of death >systematic changes
in the body = wasting , anem ia, bed sore.
3. age of blood sta in – not rel iable
4. testimony of witness when the wound was infl icted .

POSSIBLE INSTRUMENTS WHEN USED BY THE ASSAILANT IN

INFLICTING THE INJURIES
1 . contusion – blunt
2. incised 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 d iameter of the wound of entrance may approximate the
 64

ca l iber of the wound ing instrument.

Cou ld the in jury have been infl icted by a special weapon?
A physician cant determ ine that a specific weapon was used in infl icting a
wound .
I t is possible that it is caused by a certa in instrument presented .
He must be cautious in g iving categoric statements
Which of the injuries sustained by the victim caused death?
If with conspiracy – no need coz the act of one is the act of a l l .
If none- offenders are on ly responsible for their ind ividua l acts.
If mu ltiple in juries: wh ich of the wound in jured a vita l organ .
Or if same organ wh ich caused the degree of damage.
Which of the wounds was infl icted first?
If mu ltiple for the qua l ification of the offense comm itted .
First – treachery , murder
Last - hom icide

Consider:
1 . relative position of the assa i lant and the victim when the first in jury was
infl icted on the latter.
2. tra jectory/course of the wound inside the body of the victim
3. organs involved and the degree of in jury
4. testimony of witness
5. presence of defense wounds – infl icted first.
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 norma l and d irect consequence
of the in jury, and the physician is competent and in spite of exercise of degree of
d i l igence sti l l death is the outcome.
If death ensued even the wounds are m inor, and death due to the neg l igence
or incompetence of the physician then the offender cant be responsible.
Effect of negligence of the in jured person on the death
If death occurred from compl ications arising from a simple in jury owing to the
neg l igence of the in jured person in its proper care and treatment
= the offender is responsible for the death
= a person is not bound to subm it h imself to med ica l tx for the in juries
received during the assau lt.
= un less if it is proven that the neg l igence of the victim is del iberate so
offender is not responsible but on ly for physica l in juries.
Power of vol itional acts of the victim after receiving a fatal injury:
= dying declaration , attempt to ki l l the offender after the first blow of the offender
Relative position of the victim and assai lant when in jury was inflicted:
1 . location of the wound
2. d irection of the wound
3. nature of instrument used in infl icting the in jury
4. testimony of the witness

EXTRINSIC EVIDENCES OF THE WOUNDS

1 . evidences from the wound ing weapon
 65

= position of the weapon - near or grasp by victim

= blood on weapon - may be sta ined with blood
= ha ir and other substance on weapon
2. evidences in the cloth ing of the victim
= soaked with blood - hemorrhage
= gunpowder - d istance
= tears - strugg le
3. evidences derived from the exam ination of the assa i lant
= paraffin test, tears in cloth ing , blood sta ins, intoxication etc.

4. evidences derived from the crime scene

= amount of hemorrhage, wound ing instrument etc.

PHYSICAL INJURIES IN THE DIFFERENT PARTS OF THE BODY

1. HEAD AND NECK
= not be underestimated
= bleed ing from ears, nose, mouth > basa l fractures
= may have norma l x-rays yet with severe head in jury
Factors influencing the degree and extent of head in juries :
a. nature of the wound ing weapon> degree of violence appl ied
depends on the th ickness of the sca lp and the weight of the
weapon .
b. Intensity if the force > intensity and heavy agent
c. point of impact >extensive in fx of vau lts at side or back
d . mobi l ity of the sku l l at the appl ication of force
if head is mobi le, free> effect on the bra in is due to the shearing
movement imparted to the bra in .
> may produce contusion , laceration without fx.
If head is fixed and unsupported> jarring movement of the bra in is absent
but the fracture is extensive.

Head in juries are classified as to the site of the appl ication of force:
1 . Direct or Coup in juries
2. Ind irect in juries
a. contr-coup in juries
b. remote in juries – fa l l h itting buttocks> basa l fx
c. locus m inoris resistencia - in jury in areas with less resistance
3. Coup-contre-coup in juries ( d irect and ind irect in juries)
Wounds in the Scalp:
1 . it is d ifficu lt to prevent the spread of infection
2. there is proxim ity of the sca lp to the bra in
3. there are free vascu lar connection between the structures inside and
outside the bra in
4. it is frequently d ifficu lt to determ ine the extent of damage of the sku l l .
FRACTURES OF THE SKULL p. 302
GUNSHOT WOUNDS

Death or physical in juries brought about by powdered propel led

 66

substances:
1 . Firearm shot
= the in jury is caused by the m issi le propel led by the explosion of the
gunpowder located in the cartridge shel l and the rear of the m issi le.

2. detonation of h igh explosives - grenades

= explosion inside the meta l l ic conta iner wi l l cause fragmentation of
the
conta iner.
I. FIREARM WOUND

= Firearm : is an instrument used for the propu lsion of a projecti le by the

expansive force of gasses com ing from the burn ing of gunpowder.
(techn ica l defin ition)
= includes rifles, muskets, shotguns, revolvers, pistols, other dead ly weapons
wh ich a bu l let, ba l l , shel l or other m issi le may be d ischarged by
means of
gunpowder or other explosives.
= includes air rifle except of sma l l ca l ibers and l im ited range.
= the barrel of any firearm sha l l be considered as a complete firearm for a l l
purposes thereof.
Penal provisions of laws relative to firearm:
a. Sec. 2692 RAC – un lawfu l manufacture, dea l ing in acqu isition ,
d isposition or possession of firearms or ammun itions therefore or
instrument used or intended to be used in the manufacture of
firearms or ammun ition .
b. Sec. 2690 RAC – sel l ing of firearms to un l icensed purchaser.
c. Sec. 2691 RAC - fa i lure of persona l representative of deceased
l icensee to surrender firearm.
d . Art. 1 55 RPC - Alarms and Scanda ls
e.Art. 254 RPC – Discharge of firearms

CLASSIFICATION OF SMALL FIREARMS:

Sma l l firearms - are those wh ich propel projecti le of less than 1 inch in d iameter.
1 . as to wound ing power:
= low velocity firearm >muzzle velocity of not more than 1 400 ft per sec.
Ex. Revolver
= h igh power firearm > muzzle velocity more than 1 400 ft. per second
> usua l 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 spira l lands
and grooves wh ich run para l lel with one another but twisted spira l ly from
breech to muzzle. Ex. M i l itary rifle
3. as to manner of firing
= pistol – fired with a sing le shot Ex. Revolver
= rifle – may be fired from the shou lder Ex. Shotgun
 67

4. As to the nature of the magazine

= cyl indrica l revolving magazine – the cartridge is located in a cyl indrica l
magazine wh ich rotates at the rear portion of the barrel
Ex. Revolver
= vertica l or horizonta l magazine – the cartridge is held one after another
vertica l ly or horizonta l ly and a lso held in place by a spring side to
side or end to end . Ex. Automatic pistol

Types of small firearms wh ich are of medico-legal interest:

1 . revolver – usua l muzzle velocity is 600 feet per second
2. automatic pistol – self-load ing firearm, muzzle velocity of 1 200 feet per
second
3. rifle - muzzle velocity of 2500 feet per second and a range of 3000 feet.
4. shotgun - projecti le is a col lection of pel lets
A weapon in order to cause in jury must have two principal component
parts:
1 . the cartridge or ammun ition - bu l let primer, cartridge case, powder charge
2. firearm – instrument for the propu lsion of a projecti le force of gases from a
burn ing powder.

ENTRANCE WOUND EXIT WOUND

Appears to be sma l ler than the m issi le Always bigger than the m issi le
Owing to the elasticity of the tissue
Edges are inverted Edges are everted
Usua l ly ova l or round depend ing upon Does not man ifest any defin ite
the ang le of approach of the bu l let shape
Contusion col lar or contact ring is present Absent
due to invag ination of the skin
and spinn ing of the m issi le
Tattooing or smudg ing may be present when Absent
when firing is near
Underlying tissues are not protrud ing Underlying tissues may be
seen
Protrud ing from the wound
Always present after fire May be absent, if m issi le is
lodged in the body
Paraffin test may be positive Negative

INSTANCES WHEN THE SIZE OF THE WOUND OF ENTRANCE DO NOT

APPROXIMATE THE CALIBER OF THE FIREARM
In d distant fire, the rule is that the d diameter of the GSW of entrance is a almost
the
Same as the caliber of the wounding firearm except:
1. Factors which make the wound of entrance bigger than the cal iber:
a. in contact or near fire
b. deformity of the bullet which entered
c. bullet m might have entered the skin sidewise
d . acute angular approach of the bullet
 68

2. Factors which make the wound of entrance smaller than the caliber
a. fragmentation of the bu l let before penetrating the skin
b. contraction of the elastic tissues of the skin
Other evidences or findings used to determine entrance of GSW
1 . exam ination of the cloth ing , if involved in the course of the bu l let
a. fabric shows punch in destruction
b. particle of gunpowder
2. exam ination of the interna l in juries caused by the bu l let
a. bone fragments, carti lage, soft tissues are driven away from entrance
wound
b. destruction of the bone is ova l , with sharp edges
at the exit it is irregu lar, bigger and bevel led
c. testimony of witness

Determination of the trajectory of the bu llet inside the body of the victim
1 . external examination
a. shape of wound of entrance
= when bu l let is fired at right ang le with the skin> the wound of entrance
is
circu lar except in case of near fire.
= if fired at another ang le , it is ova l
= when the bu l let is deformed no such characteristics find ings wi l l be
observed .
b. shape and d istribution of the contusion col lar
= contusion col lar is widest at the side of the acute ang le of approach of
the bu l let.
= if the bu l let h its the skin perpend icu larly> col lar wi l l have a un iform
width around the GSW except when bu l let is deformed or in near fire.
c. d ifference in level between the entrance and exit wounds

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

2. internal examination
a. actua l d issection and tracing the course of the wound at autopsy
b. fracture of bones and course in viscera l organs
c. location of bone fragments and lead particle
d . x-ray exam
3. other evidences to show trajectory
a. relative d ifference in the vertica l location of entrance and exit in the cloth ing
b. relative position and d istance of the assa i lant 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 un l ike the entrance wound due to the
absence of externa l support beyond the skin so the bu l let tends to tear or shatter
the skin .
Shored GSW of exit: if pressed on a hard object l ike when victim is lying :
Wound of exit is circu lar or nearly circu lar with abrasion .
 69

ODD AND EVEN RULE IN GSW

= If the number of entrance and exit wound is even so presumption that no
bu l let is lodge in the body.
= verified by x-ray
How to determine the number of fires made by the offender:
1 . determ ination of the number of spent shel ls
2. determ ination of entrance wounds in the body of the victim – number of
entrance wounds may not show the exact number of fire:
a. not a l l fire made may h it the body of the victim
b. the bu l let may in the course of its fl ight h it a hard object thereby
spl itting it and each fragment may produce separate wounds of
entrance.
c. Bu l let 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:
1 . a bu l let m ight have entered the body but spl it into severa l fragments, each
of wh ich made separate exit.
2. one of the bu l lets m ight have entered a natura l orifice of the body. Ex.
nose
3. there m ight be two or more bu l lets wh ich entered the body through a
common entrance and later making ind ividua l exit wounds .
4. in near shot with a shotgun , the pel lets m ight have entered in a common
wound and later d ispersed wh i le 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 bu l let is not through and through and the bu l let
is
lodged in the body.
2.when al l of the bu l lets produce through and through wounds but one or
more made an exit in the natura l orifices of the body.
3. when d ifferent shots produced d ifferent wounds of entrance but two or
more shots produced a common exit wound .
Instances when there is no GSW of exit but the bu llet is not found in the
body of the victim:
1 . when the bu l let is lodged in the GIT and expel led through the bowel or
lodged in the pharynx and expel led through the mouth .
2. near fire with a blank cartridge produced a wound of entrance but no slug
may be recovered .
3. the bu l let may enter the wound of entrance and upon h itting the bone the
course is deflected to have the wound of entrance as the wound of exit.
Antemortem GSW – hemorrhage, swel l ing , vita l reaction .
- m icroscopica l ly: congestion and leucocytic infi ltration .
 70

Problems confronting Forensic Physician in the identification of GSW:

1 . a lteration of the lesion due to natura l process:drying of wound , infn ,
hea l ing proc. .
2. med ica l and surg ica l intervention : refer to cl in ica l record of patient
3. emba lm ing
4. problems inherent to the in jury itself.
5. x-ray exam – m igratory, externa l souven irs

The effects of the cloth ing on the movement of the bul let depend on:
1 . number of layers of fabric between the muzzle and subjacent skin
2. nature of the fabric; closely woven
3. muzzle- cloth ing d istance
Examination of the external wearing apparel of the victim of GSW may be
significant in investigation because:
1 . it may establ ish 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 , burn ing of fibers around the turned
fiber
= muzzle imprint
= d irt and greasy deposit may be wipe out and visible in the torn cloth ing
b.not contact but near shot
= same with (a) except for absence of muzzle imprint and beyond flame
range
c. far fire
= there is a hole tear with inward d irection of the thread
2. it may be usefu l in the determ ination as to wh ich is the point of entry and of
exit of the bu l let. Entry- the fiber are inverted .
3. it may be usefu l in locating the bu l let
Special consideration on bu llets
1 . souven ir bu l let
2. bu l let m igration
3. tandem bu l let

EVIDENCES SHOWING THAT THE GUNSHOT WOUNDS MAY BE SU ICIDAL

1 . shot fired in a closed locked room, or open un inhabited 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 usua l ly sol itary
6. d irection of fire is compatible with the tra jectory of bu l let
7. persona l h istory may revea l socia l , econom ic, business or marita l problem
wh ich cannot be solve.
8. gunpowder presence in the hand of the victim
9. entrance wound usua l ly does not conta in cloth ing
1 0. fingerprints of victim on the butt
 71

1 1 . su icide note at the vicin ity

1 2. no d isturbance in the place of death
Russian rou lette = unfortunate victim has no predeterm ined desire of self-
destruction
EVIDENCES THAT GSW IS HOM ICIDAL
1 . site of wound of entrance has no point of election
2. fire is made when the victim is at some d istance
3. signs of strugg le or defense wounds
4. d isturbance in the surround ings
5. wound ing firearm usua l ly not found in the scene of the crime
6. testimony of witness

EVIDENCES TO SHOW THAT GSW IS ACCIDENTAL

1 . usua l ly one shot
2. no specia l area of body involved
3. consideration on the testimony of the assa i lant and determ ination 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 , d istance of wound from
m id l ine, d istance of wound from heel or buttock.
3. d irection and length of the bu l let track
4. organs or tissues involved in its course
5. location of the m issi le, if lodged in the body
6. d iagram. 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 H IM?
2. AT WHAT RANGE WAS IT FIRED?
3. WHAT WAS THE DIRECTION OF THE FIRE?
4. IS IT SELF-INFLICTED?
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 ca l iber may be inferred from the d iameter of the wound of entrance.
Determination of the length of survival of the victim:
1 . nature of the GSW
2. organs involved
 72

3. presence or absence of infection

4. amount of blood loss
5. physica l cond ition of the patient
Capacity of a victim to perform vol itional acts – depends upon the area of the
body involved , involvement of vita l 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. chem ica l changes inside the barrel
3. evidences that may be deduced from the wound

DETERMIN ING WHETHER THE WOUNDING WEAPON IS AN AUTOMATIC

PISTOL OR A REVOLVER
1 . location of the empty shel ls – revolver the empty shel ls are found in the
cyl indrica l magazine chamber after the fire
2. nature of the spent shel l – automatic firearm = bu l let is copper jacketed
3. nature of the base of the cartridge or spent shel l = base of a revolver
has a wider d iameter than that of the cyl indrica l 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
d ifferent ca l ibers to identify the firearm by the sound produced .
It is not possible to determ ine the d irection of the shot by determ in ing the
d irection 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
d ischarged at a long range by the victim.
2. when the GSW of entrance does not show characteristics of a near shot
because the cloth ing are interposed between the victim and the firearm.
3. when the exam in ing physician fa i led to d istingu ish 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 . faci l itate the location and extraction of the wound
2. revea ls fragmentation and its location
3. shows bone involvement l ike fracture
4. revea l tra jectory of the bu l let
5. shows effect of the bu l let wound , l ike hemorrhage, escape of a ir,
laceration

SHOTGUN WOUNDS
Is a shou lder fired firearm having a barrel that is smooth-bored and is intended
for the firing of a changed compound of one or more ba l ls or pel lets.
Measure the distance between the two farthest shot(pel lets) in inches and
subtract one, the number obtained wil l give the muzzle-target distance in
 73

yards.

Determination of the presence of gunpowder and primer components:

Importance:
1 . Determ ination of the d istance of the gun muzzle from the victim ’s body
when fired . Usua l ly not more than 24 inches when fired .
2. Determ in ing whether a person has fired a firearm. – dorsum of the hand
= meta l l ic residues, burn ing and unburned gunpowder
= in su icide found in the pa lm

Procedures in determining the presence of gunpowder:

1 . Gross exam ination use of hand lens – Fine black powder – not conclusive
2. M icroscopic exam ination
3. Chem ica l test:
Tests for the Presence of Powder residues
1 . 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 1 50 degrees fahrenheit – Lung ’s reagent
= sma l l particles with n itrate or n itrite > blue reaction
= not conclusive: ferti l izers, cosmetics, cigarettes, urine
= Negative is not conclusive: thorough wash ing
2. On cloth ings
Walker’s test ( C-acid test, H-acid test)
= g lossy photograph ic paper fixed in hyposolution for 20 m in to
remove the si lver sa lts and washed for 45 m in . and dries.

Tests for the presence of Primer Components – meta l l ic primer residues l ike
barium , antimony, and lead .
1 . Harrison and Gi lroy test :Cotton swab moistened with 0.1 molar HCl to
gather the primer component.
= Reagent sod ium rhod isonate yields red color with the primer components.
= Add 1 .5 HCl to the red area> blue-violet or pink in lead or barium
= lacks specificity, sensitivity
2. Neutron Activation Analysis (NAA)
= Sample obta ined by paraffin or by wash ing with d i lute acid
= Extremely sensitive, even with sma l l quantity
3. Flameless Atomic Absorption Spectroscopy (FAAS)
4. Use of Scann ing electron microscope with a Linked X-ray analyzer

THERMAL INJURIES OR DEATHS

- are those caused by deviation from norma l temperature, capable of producing
cel lu lar or tissue changes in the body.
- Exposure to severe cold = Frost bite
- exposure to h igh temperature = burn ing sca ld ing

1 . DEATH OR INJURY FROM COLD

 74

- not common in the Ph i l ippines

- Primary cause of death : Decrease d issociation of O2 from Hgb in the RBC
: D im in ished power of the tissue to uti l ize O2
- Cold damp a ir is more fata l than cold dry a ir.
- Women are more resistant to cold > greater deposits of SQ fats.

Effects of COLD:

A. Local effect ( Frostbite, Immersion foot, Trench foot )

1 st – Blanch ing , pa leness of the skin due to vascu lar spasm.
2nd – Erthyma, edema, swel l ing due to vascu lar d i latation , para lysis and
increased capi l lary permeabi l ity.
3rd - Bl ister formation
4th – Necrosis, vascu lar occlusion , thrombosis and gangrene.
M icroscopica l ly: Vacuol ization , degeneration of epiderma l cel ls
: Necrosis of the col lage of the SQ tissue
: Occlusion of the vessels due to clumping of RBC
B. Systemic effects:
- Reflex in nature due to the stimu lation and para lysis of the nerves
- Pu lmonary ,Card iac action is slowed down due to cerebra l anoxia>
resu lting to lethargy, del irium, convu lsions, coma or death .

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

Classifications of Heat Injury:
a) Genera l or System ic effects:
a.1 Heat cramps
a.2 Heat exhaustion
a.3 Heat stroke
b) Loca l effects:
b.1 Sca ld ing
b.2 Burns
= Therma l
= Chem ica l
= E lectrica l , l ightn ing
= Rad iation

GENERAL OR SYSTEMIC EFFECT: death usual ly accidental

1 . Heat cramps( Miner’s Camp, Firemans Camp, Stroker’s camp)
- Involuntary spasmod ic pa infu l contraction of muscles due to dehydration and
excessive loss of ch lorides by sweating
- Tx: Flu ids with ch lorides
2. Heat Exhaustion ( Heat collapse, Syncopal Fever, Heat syncope,
Heat prostration)
- Due to heart fa i lure, cause:Heat precipitated by exertion/warm clothes
= Sudden syncope, face turns pa le, d im vision
- Tx: remova l from the heated area
3. Heat stroke(Sunstroke,Heat Hyperpyrexia,Comatous form,Thermic Fever)
- Working in i l l-venti lated places with dry temperature or exposure to the sun
 75

LOCAL EFFECTS OF HEAT

1 . Scald: Caused by hot l iqu id
The in jury by sca ld ing is not severe as burns:
a. Sca ld ing l iqu id runs on the body surface – d istributing the heat
b. Easi ly cools off
c. Temperature not as h igh except : oi ls and molten meta ls
2. Thermal burns: Caused by heat or chem ica l substances l ike fire, rad iant heat,
friction , sol id substances, electricity.
: Classification of burns/ DUPUYTREN ’S CLASSIFCATION
1 st Degree –erythema
2nd - vesicle formation
3rd - destruction of the cuticle, part of true skin , pa
infu l
4th - whole skin is destroyed , u lceration , not pa infu l
5th – deep fascia, muscles
6th - charring of the l imbs
BURNS SCALDS

1 . CAUSE Dry heat – flame, heated solid Moist heat – liquid,

steam
radiant heat
2. LOCATION At or above the site of contact Occurs at or below
3. SINGEING of ha ir is present Absent
4. BOUNDARY OF NORMAL Not clear Distinct
5. INJURY Severe Lim ited
6. CLOTH INGS Involved Not burned

Proofs that the victim was ALIVE BEFORE burned to DEATH:

1 . Presence of carbon particles in the a ir passage.
2. Increase carboxy-hemog lobin blood level .
3. Derma l erythema, edema and vesicle formation .
4. Subendocard ia l left ventricu lar hemorrhage.

BURNS ANTE-MORTEM BURNS POST MORTEM BURNS

1 . BLISTERS Abundant a lbum in/ch lorides Scanty a lbum in/ch
lorides

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 find ings
BRONCH IAL
LUMEN
5. BLOOD Abundance of carboxy-Hgb Absent

Differential diagnosis of blisters:

 76

1 . Due to putrefaction – flu id content is blood sta ined watery flu id

- asso. with putrefactive changes in other parts of body.
2. Due to d isease - heat by the size, d istribution
3. Due to friction - Hx of appl ication of heat
3. Chemical burns
Characteristics of lesions:
a. Absence of vesication
b. Sta in ing of the skin or cloth ing by the chem ica l
c. Presence of the chem ica l substance
d . U lcerative patches of the skin
e. Inflammatory redness of the skin surface
f. Delayed hea l ing

CHEMICAL BURNS THERMAL BURNS

1 . BLISTERS Absent Present
2. SKIN/CLOTH INGS Sta ined by chem ica ls No sta in ing
3. ANALYSIS OF Shows chem ica l cause of corrosion Absent
SUBSTANCE

4. LESION Borders are d istinct Diffused

Characteristic lesions by different chemicals:

a. Su lphuric acid ( Oil of Vitriol)
= most intense action , considerable destruction
= u lcerations where acid flowed , cloth ings destroyed
= blackish-brown sloughs
b. N itric acid
= Cloth ing is destroyed , brown
= yel low or yel lowish brown slough
c. Hydrocloric acid
= not so destructive
= intense irritation , loca l ized u lceration red or redd ish-gray.
d. Caustic soda and Potash
= Corrosive action on the tissues with bleached appearance
4. Electrical burns – Contact burns, spark burns, Flash burns
5. Radiation burns – x-ray, UV l ight burns

PHYSICAL INJURIES OR DEATH BY

LIGHTN ING AND ELECTRICITY
Lightning – is an electrica l charge from the atmosphere.
- 1 m i l l ion volts/ 2000 amperes
Elements of lightning that produces in jury:
1 . Direct effect from the electrica l charge.
2. Surface flash burns from the d ischarge - electrica l into heat energy.
3. Mechan ica l effect – expansion of a ir > laceration
4. Compression effect – “sledgehammer blow”

Spasmod ic contraction of cerebra l vessels > shock

 77

Electricity - ma in cause of death is shock

- Above 300 volts are l ike the effect of l ightn ing ,

Factors which influence the effect of electrical shock:

1 . Persona l id iosyncracy – persona l cond ition
2. Disease – card iac d is. Is prone
3. Anticipation of shock – Can withstand
4. Sleep – increases resistance
5. Amperage or intensity of the electrica l current – principa l factor
= 70-80 in AC and 250 in DC.
6. Resistance of the body
7. Nature of current – AC is more dangerous
8. Earth ing- shock is enhanced
9. Duration of contact
1 0.Point of entry – left more dangerous than the right

Mechan ism of death in electrical shock:

1 .Ventricu lar fib – leads to rupture of muscle fibers
2. Respiratory fa i lure due to bu lbar para lysis
3. Mechan ica l asphyxia due to violent and prolonged convu lsion .

Metal lization: - specific feature of electrica l in jury.

= the meta l of the conductor is volati l ized and particles of the meta l are
driven
into the epiderm is causing darken ing of the skin

Delayed effects of electrical injuries:

= necrosis of the area develops into gangrene
= Damaged arteries becomes brittle, friable and l iable to rupture
= Nervous in juries – retrograde amnesia, hem ipleg ia
= May enter the head > cataract

DEATH OR PHYSICAL INJURIES DUE TO CHANGE AF

ATMOSPHERIC PRESSURE ( BAROTRAUMA)

Increase of atmospheric pressure ( Hyperbarism)

-Norma l atmospheric pressure at sea level is 760 m i l l imeters of Hg .
- Henry’s Law = “ At constant temperature, the amount of gas dissolved in
a liquid is directly proportional to the pressure”
= As he goes deeper there wi l l be an increase in the amount
of gas d issolved in the blood and other body flu ids.
= If ascent is made rapid ly, the d iver wi l l suffer from the effects of the sudden
release of the gasses from the body flu ids.
= released of a ir bubbles in the circu lation and act as embol i in d ifferent parts of
the body causing interstitia l emphysema, pu lmonary embol ism, in big joints
ca l led bends.

Decrease of atmospheric pressure (Decompression)

 78

1 . Hypobarism – at h igh a ltitudes the atmospheric pressure is lower and

more gas wi l l be l iberated by the body flu id .
= release of gasses resu lts to:
a) Bends – joint and muscu lar pa in
b) Chokes – Substerna l d istress, non-productive cough ing
c) Substerna l emphysema –
d) Trapped gas
2. Anoxia- Hypoxia felt at 8000-1 5,000 feet level
- Aircrafts greater than 34,000 feet be provided with O2.

AIRCRAFT INJURIES AND FATALITIES

1 . During the fl ight

a) Altitude: Hypobarism ( Decompression)
b) Speed – spatia l d isorientation ; sudden change of d irection at a speed of
500 m i les dra ins bra in from blood to the lower parts> unconsciousness
c) Toxins – CO, CO2 saturates cabin resu lting to asphyxia
d) Temperature - At 25,000 feet 40 degree below zero: frost bite , freezing
e) Pre-existing d isease – Coronary d is./Hpn fata l due to sudden change env.

2. During crash – fata l ities occur us. during take-off and land ing .
- Fx, Rupture of the heart due to cmpression .

DEATH BY ASPHYXIA
Asphyxia – Appl ied to a l l forms of violent death due to interference with process
of respiration
- Cond itions in wh ich the supply of O2 to the blood or tissues or both
has been reduced below norma l level .

Types of asphyxial death:

1 . Anoxic death

Fa i lure of arteria l blood to be norma l ly saturated with O2 due to:

a) Breath ing in an atmosphere with insufficient O2- H igh a ltitude
b) Externa l obstruction of the a ir passage – traumatic crush asphyxia
c) Para lysis of the respiratory center – poison ing , in jury, anesthesia
d) Mechan ica l interference of the passage of air- drown ing , asthma
e) Shunting of blood
2. Anemic anoxic death

Decrease capacity of the blood to carry O2 due to Hge, CO poison ing , Low
Hgb
3. Stagnant anoxic death

Fa i lure of circu lation due to Heart fa i lure, shock, arteria l venous

obstruction
4.H istotoxic anoxic death
 79

Fa i lure of the cel lu lar oxidative process, cannot be uti l ized in the tissues.
Cyan ide
Phases of asphyxial death :
1 .Dyspneic phase – Breath ing is rapid and deep, PR inc. , Rise of BP
- due to lack of O2 and retention of CO2
2. Convulsive phase – Cyanosis more pronounced , pupi ls d i lated ,
unconscious
- Tardieu spots =petech ia /hges in the viscera l organs
- due to stimu lation of CNS by CO2
3. Apneic phase – Breath ing is sha l low, gasping
- Due to para lysis of respiratory center

Classification of Asphyxia:
1 . Hang ing
2. Strangu lations: by l igature, manua l strangu lation , spl forms –pa lmar
3. Suffocation : choking
4. Asphyxia by drown ing
5. Asphyxia by pressure on the chest
6. Asphyxia by irrespirable gasses
A. ASPHYXIA BY HANGING
= Not necessary the whole body is suspended : Pressure at side of neck
= Mechan ism 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 the a ir passage.
2. Congestion of the venous blood vessels in the bra in .
3. Lack of arteria l blood in the bra in .
4. Syncope due to pressure on the vagus and carotid sinus.
5. In jury in the spina l column
6. Combination of the above.

Hanging is ante-mortem: Vita l reaction= principa l criterion

1 . Redness or ecchymosis at the site of l igature.
2. Ecchymosis of the pharynx and epig lottis.
3. Line of redness or rupture of the intima of the carotid artery
4. Subpleura l hges.

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

HANGING STRANGULATION WITH LIGATURE
1 .HYOID BONE Frequently in jured Frequently spared
2.DIRECTION Inverted V-shape Usua l ly horizonta l
OF LIGATURE
MARK
3. LIGATURE At level of Hyoid bone Below larynx
LOCATION
4. LIGATURE Deepest opposite the knot Un iform depth
GROOVE
 80

5. VERTEBRAL Frequently observed Not observed

INJURY

Manual strangulation or throttl ing:

- form of asphyxia l death where the constricting force is the hand .

C. ASPHYXIA BY SUFFOCATION
- Occlusion of a ir from the lungs by closure of a ir open ings
or obstruction of the a ir passageway from the externa l open ings to the a ir
sacs.
Smothering:
- A form of asphyxia l death cause by closing the externa l respiratory
orifices.
Overlaying – most common in ch i ldren : pressure of pi l lows
Gagging – appl ication of materia ls to prevent a ir to have access to mouth
and
nostri ls.
Plastic bag suffocation
Choking- Form of suffocation by the impaction of F.B. in the respiratory
passage.

D. ASPHYXIA BY SUBMERSION OR DROWIN ING

- Form of asphyxia where the nostri ls and mouth has submerged in watery
flu id .
Time requ ired for death in drowning :
- Submersion for 1 ½ m inutes considered fata l .
- Average time requ ired for death in drown ing is 2 to 5 m inutes.

Emergency treatment in Drowning

1 . Schaefer’s method–Face down , prone position :operator exerts pressure in
ribs
2. Sylvester’s method- Lying on h is back, astride over body, swing ing arms

Post-mortem findings:
1 . External findings
a) Wet clothes, pa le face, F.B. cl ing ing on skin surface
b) “Cutis anserine” or “goose flesh” – skin is pa le , contracted NOT
Dxtic
c) Washerwoman ’s hands and feet – skin of hands & feet:bleached NOT
Dxtic
d) Postmortem l ivid ity – marked in the head , neck and chest.
e) Presence of firm ly-clenched hands with objects – Person was a l ive at
first
f) Physica l in juries for strugg le
g) Su icida l drown ing – Pieces of stone
2. Internal findings
 81

A. RESPIRATORY SYSTEM
1 . “Emphysema aquosum” – Lungs are d istended overlapping the heart
= Due to irritation made by the inha led water on the mucous membrane
of
the a ir passage wh ich stimu late the secretion of mucous.
2. “Edema aquosum”– Due:Entrance of water into a ir sacs, Lungs are doughy
3. “Champignon d’ocume” – wh itish foam accumu lates in the mouth/nostri
ls
= Due: abundance of mucous secretion
= One of the ind ications that death was due to drown ing .
4. Tracheo-bronch ia l lumen – congested , fi l led with froth
5. Blood sta ined flu id found inside chest cavity.
6. Section lungs shows flu id with bloody froth .

B. HEART
1 . Both sides of heart may be fi l led or emptied with blood .
2. Sa lt water drown ing – B lood ch loride content is greater than left side.
Fresh water- B lood ch loride is more I the right side. FRESH- RIGHT
Gettler’s Test:
- Quantitative determ ination of the ch loride 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 DROWN ING

1 . The presence of F.B. in the hands of the victim.

The clench ing of the hands is a man ifestation of cadaveric spasm in the
effort of the victim to save h imself from drown ing .
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 a ir passage found in the med ium
where the victim was found .
5. Presence of water in the m idd le ear due to violent inspiration when
the
mouth is fu l l of water.

Floating of the body in drown ing:

-With in 24 H due to the decomposition wh ich causes the accumu lation of
gas in
the body, the body floats.
 82

- Body is flexed because of the dom inance of the flexor muscles

-“tete de negri” – bronze color of head and neck; face as the most dependent
portion of the body.

Hom icida l D. = strugg le, motive, articles found near the place, phys. in
juries

Su icida l D.= note, heavy objects, menta l ity, Hx of previous attempt

Accidenta l = Absence of violence in the body. , exclusion of su icide,

witnesses
E. COMPRESSION ASPHYXIA ( TRAUMATIC CRUSH ASPHYXIA)

- Form of asphyxia where the free exchange of a ir in the lungs is prevented by

the immobi l ity of the chest and abdomen due to externa l pressure or crush
in jury.
- Hom icida l =offender kneels on the chest
- Accidenta l = pinned between two big objects

Burking – invented by Burke and Hare= murder for the sa le to med ica l
schools
- Kneels or sits on the chest and the hands close the mouth and nostri ls

Death by crucifixion- a lternative ra ising and lowering of the body leads to

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

F. ASPHYXIA BY BREATH ING IIRESPIRABLE GASES

1 . Carbon monoxide “ silent kil ler”, colorless, insoluble in water and a lcohol
.
- formed by the incomplete combustion of carbon fuel .
-Ma in action is O2 deprivation
Qualitative test for CO in the blood
a) Kunkel ’s test – 4 volume of water + 3x its volume of 1% tann ic acid
- crimson red if positive
b) Potassium Ferrocyan ide test – bright red
c) Spectroscope exam
d) Gas chromatograph
e) Infra-red ana lysis

2. Carbon dioxide – CO2, Carbonic acid gas

- B lown out of the lungs during respiration
- Product of complete combustion of carbon conta in ing compounds
- End resu lt of fermentation & decomposition of organ ic matters.- septic
tank
= The inha lation of pure CO2 may cause immed iate vaga l inh ibition with
spasm of the g lottis and death . = manhole, poorly venti lated rooms
 83

Tests for the presence of CO2

1 . Barium n itrate – wh ite precipitate of Barium carbonate with carbon ic
acid
2. si lver n itrate – wh ite ppt. of si lver carbonate when carbon ic acid is
added .
3. Hydrogen su lfide ( H2S, Su lphuretted hydrogen ) = rotten egg odor
- Formed during decomposition process of organ ic substances conta in ing
su lphur
- Causes titan ic convu lsion , del irium, coma, death
4. Hydrogen cyanide – one of the most toxic, rapid acting gas
- Formed by the add ition of acid to potassium or sod ium sa lt of cyan ide
- Found in plants; leaves of cherry laurel , bitter a lmond , kernels of
common
cherry, plum, peaches, ord inary bamboo shoots, certa in oi l seed and
beans
- Conta ins AMYGDALIN wh ich in the presence of water and natura l
enyzme
EMULSIN is read i ly decomposed to HYDROCYAN IC ACID, glucose and
benzaldehyde.
= 60-90 mg of Hydrogen cyan ide is fata l , death in 2 to 1 0 m in .
5. Su lfur dioxide - Heavier than a ir, pungent odor
- employed as d isinfectant, bleach ing agent,
- 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) Ch loracetphene (C.A.P.)
b) Bromobenzyl cyan ide (B.B.C.)
c) Ethyl Iodoacetate ( K.S.K.)
H igh concentration – irritation of respiratory passages, lungs, V,N
2. Vesicant of Blistering Gas – contact with skin cause bleb or bl ister
formation
a) Mustard gas ( Dich lord iethyl su lfide, yel low cross, Yperite)
b) Lewisite ( Ch lorovinyl-d ich lorarsine)
3. Lung irritants ( Asphyxiant or choking gas)
- Dysnea, tightness of the chest, cough ing , coma , death
a) Ch lorine ( Cl2) – yel lowish green gas
b) Phosgene (COCl2)
c) Ch loropicrin
d) Diphosgene
4. Sternutator – nasa l irritants of vom iting gases
5. Paralysants – Nerve gas - l ike organophosphates
6. Blood poisons – CO, H2S, Hydrogen cyan ide
DEATH OR PHYSICAL INJURIES DUE TO
AUTOMOTIVE CRASH OR ACCIDENT
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Factors responsible to an Automotive Crash

A. HUMAN FACTOR ( DRIVER)
1 . Menta l attitude: reckless driving , fatigue, inexperience
2. Perceptive defect
3. Delayed reaction time
4. Disease
5. Chem ica l factor
2. ENVIRONMENTAL FACTOR
- Poor visibi l ity, poorly ma inta ined roads, ra in , bl ind intersection
3. MECHAN ICAL FACTOR: Poor brake, worn out tires
4. SOCIAL FACTOR: Speed , insurance
5. PEDESTRIAN

Injuries and Death on the Driver and Passengers:

1 . First col lision: the impact of the moving veh icle with another or fixed
object
= The MOVING VEH ICLE –rapid ly decelerates and stops after impact.
= The degree of damage depends: a) speed b) part of veh icle involved
2. Second col lision: Impact of unrestra ined occupants with the veh icle
interior
= 1 st Col . , Occupants move same d irection/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 st
Col .
>The passenger nearest to it wi l l suffer the
most.
c) Rear impact crash – Acceleration-deceleration in jury or wh iplash
d) Rol l over crash ( Turn turtle impact )
= If veh icle is not put into a stop after the 1 st Col . > the unrestra ined
occupants wi l l continue to strike to some parts of the veh icle
interior.
Pedestrian-Vehicle Col lision :

Death or Physical Injuries to pedestrian

1 .Primary impact – Contact with veh icle
2. Secondary impact – Subsequent impact of the pedestrian to the ground
- Accounts for the mu ltiple in juries
3. Run over In juries
4. H it and run In juries

MEDICAL JURISPRUDENCE
- concerns law and lega l concepts wh ich has to do with the practice of med
icine.
Purpose of the study:
1 . Protect the publ ic
2. Promote professiona l ism
3. Develop awareness of the RO D.
 85

4. Counter ma lpractice
5. Expla in leg islation
6. Repea l and amend laws

Law
– is a body of ru les to regu late the conduct of it’s members.
Classification:
1 . Law wh ich is not enforced by the State: Natura l , Divine, Mora l
2. Law wh ich is enforced by the State
a. As to purpose : Substantive and Procedura l
b. As to nature of the subject matter: Publ ic and Private

Sources:
1 . Constitution
2. Enacted by Congress
3. Decrees, Orders, Proclamations
4. Adm in istrative acts, orders, ru les, regu lations
5. Loca l customs
6. Principles of Internationa l law

The Law and the Practice of Medicine

The right to regu late the practice of med icine is based on the pol ice power of
the
state whose purpose is for the good and welfare of its people.
By: 1 . Licensure laws
2. Code of Eth ics
3. Crim ina l laws
4. Civi l law
5. Med ica l Societies
6. Hospita l ru les and Regu lations
7. Publ ic opin ion

LICENSURE AND REGULATORY LAWS

- To ma inta in h igh qua l ity and standards of med ica l practice
Administrative bodies:
1 . Board of Med ica l Education – standard ization and regu lation of med
edu
2. Professiona l Regu lation Comm ission – supervise / regu late
3. Board of Med icine – exams, supervise /control /regu late practice of med

1 .BOARD OF MEDICAL EDUCATION :

1 . Requ irements of adm ission
2. M in imum faci l ities
3. M in imum qua l ifications of teachers
4. M in imum requ ired curricu lum
5. Accept appl ication fro certification for adm ission
6. Approve hospita ls for tra in ing
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2. PRC
1 . Enforce regu latory pol icies
2. Perform acts in the implementation of its function
3. Conduct l icensure exams
4. Ma inta in the reg ister of authorized practitioners
5. supervise foreign nationa ls

3. BOARD OF MEDICINE
1 . Determ ines contents of exams
2. Promu lgates ru les of the exams with the approva l of PRC
3. Adm in ister oath
4. Study cond itions affecting practice of med icine
5. Investigate violations, issue summons
6. Conduct hearings
7. Suspends, revoke, re-issue Cert. of Reg istration

ADM ISSION TO THE PRACTICE OF MEDICINE: He must meet the fol lowing:
1 . M in imum age requ irement – 21 y.o.
2. Proper educationa l background – A.B. , E l ig ible to enter Med school ,
- Good mora l character, B irth
certificate
3. Exam ination requ irements - Subjects in Med School
4. Holder of Cert. of reg istration - Fi l ipino citizen , Good mora l char. ,
Sound m ind , not convicted of mora l turpitude, Internsh ip

PRACTICE OF MEDICINE
It is a privi lege granted by the state to any person to perform med ica l acts
upon
compl iance with the law.

Med ica l Act of 1 959 – promu lgated by the state in the exercise of the
pol ice power.

Acts constituting the practice of medicine

A person who sha l l for compensation or none physica l ly exam ine any
person ,
d iagnose treat, operate or prescribe ( DTOP) any remedy for human d isease.
1 . By means of advertisement and the l ike either offer to undertake method
to d iagnose, treat, operate or remedy.
2. Who sha l l falsely use the title of M .D.after h is name.

Not considered a Practice of Medicine

1 . A med ica l intern under the supervision of a reg istered physician .
2. Lega l ly reg istered dentist engaged exclusively in practice of dentistry.
3. Any du ly reg istered masseur or physiotherapist.
4. Reg istered optometrist who mechan ica l ly fits or sel ls lenses.
 87

5. Any person who renders gratu itously in cases of emergency where no MD

is ava i lable.
6. Prosthetist who fit artificia l l imbs
7. Cl in ica l psycholog ist in regards to psych iatric cases.

Faith heal ing, heal ing by prayer or divine heal ing or Acupuncture
- there is noth ing in the Med ica l Act exempting fa ith hea l ing from the
defin ition of
the acts wh ich constitutes practice of med icine.

WHO ARE QUALIFIED TO PRACTICE MEDICINE:

1 . Those who compl ied to practice med icine in accordance to the Med ica l
Act.
2. Those who can have l im ited practice without Cert. of Reg istration l ike
the
Foreign physicians, Med ica l students.
3. Ba l ikbayan physicians
4. Foreign physicians qua l ified to practice by reciprocity.
5. Lim ited practioners of the hea l ing art l ike nurses, dentist, opto, M .T. ,
MW.
PT, Masseur, Ch iropod ist,Ch iropractor

On ly natura l person can practice med icine.

PHYSICIAN-PATIENT RELATIONSH IP ( PPR )

-it is contractua l , consensua l and fiduciary
- a meeting of the m inds of two persons where one binds h imself with
respect to
the other to g ive someth ing or to render some service either express or impl
ied .
a. consent
b. object
c. consideration

NO Physican-Patient relationsh ip in the fol lowing:

1 . Pre-employment P.E.whether su itable for the job.
2. El ig ibi l ity for insurance purposes.
3. M .D. appointed by the court.
4. Surgeon perform ing an autopsy.
5. Casua l questions in a party.

Psychological patterns of PPR

1 . Activity-Passivity Relation – unconscious
2. Gu idance cooperation relation – i l l but conscious, M .D. in trust
3. Mutua l participation – jurid ica l equa l to M .D.

Types of medical services which the patient may solicit from h is physician:
1 . Perform specific tests.
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2. Exam ine patient and inform h im of state of hea lth .

3. Exam ine and recommend remedy.
4. G ive emergency treatment.
5. Treat but no fol low-up care.
6. Treat with fol low-up care.

Duties and Obligations imposed on the

A. Physician in the PPR:

1 . He shou ld possess the knowledge and ski l l of wh ich an average
physician
is expected .
2. He shou ld use the knowledge and ski l l with ord inary care and d i l
igence.
3. He is obl iged to exercise the best judgment.
4. He has the duty to observe utmost good fa ith .

B. Patient
1 . G ive an honest med ica l h istory.
2. Cooperation and fol low instructions.
3. Inform physician on what occurred in the course of treatment.
4. Must state if he understands the instructions g iven .
5. Must not act as if a stranger to the problem.

Terms NOT included in the PPR

1 . Does not imply a prom ise that treatment is successfu l .
2. Treatment wi l l benefit the patient.
3. Wi l l produce certa in resu lts.
4. Wi l l not harm the patient.
5. Wi l l not comm it errors

What the law impl ies in the PPR - the physician wi l l render service.
Commencement of the PPR
- the physician is obl iged to comply with the lega l duties and responsibi l
ities.
- When a patient ask a physician to treat and the moment the M .D. wi l l ing
ly
agrees is the start.

Termination of the PPR

1 . Recovery of the patient from the cond ition .
2. Withdrawa l of the physician . – consent, ample time
3. Discharge of the physician by the patient.
4. Death of the patient.
5. Death or incapacity of the physician .
6. Fu lfi l lment in the obl igations as stipu lated in the contract.
7. In cases of emergency, upon arriva l of the attend ing M .D.
8. Expiration of the period .
 89

9. Mutua l agreement between the M .D. and Pt. to term inate PPR.

RIGHTS OF PHYSICIANS

Rights INHERENT in the privi lege to practice med icine

1 . Right to choose patient, even if no other M .D. : except in emergencies
2. To l im it the practice of h is profession .
= On ly in h is field of specia lty.
= Private cl in ic or hospita l
= With in pol itica l or geograph ica l boundary.
= On ly on certa in days, hours of the day.
= Certa in class of people.
= By d ictates of h is conscience.
= Ignorance
= Retirement
From other sources:
= Imposed by the publ ic.
= Rel ig ion – abortion
= Professiona l eth ics
= Med ica l society
= Imposed by law
= By contract

3. To determ ine the appropriate management procedures.

= frequency of visits
= Doctrine of superior knowledge – pt. fol lows

4. Right to ava i l hospita l services.

Rights INCIDENTAL in the privi lege to practice med icine
1 . Right of way wh i le respond ing to ca l l of emergency.
2. Right of exemption from execution of instruments and l ibrary.
= not deprive physicians to practice of hea l ing .
3. Right to hold certa in publ ic or private offices.
4. Right to compensation even unconscious due to Impl ied contract.
= Doctrine of un justified enrichment: service rendered , service pa id
5. Right to membersh ip in med ica l societies.

Rights genera l ly en joyed by every citizen as provided in the B i l l of Rights.

Kinds of MEDICAL FEES:

1 . Simple contractua l fee – Ap for a sum
2. Reta iners fee - Space of time, not an employee of the pt.
3. Contingent fee - resu lt of treatment
4. Dichotomous fee, fee spl itting - uneth ica l
5. Stra ight fee or pakyaw system

Methods of col lection of payments for medical services:

1 . Friend ly or extra jud icia l methods:
 90

a. Bi l l ing
b. Referra l to a bi l l col lection agency
2. Jud icia l methods

Facts to be proven in court: :

1 . That pla intiff-physician is qua l ified and l icensed to practice.
Not du ly l icensed : a. Sing le isolated case,
b. Contract perfected in foreign country.
2. That the physician performed professiona l services.
3. That the defendant fa i led to pay the reasonable PF after repeated
demands.

In the absence of agreement, the physician is requ ired to prove that the PF
- customary and reasonable.

FACTORS INFLUENCING THE AMOUNT OF PF

1 . Nature and character of the services rendered .
2. Labor, time and trouble involved .
3. Importance and responsibi l ity.
4. Professiona l character and socia l stand ing of the M .D.
5. The resu lts secured .
6. Financia l ly abi l ity of the patient.
7. Purchasing power of the peso.
8. Loca l customs

If a patient dies or incapacitated:

1 . The spouse
2. The descendants of the nearest degree.
3. The ascendants of the nearest degree
4. The brothers and sisters

Circumstances which are important as indicative of the th ird party’s

promise to pay for the patients care:
1 . 3rd party requested the service.
2. Patient is closely related to h im.
3. Part of the household .
4. Assumes control of patients case.
5 . Attended the pt. previously and pa id by the 3rd party.
6. The physician sent a bi l l to the 3rd party.

Instances when the physician cannot recover PF:

1 . Agreement that the service is gratu itous.
2. Professiona l services by government physicians in charity wards.
3. Private charitable institutions.
4. Wa iver in the part of the physician.
5. Expressed contract to cure and non-fu lfi l lment
6. Covered by Med icare.
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7. Col league is a doctor.

8. Industria l physicians to their employees.
9. To school , facu lty, students.

Defenses obliged to pay the Medical bi ll in Court.

1 . Exorbitant fees
2. No med ica l service rendered .
3. Defendant not the person lega l ly to pay.
4. No consent to such med ica l services.
5. Previous agreement that it is gratu itous.
6. Not qua l ified to practice.
7. Party is not financia l ly capacitated .

Grounds for counter complaint:

1 . Contract to cure.
2. Fraudu lent representations as to the a i lment.
3. Treatment is contrary to the agreement.

RIGHTS OF PATIENTS
1 . G ive consent to d iagnostic and treatment procedures – inform pt.
2. Rel ig ious bel ief
3. Privacy
4. D isclosure of information
5. Confidentia l information
6. Choose h is physician
7. Treatment
8. Refuse necessary treatments

1 .Give CONSENT to d iagnostic and treatment procedures – inform pt.

Basis of the consent: Fiduciary rel-sh ip, right to self determ ination
Purpose: a) To protect pt. from procedures without consent.
b) To protect M .D. from fa i lure to comply with lega l rqmts

NOT NECESSARY:
a) Emergency cases
b) Law requ ire subm ission to the procedure

Requisites of val id consent:

a) It must be an informed consent
b) Voluntari ly g iven to the patient
c) Subject matter must be lega l

5 elements of an Informed consent:

a) He must understand the nature of h is cond ition .
b) The nature of the proposed treatment or procedure
c) Awareness of the possible a lternative courses of
action
d) Risk of the proposed a lternatives courses of action
 92

e) Informed of the chances of success or fa i lure of the

proposed and a lternative therapies.

Instances when informed consent requ ire MORE Disclosure of Facts:

a) when the procedure wi l l enta i l much risk.
b) When the procedure is experimenta l or innovative.
Instances when ful l disclosure may NOT be necessary:
a) Cause emotiona l upset to the patient
b) When the med ica l procedure is publ icly known to be safe

Extention of the operative procedure beyond what is consented.

- to any abnorma l cond itions when he th inks advisable for the welfare
of the
patient and fol low the approved practice of surgeons genera l ly.

Scope of the consent:

a) Genera l or blanket
b) Lim ited or cond itiona l
c) Non-viabi l ity or excu lpatory clause in the consent

Persons who can give the consent:

a) Patient
b) If m inor, consent from parents
= Redound to the preservation of l ife and hea lth
= Expressed refusa l of a m inor sha l l not preva i l in an
emergency case
c) Grandparents, if parents are absent
d) Eldest brother or sister are of age and not d isqua l ified by law
e) Substitute parenta l authority – guard ians, teachers

2. Right to Religious belief

a) Right to bel ieve
b) Right to act in accordance with one’s bel ief
* Lim ited by the pol ice power of the state
* Freedom to bel ieve is absolute but freedom to act is l im ited by
statutes.

3. Right of Privacy
a) To be left a lone
b) Free from unwarranted publ icity
Ways of intruding to the right of privacy of patients:
1 .Physica l intrusion at a time the patient wou ld l ike to be left a lone.
2. Publ ish ing information about the patient wh ich is offensive to the ord
inary
person .
3. Used for commercia l purposes aspects of persona l ity of the patients l ife.
= Taking photos and publ ication in the print med ia can on ly be done with
the express consent of the patient or who acts in h is beha lf,
 93

= The cond ition imposed must not be violated even if it is a scientific j

journa l .
= NOT an invasion of privacy when publ ic interest demands such
publ ication .
4.Right of Disclosure
= Being fiduciary the patient is obl iged to d isclose pertinent facts regard ing
the i l lness with good fa ith and strict honesty- if not, gu i lty of fraud .
= May not revea l remote possibi l ities to the patient.
5. Right of Confidential information
= Physician is not a l lowed to d ivu lge to a 3rd party.
a) Statutory Privi leged Commun ication
Not in a civi l case – that may blacken the character of the
patient.
b) Eth ica l or Professiona l Confidentia l Information – Sacred trust
Ma in purpose: to make patient fu l ly d isclose a l l facts and
circumstances.

NOT APPLICABLE:
a) When such d isclosure is necessary to serve the best interest of
justice. = Crim ina l in nature ,Ch i ld abuse, Physica l in juries.
b) When d isclosure of information wi l l serve publ ic hea lth and safety.
c) When the patient wa ives to the confidentia l nature of such
information .

6. Right to Choose h is physician

7. Right to Treatment in emergency cases

= immed iate emergency med ica l assistance to dying and
serious physica l in juries. . First a id treatment.

8. Right to Refuse necessary treatment

= To determ ine what must be done to h is own body.
= Parents have no right based on rel ig ious bel ief or other grounds to
deny
med ica l treatment to their ch i ld .
= The state under the Doctrine of Parens Patriae to assume
guard iansh ip when the ch i ld is neg lected by the parents to
have the
ch i ld treated .

Other rights of patients:

1 . Right to receive visitors.
2. Unrestricted right to correspondence.
3. Right to be free from mechan ica l restra ints.
4. Right to be release as soon as the cond ition
Malpractice – Is a generic term that includes a l l :
( ADM IN ISTRATIVE, CRIM INAL AND CIVIL)
- Of wrongfu l acts of physician .
 94

LIABILITIES OF PHYSICIANS
Factors bringing increasing frequency of the complaints against
physicians:
1 . Gradua l d isappearance of the Fam i ly physician .
2. The “ doctors loose ta lk” or uneth ica l coach ing of other physicians.
3. Breakdown in commun ication and rapport between the physician and h
is
patient.
4. Disservices made by the mass commun ication med ia.
5. Ma lpractice is a sort of d isease of society wh ich may be endem ic or
epidem ic form.
6. Incompetence of the practitioner and commercia l ization of med ica l
practice.
7. Prol iferation of med icina l drugs.
8. Chang ing attitude of the physician in the management of h is patient.

Classification of Liabi lities of Physician arising from his wrongfu l act or

omission :
1 . Adm in istrative l iabi l ity – Right granted to hea l withdrawn > pol ice
power.
2. Crim ina l l iabi l ities - Imprisoned or fined as pena lty
3. Civi l l iabi l ities - Mora l and pun itive damages
ex: Neg l igence pena l ized in RPC, CC, Med ica l Act of 1 959

1 . ADMIN ISTRATIVE LIABILITY Reprimand , suspension , revocation C of

R
Characteristics of the Proceed ings in the PRC
a) Pena l in nature
b) Preponderance of evidence
c) Entitled to be represented by counsel
d) Decision of the Board of Med icine is fina l after 30 days un less
appea led .
e) After 2 years may be re-instated
WHO can fi le compla int:
a) Any person
b) Firm or corporation through authorized representative
c) The Board of Med icine itself

COMPLAINT : In writing and under oath .

Service of Summons - Letter subpoena requ iring appearance.
a) Time
b) Place
c) To answer with in the period specified
d) A copy of the compla int.

Rights of the Respondent in the Administrative Investigation in the Board

of Medicine:
 95

1. To be represented by counsel or be heard in person .

2. To have a speedy and publ ic hearing .
3. To confront and cross-exam ine witnesses aga inst h im.
4. To be presumed innocent
5. Right of appea l and others…

GROUNDS for Administrative Investigation :

1 . Persona l d isqua l ification
a) Immora l or d ishonorable conduct.
b) Insan ity
c) Gross neg l igence or incompetence
d) Add iction to a lcohol or drugs

2. Crim ina l acts

a) Conviction by a court of competent jurisd iction of any crim ina l
offense involving mora l turpitude.
b) Fraud in the acqu isition of Cert. Of Reg istration
c) Performance or a id ing in any crim ina l abortion .
d) Knowing ly issu ing any fa lse med ica l certificate.
e) Aid ing or acting a s a dummy of an unqua l ified or unreg istered
person to practice med icine.
3. Unprofessiona l conduct
a) Fa lse extravagant or false advertisements
b) Issu ing news or rumor wh ich is derogatory to the character and
reputation of another physician without justifiable cause.
c) Violation of any provision of the Code of Eth ics
* Physicians are to assist in the adm in istration of justice wh ich are
med ico-lega l in character.
> Decisions of the Board must be in writing and signed by the ma jority of the
members.
> A petition for reconsideration for rehearing sha l l be fi l led with in 30 days
after
receipt of the decision .
>Appeal from judgment:
- the decision by the Board wi l l be automatica l ly be fina l after 30 days
after
promu lgation un less appea led to PRC then to Office of the President.
> Execution of decision
Upon expiration of the period to appea l is perfected .

CRIMINAL LIABILITIES OF PHYSICIANS

When the act or om ission is done by del iberate intent.
Characteristics of Criminal Cases:
1 . A crim ina l act is an outrage to the sovereignty of the state.
2. The action is fi led and tried in court.
3. Proof beyond reasonable doubt.
4. Accused is presumed innocent.
5. If convicted , has the right to appea l .
 96

6. Pena lty is imprisonment or fined .

7. Add itiona l revocation of Cert. Reg is. If: law imposes/ gu i lty of mora l
turpitude

PROVISIONS RPC wherein a Physician may be criminal ly liable:

1 . Physician as wrong doer
a) Issuance of fa lse med ica l certificates
b) Abortion
c) Simu lation , substitution of birth
d) Fa i lure to report treatment of physica l in juries
e) Refusa l to render treatment in emergency cases.

2. Liabi l ities incurred incidenta l to the practice of the profession :

a) Crim ina l neg l igence or imprudence
Neg l igence - Deficiency of perception
Imprudence – Deficiency of action , voluntary, no ma l ice
b) Violation of Dangerous Drugs
c) Violation of Pharmacy law – Sa le of samples
d) Liabi l ity in the issuance of birth and death certificates
e) Defamation – publ ic and ma l icious imputation of a crime
causing d ishonor
Written defamation- l ibel
Ora l defamation - slander
3. Provisions in the Pena l code appl icable to anyone

CIVIL LIABILITIES OF PHYSICIANS

The cause of action for damages on account of the in jury may be based on :
1 . Breach of Contract – contract of warranty, not void , violated , lega l ly
cogn izable
2. Tort - lega l wrongdoing independent of contract : neg l igence or fau lt > in
jury

4 D’s MEDICAL MALPRACTICE

1 . Duty – duty of a M .D. to pt.
2. Derel iction – fa i lure to perform h is duty
3. Damage – pt. Suffers damage
4. D irect – neg l igence is the d irect cause
Duties
a) Duty to possess knowledge and ski l l of the profession .
b) Duty to uti l ize such knowledge and ski l l with care and d i l
igence
c) Duty to exercise the best judgment.
d) Duty to observe utmost good fa ith to h is patient

Fa i lure of Physician to perform h is duty:

a) Violations of positive law - abortion
b) Neg l igence - lack of care/ fa i lure to exercise ski l l
c) Ignorance - absence of knowledge
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d) Departure from accepted practice – standards of practice

Fa i lure of the physician to perform h is duty is the proximate cause of the

in jury susta ined by the patient or

the DOCTRINE of Proximate Cause.

= continuous and natura l sequence, unbroken by an efficient cause
producing he in jury and without wh ich the resu lt wou ld not
have
occurred .

Conditions that must be compl ied with in the determination of the

proximate cause:
1 . Direct physica l connection between the wrongfu l act and the in jury. -
unsteri le
2. Wrongfu l act must not be too remote from the development of the in jury.
3. The resu lt must be the natura l and probable consequences of the cause.

DOCTRINE of Efficient Independent Intervening Cause:

= may m itigate the damage to be rewarded .
Standard of care of Physicians:
1 . Degree of abi l ity by other physicians in the same loca l ity.
2. Degree of care, attention , d i l igence or vig i lance exercised by those
physicians
in the appl ication of their ski l ls.
3. Specia l or extraord inary for specia l ist.

Local ity ru le
= socio econom ic sim i larities or geograph ica l proxim ity
Alternative Treatment Methods
= as long as m inority of physicians wou ld agree with the defendant.
Bad resu lts:
= Physicians are not an insurer of the good resu lt of treatment.
= Patients do not recover or improve for a variety of reasons unconnected with
the qua l ity of care wh ich the patient have received .

The physician must keep up with the med ica l developments.

PRINCIPLES AND DOCTRINES APPLIED IN MALPRACTICE

1 . Doctrine of vicarious liabil ity or Doctrine of Respondent superior
a) Doctrine of Ostensible agent - Patholog ist/Hospita l
b) Borrowed servant Doctrine - Nurses borrowed from the
hospita l
c) Capta in of the Sh ip Doctrine - Surgeon
- Increasing complexity
- to encourage surgeon to concentrate in h is job
- sh ifting to the hospita l from the surgeon ’s
responsibi l ity
 98

= Vicarious l iabi l ity: the responsibi l ity of a person on the neg l

igence of another
= To make the owner responsible of the fau lts of the employees
neg l igence
a) The employee was chosen by the owner
b) Service of the employees accord ing to the orders of the
employer
c) Wrongfu l act was on the occasion of the function
entrusted to h im.

= NOT appl icable when the owner has exercised due care and d i l
igence in the
selection and supervision of h is employees.
Reasons in support to the Doctrine of Vicarious Liabi lity
1 .The neg l igent employee; nurses res. phy, have not enough
money
2. Employer has the power to select h is employees.
3. Employer benefits from h is servants work.
4. Employer is in the position to approximate future damage.
Usual ly involves the Surgeons activities in Operating situation:
1 . The potentia l danger is greater in the O.R.
2. Appl ication is more complex in the O.R.
3. Surgeons tend to have more servants
2. Doctrine of res ipsa loqitor / Doctrine of Common Knowledge
= the th ing speaks of itself > done a neg l igent act
= Foreign bod ies is left un intentiona l ly and a l lowed to rema in
in the pt. body.
Requisites for the Res ipsa Liqu itor Doctrine
a) The accident wou ld not occur without neg l igence.
b) The agency must be in control of the defendant.
c) There was no contributing conduct by the pla intiff.
Cases applied:
a) Objects left in the pt. body at the time of surgery.
b) In jury to a hea lthy part of the body in the treatment area or to
a part remote
from the treatment area.
c) Remova l of a wrong part of the body when another part was
intended .
d) Teeth dropped down the windpipe
e) Burns
f) Infection resu lting from unsteri l ized instruments.
g) Fa i lure to take x-rays to dx possible fx.
h) Fx set so bad ly that he deficiency of the workmansh ip is
apparent to anybody.

i) Disabi l ity d irectly resu lting from in jection of drugs into the body.
j) explosion of anesthetic gases
When Surgeon is not liable?
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1 . When the surgeon is in the stress of emergency

2. when the sponge become saturated with blood and was d ifficu lt to detect.

Precautionary measures:
1 . Fixing a pa ir of forceps in one end of the sponge.
2. Assignment of one of the O.R. nurses on duty to count the sponge.
3. Surgeon counting with the nurses.
4. Search made by surgeon by sight or hand .
5. Forma l inqu iry affirmed by h is search .
3. Doctrine of contributory negligence
= Conduct in the part of the pla intiff contributing as a lega l cause to harm
he has
suffered wh ich fa l ls below the standard to wh ich he is requ ired to conform
for h is
own protection .

4. Doctrine of continuing negl igence

= Physician after prolonged treatment of a patient produces no improvement
when in fact norma l ly it wou ld .
= Fa i ls to investigate for non-response may be l iable if in the exercise of care
and
d i l igence have d iscovered the cause of the non-response.

5. Doctrine of Assumption of risk

= An in jures person actua l ly knew the risks involved is barred from
recovery.
= Based on the maxim” volenti non fit injuria” that a person who assents and
was in jured is not regarded in law to be in jured . The doctrine is pred icated
upon
the knowledge and consent.

6. Doctrine of Last Clear Chance

= Fa i lure from the physician to apply emergency mechan ica l occlusion of
the
vessel in jured by pressure or torn iquet wh ich cause the death of the patient.

7. Doctrine of Foreseeabil ity

= Physician cannot be held l iable for neg l igence if the in jury susta ined by
the
patient is on account of unforeseen cond itions.

BUT, if one fa i ls to ascerta in the pt. cond ition for want of the requ isite ski l
l and
tra in ing is answerable to the in jury susta ined by the patient.

8. Fel low Servant Doctrine

= If an employee was in jured on account of the neg l igence of h is fel low
employee, the employer cannot be held l iable.
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= since both physician and the patient are of the same employer, workmen ’s
compensation was the pla intiffs exclusive remedy.

9. Rescue Doctrine

10. Sole responsibility vs. Shared responsibility

= neg l igent act attributed to one person
= caused by 2 or more persons

SPECIFIC ACTS OR OMISSIONS OF MALPRACTICE

1 . Fai lure to take history or P.E. > l iabi l ity for neg l igent m isd iagnosis

2. Non-referral of the patient to a special ist

3. Fai lure to consult prior physicians fro previous management.

4. Non-referral of patient to a hospital with equipments and trained

personnel.

5. Fai lure to use the appropriate diagnostic test.

6. Fai lure to diagnose infection

7. Treatment resulting to Addiction

8. Telephone orders except emergency cases

9. Experimental treatment :
Two important requ irements:
a) Awareness and consent of the patient
b) The physician to perform the experimenta l treatment must be capable
to
perform the innovative techn ique.

10.Abandonment of patients
E lements of Abandonment:
a) Physician-patient relationsh ip
b) Term inated by the physician without mutua l consent

c) No time for the patient to secure services of another

d) Continu ing need of the patient for further treatment

e) Abandonment is the cause of the resu lting death or in jury

Instances when a physician is l iable for abandonment:

a) Refusa l by a physician to treat a case after he has seen the person need
ing treatment but before treatment is commenced .
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b) Refusa l to attend a case wh ich he has assumed responsibi l ity.

c) Fa i lure to fol low-up

d) Fa i lure to arrange substitute physician in one absence

= d id not exercise with due care in the selection
= acts as a master-servant relationsh ip

Non-payment of bi l ls is not a defense ground for abandonment.

1 1 . Fai lure to institute proper prophylactic treatment

12. Blood transfusion

a) Mechan ica l
= volume: pu lmonary edema
= embol ic: a ir

b) Chem ica l and serolog ica l

= incorrect grouping
= infected blood
= chem ica l wh ich may be due to overcool ing or overheating

CASES1 . Transfusion of the wrong type of blood

= Tech . Is hosp. Employee > hospita l l iable
but if under supervision of the patholog ist : a lso l iable
= Hospita l not l iable as long with due care in h iring .

2. Blood transfusion in a wrong patient

= Defendant is l iable

3. S l ipping of the need le outside the vein and infusion of blood into the
soft tissues.

4. Infection fol lowing transfusion

5. Neg l igence fol lowing transfusion

13. Administration of drugs

Five rights Liabi l ities in the adm in istration of drugs

1 . The right Drug
2. The right patient
3. The right dose
4. At the right time
5. Via the right route
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Neg l igence in the adm in istration of a drug causing in jury to the patient
may
be attributed to:
1 . Drug reaction
= Fa i lure to note the h istory of a l lergy
= Fa i lure to test for signs of reaction
= Fa i lure to stop treatment when drug reaction has been
observed
= Fa i lure to provide adequate therapy to encounter a reaction
= Treatment with a drug not proper for the i l lness
2. Overdose of the drug adm in istered
3. Fa i lure to g ive warn ing side effects
4. Adm in istering med icine on the wrong route
5. Adm in istration of the wrong med icine
6. Adm in istration of a drug on the wrong person
7. Infection fol lowing in jection
8. In jury to the nerves

14. Product liabil ity: Doctrine of Strict l iabi l ity> any from the d istributive
cha in

LIABILITIES OF HOSPITALS
Hospital – primari ly a service institution whose concern is to serve patients,
doctors, and the publ ic.
- it cannot practice med icine

Primary duties of a hospital:

1 . To furn ish a safe and wel l ma inta ined bu i ld ing and ground
2. To furn ish adequate and safe equ ipments
3. To exercise reasonable care in the selection of the of the hospita l staff.

Classification of liabi lities of the hospital :

1 . Corporate l iabi l ities: = Fa i lure to furn ish accommodations, faci l ities
= Safe and rel iable equ ipments
= Fa i lure to make carefu l selection , supervision of
its
employees
2. Vicarious l iabi l ities “ borrowed servant “
= Nursing staff: student nurse
= Med ica l interns, Residents
Specia l ist – an independent contractor

Liabi l ities of hospital for the wrongful acts of their agents or employees:
1 . Government or Publ ic hospita ls
= A state cannot be sued without its consent.
a) Government funds shou ld be used for publ ic purposes
b) Publ ic service can be h indered .
c) End less embarassment
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d) Derived no profit from its activity

2. Charitable, Voluntary Eleemosynary hospita ls

a) Trust Fund Doctrine – contributions are on ly held in trust
b) Impl ied Wa iver Theory–human itarian contributions wa ives
damages
c) Publ ic Pol icy Theory – quasi-publ ic function

Present trend – Partia l immun ity:

a) in juries suffered by strangers
b) cases involving corporate neg l igence
c) insured charitable hospita l
d) in jury susta ined by a pay ward patient

3. Private hospita l operating for profit

- held vicariously l iable fro the neg l igent of its employees.
- The principle of adm in istrative or m in isteria l duties as aga inst
professiona l or med ica l duties.> beyond ord inary routine

Government hospital has no choice regard ing whom to adm it because it is

establ ished and ma inta ined by publ ic funds.

Justifiable grounds to refuse admission :

1 . Al l accommodation are fi l led
2. Patient is chron ica l ly i l l
3. Needs on ly conva lescent care
4. No ava i lable accommodation of the d isease
5. Contag ious and at risk to other patients.

Attendance to al l emergency cases in hospitals:

= If an emergency patient has been g iven immed iate care and the threat to l
ife
and serious in jury have simmered down , a private hospita l is not obl iged to
adm it
a patient if he cannot pay the requ ired deposit.

Transfer of patient:

= Can on ly be done if the cond ition of emergency ceases to be a threat to the

l ife
and the transfer itself wi l l not impa ir the l ife and hea lth of the patient.

Discharge of patient:
= Further hospita l ization no longer ind ispensable

Refusal of patient to be hospitalized:

= Wi l l not be a lawfu l ground to deta in h im if he is of sound m ind and of
lega l age.
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Refusal of patient to leave the hospital:

= Refer to Socia l worker

Detention of patient for non-payment of bil l:

= Fi le su it in court.

Liabi l ity for hospital infection :

1 . Infection caused by equ ipment and fau lty techn ique
2. Contact with infected patient
3. Neg l igence of personnel and staff
4. Hospita l personnel may be the source of the infection

Patients are not bound by secret limitations contained in a private contract

between the hospital and the doctor.

Two aspects of Emergency Care

1 . Exam ination of the patient to determ ine h is cond ition and need for
emergency
med ica l procedures.
2. Performance of the specific med ica l or surg ica l procedure wh ich are
requ ired
without delay to protect the patients hea lth .

MALPRACTICE LIABILITY in the Emergency Room

1 . Fa i lure to adm it
2. Fa i lure to exam ine or treat
3.Neg l igence in the appl ication of management procedures

Good emergency room records should be kept on each case handled in the
emergency room department.
The Pol ice/Emergency Room
= No question ing must be done without prior approva l of the attend ing
physician .
a) Whether question ing wi l l be prejud icia l to the l ife and hea lth or
b) Whether the patient is in sound possession of h is menta l facu lties
to g ive relevant information .
Media / Emergency Room
= Release of information by the Ch ief of hospita l or h is representative
Gu idel ines:
1 . Private patients : Acknowledgement or adm ission
Genera l cond ition
Name of Attend ing Physician
2. Emergency cases:Name , age, sex, address, occupation
Nature of accident :
Extent of in juries
Be carefu l in expressing an opin ion as to defin itive
d iagnosis or prognosis
 105

3. Restrictive information : In cases of poison ing , intoxication , stabbing ,

attempted su icide or other sim i lar occurrence
NO MOTIVE be g iven .
MEDICAL INFORMATION be g iven on ly by RIC.
4. Photographs: None taken from an unconscious patient
Perm ission from RIC and patient is requ ired .

Medical Records:
1 , To document patients Hx, P.E. , Tx
2. To a id in the continu ity of care
3. To provide a record of bi l l ing
When may the contents of the medical record be disclosed:
1 . When requested by the patient made into writing
2.When the law requ ire such d isclosure
3. Upon Court order
***Remova l , erasure > removed del iberately to suppress evidence

EMERGENCIES IN MEDICAL PRACTICE

Emergency – is an unforeseen combination of circumstance wh ich ca l ls for
an
immed iate action .
A condition of emergency is usually an exception to the observance of the
standard eth ical conducts.
1 . Must respond to any request for h is assistance in an emergency.
= un inhabited place, in jured by h im
2. Adm in ister at least first a id .
3. May exam ine and treat patient of another in case of emergency.
4. Shou ld attend on ly to patients immed iate needs.
5. Severa l physicians were ca l led , first to arrive be the physician in charge.
6. Treat patient same manner as he treats h is patients.
Emergency operation without consent:

Based on the = Theory of Impl ied Consent:

Requ isites:
a) Unconscious or unable to g ive a va l id consent.
b) Necessary to act before the opportun ity to obta in consent.
c) Surgeon best judgment that the patient may d ie, lose a l imb un less
an operation is performed
Refusal to give consent:
1 . Refusa l of the patient
2. Refusa l of the Guard ian
3. Refusa l fol lowed by an emergency - may

Who may attend to emergency cases:

1 . Any person
2. Med ica l Students/Nurses
3. Physicians
 106

DELEGATION OF PHYSICIAN ’S DUTIES

Requisites for a val id delegation :
1 . Such duty of the physician va l id ly can be delegated .
EXCEPT: the fol lowing
a) Duty is the principa l subject-matter of the M .D.-Pt Contractua l
Relationsh ip.
b) When the patient agreed to render strictly persona l services to the
patient.
c) When no one is with sufficient competency to perform such duty.
d) when the patient expressly objects to the delegation of duty.
2. The person to whom such duty is delegated must be competent to perform
such duty.
3. Proper instructions must be g iven to the person who wi l l perform the
delegated
duty.
4. The patient consented expressly or impl ied ly such delegation of duty.

HUMAN TRANSPLANTATION
= A m inor cannot g ive consent to be a donor for transplantation even if he
has
the fu l l capacity to d iscern or nearing age of ma jority. , not benefit the m
inor.
Basis of Death :
1 . Unreceptivity and unresponsiveness
2. No movement or breath ing
3. No reflexes
4. Flat EEG – best confirmation .
Certification of Death : present for at least 2 hours before death is certified .

FERTILITY CONTROL
Fertil ity Control Methods is with in the bounds of law:
1 . It must be voluntary.
2. No l ife must be destroyed
3. Publ ic welfare must be amply protected .
4. Sexua l en joyment must not be impa ired .
Guidel ines in the appl ication of contraceptive procedures:
1 . Informed consent must be obta ined before the appl ication of the
procedure.
2. The provider must respect the right of rel ig ion of the patient.
3. In the appl ication of the contraceptive or steri l ization procedure care and
d i l igence must be observed .

MEDICAL WITNESS AND THE COURT

It is the duty of every physician when ca l led upon by the jud icia l
authorities, to
assist in the adm in istration of justice on matters wh ich are med ico-lega l in
character.
 107

As an ORDINARY WITNESS
= He shou ld on ly be a l lowed to state the facts wh ich come to h is own
perception .

As an EXPERT WITNESS
= He is a l lowed to g ive inference, deduction , conclusion or opin ion from the
facts
presented to h im.
Requisites for a person to become an ordinary witness:
1 . The person must have the organ and the power of perception .
2. The perceptions gathered by h is organs of sense can be imparted to others.
3. He does not fa l l in any of the exceptions in the Ru les of Court.
Persons not disqualified from becoming a Witness:
1 . Persons interested in the outcome of the case.
2. Persons who have been convicted of a crime.
3. persons on account of h is opin ion on matters of rel ig ious bel ief.
Persons who cannot be a Witness on account pf physical disqual ification :
1 . Those with unsound m ind
2. Ch i ldren of tender age and inferior capacity incapable of receiving correct
impressions of the facts when they are exam ined .
Privileged communication :
1 . The husband or wife during marriage or afterwards
2. An attorney without the consent of h is cl ient.
3. Physician cannot in a civi l case without consent of the patient.
4. M in ister or priest without consent of the person making the confession .
5. Publ ic officer during h is term of office.

Requisites of the privi leged information between the Physician and h is

Patient
1 . That the privi lege is cla imed in a civi l case.
2. That the person aga inst whom the privi lege is cla imed is one du ly
authorized
to practice med icine, surgery or obstetrics.
3. That the physician acqu ired information wh i le was attend ing the patient
in h is
professiona l capacity.
4. That the information is confidentia l , if d isclose wi l l blacken the
character of the
patient.

HEARSAY EVIDENCE
- is an evidence not proceed ing from the persona l knowledge of the witness
but
from mere repetition of what he had heard others say.
- As a rule, it is not admissible:
1 . It is hard to determ ine whether the orig ina l declarant is irresponsible.
2. Depreciation of the truth of the statement on the process of repetition .
3. Opportun ity for the comm ission of fraud .
 108

Grounds for admissibi lity:

1 . Necessity
2. Trustworth iness
Requisites for its admissibi lity:
1 . The declaration must concern the cause and surround ing circumstances
of the
declarant’s death .
2. That at the time the declarant was made, the declarant was under the
consciousness of impend ing death .
3. That the declarant is a competent witness.
4. That the declarant is offered in a crim ina l case for hom icide, murder or
parricide in wh ich the declarant is the victim.
Factors to be considered in determining the weight of a dying declaration :
1 . The trustworth iness of the physician who reported the declaration .
2. The capacity of the declarant at the time of making the declaration to
accurately remember the past.
3. The capacity of the declarant to tel l what he remembered .
4. Factors wh ich may influence the declarant in making a declaration .
Duties of a physician with regards to Dying declaration
1 . Physician must observe patient of feel ing of impend ing death and advise
the
importance in making of such declaration
2. Observe carefu l ly the menta l cond ition of the patient.
3. Physician immed iately write down what patient’s statements.
4. He must avoid lead ing questions.
5. If the case is long stand ing , he may inform any officer of the law to take
down
the dying declaration .
6. The Physician must produce the statement taken and not to judge by
himself
the relevant points of adm issibility.
Requisites for admissibi lity of Expert Evidence:
1 . That the fact to be proven is one requ iring expert knowledge
2. That the witness is really an expert.
Three things demanded from every Medical Witness
1 . That he must be absolutely honest and unbiased in h is testimony.
2. That he has the real expert knowledge of the subject on which he is
testifying .
3. That he studied thoroughly the case in which he expects to testify and
prepared himself to look up the opinion and statement held by authorities
and
others who have written on the subject.
109